I hate it when I don’t follow my own advice, and even more, I hate admitting it. Way back when we got the Trump government in 2016, it seemed as if everyone went out of their minds daily, experiencing some variety of trauma activation from some latest news item. The restimulations were neverending. I urgently admonished everyone, including myself, to regulate their news consumption! But one thing I never stopped doing was tuning in to the BBC first thing after waking up. I managed my quantity pretty well, but the timing, well, not so much. First thing in the morning is a delicate moment. On November 22nd, shortly after awakening, I flipped on the news to a passing clip of literally seconds, announcing, “…Pablo Milanés has died. He was 79.” It hit me like bricks and then an immediate avalanche of memory.

Pablo, along with his colleague and often collaborator Silvio Rodriguez, was the founding voice of the Nueva Trova Cubana, the New Cuban Song Movement emerging in the late 1960s. A mix of traditional and folk rhythms and instruments with political, social, lyrical, and popular themes, the “trova” was the soundtrack of some of my loneliest, most painful, and at the time, inexplicably difficult post-traumatic years. Pablo’s honey-like baritone was the ever-available company and comforting accompaniment to the darkest of times. His song Tengo (I Have) is the epitome of gratitude: a musical accounting of all the precious things one has. It became my favorite song of all time. 

Pablo also introduced me to the exquisite poetry of Jose Marti, which he even more exquisitely transformed into glorious song. I keep only two CDs in my car for those times when I am completely addled by the Bay Bridge traffic: Pablo’s Versos de Jose Marti and Silvio’s Mujeres. They unfailingly get me over the bridge and home. It was on my bucket list to see Pablo in person. I did manage to see Silvio in Oakland once. But Pablo – it never came to be. Now it never will. I was heartbroken.

Many people don’t know that Chanukah is a holiday about miracles. Ironically, at least in the US, the winter holiday season tends to be an extra hard or outright miserable time for so many people, especially those who have complicated or nonexistent relationships with family, leaving them feeling more lonely and ashamed than usual. With all the emphasis on celebrating and gifts, not having enough money or not receiving invitations or presents might add to feeling like a misfit, or a worthless being. That was certainly true for me, although I made a production of creating and giving gifts. I suppose that helped. Add to that the dark and cold season, and it all becomes a recipe for bleakness. Last week as December was just starting, I thought I would write about something inspirational or upbeat, like the recent serendipitous experience I had in Hawaii that I like to call Fire on the Mountain. I sat down to write.

But as I sat staring at the blank screen, I found myself typing “World of Neglect,” and, for whatever reason, fixating on the story of Brittney Griner. I complained about the biting chill of 41 degrees Fahrenheit (7 degrees Celsius) here these days, which to us in San Francisco is a “cold snap.” I wondered what the temperature would be in the Gulag-like conditions of Griner’s Mordovia prison camp. Again, I am no sports fan, but for some reason, I am compelled and fascinated by the stories of brilliant athletes. Griner’s story grabbed me from the day it broke back in February, now ten months ago. 

I am often disgusted and angered by the fickle and sensational news business, where a story hits and captures widespread concern, even outrage, only to sink into the quicksand of world neglect, upstaged by the next big story. I felt like Griner was all too rapidly forgotten, disappearing into the gaping void of world neglect. At least as far as I knew. I had to wonder, would she have been so easy to forget if she was white and straight? If it were, say, the cherubic blond quarterback of our local football team, the man I call “Lover-Boy,” would he have been forgotten and left to languish in the bowels of a Russian nightmare? My more hard-headed and politically-unbiased husband probably said so. But I am not convinced.

Unable to refocus on my “positive” agenda, I began researching Griner, curious to find out more about her story. I find her beautiful and her 6 foot nine (205.74 cm) frame so elegant and striking that it rather shocked me to learn that, always taller than her peers growing up in Houston, she suffered miserably and was mercilessly bullied in school. The other kids called her a “freak,” and she believed them. She was already suicidal by junior high school. And as she got older, wrestling with her sexuality, she finally summoned the courage to come out to her parents. Upon hearing it, her (most likely traumatized) Vietnam veteran father lost no time in kicking her out. That was all I could find about her sad childhood. But that colored my already bleak thoughts about her, locked away, forgotten in Siberia-like hard labor conditions. All day I could not shake the image of Brittney Griner, forgotten. I had not had a day like that before, fixated on her, a political football (basketball?) punted into outer space.

The next morning in the wee hours, I turned on the radio as I always do. The first thing I heard was that Brittney Griner was free! She was on the plane and on her way home. Admittedly I was instantly in tears. How did this happen?!

This week’s blog is all about pain, inspired by The Master Series: Pain Edition, coming soon in February. Use my code RC20 to get 20% off your tickets.

When we were growing up, if we did not feel well, our dad would say, “Get all ready for school and see how you feel after breakfast.” By the time I had done all that, I had pretty much no idea how I felt, and as a result, I ended up with a lifelong near-perfect attendance record. Unless I was actively vomiting, I assumed I was fine, and that too was rare. One of the handful of occasions I did was the unforgettable time in first grade when I threw up on the blacktop at recess, and someone circled it in chalk and scrawled in large caps, “RUTH DID THIS!” Oy vey, I guess that cured me of that particular affliction. 

In my first 30 years of private practice, I missed only two days of work for health reasons. Only in 2014, when I was struck by a systemic, near-septic infection that even I couldn’t ignore, I landed in the hospital for a week, and home watching baking YouTube videos for another week. There went that record. Until then, I was not only blessed with sterling health, but also cursed with florid hubris/denial and a completely failed sensibility of interoception. 

Interoception is the awareness and ability to perceive and read sensations within one’s body. The well-oiled organism emits constant signals to remain regulated, in balanced equilibrium and good working condition: food, hydration, rest, sex, temperature control, comfort, medical attention, etc. A good enough primary caregiver works to accurately read the cues and respond to them – not perfectly, of course, but well enough. That is how a child learns to perceive and interpret them, and ultimately, with luck, learns about self-care. With luck, that is. Many are not so lucky. Many of the little organisms, as we know, are met with pain and/or confusing overstimulation instead.

I developed an early interest in the ways trauma, eating disorders, and substance abuse met in a seamless braid because of my own sorry experience. I sought and found a largely unscientific little world of body approaches to psychological problems. My always ahead-of-her-time psychotherapist referred me to a colleague of hers who practiced what was called Self Acceptance Training probably well before 1980, which was the first body approach I ever tried. I don’t remember much of anything about it, but I stayed with it for quite a while and then became interested in bioenergetics and the writings of Wilhelm Reich, one of the early founders of more systematic body psychotherapy approaches. Although his work is in some ways quirky, I still find his book The Function of the Orgasm to be one of the great tomes of all time, and his unique way of bringing together social justice, psychology, and sexuality to be truly fascinating and not without merit. (His biography, Fury on Earth by Myron Sharaf, is also well worth the read!)

Now, as a field, we are blessed with truly evidence-based and effective body-oriented methodologies as well as a sophisticated literature that takes somatic psychotherapies out of the fringy or “woo-woo” category and into the highly respected trauma and even broader public mainstream. No need to mention Bessel van der Kolk’s record-defying blockbuster The Body Keeps the Score. We have all read it by now. 

It is now largely acknowledged that there are a host of (too many) confounding, somatic aberrations that may be the harbinger or the mouthpiece of a trauma story. Because neglect is often storyless, it communicates in painful code. It behooves us to learn its language, not only for the purposes of translating to a precise language narrative, but also because so many survivors are abandoned yet again by a medical system that tells them it is “all in their heads.” Unhelped or over/mis-medicated, they suffer, roaming from practitioner to practitioner or one bogus internet remedy to the next, depleting money they often do not have, and feeling more pathological, humiliated, often blamed, and alone. 

Thankfully, the ACE Study of 1995-1997 has finally come to the awareness of the larger world, broadcasting the “surprisingly” astronomical numbers of “Adverse Childhood Experiences” endured by the employed largely middle-income research pool of 17,000 North American subjects. Researchers have begun to link childhood trauma to health and disease (see neuroscientist Ruth Lanius’ 2010 book on the subject.) Many survivors like myself wandered in a desert of numbness or a tortured world of often alternating or otherwise confounding expressions of “disease.” Many are not so fortunate as I to have had a helper who could connect the dots.

For better or worse, we are all too aware that nature’s design is to exist, survive and persist into the future by proliferating one’s likeness and perhaps broadcasting that. It is as if the world were a giant Petri dish of infinite rabid species in a wild race to replicate their own. Some organisms cross ethnic lines and collaborate to help one another in the endeavor of spreading: mushrooms helping trees, bees helping plants, many plants helping each other, and some of the heroic people who work to rescue the endangered from extinction. In Michael Pollan’s lovely book, The Botany of Desire, he poetically describes this. 

Left to ourselves, however, across nature, we would all be blindly cloning ourselves into perpetuity. With great frustration, I saw this during months when I was too busy to keep up with regular daily cheesemaker “hygiene,” and the roqueforti, like greedy imperialist pirates, ferociously took over the world in my “caves.” It was everywhere. Blue cheese is delicious and all, but when you are trying to make Gouda or Gruyere, it should not voluntarily turn blue. Oy vey. After my book was written, like rebuilding after a war or flood, recovery took many months. Lesson learned.

Many parents indeed strive, perhaps unwittingly, to sculpt little echoing 2.0 iterations of themselves, maybe attempting to get a few bugs out, maybe actually failing to see those and passing them on. There is, of course, great pride in tradition, bloodlines, and culture, and there is something comforting and safe about more and more of the same. I remember, as kids, singing “rounds:” Row, Row, Row Your Boat, Frere Jacque, Hinay Ma Tov U Manayim, repeating the same little song over and over with a different little voice jumping in at intervals, continuing to make a lovely harmony. We could go on like that for ages – it was so simple and sweet. As one with some undeniably OCD-like tendencies (unlike my variety-loving husband,) I find repetition and routine to be regulating and reassuring as well as efficient – call me boring. (I do get a lot done!)

As all who have been in the world of trauma, whether as clinician, researcher, survivor, or some combination thereof know, the area of greatest injury to life and to function is the domain of relationship. That has certainly been the crippling pain, anxiety, shame, or simple cluelessness most likely to bring people to my therapy office door, and was certainly true for me. As mammals, attachment, connection, and interdependence are primordial, fundamental to survival. That would begin to explain the urgency and despair we experience in its absence. 

As human beings, love and relatedness are at the heart of what makes life most worth living, as exemplified in our art, music, literature, and all other media of expression around the world. It is a great motivator. It is the pivotal and most often missing ingredient in childhood neglect, especially in the developmental or earliest incidence of neglect, which is so much of what I see. By early, I mean the very tender and, of course, “unremembered” infant months and years. I say unremembered cautiously, because the desolation and uncertainty of isolation are in fact on record in the nervous system and the body. We know that by now, yet it is so “easy” to forget.

For many adult children of neglect, their mechanisms of compensation and disguise may be more skilled than what is turned out by the world’s top makeup artists. The void behind the facade of high function and success may thus be elusive to the naked eye, even to the self, at least some of the time. Because solitude becomes a default and even a “cozy” hiding place, it would be easy to chalk it up as being an introvert or “highly sensitive person” until some undeniable symptom compels attention, appearing in the form of a dramatic emergency – for example, my anorexic downfall, now almost 55 years ago to the day. I literally fell crashing out of my hiding place, certainly not on “conscious” purpose. Alcohol became another good clue if anyone had had a road map, but as has been endemic with neglect, nobody did

I flailed for a long time in a punitive world that lacked the psychological, neurobiological, and clinical options that we are now increasingly beginning to have, although critically insufficient. And I had the privilege of being white, middle class, with access to good schools and libraries to hide out in, which I liberally did. Even now, I often exclaim spontaneously to my husband, “I am so glad we live indoors!” I truly am, and so grateful.

I remember thinking I only began to learn how to be a “regular person” when I got my first waitressing job and spent enough hours with “regular people” that I could learn how to talk about movies, sports, television, and mainstream activities that I felt so ambivalent and clueless about. Of course, alcohol became a great companion in the process, as not only did it make it easier to fake it, but it also made me not care as much. Later on in therapy, I (not infrequently) would ask my infinitely patient therapist “So what do people do when…?” When they are at home in the evenings with their families, or on vacations with others? I still had only the vaguest clue.

I routinely admonished myself, “I just can’t get along with humans!”Although I have bristled against the term “impostor syndrome” dismissing it as too “pop psychology-esque,” it is probably too close to home. I was undeniably aware that I felt for many decades as if I was indeed of some other, probably mostly extinct and certainly less evolved species.

Central to the experience of childhood neglect is a devastating conundrum, a Gordian knot that, for many, plagues and tortures them throughout their lives if it has not been vanquished by early and prophylactic numbing (which it all too often is). Attachment researcher Mary Main has aptly called it the dilemma without solution: when the source of infant comfort and the source of terror are the same – the essentially needed primary caregiver. 

Abandonment, loss, and the absence of connection feel life-threatening which, certainly at the most vulnerable stages of life, it actually is. That is where the other side of the dilemma is congealed or constructed: the impenetrable Fort Knox of self-reliance. It is the safe house, the bomb shelter, the default survival mechanism until it breaks or fails, which it often does. The results are all too lethal both for the child of neglect themselves and for others in their wake, as we are all too often seeing these days as the disenfranchised “go off” and act out violently in the world. So many reasons that I am adamant about helping the world become “neglect informed.”

When I started therapy in 1978, long before many of my readers were born, our mom muttered bitterly, not quite under her breath, “…the ‘blame your mother’ generation!” I have no idea why I even told her. From then forward, my therapist ever retained her reign as “public enemy number one.” Blame is not my paradigm – that I want to underline – and my purpose is anything but that! Rather connecting perhaps counterintuitive dots, that might lead to better self-understanding is my wish. And admittedly, sharing insights that might be interesting to me.

Similarly, “Refrigerators, Helicopters and Tigers” (oh my!) may seem to evoke Dorothy exclaiming the perils of a terrifying world or a bad joke (what do the three have in common…) So, bear with me please as I seek to elucidate more less than obvious expressions of neglect. 

Again, the deepest and most injurious sequela of neglect is the rupture or failure of the primary, most important attachment(s,) most notably with the mother whose body houses the child at first, and ideally would continue as a home and source of comfort, regulation, and protection from the perils of that dangerous world.

Perhaps the most integral and the first vehicle of comfort and regulation is the “simple” experience of being seen. Gazing into the face of a present and loving (ideally calm and regulated) other is foundational. Brain development begins with the resonant dance of the gaze and evolves into being accurately heard and responded to. Not perfectly of course. It seems so simple, no? A no brainer in more ways than one. Sadly, it is so very often lacking. Missteps and mistakes, of course, are part of the deal, but with repair, we are actually better for them. Confidence or knowledge that repair is possible makes the inevitability of imperfection bearable and survivable. 

The most devastating impact of neglect is the deathlike loneliness of not feeling seen, but even worse, not being or feeling known. When I am known as me, as distinctly, uniquely ME, this means I exist. This feeling or sense that I exist may, with luck, evolve to a sense of self, and with even more luck, a sense of self-worth: I exist, and I matter. Without it, we may drift unmoored in a foreign world, wondering what is wrong.

Our dad passed shortly before the pandemic of Covid-19 struck. What a blessing that was, as it would have been hell for him and for all of us to go through. The final couple of years, and worsening over the last months, he was increasingly vacant and absent, barely “there.” It was hard to tell if he was bored and disinterested, if he was hovering on the bridge to the next world, or if his tired old brain cells (those that were left) were not firing anymore. He was almost 93 when he died. When I arrived to visit, his second wife would bellow loudly in his ear “(whatever strange nickname she called him), Ruth is here!” His hearing aids were powered on, intact, and in place, but he usually did not even look up. It was as if I was not there. Sadly, to be perfectly honest, it was not that different from much of my life with him. 

I had the good fortune to make my peace with him, so I enjoyed a stretch of a surprisingly happy father-daughter relationship before he began his protracted fade-out departure. Granted, I did all the healing work on my own without his participation, but that is a story for another day. He did participate in a truly loving relationship with me for a time, and I am infinitely grateful for that.

Our dad’s final years, however, were a quiet agony. Thankfully, my sisters and I were a good team. But having my presence or absence not register, questioning whether those long, vapid visits had any meaning at all, was not only interminably empty and boring for me, but a potent reminder of the years of feeling as if I did not matter or even exist in his eyes. They were a living reminder/stimulus of long years of painful and confusing neglect. Admittedly, I lived much of those last two years in various degrees of trauma activation. Being excessively busy and perennially sleep-deprived, the routine visits took a chunk out of every weekend. But for whatever reason I kept them going diligently until the end – not without confusion and unbearable fatigue. 

Why? Was I afraid I might miss something if I did not take advantage of every possible moment with him? What might I possibly miss? I could rarely ask him questions about his life anymore. I found I would collect stories and topics and come with a “playlist” of things in mind to talk about, to entertain either him or myself. I honestly don’t know which. Due to his various cancers, he had been on a feeding tube for years, so my stories about cheesemaking challenges, my baking masterpieces, or food-related conversations, which are ordinarily pleasurable and easy for me, were off the table, so to speak. Our best bet on a good day was to sing. Interestingly, although he did not remember much of anything else, he did seemingly remember all the songs and their lyrics. Sometimes we filled the time that way, especially when I had the good fortune to visit at the same time as a sister, who brought his old guitar. She played it, but it did seem to awaken and cheer him.

Secretly, however, I remembered an old Cuban song I used to listen to and love: “La vida no vale nada…” life is not worth anything. And even though the song is about how life is not worth anything if others are suffering, I had to wonder, what keeps him going? What would make it worth continuing to live and breathe that vacuous existence? And when I dared to be really honest with myself, why doesn’t he just go?

When there is a long history of trauma, neglect, hard-earned healing, and profound ambivalence about its perpetrators and purveyors, their final years can be complicated at best. Some of us are too enraged and hurt still to be dutiful; some of us too dutiful to allow ourselves to feel enraged or hurt. If we are glaringly aware of both the parents’ own tragic and unconscionable trauma and misfortune and their own tragic and unconscionable lack of healing, it is even more complicated. Add to that whatever feelings we might have about what others (those mythical others) might think about how we navigate the loss of a parent. Some of us care. And many of the feelings are outside our awareness. 

I remember when our mom died in 2000. I was so embarrassed when people expressed sympathetic condolences as I felt nothing but grateful relief – or so I thought. I was driving the day after she passed, however, and my car broke down on the freeway. Much to my own surprise, I fell apart on the phone with the Triple A operator who took my call for emergency road service, crying rather hysterically to her about how my mother had just died. It was as if I and not the car had broken down.

The child of neglect, often virtually from the point of conception, floats in a sea of solitude. Like a fish, the water may not even register, as it can seem “natural” or the norm, the absence of attachment being all that is known. Attachment, however, is not only a birthright – it is nature’s design. To be connected is a survival need, and in effect, nurture is nature. To be left alone and adrift is a crime against nature as far as I am concerned. 

As the child grows older, solitude may become the default, seemingly “preferred” state, most likely not consciously. The less familiar state of being in company or connected with anyone may feel like a strain at the very least, if not foreign, impossible, even terrifying. More than a few neglect survivors I have known found the isolation of lockdown during the Covid-19 pandemic barely noticeable or even a welcome “permission” to simply lay low. Often, I have heard their partners complain bitterly of feeling perennially rejected. 

When I first started my anecdotal study and data collection about neglect and began to formulate the outlines of what I came to think of as the “Neglect Profile,” I noticed what I perceived as a seismic shrug, often accompanied by the words “I don’t know what to do!” or “There is nothing I can do!” Going back probably to the beginning of time in their relationship world, they felt that they had no impact at all, so the experience of powerlessness seems to rumble and quake from deep in their core. Often, these people are extraordinarily accomplished and proactive in other ways, be they professional, creative, athletic, or some other significant pursuit. 

The domain of relationships confronts the child of neglect with their core paradox: the central conundrum that plagues them, whether or not they are aware of it. It is what local treasure, Berkeley attachment researcher Mary Main, calls the dilemma without solution. If they allow themselves to feel their natural longing for connection, they are faced with a story and the ongoing threat of agony and, at the very least, vulnerability. What is to be done? Most likely, the only viable adaptation is to freeze or avoid. Often this also is the complaint of their partners: numbing, avoidance, even paralysis.

From seemingly out of nowhere, into my mind popped the theme music from Captain Kangaroo. I have no idea why; I had not thought of it in years – certainly not as long as I can remember. I always have a song in my head, but usually I am aware of the stimulus. I never even really liked the Captain. With the remembered whistling tune came a rather painful memory I don’t recall having before, when my sister was a baby, being parked in front of the Captain while my mother was with my sister. I felt lonely and left out, but also the spectrum of typical neglect feelings: rejected, unimportant, less loved/lovable, hurt, mad, and jealous– and most certainly unaware of all those feelings. To be sure, I had no language for any of it, but it all swirled in my little body and wafted faintly back with the snippet of musical recall.

I was two and a half when our little sister was born. I have always, and continue to, adore her. And admittedly, I was jealous. She was the pretty one, with great big beautiful eyes. People stopped on the street and remarked about those gorgeous eyes. Our mom was plain and non-descript-looking, but the new baby looked like our dad, who was proud and rather vain about being decidedly handsome. We recently found an ancient, dog-eared black and white of him flexing his muscles on the beach when he was in his twenties. Dad called our new sister his ”Little Monk” or “Little Monkey Baby.” Of all of us, she did not have a biblical name, so it seemed the wheels were greased from the start for her to be more “mainstream” or “American,” which I always rather envied. But long story short, her arrival meant greater scarcity of the already meager emotional resources in that house. So whatever neglect I was feeling was heightened and multiplied. Thankfully it never turned into resentment of her.

Our oldest sister was always more popular than I, or so I thought. I remember kids often saying to me in junior high, “Oh! You’re Becki’s sister!” And I bitterly thought but did not say, “NO! I’M RUTH!” But by then, I already doubted if, in fact, there was a distinct me, if I did exist, let alone had a right to. Existence is often a question that accompanies neglect. If I existed, would I not exist in the mind of the other? Oy vey, a child cannot think such complex thoughts. I just knew unquestionably that I did not matter and needed to find a way to compensate for it. (I have often wondered, how does Venus Williams do it? How does one continue to live and perform with such grace and dignity, even with immense talent in her own right, in the shadow of such a legendary sister? Kudos to Venus!)

Often neglect is a function of simply too many kids. How on earth could parents, especially single, traumatized, impoverished, enslaved by impossibly long and depleting work hours, or otherwise disabled parents possibly attend to more than a couple of children, especially in light of a western atomistic, individualistic, lacking a “village” culture of parenting? Neglect is yet another expression of all of these. And, of course, this makes it more difficult for the child of neglect to name their experience as traumatic, viewing the parent as the afflicted one, and trying to compensate for that. 

Many a neglect client of mine has been the younger or youngest of “too many” children when often there was not enough to go around to begin with, and jealousy is often the shameful and/or painful byproduct. In fact, whenever I encounter, particularly in couples, an extreme of jealousy, the first place I will want to look is at the history related to siblings. We often find the answer there. It may even be a case of a sibling with disabilities or illness that requires a disproportional amount of parental emotional energy or attention, making it even more challenging to feel worthy or to own the embarrassment of resentment.

Whenever a client laments a jealous partner or their own jealousy in general in the world, the place to look first is at the sibling story. Some profound neglect arises from the fact of simply too many kids. There was never enough to go around and with each additional birth, even less.

I envied not only my sisters but others too. I was always perhaps too aware of who got what and how much. I perennially seemed to come up short, hungry, explaining it as proof that I was not enough, and of course, the infantile lament, “It is NOT FAIR!”. I worried and envied about money for years, and when I finally became solvent enough to pay taxes without worrying about floating checks and holding my breath that they would clear before they bounced, I probably became one of the few people I know who actually took pleasure in paying my taxes – which I still do!