Making Difficult Decisions . . .

Making Difficult Decisions . . . Dear Rabbi, Recently, my father (age 82) was diagnosed with a serious and life-limiting illness. His doctors have outlined a possible course of treatment, and have also spoken to him about the possibility of hospice care. He has always been a fighter, but seems to be having a difficult time deciding what to do in this situation. My sisters and I are struggling: we are worried about him, we are anxious to know what kind of care he will choose, we are nervous about the impact of treatment on a person of his age, and we are upset about the idea of “giving up” on treatment. We know that it is ultimately his decision, but we want to talk to him about it. At the same time, none of us quite knows where to start or what to say. We haven’t really talked about this kind of decision before, and are trying to figure out what values should guide us. We have never been really religious, but it has always seemed like the Jewish tradition encourages us to place life above all other priorities. Is this true? What does Judaism have to say about this decision? What can we do to support our father’s decision-making? -H.G. Dear H.G. First of all, I am so sorry to hear about your father’s diagnosis. It is devastating, painful, and life-changing news to receive. Second, all of the fears and anxieties and uncertainties that you are feeling as a family are very normal and reasonable reactions to that kind of news. In our culture (both Jewish and North American), we often avoid talking or thinking about end of life issues. This can make it even more painful when we are forced to think about and make important medical decisions like this. You asked two very important questions. You were wondering about the Jewish values that relate to making this kind of decision, and you are struggling to figure out how you as a family relate to and support your father’s decision making process. I’ll answer them in that order. You are right that the Jewish tradition places enormous value on protecting and preserving life. The Jewish tradition recognizes that every situation is unique, and always approaches major decisions on a case-by-case basis. There are some overall Jewish values and teachings that are relevant, but each of them has to be weighed against the particular details of the individual situation. Some of these values are: Judaism teaches that each life is of infinite and irreplaceable value, that we are responsible for caring for and sustaining those around us, and that each of us is responsible for preserving the safety and wellbeing of our own body. Judaism encourages us to seek out the knowledge and advice of medical experts in the care of our bodies, and emphasizes that the course chosen should be for the greatest benefit of the patient. After weighing the risks, side effects, and probable outcomes of each, either course of treatment might be determined to offer greatest benefit. Judaism affirms the dignity of each person in seeking and receiving care, and in seeking the support of their loved ones at all stages of care. Your second question, about how to act as a family around...

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Choosing between buying food and buying medications . . .

Dear JF&CS: My husband and I are both retired. We are having a bit of trouble making ends meet. We live in a nice apartment and we can manage our rent and utility bills. We are grateful that our car is running well and we can put gas in the car. Like many people who are getting older we both take many different kinds of medications. Staying healthy is getting expensive. I am afraid we may have to choose between buying food and buying our meds. I have heard about food stamps but I don’t know how the program works or if we would be eligible. Isn’t it just for poor families with children? I also heard that if you DO get food stamps the amount is so small it isn’t worth it; and that the application is hard to fill out. I’d like to know more because I’m just not sure what our options are. – Looking for Answers in Creve Coeur Dear Looking for Answers: Your situation is very common. Many people are struggling to make ends meet, especially seniors. No one should not have to choose between medication and food. As a matter of fact, lack of proper nutrition makes seniors particularly vulnerable to a variety of health issues including asthma, diabetes, obesity, high blood pressure and depression. The food stamp program has changed a lot over the years. It is now called SNAP (Supplemental Nutrition Assistance Program). The SNAP program is like Social Security; we’ve been paying into it all our lives so that it can help us when we retire. Years ago, people had to use old fashioned food “stamps” at the grocery store. Now, we use an EBT card which looks very much like a credit card. So easy and so private. Jewish Family & Children’s Service is working with MAZON: A Jewish Response to Hunger and twelve other Jewish agencies around the country on a program called Solutions to Senior Hunger. Locally, staff from the St. Louis JF&CS and the Harvey Kornblum Jewish Food Pantry are helping our community’s senior citizens apply for SNAP benefits. In the six months that we have been working on this project, we have helped many seniors apply for SNAP benefits. The average benefit amount seniors have been receiving is $123 per month. That’s $123 that seniors can spend on food, freeing up dollars for medications and other necessities. Staff at JF&CS and the Harvey Kornblum Jewish Food Pantry can help you complete and submit a SNAP application. They can even follow up to check on the status of an application. We can even pre-screen to see if you might be eligible before going through the entire application process. Want more answers or assistance? Call Patricia Johnson at the Harvey Kornblum Jewish Food Pantry at (314) 513-1675. – The Harvey Kornblum Jewish Food Pantry...

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How should I respond to behavior problems with my children?

Dear JF&CS Therapy Team: As a parent, I am sometimes at a loss for how to respond to behavior problems with my children. Conflicts abound from the dinner table, to the bedtime routine, daily chores, sibling rivalry and countless other moments throughout the day. As the school year is coming to an end, I am especially worried about what things will be like when the structure and routine of classes and school is absent—I worry that conflicts and problems will escalate. The summer time has always been a different kind of challenge for our family. Can you help? Sincerely, M.Z.   Dear M.Z., Thank you for reaching out during Mental Health Awareness Month and for your honesty about the challenges in your family, that, I assure you, are thoughts that many parents have throughout the year. There are a few things that I would like to point out about your message. First, I commend your curiosity about how to respond to behavior problems because there is not a one-size-fits-all approach to these kinds of questions—each child (and adult) has the need to be heard, seen and understood, and each child has a unique mind and a set of experiences that constructs how that child perceives the world, their feelings and relationships. Since you did not relate to a certain age for your children, I will speak in generalities. When a child feels silenced, invisible or misunderstood, a problem in communication has occurred—a breakdown that may compel the child to act out feelings with behavior instead of articulate feelings with words. It is when words “breakdown” that many behaviors occur. It is also the case that a child just may not have the capacity to talk about certain feelings (yet), which can also lead to a behavioral way of communicating their inner experience and feelings. It is a good bet that behavior problems are really that child’s best attempt at communicating their inner world and feelings to an important other and also that child’s best attempt at regulating their own emotions. Children do important learning in play and many times communicate their feelings through art or other games that displace their inner experience and feelings into the world for all (especially parents) to see. This is where we can sometimes find clues about what is going on for a child, and where I like to look and listen in the therapy room (and you can, at home). Healthy development necessitates the growth of “emotional muscle”—a concept that was born out of work by Novick and Novick, both psychoanalysts. Children need to be able to master the ability to talk about all sorts of feelings, which requires helping them to digest, think and reflect on their mind, what is going on inside and then find words that help them feel understood in the context of a caring other. Seeing behavioral ways of communicating is a signal that more work is needed in this area of verbalizing thoughts and feelings and that we need to pause, ourselves, to think more about what is going on and listen in a different way than we have before with a particular child. Secondly, you rightly note the stabilizing nature of the school environment for many children. It becomes a routines that they can count on...

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How can I help my child from becoming a victim of sexual abuse?

Dear Child Abuse Prevention Program, Recently you came to my child’s school and presented the Safe Touch program to the students.  I was very pleased with the information that my child learned about how to keep their body safe and what to do if anyone ever touched them on their private parts in a not OK way.  I wanted to know if you have any information about how I, as a parent, can help to reduce the risk that my child will become a victim of sexual abuse. Thanks for your help, Concerned Parent   Dear Concerned Parent, Great question!  We love to hear that you are pleased with the CAPP presentations that your child received at their school.  Research shows that if students receive these lessons on body safety each year during childhood, they are more likely to use the safety plan and in the instance of an abusive event, and to understand that it was not their fault.  The understanding that they are not at fault is key.  They are more likely to tell someone what happened if they understand that they didn’t do anything wrong, or to make the abuse occur. Here are 7 things you can do to minimize your child’s risk of sexual abuse (adapted from information from the American Academy of Pediatrics): Teach your child about the privacy of body parts, and that no one has the right to touch them. She should understand that some touching is “OK” but some is “not OK”: Explain that an adult’s giving a loving hug is different from his putting a hand on her buttocks or inner thigh. She has the right to say no to anyone who tries to touch her in the parts of her body that are normally covered by a bathing suit. Naturally, your child should respect the right to privacy of other peo­ple too. Starting in early childhood, parents can teach their children the name of the genitals, just as they teach their child the names of other body parts. This teaches that the genitals, while “private” are not so private that you can’t talk about them. Sit down with your child and explain various situations that might indi­cate that a possible child perpetrator is making advances. For example, a perpetrator might offer a child candy or toys. (If your child has acquired any unexplained toys or gifts, ask who gave them to her.) He or she may offer the child money to run an errand or do a short-term job (raking leaves, shov­eling snow). He or she may take the child on “special” outings or to special events. He or she may tell the child they share a special secret.  He or she might claim that an emergency situation has arisen (“Your mother was in an automobile accident—come with me, and I’ll take you to the hospital to see her”).  Make sure your child understands that if she encounters a potentially dangerous situation like these, she should run away. Tell your child that threats from a perpetrator or anyone else are against the law—”If you tell your mother what we did, I’m going to hurt/kill her”—and to tell you immediately about them. Monitor the activities at your child’s child-care facility or summer camp. Participate in these activities whenever possible. Listen...

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To Test or Not To Test – What Should a Parent Do?

Dear JF&CS Therapy Team, My son’s guidance counselor recently recommended that we pursue psychological testing. I have so many questions, I don’t know where to start. How do I know the person doing the testing is qualified? Can I observe the testing? How will the information be used, and who has access to it? Another concern is that I have been diagnosed in the past with depression, and I’ve heard that depression can be genetically transmitted from parent to child. Not only that, but my relationship with my husband is currently very strained, and I think that might be impacting our son’s mental health as well. Part of me dreads having to do the testing, because I’m worried I’m going to discover that I’m to blame for much of his current distress. Any advice? Signed, Guilty, Unsure, Loving Parent. Dear GULP: First, some good news: all of your questions and concerns are normal and understandable. In fact they are a sign that you are a concerned, involved, and loving parent, and that means you are a great resource to help him cope with whatever struggles he is facing. Never feel bad for having questions for your psychological tester. Don’t hesitate to make a list of these questions to bring to your first interview. A competent tester will be happy to answer any number of questions about the process, about his or her qualifications, and about your child’s and your family’s problems. Many parents are unaware that their relationship with another parent or caretaker can have a decisive impact on their child’s mental health. Your willingness to acknowledge the potential effect of your marital conflict on your son’s psychological well-being says that you have the insight and sensitivity to keep your son from feeling caught in the middle. Hopefully, your husband shares your perspective; I strongly encourage you to bring him to your first testing interview. Most psychological testers of children prefer to get the perspective of all the adults who care for the child. Oftentimes, mothers are the primary “customers” of mental health services for their children, and fathers may simply be unaware that their input is welcome and valued. A word about qualifications: virtually all psychological testers have at least a master’s degree in psychology, and most carry a license in one of the mental health fields: psychology, school psychology, family therapy, professional counseling, or social work. Each of these licenses represents different strengths and perspectives. Psychologists are often very strong in their knowledge of test development, research, and severe psychopathology. School psychologists are well equipped to recognize learning disabilities such as dyslexia. Family therapists are especially sensitive to the impact of family relationships on mental health. Counselors have special training in helping people choose the right career path. Social workers are experts at linking families to community resources. The most effective members of each of these professions will collaborate with the others to take advantage of their different strengths. The main thing for you is to be sure your tester has had graduate training in diagnosis and the administration of psychological tests. The testing process usually involves a combination of interviews, “objective” tests that involve answering questions and solving problems, and “projective” tests that might involve drawing pictures or making up stories. Depending on the methods and...

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How can I increase my mental health?

Dear JF&CS Therapy Team, My friends and I were talking about all of the focus in the media about mental illness and wondered…..rather than focusing on mental illness….what if the media focused on mental health. That discussion led us to a question….are there really ways for a person to increase their mental health? Inquiring Minds   Dear Inquiring Minds – You and your friends will be happy to know that there definitely are ways to enhance a person’s mental health. Of course, it is also important to know when it is time to seek professional help for a problem that is interfering with you going about your daily life. Below are some “tips” for enhancing a person’s mental health….and Jewish Family & Children’s Service’s therapists are available by calling (314) 993-1000, if professional help is ever needed. Try These 10 Tips to Improve Your Mental Health 1. Treat yourself with kindness and respect: Make time for your favorite hobby like doing a daily crossword puzzle or planting a garden; or try something new like playing an instrument or learning another language. 2. Take care of your body physically: Eat nutritious meals; drink plenty of water; avoid smoking; exercise; and, get enough sleep. 3. Surround yourself with people who have strong family and social connections: Make plans with family members and friends who are supportive and seek out activities where you can meet new people. 4. Give of yourself: Volunteer to help someone else. You will feel good about helping someone in need — and it is a good way to meet new people 5. Learn how to handle stress: Stress is an unavoidable part of life. Use good coping skills like taking a walk, writing in a journal or playing with a pet. Also, try to see the humor in life and smile. Research shows that laughter can reduce stress, strengthen your immune system and even ease pain. 6. Learn to quiet your mind: Try meditating. Relaxation exercises can help you to feel calm. 7. Set realistic goals: Make a decision about what you want to achieve in the next week, month or year and write down the steps you will take to realize your goals. Be realistic and remember that making progress toward your goals is part of the achievement. 8. Break up monotony: We all have routines that make us both more efficient and increase our feelings of security and safety but a little change can be energizing. Take a walk in a different park, or try a new restaurant. 9. Avoid alcohol and other drugs: Keep alcohol use to a minimum and avoid other drugs. Sometimes people will use alcohol and other drugs to “self-medicate” but in reality alcohol and other drugs only result in increased problems. 10. Seek help when you need it: Getting help is a sign of strength — not a weakness. Remember that treatment is effective and people who get appropriate care can recover from mental illness and substance abuse...

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