Caregivers Quotes

My grandmother's greatest gift was tolerance. Now, in the old days, Indians used to be forgiving of any kind of eccentricity. In fact, weird people were often celebrated. Epileptics were often shamans because people just assumed that God gave seizure-visions to the lucky ones. Gay people were seen as magical too. I mean, like in many cultures, men were viewed as warriors and women were viewed as caregivers. But gay people, being both male and female, were seen as both warriors and caregivers. Gay people could do anything. They were like Swiss Army knives! My grandmother had no use for all the gay bashing and homophobia in the world, especially among other Indians. "Jeez," she said, Who cares if a man wants to marry another man? All I want to know is who's going to pick up all the dirty socks?

To care for those who once cared for us is one of the highest honors.

Affirmations are our mental vitamins, providing the supplementary positive thoughts we need to balance the barrage of negative events and thoughts we experience daily.

An algorithm that expedites care to a stroke patient in a chaotic emergency room (ER) has a good chance of adoption. An algorithm that reads a routine scan and provides some quantification of what the physicians can already estimate won’t be in as much demand. There are good reasons for algorithms to parse patient records to look for signs of rare diseases, but there are fewer good reasons for using them to evaluate clinical symptoms. It’s cool that AI tools can make diagnoses from scratch, but for most clinical encounters doctors are already pretty good at it.

Caregiving often calls us to lean into love we didn't know possible.

Much of clinician burnout is due to spending time writing notes, placing orders, generating referrals, writing prior authorization letters, and creating patient communication. In other words, burnout is caused by physicians having to generate output! With the emergence of large language models that are used to train generative AI solutions, these use cases will be at the frontier of AI’s applications in healthcare.

Behind every stressful thought is the desire for things to be other than they are.

In the heart or every caregiver is a knowing that we are all connected. As I do for you, I do for me.

I’m a modern man, a man for the millennium. Digital and smoke free. A diversified multi-cultural, post-modern deconstruction that is anatomically and ecologically incorrect. I’ve been up linked and downloaded, I’ve been inputted and outsourced, I know the upside of downsizing, I know the downside of upgrading. I’m a high-tech low-life. A cutting edge, state-of-the-art bi-coastal multi-tasker and I can give you a gigabyte in a nanosecond! I’m new wave, but I’m old school and my inner child is outward bound. I’m a hot-wired, heat seeking, warm-hearted cool customer, voice activated and bio-degradable. I interface with my database, my database is in cyberspace, so I’m interactive, I’m hyperactive and from time to time I’m radioactive. Behind the eight ball, ahead of the curve, ridin the wave, dodgin the bullet and pushin the envelope. I’m on-point, on-task, on-message and off drugs. I’ve got no need for coke and speed. I've got no urge to binge and purge. I’m in-the-moment, on-the-edge, over-the-top and under-the-radar. A high-concept, low-profile, medium-range ballistic missionary. A street-wise smart bomb. A top-gun bottom feeder. I wear power ties, I tell power lies, I take power naps and run victory laps. I’m a totally ongoing big-foot, slam-dunk, rainmaker with a pro-active outreach. A raging workaholic. A working rageaholic. Out of rehab and in denial! I’ve got a personal trainer, a personal shopper, a personal assistant and a personal agenda. You can’t shut me up. You can’t dumb me down because I’m tireless and I’m wireless, I’m an alpha male on beta-blockers. I’m a non-believer and an over-achiever, laid-back but fashion-forward. Up-front, down-home, low-rent, high-maintenance. Super-sized, long-lasting, high-definition, fast-acting, oven-ready and built-to-last! I’m a hands-on, foot-loose, knee-jerk head case pretty maturely post-traumatic and I’ve got a love-child that sends me hate mail. But, I’m feeling, I’m caring, I’m healing, I’m sharing-- a supportive, bonding, nurturing primary care-giver. My output is down, but my income is up. I took a short position on the long bond and my revenue stream has its own cash-flow. I read junk mail, I eat junk food, I buy junk bonds and I watch trash sports! I’m gender specific, capital intensive, user-friendly and lactose intolerant. I like rough sex. I like tough love. I use the “F” word in my emails and the software on my hard-drive is hardcore--no soft porn. I bought a microwave at a mini-mall; I bought a mini-van at a mega-store. I eat fast-food in the slow lane. I’m toll-free, bite-sized, ready-to-wear and I come in all sizes. A fully-equipped, factory-authorized, hospital-tested, clinically-proven, scientifically- formulated medical miracle. I’ve been pre-wash, pre-cooked, pre-heated, pre-screened, pre-approved, pre-packaged, post-dated, freeze-dried, double-wrapped, vacuum-packed and, I have an unlimited broadband capacity. I’m a rude dude, but I’m the real deal. Lean and mean! Cocked, locked and ready-to-rock. Rough, tough and hard to bluff. I take it slow, I go with the flow, I ride with the tide. I’ve got glide in my stride. Drivin and movin, sailin and spinin, jiving and groovin, wailin and winnin. I don’t snooze, so I don’t lose. I keep the pedal to the metal and the rubber on the road. I party hearty and lunch time is crunch time. I’m hangin in, there ain’t no doubt and I’m hangin tough, over and out!

There are only four kinds of people in the world. Those who have been caregivers. Those who are currently caregivers. Those who will be caregivers, and those who will need a caregiver.

I say no to people who prioritize being cool over being good. I say no to misogynists who want to weaponize my body against me. I say no to men who feel entitled to my attention and reverence, who treat everything the light touches as a resource for them to burn. I say no to religious zealots who insist that I am less important than an embryo. I say no to my own instinct to stay quiet. It's a way of kicking down the boundaries that society has set up for women - be compliant, be a caregiver, be quiet - and erecting my own. I will do this; I will not do that. You believe in my subjugation; I don't have to be nice to you. I am busy. My time is not a public commodity.

the first time the caregiver saw it on the child. they said ‘no. don’t you dare. you will not grow up thinking you are unwanted. because your parents. chose themselves. over you. this will not be your story because it is not the truth. the truth. is your creation is not about them. you came through them, my love, they were your vessel. the truth. is you were born for you. you were wanted by you. you came for you. you are here for you. your existence is yours. yes. you will want them. (and on odd and warm nights they will think of you and hold themselves tighter.) but. what you do not get. from them. does not make you less. does not make you unwanted. (trust that all you did not receive. all you need. will come to you. in time. the universe is infinite.’) — a love poem

When "caregivers" become addicted to the neediness of others, their needs may become destructive or exploitative. If women give up their empowerment, they abandon their potential for freedom and personal growth and lose their own sense of self. (" Sweet smell of Submission")

Self-care is not selfish. You cannot serve from an empty vessel.

I'll never stop caring. But the thing about caring is, it's inconvenient. Sometimes you've got to give when it makes no sense to at all. Sometimes you've got to give until it hurts.

Many of us follow the commandment 'Love One Another.' When it relates to caregiving, we must love one another with boundaries. We must acknowledge that we are included in the 'Love One Another.

We are afraid that our adult sexuality will somehow damage our kids, that it’s inappropriate or dangerous. But whom are we protecting? Children who see their primary caregivers at ease expressing their affection (discreetly, within appropriate boundaries) are more likely to embrace sexuality with the healthy combination of respect, responsibility, and curiosity it deserves. By censoring our sexuality, curbing our desires, or renouncing them altogether, we hand our inhibitions intact to the next generation.

You see, sometimes in life, the best thing for all that ails you has fur and four legs.

I love you but I got to love me more.

In contrast, children with histories of abuse and neglect learn that their terror, pleading, and crying do not register with their caregiver. Nothing they can do or say stops the beating or brings attention and help. In effect they’re being conditioned to give up when they face challenges later in life. BECOMING

It’s crucial to practice self-empathy, for trust can’t be willed into existence. That didn’t work when our caregivers tried to impose their will on us, and it won’t work internally, either. Only when we can tap into a place of self-trust, with a reliable process of reparation for inevitable mistakes, can we build trust with another person.

The worst thing about working as a caregiver is not what you might think. IT's not the lifting and cleaning, the medicines and wipes, and the distant but somehow always perceptible smell of disinfectant. IT's not even the fact that most people assume you're only doing it because you really aren't smart enough to do anything else. It's the fact that when you spend all day in proximity to someone, there is no escape from their moods. Or your own.

I know I've lost my mind. But I'm not concerned, because it's the first thing I've lost in a long time that actually feels good.

You cannot breathe life into someone refusing to inhale." Colleen Songs

Listen to me: everything you think you know, every relationship you've ever taken for granted, every plan or possibility you've ever hatched, every conceit or endeavor you've ever concocted, can be stripped from you in an instant. Sooner or later, it will happen. So prepare yourself. Be ready not to be ready. Be ready to be brought to your knees and beaten to dust. Because no stable foundation, no act of will, no force of cautious habit will save you from this fact: nothing is indestructible.

Skilled therapists and caregivers learn to discriminate between active and passive suicidal ideation, and do not panic and catastrophize when encountering the latter. Instead, the counselor invites the survivor to explore his suicidal thoughts and feelings knowing that in most cases, verbal ventilation of the flashback pain underneath it will deconstruct the suicidality.

The phrase 'Love one another' is so wise. By loving one another, we invest in each other and in ourselves. Perhaps someday, when we need someone to care for us, it may not come from the person we expect, but from the person we least expect. It may be our sons or daughter-in-laws, our neighbors, friends, cousins, stepchildren, or stepparents whose love for us has assigned them to the honorable, yet dangerous position of caregiver.

By loving you more, you love the person you are caring for more.

The power of intuitive understanding will protect you from harm until the end of your days.

The caregiver’s life is ultimately dictated by the cycle of decay and demands of someone else’s body.

Gay people were seen as magical, too. I mean, like in many cultures, men were viewed as warriors and women were viewed as caregivers. But gay people, being both male and female, were seen as both warriors and caregivers. Gay people could do anything. They were like Swiss Army knives!

I believe that the most urgent need of parents today is to instill in our children a moral vision: what does it mean to be a good person, an excellent neighbor, a compassionate heart? What does it mean to say that God exits, that He loves us and He cares for us? What does it mean to love and forgive each other? Parents and caregivers of children must play a primary role in returning our society to a healthy sense of the sacred. We must commit to feeding our children’s souls in the same way we commit to feeding their bodies.

Imagine the infant who one day cries and gets fed, and the next day cries and goes hungry. One day smiles and is kissed and hugged. The next day smiles and is ignored. This is what psychologists called 'preoccupied or unresolved attachment' with the primary caregiver--usually the mother. There was love one minute and disdain the next. Affection that was given in abundance for no reason and then taken away without cause. The child has no ability to predict or influence the behavior of the parent. The narcissist loves a child only as an extension of herself at first, and then as a loyal subject. So she will tend to the child only when it makes her feel good.

Balance” is a luxury. Equality is a necessity. When we stop talking about work-life balance and start talking about discrimination against care and caregiving, we see the world differently.

The borderline’s endless quest is to find a perfect caregiver who will be all-giving and omnipresent. The search often leads to partners with complementary pathology: both lack insight into their mutual destructiveness. For

So much in a relationship changes when a partner is seriously ill, helpless yet blameless, and indefatigably needy. I felt old. [p. 99] The animal part of him in pain accepted my caring. But the part of himself watching himself in that pain didn't believe I could ever respect him again. None of this crossed my mind. I couldn't risk knowing it. No one could and continue caregiving. They'd feel so unappreciated and wronged that it would drive them away. [p. 100]

Home was where others had to gather grace. Home was what I wanted to flee.

But in a home where grief is fresh and patience has long worn thin, making it through another day is often heroic in itself.

Doctors diagnose, nurses heal, and caregivers make sense of it all.

One of the most challenging things for a nervous system is when your caregiver is a source of some support and connection but also a source of abuse and neglect.

Attachment. A secure attachment is the ability to bond; to develop a secure and safe base; an unbreakable or perceivable inability to shatter to bond between primary parental caregiver(s) and child; a quest for familiarity; an unspoken language and knowledge that a caregiver will be a permanent fixture.

The feeling of being rejected, disapproved of, or conditionally loved by one’s primary caregivers is a monumental, long-lasting burden for a child to carry. It produces chronic shame, guilt, and anxiety. The child is blamed for doing something wrong and in doing so learns to perceive themselves as being bad.

When enforcing our boundaries, first and foremost, we are caring for ourselves, but we are also helping others to have a clear understanding of what we consider acceptable behavior. We are reflecting back to them what is not acceptable and, therefore, providing them an opportunity to consider that information and make necessary changes. If we ignore the behavior or accept the behavior, not only are we undermining ourselves, but we are denying the other person an opportunity to learn about themselves and to grow, and ultimately, we deny them the opportunity for a healthy relationship with us. -Psychotherapist Donna Wood in The Inspired Caregiver

Building resilience depends on the opportunities children have and the relationships they form with parents, caregivers, teachers, and friends. We can start by helping children develop four core beliefs: (1) they have some control over their lives; (2) they can learn from failure; (3) they matter as human beings; and (4) they have real strengths to rely on and share. These

Now, in the old days, Indians used to be forgiving of any kind of eccentricity. In fact, weird people were often celebrated. Epileptics were often shamans because people just assumed that God gave seizure-visions to the lucky ones. Gay people were seen as magical, too. I mean, like in many cultures, men were viewed as warriors and women were viewed as caregivers. But gay people, being both male and female, were seen as both warriors and caregivers. Gay people could do anything. They were like Swiss Army knives!

A pure heart faces the worst kind of evil in this world. But as it sleeps it's blessed, and it wakes up cleansed and a little bit stronger.

Sometimes our work as caregivers is not for the faint of heart. But, you will never know what you are made of until you step into the fire. Step bravely!

You can argue with the way things are. You’ll lose, but only 100% of the time. —BYRON KATIE

If our primary caregivers are shame-based, they will act shameless and pass their toxic shame onto us. There is no way to teach self-value if one does not value oneself. Toxic shame is multigenerational. It is passed from one generation to the next. Shame-based people find other shame-based people and get married. As each member of a couple carries the shame from his or her own family system, their marriage will be grounded in their shame-core. The major outcome of this will be a lack of intimacy. It’s difficult to let someone get close to you if you feel defective and flawed as a human being. Shame-based couples maintain nonintimacy through poor communication, nonproductive circular fighting, games, manipulation, vying for control, withdrawal, blaming and confluence. Confluence is the agreement never to disagree. Confluence creates pseudointimacy.

Bowlby came to believe that disrupted relationships with parents or surrogate caregivers could cripple healthy emotional and social growth, producing alienated and angry individuals. In 1944, Bowlby published a seminal article, “Forty-Four Juvenile Thieves,” observing that “behind the mask of indifference is bottomless misery and behind apparent callousness, despair.

The process of reforming the mental health system never includes the complaints that families and caregivers have regarding a need for increased access to resources, treatment, education, and financial support. Reform has continued to ignore the basic needs of families and suffering individuals with severe mental illness and special needs.

Intensive mothering is the ultimate female Olympics: We are all in powerful competition with each other, in constant danger of being trumped by the mom down the street, or in the magazine we're reading. The competition isn't just over who's a good mother--it's over who's the best. We compete with each other; we compete with ourselves. The best mothers always put their kids' needs before their own, period. The best mothers are the main caregivers. For the best mothers, their kids are the center of the universe. The best mothers always smile. They always understand. They are never tired. They never lose their temper. They never say, "Go to the neighbor's house and play while Mommy has a beer." Their love for their children is boundless, unflagging, flawless, total. Mothers today cannot just respond to their kids' needs, they must predict them--and with the telepathic accuracy of Houdini. They must memorize verbatim the books of all the child-care experts and know which approaches are developmentally appropriate at different ages. They are supposed to treat their two-year-olds with "respect." If mothers screw up and fail to do this on any given day, they should apologize to their kids, because any misstep leads to permanent psychological and/or physical damage. Anyone who questions whether this is the best and the necessary way to raise kids is an insensitive, ignorant brute. This is just common sense, right?

First do no harm. -Hippocrates Second, do some good. -Anne M. Lipton, M.D., Ph.D.

Perspective is an incredibly powerful tool. It tempers how we receive information, and guides what we choose do with it.

We have a mental health system that is dominated by political and hidden forces that keep us stagnated and unable to see real, lasting change.

The traumatic stress field has adopted the term “Complex Trauma” to describe the experience of multiple and/or chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (e.g., sexual or physical abuse, war, community violence) and early-life onset. These exposures often occur within the child’s caregiving system and include physical, emotional, and educational neglect and child maltreatment beginning in early childhood - Developmental Trauma Disorder

Parents, families, and caregivers are a “minority” group in the mental health system. This population is hungry for knowledge, direction, and peace of mind. The first step toward these things is embracing truth about our “fallen” mental health system

All infants and children require and deserve comfort in order to develop properly. Soft cooing voices, gentle touch, smiles, cleanliness, and wholesome food all contribute to the growing body/mind. And when these basic conditions are absent in childhood, our need for comfort in adulthood can be so profound that it becomes pathological, driving us to seek mothering from anyone who will have us, to use others to fill our emptiness with sex or love, and to risk becoming addicted to a perceived source of comfort.

A mom’s hug lasts long after she lets go. ~Author Unknown

People may think you're giving up, when in fact you are simply giving in to the reality of your new life

Near the end of Love's Labor, Eva Feder Kittay (1999, 154) writes that a fundamental aspect of a just society is related to the conditions and limits of mothering. In a just society, women with disabilities can mother because there is adequate emotional and material support for them to do so, and given a context of support and approval to reproduce, they can also choose not to bear children. In a just society, mothers of children with disability can mother, and they, their children, and other needed caregivers will be adequately supported." (15)

Resistance to change in the mental health system comes disguised as protection of civil liberties and freedom of speech. As a result, many parents, families, and caregivers are at a loss and feel defeated by the majority of Americans who strive to maintain the current rules of society.

If a mother cannot meet her baby’s impulses and needs, [quoting Donald Winnicott] ‘the baby learns to become the mother’s idea of what the baby is.’ Having to discount its inner sensations, and trying to adjust it its caregiver’s needs, means the child perceives that ‘something is wrong’ with the way it is. Children who lack physical attunement are vulnerable to shutting down the direct feedback from their bodies, the seat of pleasure, purpose, and direction.

Embracing a healing presence requires you to just be in the moment together.

It is at this moment that I realize the best thing I ever did in my life was to marry this woman. She is willing to give up her life for her child. I know most parents would do the same. But how many mothers would give up everything that they love, everything that they will ever be able to do in the future for the “possibility and not the guarantee” of getting their child better. Now reduce the odds of success to less than 1%. How many mothers are still standing? She is.

A lot of people believe that mental illness does not affect our children within the school system. But the truth is that a lot of bullying stems from untreated or poorly treated mental and behavioral health problems.

I’m in a caregiver's relationship with my body, a perpetual internal gauging of wellness. My spine is Hogarth’s thermometer. I ascend and descend its rungs a hundred times a day, reading the mercury level. The same dis-ease speaks many languages. If you block one mouth, another will speak. The symptoms represent differently, and as I get older, my translation changes. The prescription changes. Must be vigilant. Must be my best nurse.

One of the most common corruptions of childrearing remains the controlling caregiver’s propensity to shape the child into an object aligned with the caregiver’s own unprocessed trauma. Controlling caregivers have a variety of methods at their disposal to accomplish this, including such “civilized” approaches as manipulating, conditionally loving, withdrawing attention, threatening, isolating, shaming, guilt-tripping, humiliating, and withdrawing resources.

Never having experienced inequality, therefore, the majority of straight white men will be absolutely oblivious to their own advantages – not because they must necessarily be insensitive, sexist, racist, homophobic or unaware of the principles of equality; but because they have been told, over and over again, that there is no inequality left for them – or anyone else – to experience – and everything they have experienced up to that point will only have proved them right. Let the impact of that sink in for a moment. By teaching children and teenagers that equality already exists, we are actively blinding the group that most benefits from inequality – straight white men – to the prospect that it doesn’t. Privilege to them feels indistinguishable from equality, because they’ve been raised to believe that this is how the world behaves for everyone. And because the majority of our popular culture is straight-white-male-dominated, stories that should be windows into empathy for other, less privileged experiences have instead become mirrors, reflecting back at them the one thing they already know: that their lives both are important and free from discrimination. And this hurts men. It hurts them by making them unconsciously perpetrate biases they’ve been actively taught to despise. It hurts them by making them complicit in the distress of others. It hurts them by shoehorning them into a restrictive definition masculinity from which any and all deviation is harshly punished. It hurts them by saying they will always be inferior parents and caregivers, that they must always be active and aggressive even when they long for passivity and quietude, that they must enjoy certain things like sports and beer and cars or else be deemed morally suspect. It hurts them through a process of indoctrination so subtle and pervasive that they never even knew it was happening , and when you’ve been raised to hate inequality, discovering that you’ve actually been its primary beneficiary is horrifying – like learning that the family fortune comes from blood money. Blog post 4/12/2012: Why Teaching Equality Hurts Men

In most families, care-giving becomes the woman's responsibility. While care-giving can enrich you, it can also deplete you if you don't have support or make time for self care.

What makes people good communicators is, in essence, an ability not to be fazed by the more problematic or offbeat aspects of their own characters. They can contemplate their anger, their sexuality, and their unpopular, awkward, or unfashionable opinions without losing confidence or collapsing into self-disgust. They can speak clearly because they have managed to develop a priceless sense of their own acceptability. They like themselves well enough to believe that they are worthy of, and can win, the goodwill of others if only they have the wherewithal to present themselves with the right degree of patience and imagination. As children, these good communicators must have been blessed with caregivers who knew how to love their charges without demanding that every last thing about them be agreeable and perfect. Such parents would have been able to live with the idea that their offspring might sometimes—for a while, at least—be odd, violent, angry, mean, peculiar, or sad, and yet still deserve a place within the circle of familial love.

Not a few millions of parents strongly hope that their own children will step in by instantly becoming their own parents’ foster parents, if and when the parents reach their second childhood.

Most survivors tend to be the care-giver rather than the care-receiver. We tend to be good at being spouses and parents, anticipating our loved ones needs, going the second mile when it came to self sacrifice. But seldom can we ask our loved ones to give to us. We fool ourselves into believing we don’t need much.

There’s compelling research that shows that compassion fatigue occurs when caregivers focus on their own personal distress reaction rather than on the experience of the person they are caring for. Focusing on one’s own emotional reaction results in an inability to respond empathically to the person in need. In this view, the more appropriate term, rather than “compassion fatigue,” might be “empathic distress fatigue.” We’re not hearing the story, we’re inserting ourselves in the story.

...above all, let your focus be on remaining a full person. Take time for yourself. Nurture your own needs. Please do not think of it as 'doing it all'. Our culture celebrates the idea of women who are able to 'do it all' but does not question the premise of that praise. I have no interest in the debate about women doing it all because it is a debate that assumes that caregiving and domestic work are singularly female domains, and idea that I strongly reject. Domestic work and caregiving should be gender-neutral, and we should be asking not whether a woman can 'do it all' but how best to support parents in their dual duties at work and at home.

People tell you to keep your "courage" up. But the time for courage is when she was sick, when I took care of her and saw her suffering, her sadness, and when I had to conceal my tears. Constantly one had to make a decision, put on a mask and that was courage. --Now, courage means the will to live and there's all too much of that.

Talking about independence makes me wonder, Who is truly independent in this world? A farmer who grows food is dependent on a baker, a barber, a doctor, and so on. A doctor is dependent on other people of different professions in order to survive. I am dependent and will be dependent on certain caregivers and therapists. Those caregivers and therapists need people like me to earn their bread and butter and draw their salaries. So no one is doing any favors when choosing whatever his means of livelihood is.

it's time to be curious about what lives in the ocean of you beyond the island of other people's needs. caregiver, are you curious? what if i told you: you don't need to heal others to heal yourself. you can just heal yourself. you do not need to give love to others to love yourself. you can just love yourself. within healer and helper, there is warrior, there is priestess, there is holy whore. who knows all the things you could be?

Intuition is a wonderful gift but it can be both a blessing and a curse. If you can easily tune in to the grief of another, it is very easy to lose your way if you have not yet resolved your own present or past trauma and grief. If you have not healed from your own grief and you turn around and give all you have to give, you will find yourself drowning. Soon there will be nothing left of you.

As I discussed in the previous chapter, attachment researchers have shown that our earliest caregivers don't only feed us, dress us, and comfort us when we are upset; they shape the way our rapidly growing brain perceives reality. Our interactions with our caregivers convey what is safe and what is dangerous: whom we can count on and who will let us down; what we need to do to get our needs met. This information is embodied in the warp and woof of our brain circuitry and forms the template of how we think of ourselves and the world around us. These inner maps are remarkably stable across time. This doesn‘t mean, however, that our maps can‘t be modified by experience. A deep love relationship, particularly during adolescence, when the brain once again goes through a period of exponential change, truly can transform us. So can the birth of a child, as our babies often teach us how to love. Adults who were abused or neglected as children can still learn the beauty of intimacy and mutual trust or have a deep spiritual experience that opens them to a larger universe. In contrast, previously uncontaminated childhood maps can become so distorted by an adult rape or assault that all roads are rerouted into terror or despair. These responses are not reasonable and therefore cannot be changed simply by reframing irrational beliefs.

There were moments when it hurt so bad you couldn’t breathe, yet somehow you survived the pain. There were days when you could barely put one foot in front of the other, yet somehow you arrived at your destination. There were nights when you cried yourself to sleep, yet somehow you held on until the morning. Your life is nothing less than a miracle.

A caregiver is changed by the culture of illness, just as one is changed by the dynamic era in which one lives. For one thing, I don't have as much time in conversation with myself, and I feel the loss. Certainly I worry more about his death, and mine too, since I;m so much a part of the evolving saga of his health, which I have to monitor every day. But I've grown stronger in every aspect of my life. In small ways: speaking more directly with people. In large ways: discovering I can handle adversity and potential loss and yet keep going. I've a better idea of my strength. I feel like I've been tested, like a willow whipped around violently in a hurricane, but still stranding, its roots strong enough to hold. [p. 301]

Black girls are likened more to adults than to children and are treated as if they are willfully engaging in behaviors typically expected of Black women—sexual involvement, parenting or primary caregiving, workforce participation, and other adult behaviors and responsibilities. This compression is both a reflection of deeply entrenched biases that have stripped Black girls of their childhood freedoms and a function of an opportunity-starved social landscape that makes Black girlhood interchangeable with Black womanhood. It gives credence to a widely held perception and a message that there is little difference between the two.

He touched the sword he had taken from the ambush. "Aside from this and the trio of juggling stones, I've nothing but the clothes on my back." Well then, tomorrow we'll go-" "No. Prince Ryne told me to make sure you stay in the manor." "It's just into town to buy you a few things. Surely there won't be any danger at the market." I sensed a softening. "And we'll take along Saul or Odd." No. We'll send one of the caregivers with a shopping list," Flea said. "Hey, that's..." He waited. I huffed. "A good idea. But don't be so smug. You're not going to win every argument." "Oh, yes, I am." "Oh, no, you're not." Flea straightened to his full height. When did he get so tall? He rested his hands on his hips. "I am. Prince Ryne trusted me with the task of keeping you safe. And I'm not going to disappoint him." I crossed my arms. "You sound like Kerrick." "Thank you." Uh-huh. You do know I disobeyed almost all of his orders. Right?" I suppressed a grin. "I do. But I'm smarter than Kerrick." "You are?" Oh, yes. I know the magic word." "And what would that be?" "Please.

Solitude takes time, and caregivers to children have no time. Our children demand attention and need care. They ask questions and parents must answer. The number of decisions that go into a week of parenting astonishes me. Women have known for centuries what I have just discovered: going to work every day is far easier than staying home raising children...thoughtful parenting requires time to think, and parents of young children do not have time to think...One middle-aged female writing student spoke to me of feeling she lacked the freedom to "play hooky in nature"; it is an act of leisure men indulge in while women stay at home, keeping domestic life in order. Men often can justify poking around in the woods as a part of their profession, or as part of an acceptably manly activity like hunting or fishing. Women, for generations circumscribed by conventional values, must purposefully create opportunities for solitude, for exploration of nature or ideas, for writing.

EMOTIONAL ABANDONMENT AND NARCISSISTIC DEPRIVATION Children need mirroring and echoing. These come from their primary caregiver’s eyes. Mirroring means that someone is there for them and reflects who they really are at any given moment of time. In the first three years of our life each of us needed to be admired and taken seriously. We needed to be accepted for the very one we are. Having these mirroring needs met results in what Alice Miller calls our basic narcissistic supplies. These supplies result from good mirroring by a parent with good boundaries. When this is the case, as Miller states in The Drama of the Gifted Child, the following dynamics take place: 1. The child’s aggressive impulses can be neutralized because they do not threaten the parent. 2. The child’s striving for autonomy is not experienced as a threat to the parent.

Where there were once several competing approaches to medicine, there is now only one that matters to most hospitals, insurers, and the vast majority of the public. One that has been shaped to a great degree by the successful development of potent cures that followed the discovery of sulfa drugs. Aspiring caregivers today are chosen as much (or more) for their scientific abilities, their talent for mastering these manifold technological and pharmaceutical advances as for their interpersonal skills. A century ago most physicians were careful, conservative observers who provided comfort to patients and their families. Today they act: They prescribe, they treat, they cure. They routinely perform what were once considered miracles. The result, in the view of some, has been a shift in the profession from caregiver to technician. The powerful new drugs changed how care was given as well as who gave it.

I relaxed back into the mattress as other elements in the room began to filter though my senses, namely the extraordinary warmth at my back. The air was filled with the smell of masculine skin and hints of cologne, soap, and dryer sheets. Hank was back. And his scent wasn't the only thing surrounding me; his arm was thrown over my hip and my back was tucked nicely against his front. ... It was nice. Good. Right, even. And then another feeling struck me in a novel way. Protected. I felt protected. A disbelieving laugh bubbled in my throat as I lay there, a small smile parked on my face. I was always the one out there protecting people. And after Will and I had split, I'd had no one to go to for comfort, to let all my guards down, to take a rest from being the caregiver, provider, guard, and detective. To let someone else be tough for a while. Had to admit, I liked it. And I never thought in a gazillion years I'd find this feeling with an off-worlder. I liked Hank's strength, his power, his quirky humor, even the badass attitude he caught sometimes. I was in so much trouble.

Diagnoses —such as ADHD, oppositional defiant disorder, bipolar disorder, depression, an autism spectrum disorder, reactive attachment disorder, the newly coined disruptive mood regulation disorder, or any other disorder—can be helpful in some ways. They “validate” that there’s something different about your kid, for example. But they can also be counterproductive in that they can cause caregivers to focus more on a child’s challenging behaviors rather than on the lagging skills and unsolved problems giving rise to those behaviors. Also, diagnoses suggest that the problem resides within the child and that it’s the child who needs to be fixed. The reality is that it takes two to tango. Let there be no doubt, there’s something different about your child. But you are part of the mix as well. How you understand and respond to the hand you’ve been dealt is essential to helping your child.

SELFHOOD AND DISSOCIATION The patient with DID or dissociative disorder not otherwise specified (DDNOS) has used their capacity to psychologically remove themselves from repetitive and inescapable traumas in order to survive that which could easily lead to suicide or psychosis, and in order to eke some growth in what is an unsafe, frequently contradictory and emotionally barren environment. For a child dependent on a caregiver who also abuses her, the only way to maintain the attachment is to block information about the abuse from the mental mechanisms that control attachment and attachment behaviour.10 Thus, childhood abuse is more likely to be forgotten or otherwise made inaccessible if the abuse is perpetuated by a parent or other trusted caregiver. In the dissociative individual, ‘there is no uniting self which can remember to forget’. Rather than use repression to avoid traumatizing memories, he/she resorts to alterations in the self ‘as a central and coherent organization of experience. . . DID involves not just an alteration in content but, crucially, a change in the very structure of consciousness and the self’ (p. 187).29 There may be multiple representations of the self and of others. Middleton, Warwick. "Owning the past, claiming the present: perspectives on the treatment of dissociative patients." Australasian Psychiatry 13.1 (2005): 40-49.

What was your childhood like? What was your relationship like with each parent—and were there other people with whom you were close as a child? Whom were you closest to and why? I’d ask you to give me several words that described your early relationship with each parent or caregiver, and then I’d ask for a few memories that illustrated each of those words. The questions go on: What was it like when you were separated, upset, threatened, or fearful? Did you experience loss as a child—and if so, what was that like for you and for your family? How did your relationships change over time? Why do you think your care-givers behaved as they did? When you think back on all these questions, how do you think your earliest experiences have impacted your development as an adult? And if you have children I’d ask you these questions: How do you think these experiences have affected your parenting? What do you wish for your child in the future? And finally, when your child is twenty-five, what do you hope he or she will say are the most important things he or she learned from you?

Much popular self-help literature normalizes sexism. Rather than linking habits of being, usually considered innate, to learned behavior that helps maintain and support male domination, they act as those these difference are not value laden or political but are rather inherent and mystical. In these books male inability and/or refusal to honestly express feelings is often talked about as a positive masculine virtue women should learn to accept rather than a learned habit of behavior that creates emotional isolation and alienation.... Self-help books that are anti-gender equality often present women's overinvestment in nurturance as a 'natural,' inherent quality rather than a learned approach to caregiving. Much fancy footwork takes place to make it seem that New Age mystical evocations of yin and yang, masculine and feminine androgyny, and so on, are not just the same old sexist stereotypes wrapped in more alluring and seductive packaging.

When I consider the men (like my father) I have treated in psychotherapy, I recognize the challenge I face as a counselor. These men are in counseling due to an insistent wife, troubled child or their own addiction. They suffer a lack of connection with the people they say they love most. Chronically accused of being over controlling or emotionally absent, they feel at sea when their wives and children claim to be lonely in their presence. How can these people feel “un-loved” when (from his perspective) he has dedicated his life to their welfare? Some of these men will express their lack of vitality and emotional engagement though endless service. They are hyperaware of the moods, needs and prefer-ences of loved ones, yet their self-neglect can be profound. This text examines how a lack of secure early attachment with caregivers can result in the tendency to self-abandon while managing connections with significant others. Their anxiety and distrust of the connection of others will manifest in anxious monitoring, over-giving, passive aggressive approaches to anger and chronic worry. For them, failure to anticipate and meet the needs of others equals abandonment.

A securely attached child will store an internal working model of a responsive, loving, reliable care-giver, and of a self that is worthy of love and attention and will bring these assumptions to bear on all other relationships. Conversely, an insecurely attached child may view the world as a dangerous place in which other people are to be treated with great caution, and see himself as ineffective and unworthy of love. These assumptions are relatively stable and enduring: those built up in the early years of life are particularly persistent and unlikely to be modified by subsequent experience.

Why isn't every woman a feminist? Feminism tells a tale of female injury, but the average woman in heterosexual intimacy knows that men are injured too, as indeed they are. She may be willing to grant, this average woman, that men in general have more power than women in general. This undoubted fact is merely a fact; it is abstract, while the man of flesh and blood who stands before her is concrete: His hurts are real, his fears palpable. And like those heroic doctors on the late show who work tirelessly through the epidemic even though they may be fainting from fatigue, the woman in intimacy may set her own needs to one side in order better to attend to his. She does this not because she is "chauvinized" or has "false consciousness," but because this is what the work requires. Indeed, she may even excuse the man's abuse of her, having glimpsed the great reservoir of pain and rage from which it issues. Here is a further gloss on the ethical disempowerment attendant upon women's caregiving: in such a situation, a woman may be tempted to collude in her own ill-treatment.

In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.” People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

What’s so interesting here is that through the course of development, these secure children increasingly “internalize” their parents’ emotional availability and responsiveness and come to hold the same constant or dependable loving feeling toward themselves that their parents originally held toward them (certainly, a beautiful developmental process to watch unfold in securely attached children). Said differently, cognitive development increasingly allows securely attached children to internally hold a mental representation of their emotionally responsive parents when the attachment figures are away and they can increasingly soothe themselves as their caregivers have done—facilitating the child’s own capacity for affect regulation and independent functioning. Thus, as these children grow older and mature cognitively and emotionally, they become increasingly able to soothe themselves when distressed, function for increasingly longer periods without emotional refueling, and effectively elicit appropriate help or support when necessary. In this way, object constancy and more independent functioning develops—facilitating their ability to comfort themselves and become the source of their own self-esteem and secure identity as capable, love-worthy persons. Furthermore, they possess the cognitive schemas or internal working models necessary to establish new relationships with others that hold this same affirming affective valence.

When the attachment figure is also a threat to the child, two systems with conflicting goals are activated simultaneously or sequentially: the attachment system, whose goal is to seek proximity, and the defense systems, whose goal is to protect. In these contexts, the social engagement system is profoundly compromised and its development interrupted by threatening conditions. This intolerable conflict between the need for attachment and the need for defense with the same caregiver results in the disorganized–disoriented attachment pattern (Main & Solomon, 1986). A contradictory set of behaviors ensues to support the different goals of the animal defense systems and of the attachment system (Lyons-Ruth & Jacobvitz, 1999; Main & Morgan, 1996; Steele, van der Hart, & Nijenhuis, 2001; van der Hart, Nijenhuis, & Steele, 2006). When the attachment system is stimulated by hunger, discomfort, or threat, the child instinctively seeks proximity to attachment figures. But during proximity with a person who is threatening, the defensive subsystems of flight, fight, freeze, or feigned death/shut down behaviors are mobilized. The cry for help is truncated because the person whom the child would turn to is the threat. Children who suffer attachment trauma fall into the dissociative–disorganized category and are generally unable to effectively auto- or interactively regulate, having experienced extremes of low arousal (as in neglect) and high arousal (as in abuse) that tend to endure over time (Schore, 2009b). In the context of chronic danger, patterns of high sympathetic dominance are apt to become established, along with elevated heart rate, higher cortisol levels, and easily activated alarm responses. Children must be hypervigilantly prepared and on guard to avoid danger yet primed to quickly activate a dorsal vagal feigned death state in the face of inescapable threat. In the context of neglect, instead of increased sympathetic nervous system tone, increased dorsal vagal tone, decreased heart rate, and shutdown (Schore, 2001a) may become chronic, reflecting both the lack of stimulation in the environment and the need to be unobtrusive.

CONSENSUS PROPOSED CRITERIA FOR DEVELOPMENTAL TRAUMA DISORDER A. Exposure. The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence, including: A. 1. Direct experience or witnessing of repeated and severe episodes of interpersonal violence; and A. 2. Significant disruptions of protective caregiving as the result of repeated changes in primary caregiver; repeated separation from the primary caregiver; or exposure to severe and persistent emotional abuse B. Affective and Physiological Dysregulation. The child exhibits impaired normative developmental competencies related to arousal regulation, including at least two of the following: B. 1. Inability to modulate, tolerate, or recover from extreme affect states (e.g., fear, anger, shame), including prolonged and extreme tantrums, or immobilization B. 2. Disturbances in regulation in bodily functions (e.g. persistent disturbances in sleeping, eating, and elimination; over-reactivity or under-reactivity to touch and sounds; disorganization during routine transitions) B. 3. Diminished awareness/dissociation of sensations, emotions and bodily states B. 4. Impaired capacity to describe emotions or bodily states C. Attentional and Behavioral Dysregulation: The child exhibits impaired normative developmental competencies related to sustained attention, learning, or coping with stress, including at least three of the following: C. 1. Preoccupation with threat, or impaired capacity to perceive threat, including misreading of safety and danger cues C. 2. Impaired capacity for self-protection, including extreme risk-taking or thrill-seeking C. 3. Maladaptive attempts at self-soothing (e.g., rocking and other rhythmical movements, compulsive masturbation) C. 4. Habitual (intentional or automatic) or reactive self-harm C. 5. Inability to initiate or sustain goal-directed behavior D. Self and Relational Dysregulation. The child exhibits impaired normative developmental competencies in their sense of personal identity and involvement in relationships, including at least three of the following: D. 1. Intense preoccupation with safety of the caregiver or other loved ones (including precocious caregiving) or difficulty tolerating reunion with them after separation D. 2. Persistent negative sense of self, including self-loathing, helplessness, worthlessness, ineffectiveness, or defectiveness D. 3. Extreme and persistent distrust, defiance or lack of reciprocal behavior in close relationships with adults or peers D. 4. Reactive physical or verbal aggression toward peers, caregivers, or other adults D. 5. Inappropriate (excessive or promiscuous) attempts to get intimate contact (including but not limited to sexual or physical intimacy) or excessive reliance on peers or adults for safety and reassurance D. 6. Impaired capacity to regulate empathic arousal as evidenced by lack of empathy for, or intolerance of, expressions of distress of others, or excessive responsiveness to the distress of others E. Posttraumatic Spectrum Symptoms. The child exhibits at least one symptom in at least two of the three PTSD symptom clusters B, C, & D. F. Duration of disturbance (symptoms in DTD Criteria B, C, D, and E) at least 6 months. G. Functional Impairment. The disturbance causes clinically significant distress or impairment in at least two of the following areas of functioning: Scholastic Familial Peer Group Legal Health Vocational (for youth involved in, seeking or referred for employment, volunteer work or job training)

We cleave our way through the mountains until the interstate dips into a wide basin brimming with blue sky, broken by dusty roads and rocky saddles strung out along the southern horizon. This is our first real glimpse of the famous big-sky country to come, and I couldn't care less. For all its grandeur, the landscape does not move me. And why should it? The sky may be big, it may be blue and limitless and full of promise, but it's also really far away. Really, it's just an illusion. I've been wasting my time. We've all been wasting our time. What good is all this grandeur if it's impermanent, what good all of this promise if it's only fleeting? Who wants to live in a world where suffering is the only thing that lasts, a place where every single thing that ever meant the world to you can be stripped away in an instant? And it will be stripped away, so don't fool yourself. If you're lucky, your life will erode slowly with the ruinous effects of time or recede like the glaciers that carved this land, and you will be left alone to sift through the detritus. If you are unlucky, your world will be snatched out from beneath you like a rug, and you'll be left with nowhere to stand and nothing to stand on. Either way, you're screwed. So why bother? Why grunt and sweat and weep your way through the myriad obstacles, why love, dream, care, when you're only inviting disaster? I'm done answering the call of whippoorwills, the call of smiling faces and fireplaces and cozy rooms. You won't find me building any more nests among the rose blooms. Too many thorns.