Finding water

On Christmas Eve, one of my relatives had a re-commitment ceremony. She and her boyfriend had gotten legally married last year, but none of their family was present, and they wanted to have a ceremony with us.

We all gathered in the living room, sat silently for a while, and then the couple exchanged vows. (A Quaker wedding has no clergy; the couple give their pledge to each other without a third person mediating.) The two of them stumbled through the old-fashioned vows, but afterwards they began to speak freely about why they were together.

The bride has always been a black sheep in the family. Since childhood, she's had some serious psychiatric and behavioral problems. She spoke about meeting her husband when they were both in a PTSD treatment center. At the time she met him, she had been wearing pajamas for a month and wasn't brushing her teeth. They both had insomnia and would meet at 3 am to drink coffee and talk for hours. She knew that if he loved her when she was at her worst, he was a keeper.

Her husband spoke simply about meeting and loving someone else who understood pain.

It moved me more than some of the carefully-orchestrated weddings I've been to. These are two people who have suffered greatly. I work with many more people like them, people with trauma histories, people to whom life has not been kind. I thought about all the broken people out there, and I was so glad that two of them found each other.

Tonight, I asked the bride's father for some cuttings from his plant collection. He showed me his cacti and succulents, desert plants that grow thorns and tough hides to protect themselves. Inside, they trap precious moisture.

“I took a cutting of this one and left it in an empty pot for a few months,” he told me, holding up a plump green stem. “No water. After three months it was hardly shriveled at all. It was starting to put out roots, getting ready to grab on as soon as it touched soil.” It seemed miraculous that a plant could survive that long on only the moisture from the air.

And I thought of his daughter, thought of my clients at the jail and all the other people who live in a harsh and deadly environment. About the thorns and tough skins they grow to save themselves from the desert.

Recently a client told me his mind was “like a tape recorder,” remembering every kind word he heard from me and other staff so he could play them back to himself. In the scorching environment of jail, he was saving up those droplets of kindness to stay sane.

Even the toughest, the most scarred, the most bitter of people are hiding a thirsty heart. Sometimes their tendrils are reaching out for it, searching for a hospitable place where they can latch on and get some of what they need so much.

Here's to the couple whose improvised wedding moved me so much yesterday. It's hard to form a healthy relationship when you hurt a lot, and I don't know how successful they'll be. But they've found some sweetness and nourishment in each other, and I hope together they can drink their fill.

Placebos

In the car on the way to the family Christmas gathering, Jeff read to us about a series of studies on placebos. For some conditions, placebos can give significant relief. There's still an effect even when subjects are told "You are taking an inert pill" and given a bottle marked "Placebo." Placebos given by providers who spend more time schmoozing with patients create more relief. (Note that I haven't found the actual studies concerned, so I don't know the effect sizes, etc.)

The three healthcare workers in the car were interested in this. Jeff's mother, the midwife, said that projecting the right comforting image is a large part of her practice. (The innovation I find most interesting in childbirth is encouraging women to believe "this is something my body is capable of" rather than "this is a scary and painful medical emergency." Stress has real physiological effects, and reducing stress can make birth physically easier.) Jeff's father confirmed that making an optimistic forecast is a big part of his psychotherapy practice, too.

Then when we arrived, my mother reported that she is not losing her mind, as she feared. She realized that for an unknown period of time she had loaded her pillbox with calcium tablets instead of her actual medication.

Apparently the day's lesson is that placebos can help you with some things, but sometimes you really should just take your medication.

Reunions

My sister shared this video of one of her second-grade students reuniting with her mother, who's been stationed in Afghanistan for the last year. It's a lovely moment: the moment of realization, then the silence, the rightness of being near each other after too long apart.

It makes me think of the mothers I work with in the jail. A World Apart, Christina Rathbone's excellent book about women in a Massachusetts prison, describes another reunion after two years of separation between mother and son:

“...she ran over and grabbed Patrick, sobbing, almost unable to breathe. Pat burst into tears too, and clung to her. Across the room, her father started to cry, the officer in charge of the visiting room that night started to cry, and one by one the inmates and even their visitors started to cry along with them.”

The male inmates sometimes talk about their children, but not with the same longing the women do.  Many of the mothers describe a physical craving to be near their children, a hunger for the sound of their voices and the smell of their hair.

They worry endlessly about their children's well-being. Have they eaten enough today? Is he doing all right in school?  Will she be mad at me when I come home? How can a toddler understand I didn't leave her on purpose?

They talk about how much they want to keep their children safe from all the terrors of their own childhoods: the sexual abuse, the neglect, the beatings. For some of these women, their relationship with their children is the only non-abusive relationship they've ever had.

The mothers' pain is one side of the coin.  The other side is the children's pain, which I can only imagine.

The United States has the highest imprisonment rate in the world.  That affects not only the people who are locked up, but their families.  Every time we imprison a person, we take away a part of a family.  We should think carefully about whether it's worth it.

Pain management, social work style

Since high school I've gotten menstrual cramps bad enough to occasionally send my body into shock: nausea, cold sweat, feeling like I'm going to pass out.  This week it happened at work (and let me tell you, it's awkward to tell your boss in the middle of a staff meeting that you need to go lie down on her office floor before you fall out of your chair).  But I was pleased that my body gave out long before my mind did - I used to be terrified of the pain, but now I can handle it a lot better.

As a social worker, I spend a lot of my workday coaching people on how to cope with stress.  I think I deal with physical pain better now because I know more methods for handling it.

So, when you're waiting for the painkillers to kick in, the doctors to splint your leg, or whatever:

Self talk

Pay attention to whether your inner monologue is "This is horrible. I can't do this!" vs. "I can get through the next half hour, and then I'll go lie down."  Coach yourself through it like you would coach a child. 

Distraction
Sing songs to yourself, do multiplication facts, count ceiling tiles.  Pick an object and describe it in all the detail you can: "That cinderblock has eight dents near the bottom and a grey smudge near the top left corner."   Focus on your breathing.  Repeat a phrase to yourself: "This is going to be okay."

Stimulation

In some article which I now can't find, I read that the brain can only process so much nerve input at a time. So additional sensory input can theoretically reduce the amount of pain your brain is processing.  I found that drumming my fingers lightly on my palms seemed to help.

Placebo effect
Even when the tylenol you just swallowed can't possibly be in your bloodstream yet, try thinking about how very effective and quick-acting it is.  You may get a small placebo effect just from believing in it.

What are prisoners like?

Last week I started a new job as a mental health clinician at a jail. I hadn't really thought about working in that setting, but I decided to give it a try.

In the job interview, my boss asked what I thought inmates would be like. I said "varied," which apparently was a good answer, because she hired me. I was very curious to find out what the people would actually be like.

Some initial impressions:

- The male inmates are mostly very polite to me. I've never been called ma'am so regularly, nor had so many doors opened for me. I was expecting constant sexual harassment, but it hasn't happened so far.

- I'm allowed to bring library books to the people who can't leave their units. They all want horror novels. The women also read a lot of Nora Roberts romances.

- Most of them were physically or sexually abused as children.

- Exercise is one of the few goal-directed activities that's possible in prison. There are a lot of seriously buff people.

- I was expecting people to claim that they had been framed, but so far I haven't heard that. I've heard a couple of people say they confessed to crimes a relative of theirs committed, because the relative already had a worse criminal record and would serve a longer sentence for the crime. I've also heard people say they didn't commit the particular crime they were convicted of, but that they had done the same thing in the past and not gotten caught. They seemed to feel it all came out even in the end.

- Lots of tattoos.

- Everyone has insomnia.

- They miss their families.

- They're not allowed to have regular pens or pencils, and they all hate the flexible pens the prison provides because they're so annoying to grip. They get excited if you let them write with your real pen.

- When I ask what helps them get through difficult times, many of them say "reading the Bible." Judging from their spelling, some of them are barely literate, so I'm surprised that they get much out of a book as dense and convoluted as the Bible. From a humanitarian perspective, I wonder if the church could advise reading an easier book for comfort and advice? Maybe something in the vein of Pilgrim's Progress? Could we ask Thich Nhat Hanh to draft something?

Open letter to mental health professionals

A couple of years I came across a book on "parenting with depression" in the library. I opened it eagerly, hoping for assurance that I wouldn't necessarily be a terrible parent.

...and then I realized that none of the co-authors had depression. They had just worked with depressed people. The book contained no material by actual parents with depression.

If you work in mental health or social services, you should be reading first-person accounts of your clients' experiences.

I first wanted to be a therapist when I was fourteen, after discovering a message board for self-injurers. I didn't self-injure, but I spent a year reading and responding to what they wrote. I doubt I was very helpful, but it gave me a sense of the day-in, day-out desperation they lived with.

Later, when I was considering adopting a child from foster care, I read message boards for adoptive parents. I read the things they love and hate about their social workers. I heard the things they don't tell social workers for fear of losing the kids. I'm better at working with adoptive families than I would have been if I hadn't read these things.

Every week I read Post Secret. It's an engrossing read, but it's also a good education. People come out with the pains and pleasures they know aren't socially acceptable.


Norah Vincent's Voluntary Madness, an account of her psychiatric hospitalizations, helped me understand how confusing the legal status of psych patients is. I haven't read Andy Behrman's Electroboy: A Memoir of Mania, but I've wanted to ever since reading "When I'm manic, I'm so awake and alert, that my eyelashes fluttering on the pillow sound like thunder." You don't get that in the DSM.

If you limit yourself to material by observers, you're missing out.

Read something you haven't read before. Read a pro-ana site. Read a pro-suicide site. Your clients do.

Parent rights at what cost?

Recently, I've read two memoirs by adults who wished they had been taken away from their parents. One was Jeanette Wall's The Glass Castle, and I'm currently reading Daphne Scholinski's The Last Time I Wore a Dress.

Walls describes a childhood with two charming intellectual parents who just didn't prioritize things like groceries or heating fuel. At one point the child welfare people came to investigate, but Walls was able to head them off, terrified that she will be separated not from from her parents, but from her siblings.

Scholinski spent much of her adolescence in psychiatric hospitals for oppositional defiant disorder, which both she and the hospitals chalked up to her chaotic and affectionless family life. She describes her feelings upon being hospitalized:

"I didn't let on but part of me kind of wanted to go. Any place had to feel safer than home. Over the summer my father had sat on me, his knees on my shoulders, and poked me in the chest while I tried furiously to kick him, to get him off so I could breathe . . . I guess if I felt anything riding up the elevator to the third floor if Michael Reese, it was a stab of hope."

I realize these are extreme cases, but I wonder how many such cases are out there.

The social workers and judges who make these decision have two responsibilities. First, they must protect the health and safety of the child. Second, they must try to keep families intact. Those things don't always combine well.

I've heard parents say their children were taken away for no good reason. (Of course, they're free to say they weren't abusing or neglecting their kids, and if the Department of Children and Families has evidence to the contrary, they're not allowed to release it to the public.) And yes, I know there have been abuses of the system, especially against Native American families. Probably there still are incompetent or biased social workers taking kids away from families who could have cared for them if they had been properly referred for housing assistance, food stamps, etc. And yes, there is a shortage of those resources that may make the difference between being able to care for your kids and not.

But I've also heard social workers say they think the system is too permissive, that birth families are sometimes given too many chances, that children are moved from foster care back to the home too many times before parental rights are terminated. By the time the kids have spent a few years bouncing between homes, they're too old to be easily adoptable and have endured too many disrupted attachments.

Parents have a legal right to their children, unless they really screw up. Children need families, and in most cases their original parents are the best people to raise them. But in the cases where that's not true, I'm not so keen on protecting parental rights at the expense of the children.

I wonder what an outcome-based rather than rights-based approach to this would look like.

Children seldom say they want to be separated from their parents at the time, because children cling to the only supports they know. But once they're grown? I'd love to see a study that asks adults:

Did your parents lose custody of you?
1) No, and it was the right decision
2) No, but I wish they had
3) Yes, and it was the right decision
4) Yes, but I wish they hadn't

I don't know what results we would get, but it would be a good tool for knowing if our policy is tipping too much in one direction or another.

One more reason

Today our Spanish teacher told us that one problem in Ecuador is that people steal babies from hospitals.

"Steal?" we repeated.

"It happened to my uncle," she said. "His wife gave birth in the hospital, and she fed the baby for the first time. Then a nurse took the baby away and it disappeared. They looked for it, but it was a newborn and she didn't remember if it had a birthmark or something. They never found it."

"Why do people steal babies?"

"There are women who can't have their own babies who steal other people's. Also, there are North Americans who will pay a lot of money for a baby. So people steal babies for them."

"I knew that happened in Guatemala, but..."

"It happens more in Guatemala, but it happens here too."

I think adoption can be a very good thing in some situations. But this is one more reason why we need reforms.

Hunger hurts?

This is an ad for a food bank that appears on buses all over Boston.



Here we have a pretty young white woman hugging an older white woman. I guess the young woman is supposed to represent the food bank, since she looks happy, whereas the faceless older woman is presumably hungry and therefore in need of comfort.

Oh, wait. Except she doesn't need a hug. She needs groceries.

I have a rescue fantasy — what social worker doesn't? Somewhere inside, we love to believe that we could just hug our clients and make everything better. If we took them home and gave them a good meal and enough sympathy, we believe we could fix everything and earn their undying gratitude. But that is an inside thought. You do not tell your clients about that thought. The point is to help, not to feel helpful.

Please, people, fantasies don't belong on billboards. Everyone in the city who rides public buses — which is most of the food bank's clientèle — has seen this ad. If I needed groceries, would I really want to go someplace where I might get hugged by some misty-eyed young lady with a savior complex? No way.

What's inside

Some of my favorite patients at the hospital are hard-bitten blue-collar guys on their first psych hospitalization.  They haven't processed their childhoods or their issues or anything - it's all been stored up in there, and when they finally start to talk, it's so raw.

Last week I worked with a man who moved to this country as a child.  As a young man he joined a gang and served prison time for shooting someone.  Now he's middle-aged and the stay-at-home dad of young kids.  More than anything, he wants a paying job.  He kept telling me, "I want to support my kids and my wife. I want to be a good father."

Today I sat with a working-class man whose decades-long depression finally got noticed.  He hasn't told his grandmother he's in the hospital, and that's the part he dreads most: "I just can't stand to do anything that would worry her."  Most people in hospitals get teary when they think of how hard their life has been.  These guys tear up when they talk about the harm they might have caused others.

I once saw an unemployed carpenter calmly discuss his plans for suicide and then break down when he told me how terrible he felt that he'd left his dog with a friend and hadn't provided money to buy dog food.  My ex-gangster showed the most emotion when he talked about his mother, who had flown across the country to see him in the hospital.  He hated to think of the money she had spent on the ticket.  "I want her to move out here so I can support her. I want to repay her for everything she done for me."

If I had gone into some other field, I wouldn't sit around talking with murderers, child abusers, addicts.  And I wouldn't get to be there when someone finally speaks about how much he loves the woman who raised him, or about the pain he doesn't show to anyone.  And every time I think, Holy shit, I can't believe you've been carrying that inside you.

"...the Devil hardly ever made anyone do anything. He didn't have to. That was what some humans found hard to understand. Hell wasn't a major reservoir of evil, any more than Heaven, in Crowley's opinion, was a fountain of goodness; they were just sides in the great cosmic chess game. Where you found the real McCoy, the real grace and the real heart-stopping evil, was right inside the human mind."

- Good Omens, Neil Gaiman and Terry Pratchett

Something wrong

This week on the psych ward one of the patients was telling me why she came into the hospital.  "Sunday afternoon I was at church helping out with the coffee, and I started hearing voices. I was scared."

This woman is unremarkable by psych ward standards.  She's middle-aged and has been living with schizophrenia for years.  She wears the same clothes every day.  Her face shows no expression (possibly an effect of her medications).  Her conversation is polite, but it seems to take effort.

As she talked, I had a mental image of her behind the coffee table in a church parish hall, staring blankly, distracted by the voices.  I wondered what other people at her church thought, and instantly I knew - the same thing I would think if I saw her outside the hospital. "That woman is not normal.  Something is wrong with her."

And yet in the hospital, I notice the things that are right with her.  I expect to see someone with mental illness, so her slightly bizarre presentation doesn't surprise me.  What's noteworthy are the things that are going well - she's not suicidal, she recognizes her hallucinations as such, she has an apartment, she has a boyfriend, she knows how to get help.

In most of my life, I expect people to be whole and I take note when they break. In social work, I expect people to be broken and I take note of the ways they heal.

In reality, most of us develop "something wrong with us."  I and just about everyone I love have one thing or another - depression, diabetes, learning disabilities, overweight, chronic pain.  Some of us can hide it better than others. 

Let's be kind in each other's moments of pain.  Let's celebrate the ways we rise above.

Just folks

We get a lot of interesting people at the psych hospital. One woman came in two months ago after wandering out of her house and being picked up by the police. She has a variety of delusions.   She curses people, she blesses people, she lies on the floor and refuses to get up. In other words, she does not appear very normal.

This week I was sitting with her on a day when she was pretty coherent. We were talking about a nun she saw on a TV program, and she said, "I love nuns. They rewarded me because I was a good girl." And suddenly I could imagine her in 1968, before her psychotic break, in a Catholic school.

She's completely batty, and she's also a regular person. She loves cheeseburgers and hates tuna.  She misses cigarettes and visits from her daughter. She had a childhood, and she loves nuns.

Another man came in and gave us a long lament about his anxiety and depression and how hard his life was. At one point he put his head in his hands and said, "I'm 49 years old. I live with my parents. I just want a girlfriend or a wife."

Of course he does. People with mental illness want the same things other people want - a cheeseburger, a girlfriend, a job, to go home, to leave home. Except in addition to the regular problems everyone has, they have extra problems getting in the way - the sadness, the paranoia, the voices, the desperate struggling to feel better, the despair that they will ever feel better.

But sometimes, social workers get to help people reach those things they want. That's why I love this work.

Sober

As a social worker, I have to write things like "Patient is not motivated to maintain sobriety." That word, sobriety, sounds to me like people in gray clothes sitting in uncomfortable chairs. I'm not motivated to "maintain sobriety", so why should my clients be?

As a child in the Episcopal church, I disliked the part in the Book of Common Prayer about living "a godly, righteous, and sober life." I guess "sober" was supposed to mean "not too crazy." Quakers used to be big into sobriety, and the opposite was "gay", "vain", or "immoderate". The 1806 Book of Discipline from Philadelphia advised "that a watchful care be exercised over our youth, to prevent their going to stage-plays, horse-races, music, dancing, or any such vain sports and pastimes." "The sipping and tippling of drams and strong drink", though poetically phrased, was also frowned on. And if any Quaker should "fall into this evil practice, giving or taking strong liquors at vendues, or countenance or promote any noisy gatherings, they should be speedily dealt with as disorderly persons." This speedy dealing-with probably amounted to a concerned talking-to by some people in gray clothes, after which you would be kicked out of meeting if you didn't change your ways.

We're still using the nineteenth-century rhetoric that equates alcohol with frivolity. By the 1920s our culture worshipped frivolity, and what had everyone been taught about it? That it goes hand in hand with alcohol. If you want to be "gay" or "immoderate" (i.e. to have fun), drinking is the way to do it.

The result is that some people have forgotten how to have fun without drinking. Last Christmas when Jeff's boisterous Quaker family was gathered, a cousin's boyfriend marvelled that we seemed to be having such a good time with minimal drinking. He had never seen a family do that before.

When I dispatch my clients to a "sober house", I hope it won't be so very sober there. I hope they'll stay away from alcohol, but maybe there will be a little frivolity and even some noisy gatherings.

Love

There's a lot of grim humor in the nurses' station at a psych hospital. You have to joke, or it would be unbearable. So when a patient comes in and the nurses or social workers say, "Oh, I love him. I hope they assign him to our team," for a while I thought they were being sarcastic.

I eventually realized it wasn't a joke. When the staff say, "I just love him," or "She's such a sweetheart," they mean it. Some patients aren't easy to work with, like the woman who stands at the door of the nurses' station bawling "I wanna get ouuuuutta here! What's wroooong with you people?" As her social worker gets up to go talk to her, there's affection on her face mixed with the exasperation.

If you're a people person, a psych ward is a strangely satisfying place to work. You see a different part of people, rawer and deeper.

A typical episode: One of the older women is having a rough day. She's been sitting at the table in the milieu muttering and shouting all morning. The most veteran counselor there, a burly American Indian man the patients call "Chief", walks to the middle of the room and stands before her. He plants his feet, spreads his arms, and begins to sing.

"You must have been a beautiful baby,
You must have been a wonderful child,"

Activity in the milieu stops. The patients turn to look.

"When you were only starting to go to kindergarten
I bet you drove the little boys wild."

(This is true. She showed us a picture of herself as a young woman, and she was gorgeous.)

"You must've been a beautiful baby,
'Cause baby, look at you now!"

He finishes up, arms flung wide. It works: she cracks a smile.

There but for fortune

Today in the mental hospital where I work, I met a woman who said she had learned to be all brain and no heart. When she was five, the authorities found out her father was raping her, and she was sent to be raised by her aunt and uncle. They were hands-off academics who fed her mind but not her emotions, and in fifty years she has never had any close relationships. She came to the hospital because she was homeless and considering suicide.

This woman speaks with the richest vocabulary and most careful grammar of anyone I've talked to in a long time. Her intellect is completely sound, and she has clung to it because she has very little else in her life. She is who I might have been if I had been born into a different family.

Before I started work on a locked psych ward, I thought it would be scary to be around people who were totally unlike anyone I knew. Actually, the scary thing is that the severely mentally ill are a lot like people I know. They are people like any other people - professors, parents, dockworkers, students, cashiers - whose brains played them a trick. This, frankly, sucks.

All our brains go a bit askew at times, especially when we dream. You know that dream where your teeth are knocked out, or your finger is cut off, or you have a terrible haircut? That same fear, brought to waking life, is body dysmorphic disorder. You know how in dreams you know something is terribly wrong, even if you can't explain how you know it? That, when you still feel it the next morning, is paranoia. You know how scenes suddenly change into other scenes, and impossible things happen? That, if it goes on for months, is schizophrenia.

All our distancing from the homeless, from the insane - it's to help us pretend the distance is far, but it's not. We need to push them away to pretend it can't happen to us, or that it doesn't suck. But it does.

Remember this when services are being cut. Remember it when you hear someone shouting nonsense from a street corner. If this is not actually your neighbor, your sister, your self - it could be. It is people very much like you. Be kind.

On suffering

My social work internship this year is in a psych hospital. Today I heard a patient explain her view on suffering.

"My angels think suffering is something holy, but I don't think so. Like Christians hang a cross with a dead Jesus on it over their beds. That's sacred to them, but I think it's creepy. I don't think Jesus had to die at thirty-two. I think he should have stayed alive and raised his daughter. Did you know he had a daughter? It was on the History Channel."

She echoed almost perfectly the words of Spanish poet Antonio Machado:

¡Cantar de la tierra mía,
que echa flores
al Jesús de la agonía,
y es la fe de mis mayores!
¡Oh, no eres tú mi cantar!
¡No puedo cantar, ni quiero,
a ese Jesús del madero,
sino al que anduvo en el mar!

Song of my homeland,
that throws flowers
to the agonized Jesus
and is the faith of my ancestors!
Oh, you are not my song!
I cannot sing, don't want to
to this Jesus on the cross,
but to him who walked on the sea!

Rules

I was a weird kid. For a week in fourth grade, I wore shoelaces tied around my ears just to prove I was different. My friends were mostly weird kids, too, and we reveled in being nonconformists together. I mostly understood the social rules I was breaking, and I intended to break them. As time has passed, I've gotten more okay with social rules, but I still thought of them as things people shouldn't really have to follow.

Last year I worked with a kid with mild autism. He couldn't really pick up on social rules, and he wanted friends but didn't have any. I realized how different it was to be the weird kid because you didn't know how to be normal. So I taught him social norms.

When someone says hello, they expect you to say hello back.
I know you're excited about dinosaurs, but sometimes you have to ask other people about their interests.
You have to talk to kids your own age, not just your brother.

In college, a similar thing happened with my understanding of cultural relativism. So many things I thought of as universally standard, I realized, were actually cultural. Punctuality, personal space, gender roles - they all vary a lot. I prided myself on not valuing American norms above other cultures' norms.

This summer I've been working with refugees, helping them find jobs. We teach them how to survive in America. And we teach them American cultural rules, which sometimes require breaking the rules they learned in their home countries. It felt bad at first, but not as bad as seeing someone whose cash assistance is about to run out and still hasn't found work.

You must look your job interviewer in the face, even if he is a man.
You have to speak louder.
We say "customer service," not "customer services." It's just one of those things.
You can't go to a job in a teeshirt that says, "I'm available, but don't tell my girlfriend."

I used to hate social rules, but I was smart and privileged enough to get what I wanted without them. Hopefully these people will learn enough and become secure enough that they, too, can choose which rules to break.

Maybe I should try stimulants?

I was just told I didn't get the internship I applied for because I came across as "too reserved" for a fast-paced hospital setting. The faculty liaison noted that I came across the same way to her, and that I must try to be "higher energy" at my next interview (also at a fast-paced hospital setting). Apparently my efforts to appear calm rather than frantic with interview jitters backfired.

It frustrates me that peppiness is considered necessary for so many jobs that don't actually need it. After the first week of one of my cooking jobs, my boss took me aside and asked if I was all right. She thought I seemed sad, and she really wanted me to be happy. So although I was already happy in the job, I now had the burden of acting happier so as not to worry my boss.

My mother, a veteran preschool teacher, has noted that people judge her the same way. People who work with children, it seems, must have wide eyes and high-pitched voices. Children don't flock to her in the first minute, the way they do to some people. But in the long term she's an excellent teacher - patient, inventive, and affectionate.

If I were a patient in a psychiatric hospital, I'm not sure I would want my social workers to be so very peppy. But now I have to figure out how to act like it for my next interview. I feel like freakin' Jane Fairfax.

"Jane Fairfax has feeling," said Mr. Knightley -- "I do not accuse her of want of feeling. Her sensibilities, I suspect, are strong -- and her temper excellent in its power of forbearance, patience, self-control; but it wants openness. She is reserved, more reserved, I think, than she used to be -- And I love an open temper."

- Jane Austen, Emma

The way things should be

I used to think that social work was mostly about fixing people's problems. Or if I couldn't fix things, at least I could listen.

Working with children, I'm realizing that it's not just that. It's also teaching them how things should be. Children don't have a lot of information about the world yet, so each time they have an experience, it shapes their view of what is normal. A lot of my job is telling them when things are wrong.

They should not have called you that name.
Your father should not choke you. I know you're used to it, but you should not be used to it.
Your mother should not have told you she wanted to give you away.
Friends do not spit on each other.
Those boys should not write things about you on the bathroom wall.
I'm sorry that happened to you. You deserve better than that. You deserve to be safe. You deserve to be loved. It will not always be like this. Right now you are eleven, but someday things will be better.

Pathologizing princesses

I guess I shouldn't have expected social workers to be perfect. In general, I think the profession is oriented to meeting people where they are and helping them in a non-judgmental way. But there are times when I'm disappointed. Don't get me started on phrases from professors like "the opposite race" and "everybody has sexual desires."

As part of my social work training, I'm interning with a school counselor. This week as I looked through the child psychotherapy manual in my supervisor's office, and I saw the section on Gender Identity Disorder. I knew that the Diagnostic and Statistical Manual lists it as a mental disorder, but doesn't prescribe any treatments. This book does. Apparently if I get a girl who wants to dress like/act like/be a boy, or vice versa, I'm supposed to talk her out of it. We're supposed to talk about her mommy - doesn't she want to be like her mommy?

Gag me with a spoon.

I've seen the fear of children's gender-bending. I've seen teachers deeply uncomfortable about the idea that the child over there with the short hair and cargo pants - that one? really? - is a girl. After a nail polish extravaganza at daycare, I've seen a boy gleefully show his mother his purple-and-gold nails, only to be yanked to the sink and scoured. (She was so upset she forgot you can't take off nail polish with soap.)

It doesn't have to be like that. Take Cheryl Kilodavis, author of My Princess Boy. At first she was worried about her four-year-old son's taste for high heels and sparkles. But his family rallied around him, and when he decided to be a princess for Halloween, she called the school. And the school made it clear to everybody, students and staff, that nobody was to laugh at Dyson. On Halloweeen, some of the male teachers came as ballerinas and performed a dance for the school. The kids loved it, of course.

When he's older, maybe Dyson will transition to living as a woman. Maybe he won't. Do we really have to wrestle with a four-year-old about this?