Category Archives: scary questions

acceptance, adoption, anxiety, attachment issues, brain training, child abuse, Family, family life, family time, fear, foster care, frustration, HOME, parenting, perspective, philosiphy, psychological impact of adoption, raising kids, scary questions, therapy

Learning How to See Family

How does your child see you?
How does your child see you?
When it comes to perspective, I am not sure there is a single perspective more powerful than how we ourselves. However if there is one, I bet it is how we think others see us. Do they see all of our failings or our strengths? Do they see us as worthy of love?

Over the weekend, J and I took a hit in the how we think we are viewed by our kids. Our son,O, ran away. It started off as his usual morning defiance, riling up his younger sister and refusing to do the normal morning routine. He thought we would chase him down and force him to do it. So when I told him I had our foster baby in my arms because I was feeding him and there would be consequences if I had to go get him, he said “Make me.” After another minute of him dancing around, I put down R, and I went to go get him. He was waiting by the door which he opened with a smile towards me when he knew I could see him. He ran out into a down poor of rain. I texted J, and we thought his attempt to get attention shouldn’t work. He would come right back. After all, he wasn’t even wearing shoes.

He did not come back. He ran and 20 minutes later while J was out looking for him, he got into a stranger’s car. He told them he did not want to come home because his mom “mistreats him.” He was so lucky, because the older couple took him to the police station. The woman fell carrying our shoeless son into the police station treating him like the brave abused boy he was portraying himself. The cops heard he was “mistreated at home” and there were two other girls and a foster baby in the home. The cops took him to the hospital for an exam and to take photo’s of the bruises on his body as evidence of his abuse.

Of course by this time, I have called the police department giving his name and description trying to get their help to find him. After we had heard nothing for another 30 minutes, I called them back. They said a car was in route to my house. Two cops came in and asked if they could search the house. I replied, “Sure, I have looked everywhere in case he snuck back in somehow, and we have had a neighbor who does searches for the police over to look already, but the more eyes the better.” At this point, we have most of our street looking for him with phone calls out to all of the friends we could think he might try to reach. When they called back in, they said another cop was on the way to our house, their commander. When he got there is when I got the phone call saying O was safe at the precinct, but he was on the way to the hospital for an exam. We were relieved, and J wanted to go be with him, but we were asked to stay at home for questioning.

They took pictures of his bruises, none of which were from us. Wrestling on a trampoline with a kid who outweighs you by 30% will do that as will falling from the lip of a bathtub he was dancing on for his sister’s giggles. As I spoke with the ER doctor, I felt his hostility towards me grow steadily less when I explained his diagnoses and medications. Even though the doctor and Child Protective Services agent believed me, we still had to wait for him to come home and find out if there will be an investigation effectively ending our ability to foster children.

Now O had no idea the ramifications of what he was doing. He started off afraid of being yelled at again for misbehaving. Then it was a fear of being yelled at for running outside, and when I didn’t chase him he worried more. Fear drove him to act and then exaggerate. When the cops said they were going to go get the other kids in his house, he was happy. It never occurred to him that did not mean they would be with him in a new home. He just did not want to be yelled at again. When we questioned him about the ordeal that night, we had to be extremely careful with the wording of questions, because he was searching to say only what he thought we wanted to hear. He was still scared to the point he would have agreed to leave our house because he felt scared there.

I know his very early childhood before us was hard, but will he always be this scared? Will he always act impulsively to better his immediate situation without understanding how others perceive his actions and the motivation for them?

If one reads the Atlantic this month, it would seem likely. The article, There’s No Such Thing as Free Will, argues our thought process is predetermined by chemicals in our brains and the neural paths signals can take. Science seems to be arguing the nature side of the nature vs. nurture is the better bet for predicting and explaining actions. I buy the science behind the article, but I think it is too static. Sure we can predict/explain a behavior or action by looking at the brains pathways, but over time are we explaining the actions or the predispositions to certain actions?

Atlantic, There’s No Such Thing as Free Will

Can we change the brain process over time? Is this self determinism or free will changing the determinism?

Having seen Ericksonian hypnotherapy work, I also question how fixed these predetermined thoughts, reactions and emotions are to given stimuli. Can we not change how our brains work? If we can decide to change these paths, then the predictive value of the determinist model would seem to fall apart. Granted, one may say the decision to change was predictable, but were the situations to allow us to do so also predictable?

Family, it does a soul good. The next step is teaching our body to react to this truth.
Family, it does a soul good. The next step is teaching our body to react to this truth.

Raising kids who have gone through trauma but still have highly malleable brains, I have to hope the nurture model can help. Maybe I am but a part of the masses needing to be gullible, but I tend to think the brain was wired to make this choice and do this action is believable only in a specific static scenario. My brain, as it is right now, will always decide A if given a choice between A and B. However, I might train to look at both choices and sometimes choose B based on a different decision model. My thought processes are not carved in stone, and I hope my neuro paths are not either…though a bit more resistance to cuts of those paths would be nice (Sorry, bad MS joke since Multple sclerosis, which I have, means many cuts).

Could we not plausibly argue the brain paths simply predispose us to a course of action or thought at a given time under given circumstances? Can we then work to narrow the range of circumstances prompting the bad reactions and broaden the number of paths to the preferred outcome? If not, then why bother with parenting?

Side note: The highlight of my week came when I heard O tried to calm a girl in his class using what I had taught him. I have been working with him to be the candle giving a soft glow rather than an inferno burning everything to ash. It was all based on a nintendo Wii game where you have to sit perfectly still. We started saying to each other, “Be the candle, not an inferno.” Of course for me, the candle is my grandfather’s torch of my dreams.

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healthcare information, Medical bills, MS treatment, patient centered healthcare, patient choice, scary questions, sickville, value of treating MS

Everyone Acts For Themselves

Everyone wants more.
Everyone wants more.

Free market theory assumes all actors work with an enlightened self interest, meaning every one will do what benefits them most. When it comes to health care, I have long maintained we as patients lack the needed knowledge to act in our best interests. As I said in my last post, we have trouble picking our best source of medical care. Unfortunately, that problem only covers one part of our system’s failing. Let’s imagine four decision points where all of our actors behave as theory would have us believe, in their best interests.

Imagine for a second three stakeholders with a newly approved drug. The first is the drug company which has spent millions of dollars developing a new treatment which seems to meet an unfilled need of our second actor, the patient. The pharmaceutical company knows the need of the patient and has invested heavily over a period measured in years to bring this new drug to the patient, and they want to maximize return on their investment. Since many of these investment fail to bear fruit, the costs to the pharmaceutical is huge, and they have to pass the costs along in order to stay in business and gain investors. The cost to the patient starts extremely high. Let’s call this Decision A when a patient goes to their insurance company as says “I need insurance to cover this.”

The patient has purchased insurance from our third actor the insurance company. The insurance company has thousands of patients who could benefit from this drug. As a result of this purchasing power, they have some bargaining power. However, the pharmaceutical company knows patients’ desire for the drug is strong enough to push patients to pick the insurance company which will cover their treatments. The result is our third actor does not have the needed bargaining power to force the pharmaceutical company to lower costs overly much.

So what does the insurance company do faced with a choice of losing customers or losing money due to high costs of the new medications? They do one of the only things they can do. They attempt to influence the patients to pick cheaper medications by making patients pay more. In effect, they lessen the amount covered for these “specialty drugs.” The logic is if patients have more of a financial stake, their decisions will differ. So the insurance company raises the patient copays. Let us call this Decision B.
Our first stakeholder sees this happening too. What can they do to make sure patients can afford their drug? The smart companies identify the patients most likely to be sensitive to price and tailors programs to keep them buying the product. I suspect this is the beginning of the “copay assistance plans” many pharmaceutical companies have for their expensive drugs. Think of this as a sale for which patients must apply, and the pharmaceutical company generates good will for giving away their product at a “discount.” Let us call this Decision C to offer copay assistance.

If our story ended here, maybe it would be sustainable, but it does not. The nature of insurance in the U.S. is to have a maximum amount patients are forced to pay. After all, that is why we have health insurance, to keep health events or conditions from wiping us out. What happens when the pharmaceutical costs are so high the maximum out of pocket is reached? Suddenly, the insurance companies’ tool to contain costs disappears completely. Now the pharmaceutical company can raise rates again because the copay assistance no longer lowers their profit as all costs are being born by the insurance company again. Once the pharmaceutical company realizes there is a maximum they will have to help pay, they can make sure the cost of paying the insurance copays is included the price they charge. In effect, the insurance company is paying its own copays. Let us call this Decision D when pharmaceutical companies add the copays back into the cost of the drug.

At each of these four decisions A-D, our actors made decisions in their best interests. At decision point A, the pharmaceuticals brought a drug to market and began by pricing their drug at what the market would bare. The patients who wanted the drug could not afford it, but they had insurance which covered it. As more patients with insurance wanted the drug, the insurance company had to change things or loose too much money. The copay rise is decision B. The pharmaceutical companies realized the insurance companies would drive customers away from their product unless something was done to keep the costs from adversely impacting patients . This brings us to decision C, the copay assistance. When the pharmaceutical company realized there was no longer a constraint because patients were no longer paying the copay, the pharmaceutical companies realize they can make back their copay assistance from decision C. At this point, there is no longer a downward pressure on price which leads us back to decision point B except prices are higher this go round, and copays are no longer an effective tool to contain costs.

Wall Street Journal: Health Insurers Discriminate Against Patients Who Need Specialty Drugs

While many may read the article in the Wall Street Journal as a terrible injustice insurance companies are inflicting upon us in the land of sickville, I look at it as a predictable decision point. The article describes decision point B. I have benefited from decision point C, and I know many other patients have as well. At some point in the near future, I predict we will complete the cycle. I know the drug I take for MS still costs 70-90K a year, and the price has not dropped significantly in the 8 years I have taken it. I attribute some of this to decision point D, but I have to admit I have not looked too closely at the marginal costs of the drug maker to make another dose for me or the time frame they need to recoup their investment costs. It has never been in my interest as a patient to care overly much when I pay so little. As more patients, pharmaceutical companies, and insurance companies continue to act in their own interests, how long can our free market continue to function without collapse?

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