It happens quite a bit, and we’ve talked about it before, that the weak get weaker and the strong get stronger. There’s a Harry Potter metaphor in there somewhere.
What happens is that a perfectly wonderful individual, one who would give the shirt off his or her back to help a friend, gets a reputation for giving. And some people use people like this, prey upon them to get things done.
My father used to call the guy who drives 90 mph on the expressway a pigeon. He’s the guy that’s going to get the ticket. We get to drive at 75 mph but for the grace of the pigeon. No pigeon in sight, don't speed.
He would see someone who is being used, in general, as a pigeon. But that isn't a nice way of looking at it at all. I just see them as nice people who can't say no.
Nice people do come to therapy because they are exploited by others. When it becomes a pattern, they tire of it, burn out, even get depressed. This is exactly the kind of person that those who practice Brief Family Therapy love to get their hands on. No need to go back to childhood, get to the solution. Personally, I think going back to childhood, going into the reasons, is very, very useful. But let's try Brief Family Therapy right now.
It’s surely a disrespect, a dismissal, and a put-down when a perfectly capable individual asks a good-hearted, less assertive person to do their dirty work. We parents do this all the time, ask our kids to do our bidding, but we're teaching them life skills, obviously, when we ask them to take out the trash.
Consider adult to adult relationships instead. At the beach a good-hearted soul gets up to get drinks for everyone. (S)he will self-sacrifice for the sake of friendship, might go back and forth on the hot sand, if necessary, to serve everyone. This same individual, at some point in life, gets sick of it.
In therapy she'll learn to ask, “Does anyone want to come with me to go get us all some drinks?” There’s usually another volunteer. If there isn't, she gets a drink for herself, tries that out, feeling what it's like to take care of Number One. It doesn't feel that bad, really.
The relationship issue is that the good one, the thoughtful one, gets resentful of the thoughtless, even come close, at some point, to feeling a terrible emotion, hate. The burnt out exploited person is crying more often, suffering panic attacks at the very thought of hate, which means giving up the relationship. Before, by saying Yes, there was an element of control, predictability. Lose that, the predictability, the relationship for better or worse, and abandonment anxiety bubbles over. It is a situation becoming of the Pink song, Please Don't Leave Me.
If the crisis precipitates therapy, some of us would suggest we work on one-liners together, the baby steps of assertiveness. Assertiveness is always the facts, dispassionate.
(1) Really? You can’t do that yourself? Really? Are you kidding?
(2) Why would you ask me? You always ask me, ever notice that?
(3) I'm starting to feel used here, and it isn't feeling good.
(4) You’re a big girl, seriously, get more into the role, you'll like it.
And then there's the situation specific response.
(5) You’re out of your tree if you think I’ll be your alarm clock. Buy one. And no, don't ask me to buy you one.
That sort of thing. Responding dispassionately, saying No, empowers us, strengthens. It's a great skill, and we grow stronger every time we flex the muscle.
We learn that it can be great fun, too, seeing the expressions, the surprises looks.
My suggestion? Practice with a friend.
On the second thought, it might be better to practice in front of the mirror.
therapydoc
Everyone Needs Therapy
This social work blog reflects my multi-disciplinary scholarship, academic degrees, and all kinds of letters after my name to make me feel big. Psychoeducational and happy, I'd consider guest lecturing in a warm, sunny climate, topic your choice. The blog is NOT to diagnose, treat, or replace human to human legal, psychological or medical professional advice. References to people, with the exception of myself, and events except those about me, and even some of those, are entirely fictional.
Sunday, January 22, 2012
Monday, January 16, 2012
Martin Luther King
Why write about Martin Luther King on this blog?
Because he tried to kill himself. Not once, but twice. And we can learn from that.
Time tells us this in the "Man of the Year" article about Dr. King. (The excerpt is quoted in A First-Rate Madness by Nassir Ghaemi, reviewed on this blog last year.)
But it does seem to have been overwhelming despair that drove him to the ledge. Most of us would point to it as a strong indicator of childhood depression, rather than a grief response. The depression came first.
Ghaemi tells us that by 1966, after Dr. King had accomplished his goals, voting rights for blacks, and desegregation, that he initially felt empty and depressed, even thought he should resign. But Black Power, radical (violent) politics, the very opposite of civil disobedience troubled him, and so did the Viet Nam War.
He spent his last few years fighting for both of them. He did what he could to guilt Lyndon Johnson into ending the war, and he arranged meetings with the powerful radicals, those who believed in revolution. He didn't sleep, worked feverishly through the night, through his depression. A closer read of Ghaemi's biography finds Dr. King's personal struggle to be yet another example of an individual who struggled with mental illness-- his whole life-- and yet, what a life. What a legacy he left us all.
And he didn't take that life in the end. He didn't jump.
therapydoc
Because he tried to kill himself. Not once, but twice. And we can learn from that.
Time tells us this in the "Man of the Year" article about Dr. King. (The excerpt is quoted in A First-Rate Madness by Nassir Ghaemi, reviewed on this blog last year.)
Twice, before he was 13, he tried to commit suicide. Once, his brother, "A.D.," accidentally knocked his grandmother unconscious when he slid down a banister. Martin thought she was dead, and in despair ran to a second-floor window and jumped out--only to land unhurt. He did the same thing, with the same result, on the day his grandmother died.I read a few more accounts of the story, about young Martin seeming quite dead, then rising and walking off like a child who had been clobbered by a baseball. It made me wonder, frankly, if he just jumped, as a kid, off trees, perhaps. Kids jump.
But it does seem to have been overwhelming despair that drove him to the ledge. Most of us would point to it as a strong indicator of childhood depression, rather than a grief response. The depression came first.
Ghaemi tells us that by 1966, after Dr. King had accomplished his goals, voting rights for blacks, and desegregation, that he initially felt empty and depressed, even thought he should resign. But Black Power, radical (violent) politics, the very opposite of civil disobedience troubled him, and so did the Viet Nam War.
He spent his last few years fighting for both of them. He did what he could to guilt Lyndon Johnson into ending the war, and he arranged meetings with the powerful radicals, those who believed in revolution. He didn't sleep, worked feverishly through the night, through his depression. A closer read of Ghaemi's biography finds Dr. King's personal struggle to be yet another example of an individual who struggled with mental illness-- his whole life-- and yet, what a life. What a legacy he left us all.
And he didn't take that life in the end. He didn't jump.
therapydoc
Friday, January 13, 2012
Progress Not Perfection
This might be a spoiler if you didn’t see last Sunday’s Desperate Housewives.
We’ve been watching Tom and Lynette fight for years, and now that Tom is successful in advertising, he’s leaving her. He has found the perfect woman, someone who doesn't criticize him, who thinks he’s marvelous, and loves him just the way he is.
And she's a doctor, no less.
The couple is separated for several months, and a crisis brings Tom home. He helps Lynette through it and it is clear that the two of them are getting along, even seem happy together. Tom suggests he bring home a pizza and a DVD, that the family does pizza and TV night like they used to do in the past. Lynette jumps on the opportunity to be a family again. The children aren’t thrilled with his educational DVDs, but they go along.
The pizza is ripped open. Lynette makes a face. She doesn’t eat deep dish. She’s been telling him for years that she likes thin crust. He hasn’t been listening to her and she tells him as much. He tells her that this is exactly what he’s talking about, that nothing he does is good enough, he shouldn’t have even tried. She responds by saying that by now, after so many years, it wouldn't kill him to actually listen to her. She needs validation, too. He could care about what she wants. It would be a nice change.
He hands her the point, says he’ll try harder to do that.
An "Ah ha" moment. And she doesn't even have to get to the source, the reason why he ignores things she says, why he doesn't attend to her needs. But this is progress.
That’s television. In reality, people have reasons for not listening and it's nice to bring the unconscious to consciousness. That's called psychological growth, or insight.
The reason I like most is that not listening is associated with narcissism, being unable to see beyond what we want, seeing our needs as primary. For example, in any addiction (and you could say we all have one) the addict is dysfunctional because he disregards the needs and wants of everyone else in order to get his drugs, his drink, sex, whatever. It doesn’t matter, the promises. What matters is satisfying a craving.
Immature? Narcissistic? Sick? The 12-Step programs probably go with sick and selfish. Older 12-Steppers, people who have been sober for years, bop new addicts over the head, tell them, Grow up, be a human being. It works sometime.
The addiction metaphor is only good because addicts are selfish by definition. It can be true in mental illness, too. People don’t have to be, and that’s what recovery is all about. Rising above all that self-absorption and pain.
But take someone like Tom Savo, the guy who doesn't think to keep his wife’s preferences in mind, even when the two seem to be reconciling, a guy who isn’t an addict. I want to say that in his excitement, coming home, bringing home the pizza that makes him happy (and we can assume the children, too) he simply forgets to have her in mind. Oh yes, and a few slices of thin crust for my wife. He missed it, the opportunity.
If that is all it is, being excited, forgetting, it isn't even that dysfunctional. What is dysfunctional is when her needs are never important. When it is systematic, when forgetting his wife is a regular problem. He takes her for granted, doesn't bring home the thin crust because she hasn't made a big enough issue out of it. And even if she does, complaining makes him feel rejected, unloved, and angry, so it is likely to trigger defensiveness and an argument.
The real dysfunction is not when one partner forgets what the other wants, it is when the other's wants are dismissed. Lynette is never really in the picture. Without empathy, without feeling her sense of rejection, he can't address it.
Our relationships go to garbage without empathy.
How does a person get this way? Why are some people more empathetic, more considerate than others? You could say breeding, surely, and you would be half right. Parents can teach children to share, to care about others. It's more important than teaching them to be sure to flush, although that's a two for one. But self-centeredness is functional might help us accomplish things, meet our goals, sometimes. Being goal oriented, keeping our eyes on the prize (or just winning a game) to the exception of all else, others (who distract), we get more done. Or so it seems. There's surely loss, however, when others feel excluded, a social price.
So it could be nature, survival of the fittest. Selfishness could be something Darwin talks about. I haven’t read enough to know, but that makes sense to me.
Take a different example. A guy’s parents are very controlling. He grows up and is determined to run his own life, to finally have it his way. He marries a woman who is giving and selfless, reinforcing his need to put himself first. Except that she does have needs, and when she asserts, he ignores her.
But it depends upon the need, whether or not he ignores her. If it is for something permanent, perhaps a new dress, something she will look at in the future and think, Oh, he gave that to me, what a wonderful husband, it’s a go. He buys it for her. But if it’s something temporary, like a vacation, something intangible, he forgets. He learns that some memories are permanent. It is why we take pictures.
This couple frequently winds up in therapy, and beyond going back to childhood to determine the roots of selfishness, some of us push that 12-Step adage, Progress Not Perfection, because frankly, if we strive for perfection we we're going to be frustrated. We might even give up.
therapydoc
We’ve been watching Tom and Lynette fight for years, and now that Tom is successful in advertising, he’s leaving her. He has found the perfect woman, someone who doesn't criticize him, who thinks he’s marvelous, and loves him just the way he is.
And she's a doctor, no less.
The couple is separated for several months, and a crisis brings Tom home. He helps Lynette through it and it is clear that the two of them are getting along, even seem happy together. Tom suggests he bring home a pizza and a DVD, that the family does pizza and TV night like they used to do in the past. Lynette jumps on the opportunity to be a family again. The children aren’t thrilled with his educational DVDs, but they go along.
The pizza is ripped open. Lynette makes a face. She doesn’t eat deep dish. She’s been telling him for years that she likes thin crust. He hasn’t been listening to her and she tells him as much. He tells her that this is exactly what he’s talking about, that nothing he does is good enough, he shouldn’t have even tried. She responds by saying that by now, after so many years, it wouldn't kill him to actually listen to her. She needs validation, too. He could care about what she wants. It would be a nice change.
He hands her the point, says he’ll try harder to do that.
An "Ah ha" moment. And she doesn't even have to get to the source, the reason why he ignores things she says, why he doesn't attend to her needs. But this is progress.
That’s television. In reality, people have reasons for not listening and it's nice to bring the unconscious to consciousness. That's called psychological growth, or insight.
The reason I like most is that not listening is associated with narcissism, being unable to see beyond what we want, seeing our needs as primary. For example, in any addiction (and you could say we all have one) the addict is dysfunctional because he disregards the needs and wants of everyone else in order to get his drugs, his drink, sex, whatever. It doesn’t matter, the promises. What matters is satisfying a craving.
Immature? Narcissistic? Sick? The 12-Step programs probably go with sick and selfish. Older 12-Steppers, people who have been sober for years, bop new addicts over the head, tell them, Grow up, be a human being. It works sometime.
The addiction metaphor is only good because addicts are selfish by definition. It can be true in mental illness, too. People don’t have to be, and that’s what recovery is all about. Rising above all that self-absorption and pain.
But take someone like Tom Savo, the guy who doesn't think to keep his wife’s preferences in mind, even when the two seem to be reconciling, a guy who isn’t an addict. I want to say that in his excitement, coming home, bringing home the pizza that makes him happy (and we can assume the children, too) he simply forgets to have her in mind. Oh yes, and a few slices of thin crust for my wife. He missed it, the opportunity.
If that is all it is, being excited, forgetting, it isn't even that dysfunctional. What is dysfunctional is when her needs are never important. When it is systematic, when forgetting his wife is a regular problem. He takes her for granted, doesn't bring home the thin crust because she hasn't made a big enough issue out of it. And even if she does, complaining makes him feel rejected, unloved, and angry, so it is likely to trigger defensiveness and an argument.
The real dysfunction is not when one partner forgets what the other wants, it is when the other's wants are dismissed. Lynette is never really in the picture. Without empathy, without feeling her sense of rejection, he can't address it.
Our relationships go to garbage without empathy.
How does a person get this way? Why are some people more empathetic, more considerate than others? You could say breeding, surely, and you would be half right. Parents can teach children to share, to care about others. It's more important than teaching them to be sure to flush, although that's a two for one. But self-centeredness is functional might help us accomplish things, meet our goals, sometimes. Being goal oriented, keeping our eyes on the prize (or just winning a game) to the exception of all else, others (who distract), we get more done. Or so it seems. There's surely loss, however, when others feel excluded, a social price.
So it could be nature, survival of the fittest. Selfishness could be something Darwin talks about. I haven’t read enough to know, but that makes sense to me.
Take a different example. A guy’s parents are very controlling. He grows up and is determined to run his own life, to finally have it his way. He marries a woman who is giving and selfless, reinforcing his need to put himself first. Except that she does have needs, and when she asserts, he ignores her.
But it depends upon the need, whether or not he ignores her. If it is for something permanent, perhaps a new dress, something she will look at in the future and think, Oh, he gave that to me, what a wonderful husband, it’s a go. He buys it for her. But if it’s something temporary, like a vacation, something intangible, he forgets. He learns that some memories are permanent. It is why we take pictures.
This couple frequently winds up in therapy, and beyond going back to childhood to determine the roots of selfishness, some of us push that 12-Step adage, Progress Not Perfection, because frankly, if we strive for perfection we we're going to be frustrated. We might even give up.
therapydoc
Sunday, January 01, 2012
Please Don't Leave Me
He's Just Not That Into You--It's not a new movie, and a lot of people said they were Just Not Into It.
But the topic had me at hello.
The cast is stunning, for one. I watch chick flicks for many reasons (they're sedating, primarily), but a pleasant looking cast is at the top of the list. You can't talk about deep subjects all the time and not have a really shallow side somewhere deep down inside.
FD didn't bother with it for 30 seconds. He went to bed. But he was tired, is the truth.
Gigi Haim, (Ginnifer Goodwin, above, bottom right below) desperately seeks a boyfriend. It's the desperate part we don't like. A woman (or a man, this movie could easily have been about a desperate man) should strive for a little more pride, more independence. Hanging on for dear life when someone is pushing you away, stalking restaurants and bars to catch the prey unannounced, feels like high school. I know it's hard not to do it, and that for many of us, it's hard to have the kind of self-control necessary to go it alone. But we've got to try. That said, we can work on this for years in therapy, and we do.
Gigi anxiously waits for telephone calls, checks voicemail a hundred times a day, even when her first dates don't go well, which is always. What she wants, what she needs, is beyond her social intelligence. The social IQ should tell her that a little mystery, a little challenge, is attractive in relationships. And if the attraction isn't mutual, let it go. But we're made up of much more than social intelligence. Our emotional lives tend to rule.
She's rejected often, but nothing ventured, nothing gained. And Gigi's obsessive thinking, her compulsive man-chasing, doesn't hurt anyone. She's obsessed, but she would not be diagnosed with OCD, Obsessive Compulsive Disorder. She doesn't want to be alone, and although we might suggest she feels empty, she doesn't have Borderline Personality Disorder, either. That's the one we think of when we associate fears of abandonment with mental illness.
She's just not getting it, can't read the signs when it's so obvious that it's never going to happen. Men read the neediness in her face instantly. They politely suggest, “Call me," a nice way of saying, "I’m not interested enough to call you, so I won't be calling you, but knock yourself out."
The film is full of examples of these types of metacommunications, communications about communications. It is worth seeing for that alone. But remember, the epiphanies of a chick flick aren't usually rocket science.
Gigi's social disconnect, her persistence in knocking when the doors are all closed, is a remez (rhymes with them-pez, Hebrew for hint, but hint just doesn't quite say it as well) to the drive that makes some people successful in this world. They know what they want and get it, don't take no for an answer.
When it comes to relationships and love, unfortunately, that kind of persistence and drive doesn't usually pay off. Forcing ourselves upon others only makes us less attractive, less likable. Gigi's manhunt turns out to be the exception to the rule. It's romantic comedy, after all.
Contrast this to Pink, and her violent music video, Please Don't Leave Me. I can't even link to it for you, it's so violent. Pink bloodies her boyfriend, beats him senseless so that he can't get out of the apartment. She's a sociopath, clearly, a violent, antisocial individual. I mean, rock star. Not that rock stars are violent.
When I first heard the song, the lyrics isolated from the video screamed Borderline Personality Disorder. So I checked out the video at YouTube to see if it would work as a teaching tool for high school kids learning about abandonment anxiety. (They teach kids about that, right, in your high schools?)
Here are the lyrics:
Da da da da, da da da da
Da da da, da da
Da da da, da da
I don't know if I can yell any louder
How many time I've kicked you outta here?
Or said something insulting?
Da da da, da da
I can be so mean when I wanna be
I am capable of really anything
I can cut you into pieces
But my heart is broken
Da da da, da da
Please don't leave me
Please don't leave me
I always say how I don't need you
But it's always gonna come right back to this
Please, don't leave me
How did I become so obnoxious?
What is it with you that makes me act like this?
I've never been this nasty
Da da da, da da
Can't you tell that this is all just a contest?
The one that wins will be the one that hits the hardest
But baby I don't mean it
I mean it, I promise
Da da da, da da
Please don't leave me
Oh please don't leave me
I always say how I don't need you
But it's always gonna come right back to this
Please, don't leave me
I forgot to say out loud how beautiful you really are to me
I cannot be without, you're my perfect little punching bag
And I need you, I'm sorry
Da da da, da da
You say I don't need you
But it's always gonna come right back
It's gonna come right back to this
Please, don't leave me
Please don't leave me, oh no no no.
What's interesting to me is that both women, Gigi and Pink, are desperately in need of a relationship, both concentrate all of their energy to keep a relationship, even go to extreme measures. But they are such different women.
Engaging Gigi in therapy would be a snap. Teaching her rubberband theory, exploring her insecurities about being alone, she'd grow leaps and bounds in a single visit. Well, not a single visit, but a few for sure. It's hard to let go, and managing neediness in relationships can take a lot of therapy, it's true. Yet Gigi's not that dysfunctional. She hurts only herself.
Whereas someone like Pink would be self-mutilating in my office and throwing rocks at home. I'd call in a team to work with her.
The differences in the two women, both so needy, underscores the importance of not diagnosing based upon a single symptom, not even an extreme symptom, although the no sleep thing in Bi-polar Disorder, and the hallucinations or delusions in Schizophrenia are fairly robust indicators of disease. But even then, there are things to rule out before making a diagnosis. Like speed, acid, other physical disease, brain tumors. Things.
I looked already. Nothing's on tonight.
therapydoc
But the topic had me at hello.
The cast is stunning, for one. I watch chick flicks for many reasons (they're sedating, primarily), but a pleasant looking cast is at the top of the list. You can't talk about deep subjects all the time and not have a really shallow side somewhere deep down inside.
FD didn't bother with it for 30 seconds. He went to bed. But he was tired, is the truth.
Gigi Haim, (Ginnifer Goodwin, above, bottom right below) desperately seeks a boyfriend. It's the desperate part we don't like. A woman (or a man, this movie could easily have been about a desperate man) should strive for a little more pride, more independence. Hanging on for dear life when someone is pushing you away, stalking restaurants and bars to catch the prey unannounced, feels like high school. I know it's hard not to do it, and that for many of us, it's hard to have the kind of self-control necessary to go it alone. But we've got to try. That said, we can work on this for years in therapy, and we do.
Gigi anxiously waits for telephone calls, checks voicemail a hundred times a day, even when her first dates don't go well, which is always. What she wants, what she needs, is beyond her social intelligence. The social IQ should tell her that a little mystery, a little challenge, is attractive in relationships. And if the attraction isn't mutual, let it go. But we're made up of much more than social intelligence. Our emotional lives tend to rule.
She's rejected often, but nothing ventured, nothing gained. And Gigi's obsessive thinking, her compulsive man-chasing, doesn't hurt anyone. She's obsessed, but she would not be diagnosed with OCD, Obsessive Compulsive Disorder. She doesn't want to be alone, and although we might suggest she feels empty, she doesn't have Borderline Personality Disorder, either. That's the one we think of when we associate fears of abandonment with mental illness.
She's just not getting it, can't read the signs when it's so obvious that it's never going to happen. Men read the neediness in her face instantly. They politely suggest, “Call me," a nice way of saying, "I’m not interested enough to call you, so I won't be calling you, but knock yourself out."
The film is full of examples of these types of metacommunications, communications about communications. It is worth seeing for that alone. But remember, the epiphanies of a chick flick aren't usually rocket science.
Gigi's social disconnect, her persistence in knocking when the doors are all closed, is a remez (rhymes with them-pez, Hebrew for hint, but hint just doesn't quite say it as well) to the drive that makes some people successful in this world. They know what they want and get it, don't take no for an answer.
When it comes to relationships and love, unfortunately, that kind of persistence and drive doesn't usually pay off. Forcing ourselves upon others only makes us less attractive, less likable. Gigi's manhunt turns out to be the exception to the rule. It's romantic comedy, after all.
Contrast this to Pink, and her violent music video, Please Don't Leave Me. I can't even link to it for you, it's so violent. Pink bloodies her boyfriend, beats him senseless so that he can't get out of the apartment. She's a sociopath, clearly, a violent, antisocial individual. I mean, rock star. Not that rock stars are violent.
When I first heard the song, the lyrics isolated from the video screamed Borderline Personality Disorder. So I checked out the video at YouTube to see if it would work as a teaching tool for high school kids learning about abandonment anxiety. (They teach kids about that, right, in your high schools?)
Here are the lyrics:
Da da da da, da da da da
Da da da, da da
Da da da, da da
I don't know if I can yell any louder
How many time I've kicked you outta here?
Or said something insulting?
Da da da, da da
I can be so mean when I wanna be
I am capable of really anything
I can cut you into pieces
But my heart is broken
Da da da, da da
Please don't leave me
Please don't leave me
I always say how I don't need you
But it's always gonna come right back to this
Please, don't leave me
How did I become so obnoxious?
What is it with you that makes me act like this?
I've never been this nasty
Da da da, da da
Can't you tell that this is all just a contest?
The one that wins will be the one that hits the hardest
But baby I don't mean it
I mean it, I promise
Da da da, da da
Please don't leave me
Oh please don't leave me
I always say how I don't need you
But it's always gonna come right back to this
Please, don't leave me
I forgot to say out loud how beautiful you really are to me
I cannot be without, you're my perfect little punching bag
And I need you, I'm sorry
Da da da, da da
You say I don't need you
But it's always gonna come right back
It's gonna come right back to this
Please, don't leave me
Please don't leave me, oh no no no.
What's interesting to me is that both women, Gigi and Pink, are desperately in need of a relationship, both concentrate all of their energy to keep a relationship, even go to extreme measures. But they are such different women.
Engaging Gigi in therapy would be a snap. Teaching her rubberband theory, exploring her insecurities about being alone, she'd grow leaps and bounds in a single visit. Well, not a single visit, but a few for sure. It's hard to let go, and managing neediness in relationships can take a lot of therapy, it's true. Yet Gigi's not that dysfunctional. She hurts only herself.
Whereas someone like Pink would be self-mutilating in my office and throwing rocks at home. I'd call in a team to work with her.
The differences in the two women, both so needy, underscores the importance of not diagnosing based upon a single symptom, not even an extreme symptom, although the no sleep thing in Bi-polar Disorder, and the hallucinations or delusions in Schizophrenia are fairly robust indicators of disease. But even then, there are things to rule out before making a diagnosis. Like speed, acid, other physical disease, brain tumors. Things.
I looked already. Nothing's on tonight.
therapydoc
Sunday, December 18, 2011
More Snapshots: You Is Kind, You Is Smart, You Is Important
1. Recycling
I approach the bin, a huge black plastic garbage can, with trepidation. It's getting too full. I'll never get the mega-sized clear plastic bag to the car. Someone else will have to do it, so I walk away. But I want that stuff out of my house.
It occurs to me that recycling, although it should be a workable intervention to relieve hoarding, never works. You would think that if someone can't throw out a perfectly good cardboard box, but knows it has to go, that recycling would be solace, a certain consolation, knowing that a perfectly decent box isn't going to landfill.
But OCPD, (Obsessive Compulsive Personality Disorder) is one of our more intractable disorders. And with all of the presents, all the good boxes coming our way, sufferers are going to feel the stress.
2. Holiday Social Skill
This time of year I usually set you up for a good party. Most people find at least one party to mark the holidays, and cluster around the guac.
Let's say Billy meets Sally approaching the guac, and they can't help but say something to one another while dipping. Sally asks, "So what's going on? How's work treating you?"
Billy has a really good work story to tell and he begins to tell it, starts to really get into it when someone else joins them, jumps in with some kind of declaration, maybe news of a new baby, or a story about Newt, a joke.
Sally turns from Billy to the new arrival because she hasn't got much choice, or doesn't see a choice, and that's the end of Billy's story.
We would call this an interruption, and interruptions are bad, everyone knows this. In the process of interrupting, the interrupter is supposed to catch himself and say, "My bad! I'm so sorry! I interrupted! You first. Finish what you were saying."
But that doesn't usually happen, maybe because people are high in these situations, or nervous. If Sally had finer social skill, she would somehow get the microphone back to Billy, or at least return her personal attention to his story.
She could gently inform the one who has interrupted, "Hold on, Billy's telling a story, let him finish."
Or she could wait out the speaker, then get back to Billy. "You were telling me about something when we were interrupted." Delicious, delightful social skill. Better than the guac.
Why is it so important? Why is this process considered social skill, on par with refraining from interrupting?
Because it puts Billy back in the room.
3. Gave It to You
I walk through the front door after a long day's work singing, belting, "I got chills electrifying. And I'm losing control, . . . ." It's from that song, You're the One That I Want from the musical, Grease.
My kid gets up to greet me. He's a young adult, he should. He says, "Do these songs just run through your head all day long?"
Seems like it. But give it to someone, and you don't have it anymore. No one knows why.
4. You Is Kind, You Is Smart, You Is Important
My mother asks me if I want to see The Help. It's playing in her building and she fell asleep when they took her to the theater to see it a few months ago, channeling my father. This is a second chance. She'll go without me, of course, but it might be fun, seeing it together.
Things are often more fun in twos.
I'm pretty sure I don't want to go. I don't like sitting more than I have to sit. It is an occupational hazard, sitting too much, hard on the back muscles. And there's so much to do. But the book was great, and the movie has to be a feel good movie. Why turn down a free one of those?
Abileen, the "colored" maid, raises the children of her rich white employers. These women tend to abdicate the job of parenting to their maids. Worse, they criticize their children mercilessly for being children, behaving like children, being messy, inappropriate, and honest.
Abileen uses persuasion, positive messaging, as her parenting style. She has her little girl repeat after her, You Is Kind, You Is Smart, You Is Important. (The green You Is Kind. . .etc., links you to this priceless scene.)
I is kind, I is smart, I is important, repeats the little girl.
I think of a thousand patients who didn't have anyone like Abileen in their lives and it makes me want to scream.
5. Less Holy Matrimony
Apparently there's a PEW poll (like Gallup, survey research) that is showing fewer Americans are getting married.
And who can blame them? It's so hard to accept people for who they are, to love them anyway. Love can be a thankless job.
But I look around my mother's retirement community and the loneliness is palpable. It's like a college residence hall, except that most of the rooms are singles, not doubles.
But there are a few couples, and they touch one another. Publicly. They may have issues, maybe old issues, but they have one another, and they're grateful for that. When bingo is over, they leave together.
6. Tebowing
I just loved it when I heard that Tim Tebow gets down on one knee after playing football, gives thanks to the Old Mighty. (For those of you who are new here, this is how my grandfather of blessed memory, an immigrant who taught himself to speak and read English at the age of 16, referred to God.)
Tebowing has come to mean praying on one knee, but not just praying, taking the pose in strange places under unusual circumstances.
What's interesting about this is that in Israel you see people praying all of the time, true, not on bended knee, but everywhere, especially on buses and in airports, mumbling while staring into prayer books written in a funny language. So Tim didn't make it up, but he's still pretty marvelous.
The thing that struck me about the Tim Tebow story (Saturday's Wall Street Journal, all about the good deeds he's done, his charity) is that people are really hoping he'll fail, that he'll start to lose games for Denver. They want him to fail, want to see how he behaves when he loses, if he'll lose his faith, starts using drugs, or is caught with his pants down. Clearly unclear on the concept, his detractors.
Happy holidays everyone, no matter what your language.
therapydoc
I approach the bin, a huge black plastic garbage can, with trepidation. It's getting too full. I'll never get the mega-sized clear plastic bag to the car. Someone else will have to do it, so I walk away. But I want that stuff out of my house.
It occurs to me that recycling, although it should be a workable intervention to relieve hoarding, never works. You would think that if someone can't throw out a perfectly good cardboard box, but knows it has to go, that recycling would be solace, a certain consolation, knowing that a perfectly decent box isn't going to landfill.
But OCPD, (Obsessive Compulsive Personality Disorder) is one of our more intractable disorders. And with all of the presents, all the good boxes coming our way, sufferers are going to feel the stress.
2. Holiday Social Skill
This time of year I usually set you up for a good party. Most people find at least one party to mark the holidays, and cluster around the guac.
Let's say Billy meets Sally approaching the guac, and they can't help but say something to one another while dipping. Sally asks, "So what's going on? How's work treating you?"
Billy has a really good work story to tell and he begins to tell it, starts to really get into it when someone else joins them, jumps in with some kind of declaration, maybe news of a new baby, or a story about Newt, a joke.
Sally turns from Billy to the new arrival because she hasn't got much choice, or doesn't see a choice, and that's the end of Billy's story.
We would call this an interruption, and interruptions are bad, everyone knows this. In the process of interrupting, the interrupter is supposed to catch himself and say, "My bad! I'm so sorry! I interrupted! You first. Finish what you were saying."
But that doesn't usually happen, maybe because people are high in these situations, or nervous. If Sally had finer social skill, she would somehow get the microphone back to Billy, or at least return her personal attention to his story.
She could gently inform the one who has interrupted, "Hold on, Billy's telling a story, let him finish."
Or she could wait out the speaker, then get back to Billy. "You were telling me about something when we were interrupted." Delicious, delightful social skill. Better than the guac.
Why is it so important? Why is this process considered social skill, on par with refraining from interrupting?
Because it puts Billy back in the room.
3. Gave It to You
I walk through the front door after a long day's work singing, belting, "I got chills electrifying. And I'm losing control, . . . ." It's from that song, You're the One That I Want from the musical, Grease.
My kid gets up to greet me. He's a young adult, he should. He says, "Do these songs just run through your head all day long?"
Seems like it. But give it to someone, and you don't have it anymore. No one knows why.
4. You Is Kind, You Is Smart, You Is Important
My mother asks me if I want to see The Help. It's playing in her building and she fell asleep when they took her to the theater to see it a few months ago, channeling my father. This is a second chance. She'll go without me, of course, but it might be fun, seeing it together.
Things are often more fun in twos.
I'm pretty sure I don't want to go. I don't like sitting more than I have to sit. It is an occupational hazard, sitting too much, hard on the back muscles. And there's so much to do. But the book was great, and the movie has to be a feel good movie. Why turn down a free one of those?
Abileen, the "colored" maid, raises the children of her rich white employers. These women tend to abdicate the job of parenting to their maids. Worse, they criticize their children mercilessly for being children, behaving like children, being messy, inappropriate, and honest.
Abileen uses persuasion, positive messaging, as her parenting style. She has her little girl repeat after her, You Is Kind, You Is Smart, You Is Important. (The green You Is Kind. . .etc., links you to this priceless scene.)
I is kind, I is smart, I is important, repeats the little girl.
I think of a thousand patients who didn't have anyone like Abileen in their lives and it makes me want to scream.
5. Less Holy Matrimony
Apparently there's a PEW poll (like Gallup, survey research) that is showing fewer Americans are getting married.
In 1960, 72% of all adults ages 18 and older were married; today just 51% are, a record low.Sustaining marriage does seem like an impossible goal for many people, and getting married, a risk so many just won't take.
And who can blame them? It's so hard to accept people for who they are, to love them anyway. Love can be a thankless job.
But I look around my mother's retirement community and the loneliness is palpable. It's like a college residence hall, except that most of the rooms are singles, not doubles.
But there are a few couples, and they touch one another. Publicly. They may have issues, maybe old issues, but they have one another, and they're grateful for that. When bingo is over, they leave together.
6. Tebowing
I just loved it when I heard that Tim Tebow gets down on one knee after playing football, gives thanks to the Old Mighty. (For those of you who are new here, this is how my grandfather of blessed memory, an immigrant who taught himself to speak and read English at the age of 16, referred to God.)
Tebowing has come to mean praying on one knee, but not just praying, taking the pose in strange places under unusual circumstances.
What's interesting about this is that in Israel you see people praying all of the time, true, not on bended knee, but everywhere, especially on buses and in airports, mumbling while staring into prayer books written in a funny language. So Tim didn't make it up, but he's still pretty marvelous.
The thing that struck me about the Tim Tebow story (Saturday's Wall Street Journal, all about the good deeds he's done, his charity) is that people are really hoping he'll fail, that he'll start to lose games for Denver. They want him to fail, want to see how he behaves when he loses, if he'll lose his faith, starts using drugs, or is caught with his pants down. Clearly unclear on the concept, his detractors.
Happy holidays everyone, no matter what your language.
therapydoc
Snapshots: Masters of Destiny
Wow, that was depressing, the last post, the one about the crash, the "nervous breakdown." And long.
I know they've all been too long lately, these posts, and promise, bli neder (rhymes with see-header, Hebrew for no promises) to tighten them up in the new year.
Here are three short pre-holiday snaps to make up for it.
1. Masters of Our Destinies
Years ago, after my uncle passed away from cancer, we heard that my cousin, his son, decided to specialize in oncology.
FD said to me at the time, "We only think we choose our professions."
And me, being a therapist, got that right away.
A couple of weeks ago, I get an evite to a birthday party for a friend of my mother's. The invitation is really for mom, not me, but mom can't get to the party on her own, so they grandmothered me in. (The two older women are in their eighties).
At the party I'm chatting it up with D., a friend of my late older brother's, who is now a doctor closing in on retirement. We reminisce about my brother who passed away a young adult, over forty years ago.
D. tells me that he has a sub-specialty in my brother's childhood illness.
Why am I not surprised?
2. Knowing Your Limitations
My birthday is in December, and my son asks his girlfriend to help him pick out a present.
He has the red-green color blind gene from my father and he knows his limitations.
My father, on the other hand, wore insane colors together, refused to believe us when we told him they didn't match.
Sometimes things aren't transgenerational.
Nice, right? Matches my coat, and soft. No, I won't tell you my age.
I also scored an infinity scarf that my daughter-in-law taught me how to wear, and those gloves with the mitten flaps. And chocolate. They bought me chocolate.
No, we're not finished. Before my birthday, FD happened upon this cashmere scarf (no softer than the acrylic above) for $10.00 at a medical conference.
All of the docs crowded around the stand, and FD asked the vender how he got the gig. The man replied that he answered an ad in the New York Times.
Do you believe him? Whaddaya think?
Best gift ever, my grandson's message in a card, telling me that I'm the most funest, smartest, happyst, . . . and a few more good things . . . .bubby, ever.
3. Victimizing Himself
Let's switch gears, get a little psychological. A gang-banger, working on not being a gang-banger, describes the feedback loop of his life. He tells me to tell the world, maybe it will help people. His feedback loop is an exercise, an illustration of behavior, thoughts and feelings reinforcing one another.
Inside the circles it reads:
We go over the sequence and fill in the blanks. Although he has broken the cycle, the feedback loop described above, the patient still sees himself as a victim. He sees people as disrespectful to him, mean, always attributes negativity to the actions of others. (Twelve Step people would say this is because he hasn't worked a program, and they would be half right. He's also never worked on this in therapy.)
He may be sober and law-abiding, but his approach to people still tends to be on the defensive, and when he feels offended, he lashes out aggressively.
The more relevant feedback loop addresses this:
But this time, rather than self-justify, he owns his behavior, gets it together much faster, recovery time is short. And he doesn't steal, is determined not to become a victim of his own psychology.
4. Gangbanging fish
I buy a new fish, the orange one below, thinking that an angel is going to be angelic. I put him in an aquarium with other angelic, peaceful fish, and the rumbles begin. It's worse than West Side Story. Fish are circling one another, tailing one another, banging it out. It's ugly.
I move him to a different aquarium, one with more aggressive fish. (It's an addiction, tending to aquariums, but a nice addiction). There, in the aggressive culture, he's chased, beat on, and learns empathy for those he has bullied in his past. Over time, because he's a survivor, he's accepted into the gang. There they are, below. Things are going swimmingly.
therapydoc
I know they've all been too long lately, these posts, and promise, bli neder (rhymes with see-header, Hebrew for no promises) to tighten them up in the new year.
Here are three short pre-holiday snaps to make up for it.
1. Masters of Our Destinies
Years ago, after my uncle passed away from cancer, we heard that my cousin, his son, decided to specialize in oncology.
FD said to me at the time, "We only think we choose our professions."
And me, being a therapist, got that right away.
A couple of weeks ago, I get an evite to a birthday party for a friend of my mother's. The invitation is really for mom, not me, but mom can't get to the party on her own, so they grandmothered me in. (The two older women are in their eighties).
At the party I'm chatting it up with D., a friend of my late older brother's, who is now a doctor closing in on retirement. We reminisce about my brother who passed away a young adult, over forty years ago.
D. tells me that he has a sub-specialty in my brother's childhood illness.
Why am I not surprised?
2. Knowing Your Limitations
My birthday is in December, and my son asks his girlfriend to help him pick out a present.
He has the red-green color blind gene from my father and he knows his limitations.
My father, on the other hand, wore insane colors together, refused to believe us when we told him they didn't match.
Sometimes things aren't transgenerational.
Nice, right? Matches my coat, and soft. No, I won't tell you my age.
I also scored an infinity scarf that my daughter-in-law taught me how to wear, and those gloves with the mitten flaps. And chocolate. They bought me chocolate.
No, we're not finished. Before my birthday, FD happened upon this cashmere scarf (no softer than the acrylic above) for $10.00 at a medical conference.
All of the docs crowded around the stand, and FD asked the vender how he got the gig. The man replied that he answered an ad in the New York Times.
Do you believe him? Whaddaya think?
Best gift ever, my grandson's message in a card, telling me that I'm the most funest, smartest, happyst, . . . and a few more good things . . . .bubby, ever.
3. Victimizing Himself
Let's switch gears, get a little psychological. A gang-banger, working on not being a gang-banger, describes the feedback loop of his life. He tells me to tell the world, maybe it will help people. His feedback loop is an exercise, an illustration of behavior, thoughts and feelings reinforcing one another.
Inside the circles it reads:
Father beats son, calls him a loser at a young age for minor infractions, i.e., spilt milk →and around and around we go, until the son either gets it together, or hits bottom and either dies or stops using.
Son develops low self-esteem, thinks he’s a loser →
Son self-medicates, gets addicted to substances →
Father beats son, calls him a loser →
Son has low self-esteem, thinks he’s a loser →
Son self-medicates, gets addicted to substances
We go over the sequence and fill in the blanks. Although he has broken the cycle, the feedback loop described above, the patient still sees himself as a victim. He sees people as disrespectful to him, mean, always attributes negativity to the actions of others. (Twelve Step people would say this is because he hasn't worked a program, and they would be half right. He's also never worked on this in therapy.)
He may be sober and law-abiding, but his approach to people still tends to be on the defensive, and when he feels offended, he lashes out aggressively.
The more relevant feedback loop addresses this:
Young man gets addicted, self-medicates discomfort, steals to support drug habit →
He justifies it because he's had a rough childhood, needs drugs to self-medicate →
He beats the drugs, becomes somebody he likes, an upstanding citizen, at least more upstanding than before →
But he still reacts offensively when he feels insulted, disrespected, which is often →
The perceived insults manifest as aggression →
Fighting, even verbally, hurts him socially, and hurts his bottom line in business. Failures drive him to drugs →
He relapses, gets stoned to self-medicate, →
4. Gangbanging fish
I buy a new fish, the orange one below, thinking that an angel is going to be angelic. I put him in an aquarium with other angelic, peaceful fish, and the rumbles begin. It's worse than West Side Story. Fish are circling one another, tailing one another, banging it out. It's ugly.
I move him to a different aquarium, one with more aggressive fish. (It's an addiction, tending to aquariums, but a nice addiction). There, in the aggressive culture, he's chased, beat on, and learns empathy for those he has bullied in his past. Over time, because he's a survivor, he's accepted into the gang. There they are, below. Things are going swimmingly.
therapydoc
Monday, December 05, 2011
My nervous breakdown, not yours
Because we're all entitled to at least one nervous breakdown. It can't be, Let me tell you about my nervous breakdown, and someone else chimes in with a story about their own.
What is fascinating, in our tolerant, (almost) anything goes culture, is that there is still shame in having one at all. But there is, probably because mental illness can be debilitating and burdensome, so much so that when we are in the middle of a nervous breakdown, people fear the temporary debilitated and burdensome as symptomatic of something more permanent. But it usually isn't.
Not that a nervous breakdown isn't mental illness; it is. And we're all predisposed, vulnerable to something, under the right circumstances, some biological fever or another. What manifests to whom, and how-- that is the question.*
And another dissertation question of the week: Is the stigma we associate with mental illness due to unfamiliarity, fear, helplessness, or a combination of all of the above? Or is it about anger, having to shoulder all the work. Somebody has to get the kids to school.
Somewhere in the Stuff That Makes Us Sick section of this blog, we talk about how there is no designation, nervous breakdown, in the Diagnostic and Statistical Manual of Mental Disorders. The DSM defines episodes of depression, all kinds, mania, too, and an entire nosology of dreadful symptoms associated with anxiety. But the syntax nervous breakdown is nowhere to be found.
It is most familiar to the generation that relates (really relates) to Mad Men (the TV show). In the fifties you had to have one to get attention for feeling mentally ill.
We omit it because it is defined by better differentiated disorders. Yet, that perfect storm of anxiety, panic, blinding fear, and catatonia, an inability to communicate well, a feeling of shutting down, symptoms of several Axis I disorders all rolled into one isn't close to feeling healthy.
And it happens to many, if not most of us, and for some people, it happens at the worst of times, the beginning of a new job, the birth of a baby, making a wedding, graduating high school, college, moving away or moving toward. Certain diagnoses are more likely to manifest at certain ages.
There's never a good time, is there?
If it is ubiquitous, and symptomatic of some type of mental illness or a combination of disorders, then perhaps the stigma about the nervous breakdown isn't about misunderstanding or unfamiliarity, rather it is born of a sense of dire helplessness in the face of the collapse of another. Not knowing what to do, wanting to help and not knowing how, we displace our anxiety, judge, blame the victim. And the victim isn't doing much around the house, is the truth, which can make us very, very mad.
Caregivers who come to the rescue will need therapy themselves if the fever of their partner, friend, or family member doesn't resolve soon enough, or keeps recurring. They deserve more than the tee shirt, I'm Working on Surviving His (Her), My Mom's, My Kid's Nervous Breakdown. But a tee shirt is a nice gesture. The one who crashes gets to wear Lost It.
So many opportunities to lose it in a lifetime. There's little chance of coasting without being affected, if only temporarily, little chance of not hurting to the max emotionally. No longer grounded, sanity is penciled onto the loss list, if only temporarily. (I have my patients write one, everybody has to grieve, tee shirts aside.) Here's a short summary of family developmental steps that threaten ours.**
(a) Pregnancy
By far one of the most pathological conditions known to man, hormones shifting, bodies changing. Yet people make comments about size and weight gain, comparisons to animals (whales, mainly). It is one thing for me to describe my pregnancy as capable of filling out a hula hoop, quite another if you do.
A woman carrying a child needs nothing but love, as those of us who have survived it know. Carrying alone is justification to kvetch, we don't need much advice or personal solutions to the inevitable problems. There's enough information on the Internet to reinforce our insecurities. Ask benign questions, smile at pregnant people. That's all they need. The looming fear of parenthood will go away, if only temporarily.
(b) Better out than in, owning an infant
Babies cry so much, and sometimes they're sick, and their sleep schedules are unpredictable. Their insecurities (I'm so small, hasn't anyone noticed? Why did they leave me alone in this crib? It's freezing in hear and they don't care. Life has changed for the worse!)
Their insecurities are contagious, and parents feel a loss of control. Sleep deprived, reality isn't real, lovers become enemies. Decision-making is compromised. Life is all about four little words, Is the baby okay? When both parents are up all night no one feels good and self-pity or blaming the other natural. The best fights begin. Happiest times of our lives, for sure, those moments with the little bundles of joy.
Infancy is relatively short, and if handled graciously, with few preconceived expectations, can be delightful, delicious, and unforgettable in a positive way. It is obvious we forget how bad it can be because we keep on doing it, some of us, live to repeat the mistake. Someone's teleological trick.
(c) Parenting toddlers
The diapers, seriously, as babies morph into little people who walk, make us sick, and we feel a sense of failure as the little one, all of three years old, (usually a boy, most girls train sooner) refuses to use the potty. The pleading cry of infancy has matured to a respectable tantrum. Things break, fly across the room. Bites happen. Parents feel they must be able to control this cub-like behavior, and surely they should, but how?
And if a child is sick, has a disorder of some type, perhaps isn't progressing or begins to slip developmentally, that sense of failure becomes identity without support from friends and family. Support is of the essence and it isn't always there. Neighbors run from problem children, hope someone else is picking up the slack.
(d) Having children five and under
Little people, little problems, but no, not really. Children are complicated and because their verbal communication skills aren't perfect yet, hard to read. We send them off to school expecting them to behave, and they look around and find other little people wearing better clothes, with better phones, and better manners, or they are bullied. Their teachers are critical and not always good at what they do.
Under all kinds of pressure and social stress, missing home and picturing Mom or Dad with the new arrival, little people act out, have even better ways, demand, or sulk and hide in their rooms. We don't know how to respond to their nervous breakdowns except to say, Snap out of it or no doughnuts. This usually works.
(e) Having children in latency
Freud named the elementary school years latency, pre-puberty, a stage of development theoretically sexually dormant. Children in his world (who were these children?) settled into academics, worked hard at school. Erickson called the stage Industry.
Now, of course, there is no latency and the age of puberty has dropped, probably due to the sexual stimuli in our world or nature's way of demanding we recreate. The stress doubles as parents return to work, children aren't supervised, homework isn't done and food isn't on the table. Perhaps, by now, the slightly alcoholic tendencies of our twenties manifest as truly alcoholic, and sober partners shoulder a disproportionate amount of stress. Marital conflict warms up. Kids get symptomatic, take the hit for everyone. Good times.
(f) Parenting adolescents
By now we have shown our true colors to our partners and whatever marital issues we have, or what is thought to be a mid-life crisis, is a movie the kids have seen at least once. One of us has abandoned the other emotionally, or physically.
Divorce is imminent or discussed in front of children and friends, anyone who will listen. The stresses of money, keeping up appearances, aging, coping with the ghosts of our own childhood-- all of this crescendos as the children smugly look on and get stoned. Who has the nervous breakdown? Any or all of us.
(g) Launching
The kids are off to college or getting married, traditionally the best time for mental illness to manifest. Oh, wait. Nobody's leaving home anymore. Now the nineteenth nervous breakdown*** is about everyone living in the same house. Nobody's off to college, and if some of them managed to go, the parents are in hock for student loans they will never pay off.
Launching, when it does happen, traditionally tips the relationship system in the family, not always in a good way. The suicidal mom, you know, is a kid-magnet, ruins a perfectly good launch.
Oh, we could go on and should, but that's enough for now. The first thing the therapist is going to tell you, if you are lucky enough to get one, is that you are entitled, or you were entitled, to your nervous breakdown. And we want to know if somebody was there for you, what happened at the time and what happened later. Because frankly, the aftermath is so much more important than the crash.
therapydoc
* Jews thought they had no alcoholic gene until recent history. Our ancestors didn't drink to excess, not only because they were too poor, but you can't learn anything when you're drunk! So there was no such thing, in most families, as drinking for fun. You have a glass to toast to a new baby or a marriage, or to bring in the Sabbath. But now, as a culturally assimilated people, we drink along with everyone else. And what are we finding? Alcohol dependence! Crazy, I know.
**By no means the full list. We have to quit while we're ahead, at about the time the kids start having kids of their own. That softens some of the pain of impending sickness, coping with aging parents and helping our children who have new problems, similar to our very own, that sandwich thing. Hardly worth talking about.
***Ninteenth Nervous Breakdown is an old Rolling Stones song.
What is fascinating, in our tolerant, (almost) anything goes culture, is that there is still shame in having one at all. But there is, probably because mental illness can be debilitating and burdensome, so much so that when we are in the middle of a nervous breakdown, people fear the temporary debilitated and burdensome as symptomatic of something more permanent. But it usually isn't.
Not that a nervous breakdown isn't mental illness; it is. And we're all predisposed, vulnerable to something, under the right circumstances, some biological fever or another. What manifests to whom, and how-- that is the question.*
And another dissertation question of the week: Is the stigma we associate with mental illness due to unfamiliarity, fear, helplessness, or a combination of all of the above? Or is it about anger, having to shoulder all the work. Somebody has to get the kids to school.
Somewhere in the Stuff That Makes Us Sick section of this blog, we talk about how there is no designation, nervous breakdown, in the Diagnostic and Statistical Manual of Mental Disorders. The DSM defines episodes of depression, all kinds, mania, too, and an entire nosology of dreadful symptoms associated with anxiety. But the syntax nervous breakdown is nowhere to be found.
It is most familiar to the generation that relates (really relates) to Mad Men (the TV show). In the fifties you had to have one to get attention for feeling mentally ill.
We omit it because it is defined by better differentiated disorders. Yet, that perfect storm of anxiety, panic, blinding fear, and catatonia, an inability to communicate well, a feeling of shutting down, symptoms of several Axis I disorders all rolled into one isn't close to feeling healthy.
And it happens to many, if not most of us, and for some people, it happens at the worst of times, the beginning of a new job, the birth of a baby, making a wedding, graduating high school, college, moving away or moving toward. Certain diagnoses are more likely to manifest at certain ages.
There's never a good time, is there?
If it is ubiquitous, and symptomatic of some type of mental illness or a combination of disorders, then perhaps the stigma about the nervous breakdown isn't about misunderstanding or unfamiliarity, rather it is born of a sense of dire helplessness in the face of the collapse of another. Not knowing what to do, wanting to help and not knowing how, we displace our anxiety, judge, blame the victim. And the victim isn't doing much around the house, is the truth, which can make us very, very mad.
Caregivers who come to the rescue will need therapy themselves if the fever of their partner, friend, or family member doesn't resolve soon enough, or keeps recurring. They deserve more than the tee shirt, I'm Working on Surviving His (Her), My Mom's, My Kid's Nervous Breakdown. But a tee shirt is a nice gesture. The one who crashes gets to wear Lost It.
So many opportunities to lose it in a lifetime. There's little chance of coasting without being affected, if only temporarily, little chance of not hurting to the max emotionally. No longer grounded, sanity is penciled onto the loss list, if only temporarily. (I have my patients write one, everybody has to grieve, tee shirts aside.) Here's a short summary of family developmental steps that threaten ours.**
(a) Pregnancy
By far one of the most pathological conditions known to man, hormones shifting, bodies changing. Yet people make comments about size and weight gain, comparisons to animals (whales, mainly). It is one thing for me to describe my pregnancy as capable of filling out a hula hoop, quite another if you do.
A woman carrying a child needs nothing but love, as those of us who have survived it know. Carrying alone is justification to kvetch, we don't need much advice or personal solutions to the inevitable problems. There's enough information on the Internet to reinforce our insecurities. Ask benign questions, smile at pregnant people. That's all they need. The looming fear of parenthood will go away, if only temporarily.
(b) Better out than in, owning an infant
Babies cry so much, and sometimes they're sick, and their sleep schedules are unpredictable. Their insecurities (I'm so small, hasn't anyone noticed? Why did they leave me alone in this crib? It's freezing in hear and they don't care. Life has changed for the worse!)
Their insecurities are contagious, and parents feel a loss of control. Sleep deprived, reality isn't real, lovers become enemies. Decision-making is compromised. Life is all about four little words, Is the baby okay? When both parents are up all night no one feels good and self-pity or blaming the other natural. The best fights begin. Happiest times of our lives, for sure, those moments with the little bundles of joy.
Infancy is relatively short, and if handled graciously, with few preconceived expectations, can be delightful, delicious, and unforgettable in a positive way. It is obvious we forget how bad it can be because we keep on doing it, some of us, live to repeat the mistake. Someone's teleological trick.
(c) Parenting toddlers
The diapers, seriously, as babies morph into little people who walk, make us sick, and we feel a sense of failure as the little one, all of three years old, (usually a boy, most girls train sooner) refuses to use the potty. The pleading cry of infancy has matured to a respectable tantrum. Things break, fly across the room. Bites happen. Parents feel they must be able to control this cub-like behavior, and surely they should, but how?
And if a child is sick, has a disorder of some type, perhaps isn't progressing or begins to slip developmentally, that sense of failure becomes identity without support from friends and family. Support is of the essence and it isn't always there. Neighbors run from problem children, hope someone else is picking up the slack.
(d) Having children five and under
Little people, little problems, but no, not really. Children are complicated and because their verbal communication skills aren't perfect yet, hard to read. We send them off to school expecting them to behave, and they look around and find other little people wearing better clothes, with better phones, and better manners, or they are bullied. Their teachers are critical and not always good at what they do.
Under all kinds of pressure and social stress, missing home and picturing Mom or Dad with the new arrival, little people act out, have even better ways, demand, or sulk and hide in their rooms. We don't know how to respond to their nervous breakdowns except to say, Snap out of it or no doughnuts. This usually works.
(e) Having children in latency
Freud named the elementary school years latency, pre-puberty, a stage of development theoretically sexually dormant. Children in his world (who were these children?) settled into academics, worked hard at school. Erickson called the stage Industry.
Now, of course, there is no latency and the age of puberty has dropped, probably due to the sexual stimuli in our world or nature's way of demanding we recreate. The stress doubles as parents return to work, children aren't supervised, homework isn't done and food isn't on the table. Perhaps, by now, the slightly alcoholic tendencies of our twenties manifest as truly alcoholic, and sober partners shoulder a disproportionate amount of stress. Marital conflict warms up. Kids get symptomatic, take the hit for everyone. Good times.
(f) Parenting adolescents
By now we have shown our true colors to our partners and whatever marital issues we have, or what is thought to be a mid-life crisis, is a movie the kids have seen at least once. One of us has abandoned the other emotionally, or physically.
Divorce is imminent or discussed in front of children and friends, anyone who will listen. The stresses of money, keeping up appearances, aging, coping with the ghosts of our own childhood-- all of this crescendos as the children smugly look on and get stoned. Who has the nervous breakdown? Any or all of us.
(g) Launching
The kids are off to college or getting married, traditionally the best time for mental illness to manifest. Oh, wait. Nobody's leaving home anymore. Now the nineteenth nervous breakdown*** is about everyone living in the same house. Nobody's off to college, and if some of them managed to go, the parents are in hock for student loans they will never pay off.
Launching, when it does happen, traditionally tips the relationship system in the family, not always in a good way. The suicidal mom, you know, is a kid-magnet, ruins a perfectly good launch.
Oh, we could go on and should, but that's enough for now. The first thing the therapist is going to tell you, if you are lucky enough to get one, is that you are entitled, or you were entitled, to your nervous breakdown. And we want to know if somebody was there for you, what happened at the time and what happened later. Because frankly, the aftermath is so much more important than the crash.
therapydoc
* Jews thought they had no alcoholic gene until recent history. Our ancestors didn't drink to excess, not only because they were too poor, but you can't learn anything when you're drunk! So there was no such thing, in most families, as drinking for fun. You have a glass to toast to a new baby or a marriage, or to bring in the Sabbath. But now, as a culturally assimilated people, we drink along with everyone else. And what are we finding? Alcohol dependence! Crazy, I know.
**By no means the full list. We have to quit while we're ahead, at about the time the kids start having kids of their own. That softens some of the pain of impending sickness, coping with aging parents and helping our children who have new problems, similar to our very own, that sandwich thing. Hardly worth talking about.
***Ninteenth Nervous Breakdown is an old Rolling Stones song.
Tuesday, November 22, 2011
U-C Davis
I just don't get it, and I'm supposed to get everything. If you saw the video, you saw kids lined up, sitting in a line on the ground, heads between their knees, and policemen spraying them with pepper spray.
Many of you are therapists, but you don't have to be one to know this is sick.
Someone enlighten me here. It feels way too much like WWII, and those policemen, the Gestapo. Too much interface here, maybe, on my part, but this is unbelievable.
Not to brag, but my fair city, Chicago, handled protests with aplomb. Maybe 1968 taught us something.
Thanks,
therapydoc
Many of you are therapists, but you don't have to be one to know this is sick.
Someone enlighten me here. It feels way too much like WWII, and those policemen, the Gestapo. Too much interface here, maybe, on my part, but this is unbelievable.
Not to brag, but my fair city, Chicago, handled protests with aplomb. Maybe 1968 taught us something.
Thanks,
therapydoc
Subscribe to:
Posts (Atom)










