“Um. No thanks. I’ll clip this green hand-sanitizer holder to my belt loop. That’ll work.”
More St. Patrick’s Day:
Same child, having solved the green problem and moving on: “St. Patrick was supposed to come last night and leave us candy.”
Skeptical mother: “Oh was he, now?”
“Or green toys or something. Or a leprechaun comes.”
Mother, still skeptical: “Oh I see.”
“It’s okay. He can come tonight instead.”
Then, Saturday morning . . .
“Mom. St. Patrick forgot to come last night.”
Mother: “St. Patrick doesn’t come to our house.”
“Or a leprechaun. All my friends get candy from the leprechaun on St. Patrick’s day.”
“All your friends, eh? What are the names of those friends?”
Hems and haws for a moment, then clarifies that it’s actually her sister’s friends. “All of A’s friends at St. Urban’s get candy.”
“Oh do they? What are the names of those friends?”
“Um. Well there’s Benedicta.”
Mother is not surprised. Benedicta’s mother is like that. “Anyone else?”
“Isn’t she Benedicta’s sister?”
“Well, yes. But they both got candy. The leprechaun comes to their house.”
“The leprechaun doesn’t come to our house. Good try.”
Good problems, Catholic School edition: When your child is sobbing and begging to be allowed to go to school, and swears she really isn’t that sick.
Weird problems, Saint Books edition:
Bored child: “Mom, do we have any of those little saint books but that aren’t about someone who becomes a monk or a nun and all they do is pray?”
Mother chooses not to argue, though there may have been a slight eye roll. “Um. Let’s go look.” Thumbing through the shelf that contains middle-grades saint books, Mother pounces on St. Isaac Jogues, who was neither a monk nor a nun. “How about this one?”
Child frowns and shakes head. “No. I want one of these saint books.”
Ah. Well. In that case . . . “How about this one?”
1.1 This morning, an unwary child says: “I haven’t decided what to give up for Lent.”
Evil Dictator: “Not to worry. I’ve got you covered.”
Between cutting out extraneous sugar and sending us all to bed on time, child, it’s gonna be a long Lent. But a calm one, so we hope.
1.2 A different, diligent little Catholic bear, was determined to set a fixed penance. “What if I give up Netflix and Amazon?”
“What’s your goal?” Evil Dictator inquires.
Discussion ensues. Child finally resolves, after taking advice, to write on her card to turn in at school: “I will give up all TV and movies, with the exception of shows my parents or teacher tell me to watch.”
1.3 Good problems: And your Catholic school student wants you to come to the school Mass in the morning, which is always very good . . . and your spouse and your boy are going to be singing Allegri’s Misere Mei Deus at the evening service. Here’s an abridged version:
Another version, unabridged, and with girls in it:
So yes, I went to both. Ashes and Holy Communion at Mass #1, and then sat back and enjoyed the music and prayed along at Mass #2.
1.5 My school child wasn’t so keen to double-dip, and asked if maybe I could require her to watch a little Netflix while I was at the second Mass. Well, darling, funny you should mention that. Evil Dictator’s got quite the talent for finding all the kids’ French-language videos on YouTube, and that’s something you need to be watching over the next few months.
I pulled up tabs of French-language entertainment and . . . she read books instead. Her English is gonna be excellent before Lent is out.
1.6 So I show up at church for Mass #2 and Father Gonzo takes a look at me and says: “Did I do that?!”
He [Jesus] said to them, “Whoever divorces his wife and marries another commits adultery against her; and if she divorces her husband and marries another, she commits adultery.”
One of the reasons I think that people get upset about the question of divorce, remarriage, and Holy Communion is that they don’t understand what’s happening. I’d like to look today at the question of what an annulment is, and I want to do so by way of an analogy. Like all analogies, it is imperfect. Still, I think it sheds light on the overall situation.
An Otherwise Decent Guy Gets Into a Mess
Imagine you’re a young man in your twenties. Like many young people, you were a tad promiscuous during college, something you shouldn’t have done, but, well, you did. One Saturday morning you answer the door and one of your college girlfriends is standing there, with a darling little boy at her side. He’s the spitting image of his mother.
Your ex-girlfriend explains that the boy is probably yours. She apologizes for not informing you sooner, and appeals to your better self and asks you to do the right thing. The boy needs his father to be in his life.
A Decent Guy Becomes a Stand-up Guy
After you recover from the shock if it all, you do exactly what she was hoping: You agree that of course you will do your best to be a good father to any child of yours.
This isn’t going to be easy. There are good reasons you and the boy’s mother stopped dating each other. There will be lots of complications to work through. You are now going to have to devote a massive amount of time and income and emotional reserve to the rearing of this boy. You’ll have to reorganize your career and personal plans to make sure you can give this boy the attention from you that he deserves. It’s not easy to be a parent, and it’s even harder when you aren’t married to your child’s mother.
But you are a decent human being, and the least you can do in this world is be a good father to your own child. It’s not something you have to think about. Of course you’ll do it, you tell her.
Except There’s This Other Guy
There’s one hitch though: Neither of you are 100% sure you’re the father.
The dates all work out, but honestly? She was a tad promiscuous herself. There’s at least one other college friend who might be the father instead.
Your ex-girlfriend thinks it’s more likely that you are the father, which is why she came to you first. She asks you to take a paternity test, which will clear up all doubt. You agree that’s a good idea.
Why Does Paternity Matter?
Let’s review two important facts:
It’s quite likely you are the father.
You have every intention of being the best father you can to this little boy, if he is in fact your son.
But still, it’s important in this complicated situation to ascertain paternity if possible. Why? Two reasons:
It’s important because the boy has a right to be reared by his own father, if possible. There are many situations in which, unfortunately, a child cannot be raised by his own biological parents. But if it is possible, he and his parents will both rightly want that to happen.
Likewise it’s important because the responsibilities of a man towards his own child are significantly different than his responsibilities towards children in general.
You’re a stand-up guy. If the boy isn’t yours, you’ll still wish him and his mother well, and you’ll do all the things that any decent man does to help the children of his community. But it would not be fair to you to expect you to rear a child to whom you have no particular connection, and it also would not be fair to the boy and his real father.
The two of them deserve the opportunity to be father and son, if that is possible. It would be an injustice for you to step in and presume the rights that properly belong to some other man.
What’s a Marriage Tribunal?
A marriage tribunal is something like a paternity test. A paternity test attempts to answer the question: Am I the father of this child? A marriage tribunal attempts to answer the question: Am I married to this person we’ve assumed until now was my spouse?
As with paternity tests, we don’t examine the validity of marriages except in difficult circumstances — situations where there is reasonable doubt. If you are separated or divorced, the question might reasonably come up. Whatever circumstances led to the separation might hint that no valid marriage was ever contracted in the first place.
Like a paternity test, the purpose of a marriage tribunal isn’t to give you the answer you want, its purpose is to give you the truth: Do I have a solemn and irrevocable bond with this other person, or do I not?
Photo: The Beirtan house for divorcing people, via Wikimedia. The photographer’s description explains: “This small building stands next to the church of Biertan (Birthälm). There was the habit to close there for two weeks the couples that wanted to divorce. Inside there was only a bed and the necessary to eat. It actually worked because in 400 years only one couple eventually decided to break up.” By Alessio Damato [GFDL, CC-BY-SA-3.0, CC BY-SA 2.5-2.0-1.0].
This time a year ago, my littlest homeschooler asked if she could go to St. Urban’s, the elementary school that serves several parishes in the region. We knew some of the families at the school and liked what we saw. She had made friends with girls her age at parish events. It was not an agonizing decision, because we had already been considering the move for about a year. We did a little more research and decided this was the time.
Our experience so far has been nothing but positive. Since this is Catholic Schools Week, let me share a few of the reasons we love our school.
Everyone is kind and friendly.
When I was researching the school, I spoke to a friend who had volunteered there and at a number of other elementary schools in the region. She said to me: “I can honestly say that St. Urban’s is what a Christian school should be.”
The administration actively works to promote kindness and encouragement among the students. Recently on the drive into town my daughter told me she had to write a persuasive paper, and she had chosen the topic ofwhether there ought to be school uniforms. She asked my opinion, and I gave her the long list of reasons mothers love uniforms (thank you, school, for a simple, stain-resistant, affordable set of uniform options). I finished up by adding, “And that way, for example, a mean girl can’t say oh your skirt is so ugly, because she’s wearing the same skirt.”
To which my daughter replied: “Mom. This is St. Urban’s. We don’t have bullies. The worst thing that happened is that Scholastica wanted to play with Benedicta at recess but not Ignatia, and then they all ended up playing together anyway.”
The friendliness is welcoming to me, too. The administration respects my time. The school’s academic reputation isn’t built on sending home young children with mountains of homework every night. We parents aren’t saddled with a bazillion overwhelming volunteer projects and fundraisers. When teachers or staff do ask for parent help, they take into account our varying circumstances.
I know some private schools have a “type” of parent, and if you don’t fit in you’re on the outs. Our school is truly Catholic — truly diverse. Not just in terms of race and national origin (though there is that), but also in terms of the parents’ professions, state in life, personalities, and dare I say it: social class. It’s not a prep school, it’s a parish school.
Our faith as Catholics is 100% supported.
The school Mass is both beautiful and edifying. Prayer is part of the rhythm of the day. There are Bible verses on the walls, a well-delivered religion curriculum, and an enthusiastic attitude towards Catholicism that permeates everything the school does. I don’t know all the teachers very well, but I know that the two teachers who have the most influence on my daughter both exhibit a sincere and profound faith.
Before she went to school, my daughter was homeschooled by me. There are ways the Catholic faith was shared in our homeschool that don’t happen at the parish school, but the reverse is also true. When I came to eat lunch with my daughter, I asked her as we sat down and pulled out lunch bags, “Do we wait for grace?”
“We already said grace in our classroom,” she said. “And also the Angelus.”
The children ate and then talked quietly. The teacher who was serving as lunch monitor complimented the children, as a group, on how her husband had been moved to tears by their beautiful singing that Sunday at Mass. The children swept up and prepared to leave. Before dismissal to recess, everyone stood and faced the massive crucifix in the cafeteria and prayed the second grace, thanksgiving after the meal.
My daughter’s teachers know her.
The school is small. There are about fifteen children in each grade (it varies), so that the total school enrollment hovers comfortably within knowable limits. (See here for the theory of Dunbar’s Number, andhere for TheNew Yorker’s explanation of it. I have found this to be true in practice.) My daughter has been with the school less than six months, and already knows the names of all the students except the very youngest. But more important me: Her teachers have time to know her.
When I went to the parent-teacher conference after the first quarter, the 5th grade teacher sat down with me and talked about my daughter. She talked about my daughter’s strengths and weaknesses; what she needed to work on; and how her transition to school was going. To all of it, my only answer was: Yes, you are correct.
I’ve been teaching and rearing this child for ten years, I know her. All these things you describe? That’s my girl. You’ve paid attention, you’ve gotten to see the real her, you obviously care about her. She’s not lost here. There’s a real relationship going on, rooted in both love and quantity-time spent together getting to know one another.
The curriculum is well-chosen.
Between homeschooling and my years of small-format teaching in religious education, chastity education, parenting classes, French, economics, logic, debate, apologetics, can’t remember what else, and maybe a little tutoring here and there . . . I’ve evaluated curriculum. Oh and I wrote a book that has a thing or two to say about how to structure a class.
If nothing else, I know how to see whether a class is working or not, and what is or isn’t successful.
Everything that happens at our parish school makes sense.
Sometimes the book the teacher is using is right off my shelves, sometimes it’s one I’ve never heard of before. But I am still waiting for the day when I see some assignment or activity and can’t figure out what the point is. Everything I’ve seen so far fits with the goal. I can immediately see why the teacher chose a particular activity, and how it fits into the bigger picture. There is no busy-work. Everything converges on a well-built whole.
Sure, I’d heard it was a decent school, but I wasn’t quite expecting it to be this good. I’ll take it.
The school makes the most of its strengths.
One of the mistakes people make about homeschooling is thinking that it’s supposed to be just like school. That approach doesn’t work. Homeschooling isn’t for that. Homeschooling has a dynamic that’s unlike school, and that’s part of the point. If you try to re-create school at home, you’ll be harried and overwhelmed. The trick to homeschooling is to make the most of the distinctive strengths that only homeschooling can offer.
My parish school does that too.
There are ways to teach and learn that can only happen when you’ve got a dozen or so students the same age. There are cooperative projects with other programs nearby that take advantage of St. Urban’s downtown location. Even the way the classes are organized teacher-by-teacher makes sense developmentally — at least in the upper grades, which is what I’ve seen, the right teacher is assigned to each grade and specialty subject.
My daughter loves it there.
No school can be everything to everybody. My daughter thrives on structure, gentle but firm discipline, clearly stated learning objectives, and frequent feedback via formal assessments. Any time a child changes school systems there’s an adjustment period. She didn’t arrive at school having mastered The Way Things Are Done Here. Her teachers brought her up to speed through a steady combination of clear correction and enthusiastic encouragement.
She’s a normal kid. Left to her own devices, she’d gladly sit around watching sitcoms and eating endless bowls of ice cream. There’s a time and place for leisurely pleasures, but what she gets at St. Urban’s — the reason she’s excited to go to school every day — is the profound happiness that comes from having her genuine needs met so well. Her need for love, her need for guidance, her need for growth: Everyone at the school works together to do their part in meeting those needs.
Addendum: About that award she got.
Some people from the parish who read this blog might be thinking You’re just all rosy in the afterglow of your kid getting an award after Mass this morning. Truth? It’s the other way around. I started writing this post in my head months ago, and sat on it because I kept waiting for the inevitable bad day to show up so I wouldn’t be all honeymoon-googly-eyes. I started writing this post on my PC earlier this week, but it’s been coming along slowly because my primary vocation keeps getting in the way.
And thus before I could finish writing, first semester Awards Day came around. You know what happened? They quick gave out certificates to the honor roll kids, and then moved on to the big event.
What’s the big event? Grade by grade, each teacher gave a short talk about two students in her class who merited particular distinction. One student was lauded for attitude, effort, and improvement academically — not for grades earned, but for the student’s perseverance and diligence regardless of academic difficulties. The other honored student was praised, in descriptive detail, for kindness, integrity, piety, generosity — all the virtues that aren’t about being Number One, and are about being more like Jesus Christ.
I was asked two related questions by parish friends this week, and I answered incorrectly:
What things do we do to help our kids “Keep Christ in Christmas”?
What are we doing for Advent?
I thought the answer to both was: Nothing. This year, anyway.
I was sorely mistaken. Since both these are going to be discussion topics for our Family Fellowship group this week, here are my notes so I can keep my facts straight. These are things we do, and which have held together through the years, and which I think are probably helpful. Some are easy for anyone to do, some of them maybe not.
#1 Be a Disciple of Jesus Christ
When the SuperHusband and I first became Christians, I was a little disconcerted to notice how little our extended family’s observances of the feast involved any particular worship of Christ. It had not bothered me before, but now somehow it seemed wrong to gather together for a meal and gifts and not much Jesus-ing. A lot of years later, I’m not bothered. Those of us who are Christians get plenty of Jesus-ing all year long, including Christmas Eve and Christmas Day, and we don’t need every single moment of every single feast to have a little cross tacked on it.
(For the record, there is a very Christian grace before the big extended-family supper Christmas Eve and plenty of Christian-household backdrop going on. We’re not celebrating Festivus or something.)
My point is this: When every day and every week of your life is built around the worship and service of Jesus Christ, there’s not a need to make sure your wrapping paper has manger scenes on it. Both the “Christ” and the “Mass” in “Christmas” are patently obvious. Forgetting that Christmas was about the birth of Christ would be like forgetting what your own birthday was about. It’s unlikely to be problem.
#2 Dang I Love My Parish
My DRE has a passion for keeping Advent, and the pastor’s completely on board. (Yes, it unrolled in that order — she predates him on the staff roster.) Rather than rushing to quick celebrate Christmas with the kids before the break, there are Advent events throughout Advent, and Christmas is unleashed on — get this — Christmas. The religious ed classes host Christmas parties the first class back after the break, while it’s still Christmas season.
This is not just good for holding onto Catholic liturgical order. This is good because it causes us all to be keenly aware we are out of sync with the wider culture, and therefore aware of what we’re doing and why we’re doing it. It also gives me a little bit of ammo in my effort to keep things purple around the house, though admittedly that’s push-and-pull. Yes, in fact we do have the best Advent Lights on the block. That’s my story and I’m sticking to it.
But I would say the biggest help we get in terms of the parish enthusiasm for observing Advent is that it completely prevents our brains from equating what we do as Catholics with that merchandising event going on at the mall.
#3 We’ve got a great Advent calendar.
The one we happen to own is the Tony Wolf Advent Calendar, which I reviewed when I first got it years ago. Each day from December 1st through 24th there is a mini boardbook ornament that contains a Bible story, prayer, hymn or carol. All put together you get the highlights of the story of Christmas from Adam and Eve forward. There is no Christmas Advent tree up yet this year, so I told my ten-year-old to hang the ornaments on the hooks on the mantel where our stockings will eventually go.
She loves this. She loves reading aloud the day’s mini-book, singing along if it’s a hymn, and keeping all the ornaments organized on their hooks. The other kids are older now, so the ten-year-old’s the chief user. I remember myself having a little mini-book Christmas ornament and how much I liked to read it (mine was The Night Before Christmas). Bite-sized books are captivating.
There are other similarly good options, it doesn’t have to be this exact product. I remember growing up that my best friend’s family had a homemade Advent calendar with pertinent Bible verses for each day — same principle. I think the takeaway here on why this concept works so well is that kids like to open a new thing every day, so they bring the momentum to the daily observance, and the day’s thing isn’t just a piece of chocolate or a picture from a snowy village, it’s a piece of the Good News.
#3.5 We Stink At Advent Wreaths, Forever and Ever Amen
For your amusement, here’s a photo from a glorious Advent past:
I would have kept the thing, but it was too bulky to store easily. This year we’ve got an assortment of mismatched white candles with purple or pink ribbon tied around the base. We never remember to light them.
I’m completely in favor of Advent wreaths. I have happy childhood memories of lighting the candles at dinner every evening. We just aren’t there. Sorry.
As we dropped the ball on this one in recent years, some friends have picked up the relay. Mrs. A who first started hosting an Advent tea party every year (most years) when our girls were little has merged that tradition with a potluck supper and caroling party afterwards. It’s a good event. We stick to classic Christian carols (Silent Night, We Three Kings, What Child Is This, etc.) plus We Wish You a Merry Christmas. We only plague neighbors who show evidence of celebrating Christmas, so we’re not foisting our zeal on innocent bystanders. The response has been 100% positive.
We’re up to 4/6ths of the family now singing in some choir or another at church, so the kids get a strong dose of sacred music there as well. We go to one of those parishes where the songs are all about Jesus, which is a big boost.
Or Bethlehem, as you prefer. Way back at the time of our first caroling party (before kids), I didn’t have a nativity set, so I made one out of Lego bricks. Since that time we’ve added humans to the family and all kinds of toys. Playmobil. Fisher Price. Little Woodzees. All that stuff. Thus we have evolved an annual tradition of creating not just the manger scene but a good bit of Bethlehem and environs.
We’ve had years that featured Herod’s castle and a Roman circus (the better to eat you with, my dear), though the best was during the preschool years when we had the big red barn with the door that mooed. A traditional nativity set can sometimes look too much like Camping with Baby Jesus — Pass the S’mores. The circumstances of the Incarnation hit home more soundly when you’ve got a neighborhood of cozy cheerful dollhouses, and then the Holy Family camped out in what truly looks to modern eyes like a place only fit for farm animals.
This year, having just pared back the toy collection, we’re focusing on the unrolling of the historic events day by day. Right now the angels are all up in Heaven, at the top of the bookshelf in front of the vintage Hardy Boys collection, waiting for the big day. (That is what Heaven is like, right?) Mary and Joseph are in a caravan headed towards the city of David. The Wise Men are still home watching the sky. The stable is busy being just a stable, though the innkeeper — you might remember this from your Bible study — likes to come by every day and visit with his pet bunnies. St. Ignatius Montessori, pray for us.
St. Nicholas 2015 was more festive, but this year, thanks to the wonders of iBreviary, a poor spiritual life, and my top most annoying-to-other-parents parenting habit, we just scraped out an observance of the feast.
What happened is that late last night I finally unearthed my long-interred blogging computer. Things have been good here. I took about two weeks to get over a cold, then a third week to pounce on the opportunity to turn my bed into a work table while the SuperHusband was in Canada for three nights on business, and forsook a return to blogging in order to sort and purge the wall of backlogged paper files that had been looming over me for about a year. Now, finally, the layer of dust on the screen of my tablet has trails of finger-marks where I returned to the internet last night, briefly, and am trying again today.
How to make me have a crush on you like I’ve got a crush on Ronald Knox:Announce that you’re hosting Stations of the Cross during Advent! Yes, friends, I’m living in the wonderland. Mind you I have not actually attended Stations at my parish this Advent, because the timing hasn’t worked out yet, but I can be all happy and joyous that other people are having their spiritual lives put in proper order, anyway.
Me? My 1st Week of Advent gift was showing up to Adoration for a half an hour before fetching the kids from school, and sitting there in the pew when guess who walks in? My own kid. The whole fifth grade, not just my kid, but my kid’s the one I was particularly pleased to see. How to make me have a crush on your parish school?Random acts of Eucharistic Adoration, thanks.
So that was last week. This week, the gift iBreviary gives to good little children with bad parents: Time Zone Problems. If you check my sidebar on this blog (click through if you are reading this from e-mail or a feed-reader), the iBreviary widget will take you to today’s readings. Except that iBreviary is from Italy, so today means What Italian people are experiencing. And thus, late in the evening in North America on December 5th, what you see is the feast of St. Nicholas of Bari.
Ack! A celebration!
So I quick summon children and remind them to put out their shoes, then wrack my brain trying to think up some festive item already on hand that I can stick in those shoes to mark the feast. Fortunately, the SuperHusband has had a bucket of biscotti from Costco stashed in a secret location. Italian-American is our theme for this year.
But sadly, no, it’s not that simple.
Naturally, I completely forgot to put the biscotti in the shoes. Thus it was a cold, dark, wet, barren St. Nicholas waking for us.
So let’s talk about lying.
People hate this. I mean, they can’t stand it. It makes heads spin. But here’s what we do at our house: We let our kids know how the world works.
I know! Thus over time they learn all kinds of adult secrets, like where babies come from, and that there’s a moment in the mandatory confirmation retreat when you open a heart-warming letter from your parents, and also that Santa, the Tooth Fairy, and the Easter Bunny are all games of pretend.
Is our home life thus devoid of all magic? By no means.
The real world is far more, dare I say it, amazing than some cheap sleight-of-hand holiday trick.
If you tell your kids Santa is real, whatever. Not my problem (I’m not going to tell your kid that, but you can). So be it. To me, orchestrating such moments of artifice is a pale and pathetic imitation of the beauty of faith in the real world, where real miracles, both natural and supernatural, happen all the time.
I don’t object to figurines of Santa at the Nativity; but today (December 6th) in particular, and every day more generally, we get St. Nicholas adoring Christ, for real, at the Holy Mass.
Is that too abstract for children? By no means. Children know very well that what something looks like is different than what it is. They know that there is real supernatural power in this world. The game of Santa or St. Nicholas is, if you let your children play the game rather than hogging it for yourself, like a game of house or soldiers or any other dress-up: We’re children playing at real things, trying them out.
The game is marvelously fun, even when you nearly forget it, twice.
If your children are in on the game, the wonder of it no longer depends on falliable you. It now can rest on its own power, and wreak its real marvels even when you yourself are a few marvels short of a shooting match.
Thus, today, as I was rushing out the door at 7:10 to quick drive a teenager to school before coming back for the 5th grader, said 5th grader noticed the shoes were still empty.
Oops. Time is tight, but the feast is only once a year. “Run back to your room, quick, so St. Nicholas can come.”
I grabbed a stool, she went and hid in her room for a minute, and I found St. Nick’s stash of biscotti and quick doled it out, one-per-shoe.Magic accomplished.
And in that moment, I can tell by her face that no one has updated the chart. It still says Conversion on the line for diagnosis. Nobody has put in the test results and new diagnosis from last October. I can see it as plainly as I can see that her eyes are brown. We’re still suspect, and this still isn’t over.
Feeling proud about what I had accomplished through daily exercise, I shared my marathon story with one of the intern doctors who was assigned to me. Rather than congratulating me, he basically accused me of faking my asthma. His words were ” There’s no way you could’ve walked a marathon if you have severe asthma.” I found out later that in my chart he actually wrote, “patient presents with factitious asthma, claims he walked a marathon“. That probably explains why some of the nurses were treating me so strange during the hospitalization. A rumor had spread that my asthma was very mild and probably psychosomatic in nature. I remember some of the medical staff trying to convince me that my breathing difficulties were all in my head and that I had some kind of generalized anxiety disorder. Are you freaking kidding me! And even scarier, this happened at a well respected teaching hospital.
That incident caused me a lot of grief and took over 3 years with lots of letter writing by my pulmonologists to have that false information removed from my medical record. The reality is that these are the kinds of screwy preconceived generalizations that people have about the way sick people should look and behave. And if I want to be completely honest here, there have been times when I’ve guilty of the same.
For background: Gaudet is a respiratory therapist who is treated by one of the top pulmonologists in the nation.
Just about every Dysautonomia patient with whom I’ve spoken over the last few years has, at one time or another, been told that the symptoms they were experiencing were all in their head. Diagnoses such as Anxiety disorders, Depression, Conversion or Somatoform disorders, and even Bipolar disorder are haphazardly applied to patients when no clear aetiology can be discovered to explain their symptoms. Normal reactions to abnormal situations, and purely medical/physiological symptoms are over-pathologised or misdiagnosed with alarming regularity, and to the detriment of the patient.
When unfounded these diagnoses leave a mark on the patient, a wound which if left untended will follow and influence all future relationships with the medical professionals. It also leaves a glaring mark on medical records that will be incorporated into future investigations and the overall diagnostic process. Even when unsubstantiated or proven to be untrue following psychological assessment, it can prove extremely difficult to remove such diagnoses from a patient’s medical file.
It is possible that what may be interpreted as “red flags” of Munchausen’s may alternatively be attributed to the demands and anxiety related to care of a very sick child. For example, anxious parents may not give a good history, or may “doctor shop” because they are unsatisfied and may be unhappy with the care their child is getting, especially when they feel that no one can actually diagnose, treat or understand the problem. Certain conditions, especially mitochondrial disease, will present with intermittent symptoms, and it will take a skilled and patient clinician to arrive at the right diagnosis – one that is an illness not Munchausen’s by proxy.
Psychologists have described that the population of patients and parents of children with Mitochondrial Disease are much more vulnerable to a false Munchausen’s by proxy accusation simply due to the nature of the disease. In fact, a hallmark characteristic of mitochondrial disease is the presentation of several unrelated symptoms that together, “don’t make sense”. Clinicians who feel that a parent is intentionally making symptoms appear, is behaving to insure that the illness continues, and consults multiple physicians may suspect Munchausen’s – but should still “trust, then verify.” In other words, believe the parents, run appropriate diagnostic tests, seek the input of every part of the child’s team, and take very seriously the responsibility to the child to act as an advocate and do no harm.
Non-psychiatric misdiagnoses happen, too, of course. It is frustrating when a physician (or team of physcians) flubs a diagnosis through honest error — we humans aren’t ominiscient, so it’s bound to happen. It’s galling when the misdiagnosis involves dismissing serious serious symptoms as some much more benign illness that doesn’t fit with the case history. But pushing off a poorly-substantiated mental health label on a patient with an atypical presentation is both physically and emotionally harmful to the patient.
Unfortunately, this dangerous habit is actually enshrined in medical practice.
I Guess You’re Just Nuts, Then?
Many misdiagnoses are just idiocy. Some popular lazy-diagnoses include fibromyalgia, depression, and anxiety disorders. All of these disorders have specific criteria you can use to evaluate yourself (or your patient) and see if they apply. It’s almost helpful when a physician throws out with confidence, “I think it’s probably just ________” and inserts some illness utterly outside his or her specialty, and which a quick Google search would immediately rule out. Then you know you have a stupid doctor, done. It’s wearying, and can put you off the medical profession for a while, but it’s possible to come to a definitive conclusion one way or another.
There’s at least one mental health diagnosis, however, that can’t be ruled out by logic and good medicine.
Conversion Disorder, which is what Ella Frech was persistently misdiagnosed with (despite presenting with symptoms of a known side effect of one of the medications she was taking), is where modern medical practice bares its hubris.
Many of you would argue that I didn’t go nearly far enough- that there should be no ‘Somatic Symptom Disorder’ at all in DSM 5 because there is no substantial body of evidence to support either its reliability or its validity.
. . . I am sympathetic to this view, but realized that it would have no traction with the work group and chose instead to lobby for what seemed to be clearly essential and relatively easy changes that would solve most, if not all, of the problem.
. . . My letter cautioned DSM 5 that it was invading dangerous territory. Here was my warning to the DSM 5 work group:
• ‘Clearly you have paid close attention only to the need to reduce false negatives, but have not protected sufficiently against the serious problem of creating false positives. You are not alone in this blind spot—in my experience, inattention to false positive risk is an endemic problem for all experts in any field. But your prior oversight needs urgent correction before you go to press with a criteria set that is so unbalanced that it will cause grave harms.’
• ‘When psychiatric problems are misdiagnosed in the medically ill, the patients are stigmatized as ‘crocks’ and the possible underlying medical causes of their problems are much more likely to be missed.’
• ‘Continuing with your current loose wording will be bad for the patients who are mislabeled and will also be extremely harmful to DSM 5, to APA, and to your own professional reputations.’
I also raised the point that this could lead to a boycott of DSM 5. Pretty strong stuff, I thought. But totally ineffective.
Somatic Symptom Disorder (which is the umbrella term in the current terminology under which Conversion Disorder falls) is thus a particularly hazardous diagnosis because it has no symptoms of its own.
It is literally a disorder whose defining symptom is, “We the physicians don’t know what you have. Therefore, it must be psychological.” This is an awkward assertion for a profession that has evolved more in the past century than any other field of human endeavor. The developments in medical research just in the past twenty years are astonishing and marvelous. My children’s high school biology textbooks are utterly different than mine, because the depth and scope of our knowledge about human cells and the chemistry of the human body is orders of magnitude past what we knew a generation ago.
It seems, therefore, ludicrous that any sane person could hold that our knowledge of medicine is now perfectly complete. But this is the implicit assertion of somatic symptom disorders.
I sometimes joke that idiopathic means that you and your doctor both agree the other person is an idiot. But really it just means we don’t know. That happens. Humans aren’t all-knowing. What is the sane response to ignorance? It isn’t to fabricate some fanciful explanation to cover over your lapse. The sane response is to humbly admit, “I’m sorry I don’t know.” And, where the stakes are high, the sane person adds, “And we should keep investigating until we get a solid answer.”
Last week was our parish’s first week of religious ed, and my 7th grade daughter came home with an example of ordinary catechists in a traditional classroom program doing a great job at supporting parental involvement in their children’s faith.
There were three parts of the memo-from-the-teachers that made me swoon with gratitude.
1. Invitations (lots of them) for parents to come join the class anytime.
I’ve known our DRE for many years and she’s always had a very warm and open attitude towards parents’ involvement in their children’s formation. But to have the teachers repeatedly invite parents to come sit in class any time at all communicated an important message: They want us! They’re happy to have us. They’re happy for us to see what the kids are learning and take an active part in weekly faith formation.
Inviting parents to class does change the dynamic. It takes confidence and good teaching skills to be comfortable working with an audience. (And the reality is that watching people teach religious ed isn’t always the most exciting way to spend an hour. It can be, but sometimes you’re maxed out on sacrament charts and so forth.) But I love that my daughter’s teachers want me to know I’m not getting in the way. Me showing up and being involved is a good thing, not a hindrance.
That’s a rightly ordered relationship (even if I never take them up on the invitation), and I think their understanding of that relationship is why they did such a stellar job on the other two very simple helps they added to the class.
2. Weekly bring-back-to-class assignment: Noticing God’s action in our lives.
I’m sure the day is coming when we all bring in mini-tubes of toothpaste for the homeless, or spare change for missions, or whatever other project it is the kids are undertaking this year. Corporal works of mercy are good. But those works have to spring from a lived relationship with God, or the Catholic faith becomes just another option for Ways to Be Kind to People.
So every week, the teachers are asking the kids to report back one instance when they became aware of the presence of God in their lives — whether in prayer, in the created world, in the action of others, whatever it be.
Does this sound too Spirituality Lite? Let me offer firm correction: This is an age-appropriate way for kids to start crossing the bridge from an inherited faith to personal ownership of their faith. It is an age-appropriate way for the kids to become comfortable with talking about their relationship with God. It is an essential exercise, because awareness of God’s action in our lives is the foundation of the spiritual life.
Not Lite at all — it’s rock solid stone. The beautiful twist on this assignment is that by getting the parents involved, my daughter’s teachers are handing us, like a weekly subscription to the spiritual goldmine, an easy way for we parents to get comfortable with talking about discipleship with our kids. If you actually take the teachers up on this opportunity for the next twenty weeks, they’ll have helped you the parent build a habit of discussing the faith in a profound, personal, and non-adversarial way with your teenager.
This is the catechetical mission lived large: Genuinely assisting parents in their role as the primary teachers of the faith.
3. Weekly do-at-home assignment: A question for parents.
But that’s not all! Our catechists are taking it one deeper by sending home a second discussion question as well, which will change every week. Week One’s question was about promises: What promise have you made recently, and what was the outcome? What was something someone promised to you, and what was the outcome?
I liked this question a ton because it fits totally with the topics that came up in class (vocations and sacraments), it fits with questions about the moral life, and it’s not a “religious” topic even though it’s a religious topic. It’s not a question that has a “right answer” for the kid to parrot back. It’s a question, though, that hits a big tender spot in the faith. If you habitually break promises, or the people who are forming your faith (Mom and Dad) are flagrant promise-breakers, you’ve got a cracked foundation you’re building on. There’s repair work to be done. Healing work.
In contrast, if the question reveals you’ve got a solid foundation, then look what’s coming: We need to keep that relationship of trust strong through the next five or ten years. Further, for you my child who’s preparing for confirmation in the next few years? We need to think about what it is your baptismal promises mean, and what they entail.
That’s a lot impact for a discussion that took about five minutes in the car when I happened to get a snatch of time alone with my daughter for uninterrupted conversation. Twenty of those through the course of the year? The possibilities are breathtaking.
Inviting the Parents to be the Parents
The beauty of these assignments is that they help us parents do the part of the job that only we can do. Catechists can review facts and fill in gaps in the kids’ knowledge, but discipleship is parent-work. (We were also gently encouraged to get our kids to Mass regularly — another job that only a parent can do.)
I was very impressed by our first week because I felt like my daughter’s catechists understand what’s important and how this all works. When I went by the classroom, they were visibly happy to meet me and get to know me.
As far as I know, my daughter’s teachers are just a couple of ordinary catechists — goodhearted people who love God and love the kids and want to give it their best, but just normal people. And that to me is a very hopeful thing: Normal people are out there doing smart, simple, easy things to help me raise my child in the faith.
So here’s a weird story that was a wake-up call for me:
I was getting the high school kids signed up for youth group, and one of the forms was a bit of information from the parents — contact info, are you available to chaperone, does your kid have dangerous food allergies, etc. Necessary stuff. Now right after the parent email and phone number lines was:
Preferred method(s) of contact: ____________________________________
Because I am a bad person, I answered the question honestly.
Preferred method of contact: In person.
Now allow me to say right now that I don’t actually expect our youth ministers to personally hunt down me and every other parent of a student in the program just to let us each know that they need someone to bring plastic cups this week, thanks. I do live a little bit in this century. (And I solemnly promise to clarify that on the form before I turn it in tonight.)
But this lapse of mine got me thinking. Why was my writing that answer such a radically crazy, even potentially offensive or alarming thing to do?
Let’s review the facts:
The youth ministers and our family attend the same parish. We’re part of the same Christian community. (We even show up at the same Mass most Sundays — which defies the odds, but we’re lucky that way.)
The youth ministers are taking on the task of mentoring our children through their final years of Catholic youth. Next stop is full-fledged adulthood.
These are the years when kids make tremendous decisions about their vocations, their relationships, and even whether they’ll continue practicing the faith.
For the next few years, it’s quite likely that after my husband and myself, the kids’ youth ministers will be the other set of practicing Catholics with whom my children have the most frequent and most significant contact on a regular basis.
This is a big deal.
What youth ministers do — their role in the work of the Church — is huge.
But our concept of communal life in the Church has become so watered down that I feel brazen for even suggesting that such significant persons in our children’s lives should speak to my husband and me in-the-flesh as an ordinary, habitual mode of communication.
We’re used to this. In my years as a catechist in a traditional religious ed program, I typically met my students’ parents one- to -three years after the school year ended. (Format: I’d run into the kid at a parish event and ask, “So are these your parents?” and that’s how we’d finally meet.)
Once I had the chilling-but-fortunate experience of being in the room while a parent explained to the DRE about a problem in my religious ed class the previous year. [Sadly: A problem I could have fixed if I’d known about it, but it was the sort of thing you can only know if the parent or student tells you.] The reason the mother felt so comfortable laying out her problem right there in front of me is that she had no idea I had been her child’s teacher.
Not knowing people is the norm in parish life.
This is wrong.
There are many causes of this problem and only one complicated, difficult solution: We Catholics need to spend more time living with each other.
That’s all I know for now. If our youth ministers hadn’t posed that foolish question, I probably wouldn’t have even thought about it, I’m so used to living with this problem, and so used to treating it like normal life. But at least now I’m more deeply informed of what’s not happening, and can start looking for ways to change my tiny part in all this.