The Power of Unconditional Love

Listen, I don’t pretend to be a perfect practitioner of unconditional love. I wish I was. My loved ones would have had such better lives, had I had any notion of what unconditional love could do.

For example, on July 20 I bought a skinny, sick, fearful dog, for a ridiculous sum of money. I was in a terrifically needy state, having lost my beloved dog Aress to a freak accident. I looked into this pitiful sick doggie’s soft brown eyes, paid the sum, and took her home.

It was clear that she had never been in a real house before. OK, I don’t really live in a “real house,” since I make my home in a fancy van. But it is undeniably a home, and it was clear that she had never been in one. She lived in a kennel outdoors, was taken out to train, and put back in her kennel. From her lamentable condition, it was also clear that nobody had ever paid much attention to her.

In the six or so weeks that I’ve had her, she’s become a sleek, happy pup who loves almost everybody except people she deems untrustworthy. This is her job, and she does it well. She’s affectionate to the point of occasional annoyance, since there are things that must be done (according to me), like writing, doing chores, paying bills…but to Atina, these are annoyances to her, for damn the torpedoes, the play must go on!

An old buddy of mine stopped by to camp for a few days (hi, pal, in case you’re reading this!). I showed him the picture of Atina when I first got her. You could count her ribs and all her vertebrae, and the bones of her pelvis stood out like a sick cow’s. Her coat was dull and ratty: so much so that I had her tested for mange.

My friend asked me how I had managed to rehabilitate her into the sleek, happy girl she is today. I shrugged.

“Love,” he said quietly. I nodded, tears stinging.

Although he gets furious when I bring up the topic and vigorously denies it, my son is a very high functioning autistic. He learned to speak before the age of one, and before that, he developed his own version of sign language. By 19 months he could count to 19, and by three he could tell you the names of every dinosaur known to man, where they had been discovered, and what they did, their diets, their habitats, and what era they lived in. By four he had taught himself to read and do basic arithmetic via “Reader Rabbit” and “Math Blaster” on our desktop Mac.

On the other hand, he hated anything to do with other children, refused to participate in preschool, and whenever possible isolated himself in corners, absorbed in a book or playing with his plastic dinosaurs or action figures. At three, he was already seeing a child psychologist. We managed to get through private kindergarten in five-minute segments. If he cooperated and sat in the circle with the rest of the children for five minutes, he got to go to his corner and be alone for fifteen minutes. Later in the year he discovered the school office and became enamored with the laminating machine, so he became more motivated to sit for five minutes so that he could run to the office and laminate for fifteen.

First grade was a bust, as far as the teacher was concerned. We enrolled him in a progressive Quaker school: small class size, emphasis on art and music, compassionate teachers–what could be better? Nothing, I guess. Literally nothing. My son staidly refused to cooperate with anything whatsoever. His teacher, a caring and earnest young man, could not get him to do anything. He retreated to a corner and refused to come out. Somehow he managed to ace all the tests, though. But he would not come out of his corner, nor would he speak a word. The teacher called me on a weekly basis.

“He refuses to participate. What shall I do?”

I was busy, harried, frustrated and sleep deprived, so my stock answer was, “You’re his teacher. YOU find a way.”

This did not work.

Finally I had a brainstorm: “Make him the class scribe. Give him a tape recorder, and have him sit just outside the class circle and record everything. This way he’ll feel like he’s got an important job and is not simply one of the (muggles, but that word had not yet been coined by Rowling).”

It worked. We managed to make it through first grade without any further conflict.

In later years, I experienced what happened when I tried to force my son into anxiety-producing behaviors using negative consequences. He either withdrew, or else he simply sat down on the floor and crossed his arms, earning him the nickname “Sitting Bull”. When he got older, he became threatening and intimidating. I was not about to knuckle under, so I upped the ante, and so did he. Soon a full-blown war was in progress.

Now, I don’t believe in accepting bad behavior, not even from a “special” child. But there are ways, and then there are ways.

My moment of epiphany dawned upon reading Karen Pryor’s amazing book, Don’t Shoot the Dog. Pryor was the head porpoise and Killer Whale trainer at Sea World for many years. Now, you can’t make a large sea mammal do anything it doesn’t want to do. You have to make doing the desired behavior so attractive, that said mammal would rather do it than just swim around and play, like porpoises like to do. You have to make it fun to do what you want them to do.

Pryor’s book, as its title implies, carries this philosophy over to dog training. At the time her book was published, most dog training was based on negative reinforcement: You don’t do what I want, you get your neck jerked, you get yelled at, you might even get hit with a rolled-up newspaper for doing your business where you’re not supposed to.

Pryor applied what she had learned as a sea-mammal trainer to dog training. Thus, lucky dogs found out that doing the desired behavior resulted in treats and praise, while negative behaviors got them…nothing. Ignored. Exactly what a social mammal desperately does not want.

Of course, psychology students already knew this from getting rats to do things that humans had a hard time with, by simply having a tasty treat at the end of the maze. But applying methods that worked with “lower life forms” to humans? How insulting. Humans ought to just know that what they were doing was good or bad. Adam and Eve, right? Tree of knowledge of Good and Evil, and stuff like that.

The Behaviorist School of Psychology, pioneered by B.F. Skinner, showed that positive behaviors rewarded with positive reinforcement produced more positive behaviors, while negative reinforcement inhibited negative behaviors. A third strategy was called “extinguishment.” You do what I want, you get left alone to do what you want. You don’t do what I want…nothing. The behavior “extinguishes,” for want of reaction. In many cases this worked better than negative consequences such as electric shocks. (N.B.: a rumor somehow began that Skinner experimented on his own child by placing her in a “sensory deprivation” cage. This is not true.)

Pryor capitalized on Skinner’s Behaviorist School of psychology and its “behavior shaping” model in her sea mammal training program. She then morphed it over to dog training…and concluded her book with a chapter on shaping the behavior of humans.

I can’t say that I ever mastered behavior shaping, either in dogs or in humans, but I have tried to incorporate it, when I remember.

What I’ve learned through the years, though, is to assimilate and practice the art of “Love the person, even if you hate the behavior.”

I have always loved my son, completely and passionately, even when I was dodging head-butts when bear-hugging him through an autistic melt-down, or once again leaving a cart full of groceries in the checkout line when all those people were just too much for him, or agonizing through the time he was in and out of countless outpatient and inpatient addiction programs as a teenager, or sitting up nights worrying when his stepmother threw him out and he lived in a drug house, on the street, in a homeless shelter, in a psychiatric ward zombied out on legal drugs.

Finally he got arrested, and this was my chance to save his life. I called the judge, whom I knew from my work with the court system (yes, this was taking advantage of my position), and begged him to remand my son to long-term inpatient care. The judge reprimanded me for calling him, but honored my request.

After a long period of searching, we found the perfect place. The students were held to a strict policy of personal accountability. Positive behaviors were rewarded with increased privileges; breaches of the rules resulted in suspension of free time, which was instead spent writing a paper examining the undesirable behavior, why the kid did it, what the internal meaning of the behavior was, and why this was counterproductive to the kid’s development as a productive, independent, successful individual. The student then presented the paper to a mentor, who helped process the ideas and helped the kid internalize them. There was still a consequence in terms of loss of privileges for a finite period, and a defined way to regain the lost privileges.

In this way the teens learned that self-determined productive behaviors resulted in more freedoms. In addition to these interventions, the kids had daily group therapy, thrice-weekly individual therapy, a staff mentor who was always available for processing issues, family therapy monthly, and many other interventions. It turned many lives around. It gave my son tools that he is still using, ten years later.

For me, it reinforced that the power of unconditional love moves mountains and saves lives.

Amen.

My Magic Wand

When I was in active Pediatrics practice, anxious parents used to ask me all the time, “When will this get better?  Will it get worse?  Can you make it go away?”  This, usually in reference to some unpleasant chronic condition like asthma or psoriasis.  My answer to them was always the same:

My Magic Wand is in the shop with my Crystal Ball.”

This usually provoked a crestfallen look.  But I do not lie, I do not dissemble.  I tell the truth even when it is not what anyone wants to hear:

“Your child has leukemia.”

“Your child has meningitis (because you staunchly refused to give him the vaccination against that--but I would never say that.  They will either figure it out or not, but I will not increase the suffering of an already stricken parent.)”

“Although we did everything in our power, we were not able to save your child.”  That was the worst, the one I dreaded the most.  Where there is life, there is hope, is a true statement.  There are conditions which are dangerous, which are usually fatal, but where there is life, there is hope.

But the outcome, in the end, is not in my hands and I cannot foresee the future: my magic wand is in the shop with my crystal ball.

And now that I am the patient, I juggle these things.  Some things about my diseases can be predicted, and some can’t.  I think sometimes the most distressing part of having a disease is the uncertainty of how it will turn out.

Take Ebola, for instance.  The media has whipped the fear-and-paranoia quotient to the moon.  People are starting to fear each other on the streets.  There is talk of people wearing masks in public places, even though it has been proven that in order to pass the virus via the respiratory route, like a sneeze or a cough, someone would have to be so sick that they would be on life support anyway, not likely to be in the subway station or the mall.

Will the virus take hold in other nations, or will it peter out the way Bird Flu did, the way the previous Ebola outbreak did?

Sorry folks, my magic wand is in the shop with my crystal ball.

I am fortunate to live in two countries where one is relatively free to chose one’s own doctors, for many things, anyway, if one’s health plan permits.  If I don’t like my doctor, I simply fire them and get another one.

Very fortunately, my shrink in America, whom I have been in a cordial therapeutic relationship with on and off since 2001, is a funny, pragmatic man, who is just as likely to say “I don’t know” as he is to say “Hello, how are you?”  –which he says in a jovial yet businesslike manner, because he REALLY wants to know how you are.

Thirty minutes later I leave his office both confident and perplexed, which is the way he means for me to feel.  I am not sure our plan of treatment will work.  Neither is he.  His magic wand is in the shop with his crystal ball.

He must be in cahoots with my therapist, whose office is just the other side of his wall.  I give her a hard time, saying, “I could do your job right now.  Right now!  All I would have to do is rotate the following exclamations:  “Really?  No!  You HAVE to be kidding. [silence]”  She did not quite find that funny, but I did and that’s what’s important, especially if your DSM diagnosis was changed, without your permission, from Asperger Syndrome to Autistic Spectrum Disorder NOS.

But in reality she is a really good therapist, because she does indeed give me both space and support, and cognitive feedback, which I truly appreciate.

She DOES have a magic wand in her office, but it’s one of those fake ones, you know what I mean, with some kind of thick fluid and glitter than flutters down through it when you upend it.  But crystal ball, no, she leaves that part up to me.

My family doc in Israel is a one-of-a-kind gem.  He listens to me; he is open-minded yet erudite, and he most certainly owns neither magic wand nor crystal ball, and if he did he would have to lock them away from his kids.

Now.  I want you to know that luck played very little part in my finding my Medical Knights and Ladies.  I fired many a therapist, and several psychiatrists, before I happened upon the ones I have.

The position of Primary Care Physician in America is still open.

My psychiatrist in Israel, bless his heart, had a severe psychotic episode and had to be hospitalized, and I don’t think he’s practicing anymore.  I hope not.

Far be it from me to be anti a mentally ill psychiatrist; my shrink here has Major Depressive Disorder, and he knows how it hurts.

But my Israeli shrink started showing signs of paranoid psychosis while I was in his office, which was in a basement room with no windows and you had to be buzzed both in AND out.  Oh dear.  Nothing short of Magic Wand was going to help him, poor man.  He was kind enough to renew my prescriptions for three months, giving me time to find out there wasn’t anyone else on my health plan who speaks English.

All of this is to say:  We just don’t know.  We don’t know what will happen to us in the next moment, let alone days, weeks, months, or years.

I was in a traffic jam going up a steep hill on a two-lane road once.  When traffic finally got moving it became clear that a huge tree, its roots sodden with the torrential Monsoon rains, had fallen atop a Jeep, crushing both it and its occupant.  She died instantly.

After watching my father wither slowly away over years, months, weeks, days, and moments, it was hammered home to me: I don’t have a crystal ball, and I certainly don’t have a magic wand.  But I want that lady’s tree-falling-on-vehicle sudden death.  I don’t want to fade slowly into more and more and more pain, up till the very last breath.  If only I could have that crystal ball, to see my death, and that magic wand to change it, if it isn’t one I can live with.

Nature News Special : The Autism Enigma

http://www.nature.com/news/specials/autism/index.html?WT.ec_id=NEWS-20111108

Here is a wonderful collection of cutting-edge articles on autism research.