Tuesday, September 09, 2014

Ray Rice, Power, and Domestic Violence in the NFL


Rape, now more commonly called sexual assault, is the end and the beginning of many things. It can be the end of innocence and trust, for as long as it takes to recapture that, and the beginning of guilt, shame, fear, sexual problems, infertility, mental and physical illnesses, isolation, and more.

Tearing it apart, the perpetrator overpowers a victim, a person who protests, and having more power over this person, commits a crime of passion, of sorts, Those cries of "No, I don't want you to . . ."  (do whatever it is that is objectionable at the time) are overruled by brute force.

We tend to think of a sexual assault perpetrator as larger-than-life, stronger than your average Joe, but more often than not, he's not. Sometimes he's the person you would never suspect, might even respect (think of teachers). When the suspect is a professional football player he is stronger, indomitable.

Six years ago sexual violence was outed in the NFL.  Ben Roethlisberger, accused of numerous sexual assaults settled one of them, a casino incident. Stories like this are buried, no surprise.  If you want access to our locker rooms for your sports column, you had better make this one die of natural causes.

Now we have Ray Rice beating his wife to unconsciousness. And nobody is burying anything.

Strangely enough, before I saw the infamous clip, public since February (!), I was watching highlights of Monday night football and came to a crazy conclusion.  That athletes brush off tackles and crashes to the head is astounding. These people are stupefying, superhuman. Inhuman, brushing off falls that would put most of us out of commission for weeks. How does a person endure so much physical abuse and still pop back up and play ball?* Players learn to endure pain, is the answer, and it is admirable.

But here's the point:  Maybe they project that invulnerability onto others, assume we ordinary mortals can take physical abuse, too. There are other explanations, from poor family and peer role models to the narcissism learned as a child, treated special, always, as a potential star. Groomed for college ball and maybe the NFL, women and cars, hotels and alcohol, are assumed. Those courses on ethics are skipped, too boring.  And maybe men like Ray Rice actually are fooled into thinking that women like his fiance can take a wallop on the head, like he can.

Ray Rice needs to know what it is that happened there in the elevator, decking his wife with one blow, dragging her seemingly lifeless body from the elevator floor to the corridor. He is probably as surprised as any of us, and yet, it is unlikely this is his first physical altercation. His father died when he was one year old, shot dead. John Clayton:

"I faced a lot of adversity," Rice (told me once by phone), "and I had to be a man real young.".

The NFL response? New policies are in the works that will (surely) reduce violence perpetrated by players. That is the intent.

Not everyone agrees that the new policies will be enough. Certainly not those of us who work with victims and perpetrators. It is changing personality we are talking about: impulse control, narcissism, and empathy, and a different defiintion of manhood. A year in therapy is a start, but education, workshops, testimonies from survivors of assault, so many that the words of survivors are predictable, this type of exposure is what these very large men, players like Ray Rice need. Even with those workshops there will be sociopathic players who feel they are above being told what to do and what not to do, what is expected of them as human beings, members of the human race.

Social workers approached Roger Goodell, the commissioner of the NFL, with assault prevention workshops years ago. As anti-violence experts, we received polite applications. Fill these out. Let us know your plan. We'll get back to you. Don't call us. . .We'll call you.

Something tells me the applications hit the waste basket pretty quick.

therapydoc

 *Players aren't actually superhuman, and they know it. Concussions, many of them, are an occupational hazard. The self-abuse of a life-time in sports is future-changing, predicts a difficult retirement. Cognitive functioning, you know, is a terrible thing to waste.  I hope Janay Palmer is okay.


Thursday, September 04, 2014

When the Diagnosis is : All of the Above

Most of us aren't Diagnostic and Statistical Manual (DSM) experts, but are aware of this thing we call the DSM-5, or Diagnostic and Statistical Manual of Mental Disorders that therapists memorize. The bullet-point system of features at the corner of the desk is likely a well ear-marked spiral-bound copy of the bible. Docs flip easily to a suspected disorder.

"See?" we declare knowingly. "That's you."  Or more likely, "That's her."

Some of us read the patient right away. He belongs to either the anxiety disorder family, or the affective (depressive-manic) disorder tree, because so many of us do. The lucky belong to both. The experienced professional also recognizes substance abuse, eating and gambling disorders, personality disorders, everything.

Still, we work at that differential diagnosis, want to narrow the problem down, if there even is a real disorder, one that has met the full DSM criterion. Not everyone has a particular disorder, but we live in a world replete with mental and behavioral messiness, so a typical therapy visit also means someone else, someone who is not in the room, is the subject of that "See? That's her." Yes, you should worry when your partner gets a therapist.

All well and good. But what's a therapist to do when the patient begins by saying, for example, that as a kid he had an addiction to pot, and can't remember being depressed as it presents in the books, but knows he had suicidal thoughts. He will continue to say that he treated teachers as inferior beings and passive-aggressively refused to answer questions, yet never scored lower than an 90 on a test without studying. She'll tell you, too, change the gender, that she binged and purged before even knowing it would be popular in college, and that by the age of twenty started having obsessive thoughts when she saw a knife, visualizing the knife slashing her of its own accord. Or she might irrepressibly slash herself. Add to this a social network disorder that culminated in job loss, and compulsive sexual relationships on the internet. Oh, and she has a new job and she hates it.

All this without any family history, as if to say, It is my genetics that made me do it. I have a mental disorder and none of the doctors in the past have managed to narrow it down. Would you do that for me please? I'm under a lot of stress.

I look at you, do my best to read you. You return the favor, read me. I ask, How did you find me? Why me? This yields wonderful diagnostic information. Another question: What does your primary care doctor think?

Inevitably, assuming the pri-care is a family physician, the answer is: That I need counseling. I need to talk to someone like you.

Those of us who have helped people in one or two visits, who specialize in "only evaluations" or are in a hurry or don't have evening appointments might want to pass him on to another therapist. Our patient with a million symptoms and as many diagnoses and problems likely had a very messy childhood. One of my mentors once told me that if a person has been incested, that means twice a week for years.

Makes sense, right?  There are so many forms of incest, is the thing, and indeed, twice a week on the couch for years is an incredible luxury. And it usually isn't necessary, all due respect. Who has that kind of time? Job stress is at the top of the list. There is a V-code, I think, for that.

Upshot: If the patient with All of the Above* is your new patient, then settle back and relax. Feet up on the ottoman. Do the therapy that the primary care doctor has asked you to do. And don't worry about the diagnosis, the medication, or even who else you think should be in therapy. This one's yours. Embrace it.


therapydoc

All of the Above*: Not to say that there aren't a few diagnoses, but usually there are a few features of several diagnoses. One does have to go through that process, vetting those features, finding illness. All I'm saying is, don't let the diagnostic process get in the way of the therapy. Because it really can, seductive monster that it is.

Monday, August 18, 2014

The Year of Mourning

We've talked about it before, ritualized grief. It is healing, if executed well. And at the end of an official year (especially if you do it the Jewish way) one feels different, as if a millennium has passed.

We're returning from Ruby Falls, a tourist trap in Tennessee. I had the front seat of the van on the way out, but am in the back now, hosting three very little, dirty and exhausted children. They are engrossed in movies. I can stretch out my legs. Not a bad way to travel. Gazing out the window, road trip lyrics come to mind:
Let us be lovers,
We'll marry our fortunes together.
I've got some real estate here in my bag.
So we bought a pack of cigarets.
And Mrs. Wagner pies,
And we walked off to look for America.
America, the Bookends Album
Hard to get the Bookends song out of my head. Now you've got it. That's what we do in my family, pass off songs.

My son asked if we could take a short vacation, come for a visit this summer. So just before the year of mourning ended, FD and I got on an American Eagle jet and took photos of clouds, seeing clouds from both sides now, obviously. Changing the song works, too.

But only one  emotional snapshot stands out from that vacation.

The children have personal entertainment consoles;  The Lego Movie and Lilo and Stitch play on and on. I look out the window and watch the landscape, hoping for an occasional rooster or horse. The Paul Simon song attacks and I want to sing but can't remember the words, immediately Google them on my phone.

A patient had just complained about her niece and an internet addiction. More accurately, a media addiction. And I think: My grandchildren will have to wait until they have children of their own to even  begin to look for America, feel the sensory joy of looking beyond their phones, their tablets. They will have to take their kids on road trips. Drive.

But maybe not. My kids are pretty conservative, don't even let the little ones have email accounts. I understand you get one now at your bris.

So I sing softly to myself, thinking it odd that during the first year of mourning, if you observe those Jewish rituals, singing is permitted, but not listening to music. Certainly not live music. Recorded music is discouraged, too, really. Paul Simon whispers in my brain and there's no need to adjust the volume, no headset.

So I looked at the scenery, she read her magazine, and the moon rose over an open field.

Ruby Falls at Lookout Mountain
Why forbid music during a year of mourning?

Too happy, maybe. But until it ends we don't understand the real reason. After a year of sensory deprivation, at the end of that season of grief, the anticipation, the desire, the need to live is indescribable. And when you finally hear the sound of music, you cry.  It is as if life begins again.

As it should. That is the point. (We only grieve this long for parents, by the way).

So picture me the last evening of that season, a Thursday night. I have invited guests for a Friday night dinner, cooked a few hours. It is finally dark. Pitch black. FD comes home, has a quick bite to eat. I am in a chair, exhausted, feet up, watching my fish swim in the aquarium. He asks me if I want to hear what he's been working on. (He is a classical pianist). I thought you would never ask.

For a year he practiced on a keyboard, headphones on, and all I heard was the banging of keys, no notes. So now he plays the scherzos so that I can hear them loud and clear, explains each one. Then we listen to yet another on YouTube, one that he hasn't learned because it hasn't been transcribed for piano. He's working on the transcription. He tells me that a scherzo is a musical joke. The thought makes me smile. Weird Al has nothing on a scherzo.

The next day I am texting the kids, asking them for the names of popular songs that I missed during the year. I use itunes (forgetting all about Pandora) and listen, wondering if I even like the choices. As I dice onions, the enormity of it all, the trance-like feel of transition, works its effect. Guests! Fun! Friends. For a year socializing has been limited to family, primarily, and a few couples, one at a time, let's not over do it, very few. Certainly nothing remotely like a party. Tears applaud this moment, make it memorable.

My grandson would videotape the scene: An aging female seeking show tunes on her iphone, crying as she dices onions. Funny, no?

But it is sad. Setting the table, it is clear to me that my mother would love the china, the silver, the royalty of this Sabbath meal especially, for her touches are on everything. She is everywhere.
Waterford rose bowl


Then at night, after the dinner, a dream, a disturbing dream. She is alive, but not really alive, wearing a pale green dress that I don't remember, but her style (and green is a good color on her, but not this time). She is thin and disabled, and it is my son's wedding, which she missed due to her illness. But she's there now, and I have lost her and am in a panic trying to reconnect. She is in a carriage, or a rickshaw, on her way to the synagogue where we are hosting a huge celebration after services, the occasion of the day. I miss the whole thing trying to find her a lemonade.

Not a good dream, and it cast a pall over the weekend. We don't lose bad dreams easily, and even though it was nice to see her, it wasn't a picnic. I blame the short glass of excellent red wine, a Gallil Mountain, Yiron 2010. My guests chose well, but wine can be dangerous, even in small quantities.

The next night we dress up again. FD has tickets for Brigadoon at the Goodman Theater downtown, and from the very first note, the voices so clear and high, so strong and powerful; the scenery, brilliant; the story, fanciful, I am lifted there, to Brigadoon. A musical is surreal under any circumstances, which is why we love them, but to hear the songs that Andrew Lloyd Webber pirated (you're undoubtedly familiar with Phantom), and gaze closely at classically trained dancers up on their toes, stepping, twirling, skirts flowing, everyone smiling on stage, in the audience, everywhere.

Quite a sensory whirl.

We meet a few friends at the theater, too, also odd, because who goes to see Brigadoon? (People a bit older, that's who). Our friends go to the theater often and suggest we try the Lincolnshire if we haven't already. Very reasonable, wonderful productions. My parents had season tickets, I say, but we never took them up on their offer to go; the drive is a little far. Now I want to go. I am becoming my mother, I laugh.

Brigadoon-Goodman Theater
One of the women notices and compliments my beaded bag.  She has one like it, her grandmother's. She is nostalgic, her eyes look up and to the left, remembering.

My bag was my mothers, naturally.

therapydoc


Tuesday, August 12, 2014

Robin Williams and Bipolar Disorder

Robin Williams
I know he denied it, but it does seem that Robin Williams had bipolar disorder. So based upon the presentation, at the very least I'm going with a Bipolar II. You only need one manic episode for that one.  A depressive episode took his life.

I get my first world news updates from Robin Meade's early morning show. Her voice is calming. In therapy, people who work on a morning news show are at work at one a.m. They will tell you that to get through that shift: You drink a lot of caffeine.

Many of us do, too, drink a lot of caffeine, if only in the morning, and it makes us a little  manic (I am typing fast) and we wouldn't trade the feeling. Half-caf is a suitable alternative. 

There is a world of difference, however, between the manic feeling associated with two cups of coffee and the "manic" in manic-depressive, or bipolar disorder. We now really only use the term, bipolar disorder. I don't know why.

One of my first posts on this blog, back in June, 2006, hosts a long list of celebrity sufferers, including Mark Twain, Agatha Christie, Abraham Lincoln, Plato, Graham Greene, and Sir Isaac Newton. Dozens of Hollywood stars rate inclusion, celebrities gone public about their disease.

We have to add Robin Williams, now. He killed himself to escape the disease. He was in Hazeldon for rehab only last month and had treatment for depression, too, fairly recently. His daughter Zelda just turned twenty-five. Susan Schneider, his loving wife, is "utterly heartbroken." Millions of fans, everyone, mourns with the family. It is a dark day, and it isn't just the weather.

When I see the montage of photographs it seems as if the actor is crying in most of them. The editors on television shows know how to relate, convey empathy. There is a sadness in Mr. Williams, a sadness in his eyes.

It is not the sadness of Lesley McSpadden who lost her son, Michael Brown, on the same day, although her eyes are sad, too. A policeman in Ferguson, Missouri shot the boy down; Michael's hands up in surrender. A riot ensued, teargas to contain the mob. Ms. McSpadden shouts to police:
"You took my son away from me."
The shooting, racially motivated. Had it been a white teen on the street, it is unlikely this would have happened. So Ms. McSpadden has fellow mourners, millions, too.

It is not the sadness of the family and friends of Rabbi Joseph Raksin:
Rabbi Raksin: Victim of hate crime
In cold blood.

Homicide victims, symbolic of the racial tensions of the day, are now common. And we haven't even discussed Knockout, a video game encouraging players to take to the sidewalks. One rolls the camera while the other casually knocks out an innocent pedestrian. Victims happen to be Jewish in New York. It is rumored to have happened a few weeks ago in Chicago, and the victim died. So scary that some of us think, "I should buy a gun and learn how to use it."

Then there is Robin Williams, who died with a belt around his neck, a man who brought the world happiness and tears, the tears we love to cry at the movies. It feels like a crime, too, his suicide. He describes his quiet childhood, and tells NPR that he certainly suffered sadness, but everyone does. Yet others speak of disabling depression. A person can take only so much. He probably thought he had tried everything. 

But he hadn't. We know that because he's gone.

To "treat" his disease, among other interventions, he used alcohol and drugs as "controllers." He suffered a dual-diagnosis, most likely: bipolar disease and poly-drug dependence, hence the stay in Hazeldon, a popular, effective, addiction treatment center. Following his release, clearly, he should have been evaluated to be sure he didn't kill himself, to see exactly where he might be falling, alcohol-free, on the depressive continuum. For those with dual-diagnoses, treating one and not the other is futile. Easy to see this with hindsight, but Mr. Williams should have been admitted for a long stay in a psychiatric facility, a nice one, of course, for observation. He could afford it.

We can assume he had been there and done that in the past, probably plenty of it. It is a cyclical disease, however, and a cycle can last. A depressive cycle can be so painful that the patient wants to make it stop lasting. We might say Mr. Williams needed a much longer inpatient stay, longer than he had ever had before. Again, twenty-twenty hindsight, but we're talking about a legendary actor, and there are other legendary actors who suffer, much like Abraham Lincoln, Sir Isaac Newton, Mark Twain. . . Not that they all killed themselves, maybe none of them did, but one in ten with bipolar disorder do. We have to learn from these suicides, don't we?

therapydoc

Wednesday, August 06, 2014

Enmeshment and a Proper Ending

We haven't talked about family of origin in awhile, so why not get back to it. I was going to write about guilt, anyway.

I have an optometrist who made me a pair of rimless glasses about fifteen years ago, glass.  "Treat these like jewelry," he warned. "They are very fragile."


Random building, random car, not the car
or building in the story
.
The Story:
Five or six days out of the week I swim. At the same time, as I walk into the looming multi-unit building, a frail older man in a white shirt and tie, black suit and hat, is leaving. A large SUV waits at the curb. The gentleman struggles with the passenger front door, steps up carefully into the car. He and his driver are likely off to morning prayers.

The windows are dark, but I assume the driver is his son. I can picture the older man tossing the cane into the back seat.

Hating myself for judging, it bothers me that whoever it is picking him up, for whatever reason, hasn't popped out of the car to help. It is what I did for my mother at any opportunity, pop out, although she complained.
"I can do it."
She couldn't.

My bad for that? Should I have respected her need, her desire for independence, the very thing we crave most of our lives, especially in the more traditional marriages, marriages like hers, as in, serving-is-just-what-we-do? But I wouldn't have dreamed of letting her risk a fall while struggling with a car door. Any fall at that age is critical. The recollection of her broken pelvis as a younger woman is enough.

But giving the benefit of the doubt, the resident is a man, after all, if an older man, less brittle perhaps. Maybe the passenger sternly warned the driver:
 "I am not an invalid. Do not insult me. I can get into an automobile." 
Said with feeling, spoken with intensity, the lasting affect of a more youthful personality. And obviously, he can. The son shows respect. The father, surely at one time a person who drove his own automobile, has his autonomy. What choice is there?

And inside the car it feels intimate, it has to. Because as we lose height and balance, we suffer fewer niceties, fewer formalities. Less tip-toeing around feelings because there's no denying the need for doctors, medicines, help. Aging, accompanied by aches and pains as a rule, begs to be expressed. "How do you feel?" and the cork is popped. The answer, in a whisper or a roar, will be better in Yiddish.
Elaine Stritch on NPR's Song Travels

Elaine Stritch recently died, but worked well into her last years. Even before reaching a certain age her style was direct, honest. Comedians get their laughs precisely for that, their honesty and self-disclosure. Even their memoirs are intimate. Watch famous younger actors fawn over Ms. Stritch in Shoot Me. The actors want a relationship with her, want her time. It is more meaningful than a random act of kindness to a stranger, not that helping someone across the street feels bad.

So fellow actors, make-up artists, coffee fetchers and valets will grieve an actress like that.

Of course, they aren't family.And let's not forget, there are old people, and there are old people. Generalizations about intimacy are meaningless when people age mean and difficult.

Which brings us to a few dissertation questions for the graduate student's consideration.

Long-term outcomes of childhood enmeshment

(1) Does childhood enmeshment predict a good result for the aging parent?

We assume it is bad for the child, especially toxic for a teenager who is denied a life, who cannot run with friends, socialize or leave home for college,individuate, become his own person. And it is bad for younger children, too, never having play-dates, missing school to stay home with a needy parent. All because of a psychological (and sometimes physical) need for control and attention.

But does it work for that parent during those senior years? Or is it payback time.

(2) Does childhood enmeshment predict depression, anxiety, substance abuse, etc.? Fill in the blank.

Does an enmeshed child's mental health fare that badly over the course of a lifetime?

Studies would have to control for confounding variables, like the degree of enmeshment, degree of psychopathology, characteristics of the adult child, the parent. Keep it simple for a dissertation.

In some cultures enmeshment is an emotional death sentence for the oldest or youngest daughter, destined to care for her parents, not to marry and move on. But usually enmeshment is less formal, isn't reserved by birth order. It is the coddled son who never marries, who is still living with his parents well into middle-age and is drinking with them on the couch in front of Dancing With the Stars.Or a family like we see on Everyone Loves Raymond. 

Logically, over-involvement, interference, should predict anger, but it might not. (Alcohol keeps it in check, and humor can, too). But the guilt associated with the very thought of leaving home has its own sedating effect, is my thinking.

For those of us who treat family problems, who see the way the family operates as a having an impact upon mental health, another question is relevant. What can we do? There is a field of outcome research that evaluates the efficacy of our interventions. I'm proposing one here. Call it, the future tripping intervention. A more professional term would be
  projecting into the future  
A final research question then,

3) Does projecting into the future function to dis-enmesh families that have problems with one generation respecting the physical and psychological boundaries of another? Narrow this down, of course, focus and study in-laws and their adult children.

It is the adult child who comes to therapy, generally, alone or with a partner, and many therapists leave the invasive in-laws out of the treatment intentionally, assume that it is healing for the patient to buck up, assert. The asserting is scripted, sometimes as an unimaginative ultimatum to the parent:
"If you can't stop . . . then. . . we'll move away." Or more typically, "won't answer your calls."  Fill in the blank.
The famous moratorium. Sometimes it works, but it is painful for everyone, and feels like over-kill. Parents with personality disorders will find ways to make the child feel even worse, will sabotage or retaliate. Parents who are less disordered might miss the entire part about the family's overall mental health.

Include them in therapy and it is another situation entirely. The therapist is a witness, one that will validate, certainly to a degree, rather than an attack the older generation, the one that ostensibly is responsible for the enmeshment. They need help, after all, do they not? Therapy should feel like an unanticipated benefit, enacted well. Add the projecting into the future, what it will be like when these people will really need attention, and the thought that by that time their children may resent the inconvenience (not that they do now, but in the future. . .) and you have a winning hand.

Nobody wants their children to have a mid-life crisis and abandon them at the worst possible time, about the time they can't find their reading eye-glasses.

Always use abandonment fears in therapy when you can.

Projecting into the future isn't an intervention only for enmeshment, but a natural technique in any type of multi-generational family therapy. Any family-inspired mental distress will do. It is useful, especially, when the parents have been abusive. Abused adult children often still seek the love, want it, which explains why many take care of their parents at the end, no family therapist need apply. But it is a gamble for the abuser to depend upon that.

So to me, seeing that SUV, the father-son relationship played out in the early morning, is a snapshot full of possibilities. I want to know how they got there, how he got to be the good son. Or was he always that way.

therapydoc


Tuesday, July 22, 2014

More Snapshots

We are deep into summer and the activity level rises. Consequently, it's getting harder to function in the morning. I feel like a drunk, but grind the coffee beans, add water from the Ice Mountain water cooler, and pretty soon, can bless G-d, check my messages, and write a little. Always in that order, naturally. (No Keurig, although I understand there's a small one for $52.00. A thought.)
Bike Selfie, therapydoc

(1) FD and I try to take a bike trip on our anniversary. The day we met he won a Raleigh 10-speed in a raffle for Native Americans. He still rides it. We keep our bikes inside, no rust. And no home-invader would want them.

Frankly, fixing a bicycle, to me, has always meant filling tires with air, or perhaps grabbing a stick when the chain falls off to slip it back on. That's as far as my skill goes, and it doesn't matter because FD is a good bicycle mechanic, and Bob, who I think of as an authentic bike guy, is a bicycle savant.

One night, heading home from the office, my pedal fell off, or was that the derailleur. You can't ride very far without these things, but a bike shop loomed ahead, lucky for me, so I gathered the pieces and walked over.

Bob, working late, suggested that I leave it with him, he would work on it that night, have it for me the next day. I whined, "Then how would I get home?"

He agreed. Neither of us even considered the bus or a taxi, and Uber didn't exist. So Bob, who channels Haight-Ashbury, rewired the whole bicycle, charged me almost nothing. Now, whenever something goes wrong, he's my go-to guy. FD might be jealous, not sure.

Anyway, we're about to launch our annual anniversary trip, only a day trip, no plans to stay anywhere over night. FD has found us new bike paths north of Chicago, trails we've never seen before. Aside from the nuclear reactor a few yards away, and the black sand on the beach, it looks really great. But my bike gears don't work and FD is really busy. I am, too. Things are getting tense, as tense as if we were off to another country and hadn't packed.

My only hope, Bob. So I stop in after work, but he's not there. Two other guys are lolling around the shop (this place is like a barbershop, honestly). One takes my bike for a spin, comes back and pronounces, "It's frozen. The gears,or whatever, frozen. No clicks at all."

This I knew.

"So fix it, no?"

"You can't fix that."

"Bob has done it many times. Maybe I need a new whatchamacallit.  Can you do that, replace it?"

No, that's an old bike, and finding the whatchamacallit will take time. It so happens that this bike shop is a museum of bikes, and Bob can do this in five minutes, either repair it or replace the shifter. He would have known which bike to pirate it from.

"Where's Bob? Can't you call him?" I ask desperately. "I know he'll come in for me. He made me a bike once (He did). He knows this bike."

Oh, Bob doesn't have a phone. "You can leave the bike if you want. Maybe he'll be in later. Maybe not."

"Thanks anyway."

The bike gets me home with two working gears, but riding 10 miles the next day is going to be a drag.

In the morning FD is fiddling with his bicycle. He will get to mine, surely, but I take out a screwdriver and a wrench, pry open the clicker. I pull on a cable, tighten a bolt, squirt in a little WD-40, then climb on to try it out. It works! (A reader tells me that Finish Line is better for bike chains, already on order.)

You would think I have discovered a cure for cancer, maybe one for mental illness, fixing my own bike.

That's how self-esteem works. Too bad it is so easy to undo. That clicker has a short life, too, I imagine.

(2) Funding for mental illness

The US government has cut back on biomedical research, so when two of my sons went into bench science, my hopes for a comfortable retirement based upon their wildly important discoveries flitted away. I have an almost daughter-in-law, also in a bench scientist at Harvard. She toyed with real estate before a fellowship made that a less-than choice. What is with this attraction to selling buildings?

But thankfully, the Broad Institute in Cambridge will a receive $650,000,000 gift, the biggest gift worldwide for psychiatric research, ever. Ted Stanley's son Jonathan had a psychotic bipolar episode in college at the age of 18. The Stanleys decided that the best use of Ted's hard earned money is to find cures for these troubling life-breakers. He made his money marketing and selling collectibles.

Good for the bench scientists, and wonderful news for everyone else, too. Because although we're affected by everything from the air we breathe and our experience coming out of the womb, to the way our parents and everyone else treated us since then, it is biology that holds immediate power for the fastest cures. No worries. Therapists will always find work.

(3) And in Antisemitism news
Jewish owned pharmacy in Paris  Http://tinyurl.com/m2mldag
Technically, antisemitism should also refer to being anti-Arab, too. But it doesn't.

Due to the war in Gaza, at least one mob is breaking down doors to Jewish businesses, ransacking Jewish lives, burning stores to the ground.

Shades of the late 30's, early 40's, Hitler. Skin-heads. In Berlin the call for an end to it goes unnoticed. Politicians try, but the taste of violence is irresistible.

In my own neighborhood, Chicago, Illinois, death threats: We know where you live.

No, we don't have the right to be happy, not when people are dying, when stores are burning, people dying. Palestinians need to get out of their homes, let the Israelis find the tunnels, the rockets, disarm them, stop being human shields. It should be a war of words.

Easy for us to say. But if Canadians tunneled into Minnesota armed with grenades and explosives, ready to blow up the Mall of America, taking down hundreds of Americans in one blow, Americans would stop them. This is insanity, waiting for terrorism in Israel. So innocents die in Gaza, told they have a straight shot to Heaven. My guess is that they will.

There is a pro-Israeli rally in downtown Chicago today. My colleague, the woman who shares a suite with me, asked if I would go with her. She'll drive.

Someone guilts her into going, she guilts me. Despite FD's warnings to consider other ways to show support (worried about rocks and other projectiles), it seems like the right thing to do. It is too hard watching the war online. Even Palestinians want an end to Hamas terrorism even if they lie down and die for them.

At the rally, about fifty Palestinians, held back by police, shout at Jews and wave their own flags. We make eye contact, although I keep walking, don't stop. But I can see that these people are not violent, they have fears, concerns, likely relatives back home under fire. They plead, heart-felt, need to express their own angst, be understood. I don't take a picture of them, feel it is an invasion of privacy. Whereas the Jews at the rally are landtsmen. Wouldn't it be something if we took 5 Palestinians at random, and 5 Jews, and sat down for a conversation?

The rally was over in 30 minutes. As my ride told me, "Jews aren't going to miss lunch."
Rally in Chicago-pro-Israel




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Pro-Israel rally Chicago





Thursday, July 17, 2014

Sugar Daddy

A screenshot of Alix Tichelman's Facebook page
KSBW News http://tinyurl.com/nxvkxjd
All set, once again, to write about guilt and psychopathy, when Alix Tichelman's court appearance pops up in the news. Feast or famine. 

On November 13, 2013, Alix Tichelman became famous as the prostitute suspected of murdering Forrest Timothy Hayes, a Google exec who worked on Google Glass.

Alix is the one on the right. Who is she? A 26-year-old woman from an upper class Georgia family, her dad a CEO. She left home and lived on her own awhile, ran out of money and became a call girl, a prostitute with a heroin addiction. Not so unusual, that association, heroin and prostitution.

We don't know if her addiction to drugs came before or after her decision to make large sums in the sex trade, but it would seem that heroin came first. Hayes, owner of a yacht (The Escape) lived in a 4 million dollar home with his wife and 5 children. He found Alix, or she found him, on a sugar daddy website, Seeking Arrangement. Tichelman injected Hayes with heroin, his last dose ever, and watched callously as he fell into a stupor and died. Security tapes tell all. You would think people would know that they are everywhere, certainly on a Google exec's yacht.

The first thing a sugar daddy should know, obviously, is that you can't go sleeping around with just anyone. Get references. I'm sure there's a reference website for that. Coming soon.

Ms. Tichelman's previous boyfriend, Dean Riopelle, owned an upscale nightclub in Atlanta. Her Facebook posts express love and passion for him, they lived together. When he, too, died of a heroin overdose, it was ruled as an accident. But someone put two and two together, the common denominator in the deaths, aside from heroin, is the call girl.

Riopelle, who died two months prior to Hayes,  played in a band.

"There is no way that guy did heroin, no freaking way," bandmate Allen Vine told CNN.
Well, he did at least once. 

On Facebook Alix writes dark poetry about heroin addiction and how she admires serial killers. She has tattoos, Hell is Love and Kiss or Kill. Her favorite book: The Satanic Bible.

She also posts her poetry, and some of it is really good

"this private downward spiral-this suffocating blackhole
makes you feel so warm inside,
yet makes your heart so cold.
each day takes it's toll,
your thoughts become emotionless
your soul feels too old.
the demons whispers to me ever so lightly,
he never let's go of his hold,
taking everything from me, I'll end up dying alone.

and some of it is gruesome.

"Sick of the lies and all the pain you have given me,
Wrapped up in a bow like I thought it was supposed to be
But now you're laying in a box, waiting to suffocate,
Saving your last breath as you scratch at your coffin case.
I know I'm crazy, but vengeance is mine,
The dirt that pours in your mouth into your eyes,
Never thought I would see you so surprised
Cause im watching up above as you choke on the dirt, 
Bury th elies and the memories cause all you've done is hurt.

Can we diagnose from poetry?


So Yes, drug addiction is really bad for the personality. In fact, when we diagnose, we have to add information about organic causes, medication. Even prescribed medications can cause psychosis.

So what have we here? A personality ruined by heroin? A woman with an antisocial personality disorder who has no guilt (is that so enviable?), no regard for others? Does she have a mostly borderline personality,  Abandon me and I'll kill you; or a narcissistic personality, Fail to admire me and likewise?

And who is Dexter, anyway, that she should find the show so amazing? She loved a good serial killer. So perhaps it is a case of transference.

We don't know. I'd love to hear about her childhood. My guess is that there is childhood sexual abuse of some kind. Often, with prostitutes, that is the case.

I remember speaking with one who had no feelings for her clients. None. They were a means to an end. She told me that's common.

And I remember speaking to someone who had no interest in prostitution but wanted the benefits of offering himself/herself to a rich man/woman. Wanting to leave a 9-5 corporate job to marry a sugar daddy/mommy isn't uncommon. My patient's thinking? He/she could provide for his/her lover, and the lover could reciprocate. Age no object. Nobody cares.

But what if this person is married, I asked.
"Oh, in that case, forget it."

One day my friend found the right one, felt great, stopped therapy. I never saw the patient again.

But there have been other cases, too, of high class women, mostly, seeking rich men, women paid for their services, tipped in lavish ways, who are delightful and wonderful and have had several proposals for marriage. But they turn them down, won't settle down, not with any one of them. Why? Missing self-esteem. Instead, a sense of unworthiness, and the fear, unwillingness to bring a lover down.

Alix Tichelman apparently isn't like that.

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