Contents
In what cases should you contact a specialist?
- In all cases where there is even the slightest suspicion that the somatic disease (diseases) of the child have psychological causes, that is, the child has fallen into the unenviable role of a “symptom carrier”. Parents usually fail to unravel this, as a rule, extremely tangled tangle themselves. In such cases, family, group or individual psychotherapy is used (depending on the complex of existing problems). Indirect indications of such a situation can be: an extensive, often changing list of functional diagnoses in a child; exacerbation of existing diseases during a period of special tension in family relations; the occurrence of a disease directly related to some family-wide stressful event (a threatening divorce, loss of a job, status, death of one of the family members, etc.).
- When the symptoms of a child’s psychological distress are not explained by anything that happens directly to him, and are also not within the competence of a neurologist. In these cases, it often makes sense to examine the family system.
- When the tangle of family problems and contradictions is incredibly large and confused, and simple common sense tells adult family members that all this simply cannot but affect children. In such families, everyone feels almost like the heroes of a soap television series, and to clarify the most complex long-term interactions, more than one, or even two psychotherapeutic sessions are required. Work with such families can be preventive and corrective. As a rule, deep psychotherapy is not used here, since over the years they have formed their own protective system of checks and balances, which should not be touched without good reason.
Example of life
Vasya Konoplyanikov is nine years old. He has freckles on his nose, and on his head is a dark blond, dull buzz cut of hair sticking out in different directions, which you just want to wash with some of the modern shampoos that make your hair «shiny and healthy.»
Vasya does not study well, he often suffers from colds. When Vasya was a preschooler, he did not pronounce five sounds at once, he studied with a speech therapist, and then went to a speech therapy kindergarten for another year. Now Vasya speaks clearly, but quietly and reluctantly, shaking his head during the conversation, as if doubting that he will be able to say anything interesting to the interlocutor. Mom says that Vasya used to bite his nails “to the meat” and peel off the burrs until they bleed. Now he doesn’t seem to do this, but he loves to wind his hair around his finger. To rid him of this habit, Vasya had to cut his hair so short. Vasya also has one more trouble — he still suffers from enuresis, that is, he pees at night. Sometimes it happens during the day, when he plays or gets nervous. Vasya’s enuresis is not permanent. Sometimes a few days, weeks, or even months is all right. And then suddenly — every night, and more than once. And he didn’t seem to catch a cold anywhere, he didn’t change his daily routine, he didn’t drink anything at night …
Vasya has a big family, everyone lives together, in the same apartment. There are grandparents, father’s parents. There is a mom and dad. There is also an aunt — my father’s younger sister. She does not have a husband, but she has a daughter, Vasya’s cousin. Her name is Irochka, and she recently turned five years old. Vasya also has an older brother, Gena, who is already sixteen years old. Gena plays football for the youth team of the city, studies at some technical college and is almost never at home. There is also a castrated cat and a lap dog — old, arrogant and lazy, also family members, favorites of grandparents.
The apartment, of course, is very crowded, but Vasya, unlike Gena, does not like to go anywhere and almost always stays at home. Even walking on the street Vasya has to be driven out by force. Mom offered him different circles to choose from, and his older brother tried to bring Vasya to the same football school where he himself had once started. Vasya refused everything, and when his mother nevertheless enrolled him in a circle of technical creativity and dancing (in order to become more confident in himself, to learn how to move — so, quite reasonably, she explained her choice), he began to get sick and write so desperately that he had to stop this thing.
They don’t talk about Vasya at school. Mom even takes offense at this. The teacher at the meetings first praises some, then scolds others, then gives advice to all those mentioned. Nothing gets to Vasya’s share. He does not hooligan and does not violate discipline at breaks, does not chat and is not distracted in the classroom, does not fight and does not show any talents and abilities. When my mother directly asks the teacher about him, she shrugs her shoulders and says:
— You know, he’s kind of invisible. There is nothing to even say. He studies poorly, but you can’t even say that he is below his abilities. The boy is trying, I see that he is generally fulfilling the program. He often gets sick, misses, this may be the difficulty. And so … he has no friends in the class, but it seems that he also has no enemies. Here, psychologists conducted sociometry … Well, you know, if you like it or not, you would start playing, would not play, would go into intelligence, invite you to a birthday party, definitely would not invite … So none of the children in any column never mentioned. Neither bad nor good, you know? Psychologists told me: «Pay attention.» What can I do? Here I tell you…
In the family, Vasya is as invisible as at school, and attention is paid to him only when he falls ill again. Then Vasya is examined, treated, given medicine, forbidden to sit by the window, walk without slippers and watch TV until late. Vasya is not happy with such attention at all. There are many people in the family, everyone, including the cat and the dog, has some kind of complex, long-term relationship with each other. To the question: “What is the relationship between your husband and his sister?” — Vasya’s mother answers for a long time and in detail. To the question: “What is the relationship between Vasya and his cousin?” — at first confidently answers: «None!» — then he is embarrassed, he chooses words for a long time and in the end does not say anything definite.
In general, it is completely unclear what role Vasya plays in the family. Gena is the pride and hope of the older generation. He is not particularly intelligent, but clearly has the will and perseverance to achieve his goal. Irochka is everyone’s favorite. She is caressed and pampered, but she has a good character and has not yet sat on everyone’s neck. If she is given something tasty, then she will definitely leave a piece for her mother and brother Vasya. She would leave Gena too, but Irochka hardly sees him and sometimes even forgets about his existence. The kindness and generosity of Ira touches those around her even more.
— And Vasya shares with Irochka? I ask.
“I don’t know,” mum thinks, discouraged.
After a little “disassembly”, it turns out that Vasya and Irochka simply have nothing to share, because if Vasya is given something, then Irochka, as a rule, already has it. Vasya, when he was smaller, tried to share with Gena, but the elder brother himself stopped this, with his characteristic determination:
“Thank you, brother, of course, but you don’t want to. I don’t need these pieces. Eat everything by yourself. It will be so honest. I eat at school and buy something on the way to training. Do not leave me a piece of pie in a piece of paper or cola in a jar on the bottom, right? Vasya always respected the opinion of his elder brother and immediately obeyed his order.
— And how is the situation in your family in general? I asked as neutrally as possible. — Are there many conflicts? — Yes, how can I tell you? Vasya’s mother shrugged her shoulders again. — I think like everyone else. No more, no less. Our grandfather was not a fool to drink before, now he has calmed down. Dad, too, sometimes … Well, who doesn’t have this?
“Yes, yes, of course,” I nodded hastily, feeling that Vasya’s mother was not yet ready for a frank conversation.
The reason for the appeal of Vasya’s family to a psychologist was the following. Recently, Vasya began to sleep very badly. He gets up completely unrested, sluggish, sleepy all day. From early childhood, Vasya had fears that seemed to recede after six years. And suddenly — four people in the room are watching TV, Vasya looks fearfully somewhere in the corner, obviously sees something there and asks his brother (against his usual Gena was at home that evening) to take him to the kitchen to drink water. Then Vasya goes into another room and goes to bed with Irochka.
What the brothers were talking about is unknown, but Gena returned to the TV angry and determined.
— Have you completely made your brother a psycho?! he threw to the taken aback relatives. “It took a long time to separate, to live separately. But it’s okay — I’ll gnaw the earth, but I’ll earn money for an apartment. I’ll take your bro. If I succeed…
And before the stunned parents could ask or say anything, the gloomy teenager grabbed his jacket, jumped into his sneakers and rushed out of the house, slamming the door with a deafening slam. Gena returned after midnight, refused to give any explanation. He only kept repeating that he would take his brother away from his relatives at the first opportunity. The next day, the nervous dad went on a drinking binge, and the family had other problems. Gena, as always, disappeared somewhere at school and training, Vasya, as usual, behaved quietly and imperceptibly. Mother, of course, could not forget about the frightening episode and, not knowing whom to turn to, consulted with the teacher.
«Go to a psychiatrist immediately!» the teacher exclaimed in alarm. It must be schizophrenia! I’ve read it often starts like this. Yes, and Vasya with you, you know … he was always with oddities …
Now my mother’s sleep is also disturbed. She did not know where psychiatrists met, and for some reason thought that they only accepted in psychiatric hospitals. Going to the hospital was scary. Telling relatives about a terrible assumption is even worse. Then she overheard the evening conversation of the brothers among themselves. Gena devoured naval-style pasta straight from the frying pan, plentifully poured with ketchup. Vasya sat at the table opposite his brother and listened to him.
“Well, how are things at your school?” the elder asked. — Don’t worry that you’re not studying well. Remember, I wasn’t a perfect student either. The main thing is to find yourself in life … That’s how I am … You look, bro, look for your own, do not listen to anyone …
“You know,” Vasya smiled softly. “It seems to me that the teacher is afraid of me for some reason …
— Fears?! — Gena was amazed and looked up from the pasta for a second. — Why is that?
“Yes, I don’t know myself,” Vasya shrugged. “I didn’t do anything like that. But she’s looking at me like I’m… well, like I could bite or… well, I don’t know what…
“He is afraid, and it’s good, let him be afraid,” Gena affirmed indifferently. — Fool, probably. Don’t take it into your head. Do not be afraid of anyone — this is the question …
— Yes, I’m not afraid … — the younger smiled again.
— It is right! Gena slammed his palm on the table and set aside the empty frying pan. — Well, don’t be angry, bro, my eyes are sticking together, I went to bed.
The next day, Vasya’s mother, together with him, came to see me.
I confess that the episode with hallucinations (?) alarmed me almost as much as the teacher, but still seemed to me far from being the main one in the existing clinical picture of the disorder. From the very beginning, the thought arose that there was no point in considering Vasya’s problems in isolation, in isolation from the family. And I decided to get to know Vasya’s family better.
Vasya’s family
Gena, 16 years old:
— You should leave. But where, how? You know how it is with apartments now. Vaska was always quiet, so they shut him up. If there were fewer people, but more freedom, maybe he would have turned around. Sick? No, he’s sick! Did it happen? Well, it happens to everyone. When I was with the boys … well, I dabbled, you know? — I also saw everyone. In family? What about in the family? Just like others. Our dad is a quiet drunk. But he doesn’t drink anything from home, and he brings money. Basically … Mother does the housework, but she works — she doesn’t have time to breed all sorts of subtleties there. I was even surprised — why did she run to you? Maybe because I freaked out then? I don’t know what to do for Vaska. I’ll go into power — I’ll take him to me. Let him rest. You do not think that I am not for a red word, it will be so. Now, I don’t know. I’m not there, but he’s there, with them. And so, you do not think he is a good kid. He was still very young, he defended me from my parents, he went to negotiate for me. Forgive me, he says, Genka, I’ll give you my jelly at dinner. Well, they laugh, of course, and all the anger passed …
Lena, sister of Vasya’s father, 28 years old, Irochka, her daughter, 5 years old:
— You know, Vasya, he was always kind of quiet, inconspicuous, like a mouse. I even spoke to Sveta, his mother. “It would be necessary to bring him somewhere so that he would somehow become more reckless, or something.” But he doesn’t want anything. Genka tried to get him into football… Sick? No, he doesn’t look like a patient. A normal child, like everyone else, well, not very capable … So he tries, don’t think, he always does his homework. Genka was somehow much more sloppy, and dragged twos and ones in bags. Now, in a technical school, I came to my senses like …
“Gena fights, and if you get into his table, he’ll give you a pendel,” Irochka got into the conversation. — And I only wanted to see the badges and did not touch anything. And Vasenka is kind. When he is sick, I always come to his bed, he tells me fairy tales.
“Yes, yes,” Lena said. Vasya is a good boy. And if you ask for something, he will always do it. Genka, or even mine — you’ll be confused until you interrogate. And I only talk to my brother through him. Especially when he drinks, well, you understand … Then he is angry at everyone, well, but it’s impossible to be angry with Vaska — he’s so … fuzzy. Even Sveta sometimes sends him to her husband …
Roman, 38 years old, Vasya’s father:
“Yes, I don’t know what to tell you, doctor. Two sons, consider, grew up, and I, as it were, had nothing to do with it. Genka is like this, Vaska is like that, but what, why — who will sort him out? The apartment, of course, would need a separate one. Yes, I’m a worker, it seems that I don’t loafer all my life, I work, but somehow it doesn’t work out with an apartment … What kind of relationship do I have with Vaska? No, doctor! Here I tried to educate Genka somehow, tore him like Sidorov’s goat, and believe me — there was something to fight for! And Vaska — what’s wrong with him? He studies badly, so my wife says, he can’t do better, but I can see it myself — he doesn’t drive in the yard, he sits behind these textbooks, he doesn’t skip school either, there, the teacher says, he’s also not noticed in hooliganism. Why scold something? To praise? Praise for what? Well, you are right, of course, education is, of course, not only swearing. But only I myself was brought up in this way, and somehow I was not able to read smart books on this matter. In vain, maybe … No, well, I talk to him sometimes, of course, I’ll ask about the school, or they bought him a game console. Since he’s still at home. I ask him what cartridges to buy… Yes, you will probably judge me, but when I’m on this case… well, you understand, I have no friend better than Vaska. He is silent, of course, but to bring, and serve, and listen — so he is much better than his mother. And talk to her… Sick? Well, doctor, why is he sick? Yes, one fool. It will outgrow, I tell you right. This wife is causing a panic here …
Vasily Petrovich and Anastasia Ivanovna, Vasya’s grandfather and grandmother:
— Well, doctor, Vassenka is a very good boy. Everyone would be like that — obedient, quiet, modest. Now there are few of them. He studies badly — so, well, not all scientists should be. We, too, did not shine in schools, — right, grandfather? — but life, read, lived, and people are not ashamed to look in the eyes. And Vasenka — he loves animals too, he will never offend, and he will help the elders. And he separates everyone — a cat with a dog, and a father with a mother, and brother and sister. It seems that he won’t say a word, but he will divorce everyone in the corners. But the other day, my grandfather and I were arguing, so he came up to me from the side and said: “Something, grandmother, I want pancakes. And Irochka also asks … «Well, I went to my frying pans …
— And she did the right thing. You, doctor, don’t listen to your daughter-in-law. It was the teacher from the school who sang to her, they say, he is stupid with you, retarded. And the peasant, if you like, has many kinds of intelligence. There is a mind of the head, it is not given to everyone. There is a mind in the hands, it’s like Romka, our son, and I myself, how younger I was. There is still a mind, excuse me, in all sorts of male personal belongings — this is in trouble for the women, and we don’t have a conversation about that now. And there is the mind of the heart, it is the least common among men, it lives more in your, excuse me, sex. So Vaska has just this last mind and there is more than all of us, sinners, put together …
And again Sveta, Vasya’s mother, sits in front of me in an armchair, and again her gray, tired eyes look at me with fear and hope. Well, why am I not a sorcerer and not a healer, and I can’t cure everything in one session, as they promise in the tabloid newspapers!
“Let me announce the entire list,” I say, deliberately mocking, and I describe in detail to my mother the entire list of Vasya’s virtues, as he appeared before me based on the stories of his family members.
“Yes, I myself knew that he was a good boy,” Sveta says, shaking her head thoughtfully.
“He’s not just a good boy,” I chirp. — He acts as a stabilizer in your huge family, where no one has ever bothered with even a hint of reflection. Do you know what reflection is? Light shakes her head. — Reflection is self-awareness, thinking about yourself, about your thoughts and actions. Vasya, of course, does not know this either. He is guided by the very mind of the heart that your father-in-law spoke about so well. He serves as a mediator, a mediator in all your conflicts, he softens all sharp corners and prevents all quarrels that can be prevented. And it is precisely his merit that Irochka has not yet turned into a spoiled egoist, and Gena, brought up by a belt, has not gone “to the left”. You are surprised that he stays at home all the time. But he can’t leave this anthill of yours even for a minute. You’re there without him all perekapaetes, and then — disentangle him! You are surprised that he tries, but does not study well. That he is often sick. But he’s just not strong enough! He’s only nine years old! This burden is not for him, but for an adult strong person with good psychological self-education … I will not hide from you — the episode with visions is really extremely disturbing. If things continue as they are, the risk of mental illness cannot be ruled out…
“But what are we to do?!”
— Divide Vasya’s burden for everyone, — I suggested on the move.
Then there was what is called family psychotherapy. We did not dig deep, but worked only with the relevance of today, well, in extreme cases, yesterday. All the adult members of the family (except for Sveta, who immediately believed me with the exaltation of an enthusiastic schoolgirl — in the future this more hindered than helped the case) at first were very distrustful of what was happening, but when Gena admitted that only the fear of giving up prevented him from some very dubious steps not the best example for the younger brother and to leave him without cover at all, the attitude of the family towards psychotherapy has changed significantly. Conversations with a philosophical grandfather gave me real pleasure. Vasya, having learned about the complete and even expanded list of his merits, suddenly burst into tears. Reassured, he said:
— I often thought like this: why me? And now it turns out, I need it too, right?
“You are needed very much,” I assured the boy. “But you have taken on too much, and now you need to unburden yourself a little.
“But sometimes only I know how, and they all don’t know,” the boy objected.
“So we’ll teach them,” I promised. — And you can walk in the yard, go to circles and study better. However, a cat and a dog will still remain on you. Because even I can’t teach them anything…