The Journal of Asthma Research.
Vol. 12, No. 3, March, 1975
Editorial Some Thoughts on Parentectomy
J Asthma Downloaded from informahealthcare.com by Nyu Medical Center on 03/05/15 For personal use only.
JOANNE BENTLEY,M.A. As a method of treating intractably asthmatic children, parentwtomy has proved its eff ectiveness many times over. Nevertheless, some doctors still feel that children are traumatized by being sent away from home for an extended period. For example, a pediatrician and two psychiatrists writing recently in the American Journal of Psychiatry contended that children react to being separated by feeling “helpless and defective;” a “negative self-concept” becomes crystallized.’ I don’t think that an observation of these children will bear this out. Feelings of hclplessness and of being defective do exist, as many investigators can attest. But the feelings are not caused by parentectomy; rather, they are one of the reasons why some form of psychotherapeutic intervention has bccome so necessary. The intractably asthmatic child has found himself unable to cope with familial and intrapsychic stress except by having asthma. When he is taken from home. and placed in another residence he may (and usually does) re-cxperience some of the painful feelings and conflicts which devoloped around relationships with parents and siblings a t earlier periods of his life. But this he would do anywhere because the conflicts have become intcrnalizcd. It seems to me that the question that needs t o be asked, in considering parentcctomy from a psychological viewpoint, is not “Is a child traumatized by being sent away from home?” but rather, “Is parentectomy successful in reducing the child’s helpless feelings in the long run, and if so, how?” Aftcr all, no useful psychotherapeutic method achieves its purpose without stirring up some feelings of pain. The children we admit to the residential treatment center in Ossining have various reactions to being sent away from home, Many fed homesick for a short time. Others don’t appear to miss thcir parents in the least. All a t one time or another feel angry a t staff members for enforcing rules and regulations. Their angry feelings against their parents are not so apt t o be openly expressed, but I have found this feeling to be one of the most common reactions to parentectomy. One can see an example of it in the vehement, accusatory letter which was quoted in the September 1974 issue of this Journal. The boy writer is blaming his parents for his own unhappy relations with peers and adults. The. implication is that if he were home his relationships would be happier. This onc can’t believe. But the more interesting point about the letter is what it reveals about the boy’s feelings of helplessness when he is away from his parents. All through the letter he talks as though everything bad that is happening to him is their fault. I’arentectomy has made this boy more aware than lie wants to be that he doesn’t function very well on his own. 125
J Asthma Downloaded from informahealthcare.com by Nyu Medical Center on 03/05/15 For personal use only.
126
JOANNE BENTLEY
Others of the institutionalized childrcn rrvral their angry feelings against parents through fantasy. I have been interested to discovei, in looking over psychological test materials of our children, how many of them tell stoiies about running away from home. The wish to run away is such a common reaction (even in normal children) t o feelings of helplessness and anger against parents that it needs no special commcnt. Its presence in children who have recently been sent away from homc isn’t surprising. Clearly these children arc trying t o cope with painful feelings that have been aroused by identifying with those who have caused the pain. By devising fantasics which turn the passive experience of “having been abandoned” into an active idea of doing the abandoning, they are saying in effect, “I too can be mean, I too can reject.” While no one would want t o claim that this reaction is, in itself, therapeutically helpful t o the child, I think everyone would agree that identifying with frustrating parcnts (becoming the one who acts instead of the one who is acted u p o n ) is one way in which every child learns t o give up his carly total dependence on his mother. If we think of intractably asthmatic children, as many people have, as having special problems in the area of dependency, then pcrhaps i t is possible to see a potential usefulness to these patients in fantasies of revenge against parcnts and even in open expressions of hostility. These angry reactions may br a necessary first step in the process of making the emotional separation which the child has failed to make earlier. Perhaps this will become clearer if we briefly review some of the stages of dependency that all childrcn go through in thc course of their development. The child first attempts to assert a sense of independence a t that period when he cxperimcnts with saying “no” and with dashing away from his mother. Up to that time he has relied on her for t h r satisfaction of almost all his needs, and he has experienced himself not as a rcparate entity but as part of a mother-child dyad. If the relationship with mothcr has been satisfactory enough, and if the child then finds that he can ray “no” and dash away *ithout fearing that he will lost: mother altogether, hc can subscqumtly begin to explore the larger world and to test himself in it with a groq ing sense of confidence. His need for symbiosis will lcssen as hr. finds himself morc and more able t o rely on his own knowledge and skills. Of coursc he will remain dcpendent on both parents for many years, but his fcclings o f deprndence will be experirnccd and expressed as time goes on at increasingly highrr levels of maturity. Howcver, there arc many rclasons why a child may fail t o make the important developmental stcp away from mother. The mother may cling t o the child and refuse separatioii hccause of her own nerds and anxieties. Or she may be much too willing to lrt the child go, cnforcirig too much independence a t a time when the child is ready for just a little. The child’s oum feelings and attitudes will contribute. If his earliest rxpcriences have been excessively traumatic, or if hc has rcwtcd to them as if they were for constitutional reasons, he will be much less willing to cxpcriment with srparation a t the appropriate time. His own feeling of inadcquacy and helplessness will increase as more and more demands are made on him to cope with situations on his own. An emotional separation from mothcr is essential for the development of his own identity.
J Asthma Downloaded from informahealthcare.com by Nyu Medical Center on 03/05/15 For personal use only.
THOUGHTS ON PARENTECTOMY
127
Abranison has observed that thc intractably asthmatic child t m d s to feel (ingulfed by (or inscparable from) his mother. The process of growing up is exceptionally difficult for such a child. He will resent the strong emotional tic to mother which interferes with his wish to act independently, but he will fed the longing, the regressive pull, a t the same time. The result will bc an insolublc conflict. By the time we see the child in a residential treatment center, lie may havc advanced through scveral stages of his development with some succc~ss,but becausc hc has been largely unable to resolve the early problems of separation, his s m s c of his o w i identity will at best be shaky. And he will look to adults (either consciously or unconsciously) for the kinds of gratification that the very young child expects from his mother. He will also, of coursc, feel resentment becausc hc does have these nccds. Anyone \tho has worked in a residential trcatmcrit ccntc.r for asthmatics will have noticed this. Most of these children have intense cravings for attention and supplies. Even their belligerence can oftcn be discerned as an insatiable demand to be noticed and loved. They are dependent on adults, in other words, a t a quit(. primitive level. One finds this early-level feeling of necdiness in the children’s tcst materials as well. The ones who fantasize running away from homc also imagine arriving a t new places where there will be an abundance of toys and moncy and food. Thus, we find one child imagining finding “many motliers,” another child finding a village made entirely of cake icing, still another fantasizing a world full of toys which all belong t o him. Most parents help a child amelioratc such intense longings by bcing giving (though not limitlessly so), and a t the same time introducing alternat!c sat,isfactions. Personnel in residential treatment centers for asthmatics do the same thing. By offering pleasurable activities which can be shared with peers and by encouraging the development of a child’s skills, they are in cssence helping the child to climb up thc developmental ladder. The child who arrives in residence feeling mragcd a t his parents because he is so inadequate and helpless without them will go home, if parentectomy has been successful, with much friendlier feelings toward those same parents. His parents may not have changed, but his own desperate need for them will have. I a m thinking of a child who arrived in residence in a state of panic. For weeks she was unable to sit still in a classroom. She had nightmares when she went to bed, and during the day she demanded almost constant attention. I n therapy she repeatedly dramatizcd her fear that she would die if she were left alone. Yet her drivc for independence and mastery was as strong as her fear. As she began to make friends and develop skills, she began opposing those same adults whose attention she had sought so desperately a t first. At the same time she began identifying with their attitudes and goals. I n the space of two ycars she devclopcd from a child who needed constant mothering into a sturdy little girl, still conflicted but with a mind of her own. Before she left she showed her therapist her view of what had happened t o hcr. One of her greatest fears had becn of drowning. Now she strapped an oxygen tank onto a doll and showed how the doll could leave home, swim undclr water to a n island where other children wcre picnicking, and then
128
JOANNE BENTLEY
return home “because of that tank of oxygen.” She was talking, of course, about her greater capacity to function on her own. It seems to me that this is what parentectomy achieves for those childrcn who are motivated and responsive. Asthmatic Children’s Foundation Ossining, New York References 1. LII*:HMCN, R., MINUCHIN, S.,AND BAKER, L., “The Use of Structural Family Therapy in the Treatment of Intractable Asthma,” in T h e Aniericaib Jouriaal of Psychiatry, 151:5, J Asthma Downloaded from informahealthcare.com by Nyu Medical Center on 03/05/15 For personal use only.
May 1974.
Vol. 12, No. 3, March, 1975
Editorial Some Thoughts on Parentectomy
J Asthma Downloaded from informahealthcare.com by Nyu Medical Center on 03/05/15 For personal use only.
JOANNE BENTLEY,M.A. As a method of treating intractably asthmatic children, parentwtomy has proved its eff ectiveness many times over. Nevertheless, some doctors still feel that children are traumatized by being sent away from home for an extended period. For example, a pediatrician and two psychiatrists writing recently in the American Journal of Psychiatry contended that children react to being separated by feeling “helpless and defective;” a “negative self-concept” becomes crystallized.’ I don’t think that an observation of these children will bear this out. Feelings of hclplessness and of being defective do exist, as many investigators can attest. But the feelings are not caused by parentectomy; rather, they are one of the reasons why some form of psychotherapeutic intervention has bccome so necessary. The intractably asthmatic child has found himself unable to cope with familial and intrapsychic stress except by having asthma. When he is taken from home. and placed in another residence he may (and usually does) re-cxperience some of the painful feelings and conflicts which devoloped around relationships with parents and siblings a t earlier periods of his life. But this he would do anywhere because the conflicts have become intcrnalizcd. It seems to me that the question that needs t o be asked, in considering parentcctomy from a psychological viewpoint, is not “Is a child traumatized by being sent away from home?” but rather, “Is parentectomy successful in reducing the child’s helpless feelings in the long run, and if so, how?” Aftcr all, no useful psychotherapeutic method achieves its purpose without stirring up some feelings of pain. The children we admit to the residential treatment center in Ossining have various reactions to being sent away from home, Many fed homesick for a short time. Others don’t appear to miss thcir parents in the least. All a t one time or another feel angry a t staff members for enforcing rules and regulations. Their angry feelings against their parents are not so apt t o be openly expressed, but I have found this feeling to be one of the most common reactions to parentectomy. One can see an example of it in the vehement, accusatory letter which was quoted in the September 1974 issue of this Journal. The boy writer is blaming his parents for his own unhappy relations with peers and adults. The. implication is that if he were home his relationships would be happier. This onc can’t believe. But the more interesting point about the letter is what it reveals about the boy’s feelings of helplessness when he is away from his parents. All through the letter he talks as though everything bad that is happening to him is their fault. I’arentectomy has made this boy more aware than lie wants to be that he doesn’t function very well on his own. 125
J Asthma Downloaded from informahealthcare.com by Nyu Medical Center on 03/05/15 For personal use only.
126
JOANNE BENTLEY
Others of the institutionalized childrcn rrvral their angry feelings against parents through fantasy. I have been interested to discovei, in looking over psychological test materials of our children, how many of them tell stoiies about running away from home. The wish to run away is such a common reaction (even in normal children) t o feelings of helplessness and anger against parents that it needs no special commcnt. Its presence in children who have recently been sent away from homc isn’t surprising. Clearly these children arc trying t o cope with painful feelings that have been aroused by identifying with those who have caused the pain. By devising fantasics which turn the passive experience of “having been abandoned” into an active idea of doing the abandoning, they are saying in effect, “I too can be mean, I too can reject.” While no one would want t o claim that this reaction is, in itself, therapeutically helpful t o the child, I think everyone would agree that identifying with frustrating parcnts (becoming the one who acts instead of the one who is acted u p o n ) is one way in which every child learns t o give up his carly total dependence on his mother. If we think of intractably asthmatic children, as many people have, as having special problems in the area of dependency, then pcrhaps i t is possible to see a potential usefulness to these patients in fantasies of revenge against parcnts and even in open expressions of hostility. These angry reactions may br a necessary first step in the process of making the emotional separation which the child has failed to make earlier. Perhaps this will become clearer if we briefly review some of the stages of dependency that all childrcn go through in thc course of their development. The child first attempts to assert a sense of independence a t that period when he cxperimcnts with saying “no” and with dashing away from his mother. Up to that time he has relied on her for t h r satisfaction of almost all his needs, and he has experienced himself not as a rcparate entity but as part of a mother-child dyad. If the relationship with mothcr has been satisfactory enough, and if the child then finds that he can ray “no” and dash away *ithout fearing that he will lost: mother altogether, hc can subscqumtly begin to explore the larger world and to test himself in it with a groq ing sense of confidence. His need for symbiosis will lcssen as hr. finds himself morc and more able t o rely on his own knowledge and skills. Of coursc he will remain dcpendent on both parents for many years, but his fcclings o f deprndence will be experirnccd and expressed as time goes on at increasingly highrr levels of maturity. Howcver, there arc many rclasons why a child may fail t o make the important developmental stcp away from mother. The mother may cling t o the child and refuse separatioii hccause of her own nerds and anxieties. Or she may be much too willing to lrt the child go, cnforcirig too much independence a t a time when the child is ready for just a little. The child’s oum feelings and attitudes will contribute. If his earliest rxpcriences have been excessively traumatic, or if hc has rcwtcd to them as if they were for constitutional reasons, he will be much less willing to cxpcriment with srparation a t the appropriate time. His own feeling of inadcquacy and helplessness will increase as more and more demands are made on him to cope with situations on his own. An emotional separation from mothcr is essential for the development of his own identity.
J Asthma Downloaded from informahealthcare.com by Nyu Medical Center on 03/05/15 For personal use only.
THOUGHTS ON PARENTECTOMY
127
Abranison has observed that thc intractably asthmatic child t m d s to feel (ingulfed by (or inscparable from) his mother. The process of growing up is exceptionally difficult for such a child. He will resent the strong emotional tic to mother which interferes with his wish to act independently, but he will fed the longing, the regressive pull, a t the same time. The result will bc an insolublc conflict. By the time we see the child in a residential treatment center, lie may havc advanced through scveral stages of his development with some succc~ss,but becausc hc has been largely unable to resolve the early problems of separation, his s m s c of his o w i identity will at best be shaky. And he will look to adults (either consciously or unconsciously) for the kinds of gratification that the very young child expects from his mother. He will also, of coursc, feel resentment becausc hc does have these nccds. Anyone \tho has worked in a residential trcatmcrit ccntc.r for asthmatics will have noticed this. Most of these children have intense cravings for attention and supplies. Even their belligerence can oftcn be discerned as an insatiable demand to be noticed and loved. They are dependent on adults, in other words, a t a quit(. primitive level. One finds this early-level feeling of necdiness in the children’s tcst materials as well. The ones who fantasize running away from homc also imagine arriving a t new places where there will be an abundance of toys and moncy and food. Thus, we find one child imagining finding “many motliers,” another child finding a village made entirely of cake icing, still another fantasizing a world full of toys which all belong t o him. Most parents help a child amelioratc such intense longings by bcing giving (though not limitlessly so), and a t the same time introducing alternat!c sat,isfactions. Personnel in residential treatment centers for asthmatics do the same thing. By offering pleasurable activities which can be shared with peers and by encouraging the development of a child’s skills, they are in cssence helping the child to climb up thc developmental ladder. The child who arrives in residence feeling mragcd a t his parents because he is so inadequate and helpless without them will go home, if parentectomy has been successful, with much friendlier feelings toward those same parents. His parents may not have changed, but his own desperate need for them will have. I a m thinking of a child who arrived in residence in a state of panic. For weeks she was unable to sit still in a classroom. She had nightmares when she went to bed, and during the day she demanded almost constant attention. I n therapy she repeatedly dramatizcd her fear that she would die if she were left alone. Yet her drivc for independence and mastery was as strong as her fear. As she began to make friends and develop skills, she began opposing those same adults whose attention she had sought so desperately a t first. At the same time she began identifying with their attitudes and goals. I n the space of two ycars she devclopcd from a child who needed constant mothering into a sturdy little girl, still conflicted but with a mind of her own. Before she left she showed her therapist her view of what had happened t o hcr. One of her greatest fears had becn of drowning. Now she strapped an oxygen tank onto a doll and showed how the doll could leave home, swim undclr water to a n island where other children wcre picnicking, and then
128
JOANNE BENTLEY
return home “because of that tank of oxygen.” She was talking, of course, about her greater capacity to function on her own. It seems to me that this is what parentectomy achieves for those childrcn who are motivated and responsive. Asthmatic Children’s Foundation Ossining, New York References 1. LII*:HMCN, R., MINUCHIN, S.,AND BAKER, L., “The Use of Structural Family Therapy in the Treatment of Intractable Asthma,” in T h e Aniericaib Jouriaal of Psychiatry, 151:5, J Asthma Downloaded from informahealthcare.com by Nyu Medical Center on 03/05/15 For personal use only.
May 1974.
