July 20, 2016

Heroes We Meet Every Day

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Stanley Kapuchinski, MD

Punta Gorda, Florida


I was of the generation of psychiatrists who endured the notion that the psychoanalytic approach to psychiatric problems would explain all. Insight into subconscious issues was the key to learning about oneself. Gaining this insight, or having the “aha!” experience, would lead to a lessening of the neurotic state. At that time in psychiatry, the patient’s past explained the present.

My education included learning about the “schizophrenogenic mother,” the “castrating mother,” and the “aloof, cold mother.” These heinous women caused psychic devastation to the sensitive mind of the growing child. The schizophrenogenic mother gave double messages like “Why don’t you sit here by me?” and then “Get away from me, you awful child,” or “You’re Mommy’s love” followed by “You stupid child, I wish I never had you!” These contradictory messages supposedly could drive someone psychotic. The castrating mom was controlling, inhibiting, and smothering. As I recall, she was the responsible party for turning young boys into homosexuals. These women supposedly drove their sons away from relationships with any women and into the arms of men who were less threatening.

There were glimmers of ideas that neurochemicals might play some role in psychiatric issues. One idea I particularly liked was the “pink spot.” The theory was that people with schizophrenia produced abnormal metabolites that formed a pink spot in their urine chromatography. It at least was a beginning for the concept that a chemical basis of psychiatric problems might exist.

But, the notion of some “bad guy” in the person’s past was the prevailing norm to explain psychiatric maladies … and the mother was usually the culprit. If she had been more caring, less controlling, less giving of double messages, or warmer, there would have been less psychic damage to the vulnerable child.

Curiously, in my daily, real-life treatment of psychiatric patients, I found flaws in this tenet. I have seen the moms who are the heroes in their children’s lives. I have witnessed women who have nurtured, cared for, and supported their very needy and dependent children and who lost their own “normal” lives in the process.

For example, I have a patient with schizophrenia in his mid-twenties. He constantly smokes and drinks coffee, doesn’t always take his medication, doesn’t work, and stays at home in his room. Psychiatrists in the past used to blame the mother for situations like his, but I see that she’s the only one who is taking care of him. She tries to get him to take his medicine, feeds him, and keeps him from being homeless.

Bob is another patient. He is 28 years old. Born with cerebral palsy, he has been wheelchair-bound from infancy. He can become very agitated and strike out at anyone nearby. Caregivers have come and gone because Bob has assaulted them. Mom has had a broken jaw from one of his tirades. He can be incontinent. Bob generally stays at home because of his unpredictability. Dad left years ago because he couldn’t stand it. Only Mom endures. She loves her son, and this sustains her. Mom does not play the martyr and complain about the life she is missing because her son needs her. There is no extended family to help her. No one wants to take Bob because of his behaviors and needs, so Mom has had no vacation in several years.

In days of yore, psychiatrists would consider the psychodynamics of Mom’s behavior and her “neurotic” needs. We might have said she has guilt for something in her past and therefore has a need to punish herself. Perhaps she wants to avoid relationships with people her own age, possibly stemming from low self-esteem and a feeling that she would be rejected. And then, possibly she has a need to infantilize her son, wanting to keep him dependent on her to guarantee a continuing relationship.

But, I do not find these “neuroses” with Mom. Instead, I see a woman’s selflessness in trying to make her son’s life resemble something normal.

When Bob came to me, he was taking a cornucopia of psychiatric medications. It’s the usual story of one treater after another adding something and not subtracting anything. I was no different. I felt the need to help both Bob and his mom.

At the present time, Bob is doing better. This means that he has not assaulted anyone and seems to be in better control of his behavior. He and Mom have gone to a restaurant and more recently even took a trip to Disney World. She was able to enjoy herself because he was able to enjoy himself.

She loves her son.

I am content to see her as one of the heroes I have been privileged to know.

© Copyright 2016 Stanley Kapuchinski, MD.
Financial disclosure:Dr Kapuchinski had no relevant personal financial relationships to report. ​

Category: Mental Illness , Schizophrenia , Women
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