Psychosomatic group therapy with parents of children with intractable asthma. VIII: The Kohl family. Part II.

The Journal of Asthma Research.

Vol. 16. No. 2. January, 1979

Psychosomatic Group Therapy with Parents of Children with Intractable Asthma. VIII: The Kohl Family. Part I1 J Asthma Downloaded from informahealthcare.com by Flinders University of South Australia on 01/12/15 For personal use only.

H. A. ABRAMSON, M.D.

AND

M.M.PESHKIN,M.D.

APRIL 14, 1958 (General

discussion about fighting among children.)

Mr. K.: All these kids fight at one time or another. When my kid came home crying I would say, “If he’s bigger than you, you can’t fight with him, so go and play with someone else.” Then there were days when he would pick on younger children or those his own age and beat them up. Their parents would come to me. We have had many an argument where one or two of us didn’t speak. I would just say, “Let the kids settle it themselves-the worst they can get is a black eye or a bloody nose-and we are going to get into a fight and will never talk to each other.” And as for hitting my kid, I have done it many times, but spasmodically, when I thought it was necessary, and it seemed to work all right. I lived in Manhattan and my boy stepped into the gutter. I don’t think that I ever put my hand on him before, but when he stepped into that gutter I hit him. He never stepped into a gutter again. I a m trying to bring out that that was a perfect reason for hitting him or spanking him on his buttocks. Mrs. K.: Billy was always thin and weak, but his spirit was stronger than an ox; and he was the type to hit back if someone hit him. A boy used to pick on him-a big, strong, husky boy about six months older than Billy. He was in the same class and lived across the street. He used to continually belt Billy on the way to and from school to the point where he even had a rusty wire put up Billy’s nose. Oh, he was a “darling child”. His mother wasn’t the type of person you could talk with. I surely wouldn’t say to Billy, “GO get him,” because I didn’t think that was the way of remedying the situation. I asked Billy if Jerry was smart in school and he said that Jerry is the dumbest one in the class. “And that is why he picks on you,” I said. “Now you are smart and he is not so bright. You can’t fight him with brawn, so you must fight him with brains.” I told him the only way to punish Jerry was to outsmart him.Since he picked on every one of the boys, I told Billy to get the boys together and not play with Jerry. And he did just that. He got all the other boys together and they wouldn’t play with Jerry, and Jerry was taught his lesson. After that he begged in. I said to Billy, “Isn’t it easier? If you had hit him,you would have come back with a bigger lump than you would have given him. Use your head and not your fists. When you get huskier and stronger, then he might be an even match.” Dr. P.:I want to ask you a question about Billy. Perhaps I don’t know him as well as I thought I did. Before he went to the home, what kind of a personality do you think he had; his behavior, his attitude? What was Billy? 63

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J Asthma Downloaded from informahealthcare.com by Flinders University of South Australia on 01/12/15 For personal use only.

Mrs. K.: He was an average boy, when he didn’t have asthma. Why? Dr. P.: I am asking you a question. Don’t ask me why. Mr. K.: I think he was a wise-guy kid. Dr. P.: Tell me what you mean by that. Mr. K.: Hot shot-knows everything-no one can tell him anything. Dr. P.: Does he get into much mischief? Mrs. K.: When he was well? Yes. In school he would be the one who would be caught talking, or whenever they would do anything he would be the one who would get caught. Someone else would be talking, too, but Billy was always the one who was getting caught. Dr. P.: Would Billy be the kind of a boy who was led by others? Mrs. K.: Yes. If he admired them, yes. Mr. K.: Or if they called him chicken, he would go and do anything. Mrs. K.: That’s right. And I always told him that I would rather be a live chicken than a dead duck, but he didn’t listen to me. Dr. P.: Would he be belligerent about it? Mrs. K.: Yes. Dr. P.: Stubborn? Mrs. K.: Stubborn as a mule; you couldn’t reason with him. I tried. Dr. P.: Okay. Billy was having asthma the day I examined him. He came into the infirmary and he was really having asthma. I couldn’t make out what it was all about. He weighed 81-74 pounds and was 59 inches tall. He was admitted on the morning of the 11th of April with asthma. We kept him in the hospital. He said that he had had it the night before, and also had had it three days before, but it had cleared. He had a few mild attacks at the beginning of April, but it cleared quickly. He has had an allergic nose on and off. He often uses this as an excuse to get out of school, but his doctor sent him to school anyway. He gets good grades, but he doesn’t like the kids in school. He doesn’t want to go home. Examination of the nose showed that he had a cold-and a bad throat, too. I think that he was actively asthmatic. He had adrenalin at 1O:OO o’clock that morning. He was given medication and also antibiotics, and I advised him to keep as quiet as possible and not talk too much, so as to give his lungs a chance to rest and clear up. The next day, on the 12th, while he was in the hospital, I said, “You stay in the hospital and rest up.” He simply got up and dressed and went out of the hospital without permission. Of course he was picked up again and brought back. I had a long conversation with him and, with tears in his eyes, he listened very dutifully and said that everything that was being done was wrong. However, he admitted everything. I patted him on the back, shook hands and he went out. (Dr. Peshkin revealed that Billy was one of a small group of boys who had set off large firecrackers. They took part in general vandalism at the Home, which resulted in considerable damage to buildings, furniture, etc. Billy, however, was not the ringleader. These boys were put on probation.)

Mrs. K.: Where did they get the firecrackers? Dr. P.: I didn’t ask where they got them, and I wasn’t interested. I was only

THERAPY WITH PARENTS. VIII. THE KOHL FAMILY

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interested in this behavior pattern. And when they told me, “Hell broke loose,” this, I think, was indirect antagonism to authority-hatred of authority, and I am one of the authorities. Mrs. K.: I just thought I would let you know that when Billy fist went to the Home he said he was getting used to the place. He was very anxious from the first week to get into the Peshkin Building. He said that the boys in the Peshkin Building liked him and they wanted him there, and that he is the only one in the boys’ building that they want in the Peshkin Building. MAY 19, 1958

Dr. Peshkin: (who has returned from the Home) Now, Mrs. Kohl, your boy is a very good boy. Mrs. K.: Thank God! What happened? His father wrote him a nice letter. Dr. P.: It wasn’t his father-it was the boy himself. It merely proves that he didn’t want to be chicken, either. Mrs. K.: No! Dr. P.: And that is the whole secret of that episode. He’s been just the way he should be-a little mischievous, like all kids are-but a perfectly wellbehaved boy. And he’s having much less trouble. The first two weeks he had a little, but the last two weeks he’s really been fine. He’s been well. I have a copy of the letter that the psychologist wrote to you, and I had to smile, because they sure do remember things. I’m glad they put it down. Mrs. K.: The last paragraph? When he was on probation? Dr. K.: Yes. I had to do that. You know why, don’t you? Mrs. K.: Yes. Dr. P.: I didn’t want to show any favoritism. If I showed favoritism, then he’d be criticized more. I was always fearful that they might call him teacher’s pet, too. And that’s no good either. I try not to do that. I try to show all children that they are all wanted, are all liked and are all respected and enjoyed- and that they are all teacher’s pets. Every one of them. Mr. K.: In other words-he was on probation for a month, is that it? Dr. P.: Yes. Now the clinical psychologist reports: “Billy was recently put on one month’s probation by Dr. Peshkin. This was because he was involved in a number of incidents about and around the Home. It would seem that in observing Billy’s behavior since this time he was quieted down considerably, and it would appear that he will be able to adjust himself and stay in the good graces of the authorities.” Billy is all right. I talked with him. He seemed just like his old self again-he’s doing well. On the 16th, Saturday, he weighed 82 pounds and was 59 inches tall. He said that he’s had very little or no wheezing since the last visit. He was discharged from the hospital on April 18th and is not receiving any treatment. Mrs. K.: Does he get desensitization, Doctor? Dr. P.: Injections? Yes. But no medication. This is desensitization, and it’s different. I’m talking about medicine. Mrs. K.: Yes, medication, yes. No medication whatsoever? Dr. P.: Didn’t need it. His chest was clear. I said to him, “Billy, I hope you’re


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happy. Good luck ! Keep it up.” Billy merely smiled and said, “Good-bye,”and left the room. He was very happy. His behavior has completely changed for the better. He had a very slight sore throat May 13th, without fever or asthma, but he didn’t want to miss school, so he did not stay home. Mrs. K.: He was very worried about his schoolwork. He said he got 4 E’s. Dr. P.: Well, this time he had the sore throat. There is a change in Billy. He used to go every morning to the infirmary, looking for an excuse not to go to school. You known that, don’t you? Mrs. K.: Yes. Dr. P.: He used to say that he had a sore throat. This time he had one, and he said, “No, I’m going to school. I can’t afford to miss it.” So you see, again a change has taken place. I’m not worried about Billy and his behavior from here on out. NOVEMBER 17,1959 (One of the fathers described a baseball game which took place at the Home and revealed that the boys felt the counselors were unfair.)

Mr. K.: Wouldn’t that be a normal reaction, whether the kids are at the Home or any place else? It is a perfectly normal reaction of anyone. Mrs. K.: I saw something at the Home that I thought was absolutely fabulous, besides everything else there. I watched the boys playing ball here in New York and I have never seen sportsmanship as it is shown at the Home. When my son used to play ball here, he used to play first base, second base and third base. He was all over. Here he was first baseman and that is all he played, and if he lost the game they had a wonderful expression: “It’s only a ball game.” A t one time a little boy, a very sensitive child, was up at bat and struck out. He sat down next to me and his eyes welled up with tears. I didn’t want to say anything, because no matter what I said I knew he would start crying immediately. Just then another boy came over, grabbed him by the hand and said, “It’s only a ball game, Mike.” Well, that kid turned up at the corners. I was so thrilled with that, I said, “Why can’t they play ball like this all over?” It’s really wonderful-their sportsmanship-they are terrific. That’s what I saw there, besides the wonderful buildings and everything. They have a sense of fairness and they respect each other-no matter what age they were, they gave each other their due respect. It was wonderful, and I was thrilled. Mr. K.: That’s what I was going to say. I think out there it is all fair play. I never saw any of the kids argue and they never argued with any of the counselors. I happened to umpire a game when I was there, too. I called a couple of bad ones a hit, but it was just a mistake and the kids took it in fun. I even said, “Well, I can make a mistake,” and they laughed it off. Everything was fine. Something else I’d like to add about my son, alone. I think he grew up an awful lot in the short period of time that he is there. Mrs. K.: Emotionally he has changed. May I say, with due respect to Dr. Peshkin and Dr. Abramson, so have we. Dr. A.: What makes you say that?



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Mrs. K.: I know that I have changed, personally, and I know my husband has changed. When we had Billy’s bar mitzvah we had the big birthday cake which we brought into the Peshkin Building. Now, this is what I would have done ordinarily. I would have done that instinctively. I would just think, “You don’t know how.” I held myself back and he cut the cake. I stood on the side and I was proud of him, and believe it or not, he did a good job. My son preferred his father and he has shown it. As a matter of fact, he even told it to us and he said, “Don’t feel offended, Mommy; don’t get hurt, but I would rather have Dad with me than you.” That’s understandable. I don’t bowl, I can’t ride a horse-I can’t do any of these things and I don’t want to do them. Washing dishes is my limit, and that’s it. Another thing that I remember very well. I saw one of the boys-a little boy-I think his name was Bobby-they call him the Giant-he’s that big and he is fifteen years old-and after the ball game he felt heavy and he ran into the hospital and he took a neb. A gorgeous-lookingboy passed by and hollered, “Hey, asthmatic!” (MUCH LAUGHTER) Bobby took the neb out of his mouth and said, “When did you have a neb last?” The other boy said, “Who, me?”, as if he didn’t know what it was, and Bobby said, ‘(Yesterday,remember, in school.” That was their attitude, which I thought was absolutely wonderful. If I ever had to give my son a vitamin pill, in front of anybody, there would have been a lot of grumbling. He would take a neb, but he would choke first before he would put it in his mouth, and here we went somewhere and he had to take his metacortin with him, as he had to take it at 800 o’clock. I said, “Billy, it is 8:OO o’clock”, and he said, “Oh, that’s right.” At a public water fountain in Lakeside he took the pill. Anybody who walked by could have seen the pill. He put it in his mouth and swallowed it. To me that was a great stride forward. He was so much more mature and he was a baby when he left. I don’t mean in his chronological age, I mean in the way he acted. He was so much more mature. He has grown so and he is sure of himself. Dr. A.: Well, you gave Dr. Peshkin and me some credit for the change in your feelings. Would you be d i n g to attempt-I know it is diffcult-to describe feelings is always difficult-in what way the meetings here helped you accept your son and your son accept you? Mrs. K.: Very simple, Dr. Abramson. First of all, my husband and I happen to be very stubborn people. I admit it and he will admit it. And if I say something is right-maybe it is the way I word it-he will say, (‘Oh,you know everything.” Then I will answer back, “NO, I don’t-you know everything,” and in this way neither one of us will know anything. But when we came here, we said, ‘‘Dr. Abramson and Dr. Peshkin will tell us.” So whatever you decided-the way you discussed the thing- we followed you. Then we would discuss the meeting all the way back home, and we found out the things that we were doing wrong, and we have changed considerably. Dr. A.: Do you remember any of those things? Mrs. K.: Oh, sure. I remember very well. My husband used to explode and I would wait until he quieted down, and then I would explode a little bit. Now we have a wonderful system and I’ve seen it work. When he explodes I laugh


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at him and he has to laugh, too. And when I explode, he makes fun of me and then it’s nothing. It is really very placid now. I am very, very happy. And I know that when my son comes home he will find a much happier home. Dr. A.: You think, then, that this volcanic life that you two previously led upset your son? Mrs. K.: Yes, definitely. I know it. As a matter of fact, maybe there is another thing that we have gained. We always had love for each other, even with our volcanic dispositions, we had that. But we have something now which we never had before. We have respect, which I think is very important, just as important as love. Dr. A.: Could you please help us understand in what way our discussions here helped you gain that respect superimposed on top of the love? Mr. K.: Maybe I could add something to it. We would talk in loud voices, which would only end up in an argument, and we wouldn’t get any place. Instead, we were taught here to discuss things as two human beings would, and finally we came to a decision of right or wrong. We did it in a mild manner instead of a loud maniier, as we did before. Mrs. K.: We also concede to one another. Before this, either one of us would explode rather than say, “You are right.” It was like a dirty word. But now we have matured enough to say, “Give credit where it is due. You are right.” Mrs. W.: Did you realize that you were wrong when you didn’t give in to each other? Mrs. K.: I said we were both stubborn, and I said we were both emotionally immature. Mrs. W.: You still wouldn’t give in and make peace? Mr. K.: There would always be peace. Mrs. K.: There would always be peace. But peace didn’t last long in our house, because neither one of us had that disposition. In five minutes it was over. Mrs. W.: But the children took it differently? Mrs. K.: Well, each child took it differently. Billy would get nervous. Once, after we had an argument, Billy said, “You know, if you two would get a divorce, I don’t know who I would go with.” I said, “What do you mean divorce? Perish the thought-there won’t be a divorce. Daddy and I had a discussion.” and he said, “DISCUSSION?” I answered, “All right, so we don’t happen to be very soft-spoken.’’ He said, “I would rather go with Daddy, but then again, you know how to take care of me.” I said, “Look, there isn’t going to be any divorce. Daddy and I love each other.” And then when my husband heard it he said, “What is this about divorce-Mommy and I are having a discussion.” The poor kid was bewildered. The middle child doesn’t care what goes on in the world. He is a very happy individual and says “It’snothing-it’s nothing.” That’s the kind of a child he is. Billy is sensitive. There is another thing I have learned here. When we stopped having the sessions in June, I said, “What am I going to do in July and August?” Dr. Abramson and Dr. Peshkin were our crutches. We were leaning. I even used the expression to Dr. Peshkin, “I won’t even breathe towards Billy unless I



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have your approval.” I felt as though I had been thrown into the water and left to swim. I said, “We will have to use our own judgment.” And that’s the time we learned. It didn’t come overnight. It doesn’t. We learned and we were patient. And we have since developed an awful lot of patience. One more thing-I just wanted to mention that those people who do not have the advantage of these meetings are unfortunate. I had the misfortune of meeting parents at the Home-a man and wife and a little boy. They were not from New York, and they said they didn’t have these sessions. As soon as I heard her talk to her son I said, “Oh, does she need lessons!’’ The first things she said to her son was, “Sit still. In six months you didn’t get a good whack from me.” DECEMBER 1,1958

Mrs. K.: One of the mothers said earlier this evening, “From what was said here two weeks ago, it seems that many parents have solved their problems and are very content.” We didn’t solve our problems. We just learned to understand them. That doesn’t mean that we won’t have any problems. We have them every day, but we don’t lose our heads about them any more. We came home two weeks ago to a situation which, had it happened last year, whee, would have caused fireworks. The dear boy, my husband, would have gone on full blast and I would have joined him. We wouldn’t have talked to each other for ten or fifteen minutes. The children would have been unhappy and we would have been unhappy. But instead, we are the star pupils of Dr. Peshkin and Dr. Abramson. We come home twenty after eleven. My dear children were still up and they refused to go to sleep. My husband said, “Now, you are being naughty, go to sleep. Daddy is angry at you. Daddy loves you, but he is angry at what you did.” Everything fits in the groove. We measure what we say and then he sat down and I made him some tea and he said, “We’ll have to solve this.” I said, “You’re right. What can we do?” He said, “Well, I suggest that tomorrow morning, when they’ll want to sleep late, we’ll wake them early.” That is the way it was solved. Nobody raised a voice, but the problem was there. Mr. K.: There is something I’d like to bring up. Several fathers mentioned that their children behaved perfectly and never had any asthma when they took them places while at the Home. I had the same experience. I saw there that my son had grown up. Now, I think when we men take our sons out we act differently toward them than the women. We look at them like grownups-we let them do things that they want. Now, each of us has more than two children. I have three. Every child is a different case, and I think that the women baby these sick kids more. I will say it is so in my family. Yes. Where my middle son is three years younger than my oldest, my wife would never allow my older son, who is Billy and has asthma, to do the things that she would allow the younger one to do. And I would say, “What’s the difference?” and she would say, “Well, he can take care of himself-Billy could never take care of himself.” 1would say, “Why?” and it would never end. It seems to me that the problem concerns all


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of us, that we all have that same problem-that the women don’t let these kids grow up. They wouldn’t even let them go out and buy a pair of shoes by themselves. God forbid that they should go out in the street on a cold day like this and say, “I don’t want to wear my hat!” The roof would blow off the house. Then I would blow my top and say, “What’s the sense of arguing?” And it was proven to her this summer out at the Home that the kid will come and ask for his coat and his hat if he is cold. We went to a rodeo there one night. We got permission to go there and we took two boys-another boy and our son. It was cold up in the mountains and I don’t have to tell you how cold it got. Well, we took our jackets along and we took the kids’ jackets along, and his mother said, “Don’t you want your jacket?” and he said, “No. We are acclimated and you aren’t. You have to wear yours.” The other mother and my wife got together on the side and said, “What shall we do, what shall we do?” Well, Dr. Peshkin said, “If they want it, they will ask for it.” Mrs. K.: Lesson Number One. Mr. K.: And it didn’t take a half hour, when the kids came over. “We’re cold. Give us our jackets.” Now, I think that was a big lesson to them; and what I am trying to bring out is that when they were home they would never let these kids be on their own. No matter what they wanted to do, their mothers would be on top of them. 8, 1958 DECEMBER (One of the mothers stated that her children compete for the attention of their father.)

Mr. K.: This comes back to the same topic I mentioned last week. When the father takes the sick boy out, the boy acts well, behaves well and feels fine yet when he goes with the mother, or the mother takes care of him, the child becomes sick. I think that they like us, they don’t hate us, or they don’t like us any more than the mother, but for some reason they act this way, and it gets bounced around here in one fashion or another. I think if we all discussed the same topic we would get to know why it is that they all want the father. Mrs. K.: Because they don’t see their father all day long-they see the mother and they get fed up seeing the same face all day long-the one that reprimands them, do this and do that, or take your medicine-and when the father comes in it is a fresh face. Well, we do get tired. We are not made of iron. We are definitely made of the same flesh and blood. We get tired and we get bored, and when somebody comes in, especially your partner, which is your husband, you see relief come in. DECEMBER 15, 1958

Mrs. K.: I want to know what’s the matter with Billy’s nose. He wrote me that when he was in the hospital he had asthma and he was being treated for asthma for one day, but they kept him there and he had a sinus condition and he was being treated for that. (One of the doctors at the Home visited the group on this date and was questioned by Mr. and Mrs. Kohl.)



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Doctor: He was the one that we sent to a specialist, a nose and throat specialist, to look into his sinuses. There was no abnormality there. Mrs. K.: No? Doctor: But he had a bad infection, and kids mighty frequently will have. What we will diagnose as being a sinus involvement, together with his nose infection, might keep him a little longer for that reason. Mrs. K.: He said that he had bad asthma one Sunday and you said he had some temperature. But he said it puzzles him.He doesn’t know why he had bad asthma that day. Doctor: I want to make a note of the fact that Billy should be given a little more information about his asthma. He had a bad infection and his temperature was up to 101, and he had asthma with it. Mrs. K.: And he said there was nothing wrong with it. Doctor: Maybe he is just being big and trying to keep you calm. Mrs. K.: Probably. Another thing, Doctor. Does he get any counseling? Doctor: I see no mention about this at the moment. Mr. K.: He was always against that. Mrs. K.: He discontinued it himself during the summer. Doctor: I will look into this, too. Mr. K.: It seems as if as soon as he is taken off the drug he goes back and has asthma. Is he one that constantly has to be on drugs? Doctor: Forever, you mean? Mr. K.: I mean right now. Doctor: He is one of a special group that we are very much interested in. We pay special attention to him. We are trying to solve this problem of why it is that he has to be on the drug. However, we did get him off it as of November 12th and he was off the drug for about three weeks. So we have one clear spot with him. We always pay particularly careful attention and follow very closely this kind of problem. This kind of child has to have the drug for a long time. When we stop it he gets along all right. But then we give it back again and our experience has been that eventually we get him over the hump. Other things will be started. We make him look in on the counselling and psychological services and all of a sudden he gets over the hump and everything begins to click. Mrs. K.: Is he still being desensitized? Doctor: Yes, he is getting grasses. DECEMBER 22, 1958 (The mother of a child just returned from the Home checks on her son’s condition nightly, and is greatky disturbed because of his wheezing in his sleep.)

Mrs. K.: I think you forget that although your son was wheezing at night, he was sleeping, thank God. That’s one thing we never had. When our child used to wheeze he would get attacks and be up all night. But your son wheezed at night and when he got up he cleared his chest and was fine. You ought to be thankful for that.

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(One of the fathers stated that when his daughter returned from the Home he woke nightly to check on her and to this day has continued to do so. “It’s habit.”)

Dr. A.: I have the feeling that that is a rather dangerous pattern to continue, because I feel that even though the child is asleep she unconsciously knows that you are coming in. I strongly recommend that you give it up. Mr. K.: This is true, because when Billy was home I used to get up at 4:30 or 5:OO o’clock to go to work, and on the nights that he was sick and had his attacks I would go into his room to see what was what before I went to work. I would swear he was sleeping, but when I came home in the afternoon he would say, “You came in the room this morning.” He would say the same thing about my wife, too, whether she would go once a night or a hundred times a night. He would know everytime we were there. DECEMBER 29, 1958 (Discussion concerned the management of two daughters who fight constantly. The mother believes in letting them fight it out; the father feels that something should be done to ease the situation.)

Mrs. K.: I have sons-Billy is the oldest. He is at the Home. They are boys and so they are supposed to be bloodthirsty, but your girls take the cake. My boys have never actually hit each other when they were angry. They will horse around, they will wrestle, but never in anger. I remember one time when Billy was angry at something. I got so frightened and said, “Billy, he is your brother-I don’t care how angry you get-he is your brother.” Then he stopped and realized and walked away. I said, “This is not a stranger in the street. He is your brother, your own flesh and blood.” I always try to remind the boys they are brothers; there are three of them. Each one takes care of the other, and that’s the way they will get along in the world. I said, “If brothers don’t act this way, how do you expect strangers to?” And my husband even said he has never seen that with our boys. Don’t your daughters say anything to you when you are a spectator? Don’t they ask for authority? Don’t they look to you after it is all over? Mr. K.: I don‘t know. Maybe I have another solution. Once when my kids did fight-I mean they have a little fight now and then-after all, boys are boys-the bigger one took advantage of the smaller one. I went over to them and said, “Look, both of you hit me and get it over with.” They said, “Why should we hit you?” and I said, “Well, if you hit him and hurt him, it hurts me. If either one of you gets hurt it will hurt me anyway. So hurt me now and get it over with.” They looked at me and it seemed to startle them for a minute, and maybe they realized later and then I spoke to them like my wife did. I said, “You are brothers. You love each other. Why should you go ahead and battle?” So what I think you should do is one of you should go in and say, “Take it out on me once and for all, because you hurt me anyway.” The main thing is to find something to get their anger out of them. Mrs. K.: Let things be peaceful between you two and it rubs off on the kids. Mr. K.: I think you should both go out with your children. I’ll tell you why; because I used to shudder when I had to take my kids out. And now the more


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I take them out the better they behave and the more they get to respect each other.

JANUARY 5, 1959


(Discussion on the possibility that steroids cause obesity.)

Mrs. K.: Billy has been writing me that he is gaining and gaining. He gained eight pounds in less than two weeks and he is also on the steroid drug. I received a letter on Friday in which he said he was on half a pill every day and that in two days he would be off the steroids completely. But he has been gaining a lot of weight in the past two weeks. Could he be gaining because of the drug, too? Dr. P.: Half a pill a day in a two-week period certainly doesn’t cause a gain in weight, nor a relief of asthma, or anything like that. Mrs. K.: Then he is gaining it all on his own? Dr. P.: Yes, ma’am. Mrs. K.: I wondered. Well, that’s wonderful. Dr. P.: In other words, he is going to be weaned from the drug. Mrs. K.: Yes. By now he is probably weaned, and I hope to God he won’t be needing it any more. He writes also to Frank, whose parents are part of this group, and to a few other Home alumnae-his friends. But he writes letters to Frank that he would never write to the other boys. He gives his medical report to Frank and he gives medical reports of the boys they were friendly with. This is such a wonderful thing. When Billy comes home from the Home he and Frank, and maybe a few of the other boys who haven’t quite gotten over the hump, will be buddies who can talk together. The children receive such wonderful therapy from each other that I would like them to get together when they come home. Dr. P.: They usually do. Mrs. K.: They do? It’s wonderful then, because they compare notes so beautifully and have so much in common that they can’t find anywhere elseno one else can understand as well. JANUARY12, 1959 (One mother stated that physically punishing her child produced such guilt in her that she would tearfully apologize afterward.)

Dr. A.: Does everyone approve of a mother apologizing this way? Mr. K.: I don’t approve wholeheartedly. But at certain times, yes. Even though a mother or father has made a mistake and punishes the child-I mean in restriction, not the hitting angle-I don’t think the parent should give in to the child because then the punishment-the restriction-will never fulfill whatever the parent is trying to accomplish. Dr. P.: May I reword it another way-that parents lose their sense of authority? Mr. K.: That’s right. Dr. P.: And a child would not respect this authority when you exercise it? Mr. K.: And another time will take advantage of you.


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Mrs. K.: Well, Dr. Peshkin, for the first time last Saturday night I did just exactly what you said-sympathetic firmness-quite unconsciously. I didn’t realize it. We had guests and I said to my husband, “I wonder how we are going to handle this,” because my five-year-old son thinks that he is the host and he will entertain. We showed a film on the Home and he narrated. Nobody asked him, but he narrated the whole thing. “That’s my Mommy, that’s my Mommy, that’s my Mommy.” He Mommies me to death. “I love you, I love you,” and he kisses my hand and he hugs me. I have three children, but no one loves me as much as this one, believe me. When he has nothing to do, he looks at me and says, “I love you so much.” All right, but there is a limit. All right, I love him. Dr. P.: Not for him; there is no limit. Mrs. K.: He just sits and hugs me and loves me. When I walk with him in the street and we stop for a red light he walks up to me and says, “I love you so much.” Dr. P.: A red light is dangerous to him.Have you ever stopped to thinkhave you ever said to yourself, “Twenty-five years from now I only hope he will share some of that love and let me have it then.” Mrs. K.: I know I am bringing him up for another woman-it doesn’t bother me. Dr. P.: It doesn’t bother you? Mrs. K.: No, as long as I have this one (indicating her husband). That’s all. Dr. P.: This little boy will do, too? Mrs. K.: Anyway he was narrating and after the film I said, “Now you go into my room. . . . ” Dr. P.: What time was it? Mrs. K.: Ten o’clock. Dr. P.: A five-year-old boy up at ten o’clock? Mr. & Mrs. K.: You can’t get him to bed. Mr. K.: He won’t go to bed before the big one goes to bed. Mrs. K.: The eleven-year-old. And the eleven-year-old will not go to bed when he is supposed to go-after all, there is a six-year difference. Mr. K.: You put him to bed say an hour before-nine o’clock or eight-thirty, and he will be bouncing in and out until the big one goes to bed. And this goes on continuously. Dr. P.: When did this start? Mrs. K.: All three boys share the same room. I didn’t want to show partiality to any one, so I put them all together. And I think, first of all,the youngest one used to get up for a two o’clock bottle and I am very much ashamed to say that he broke it at the age of five. When I told people my baby stopped drinking the two o’clock bottle and he is only five, they thought five months and not five years. He drank a quart and a half of milk before he went to bed. He is a wonderful eater, knock on wood. I never denied him-he was always on the demand feeding and he demanded. To this day he tells me what to make. He has peanut butter sandwiches with junket for breakfast.



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Dr. P.: You mean your son is demanding in every respect? He demands to stay up, he demands to narrate, he demands. . . . Mr. K.: He doesn’t. Mrs. K.: Wait a minute, he does. Dr. P.: Mr. Kohl, you don’t agree? Mr. K.: I disagree. He doesn’t demand to stay up. I’ll put it to you this way. When my wife goes out and I am left alone with him I always put him in a half-hour before my older one. I know he is going to bounce up and down when he goes to bed a half-hour before.. . . Dr. P.: What time is that? Mr. K.: About nine o’clock. Dr. P.: A five-year-old boy at nine o’clock! Mr. K.: You can’t get him to bed any earlier. That goes into other reasons which I think in my household are wrong. I say late risers, late go-to-bedders. Early to bed, early to rise. That’s what I believe. But that’s another story. The little one gets up at nine o’clock, nine-thirty, ten o’clock. Mrs. K.: He has to be awakened. Mr. K.: You have to wake him. But how can he go to bed any earlier? That’s why I argue with my wife. She likes to sleep late, too. Mr. S.: What is he going to do when he goes to school? Mrs. K.: That will be wonderful. Mr. K.: I don’t raise my voice, I don’t get angry with him, I don’t hit him any more. Years ago, maybe I raised my hand every six months. Well, anyway, as I said before, I put him to bed at eight-thirty, and nine o’clock the big one goes to bed. They go to sleep pretty soon. By ten o’clock all is peaceful. But when my wife is home, they run out to her. Dr. P.: Would you say that when your wife is home with you, they go to bed later? Mr. K.: Definitely. Definitely. They take advantage of my wife. Dr. P.: What do you do about it, Mrs. Kohl? Mrs. K.: I am like a real yo-yo-in and out-“Water; cover me; I fell off the bed.” One time at three o’clock in the morning he got up and said he wanted a sandwich and I said, “You are not getting it.” He is the type that all of a sudden calls, “Ma,” and the minute he sees me he smiles and is happy and will lay his head down. This goes on all the time. It is only the past few months that we have been very lenient and let him go to bed whenever he was tired. We tried to be f m with him, sympathetically, and he just took it, though he didn’t get up during the night. That’s one thing that helped. Dr. P.: There is a possibility that when he goes to school, nature will take over because he will have to get up early. He will feel tired at night and will go to sleep, I hope. Mrs. K.: He goes to school now. He goes in the afternoon, from one to three. And he is happy there. He loves it. He can hardly wait to go and he is so happy. Dr. P.: Transfer him to a morning session.

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H . ABRAMSON AND M. PESHKIN

JANUARY 19, 1959


(Discussion on problems and difficulties entailed in the sending of clothing to the children at the Home.)

Mrs. K.: Sending pants is no good at all. I’ve been sending pants and Billy has been sending them back to me because he doesn’t like the way they fit“Get me this kind.” Finally I wrote and said, “Go out and buy them yourself, and then you will have what you want.” And he knows exactly what he wants. The kind you send fits them over here, but they don’t wear them there anymore. They wear them so tight, they can hardly walk. I saw them there last summer. And they’ve got to wear special shirts-if you send them shirts without buttons, it is no good. It has to be Ivy League and it has to be a certain color and worn a certain way. If they like somebody else’s, they buy it for a quarter or a nickel. They were telling us the way they swap back and forth. I will not send him any more pants. If he needs them, let him tell me and I will send him money and let him buy them. Dr. Abramson, I read your book The Patient Speaks and I found it very interesting. Very. It gave me a lot of things to think about, especially the article towards the end where you wrote about a boy whose father could accept a well child, but not a sick child. It struck home. When my husband would come home and find Billy wheezing, he would walk in and never say anything. He would just look and sigh and he would look at me and I would just nod my head. But when he saw his son when he was well, as he did this summer, playing ball at first base doing a good job, Daddy was always right there in the middle, umpiring, etc. He accepted him when he was well, but he rejected him when he wasn’t. (Dr. Peshkin suggested that some fathers might feel ashamed of their asthmatic sons. One of the fathers in the group wanted his son to do “breathing exercises” to develop his chest.)

Dr. P.: He wanted him to straighten out. Never mind the wheeze. Let’s accept what that means. Mrs. K.: I know, I know, because my husband was an athlete. He was almost a professional baseball player-that’s how good he was. When we got to the Home, it was so cute. We went bowling and Billy said, “Okay, Dad, it’s your turn.” My husband hadn’t bowled in fifteen years. He said to me, “I hope, for the kid’s sake, I do all right.” I said, “Well, I’m with you.” He got up there and he bowled the first ball and he struck them all out. Well, Billy turned around and was so proud. My husband said, “Am I glad I didn’t goofl” He was so proud of himself, My poor husband had a charley-horse all week, but he was trying to prove to Billy, and Billy was trying to prove to his father, that he also is a good athlete, which he is. Then he wanted his mother to go up. I had never bowled in my life-I am no athlete. I took the ball and quite by accident I only had one up there. Billy said to continue and I said that was enough. They had such a wonderful time.


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JANUARY 26, 1959


(Discussion concerning the best way of imparting sex information to children.)

Mrs. K.: I remember the first time Billy asked me the facts of life. I was diapering his youngest brother and I almost dropped the child on his head. You don’t know when they are going to come out with it. I was taught, I don’t know where, that when they ask you, answer them right then and there in a matter-of-fact way. It is very simple. Dr. P.: Matter-of-fact. Mrs. K.: Matter-of-fact. I answered him and I told him everything, but he must have known before. He wanted me to confirm it.

FEBRUARY 2, 1959 Mrs. K.: Last week Mrs. B. stated that she had a report about her son, and I have been very much worried about it. He was to come home during this week, and I wanted to find out how he was. The report was that he was rebelling and that was why he was coming home; because he needed to have a change in surroundings and that’s why his home would be better. Mrs. B. tells us that he has no asthma. (Mrs. B. discusses a t length some of the problems she faces in her home related to her son’s return from the Home. On the basis of his first day back a t school, she is concerned that he is scholastically behind his chronological grade and questions the advisability of tutoring.)

Mrs. K.: I don’t think you are anticipating anything from your son. Give yourself a break, too. You have resigned yourself to the fact that he doesn’t know it now and he won’t know it. That’s the attitude that I get. Don’t be like that. Mr. K.: I think the best help that anyone can get is from an older brother. Take your time now and see how it works out. As long as you say he gets along with the older son, I would leave it alone for a couple of weeks and see what happens. That would be my opinion. Mrs. K.: When Billy first went to the Home his marks were terrible. He got all E’s-five E’s. Remember when you told me that everyone was promoted and I said, “Everyone?” and you said, “Yes, Billy too.” He got all E’s and he thought he would have to go to summer school. Well, I am very proud. Billy had A in mathematics, A in science, B in English, B in social studies and C in French at the end of the term. Mr. K.: I agree wholeheartedly with the tutoring idea, but if you don’t have the money for a special tutor it should be conducted in the house. It could be a son, but in our case it would be my wife or myself. We used to have arguments as to the way of tutoring. For instance, Billy would tell me his problem and I would sit down to help him. He would have to write a composition or a report on the one page that he read. So I would ask him to read that page. He would read it and I would say to him, “Now, what did you read?” And he would tell


78


me. I would say, “Now, sit down and write.” My wife would butt in and say, “You write it for him.” Mrs. K.: I didn’t say that. Mr. K.: Something to that effect. Billy would say, “I can’t write it,” and I would say, “You just told it to me, so sit down, no matter how you write it, sit down and write it. Then I will read it.” My wife would hear this and she would say, “What are you arguing about?” and before you knew it, there was an argument. She would say, “Sit down and write it for him.” Now, I don’t agree with that. Mrs. K.: I never said, “Sit down and write it.” I said, “Help him.” The only thing I’d like to add is this. After listening to Mrs. B., I hope that I am preparing myself in a much more stable way. When I visited Billy this summer we put our best foot forward and thought twice before we did or said anything. Now I hope to God that when he comes home, I will have all the reflex actions and I won’t have to think. Right now my house is conducted quite differently than before Billy left. There is no tension and it is a happier house and I am positive that I will carry through the same way. I hope that I won’t get as nervous and forget what I have learned.

FEBRUARY 9,1959 (Billy has written to a friend that he expects to come home in August.)

Mr. K.: The reason for our concern goes back to the first time Billy was hospitalized for asthma. The doctor told him he would go home on Friday, but Thursday night Billy contracted a little cold and the doctor said he was better off waiting another few days. Billy took a turn for the worse and was so bad that they had to send him home on Sunday, figuring that they had done something wrong with him. He came home on Sunday, about twelve or one o’clock, and by six o’clock that same day we had oxygen in the house. Now, what I am trying to bring out is that if Billy is told he is going to come home in August, and I think I know my son pretty well, I am afraid something may happen. I want him to come home well. Dr. A.: Well, why not write to him? Mr. K.: I don’t want to probe into that. I don’t think it is right for me to probe into that. Dr. A.: But you are involved already. You have certain fears and I think you should tell him the truth. Mi-. K.: Yes, but he didn’t mention it to me. If he had mentioned it to me, then I would have answered him. Dr. A.: But it reached you. Mrs. K.: Yes. Dr. A.: And you are concerned about it. Mr. K.: I don’t know whether I am supposed to know about it. Dr. A.: I don’t know whether Dr. Peshkin will agree, but I would tell him it reached you. You should start treating him like a grown-up and not like a child. You can suggest to him that any information he receives is unofficial or tentative, or any other word you want to use, and for him to make sure that



79

the information you have is correct. You might even remind him that sometimes he reacts badly to disapppointment. Write to him just the way you just spoke to me. I recommend that. Dr. P.: The doctor states in his report of January 29th that Billy has been scheduled for regular contacts with the psychologist. “Initially, he resists getting involved in relationships. However, he is now actively working toward self-understanding. His major problem is his limited control of his anger feelings and subsequent resorting to crying.” This, I would say, is very classically put about Billy. I observed this when I confronted him early this spring, when I was there, and we had this problem, you remember? Mrs. K.: Yes. Dr. P.: ”He is an active and popular boy in his cottage group. For some time he tried to equal (this is another interesting interpretation, which is true) the older, bigger boys in his group. However, after being frustrated in these efforts, he accepted his physical and emotional status more realistically. At school his work habits are improving. He states that he wants to learn how to study and he is striving to achieve this end.” I get the feeling that Billy is beginning to come around. Mrs. K.: That’s good. Dr. A.: I want to reassure Mr. Kohl that where you have people in an institution, there are always rumors. I would accept that. Mr. K.: I know that it is more of a rumor than anybody coming out and telling him. Mrs. K.: I would like to ask something else. According to the psychological report that you received, Dr. Peshkin, I feel that if Billy has accepted it he is 75% ahead of the game, isn’t he? Because up to now he hasn’t accepted any counselling service. Dr. P.:I believe that from here on in Billy perhaps will show another side of himself-a little more mature side. MARCH16, 1959 (One couple complained that their son is constantly forgetting where he leaves his personal belongings, since his return from the Home.)

Mr. K.: Billy was exceptionally bad. He would go to the playground with his bike and come home without it. I bought him baseball gloves and baseballs by the dozen. He would go to the playground and come home without his glove. I may have argued, I yelled at him once. After the second and third time, I would say, “What’s the sense of taking a brand new glove to the playground and losing it?” Dr. A.: This was while Billy was having asthma? Mrs. K.: Yes. Dr. A,: Well, he was having problems. Most boys won’t lose their gloves. Mr. K.: He didn’t lose it. He just left it there. His mind was occupied with something else. This was while he was playing ball. He would go to the playground with a bike and come home without one. Mrs. K.: Any one of Billy’s friends was welcome to anything he had. He was


80


over-generous, which I didn’t like, because that was wrong, too. That was his way of gaining his friends. He doesn’t do that at the Home. He takes care of his things and he makes sure that he keeps them and doesn’t throw them around. He might share-they share beautifully out there. But whatever he lends he gets back. When he lived at home he used to lend things which his friends would sometimes return and sometimes wouldn’t even bother to. Billy wouldn’t care. But at the Home he did put his mind to taking care of his things. Dr. A.: The Home is a different social community. Mrs. K.: Yes, I know, because Mommy and Daddy aren’t there to replace things. MARCH 23, 1959 (Dr. Peshkin has returned from a visit to the Home and is reporting on the children.)

Dr. P.: Billy Kohl weighs 100 pounds and is 60%inches tall. He has been on steroids since the month of January. He has had wheezing on and off since then, but not troublesome or disturbing at any time. BiUy states that if he doesn’t have any colds, which he had only last week for several days, he does not wheeze. “Well, Billy, you look pretty good to me. What’s new?” He said, “Not much.” I said, “With all the excitement that goes on around here?” Billy said, “I want to go home.” This is really interesting. I said, “You want to go home? So do we all want to go home. How soon do you want to go home, Billy?” He said, “About August.” I said, “About the end of August? That will be almost twenty months. Is that right? Well, we will certainly have to think about it. Twenty months is a reasonable request, I think. I only hope that you will maintain improvement so that you will not wheeze for three months consistently. You are getting injections now. You have been getting pollen injections since last summer. AU right, let’s look you over then.” I examined him and his lungs were entirely clear. He had no wheezing sounds, no squeaks, nothing. His chest showed a very slight minimal deformity. Otherwise he was perfectly all right-nothing unusual. He was nice and quiet, gentlemanly, wellbehaved, polite. Quite different from when I saw him in August. Mrs. K.: I think he has grown up quite a bit since August. Dr. P.: I think so. He was quite different. He wasn’t belligerent or hostile. Many of the children at the Home have expressed their desire to go home. They hear the other kids. When they go home what do you think happens? They say, “I want to go back to the Home.” Mrs. K.: One of the boys Billy writes to said that. Billy wrote him a letter saying they had a wonderful New Year’s Eve party and the boy said, “I had to come home so soon. I would have stayed there a couple of weeks more.” That’s what he said. Mr. K.: When he came home, he said he would like to be at the Home certain times and he would like to be at home certain times. Dr. P.:Children have a back and forth attitude about going home and being at the Home. I don’t mind when they start saying they want to go home. It must be very normal if everybody says it.


THERAPY WITH PARENTS. VIII. T H E KOHL FAMILY

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Dr. A.: I think in this case it must be an epidemic. The oldest boy there is acting out certain needs of his own to show independence and leadership. I think the very violent need to go home or to express himself that he wants to go home has spread to the 15’s, the 14’s and the 12’s. It just goes right down the line. Mrs. K.: Billy has never expressed any desire to go home. This is the first with you, Dr. Peshkin. Never even with us when we were there. I want to make sure, Dr. Peshkin. If Billy continues to do well, he will be home in August. Dr. P.: That’s right. Mrs. K.: I want to get his room ready.

Psychosomatic group therapy with parents of children with intractable asthma. VIII: The Kohl family.

Psychosomatic group therapy with parents of children with intractable asthma. X: The Peters family. part II.

Psychosomatic group therapy with parents of children with intractable asthma. IX: The Peters family. Part I.

Experiences of living with asthma - a focus group study with adolescents and parents of children with asthma.

Group therapy for psychosomatic patients at a family practice center.

The family doctor in Canada. Part VIII. The way ahead.

Anesthesia and ventilation strategies in children with asthma: part II - intraoperative management.

Family therapy, group therapy.

The relationships among family management behaviors and asthma morbidity in maternal caregivers of children with asthma.

Family Functioning, Eosinophil Activity, and Symptoms in Children With Asthma.

Coordinated group psychotherapy of children and parents.

The psychosomatic aspects of children with vocal nodules.

Designing a physical activity intervention for children with asthma: a qualitative study of the views of healthcare professionals, parents and children with asthma.

A comprehensive study of the distressing experiences and support needs of parents of children with intractable cancer.

Behavioural characteristics in in-patient group psychotherapy with psychosomatic patients.

Chemical modification of N6-(N-threonylcarbonyl) adenosine. Part II. Condensation of the carboxyl group with amines.

Support Group for Parents Coping with Children with Type 1 Diabetes.

Randomized trial of a health communication intervention for parents of children with asthma.

Insulin therapy in hyperglycemic children with severe acute asthma.

Training children with asthma to use inhalation therapy equipment.

A self-help group for the parents of asthmatic children.

Family Rituals and Quality of Life in Children With Cancer and Their Parents: The Role of Family Cohesion and Hope.

Clonazepam in the treatment of children with intractable seizures.

Meeting Swedish Health Care System: Immigrant Parents of Children With Asthma Narrate.