Modern Parenthood through the Eyes of a Psychiatrist

Introduction

It gives me immense pleasure to welcome you all to this gathering. Being a President of the Bombay Psychiatric Society gives me an opportunity to introspect, to witness my own past and also to share some of my insights with you.

The seeds of what I am today as a psychiatrist were sown in my days in the Department of Psychiatry, KEM Hospital. All my teachers there were competent, each endowed with unique abilities. I learnt a lot from Dr. Doongaji, Dr. L. P. Shah, Dr. P.V. Pradhan, Dr. Ashit Sheth, and Dr. P. D. Lakdawalla. They not only trained me to develop an excellent clinical approach but also inspired me to inculcate within me their own qualities of giving, sharing and teaching.

After getting out of KEM Hospital, I started private practice. It was like opening the doors to a new world but with no map. The very little inputs in Child Psychiatry had got me interested in the subject. I discovered that it was a challenging field: allowing scope for various drug and non-drug treatments, many of them off-beat and unconventional. It was a field which allowed one’s own creative potential to grow and flourish, and also kept the child within alive.

Children and Their Parents

I like children. I like to work with them. However, an inevitable component of Child Psychiatry is the parents. One cannot work with children alone. One has to deal with parents, who can either be facilitators or obstacles in the treatment of a child. They bring the child for treatment, they give the presenting complaints, they paint the child’s picture – positive or negative; and the clinician has to sort out the true colours of the child from the pseudo-colours often painted by the parents (See also this issue pgs 31-46).

Psychiatric literature is replete with references to different aspects of parenthood, bio-psycho-social, and the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) classification mentions several categories of disorders of childhood (American Psychiatric Association, 2013).[1] Let us see how this helps in handling children’s problems. Recently I saw a 5-year-old child attending six kinds of classes-General Knowledge, drawing, yoga, tabla, karate and swimming. He was brought by his mother with complaints of irritability. The mother, incidentally, was a postgraduate in human development. She wanted him to develop into an all-rounder; and wanted to get his IQ/EQ/CQ and SQ done. I felt like telling her–return your degree! The only diagnostic term I could think of was ‘Overanxious disorder of parenthood’ which is conspicuous by its absence in the DSM classification. I am sure all psychiatrists see varieties of the same syndrome in varying degrees day in and day out.

I have had the opportunity to work for the past 14 years as an honorary psychiatrist at a parents and Child Guidance Centre run by a social institution in Vile-Parle, Mumbai, and also with the Juvenile Diabetes Foundation for the past 8 years. I have learnt my Child Psychiatry and ‘Parent’ Psychiatry (as I call it) in these two places. I interact with not <2000 parents every year by way of community programmes and also individual consultations. I calculated this figure just yesterday, and was myself amazed: just shows the increasing need among parents for guidance and assurance.

Torn between Two Extremes

Whenever I address a group of educated parents who belong to the same socio-economic class as I come from, and also those who belong to the same generation as I do, I am surprised at the way they function – they seem to be torn between two extremes. On one hand, they are over-concerned about issues they read about in books or see on TV or the Internet; they have got their child’s IQ done, have been to 3 psychiatrists and 2 counsellors confirming that it is normal. On the other hand, they are not aware of many basic commonsense issues. For example, I have seen parents asking such questions to me – what toys should we give to our child? How should I spend time with my child? Should my child play with friends, or is it better not to allow him to mix? How should I handle sibling rivalry? How so I discipline my child? I always wonder – did our parents never have to face these problems? Did they not get such questions in their mind? No one ever taught them how to bring up their children. Were they not educated? Of course, they were. But they never went to any workshops/lectures on parenting. And yet, I believe, children were brought up pretty normal. What has happened to our generation of parents?

There is a famous quotation of Rabindranath Tagore: Every child comes with the message that God is not yet discouraged of man (Tagore).[4] If at all there is someone like God who is sending children to this earth and if He is concerned about their welfare, eventually He will have to stop doing so, looking at their state in their parents’ hands. We have moved away from the joint family. The population is growing exponentially and so is the competition. There are only one or two children per family (among the educated class, at least). They become the sole target of the expectations of the entire family. The number of working-women has increased in the past few years. A typical working woman is an employee somewhere outside home, an employer of the family inside home, full of guilt that she cannot give enough time to her child and fighting to compensate for what she cannot give. The definition of a successful person has been reduced to a person with plenty of money. There is hardly any communication among members of one family. Not far away is the situation when the husband, wife and the child will write E-mails to each other from one room to another in the same house. In the whole bargain what is getting lost is the human touch. Parents invest money in the child, and the child is supposed to give returns in terms of certain percentage of marks not only at the S.S.C. and H.S.C., but also at the smallest and the most trivial of examinations in school. Parents make panicky phone calls for emergency appointments, the reason being that the 7-year-old child going to standard II is scared to appear for the 2^nd unit test.

The Oxford dictionary meaning of the word parenthood implies both responsibilities and joys. What has happened to the whole joy of parenthood? We see so many responsible parents who are unhappy. Why is it so? In fact, the word ‘parent’ seems to be not a word but an acronym – P = Pressure, A = Ambition, R = Reproach, E = Expectation, N = Negativity, T = Tension. Today’s parent has been poisoned by the current system of education, and is trying to poison the children. Can we look at some of these concepts differently?

Some Poisons

Life Moves like a River, Not a Train

I think we, the parents of the present generation, are trying for a child who does not commit any mistakes, who is absolutely efficient, who moves on the unfaltering lines of mathematics. Such moving is like a train running on the railway tracks. But life is much more dynamic – and dynamic in all directions. Life moves like a river, not like a train. It has freedom that cannot be contained in the fixed structures of intellect. It runs on unknown, unfamiliar paths. It is high time parents realise this fact.

There are other aspects of life that are probably more significant than the intellect. Our children are made to do everything through the intellect. We do not appreciate beauty only through the intellect, we do not listen to music only through the intellect. We do not love through the intellect, we do not get angry through the intellect. None of the deeper experiences of life are attained through the intellect. Therefore, parents should surrender to the fact that the sources of life are much deeper. Giving importance only to the head and not to the heart or the hands is producing unbalanced human beings – probably a new human species is evolving – with no movement, no clear goal, no music, no rhythm in life.

I know I am not talking from any textbook or journal. After some years, one realises that life is more experiential than textual. Let me share this with you. My wife is a paediatrician. When we had a child, I had to take up some responsibilities of parenthood. I was only ready to take the joys but my wife said no to that. She taught me some basic paediatrics. I tried Nelson’s textbook too. But none of the things mentioned therein seemed to happen. When our son was very small, there were 3 moods I would find him in: mood 1-just about to cry; mood 2-crying; mood 3-just finished crying. My job was to keep him in mood 3 as far as possible. I found that traditional ways to do this helped better than the textbook ways – when the child cries, you and your spouse should pass it back and forth repeatedly and recite these words in unison, ‘Do you suppose he is hungry? No, he can’t be. He just ate. Maybe he needs to be burped. No, that’s not it. Maybe his diaper needs to be changed. No, no, come on, it’s dry. Do you think he may be hungry?’ And so on, until the baby can’t stand it anymore and decides to go to sleep.

Textbooks Don’t Always Speak the Truth

We have read in physiology that food is absorbed through the stomach or the intestine. But no, in the case of children that does not seem to happen. I think a theory might evolve after sometime that children absorb food through their facial skin; so the most effective way of feeding a baby is to smear the food on its chin. Unfortunately, many inexperienced parents insist on putting the food in the baby’s mouth-spoonful after spoonful, sincerely believing that they are doing something constructive. Really speaking, food merely goes round and round the ‘baby food return loop’ which all humans are equipped with till the age of 18 months. After the so-called feeding is over, the baby starts bringing out food under high pressure until its face is covered with food, which it can then absorb. Textbooks don’t always speak the truth.

As a professional working with parents what did I learn? I think as parents we must laugh heartily-laugh at ourselves and laugh with the child. As professionals we have to teach our parent-clients this. When we advise our parent-clients, we should not hesitate to share our own experiences of parenting, the likely mistakes, and finally the assurance has to be that it is all right to make mistakes. The whole business of parenthood has become such a serious affair. It has to be carried out in a lighter vein. The process of parenthood is an ever-changing, ever-evolving one. Parents also grow with their children. If we are able to make them understand this one thing, we have done a good job (See also the bi-directional model at pgs 31-46 this issue). The point is – happiness is not a destination, it is the manner in which you travel. Our job as professionals is not to give them ready-made solutions, no formulae, no recipes, because there aren’t any. Our job is to relax them, make them more self-aware, introduce their child to them the way we have understood him or her and suggest ways of handling the problem: not in a theoretical but a practical manner, in the form of guidelines, not doctrines. Guidelines that they may apply in their own case and handle their problem in their own unique way. Many times what your tell them and what they perceive may not be the same. We try to make sure they are the same. What we give them is information, they have to couple it with their own experience which converts it into knowledge. And, knowledge when applied within a rational framework, becomes wisdom. But mere wisdom is not sufficient. At the core of wisdom has to be happiness. Happiness, like music, needs to be practiced. The best way for a parent to practice happiness is to spend quality time with children, and keep the child within them alive.

What Kahlil Gibran Said to Parents about Children

I think I have said enough about parenthood, and the way I look at it. My perceptions are also changing. They are not static. What I think today may not be what I might think after a few years. Nevertheless, what Kahlil Gibran has said to parents about children is the ultimate truth (Gibran, 1991):[2]

Your children are not your children.

They are the sons and daughters of Life’s longing for itself.

They come through you but not from you.

And though they are with you, yet they belong not to you.

You may give them your love but not your thoughts.

For they have their own thoughts.

You may house their bodies but not their souls,

For their souls dwell in the house of tomorrow, which you cannot visit, not even in your dreams.

You may strive to be like them, but seek not to make them like you.

For life goes not backward nor tarries with yesterday.

You are the bows from which your children as living arrows are sent forth.

Conclusions [Figure 1: Flowchart of the Paper]

In the past few years, there have been many changes in our society, which are directly affecting the clinical picture of cases in Child Psychiatry. We have moved away from the joint family to the nuclear family. The number of children per family has reduced. The number of working mothers has increased thereby increasing the guilt in a typical working mother as she cannot devote much time to her child. The population is growing enormously and so is the competition. There is hardly any communication among members of one family. Overall there is an increase in the stress level of parents and children.

Modern parents are subjecting their children to comparison, competition and ambitious goal-setting. In spite of their high level of education and awareness, they are anxious and confused about how to bring up their children.

When, as professionals, we advise our parent clients, we need to share our own experiences of parenting, anticipate the likely mistakes and finally reassure them that mistakes are human. The process of parenthood is an ever-changing, ever-evolving one. Parents also grow with their children. We do our job well only if are able to make parents understand that happiness is the most important aspect of parenting. Our job as professionals is not to give them ready made solutions, no formulae, no recipes, because there aren’t any. Our job is to relax them, make them more self-aware, introduce their child to them the way we have understood him or her and suggest ways of handling the problem: not in a theoretical but a practical manner, in the form of guidelines, not doctrines.

Take Home Message

There are three important points to be remembered:

1. Parenthood is an important aspect of Child Psychiatry and it is crucial to realise the various dimensions of parent clients when we deal with a child’s case.

2. The typical modern educated urban parent is overly aware, concerned and anxious while dealing with his/her child. It is important to identify this issue in therapy.

3. Mental health professionals need to address the anxiety and fear in the parent clients as they deal with their child client.

Questions that this Paper Raises

1. Is it essential to carry out a separate assessment of parents while dealing with a child case?

2. Are there any specific tools to evaluate the ‘parenting aspect’ of adults?

3. What cognitive and non-cognitive techniques can be used to deal with parents in therapy?

About the Author

Manoj Bhatawdekar MD is a Consulting Psychiatrist practising in Mumbai, India for the past 25 years. He has worked in various areas of research such as psychopharmacology, cross-cultural psychiatry and meditation. He is an author of books for awareness in Psychiatry in Marathi. He is also a disciple of music, a lyricist and a composer.