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Introspections   |    
Pater Familias
William Houghton, M.D.
Am J Psychiatry 2004;161:807-808. doi:10.1176/appi.ajp.161.5.807
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Alexander Doyle strides in wearing the bulky Harris tweed sport coat that he bought himself as a reward from a British mail-order house. He’s talking after taking two steps into the room and heads for the big leather lounge chair.

"A bad week; too much happening. My genes are coming out all over the place."

I hold my tongue because I know how he tells a story. The plot will thicken.

"Maggie was home for the holiday break, you know, after her semester in Europe. We had a nice visit and last weekend drove her back to Kenyon for the final semester. Only two more payments! We hooked up the electronics in her room, and then she broke down crying—she has no friends, and what is she going to do? She couldn’t stop bawling, and we stayed an extra day. We got her to see a counselor at the student health service on Tuesday, and I gave the doctor a heads-up on Monday."

He pauses as if there is nothing more he needs to say. It’s a disastrous conclusion: Quod erat demonstrandum.

My sympathies are with this Alexander Doyle completely, one highly responsible father. His wife, Kathy, is just as dedicated. I see also the something extra Al brings to the process, a burden and point of view, which is what makes me useful to him. But I’m a father, too, and each of my three children has caused me painful worry at times. I know how Al feels and how kids morph.

Maggie is his all-star, soccer-playing, straight-A daughter, and here she is collapsing on him. Two years ago, his younger son, Michael, was found to have a drug problem and took an overdose. Al felt the chill of mortality. Mike spent months in Hazelden—only partly reimbursed by insurance—and Al visited biweekly. When a bipolar disorder was diagnosed, he researched it diligently and started an educational program on drugs and mood disorders at his office. Both his parents had serious depressions; his father had manic spells, too; Al took care of them for years until they died. Now the prolonged psychosocial moratorium of American adolescence is giving him an extended workout. He is tense and tired at times but not clinically depressed. He aims for equanimity but the daily shocks knock his gyro out of kilter. He’s a caretaker par excellence.

We have been meeting weekly the past year to talk about the stresses of living with Mike. Al is inclined to lecture his son about using medication properly, with variable success. I encourage him to talk with his son about music, philosophy, and girlfriends, too, figuring the meds are just a doctor’s chemicals and diagnoses are labels but a relationship with your father (or son) is something real you can put your hands on. Who wants to be "a bipolar" with your parents pushing drugs down your throat? At first I pictured Mike as a demon, smashing furniture. Then Mike came along with Al to an appointment, and I was surprised to see a well-dressed 15-year-old boy with an ear stud in the waiting room, quietly reading a Harper’s magazine. Reality always pulls a switch that is more complex and various than the headlines. So far, Mike and Al are doing OK. I really admire his aggressive dedication to helping his kids. I see so many who do the opposite. He’s a hard worker, and I let him know that I think he is doing a good job.

Now Maggie is coming down with the same thing? Al’s genes are coming out all over the place!

"It sounds like you’re covering all the bases," I say, "giving her support and making sure she sees a counselor, but is her situation exactly the same as Mike’s, and is this all the result of your genes, or could there be other factors?"

His wife went through a depression, too. Her genes may have been involved, he admits. "And I guess Maggie is rather different from Mike," he says, "with all her friends and academic record."

He rehearses again the events of the weekend and the things he and his wife did to keep her safe. The chill of death is never far away.

"I asked if she thought of hurting herself, and she said ‘No.’ I told the counselor at the health service, and she seemed to listen."

His father’s drunken rages haunt him, and sometimes he repeats the date in October when Mike took an overdose, marking the months elapsed.

"You must have been tired after such an emotional weekend," I say. "You did all the things you should, but I wonder if you were a bit frustrated with Maggie, dumping all this on you after you sent her on a great semester in Europe?"

"A little bit frustrated? We’ll be paying off that semester in Europe for years. And the next thing she wants is a car! In her dreams! There’s no way that’s going to happen."

Then his voice lowers with appreciation of his daughter. "She got excellent grades in her classes there. She learned a lot, and she’s quite an accomplished young lady."

"Which will probably pull her through," I say, "after she gets over her bout of senioritis."

"I was watching President Bush," he says, "and I thought of his problems with alcohol and his overcoming that. His sister died and his two daughters flipped out, too. Still, he carries on and is ready for anything."

Caught up in the drama of Al’s family, I see his vision of reform and perseverance.

The labor of the father is endless and thankless. He has a day job and a night job, too. Fusses all day, frets all night. The father knows death and the limits of things; the kids don’t. They dream that time is forever. He takes out the garbage. The poor chump has to make decisions, never knowing if they’re right or wrong. In fact, he’s pretty sure that both options will be seen as wrong by someone. Furthermore, he’ll be hated. Who wouldn’t be bitter? But he’s supposed to be warm and fuzzy, too. No wonder his smile is a little tight. A hero if he turns out right or handy to kick if wrong. Heavy lies the head that wears the crown. King Henry V longs to be Prince Hal again. The father is a fuel-efficient family van, container, navigator, and transporter that is guaranteed not to suffer vapor lock—the chief executive.

Fathers like us soldier on with the occasional backfire but no major malfunction—Al Doyle, George W., and me.

Address reprint requests to Dr. Houghton, 2437 N. Terrace Ave., Milwaukee, WI 53211; puck1595@worldnet.att.net (e-mail).

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