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Are Illness Coping Mechanisms Learned From Parents?

Photograph: Roger Bamber

How far do we travel from our parents’ patterns?  A question psychotherapists and their clients have been wrestling with for decades.

We can’t escape the parental imprint.  Some of us may not want to.  But those of us who did hope to be different often find ourselves in our 40s or 50s unexpectedly leaking parental behaviors or attitudes we thought we had purged ourselves of in our 20s.

I sometimes hear myself saying to Richard, my partner, as he heads out the door for his Tae Kwon Do class, “Be careful.”  He has a second degree black belt and has been studying for years.  He is always careful.  My admonition is a spillover of my father’s anxious voice warning me to be on the lookout for endless, unnamed dangers hiding in plain sight at every turn.  Other times I see myself tighten up like a fist when something I thought I had control over twists in an unpredictable direction.  It is not my jaw that clenches in agitation; it is my mother’s jaw, on my face.

How our parents do or did illness is a powerful pattern.  Did they suffer in silence, while allowing no one to offer tenderness or help?  Did they submerge into illness and allow it to define who they were?  Did they use illness to control and manipulate?  To get attention?  Did they remain engaged in living and loving?  Did they learn from illness to become more fully who they were?  Did they become nastier to each other?  Or sweeter?  And finally, did they take care of each other — physically and emotionally?

My parents, who kept each other at a distance when well, became even more separated when ill.  They went so far as to resent each other for their increasing incapacities.  It was not pretty.

There were times when I was in the thick of my pain condition, that I isolated and withdrew from Richard.  But more often, I allowed my pain to teach me to reach out for comfort and connection.  I had to.  For me, the voice of pain was more powerful than my parents’ example.

Dealing with illness can be a consuming job.  When you find yourself behaving in ways that don’t create the kind of bridge to your partner that will help lighten the load for both of you, pause and ask yourself:  “Am I playing out a pattern that doesn’t really belong to me?  Whose voice am I speaking with?  Can I do it differently?”

How did your parents deal with illness?  What did you learn to do and not to do from them?

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Barbara Kivowitz is a psychotherapist, business consultant, and book author. She blogs regularly at In Sickness And In Health.


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One Response to “Are Illness Coping Mechanisms Learned From Parents?”

  1. Marielaina Perrone DDS says:

    Oh I defintiely believe these mechanisms are learned from parents to a certain degree just as dental phobias are learned as well.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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