DOCS: The Distant Obstreperous Child Syndrome

Even when long, life is brief

From the tree one must drop, like a leaf.

For those left behind,

We’re all of a kind,

Love is paid for with grief.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

Weekend call comes with a theme; this weekend I keep foundering in the shoals of familial dysfunction in the wake of parental alcoholism.

I do a lot of explaining from my own family story.  “It does something to you,” I said far too many times this weekend, “to watch someone you love killing themselves.”

Terrible ambivalence devolves upon the only child of a self-destructive parent, that same anguish spread through a larger sibling cohort pushes children into emotional roles that come to dominate their lives.  From experience, the most geographically distant child moved the furthest away emotionally; having left the most unsaid, when the final hours of that parent come that child has the least emotional preparation for the ultimate separation and will make the most trouble for the health care team and the entire family.  At the Practice Formerly Known As Mine we called it DOCS, the Distant Obstreperous Child Syndrome.

In those cases, I point out to the other siblings that the one child making the most noise really can never be ready for the parent to depart, and takes upon him or herself the feelings of unfinished business of all the brothers and sisters.  Thus the observation than under the best of circumstances a split in the siblings follows the death of a parent and that split seldom heals.

The child who has had the most involvement, who sees clearly the limitations of the human condition and knows that the time has come to embrace the grief and then move on, rarely makes a show out of their internal emotional state.

The same things happen in families without dysfunction but alcoholism or any other addictive behavior magnifies the drama and multiplies the irony, especially if the mechanism of death comes from the addictive behavior.

If a parent firmly places a finger on the self-destruct button, and has only one child, all those sociologic and emotional roles get concentrated into one psyche, and the whole grieving experience will increase by orders of magnitude.

Things only get worse in the absence of advanced directives.  If a person puts first things first, and, seeing the end coming, makes out a clear will, pre-arranges funeral plans, and attaches a Do Not Resuscitate form to the refrigerator, they probably didn’t indulge their destructive addictions at the expense of their families. 

By the same token, addicts, alcoholics, and adulterers maintain a steady stream of chaos and leave behind a mess of unfinished business when they go.

If people could live forever, we wouldn’t love the way we do.  Human love remains an undeniable force even in the face of bad parenting and addictive behaviors.

If a split comes between you and your siblings, I say, it can only continue if maintained, and don’t you be the ones who puts more energy into the maintenance than everyone else.   And if you have no siblings, don’t isolate yourself in your grief.



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