two articles

two articles
Wednesday December 10, 2008

— On Wed, 12/10/08, Bodhi Kikue Kanzeon wrote:

From: Bodhi Kikue Kanzeon
Subject: Thank you!
Date: Wednesday, December 10, 2008, 12:21 PM

Dear Dr. Miller,I have read nearly all of your books and can truly say that they have helped me tremendously and changed my life. I am a public health psychiatrist in Seattle, USA and did not ever realize that I had been traumatized by my parents until I read your books. I am in the midst of the dissolution of a 4 year, abusive marriage and in trying to work on myself as a result of the suffering I have endured, encountered a therapist who was familiar with your work. I had not received much education while in training about psychoanalysis, and did not believe in introjection or repetition compulsion, but the examples that you give make a lot of sense. I especially found the book “For Your Own Good” very helpful in that you show to what extent people can be driven to act out their histories of pain and suffering if they do not confront them truthfully and must “keep their parents good” by maintaining the fiction of their appropriate childhood. Since it says on your web page not to send attachments, I am going to cut & paste here 2 essays I have written inspired by your work about subjects that I am very experienced in. You have my permission, if you cite me, to disseminate these in any way you feel would be helpful, including posting on your website. I only wish my ex-husband (who is also a psychiatrist by training) would have read more of your books than just “Drama of the Gifted Child” and that he had taken them to heart instead of just approached them with his intellectualizing defenses intact, and that way he would not have had to inflict on me what his parents (also physicians!) inflicted on him. Thanks again.Bodhi Kikue Kanzeon MD (formerly Judith Kikue Centerwall MD) ALL PHYSICIANS HAVE BEEN TRAUMATIZED

Bodhi Kikue Kanzeon MD

10 December 2008

The reason, as I will show in this essay, that all physicians have trauma histories is because the process of medical school admissions selects for this type of personality. Medical school admission is a process involving jumping through a series of hoops, and doing so better than other applicants. Therefore this process selects for people who are bright, tough, competitive and good at pleasing others by jumping through hoops on command. Those last two words were intentionally redundant, because who jumps through hoops who has not been commanded to do so? But it is a key phrase, because what are the characteristics of those who people-please proficiently by jumping through hoops on command? Overcontrolled, hypercompliant people. And how do people become overcontrolled and hypercompliant? By introjecting their overcontrolling, hypercompliance-demanding parents.

So you had – in the history of our successful, hoop-jumping, people-pleasing med school applicant – overcontrolling, hypercompliance-instilling parents attempting to raise a bright, tough, competitive child. This is a recipe for trauma, because anyone who has been through medical school knows it requires people to be bulldoggishly goal directed. So once this child, future bulldoggish medical student, decides he or she wants something, woe to whoever gets in their way. And if who gets in their way is their authoritarian, probably also tough/bulldoggish (where do you think they got it?) parents, what you have is a clash of titanic wills – which you can bet is going to be won by abuse of power, which is the only way of winning such a clash. This results inevitably in trauma and damage to the child.

This is why medical schools are so pedagogical (read = authoritarian and abusive) in the sense described by Dr. Alice Miller. Since few physicians, now respected by society, are going to be willing or able to face up to their history of abuse, they will be tempted to act them out on others. What better way than to abuse medical students in the name of “I had to go through it, so they have to too”? Here I content myself with but one example of the abuses of power that I experienced at the hands of higher-ups in medical school (the hierarchy is in itself pedagogical).

During my required fourth-year rotation in family medicine, I was assigned to do one of my first pelvic examinations on an elderly woman whom I had never previously met. This patient, I was told at the time, was a “pet” patient of my instructor, who was the physician in charge of the family medicine rotation at his clinic. He directed me that he would do the interview and the initial part of the physical examination, since he was familiar to the patient, and that would make her “more comfortable” in preparation for me to come in there (totally new to the patient, and not having had any contact or conversation with her in any way) and do the pelvic exam portion of the physical. I did not even get to review the chart prior to the exam. What he neglected to tell me was that the patient had had a hysterectomy. I had never been instructed in how to do a pelvic exam on someone who was status post hysterectomy, and since I did not even know that that was the case in this patient, of course completely bungled the entire procedure. Afterwards the attending physician/instructor proceeded to thoroughly verbally discipline me at length, claiming that I had “traumatized” the patient in my attempts to find her (nonexistent) cervix and insert a speculum. This was made even worse, he claimed, by the fact that she was such a “nice” person and one of his favorite, most long-term patients. After this verbal beating I felt completely humiliated, guilty and ashamed, not to mention empathetic towards the pain and suffering of the elderly patient. It was not until many years later that I realized that he had submitted both myself and the patient to this whole humiliating procedure on purpose. He had deliberately set me up, disguising from me the simple fact that the patient had no uterus, when he could have used the whole occasion as a teaching experience in how to do a pelvic exam on a hysterectomized patient if he had just explained the whole thing to me beforehand and/or let me review the chart and sit in on the interview and rest of the physical examination. He had thus subjected the patient, whom he claimed to have great affection for, to a painful and humiliating procedure at the hands of someone she had never met, hardly spoken to, and had no interaction with outside of the situation of the pelvic.

This was not a man from whom I otherwise experienced negative interactions, but I use this example because it shows how pedagogical the whole situation of medical school was – the attending (read parent) is entitled to enact any sort of situation or scenario at all on the innocent student, and the student is not allowed to complain because we are supposed to “appreciate” the learning experience that we are receiving. Just as with Miller’s discussion of teachers and parents, this situation is supposed to make us “stronger” and “better.” The University of Washington School of Medicine (in Seattle, Washington), in fact, is proud of its reputation for producing “tough,” driven, hard-working young doctors. This will serve them well in their careers, after all (so the rationale goes), because they have to be tough and hard-driving to survive residency and their future medical careers.

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10 December 2008

Bodhi Kikue Kanzeon MD

I work at a multi-social service agency specializing in treatment and services provision to Asian and Asian American refugees, immigrants and their descendants. I manage the medical staff and provide consultation to case managers working directly with mentally ill clients in the behavioral health program. During one such case consultation, a discussion arose around cultural issues in immigrants’ relationships with their American-born and ‑raised children. The thought came to me during this discussion that there are some issues in child rearing (in the pedagogical, negative sense of this phrase used by Dr. Alice Miller) that transcend culture and are universal (or else I would not resonate so strongly, being a Japanese American raised by a Japanese immigrant mother, with the writings of Dr. Miller, most of which draw on European examples). This is because when a child is abused, she[1] does not know the real reason for the abuse. The parents may tell the child that it is “for her own good,”[2] or may cite the specific violation for which the abuse is allegedly “punishment,” and I am sure that consciously they believe this to be true. But this is not the real reason for the abuse, and the child can intuitively sense this with their infallible, built in truth sensors – sensors which the adults have long since lost, since with almost all other inborn gifts of childhood they have been suppressed and beaten out of them (adults are threatened by something at which the child is more proficient than the parents).

What is the real reason for the abuse? There is only one reason a parent abuses their child (and I think we all realize this deep down as obvious, but as with most intuitively clear issues, this truth also gets buried): the reason is because the parents themselves have not come to terms with the implications of their (the parents’) own histories of abuse – so, as Miller so eloquently describes in her books, they are doomed to repeat it on others. But the child does not know this (nor would it help her if she did, because it would not make sense to her that she is the target for this revenge, so she would not be able to incorporate this in any useful way), so we are back to being abused for no reason.

Since being abused for no reason is scarier than the abuse itself, the child has to arrive at a reason within herself. This is where the damage – a damage that is transcultural – occurs, because the child usually decides (if she is not explicitly told) that she is being “punished” because she is bad, wicked or evil, so in order to try to become “better,” she begins to repress things about herself to try to please the adults around her. Now since she does not know which things about herself are the source of her problem, she usually tries to cover all possible bases, so she represses everything about herself that she can. Many times the end result is sadly that everything unique, original, alive and childlike about the victim ends up being self-judged as bad and suppressed.

So we end up with the tragedy of the “obedient, quiet, good” – and spiritually dead – child. The worst thing about this is that, since obedience and “goodness” (read toeing the line and not rocking the boat of authority figures) are rewarded in our society, these children often grow up to be perceived as competent, highly functioning, successful individuals and so do not feel motivated to find the cause of their inner alienation – if they are even self-aware enough to perceive it as such. Even if the former abused child does realize that something is amiss – perhaps because she develops symptoms of anxiety, depression, rage episodes, eating disorder, OCD, substance abuse, or relationship dysfunction – she would never (since a “good” child does not talk back or find fault with parents) look to the way she was brought up as a cause.

[1] Throughout this essay I will refer to the abused child as “she,” because I am female and because there are no appropriate gender-neutral pronouns in English.
[2] The title of a book by Alice Miller, and also a phrase she uses many times in her works.

AM: Thank you very much for your letter and the articles, full of important observations that we publish with your full name as you agreed. I think that they don’t need any comment.