Wednesday, July 19, 2017

Snapshots: My Glory Was I Had Such Friends and Blue Whale

(1) My Glory Was I Had Such Friends is a memoir, the story of a lawyer who needs a heart transplant at the tender, life-affirming age of 25. We tune in at 50 when she needs another. The first donor heart is failing quickly, symptoms painfully communicating that she is in trouble.
Amy Silverstein's My Glory I Had Such Friends-- glorious

The disease turns unbearable, and she has endured a great deal. This is an emotionally strong woman, but we all have our limits. Pain medication can kill her, slow her heart to a stop. She is going it alone, white knuckling pain.

Not easy reading. But it is chick lit, and we love any book with the word "friends" in the title.

And Amy has friends, many of them, amazing women who will leave their daily lives to travel across the country, tend to her when she needs them the most.

How in the world does this happen? How are some people so blessed, or so lucky?
New from Harper-Collins

Once I asked a man why he married his wife. He told me that he had to marry her. She was the only one, outside of himself, who still had all of her friends from childhood. Not many of us can say that.

To have friends who will stay with you when your life is at its most challenging, this is nirvana, heaven on earth. As it is written, not sure where, but someplace holy, probably the Ethics of the Fathers, A close friend is better than a distant relative.

On Saturday, Shabbas, the last day of the week, almost finished with this biography, I'm looking around the sanctuary, checking out who is here, listening to the reading of the Torah, all the while wondering:
If, G-d forbid, I were in this position, sick and stuck in a hospital prison, waiting for a donor organ to come through, not knowing if it would or it wouldn't be on time, could I count on any of these women to fly to California and stay with me for a few days, then maybe come back and do it all over again? 
After all, being alone in a hospital room for months, isolated from the usual and customary everything, well, that's pretty depressing.

Amy has a rotation of super stars, and they are furious, no distressed, that she has lost her will to live. Her irritability, her anger, her pain, all of it is on the surface, she can't hide a thing. She is in agony, breathless. Her pacemaker, working to keep her heart beating, mercilessly, repeatedly sparks all night. It is electrifying, begins just as she dozes off. But her friends are there.

There will be a decision, and it is hard for some of us to even read about this, wanting, like Amy's friends, for her to choose life. Is there really any other choice? But she has a choice. She can legally let go, refuse treatment, choose death as an alternative. I want to close the book, stop reading.

But she writes too well. The book is beautiful, so stopping is impossible. As a coping strategy, Amy quotes poetry, by heart. (Who does that?) She never whines. You don't want her to die. You are her friend, too.

Not fair to spoil it any further, check out My Glory Was I Had Such Friends. Enough to say that it is a lesson in friendship, how to be a friend. It isn't easy.

(2) There's something else going on, the Blue Whale Game. This is painful, too. This is about who not to choose as your friend.

A 16 year old girl (her name is protected) kills herself, identifies with the blue whale, a species that voluntarily beaches itself to die.*

The girl has followed the rules of a Russian internet game, one that has claimed many teenage lives. The creator is a 21 year-old psychology major, Philip Budeiking, since found in Russia and arrested. But the game continues in other countries, has other administrators, or "curators."

News sources have reported two teenage suicides in the United States associated with Blue Whale Game. There are likely more.

The "game" takes place over 50 days. The curator gives players daily tasks to accomplish and requires them to submit photographic evidence that they have completed each, keeping their communication private.

The tasks leading up to it include watching horror films, cutting their lips, incising an image of a whale on their arms, sitting on the highest rooftop they can find, legs dangling. The are to visit the ocean, find railroad tracks.
. 
. . .the curator sends teens to scope out the location of their deaths in advance as one of the challenges. . . Each task becomes riskier.

The final task is to kill yourself. Jump.

130 teen suicides could be linked to the game, because almost all the victims were in the same internet group. However, it later said that only 80 of those could be proved . . . definitively linked to the game.

Oy vey. Eighty validated suicides related to a . . . game.

Teens are told that once they begin the game, there is no turning back, that the curator knows who they are and he will come after them.

To see a list of all 50 challenges, go to Youtube.com.  Suffer through the info-video by Anonymous titled Blue Whale Group Exposed- 2017 #OpBlueWhale.

 


I just couldn't bring myself to link to it, or embed it. This is too scary, too upsetting. They have enough attention already, these sociopaths.

But tell everyone you know about the Blue Whale game, because people have to know these things. Warn friends, talk to parents, and especially talk to children.

Maybe it has never been harder to be a parent, or perhaps, even a child.

therapydoc

*There are many reasons that the blue whale might beach itself, none proven conclusively.

Thursday, July 13, 2017

The Art of Fear

A friend of mine was telling me over a piece of Torah (This could be anything learned from the Jewish holy books, from the most complex argument, to a simple story.) He added that on the day he learned it, he also came across the same lesson from a different source. And then it happened again, the very next day, same lesson, while reading something secular. 

Cool, right? We both said it at the same time. But a part of me thought, Or random. What my friend is referring to is Torat Emet, a sign, repeated pointers, to the truth of the lesson. The emet. It is a spiritual thing that manifests in the real world.

Knowing this, while reading Kristen Ulmer's book, The Art of Fear I had a similar experience.

Otherwise it would be easy to dismiss this bio-self-help book, like my professional self insisted. Because Ms Ulmer isn't a mental health professional, and she cites no research or empirical validation of her methods. The Art of Fear is about the lessons she has learned from life as an extreme skier, as the first woman to break into extreme ski jumping, or simply, flying off mountains. On skis. She's learned much from her Zen master, and we could say that this teaching, her book, is her Torah.

So two things happened in that odd, spiritual way, that pointed to taking Kristen's work seriously, one anecdotal, the other clinical. We'll get to them. But something is bothering me. There's a huge problem, and it is laced within the pages of The Art of Fear. It isn't content, not the lack of empirical evidence back up her own claims of treatment efficacy, but an opinion, a slap in the face, a narcissistic injury. Our author dismisses the whole of psychotherapy, all of it, behavioral treatment, dialectical, cognitive therapy, everything, you name it, based upon a handful of visits to a psychiatrist and a therapist. She thinks that time spent with people like me, or maybe you, too, the clock ticking dollars and cents away, is time and money wasted.

What, Kristen, you didn't think we'd notice?

A short rant to the author is in order:
My life, and the lives of every other therapist in the world, the millions of patient hours that we spend with the people we see, matter. Our time with people helps. And although some might benefit from The Art of Fear, I'm sorry, many will not. 
 The online courses offered on your website may be fabulous, Kristen, but the bias, your accusation about the mental health professions are simply outrageous, and not nice. And those online courses that promise, well, everything? Smack of snake oil.
That just came out, the part about the snake oil, because meditation isn't snake oil, not at all, far from it, or quackery. We see good results with patients who have studied with zen masters, and many of us recommend meditation almost always for emotional management. Yes, management. It is like sending an alcoholic to an AA meeting, very helpful. When it works. If he works it, it is therapeutic to manage emotion, when we can pull it off, and more so, to make behavioral changes. Life should be about change, growth. Not navel gazing.

Still, this method does help. And Kristen's way of seeing, a nice way to conceptualize emotion, so we won't dismiss it. To sum up her therapy in two words, they would be body meditation. In this practice one learns to switch from nagging thoughts to the body, to feelings and where they are located. Body meditation practice can be very very helpful, especially for anxiety, thus no disrespect. But my patients come back to me a month or two later as if they have forgotten all of it. They lose the entire Torah.

"Are you still meditating?" I ask.

"Well of course, and it is very helpful. I'd be a mess without it."

"Keep that up," is my stock response. Then we proceed to discuss the entire gestalt, feelings, thoughts, behavior, the past, the future, all of it, everything that is bubbling over in that moment. And yes, we are speaking, feeling, in the here and now, yet talking about the past and the future. Because being here now, the patient is still a mess. And needs to talk about it now.

So here's the story.

The Good Reads book tour sends me intriguing paperbacks for review, and The Art of Fear landed in my mail box a few days before my vacation in early June.

Good Reads
Having buzzed through half the book before leaving, I get a call from a patient having a huge panic attack. His anticipatory anxiety is about an upcoming event, and his state of panic is his worst ever.

We had worked on the likelihood of ensuing panic before and during the event, and he had a few tools to work with. These usually worked: the breathing, the muscle contraction, finding rational reasons for and counters to his fear. He wanted to try a treatment strategy, virtual reality therapy, or VRT, that based upon my review of the research, might help, too. But the treatment center that advertised it still hadn't set up a program. So glad you called. Try us in December.

Kristen's words still fresh in my head, it was a no-brainer to try her intervention.
Listen, I said. You and your fear are one person. And you are a good person, Fear is a part of your self. It is you (one of you). You have fear for a very good reason, and you are showing respect by letting Fear out of the basement, not repressing her. She won't kill you, she loves you. All she's saying is, Pay attention to me, would you PLEASE? Because if you don't, I'm going to mess up this event, it will be a rocky affair and there is nothing you can do about it.
Fear can be a relentless, mean part of our psychology, And it is true, our emotions, ourselves, one in the same. Every therapist knows this. We don't suggest running from it, avoidance, or repression. Those are primitive defenses. We talk, and experience, feel and dialogue. It is what therapy is. We do a million other things, too, because there's no one size fits all in this business.

Fear, Kristen rightly tells us, is on our team, working for the good, just one voice, one of ten thousand employees at work in our community of selves. All for one, one for all, our feelings are hard at work, teaching us about ourselves, and they are starved for attention.

Her advice in The Art of Fear? Just listen, give Fear all of your attention, bow to her. Fear deserves respect. And pay no mind to all of that negativity in your head, those scary interpretations about fear, and her representative, anxiety. Negative thoughts build on one another (as if you didn't know) and grow more powerful as we obsess, even when there's no reason to believe any of it to be truly likely to happen. There's always a chance, however, so the thinking brain will go crazy, lawyering around, defending reasons to feel afraid.

I like to tell patients,
When you hear a rustle in the park, it could be a bear, but it could be a bird. 
Giving negative thoughts all that power is irrational, so goes traditional cognitive behavioral therapy. Kristen would say, and she's not wrong, that the thoughts are our off-course way of controlling Fear, and Fear doesn't need to be controlled. She just wants some respect, time. We try to come up with a plan to keep her in the basement, but she will not be denied! Give her a few crumbs, heck, the whole loaf, junk the thoughts driving her.

(Because that's easy).

The treatment: To stop the madness (the thinking), shift to the body, become aware of how it feels, find the emotions, especially fear. Give her equal time, no, much more time than you spend justifying why you have cause to worry. need to be afraid.

Brilliant! It is. And if you like metaphors and little stories, the book is full of them.

The therapy is called Shift Therapy, and I like it very much, because it is so familiar, a warmed over version of Psychotherapy 101, first year graduate school education. Social workers (most therapists, believe it or not, are social workers) since the early 1900's, are trained to tell patients to give emotions their due, to validate them. The patient should get in touch with her feelings. Just feel. Stop working on not feeling, because feelings might escape in one way or another, disguised as anger or resentment, jealousy, blame, shame. Let the tears come, we say, and it is okay for the heart to quicken. It is telling us we're alive.

Old school, still delicious.

And what goes up, you know by now, must come down.

The art of feeling is nothing new, still remains the essence of a good psychotherapy, despite the dozens of manuals prescribing treatment protocols. Kristen's is now one of them, or could be, if she didn't have to diss the mental health professions to go it alone. That, darling, should say something, not to play therapist here.

My patient, the one with the panic attacks, reported that the event went spectacularly, by the way. He had a great day. It could not have gone better. I took that as evidence, validation of some of the truth of Kristen's book, grateful to have found it by chance. Or was it chance?

Then, last night, a few of my friends and I had movie night. We don't go out. One of us goes to the library and takes out five or six DVDs. We bring our own dinner, chow down and talk, then go through the selections to find one we haven't seen. We chose Eddie the Eagle.

Sounds like a dumb kids movie, but this is about a little boy who becomes a big boy, then a young man, who remains a little boy, forever. Eddie has always had just one ambition, to be an Olympic contender. He wants medals. He has a cute metal box awaiting them.

He fails miserably at all sports, is told that he is not an athlete, that he never, ever, will be in the Olympics, but he doesn't care. He keeps looking for yet another sport. He will practice, hard, because he is determined to be an Olympian, to compete with the gods of athletics. He is positive, he is sure, and he is, in a word, almost fearless.

I don't want to ruin this one for you, so we stop right there. This is a feel good movie, and a true story.

A seemingly random choice of a film, still, a sign pointing in the direction of Kristen Ulmer's book. Why? And why was I a day late blogging for the book tour? Because apparently, it had to wait until three women poured over some DVDs, only to decide to watch one about an Olympic ski jumper.
Kristen Ulmer's new book

Kristen Ulmer is a ski jumper, the first female extreme sport hero with accolades to prove it. Most of her life, she tells us, she kept Fear in the basement and fearlessly pursued all things dangerous, like flying on skis off cliffs.

Simply mind-boggling to anyone with a Jewish mother.

So that's it, the story, the whole truth.
A final word to our author:
I love the technique. It will work for some, not all, and I will continue to refer out to zen masters. My advice to you, however: Refer out, as well. Punt when you're in over your head, tackling the hundreds of other diagnoses in the DSM 5. Stick with athletes. You get them. For this work is not all about fear, believe it or not, and there's no one size fits all to calm that monkey brain.
Avoid all shades of autism and be very, very careful with patients with severe personality disorders and psychoses, even OCD, and certainly suicidal patients.
This is painful work, you will absorb more of it than you care to admit, and you'll cry, too, and laugh often if you love it.
But obviously you won't be keeping your emotions, and hopefully not your laughter, in the basement.

therapydoc





Sunday, June 18, 2017

The Inevitable Welling Up and The Fidget Spinner

I asked FD, one morning, having been chased inside by mosquitoes the night before, "Why is it that mosquitoes come out at night, and they're gone in the morning?"

He thought about it for a minute and said, "You know, they have lives too.


And I didn't see that coming. 

Just wanted to start with a joke, even if it has nothing to do with the rest of this. Some of us are wanna be stand up comics at heart. Except, that would be so vulnerable-making.
Here we go. 

It has probably happened to you, that moment of unparalleled embarrassment and emotional powerlessness. It comes out of nowhere, but definitely, somewhere.

You are speaking with an acquaintance or a coworker, maybe, or especially an old friend. And she asks about a touchy subject, a topic that tends to be upsetting, and this unexpectedly renders you defenseless. You want to cry, escape.

It is a hot button. You're aware that the subject hurt, but until this moment, not entirely how much. It might be an innocent question, maybe about an ailing relative, a parent, child, or spouse. Or maybe it is entirely about you. Your friend didn't know the project failed, or the application, rejected. You had such high hopes, you told everyone. (This time for sure!). But no, not this time, and those tears rush in. You're dying here. It is a Shoot me moment, you tell your therapist later. 

Even if this is a person who would understand, could empathize, the reaction is the same.

Sometimes you know perfectly well you are about to step into a landmine, you're already a little shakey, well before the tears rush in. But when they do, that dialog bubble over your head shouts an expletive. 

This is about feeling vulnerable, caught weak, flawed, pathetic. Being comforted implies we are needy, that we need comforting, and what is comfort, if not love? And what if we aren't lovable, really, what if we aren't worth that. (Many people are raised in just this fashion, sure that showing weakness, being needy, falls on deaf ears, proving the ridiculous false thesis of unworthiness.)

There are reasons a person wouldn't want to be caught being human (highly imperfect). Reasons the tears that rush in feel so bad.

Fear of being judged unfavorably, as a loser of some sort.
Fear of the intimacy of the moment, the exposure. The relationship isn't there, we're not ready to take comfort from this person, and this isn't a choice, there's no control.
Being weak is not what the other person expects, and now we will have to deal with their feelings about what we're feeling. 
We like our distance, integrity, our identity, persona as strong. 
As women, this is the last thing we want a man to see, for men already perceive us as needy.
The role of comforter is a lot easier, many of us are well-practiced at it.
The other's question is invasive, this is a sensitive subject, one we would prefer to open up on our own time, i.e., Yes, she's still on heroin and she lives in her car
Feeling unworthy of connection to others.  
There are more, let me know if you think of them.

Years ago, before I took notes on a laptop, I did process recordings and treatment plans using pen and paper. It was convenient, for me, having a pen in hand, because if someone said something outrageous, and this often happens in couples therapy, I could whip the pen into the air and it would land behind my chair, or occasionally on someone's lap. After this I would smile at their reaction: "Seriously, what was that?!*" We would discuss what was said just prior in a more productive fashion. Eccentric, sure, but sight gags work. 

Alas, this is 2017 and even finding a pen in my office is difficult. There's one somewhere (and this kills a little time, allows room for thought on the patient's end) because pens are sill needed to illustrate family relationships with circles and squares, at times.

The pen, as we've established has multiple functions, and helping us out of vulnerable situations, those moments before the tears, when a well-meaning person has asked us about that job hunt, is one of them. We can't always, as we've also already established, lean in and embrace the pain, cry in front of others. So we need one on hand, when we're in social situations, in our purse of pocket protector.

Then, when triggered, we drop it. We can drop anything, it is true, keys work. Drop it something handy and spend a few seconds retrieving it, collecting yourself. A marble would be perfect for this. Upon retrieval, of course, the object needs to be wiped off, so search the room for Purell and a tissue.

Avoid eye contact at all costs. "Just a second I forgot . . ." Then drop your fidget fidget spinner. I got one for free for buying over $20.00 worth of tee-shirts.
fidget spinner








(They say the fidget spinner is good for ADHD, next on the list of things to discuss). A fidget spinner is not for everyone, may cause nausea or possibly seizures, so think before giving one as a present.)

Other strategies during the vulnerable moment:

tie your shoes fake a sneeze or a coughing jag, thenlook in your purse for a cough drop 
fake taking a call, or having to make a call 
have an answer ready ahead of time, or just
answer. 

Oh dear, answer. Be honest. Authentic. Be who we are.

You must know that this problem really is about being vulnerable, feeling unworthy of love and belonging, fearing of rejection. And yet, emotional vulnerability, those fears, flaws, weaknesses, our very humanity, is what make us lovable. Nobody loves a robot. 


In therapy we say: Fine, if you must, work on what you see as your faults. But you don't have to be a work in progress all of the time. Being you is unique and interesting and worthy, as is. 

They never believe us. The message is a tough sell. Which is why below you'll find the Brene' Brown, exposing her own vulnerability, empowering us to do the same 

Take 20 minutes and listen, closely. Then listen again, especially to the parts about numbing our vulnerability, how we go about masking who we really are, and how much work that is, trying to be perfect, trying to perfect our children. 

therapydoc













Friday, May 19, 2017

Snapshots: Book It

I didn't really have to go to school all those years, we're finding. So much self-help out there, catchy titles and awesome covers to grab our attention, and much of it is surprisingly, helpful. If only to talk about it, half the time. Still, there's a lot of wisdom to be found at $15.99.

In graduate school in the previous century, academia beat us over the head with the notion that what we heard on the radio, watched on television, read about in magazines, newspapers, and self-help books, journalism, is not science, isn't even social science. But that's not the way it is today.

Research-based academic journals, think ScienceCellLancetNatureNature GeneticsHuman RelationsJournal of Marital and Family Therapy, Family Process, American Behavioral Scientist, Qualitative Research, and dozens more, are invested in public relations, shoot out press releases to the AP to herald new scientific discoveries, the ones about to go to print in their publications, of course. Journalists follow up and we get smarter.

Researchers publish their own books, too. Two of the three mentioned below, for example, The Compassionate Achiever and Proposing Prosperity: Marriage Education Policy and Inequality in America as products of scientific study, really took years to write. The authors lived these books.

You won't find Proposing Prosperity for $15.99, but if you are a student of social policy and have always wondered how the government works to turn around the number of single mothers on welfare, this is an excellent choice. Plus, the author attended so many relationship therapy workshops  you can't help but learn something.


Compassionate Achiever

The Compassionate Achiever: How Helping Others Fuels Success,  by Christopher L Kukk, PhD proposes four steps that maximize compassion, a little known key to success. I'll try to write more on it in a post about compassion, but for now it is enough to know that the definition is very different than the definition of empathy. An empathetic person intuits, senses another's feelings. One with compassion does something about it.

What about Extreme You: Step Up. Stand Out. Kick ___. Repeat.
Sarah Robb O'Hagan's Extreme You

Not academic, but we learn from the stories of others. A good anecdote is data, too.

Sarah Robb O'Hagan is entertaining, full of energy, confidence and creativity. So her book is too. I admit, I jumped around to find the stories.

Extreme You: Step Up. Stand Out. Kick ___. Repeat

If I got it right, it is about risk, putting yourself out there.

Well, from a therapist's chair, it isn't easy to take risks. We can work in therapy for months, years sometimes, before a naturally anxious, safety-prone person is willing to step out of a comfort zone. But this is the message of Extreme You, a just do it book. In all fairness, she did work for Nike. This one is about how she made it in marketing. The road, if it works in that field, probably generalizes to others, too.

Go ahead, try out your latest brainstorm, tell it to your boss, get an audience if at all possible, with the Pope. Silence won't get you anywhere.

Assert, assert, assert. Any therapist will tell you this is key to beating depression, and passivity is depression's friend. So act. Just do it.

Whether or not Sarah Robb O'hagan will sing to you might depend upon how you were raised, because it is the message of supportive families, the ones that raise kids to hold their heads up, to strut their stuff. But supportive is the active ingredient.

Our author holds nothing back as a writer, doesn't edit out words that once upon a time would have been edited out, censored. Some of us liked it that way. But the author's intent, remember, is that we try the wild side, for once.

And we wouldn't want to throw the baby out with the literal bathwater, right? The tone of Extreme You is very Mindy Kaling; her voice is the same, too. Some of us first saw Mindy on The Office, became huge fans. Her books are in the airport bookstores, with titles like Is Everyone Hanging Out Without Me (and Other Concerns). and Why Not Me?  She dishes out advice, as does Sarah, from her experience, lately writes about the Impostor Syndrome, something else we should discuss one day, on CNNBC's Make It. 

If you're wondering whether or not this concept is a good fit, if perhaps you are too conservative, probably should shake out the emboli, take a walk over to Sarah's website and take her quiz. I did it but didn't leave my name or get more information, like is the quiz reliable and valid. Still, what have you got to lose?

The premise of Extreme You, that we're all highly individuated and the world needs to hear different sounds, new ideas, works for me. But are we all talented, so talented that we can and should cross lines, step out of line, take risks?

A systems therapist would say, know your system, know your audience, before you express yourself. I'm pretty sure Sarah tells us that, somewhere in there, because heads do roll, we hear about them in therapy, patients who hardly know the names of their teammates before the team changes.

That said, lathered with sensitivity, we can get away with almost anything. If you have to draw attention to yourself to make it, let it be known how incredibly sensitive you are. And empathetic. And compassionate. Extreme, to all of the above.

Because when all is said and done, really successful people work really, really hard.

therapydoc




Tuesday, April 25, 2017

13 Reasons Why

I know I've been away for awhile, and have so much to say, but all those snapshots about less essential things will have to wait. 

Because this is really important. 

There is a new show on Netflix, 13 Reasons Why, capturing the attention of teenagers and adults everywhere. When I saw it on the Netflix menu last week I passed without thinking. It seemed so much like work, you know?

But it is at the top of my list now. A therapist has to be informed.

This is a series of 13 shows focused on 13 people, people who in one way or another contributed to a teen's decision to end her life. Hannah Baker has already done the deed, leaves behind 13 audio cassettes implicating others. The screen adaptation is based on teen fiction writer Jay Ashers'  2007 novel of the same name.

Any therapist will tell you that we all, in one way or another, have at some point in our lives, affected the mental health of another person, for better or worse. Indeed, there is a therapy adage, well-understood:
For every suicide, there is someone else who wanted that person dead
Yes, that sounds macabre, but it is true. Well, sometimes it is true. Certain personalities are so grating, so annoying, so abusive (whether intentionally or not) so hard on us, so needy and intrusive, that loved ones (loved ones!) wish they were dead. And the one who is the problem picks up on that.

The suicides of patients diagnosed with BPD, Borderline Personality Disorder are often blamed (in notes) on family and friends who could not meet insatiable needs, or who outright rejected them, ended the relationship. The one who took his life likely put impossible demands upon others, expected them to drop everything to help. But it catches up on people, dropping everything else. It takes a toll. It becomes a matter of survival to limit the relationship.

We can't love everyone, and love can hurt. Mostly it is the lack of love that hurts the most, the withdrawal of love.

Borderline Personality Disorder is probably not what 13 Reasons Why is about (remember, I haven't seen it). In Alexa Curtis's article in Rolling Stone (a must read) we learn that Hannah has been raped by a popular boy, and witnessed sexual assault, suffered from bullying and the rejection of friends. She likely didn't have BPD, rather suffered loneliness, hopelessness, low self-worth, and depression.

Alexa Curtis, nineteen years old herself, a survivor of teenage bullying, upon hearing about 13 Reasons had to watch it. She is the founder of Media Impact and Navigation for Teens (M.I.N.T.), an online guide to media, self help. Alexa thought to herself, Had I watched this as a young teen I would have done it! I'd be dead today!  In her Rolling Stone opinion article she suggests that the show does more harm than good, the risk of glamorizing suicide is too great. Her opinion-- Hannah's story lives on forever in the audio tapes, and suicide should be an ending-- that's the point.

Which is not true, unfortunately. It is never an ending, because those who have loved and lost someone carry that person's legacy forever. They never forget the salient details of that person's life, now snuffed out, and will talk about it in therapy, given the opportunity, speak with tears and self-recrimination, of their own guilt, their failure to provide enough help, support, love. The survivors own it, right or wrong, their contribution, and attribute death to their failure.

There is that percentage, one in five of all borderline patients in a clinical population, for whom suicide will be the answer. The act is often to punish the "failures"of other people. The suicide literally says,
It Is Your Fault. 
For others suicide is the choice because they can no longer cope with their depression and need it to stop. Suicidal patients are at the greatest risk when they feel a little better, have the energy to do it. It takes a lot of energy to kill yourself. Depression, abated somewhat, is still close enough to touch. Why not now, is the thinking. It will come back.

And sometimes, with mental illness, even with much, much therapy, the memories of the many reasons not to do it, reasons discussed in therapy, are entirely erased. It is as if, in the throes of an episode, either manic or depressed, the only right thing to do is end it. It is the logical choice of an impaired, illogical mind, a painful choice, sometimes, and always illogical.

And there are other reasons, more than 13 of them, most likely. Complicated reasons.

So we have to have these discussions, talk about them. Make them long discussions.

Teenagers will be watching this new show that depicts fictional Hannah Baker's suicide in one of those episodes, and it looks frighteningly real. And our kids, our friends, the ones who watch, who are vulnerable and depressed, who have been bullied, perhaps, will consider the option. Peers, siblings, children. There will be copycats. Some are videotaping themselves right now.

It is a graphic show, we're warned, one that begs discussion, conversation.

And there is a media debate about it:
Is this the best way to raise suicide prevention, to get the conversation started?
Yes, because everybody's talking about it.
No, because there will be copycats. Kids will die as a result, will feel empowered. Hannah did it, so can I. 
We have a teenage suicide epidemic going on.

I thought about it and made a note in my calendar to make a few calls, catch up with the adolescents I've seen in the past year who haven't come back, who for one reason or another, dropped out of therapy or terminated therapy. That's one thing I can do.

What can you do?  Well, ask any teenager you know,
Have you seen 13 Reasons Why?
And get a conversation going. You might save a life.
Because for every reason why, you're likely to be able to counter with a good reason Why Not.

therapydoc

Other discussions on this blog about suicide:

Ten Reasons Not to Kill Yourself

How to Save a Life

How to Save a Life, Part 2

How to Save a Life, Part 3








Sunday, March 05, 2017

Snapshots: Breaking, Mending, Breaking and Bowling


Miami Beach, foggy at times
"Is there a free airport shuttle to the hotel?" I ask the switchboard operator

"The Trump National Doral Hotel is only five miles from Miami International Airport. A cab is about $25.00," she laughs, not exactly laughs, but informs, sounding a little like Siri. "Or you can take an Uber for less."

"Thanks," I mumble, hanging up. Her implication is obvious. If you can afford to stay at the Trump, you can afford the taxi. 

Who stays there? Mostly golfers, just a hunch. And others who are comped by their hosts. 

It did seem like a secure place to be, which always feels good, security at the gate, men in sun glasses on the roof, watching the stunning outdoor wedding. The chupah, or wedding canopy, is homemade, borders the greens; guests are in their finery. Rabbis in beards and long black coats bless the ebullient couple. Uninvited hotel guests and staff watch from a balcony above, no different than at any outdoor-at-the-swimming pool affair at any other hotel. But this feels different. 

You can rent bicycles at the Trump National, tour the grounds, ride the soft-hills on a paved path meant for caddies. There are several species of wild birds grazing, sipping at the fountain. Nearby villas for guests are named for famous golfers, the suites in taupe and white, the accents in gold, naturally, if faux. It is a beautiful place for a wedding, a beautiful sunny day in Florida, with an occasional light sprinkle of rain for good luck. We're grateful. 

But there's this feeling, like we're imposters, have no right to be here. We should talk about that some day.

The fountain at the Trump Doral Golf Course
1. Screen Busters: Breaking Things and Mindfulness

"How do you do it?!" he asks me in a calm, controlled voice. "It has to be a record, three phones, little over three months. One of the phones, need I remind you, mine."


No, he will never let me live that one down. His Nokia Windows phone screen smashed, leaving him, a doctor, with no means to communicate. 


This on a quick trip to Atlanta in November, a blustery, cold, miserable day in Chicago. We're searching for our preflight garage, a reasonably priced, shuttle-operated operation near Ohare. FD takes a wrong turn. He hands me his phone.


"Can you figure out where we are?" 


His phone (establish your excuses early) is a mystery to me, so I put it on my lap, search mine. He finds the garage without me, a valet opens my door. In the hand-off the Nokia falls to the pavement, an ex-phone, except for a hum when a call comes in.  


He’s upset, sees no humor in this (one can only try), and as much as I apologize, it will never be enough. But i
n all fairness, it had to be torture. A solo practitioner, he has chosen his volunteered slavery, as Roland Kirk, the jazz great, would have called it. He chose medicine, primary care. For whatever reason, it was hard to empathize, probably since he blamed me, and most of us check out when we're being blamed. He replaced his phone with another not-an-iPhone, an older Samsung, this time, that even he hated from the start.

But pride would not allow him to for complain.


Soon thereafter, mine broke. It hadn't been handling IOS software updates anyway, but rather than buy new, I had it fixed right away. Nobody saw the fall as the phone brushed off the counter to the floor at the Peggy Norbert Nature Museum

Mind those ceramic tiles at the entrance in the foyer, if you're off to see the butterflies. 


A few weeks later it happens again, but in an odd way. The almost new tempered glass is supposed to protect the screen, but the technician tells me that even tempered glass has a point of vulnerability, a place near the microphone, and a key in my coat pocket must have hit it just so


My empathy for FD kicks in. But as he examines the latest shattered display, he smiles nothing less than a schadenfreude smile, satisfaction with my loss. His stupid Samsung is working just fine. "Get one of these," he suggests.


I don't think so.

It becomes hard to confess to something else, opening a kitchen cabinet door only to face a terrorist Tupperware that resettles, knocking a juice glass to certain death. An accident waiting to happen, it still surprises me. Shards of thin blue glass everywhere. It could happen to anyone, to any glass, and manically sweeping, I consider: What  does one even do with broken glass? Is it recycle-able?


This quality of carelessness becomes a little scary.


Hand off a baby, a child, to a grandmother, and she'll hang onto it for dear life, snatch it before a fall off the sofa, grab a tipping lamp out of nowhere, a chair. The mischief and energy of toddlers is exhausting, but a return to motherhood and total functionality. You're on. When things are the center of attention, off. Not just off, but flip. Who cares? But is that normal? We always say:It's just a thing. But things aren't nothing.


We must take a closer look. 


Theoretically, joking about material loss could be, historically, due to one's early childhood, the cultural environment. Material things are exactly what mattered to a generation now passing, mothers and fathers, immigrants mostly, who took them very seriously. Those of us whose parents covered the sofas with plastic, who couldn't contain their disappointment when a kid broke something expensive, eventually got over it. Their children grew up, and they got over it, too. Once having winced at the criticism, accidental loss became a trifle, not such a big thing. At least to some of us. Grieve it and leave it, nobody's perfect, let it go, whatever it is.


For our parents it was about the value of money, the value of things and they were totally right, for them, in their world. If you have only a few things that are dear to you, you appreciate them, protect them, invest in a curio cabinet, maybe. But even the essentials, clothes and furniture, warranted care, because, let's talk, good stuff doesn't come cheap.


My mother-in-law, quoting her mother:

We're too poor to buy cheap things.
My mother:
We worked hard all our lives to get by. 
as the Beatles used to sing. Amazing song.

So shrugging off a broken phone or three could be about differentiating from parents, reconciling the trauma of parental rejection for not being cautious.


It is hard to think of the quality, the value of caution, however, as something over-played. Behind the wheel, it only takes a moment of carelessness and lives are lost. Caution is a virtue in the professions, too. In mine, if a patient alludes to suicidal thoughts, red flags should wave furiously. We therapists are cautious. Attention can be life-saving. Substitute today's buzz words mindfulnessawareness, being present.  These are qualities to be valued.


How to get there from distracted, hurried, and careless?


For one, break a few things, consecutively, within a few short weeks, like phones, a crystal goblet, or just a juice glass, a cereal bowl. Soon the cabinets are better organized, the new phone will have a bullet proof case, insurance. Because habits change when you hit bottom. People in AA know this all too well.


Otherwise, you're stuck talking about it in therapy for who knows how long.


2. Hating Hate

Desecrated Jewish cemetery in Philadelphia


Bomb threats, swastikas etched on automobiles and subway car windows. Synagogues and cemeteries vandalized, some 90 hate crimes, just against Jews and Jewish institution in over 30 states and in Canada. Hate crimes more than doubled in NYC from January 1 to February 15, in 2017.

FD and I use the Jewish Community Center in Chicago, almost daily, and our grandsons go to nursery school there. Now, because of the bomb threats, we must stop at the front desk to scan in our membership cards before we swim. Staff need to know who is in the building.


You don't ask why.


These things upset me, but at dinner Friday night, a guest, a Holocaust survivor, is clearly moved by the discussion. She shakes her head. She knows hate. "This time," she says, "we will fight back. Never again."


The bomb threats have been baseless so far, hateful harassment. In one case authorities are still sorting out a spurned lover's ridiculous vendetta. Juan Thompson made bomb threats by phone to several Jewish community centers in the US, identifying himself as the woman who rejected him, his creative way of hurting her.

Then there's this:
Headstones are expensive. What wonderful achdut (Hebrew word, rhymes with Bach-shoot, means unity). You have to love this.

FD and I paid special attention to the Missouri cemetery desecration because his father is buried there. His brother, still in St. Louis, explained that their father's grave is fine. Security is stepped up in the area, but investigators are still looking for evidence that the vandalism was a hate crime.


Nearly 200 headstones turned over at last count. Must have been an act of love.  


3. Bowling and Bonding


It is time to go bowling, one of our guilty pleasures


We're that cute older couple that high fives with every strike or spare, occasionally jumps up and down. We have our own shoes, our own bowling balls, but no league, thank you.

Bowling balls

We settle into Lane 37, change shoes and work the video scoreboard above us. I change the boring background to a Disney theme. FD starts us off with a strike, and it is looking like this could be a good night.


It is an after 9 PM crowd, which, unbeknownst to us, is the time that rates go down to $9.00 a person until closing. So kids start filing in, filling up the place, and a large group of teenagers join us at Lane 36.


There's something about getting older. You feel a little vulnerable, as if the energy alone of a group of teenagers could knock you down. It is my turn and I get a spare, catch the eye of a beautiful dark-eyed teen watching me from 36. She is smiling broadly, and this is contagious. I smile back, more for her, to thank her for liking this, liking me, than for silently applauding my spare.


Then I watch as her boyfriend rolls up his sleeves. He is a young man already, tall and muscled, his hair cut very short, a tattoo in Arabic scrolls along his biceps. The writing feels threatening to me, and I know, at this very moment, based upon the Harvard racism test (anyone can take it online), that we are all racists, each and every one of us, that this fear of mine is exactly that, my racism, so I put it to rest, out of my head, the fear, the intimidation. We are so obviously yiddin, they are so obviously our cousins, let someone else play out the politics in the Middle East.


And for the duration of our two game max, the girls and I cheer one another along, and the boys smile at us, too, when we knock all of those pins down, and even when we don't. And we smile at them, because everyone, it seems, can be a good enough bowler with enough practice. At only $9.00 until closing, Lane 36 has a good start.


therapydoc

Sunday, January 15, 2017

The Man Cold

It's been coming up in therapy that men need to be babied when they are sick. They think they're dying at the first sign of a headache, a cold, weakness, and if they are married, expect their partners to drop everything to take care of them, nurture them. And all their partner wants to say is:
 Man up. It's a cold.


That's pretty funny, no? Is it true? Are most men big babies when they're down for the count? Sometimes, surely not universally. We all know men who refuse to stay home from work when they have a cold, even a fever, or who might stay home but won't call their moms to make them chicken soup. They make it themselves, or order in, or do without.

Are the less needy ones the same men who second shift, who know that there are other things that have to be done, more important things than lying around to wait for the fever to pass? Maybe. But it is more likely they had to take care of themselves as kids, didn't have a mommy hovering over them when they came down with symptoms. They took a couple of Tylenol and went about the work that had to be done, went to school, made their own lunch as kids.

Women want to be nurtured, too, is the subtext, when they're under the weather. But traditionally, carrying the second shift, they haven't the luxury of staying in bed. They still have to make lunches, do the laundry, drive car pool, unless a partner isn't off to work and can do these things for them. If he is expected on the job, then she has no time to go back to bed. Men who never lifted a dish, who never did laundry in their lives, can't relate. They don't see the urgency, and when they feel uncomfortable become, or hope to become, the center of attention, helpless. They really feel helpless.

Why would women tolerate the beached whale, a self-indulgent male partner who keeps ringing a bell for room service? Maybe it is because we saw our mothers doing it for our fathers, women grumbling under their breath, as they brought yet another cup of tea, joking to anyone in earshot, Such a baby, your father. It was cute, Dad being sick, perhaps the only time he let his machismo down.

But if the model was different, and Mom and Dad both toughed out their viruses, daughters would expect their partners to do the same.

Just a theory. But I think it's got to be in there. They're cute when they're sick, but not too sick, and we might be cute, too, under the same circumstances, given the luxury. This isn't death defying stuff, a cold. And really, if someone's late with the tea, just maybe, if it is a he, someone with a man cold, he'll get up and get it himself.

therapydoc