Autism is a disorder of extremes. Too much talking or not enough. Running around all day or not moving. Eating everything or eating five foods. Boundaries work the same way: too close or too far, because we can’t see where we’re standing. We would never believe that about ourselves. We’re obsessed with self-knowledge, so we assume we have it. But knowing a lot about yourself is different from knowing where you are in relation to another person.

Enmeshment and neglect are the same thing

An enmeshed parent can’t separate from the kid. The parent’s childhood was about making their own parent happy, so it’s logical to them that the kid’s job is to make them happy, even while they say everything I do I do for you. Neglect is not the opposite of enmeshment, it’s the same. When no one is home, the kid feeds himself, comforts himself, does the parent’s job for the parent.

In both enmeshment and neglect the parent doesn’t see where the kid ends and they begin, and from outside that looks like someone who thinks the world revolves around them. Ask the parent and they’ll tell you they care so so much and how could you even ask. Give them an example and they’ll tell you their great explanation. But a parent without boundaries always picks the part of the job that’s more interesting.

Olympic champ Alysa Liu had to quit figure skating to get her dad to stop running her life. He went to everything, fought with the coaches, and made her skating his skating. When she quit, she said he didn’t deserve to have an opinion about it. That’s enmeshment. It’s also neglect, because he only cared for the part of her that was interesting to him. He has five kids by surrogate and decided they didn’t need a mother: easier for him this way.

He devotes almost all his time to his children. He would never think he’s selfish, and he’d be right that he’s trying hard not to be. Research on narcissism shows the concern narcissists have for other people is real, and it’s driven by fear. He’s taking care of his kids to manage himself. What Alysa makes clear is her dad can’t see where he stops and his kids start.

You can see it in everyone but you

A child can’t defend herself from a parent with no boundaries. But an adult can. If you grew up with no boundaries, you marry someone who also has no boundaries. The signs are everywhere when you meet someone. Something as basic as asking for money early in a relationship is a red flag to everyone outside the relationship. The person inside it can’t see those flags.

This is the disorder: not just that we see crossed boundaries in other people’s lives but not in our own. But also we don’t believe that we don’t know what we don’t know.

So let’s say you leave and find someone different. They won’t be different because you can’t value a skill you can’t see, and the people who have good boundaries expect that from their partner. Also, don’t tell me you married your opposite. Anti-conformists date other anti-conformists, which is why they all look alike. Everyone marries someone like them. You’re better off figuring out how your partner is like you than explaining how they aren’t: that’s how you’ll learn about yourself.

Nino and I were both neglected. I felt unloved and lonely, so I made sure to always there for my kids. I quit my job to work from home, homeschooled, chose where we lived based on the kids. I was always veering close to enmeshment. I thought I escaped my parents’ neglect by doing the opposite. But really I brought that inability to see boundaries into my own marriage.

Nino grew up with an only child who didn’t do child things – the parents treated him as an adult. So to Nino, a family organized around the children felt like there was nowhere for him. From the outside it looked like narcissism: I worked all the time and he was disinterested in the kids. Inside, we were two people who wanted desperately to feel closeness and love and didn’t know how to get there.

Annoyance is part of love

First you’re infatuated, then you find out what’s annoying about the person, then the annoyingness feels like an emergency you have to fix. If you stay past that, the annoying thing becomes something you understand about the person. And only then does it become something you understand about yourself, because you picked them.

Divorce was terrible for me and Nino which is maybe explained by people with anxious attachment don’t bounce back divorce. And guess who has anxious attachment? Couples with narcissism.

I read that sharing meals stabilizes a family more than money does. I stopped fighting with Nino about money and now we eat together almost every night. I’m not saying dinners are perfect, but they’re closer to perfect than divorce. Because you can’t learn to do boundaries by getting rid of the person you can’t do them with.

The post Why is my life full of narcissists? appeared first on Penelope Trunk Careers Blog.

I tell Natalie I’m not calling 911 until she sends the thank-you note for yesterday’s job interview. I tell her, “I’d rather die from a heart attack knowing you sent that email.”

She tells me I sound like the people who stayed at their desks on 9/11, and she dials 911 herself.

The EMT asks if I have medical conditions. The list is too long, so I say no.

Natalie says, “She has autism.”

They ask me how bad the pain is. I have no idea what to say. Relative to childbirth? A one. Relative to how embarrassed I am for calling 911 for a heart attack? A three. I think my embarrassment is a four.

We are two blocks from a world-renowned hospital because it’s Boston. I have thought about many scenarios where there’s a terrorist attack and I’m okay because there are so many doctors in Boston that the whole city is a triage unit. I tell the EMT I can walk to the hospital.

“Mom, no. You are not walking to the hospital. There are people here to help you.”

I shield my face while they wheel me out on a gurney. Really I’m just embarrassed. I’m too young to be having a heart attack.

The EMT wheels me into the ambulance and asks if I’ve ever had a panic attack.

I consider telling him he should not minimize women’s medical symptoms. But the ambulance quarters are too tight for soapboxes, and likable people get better medical treatment. Not that I’d know. For me the idea is aspirational. So I tell him I had a panic attack right after 9/11. “I was there,” I say.

He says, “Then you’d probably recognize it now, right?”

Wait. What? We are not going to talk about 9/11? If he were my age he’d tell me where he was that day. If he were a millennial he’d say, “Wow. I’m sorry you had to go through that.” But he’s Gen Z. He doesn’t care.

I feel grateful that Natalie always looks for exits. It’s her Gen Z nod to my incessant training.

Natalie says goodbye. The EMT takes my pulse. I tell myself I have to treat myself like precious cargo. I wouldn’t walk toward burning buildings like I did on 9/11, but I feel that feeling coming back: It’s so over the top to fret about my own wellbeing.

I think: What would Kim K do? She has a grand sense of self, and she would feel it was very important to have someone rule out a heart attack. I channel Kim’s self-esteem long enough to settle into my gurney.

Z calls because Natalie called him. He asks if I have a will. I tell him I’ll be fine. He asks me to put the EMT on the phone.

I remember when I ended up at someone’s apartment on the Upper West Side after 9/11 and Nino told me to put someone else on the phone. When he tells the story, he says when he finally got me on the phone I sounded completely out of my mind. I wonder if Z thinks I’m completely out of my mind right now, or if he’s just internalized the routine from hearing the story so often.

At the hospital entrance there are four people on ambulance beds. I think it’s the maybe-I-had-a-heart-attack entrance. The guy next to me tells the nurse he got off a plane because he wasn’t sure if he was having a heart attack, but he didn’t want to be in the air. I feel less alarmist about calling an ambulance.

The guy’s voice has the spunk and verve of a football announcer. The nurse asks what medicine he’s on and he explains the list by way of surviving brain surgery and stomach cancer. He’s a living miracle. I try to look a little perkier, like we’re all living miracles. But I can’t muster it. I have to work on not dissociating so much that I forget why I’m here.

They call my name and I realize that when I die I’ll die as Adrienne, not Penelope. There are no pen names in the ER.

Now a nurse is hooking stuff up to my breasts and there’s an understanding that I’m too old to flinch or take cover. Then she asks, “Did those socks get dirty from walking around here?” I tell her I forgot shoes. But really they’re always that dirty.

There’s a mom with two little boys. The kids keep asking about their dad. The mom says they can see him soon. They ask and ask until she gives them paper. One boy says, “What should I do?” The mom says, “Do some j’s and b’s.” I’ve been in that mom’s position for so long that I have to remind myself I’m not anymore.

I wish I brought my laptop. So I must be fine now. Dying people don’t ask for their laptop.

Though I wonder if I might, because I wrote during labor. The second time, when I got an epidural. The first time I was ignorant enough to commit to natural childbirth even though the doctor induced labor. I told Nino, “Don’t let them give me an epidural. It’s us against the nurses.” But I told him that in the first trimester, when I still thought a mom had control over the baby. In labor and delivery the pain was so bad I told Nino to get me a gun. If you’re wondering what Nino did, he did nothing. He just sat in the chair for the dads.

My chest still hurts.

I think I might be having a panic attack because I’ve had a plan for two years to do something for the 25th anniversary of 9/11, and it’s two days before and I have nothing. Well, I have two suggestions from the kids.

Natalie says I should write about new evidence that New York knew the air after 9/11 was unsafe and told people to go back to work anyway.

I ask her, “What’s your point?”

She says, “The point is our government killed more people cleaning up 9/11 than the terrorists killed knocking down two buildings.”

Z says I should write about how when his friends need an example of why his family is weird, he tells them his mom was at 9/11. He says, “The real reasons would overwhelm them.”

I’m scrolling through 9/11 notes on my phone looking for where there’s a story. The nurse tells me my bloodwork is fine. She says, “It’s good you came in. At your age you shouldn’t take any risks with your heart.”

I nod. They discharge me.

Nino walks me home from the hospital. He tells me Gil Scott-Heron came up on his feed.

“Who’s that?”

“Remember? He’s the poet who was arrested when I volunteered in the jail after 9/11. The security guard asked for his autograph.”

“What? I don’t remember that. I think you told someone else.”

He says, “Who else would I have told? There’s been no one but you.”

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Yiyun Li’s older son, Vincent, killed himself in 2017. He was sixteen. She wrote a book about him. Her younger son, James, killed himself in 2024. He was nineteen. She wrote a book about him too, and that one won this year’s Pulitzer Prize.

Between the two deaths were six years, and Li has described them herself: James was lonely for all six of those years, she said, with a loneliness no mother could do anything about. Vincent had been nearly the only person James talked to. After Vincent died, James mostly stopped talking. When James was six he told her he suffered from monophobia, an extreme fear of loneliness; he had looked the word up so he could describe himself to her accurately. And for the six years after his brother died, James didn’t cut his hair. He grew it the way Vincent wore his.

She also tells us what she did during those years: “I did not stop writing or take time off from teaching.”

People read that sentence as resilience. But it’s neglect, because there was a child in the house. And when that child killed himself too, the most educated people in America gave the book about him their biggest prize. And even now, Princeton presents Li to students as a mentor.

We have a whole vocabulary for bad mothers and we use it every day. A poor mother who leaves her kid unsupervised gets a caseworker in her kitchen, a court date, mandatory parenting classes. Ruby Franke put her kids on YouTube and people spent years calling her a bad mother, and when one of her children escaped through a window, malnourished, she went to prison. Nobody said “parenting is complicated” or “we shouldn’t judge.”

We are happy to judge parents, but we means-test the judgment. Poor parents can’t get government services without being judged. Middle-class parents can’t put their kids on the internet without being judged. Above a certain income, judgment becomes structurally impossible, because every adult positioned to judge the parent is either paid by the parent or outranked by her.

When I wrote about what women in high-paying jobs actually do about childcare, I said the president of Cloudflare has a stay-at-home husband. Her PR firm contacted me to say I needed to fact-check: her husband is a startup CEO. I asked: if that’s the case, who takes care of the children? No reply. Poor parents get caseworkers. Rich parents get publicists.

A poor family in crisis triggers mandatory reporters — schools, clinics, caseworkers. Strangers are entitled to ask what is happening inside the house. A rich kid who stops talking is surrounded by mandatory reporters — school, psychiatrist, coach — but all of them answer to the parent. The parents gain privacy, and it’s the kid who pays for it.

Li taught at Princeton. Vincent went to Princeton High School. James died there as a freshman. No family was surrounded by more people trained to recognize risk. And the family’s risk wasn’t even private. Li had already published a book about her two suicide attempts, back when her sons were young. What the people around her did with it was treat her continued productivity as evidence she was coping.

Where was the father? He was there for all six years too. Somewhere in those six years, someone should have said: James is the emergency now. He needs to be somebody’s entire job. There were two parents in that house and two full-time careers. Nobody said that to either of them.

Ok, back to the prize. I believe Li’s books are great, but that makes it worse. Because when it comes to judging parents, the better the writer, the bigger the exemption. And it’s why our award system is rotten: prizes can only measure output, and nobody can win one for stopping.

I know because I stopped. My kids demanded final approval of what I write about them, and the years right after that were the least productive of my twenty years of writing. I had to rebuild how I write, and why I write, which meant failing in public. There is no award for the book you don’t write because your kid said no.

We absolve every accomplished parent with one of three sentences. Susan Wojcicki ran YouTube and her husband was a director at Google; after their son Marco died of an overdose at Berkeley, his sister said his friends knew far more about his addiction than his family did. We didn’t know. Patrick Radden Keefe tells the story of Zac Brettler, who accumulated a chauffeured limo with unexplained money, and an invented identity in front of his parents before he turned up dead at nineteen. We didn’t understand. Toni and Allen Plante’s daughter Ana was “really afraid to be away from us” in kindergarten; her parents decided she was shy and kept working. After Ana started trying to kill herself, then came psychiatrists, hospitalization, medication, locked knives. She died at fifteen. We did everything.

We didn’t know. We didn’t understand. We did everything. Those three sentences answer the same question: when the parents found out.

A kid in crisis finally puts a spotlight on the parents, and the parents start behaving — that’s what the psychiatrists and the locked knives are. We did everything is true about the year under the spotlight and says nothing about the twelve years before it.

Suicide prevention is staying home with a five-year-old who is terrified to be away from you. Parents and kids need to practice their connection, and establish that it’s always there. You build that connection with time and energy. The exact same thing a career requires.

A child is not somebody’s primary responsibility when the child has to compete with two careers for time and energy. Somebody has to choose the kid. Educated women already know this, which is why they’re more likely to assign primary caregiving to themselves or marry a full-time caregiver. Parents who spend their kids’ childhoods on their own self-actualization raise kids who do the same thing to their kids — it runs in generations.

A two-year-old who cries learns that trouble is something you take to whoever picks him up. If that’s you, he becomes a six-year-old who tells you a kid hit him, a twelve-year-old who tells you he’s lonely, a sixteen-year-old who tells you he wants to die. You can’t build that when your kid starts talking about dying. So beware of saying I didn’t know. It’s an assessment of your parenting, and it’s not good.

Don’t tell me it’s cruel to judge a grieving mother. Grief doesn’t retroactively make the parenting good. We refused to judge her, so nobody protected James.

We have mandatory reporters because otherwise people look away. But most bad parenting never reaches the threshold that forces somebody to report it. Everybody just watches.

Think of the family you know where something is wrong. The kid who is lonely, terrified, disappearing, using drugs, begging not to go to school. Did you tell the parents they were the problem? Or did you help them keep believing they were doing everything they could?

The people around Yiyun Li helped her keep believing.

We should all be mandatory protectors of children.

The post We only judge parents who can’t fight back appeared first on Penelope Trunk Careers Blog.

Dewey vs. Truman (The Great Debate) by Norman Rockwell (1948)

People go to marriage counseling because they think their partner doesn’t understand. But your spouse understands you just fine; they just don’t like what they understand. They don’t like that the thing they’ve explained to you forty times has somehow failed to turn you into a different person.

The evidence for lasting effects of marriage counseling is much less impressive than the cultural faith we put in it. Therapy can change how you understand someone but it’s not very good at changing who that person is. Which means the useful question is not: How do I get my partner to change? It’s: What if they don’t?

I coach a lot of couples, which you might think is shocking since two men divorced me. But I have three useful qualifications: disappointment, adjustment, and personality type. I have extensive experience with the first two, and it takes me about five minutes to tell two people what they will fight about for the rest of their relationship.

The thing you most want your partner to change is usually the thing you’ve decided is unreasonable. But if it were merely a bad habit, they’d have changed it already. The quality you cannot stand now is attached to the quality you loved in the beginning; distinctive parts of someone’s personality are the parts you notice first and the parts you keep noticing forever.

But this doesn’t mean you made a mistake, because there are no conflict-free personality matches: Opposites cover enormous amounts of territory for each other, but each person spends a lot of time operating in the other person’s blind spot. Similar people understand each other more easily, but they want control over the same territory while neglecting everything neither one likes doing.

Here’s a couple I coached this week (who agreed to be an example).

He’s an ISFJ. She’s an ENFP. They want to spend more time together, so they’ve started meeting at the gym. This is going terribly.

The ENFP walks into the gym and looks around for something that interests her. Maybe today she’ll do sit-ups because she can suddenly envision herself having great abs. The ISFJ has arm days and leg days. He knows which exercises produce which results. He looks at her wandering around the gym and sees inefficiency. She looks at his program and sees imprisonment.

Neither of them is doing the gym wrong. They disagree about what it means to do anything well. For the ISFJ, mastery comes from depth: learn the proven method, repeat it, refine it, get better. For the ENFP, mastery comes from understanding possibilities: make connections, try something interesting. Once the concept is obvious, endless execution feels like overkill.

This same fight shows up everywhere: vacations, children, money, restaurants, businesses, the kitchen. The useful part of personality type is that the argument stops being evidence that your spouse is insane. Ask this important question: Does your partner actually like doing it their way? Usually the answer is yes. No one is secretly waiting to be rescued by the other person’s superior system.

Good couples coaching doesn’t eliminate the conflict. It eliminates the fantasy that the conflict will disappear once the other person finally understands. This is why the most useful couples counseling might happen before marriage, when you can ask: Do I want to have this fight for forty years?

Most of us don’t ask. So later the work becomes coming to terms with what we chose. Which brings me back to my primary qualification for couples coaching: disappointment.

You can survive an astonishing amount of disappointment once you stop treating it as evidence that something has gone wrong. And sometimes disappointment is just what reality feels like after you finally understand it.

Personality Type Office Hours

My next personality type office hours will be Friday, Sept. 18, at noon Eastern. We’ll talk about using type to decrease conflict in relationships. There will be disappointment. But it’s a group, so there will also be schadenfreude.

New This Week

• ENFJ: Who gets the best of you?
• INFP: You’re stingy with sincerity
• INTJ: Am I boring you?
• ENFP: A job is not a personality test
• ENTJ: Stop making lists of companies you could launch
• INFJ: You overvalue the ability to change

The post Your spouse understands you. That’s the problem. + New personality type posts appeared first on Penelope Trunk Careers Blog.

Last week I wrote about Lindsay Clancy’s postpartum psychosis. I was excited about the case because the mental health profession would be challenged. Now, after two weeks of reading transcripts and listening to testimony, I think I missed the most important thing: motive. Her husband, Patrick, was having an affair and three weeks after the killings he vacationed with his girlfriend in Costa Rica.

The trial is two questions: did Lindsay do it, and if she did, could she understand it enough to stop it. Lindsay has pleaded not guilty. She has never said she did it. What she says she remembers is not a confession: she does not remember locking the door, she does not remember moving furniture, she felt like she was watching someone do everything to her. The prosecutors decided it was a confession. I think Patrick killed the kids and he tried to kill her.

Here is the math that convinced me. Patrick says he left the house at 5:25 pm and confirmed the kids were alive. A neighbor’s camera shows Lindsay lying motionless in the snow under the bedroom window at 5:50 pm. Patrick called 911 at 6:11pm. The paramedics arrived at 6:16 pm and all three kids shows signs of strangulation. But one of the three kids was still alive, and according to the forensic pathologist, that child could not have been strangled earlier than 6:11 pm — far past the time Lindsay’s neck was broken. Also: The state police analysis did not find Lindsay’s fingerprints on the knife or the bands.

Patrick testified on day one and two for the prosecution and was supposed to come back on day 16 to testify for the defense. The jury arrived, and then the jury went home early, because Patrick didn’t show up.

Only Patrick’s mother showed up that day, and her testimony was the saddest moment of the trial. She said Lindsay was a wonderful mother. She said she texted with Lindsay every day. The prosecution told her Lindsay said she rarely heard from her mother-in-law, and she seldom spent time with the kids. Then the defense showed the mother-in-law the texts. It was clear in that moment that she had been texting with Patrick, posing as Lindsay, and he told her not to come help out. The look on Patrick’s mom’s face was pure devastation.

Millions of people online are more powerful than corrupt police on the scene. Remember the Karen Read case? The internet said the wrong person was being prosecuted because the real murderer was friends with the police. The internet was right. A blogger did an independent investigation every day for years, and the crowd found what Read’s lawyers needed for a not-guilty verdict. Gabby Petito’s case is another example: police treated domestic violence as a minor spat and did not investigate; the internet followed breadcrumbs online to show her boyfriend murdered her.

What about Patrick? Public records show he sold the family house — with everything in it — to a former Plymouth County assistant DA. When prosecutors wanted the jury to view the house, the new owner objected. The internet found that record too. Millions of people, checking each other’s work, are hard to beat.

The hunch is the last legal skill that can’t be automated. Most routine legal filing can already be done with AI. The lawyer AI talks, the opposing AI responds, the court AI confirms everyone did what they were supposed to. But AI cannot investigate crazy theories. AI cannot decide someone is probably lying on a hunch, because most people’s lies are crazy, and there is not enough training data on the crazy ways people kill their families. And AI turns out to be very good at confirming hunches: find every photo on the internet of one hotel on one night in December 2022. Every time new evidence gets released, the crowd extracts more from it than the state did.

Court TV is the new reality TV. Jersey Shore was groundbreaking because the people in it were not self-consciously reality stars; once reality TV became a launchpad for personal brands, it became formulaic. In a courtroom the stakes are real, nobody controls the edit, and we watch the truth unfold at the same time the people in the show do.

Crowdsourced evidence is a new form of participatory democracy. The watchers become investigators. As our power to affect the executive branch wanes, our power to influence the judiciary increases. E. Jean Carroll won against Trump when Congress could do nothing.

Philosophy will replace CS as the go-to major. CS is about facts, and AI does facts now, which is why even at MIT people are walking away from the major. Philosophy is the questions above the facts: what counts as a fact, what a fact weighs, who owns it. The prosecution had every fact in this case — the heart rate, the timeline, the fingerprints — and couldn’t string them together, because stringing facts together requires a point of view about which ones matter. The prosecution had the most facts in that courtroom. but the internet had the point of view.

The post What the Clancy trial reveals about the future of work appeared first on Penelope Trunk Careers Blog.

Lindsay Clancy is on trial for strangling her three children, but her lawyers are putting the mental health system on trail. Clancy had three psychiatrists prescribing medicine at the same time. She had twenty prescriptions simultaneously. One of the prescribers had never had a postpartum psychosis client. Another did not know Clancy had been diagnosed with bipolar disorder. All the prescribers could have looked at Clancy’s records and they didn’t.

Mere mortals are unable to challenge the mental health system. Clancy is an experienced nurse and she kept incredible records of her own treatment — qualitative and quantitative. Her records are more thorough than the doctors’, which is why she can challenge institutional mental health providers.

Husbands, take notice. Every trial about postpartum psychosis has a spouse who was oblivious to how serious his wife’s condition was, and he left the mother alone with the kids. Andrea Yates’s husband left her alone with the five kids for an hour every morning even though her psychiatrist said to never leave her alone with them. Clancy’s ex-husband (he’s ex now that the kids are dead) said he had never heard the word psychosis before she killed the kids. But Lindsay was googling questions about psychosis long before the day of the killings. He thought the mental health issues were hers to handle. Meanwhile he was taking control of other things: he decided that if Lindsay was not going back to work, he would fire the nanny.

I noticed this right away because I had postpartum psychosis. It happened after my second kid. The first had already been diagnosed with autism, and at three years old we attended early intervention 40 hours a week. My second was born with a major facial deformity: hemifacial microsomia. We had a team of sixteen doctors to address the problem. I was so scared I wouldn’t bond with the second kid that I never let go of him. Held him all day.

I was also working. Nino was laid off, and I was supporting us by writing. I wrote a column right before I received the epidural. But months later I couldn’t write anymore, so I was submitting articles that had already been published. I knew I would get found out eventually.

We were already in early intervention, so we had a social worker helping us parent. A week before my psychotic episode, Nino and I were sitting across from the social worker in our living room. I stood up to try to get the baby to stop crying. And while I was bouncing I said, “I want to just slam the baby’s head into the wall.”

The social worker stood up and said we need someone else to support our family.

I remember feeling abandoned. But only for a second. Because the baby was crying.

Nino and I were together most of the time. He managed the older kid in therapy, and I went there, holding the baby, not wanting to miss talking with the therapist or time to bond with the baby. We were like a parade.

At night, Nino put the older one to bed, then he sat in the kitchen, because we were in NYC in a 500-square-foot apartment and the living room became the bedroom at night. I was holding the baby and doing the dishes, slowly, with one hand. And I picked up a knife and pushed it into my head. I remember it not getting in. Like, my skull was too strong. So I pushed harder. Slamming the knife like I could make headway.

Nino took the baby from my arms. He called 911. I screamed that he couldn’t take the baby. So he told me to put the knife down and sit in the chair and he’d give me the baby. Then the ambulance came.

He stayed with the older kid. I went to the hospital. In the ER I said I wouldn’t leave the baby.

They told me it was okay to leave the baby to go to the mental ward. “The baby needs you to be safe and healthy,” they told me.

I told them I won’t bond with the baby if we separate. “Look at his face,” I said. “It’s a mess. I am scared he won’t feel loved.”

One nurse stayed with me. Then a social worker. People had conferences. I remember feeling like I hadn’t slept as well as I was sleeping in the ER, under constant surveillance and ER chatter all night long.

People told me I can’t go to the mental ward with a baby. So I said I’m not going. People tried to explain how serious it was. I tried to explain how messed up his face was.

Finally the doctors agreed to let me stay in the ER. They were not allowed to release me when I was a danger to the child, but they wouldn’t be violating the law if they let me stay in the ER. I had a bed, and a social worker, for three days. It was support I could not get when I had two kids and a husband and 40 hours of therapists all over NYC.

The hospital called Nino and told him I couldn’t be alone with either kid. I remember thinking that sounded crazy. We can’t do that.

But we did it. Nino took one kid to multitudes of therapists, and I stayed at home with the baby and a nanny. The nanny was $75 an hour because we had to use an agency — we needed one on no notice — and we needed someone who was okay being in charge of not letting me use a knife again. Or anything else.

It took a community, and both our 401Ks, to care for two special needs kids without letting me be alone with either one of them. I used to think we were so irresponsible for cashing out the 401Ks. So irresponsible for neither of us working. Now I’ve seen what happens when a spouse continues going to work in the face of postpartum psychosis. It’s a full-time job to allow a mother to keep bonding with the baby and keep parenting the other kid while still maintaining awareness that she could be dangerous.

I want to tell you I was annoyed by the surveillance. But it was so, so scary how quickly I put the knife in my head. It was so, so scary that I could have been separated from my kids. I just wanted to feel like that wouldn’t happen again.

As years passed, foggy memories made me wonder if the psychosis really came on that fast. How could I be caring for the baby one second and putting a knife in my head the next?

Then I was in the emergency room with Z for his traumatic brain injury. His headaches were so bad he was vomiting for the second day straight. They gave him an IV of anti-nausea medicine and I sat by his bed holding his hand.

All of a sudden he told me he needs to rip out the IV. He said he needs to get out of his skin. He scratched at his body. He was yelling: “I need to get out.”

I said, “You’re okay. The medicine works. It will get better.”

He said, “Get away from me or I’ll kill you. I want to kill everyone.”

I opened the door. Said to the first nurse I saw, “My son’s trying to take out his IV and he’s telling me he wants to kill me.”

Ten nurses and doctors were in the room immediately. They were holding him down. He was screaming, “I need to tear off my skin! Let go! I’ll kill all of you!”

I was standing in the doorway saying things like, “He’s a good boy. He practices cello six hours a day. He never breaks rules. He’s such a nice boy.”

No one was listening to me. But five minutes later they told me and Z that psychosis is a known side effect of the medicine he was taking. Akathisia. That’s the word they used.

I didn’t realize it was psychosis until I was listening to commentary on the Lindsay Clancy trial. I felt a little like her husband: I did not know Z had psychosis even though I was standing right there.

I am so lucky I had the doctors in NYC who kept me in the ER with my baby. Lindsay was upset being away from her kids. I would never have taken medication because I would have had to stop breastfeeding. But Lindsay wanted to get better so much that she took the medicine.

Pay attention. This trial affects you. You need to understand psychosis so you know it when you see it. And pay attention to who is going online to criticize Clancy. They are mental health providers who don’t want to believe they’re in a corrupt, poorly regulated industry. But they are.

Lindsay Clancy is going through hell in this trial. But she’ll save so many women from going through hell themselves.

The post The mental health system is on trial with Lindsay Clancy appeared first on Penelope Trunk Careers Blog.

1. When a school tests your kid, that’s not really testing. Even the most high-functioning autistic kid is very, very expensive for a school district, because that kid has the right to so many extra services. Schools don’t like to spend money on one kid. So schools do the bare minimum: test for a narrow range of issues and default to “your kid is fine” unless the kid is disrupting the classroom.

2. Schools don’t have to help your kid make progress. Schools have to make a reasonable effort to help your kid make progress. So schools tell you “we love your kid” and “your kid is doing great” and anything else they can say so you don’t sue. There are about ten schools in the US that make a reasonable effort. That’s why when parents sue a school for not meeting the standard, the school loses.

3. Even private evaluators don’t want to tell you the truth. It’s too much work. A private evaluation is more thorough than a school evaluation, but evaluators still won’t tell you everything, because you’ll argue. If they tell you your kid has gait problems and you’ve never noticed, they don’t want to fight with you about how gait affects school success. If your kid has pragmatic language issues, they don’t want to spend an hour teaching you what pragmatics are and why ignoring the problem means your kid can’t get help from teachers.

4. An evaluation without parent support does nothing for your kid. Research shows interventions don’t help children unless they come with support for the parents. But most evaluators hand you a report and disappear, because writing a report is 1000 times easier and more profitable than supporting a family. So why am I telling you to get your kid an evaluation anyway? Because the evaluation was never for the school, and it’s not even really for your kid. It’s for you, the parent.

5. A private evaluation is how you manage the school. The school doesn’t work for you, so you need someone who does. You cannot see your own kid’s learning profile intuitively. A kid with dyslexia has ADHD. A kid with poor working memory has gait and vestibular issues that affect attention. It’s all interwoven, which is exactly what the school doesn’t want you to know, because the costs add up fast. Your kid has a right to those services, but you can’t advocate for a kid you don’t understand.

6. The IEP preserves your kid’s rights — and teaches your kid to use them. You might think your kid doesn’t need an IEP. Consider that 20% of kids in the Ivy League got extra time on their SATs. That’s because smart parents of smart kids advocate for their kids effectively in school, and it starts with the IEP. It’s also where your kid learns self-advocacy: kids who understand they’re autistic at an early age do better in college because they understand how to manage their environment. In grade school, you model advocacy. By high school, your kid practices on their own.

7. The stakes are too high to skip this. Autistic kids are six times more likely to attempt suicide than neurotypical kids. The best protection is using the IEP to remove structural stigma at school — and you can’t remove what you haven’t identified. That learning process starts with the evaluation.

Bottom line: you don’t get an evaluation to find out if your kid is autistic. You get an evaluation so you can get an IEP, understand your kid, and model self-advocacy in a world full of structural stigma. Also, recognize that kids today are much more accepting of autism than your generation, so your fear of labels might actually be part of the stigmatization you’re trying to shield your kid from.

But remember rules 3 and 4: an evaluation is only as good as the evaluator, and an evaluation without ongoing parent support leaves you hanging.

So I’m having a live conversation with my favorite evaluator, Megan Cawlfield. I’ve worked with families all over the US, and every time a family needs an evaluation, I bring in Megan. That picture up top is Megan mid-evaluation, teaching a parent how about their kid’s movement. Megan and I will talk about how to get an evaluation so strong that it helps everyone in your family, and how to turn that evaluation into an IEP that works.

If you’re considering an evaluation or an IEP — or the school told you your kid is fine and you don’t believe it — join us Friday at 10am Eastern. It’s free if you’re a paid subscriber. Bring your questions. This is the conversation the school will never have with you.

The post Most autism evaluations are useless. Get one for your kid anyway. appeared first on Penelope Trunk Careers Blog.

Two years into Z’s head injury we went to a pain clinic. The program was for families with a teenager in chronic pain, and people flew in from all over the country. Z was the only musician who couldn’t play music anymore. But there was an all-state field hockey player who hadn’t played in years but still went to every practice. There was a girl who’d been a ballerina her whole life and then suddenly couldn’t dance: she’d grown half a foot, and now her body was built for basketball. Her proprioception was off and now movement felt like violence.

About an hour in, I understood two things. First, everything they were telling us to do was what doctors had been telling me to do for Z for two years — and I hadn’t been doing it, because the things are boring and I didn’t trust them and I wanted there to be something else. Second, every parent in that room was autistic. The whole program was a parent intervention. The kids were only there because no parent would come to a thing called What You’re Doing Wrong.

Leading up to this: doctors kept telling me that Z feeling pain didn’t mean his brain was getting more damaged. He’s feeling pain? We’re done. Stop the exercises. Then the pain would feel worse, and Z and I would demand new tests, and the tests would show nothing was getting worse, and I’d be so angry I wanted to sue everyone. That exact story was all over the room: parents hunting for some other cause, because the remaining explanation was us not following orders.

Here’s the science the clinic taught, which I could finally hear once I understood whose intervention it was. Pain is output. It’s not a meter reading damage — it’s your brain issuing a signal, and the brain learns what to issue. Touch a stove, and a normal brain files it away: don’t do that. A perseverating brain files it differently: there’s a stove in this house, there’s a stove, there’s a stove.

One in four people will have chronic pain at some point, and most of them adjust, some without ever calling it chronic pain. What makes pain take over a life isn’t usually the injury but the brain not being able to redirect. And low ability to redirect is the definition of autism.

Also, autistic people have a survival skill of mislabeling our own sensory wiring as toughness. Me: I don’t feel heat and I get burned all the time. That’s not high pain tolerance, that’s sensory integration dysfunction — missing output. Meanwhile I process cold as actual pain and wear a coat in weather nobody else considers weather. Too much signal, too little signal, never the normal amount: that’s autism in every domain. Pain is one of those domains.

The clinic also said something I haven’t stopped thinking about: chronic pain patients are the loneliest people there are, except for autistic people. Loneliness isn’t a mood, it’s a disorder, and it travels with chronic pain — which means an autistic kid in chronic pain is getting it from both directions, and his brain treats the pain and the loneliness as one fused thing. The longer nobody intervenes, the better the brain gets at reminding him. The pain isn’t worsening. The brain’s commitment to it is.

So what works is exactly the list you’ve been ignoring your whole life: exercise, regular sleep, going outside in daylight, eating like an adult, seeing people. Plus one trick that sounds fake and isn’t — when the pain spikes, put your whole face in cold water. It switches the brain off the pain channel. Not for long. But doing it every time teaches the brain there’s no reward for ringing the alarm, and the alarm rings less.

CBT doesn’t work for autism — it runs on the frontal cortex, and if we could leverage self-discipline to change our lives we wouldn’t have autism. But chronic pain is the exception, because pain functions like an external deadline. We can’t do discipline for abstractions; we can do it when something is ruining our lives in a way we can feel. The clinic’s whole bet is that the pain itself supplies the urgency the autistic brain is missing. It’s the only context I know of where CBT works on us.

So the clinic worked on us, eventually — but not because the science was new. The science fits on a post-it note. What took two years was the diagnosis nobody was willing to say out loud: the kids weren’t refusing treatment, the parents were. Every demand for a retest was me looking for a cause that wasn’t me. The program never confronted us about it, because you can’t — we’d have left. They just kept calling it a clinic for teenagers, and waited for each parent to look around the room and recognize the place.

Z kept in touch with the kids. The compliance problem was ours — the parents enforce the rules or nobody does. But parents can’t fix the loneliness half, and the clinic knew it: the kids left with a group chat, the only other people on earth who understood chronic pain. It didn’t last years. It didn’t need to. Each kid got to watch the others move forward.

I’m starting a small group for autistic people with chronic pain, because I want to see what happens when we talk about the pain without having to explain the autism first — the sensory problems, the perseveration, the routines we can’t change, the loneliness, and the constant question of whether to listen to your body or teach your brain to stop sounding the alarm.

We’ll meet on Zoom once a week for six weeks. There are four spots and two are taken. The cost is $195.

If you want one of the last two spots, reply to this email and tell me a little about yourself. We’ll pick a meeting time that works for all of us.

The post I took my son to a pain clinic and every parent there was autistic appeared first on Penelope Trunk Careers Blog.