Borderline Personality Disorder and the DSM

Almost 30 years ago, when I started my master's degree program, if we discussed borderline, that meant we were discussing psychosis. A "borderline" was a person on the "border" of psychosis.

In those days we were taught that psychopathology either manifested as

(1) a neurotic disorder, people were depressed or they worried endlessly over problems stemming from unresolved childhood guilt; we called them the Woody Allens;

(2) a psychotic disorder, accompanied with hallucinations and/or delusions; the patient being out of touch "times three," meaning he didn't know his name (person), where he lived (place) or the day of the week (time) ;

or

(3) a borderline disorder, essentially No-Man's Land, neither neurotic or psychotic, but definitely leaning towards the latter.

Borderline meant having such poor boundaries that the patient felt blended with others psychologically, did not see where his or her perception of others' thoughts or intentions could be wrong. The condition would manifest as severe abandonment anxiety, anger or depression, and certainly suicidality, ala that movie, Girl Interrupted. Perhaps the behavior was manipulative, but who knew for sure?

Disturbed, that we recognized. Depression didn't have to enter the equation (but it usually did).

Merging was thought the natural consequence of not having separated properly from parents, not having individuated or developed into an independent person, secure all on one's own. And to individuate well, one needed psychologically healthy parents who encouraged that differentiation and confidence.

You see why I push it, some thirty years later.

The first Diagnostic Statistical Manual (DSM, 1952), the Big Book of psychiatric diagnosis, included an etiological component that subsequent versions for the most part phased out in favor of statistics. Empirically-based medicine had evolved.

But ideas of merging and family dysfunction had a place in the first manual, as did other etiological explanations of pathology, such as the stress of combat contributing to substance abuse in the military. Not surprisingly, the American Psychiatric Association (APA) released the first DSM to meet the needs of the military— soldiers had returned from war alcoholic and traumatized.

This was also about the time that psychiatrists recognized the association between self-medicating with alcohol, and the manic component of bi-polar disorder.

The need to mesh psychiatric diagnosis with numeric coding consistent with the International Statistical Classification of Diseases and Related Health Problems [(ICD), the World Health Organization] followed soon thereafter. Then the mission of the DSM officially shifted from the explanation of psychiatric disorders to descriptions.

And as clusters of features and symptoms emerged for each new edition, psychological disorders became medical disorders, handily recognizable sets of features and symptomatology.

Our latest edition, the DSM IV-TR has refined the process, adding cultural diversity to the mix and some general psycho-social history that is associated with certain disorders. There is also an occasional reference to how genetics steer the course for others.

But to diagnose, we focus upon what we see and hear in our offices.

And borderline no longer necessarily implies having "poor boundaries." The disorder is now neatly cataloged as an Axis II personality disorder with easy to recognize socially dysfunctional features (see below). But those of us who remember what it means to people to feel less than whole, to have a need to own or merge with someone else's ego, body, or personality, are more likely to empathize with that particular pain, even though it isn't on the list.

Lucky for us, the DSM modifies, adds, and removes diagnoses with each edition.* So I look forward to seeing what the next one (2012) will do with borderline.

As it stands, anyone with or without a college vocabulary can take a stab at reading and understanding the DSM IV-TR to diagnose family and friends. Anyone can look up a diagnosis like "Borderline Personality Disorder," find the features, and label others. I started this post because a patient wanted me to list the features so that she could do that. You, too, might become rather good at psychiatric diagnosis with a working knowledge of the DSM IV-TR, assuming memory and retention serve.

It is a free country. Go buy a copy. (But pop for the full edition if you do, not the condensed spiral). It will teach you little about how a person develops a disorder or what to do about it, but at least you won't be caught using terms like "split personality" or "multiple personality disorder" anymore.

We'll get to the Dissociative Disorders another day.

But you wanted to know about Borderline Personality Disorder. So here you go. Here's what it says in the book:

Diagnostic criteria for 301.83 Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization or devaluation

(3) identity disturbance: markedly and persistently unstable self-image or sense of self

(4) impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

(7) chronic feelings of emptiness

(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

(9) transient, stress-related paranoid ideation or severe dissociative symptoms

Well, on the re-read, perhaps one might need a dictionary, if not a graduate school education, to really get this.

You can see why it's considered a VERY painful condition. Painful to have, painful to treat, painful to live with, all around painful. The disorder always calls me to task, forces my patience, and ultimately brings out my compassion. It's difficult, emotional work and I've heard time and again from peers that working with too many patients suffering from borderline personality disorder contributes significantly to burn-out.

But there are those who burn-out working with people who suffer from depression, too.

Notice my use of language. SUFFER FROM. You'll read on the Web that people think of themselves as borderlines, or bi-polars, obsessive-compulsives, depressives, or schizophrenics.

The better way to refer to someone with a disorder is:

a person who suffers from schizophrenia

or a person suffering from borderline personality disorder.

And so on. We don't say, "She's schizophrenic." Or, "He's bi-polar."

That minimizes a person. The process does that already. We don't need to add to it.

Copyright 2007, therapydoc

*Homosexuality, for example, is no longer considered a disorder, and it is likely that in the fifth edition of the DSM we will see Adult Asperger's and Adult Attention Deficit Disorder, currently two disorders of childhood.

The First Collection of Posts about Obsessions

You knew I'd go with that pic for this feature, right?


It's not usually fun, having an obsession. For example, Dealing With Healing has an issue with a crime that won't die. (neither the perpetrator, nor the obsession).

But Mad Kane's humor blog presents us with a LIST obsession. I'm there.

But a tech blogger is obsessed with moulding ANY topic and making you see it as simple, pertinent and wonderful. I'm perplexed, but okay, that's never stopped me from going with the flow.

Phil for humanity is obsessed with flag burning-- it should be your right, according to him, which would make him somewhat to the left, no?

Just kidding, Phil. (I've learned I have to say that.)

And Dr. Scott Davis addresses your kid's addiction to Internet pornography. Someone had to. Thanks Scott.

Zenofeller has so many obsessions operating at once that I don't know where to begin, but I think this post is about thinking, obsessing, about making money while blogging.

Like anyone could get obsessed over money, seriously.

Our last booth is about sleep, which is an obsession for the 24-hr Paradigm.

Well, it wasn't what I expected, but we're not so into control on this blog now, are we?

obsessively yours (read the chocolate blogs, and that's just for starts),

therapydoc

Classical Music and Jewish Jokes

FD read the last post (Music Lessons) and said, That wasn't about Scarlatti.

I guess he thought I'd tell you something interesting about the composer's life, like he was born in Naples in 1685, was from a large musical family (lots of sibs to fight with), wrote over 500 keyboard sonatas. A contemporary of Bach and Handel, Scarlatti went unappreciated in his lifetime, but had future admirers the likes of Chopin, Brahms, Vladimir Horowitz. And FD.

I took most of that directly out of Wikipedia.

FD has told me much racier stuff about other composers.

Below we have a more modern musical hero, Ottorino Respighi. It's looking racier already!

Nah, nothing racy to report on him, either.

But the other day I couldn't get out of the car because the Pines of Rome had me gripping the steering wheel. Life's too short, let's not rush it (one of the themes of this blog) should not be confused with sitting in your car looking like a stalker.

There's history.

As much as I couldn't wait to see my kids after work when they were little, if there was something good on the radio I forced myself to wait until it was over before facing whatever awaited inside. I needed to do that.

Some people finish their crossword puzzle.

The idea is, of course, slow it down. Nobody's doing a crossword puzzle and driving. Theoretically, classical music is good for slowing people down, especially good for Type A personalities (there's research!) and overly caffeinated people who can't relax (my guess).

Should you fall into this class of personality, you might want to buy, or take out from your locally enlightened library, Respighi's Pine's of Rome. Find a copy that's not too scratchy, preferably conducted by Arturo Toscanini.

Onto other coping strategies. Jewish jokes.

My friend Sarelle is known for them. She must read hundreds and passes them along, thinking people will read them. I generally leave them unopened until AOL starts archiving everything forever. Then I know. It's time.

Try these two. This is how some people grew up. Constantly battling

Jewish Logic

(1)

Moishe walks into a post office to send a package. The postmaster says, "This package is too heavy -- you'll need another stamp."

Moishe replies "And that will make it lighter?"

Not bad, right? Try another.

(2)

Three prisoners, about to be executed, are asked what they wish for their last meal.

The Italian responds "Pepperoni pizza," which he is served; and then he is promptly executed.

The Frenchman requests a filet mignon, which he is served; and then he is executed.

The Jew requests a plate of strawberries.

"STRAWBERRIES"?

"Yes, strawberries."

"But they are out of season."

"So, nu? I'll wait."

therapydoc

Music Lessons

It's Domenico Scarlatti's birthday, which means that if you turn on a classical music station, you'll probably get lucky.

Did I ever tell you the story of my first date with FD?

I was a Resident Adviser in this cool run down old house in Urbana, Illinois, a female cooperative house unit of UIUC. About 8 rowdy wonderful young women, great people, lived in that clapboard house. I learned how to make bread and yogurt and only had an occasional potential suicide to manage.

Anyway, I'll save how we met, but FD picked me up and saw the upright piano in the sitting room.

Oh a piano!

Do you play?

A little.

Do you know any Bach? (I was in my Bach phase, this was a test)

Why yes, yes I do.

And the rest is history. Years later, I told an elderly woman that my daughter was taking piano lessons. She nodded sagely and smiled, Oh, a girl playing piano. There's nothing more lovely.

My own personal history with lessons is traumatic, so we won't go any farther. My feeling is that if this is an affordable thing, finding out if your child has this aptitude is the right thing.

You never know where it might lead.

therapydoc

A Day Late, a Dollar Short

Had I known, I'd have added this link, too, on the back a' cha's

If you like ENT you go to this link and read the interview they did with me and arrange your own, maybe.

I can't believe I waste time with this stuff. The interview is terrible. It was as if I had to catch a plane or something. Wait a minute. I did have to catch a plane.). No pressure.

therapydoc

back a'cha and regrets

This is the kind of thing I try to do once a month, send readers off to read other bloggers who put out good stuff and happen to have linked to me, maybe quoted me or they barked loudly at a carnival. Actually, this really is a carnival, with less barking.

The fact that I'm a little too glib sometimes on ENT and am also hoping to be cute when I comment on other people's blogs may be due to being so suppressed (muzzled) as a therapist. That's a good thing, by the way. There are SO many things I want to say, am thinking, and DON'T say. Even here, on the blog, believe it or not, I edit like crazy before posting and rethink what I write a thousand times (am a sucker for hyperbole, clearly).

Nevertheless, I'm trying to reign it in when I comment on other people's blogs, which is harder, since you only have a few seconds to comment, and once a comment is posted, it's unlikely the person who commented will really revisit that comment again. I don't know the statistics.

BUT I offended two bloggers and am mortified, since it was never my intention and consider that a terrible thing, offending anyone. I linked to 2 blogs in the last back a'cha and what I wrote in my own post wasn't taken in the way I wanted it to be taken (lightly), and the bloggers let me have it in cyberspace.

The rule here is that if I link to a blog, it's because I LIKE it, usually, not because I disapprove or think the blogger is unconscionable. I may not agree with what you people write, but I truly respect the time and effort you put into expressing your right to free speech.

If I really disagree or find content objectionable, the I won't link back to you in back 'acha (this feature), and I wont talk about it or criticize it, most likely. It's like when they send me books to review. If I don't like a book, you won't read about it here.

So on that note I owe a huge apology to certain bloggers who didn't see the humor in my last back a'cha. Furious Seasons and BipolarBlast were both upset with what I wrote and didn't like the comments I put on their blogs. I generally defend physician medication recommendations and this time urged people to not discontinue medicines based upon what FS wrote about Zyprexa. Furious brings research on psychotropics to our attention, and it's a wonderful blog. All I really wanted to do was bring that blog to your attention. Apologies, FS.

And BipolarBlast took my defense of labeling (diagnosing) disorders a little hard (I think, correct me if I'm still not getting it). I said that for people to be able to collect social security for a mental or behavioral disorder, they need a diagnosis. You won't get help from the government for a disability without it. I'll add that a doctor also has to provide substantial medical evidence, and that takes time.

In truth, however, Bipolar Blast is correct. Diagnosis and labeling can make recovery and life much more difficult and money won't always help. Labels do stick, whereas people get well. One of the first things family therapists do, as a matter of fact, is stare behind every individual diagnosis for the family pathology and go there, treat that first, if it's possible. The individual diagnosis often melts away. Apologies, BB.

Okay for other news fit to print, check out one of my favorite primary care docs, Jay, at Two Women Blogging.

And Kim, at Emergiblog has a number of fabulous links and great posts about emergency medicine. The fact that she lets me in makes me feel good. This blog is rarely an emergency.

I got a major complement over at MyShrink.com, apparently am not the only one who thinks we all need therapy. (smiley emoticon here) Thanks Shrink.

Anything Goes and General News
is a new blogger. Reminds me of that song, In olden days a glimpse of stocking was frowned on as something shocking now Heaven knows, anything goes. Boy, they don't write 'em like they used to.

And an aspiring film maker at Production Blog Blue Skelton (related to Red?) isn't afraid to share celebrity gossip.

But creativity in the blogosphere abounds. For example, The Lost War on Drugs at Death by 1000 Paperclips will have you wondering (if you're me) where you've been. And I don't know where I stand on legalization, by the way, so no assumptions here. I'm probably not pro.l

Then there's the People's Choice a carnival chock full of great posts, with voting happening there. I didn't have time to vote and not being a Chicago blog, nobody came to my door to drag me to the polls. Sorry PC.

And at the Books Den you can find hard copy, always a concept worth thinking about, real book reading.

MimiLenox is pushing peace, bless her, around the globe. And for more on positivism, here's positive thinker.

Can't get enough personal coaching? Two more and that's it for the day. The coach at I Will Change Your Life can tell you how to beat a "bad mood" and you're advised to eat breakfast (FD agrees) at Former Fat Guy.

No comment.

An awesome blogger tells us about a farmer's crop charity at One day at a time.
If you're into politics, try Morning Globe News.

Best Medical Blogs is worth a peek. As is this one on social skills training.

The 13th Story is a grant writer, political writer, and all around renaissance man, whereas Be Conscious Now is not kidding. I should have done this together with the Carnival of All Substances. Changetherapy included my definition of addiction in one of her posts. I think and has a great discussion of guilt going on. All of these docs are over my head, seriously.

Speaking of docs, Dr. Aleksandr Kavokin has been putting out good medical material at RDoctor.

And have I mentioned history at Osprey Publishing? So interesting. History, unfathomable.

Whereas MovieTrailers, I understand. And there are still more personal development bloggers pushing Priscilla's list. Such a list. Including Robin's Reflection's.

For a blog about kids with special needs, try Kintropy.

And a yogi blogger likes to draw and quote physicists. Check out resonent enigma

College bloggers into pizza and beer need only go for Pizza.beer.tech for refreshments.
Just watch it, okay?

For women's health and wellness, try ModernSage. But for feminism, Femtique is best.

Now, if I REALLY wanted to work on my chocolate fix, I'd go to Raising a Healthy Family and put a little more effort into my cooking. It's not true, I suppose, that you can stir fry EVERYTHING.

Oh, and one more thing. There still are such things as political pundits. Check out these, Morning Globe News
and The New Pundit.

that's it for now. waiting for a really cold morning for the next one.

therapydoc

Lars and the Real Girl

When I told my mother that I went to see a movie (Where were you?) about a man who loved a life-sized doll, she said, "Oh. You went on a busman's holiday." Meaning it's not a holiday when a busman takes a bus.

It's why FD wouldn't see The English Patient.

But she was wrong. Lars and the Real Girl is real professional escapism.

In Chicago this movie is only playing at the Landmark Cinema, 2828 N. Clark Street. I'm telling you this so you should go.

The fact that I got it together, dragged FD to the show, faced the nauseating indoor parking garage (while he made telephone calls), and made the movie on time (autumn construction at every known city artery) is nothing short of a miracle.

Usually, I just stay home.

But I thought, What if it's not released locally? That would be bad. I'd miss it.

And it's PG-13 (!)

Cast includes Ryan Gosling, amazing; Emily Mortimer, so expressive; Paul Schneider, Kelli Garner, Patricia Clarkson, Nancy Beatty, Maxwell McCabe-Lokos, Karen Robinson, and a host of naturally engaging others playing the townies. Craig Gillespie directs a perfectly spartan script by Nancy Oliver.

The performances are wonderful.

If you work in mental health or are going into one of the mental health professions, or perhaps any health care profession, you want to see this movie. I'll have all of my students watch it and might even see it again, which is not like me.

Lars and the Real Girl is the best movie about a mental disorder since A Beautiful Mind, but much more hopeful.

That's the best thing about it, and there are many good things about it. The story is uplifting for people who have given up hope on loved ones suffering from serious mental disorders. When it seems things are psychotic, life-defining, and irreparable, sometimes they are not.

In my biz we see patients like Gus (Paul Schneider), Lars' brother, broken-hearted, who are sure that all is lost and blame themselves.

Which is wrong.

Seeing this movie will help you understand that there are softer, kinder eco-systemic interventions that make simply sending a sick person off to the doctor seem pathetically remiss treatment of the mentally ill. Not that the family doctor (a captivating performance by Patricia Clarkson) isn't remarkable here. She is. But she's not enough. The best psychiatrist wouldn't have done as good a job, either.

Sublime intervention like you'll see in this film is so rare that for a moment I wondered, Do such things even happen outside of Hollywood? But I know that good therapists can and do put good therapy into motion, they use significant others. That's the trick, you see. Our stage is simply smaller.

One would assume that to exact what you see here requires a deep understanding of what's really going on with the patient. Yet here the town stumbles upon the cure without so much as an introduction to Psychology 101.

Family therapists are known as intrepid screen-writer/directors, such is the nature of their creativity in treatment, especially if they naturally lean towards strategic family therapy. Indeed, a creative therapy is sometimes the only therapy that will work. When a seemingly effortless, yet on-the-mark intervention is uniquely woven into the fabric of a particular context, surprising things happen.

It is what we aspire to as we wonder, crunching the facts of a difficult history, What, oh what in the world, does this person need to get better?

I'd call this an example of unintentional strategic ecosystem family therapy (the freshly coined oxymoron treatment modality of the day, you heard it here first). My tag line?

A close-knit rural community works together and seizes new opportunities to help a young man with his relationship with. . . yes, a doll. Not really knowing why.

FYI, the architects of the formal US social service delivery system, community-based mental health, had nothing on Ms. Oliver, the screenwriter. Lars gets out of his bedroom in a garage and into the world.

But back to me going to the movies.

FD is sitting next to me in the theater. "His treatment would go a lot faster and be a lot cheaper with a little psychotropic intervention."

SHUSH, I say.

It is the town, a very small, cold, snowy, foot tingling town of simple loving, like-minded people who orchestrate the intervention. The sole town family practitioner, nibbling at mid-day sandwiches while talking to her patient, kick starts the process by treating the life-size doll that Lars has ordered from the web, as a patient.

She is not a fancy psychiatrist in a plush downtown Michigan Avenue office, but she does the job splendidly with a little understanding and a lot of love.

That's all the plot you get. You have to spend the ten bucks and see the movie. I'll make this a 2-part post with the salient mental health issues and treatment implications in the next one and won't publish it until most of you have seen the movie or DVD. My hope is that it really does hit theaters near you some time soon, and I'm pretty sure it will. The performances, the direction, the story, everything about this film is, well, perfect.

And I don't idealize movies about mental health.

As I said to FD as we slugged down Devon Avenue from Assyria to India to Pakistan to the kosher pizza shop for overcooked, almost edible falafel,

Theses films are so often negative, depressing, and wrong, or they inappropriately try too hard to be funny. They're too silly and lack empathy, and are clinically off the mark, too, which is why I hate most of them. I loved Lars because not only did it have heart, but because for the most part, it was right.

So no, not a busman's holiday. But a holiday in every sense of the word, a feel-good, people-are-good movie. And the doll, if a little scary at first, kind of grows on you.

therapydoc

Albus Dumbledore and Being Gay

Apparently they gave Jo K. Rowling a standing ovation in Carnegie Hall when she revealed that Albus Dumbledore was gay. She responded, "If I had known this would have made you this happy, I would have announced it years ago." Click here for more on the story.

If you don't know the actual plot, and I don't think I'm really spoiling anything here, Harry Potter learns that Dumbledore, the headmaster at Hogwarts and Harry's hero, had a best friend, Gellert Grindelwald, a young man who went in a different direction, magically speaking. So the boys parted ways.

I think the relationship ended because Gellert chased after the Dark Arts, but since I sort of buzzed through Deathly Hollows, correct me if I'm wrong.

No matter. Such a wonderful affirmative world we live in, that Ms. Rowling would get a standing ovation for having the courage to make the headmaster, the supporting protagonist of her novels, a gay man. But I wondered, Why wasn't it made more obvious in the text? Why didn't Dumbledore say, Harry, you know I'm gay, of course, don't you? I was in love with Gellert.

Maybe for a few reasons.

(1) Having a gay headmaster might not have seemed politically correct for an international readership of children. And yet, what an opportunity it was to change an internationally ever-so -heterosexist perception of gays.

(2) Why should Albus discuss being in love with Harry? Since when do teachers talk about their love life? Since when does ANYONE have to talk about his or her sexual orientation? Shouldn't some things simply be private?

(3) Just because he was gay didn't mean his relationship with Gellert was necessarily sexual, be it requited or unrequited. He LOVED his friend, his intellectual equal. That should be enough for teenagers, love.

And finally, (4) She never said he wasn't gay. She left it open. Indeed Dumbledore loves Harry, too, and there's never any hint of sexuality in that.

Same sex love between peers is very powerful and very good, and when I went to school, when I read Freud, Theordore Lidz and Erik Erikson, and other developmental theorists, it was considered GOOD to love your friends, to choose them over your parents. It constituted a developmental leap.

These days everything has to be sexual or it's not salable.

Even Harry Potter.

Sense and sensibilities. Call me old fashioned, but not homophobic in the least,

therapydoc

I Did it for You

The kids came over for lasagna the other night and Cham said, "Mom, you're really misleading people on your blog! If they knew you, then they wouldn't think that you have bad eating habits!"

She's talking about those of you who gave me advice (One Piece of Chocolate) about how to avoid the chocolates that my colleague, Not So Serious Doc, keeps in a bowl in the office next to mine. (They're Hersheys Nuggets for crying out loud.)

Serious and I share a suite and I'm there all the time getting free therapy.

How could I resist a huge bowl of chocolates? Especially the ones with the bits of toffee. Who notices a single piece that's missing when there's an entire bowl left to choose from, anyway?!

But Cham, what I didn't tell you is that I'm actually trying out reader suggestions. I bought a big bag of pretzels at Jewel just the other day. Not the kind with the honey and mustard, either. I'm going for filler, not flavor. I realized that the reason the chocolates beckoned me from the next room, when ordinarily they would not, was that I was, in a word, hungry.

And it's the fault of my patients that I've been hungry. Indirectly, it's their (your) fault, and not because I'm not paid enough to afford food.

Here's the story.

I used to be a normal person and ate sandwiches. I would skip breakfast (go ahead, beat me up for skipping breakfast, tell me again how it's the MOST IMPORTANT meal of the day). But I'd make a really great sandwich for later on, and didn't care in the least if the office had a faint odor of onions, mushrooms, garlic, and green pepper in an omelet that lovingly fondled the salad in a pita. Every creation had something new, maybe a tomato, maybe a little avocado.

The better, grainier loaves of bread at the grocery store had to be tested. Anything could find it's way into my sandwiches as long as it was kosher* and hadn't once been part of a mammal.

Even Swiss cheese, but especially muenster. And since it would be my only meal of the day, I didn't worry at all about calories. I'd linger over the sandwich sequestered in a drawer or a brown bag, stealing a few huge bites between patients. I'd only devour it all at once when I was really hungry. But generally brunch would be history by 1:00 pm.

And it was a good life.

Then one day I noticed I was dozing off on the job. I mean, there would be moments when I couldn't keep my eyes open! I'd have to nap between patients, literally lie down on the sofa. Maybe it was me getting older, maybe it was stress. But patients noticed, for sure they did! And I was embarrassed that it was obviously a strain, keeping the lids over the baby blues propped up.

I could retain what people said, meaning I could repeat back, and I'm skilled enough to still do the therapy literally in Stage I sleep, but it was terrible!

This went on a few weeks before I knew what had to give. The food. Without food I'd have no problem staying alert. Maybe it's the opposite for most people, but it is this way with me. So I changed my eating habits, saved the big meal of the day for the evening, and haven't looked back.

And for the most part, not eating during work hours has worked out just fine. I bring grapes to the office, and some dried fruit. An apple in season is divine. The thought of eating candy was never something in my dietary scheme. Oh, maybe a sliver of good chocolate cake, but not candy.

I stay awake now, and will add a few pretzels to the mix, see how that works out.

So friends. When you ask me how I got myself into this predicament, this problem of choosing to eat or not to eat the candy, I have to tell you. It would never have tempted me in the old days, but it tempts me now that I've given up real food.

And if you were to ask me why I did that?

I would have to say, I did it for you.



therapydoc

*kosher is a very complicated subject, and I couldn't possibly begin to tell over all of the rules. For our purposes it would mean no reptiles or crawly things, shell fish or most birds that fly in the sky, certain fish, and pork. Most meat requires all kinds of attention and special treatment, and even vegetables and fruits (especially if there might be a worm or another bug feasting upon them) can be a problem in the land of Israel if you're Jewish. Also, non-Jewish wine, cheese, leavened products during Passover and those owned by Jews during Passover, after it passes over. . ."new grain" products. Things made in vessels that have contained or been used to cook non-kosher food. Oh, and mixing milk and meat is out. For all intents and purposes, Jews should be the skinniest people on earth. :)

Zarganar

Yes, but I hate the thought of priests beaten and herded off to jail in Yangon, Mayanmar. (Burma in years past). And there's a good joke in the WSJ that you might not have heard.

Maung Thura (Zarganar, or tweezers in Burmese) is a comedian who makes his living sending up the Mayanmar Military Regime. Before the regime, Zarangar spoofed Gen. Ne Win in the 1980's. The comic is fearless, heroic.

He's probably not in Myanmar at this moment or it's likely he'd be in jail. But they say he's there, still telling jokes.

Zarangar was in dental school when he realized he was just too funny to be a dentist. And he HAD to speak out politically. The Al Franken, I suppose, of Asia.

You might remember the rebellion last month, Burmese priests and throngs of people marching in defiance of bans imposed by Myanmar’s ruling military junta. Between 300 and 2ooo people have been detained (depending upon your news source) and hundreds are said to have been killed. I was under the blissful influence of media-deprivation, busy in the synagogue and the succah

In 1988, it was students, brutally crushed, who protested against the Myanmar Junta. Over 3000 are thought to have been killed, many more tortured.

I tell you all this to keep you honest, to keep you grounded. We think we have problems and we do, we do. I'm not minimizing. I'm relativizing.

Here's Zarganar's little joke, straight out of Christopher Rhoad's front page article.

George Bush, Hu Jintao (China's president) and Than Shwe (Myanmar's military leader) went to visit God.

Bush asked God, 'When will the U.S. become the most powerful nation in the world?'

God replied, 'Not in your life,' driving Bush to tears.

Mr. Hu then asked when China would become the richest nation in the world, which drew the same "not in your life" answer from God and tears from the Chinese president.

Finally, Myanmar's ruler asked when his country would have enough water and electricity. This time it was God who broke into tears, saying, "Not in my life!"

He has funnier jokes, of course.

It's so hard to fully comprehend such poverty. Perhaps, rather than visiting Washington for class trips, or where ever it is the children go these days, the more privileged of our nation, those who have parents who can afford it, should be visiting Mayanmar. Or some less dangerous poverty stricken country.

Just a thought. They could send the message home, write about it, work for a cause. It might be good for all of us, that sort of relativism.

therapydoc

Calvin and Hobbs and Reality

There was a time, you should know, when I didn't watch much television. Except for the Smother's Brothers, That Was the Week That Was, and the Ed Sullivan Show (if he had the Beatles on). It just didn't talk to me.

Then there were years, literally, when there simply was no time to watch. Graduate school sucked me in, and there was the marriage thing and working to eat. And years, and years of child-rearing. During those years the television was the enemy. It was the thing that could potentially steal a child's brain, gobble it up.

And as a Sabbath observant Jew, we simply didn't turn on any appliance on the Sabbath, and it wasn't within the spirit of the law to leave a television on for 24 hours. If you leave something on the whole day, that's okay, but you wouldn't leave something on that you'd be tempted to adjust or fix if it broke down.

So we did very odd things instead, non-electrical things. The kids these days don't understand them. One was called Scrabble (or Connect Four when they were younger). Another had to do with printed pieces of paper bound between cardboard shells. I think these were called books. We read hundreds of them.

The best of them had pictures and didn't need many words. They often rhymed. We've talked about children's books before, and even now my son B. buys his nephews some of the books that I read to him when he was a little boy. Quite frankly, I personally like the newer ones even better, with the exception of the Dr. Seuss books and a handful of others from yesteryear.

The books in our house that took the most abuse had to be the Calvin and Hobbs anthologies. Obie Wan loved them, and I believe he started reading them over and over again when he was about 11.

I tried to be a good sport about it and laugh when he showed me pages he liked. But there was a real element of cringe for me. I thought Calvin's parents were SO mean! They had this fabulous creative kid with so much imagination. His tiger existed. His blanket was a cape. He was Spaceman Spiff, bounding effortlessly for a landing.

The world was a dangerous place. Dinosaurs everywhere. Yet Calvin preferred the great outdoors. Intrepid, I believe was the adjective. So he got muddy, so what?! His mother made it seem a federal crime to play.

Well, there I was in Obie Wan's old room the other day, sweeping out a bit of dust, and I found The Calvin and Hobbes Lazy Sunday Book (Bill Watterson). I took it upstairs and opened it up to a random page (84, if you must know).

There's Calvin in the top panel.
"My parents are the two stupidest people on Earth."

Below it,
"Just my luck they'd get married and have ME."

Following Hobbes to a narrow cliff, Calvin continues,
"I hate everybody."

Third row, left panel,
"I don't see how anyone could ever fall in love. People are jerks."

Hobbes, smiling innocently offers,
"Sometimes they are, but look at all the colors on the trees today."

Calvin,
"Yeah? So What?"

Hobbes,
"I think it's more fun to see something like this with someone than just by yourself."

Calvin thinks about this. He looks up at Hobbes, last panel to the right.
"I guessss so... But I'd still rather see this with a tiger than a person."

Hobbes responds,
"Well, THAT goes without saying."

It's hard to read page 84 and think that Hobbes is anything but real, right?

I'm so glad we restricted television when the kids were young. They watched some, Obie Wan even made it a living, eventually, which was why we excused it, knowing he would go into the creative arts. But neither he nor his siblings saw as much as they would have liked. And I'll be the first to say that television is MUCH better than it used to be, and admit that I really enjoy it. With cable we have so many options, movie classics, weather, nature shows, endless comedy and drama. We can watch wars.

But something different happens when you read, when you only see two dimensions. Something different happens in the brain. I believe it has to work harder to absorb the information, to make sense of what it sees. And it's somehow very real, at least it seems very real to me. More real. Like Hobbs.

More real than television.

therapydoc

One Piece of Candy

It's not fair, it's not fair. I shouldn't be so down on my favorite colleague, the one who shares a suite with me in my new digs. I shouldn't but I am, and hopefully she doesn't read my blog.

Here's the thing. I try to avoid junk during the day. A little junk food at night (especially a few tablespoons of ice cream or a SMALL piece of good chocolate cake, or even a handful of decent chocolate chips, wow) is essential. I'll even start the day sweet. Why not? But there's something about the in-between hours. I just can't risk the insanity.

We'll talk about eating habits one day.

But the story is that I moved in with my dear friend and it was very stressful. I've not even recovered, honestly, from the move and the holidays and the visits with the kids. Who can?

And here I am, a few pounds fatter from the holidays, and there's her suite. The one with the candy bowl. She keeps CHOCOLATES in this bowl. Hersheys, usually, but Mars, too. And I'm a big chocolate lover.

What's a person to do?

I have zero resistance.

Now you would think that one or two nuggets wouldn't hurt anybody, but it DOES! It's changing my life for the worse! I don't like the lack of self-control and I don't like anything about what it does to any part of my body but the palate.

And I know many of you are going to be dealing with Halloween soon. So what should we do?

Mainly, what should I do? Okay. I'm the therapist. I'm going to try it today. I'm not going to eat any of it (blee neder, meaning no promises). No candy. Zero. It's generally the way we deal with compulsive behaviors, don't start. There are other ways, of course, and we'll get to them.

And I'm bringing the dried fruit to the office from home to substitute.

Who's betting on me? I'm not sure I would. But writing this is actually part of the intervention. Isn't that cool? But of course, you all know that writing is therapeutic. Unless you're blocked, that is.


therapydoc

Secrets and Therapy

I had no idea people still held onto them, secrets. (smiley emoticon here).

But I watched the season premiere of Desperate Housewives, all about secrets, confirming that we do keep them. And then something random happened. A couple came in the very next day to discuss a few that they had deliberately kept from the children.

I exclaimed, You two are missing out on the most powerful parenting tool in the universe!

"What! What's that?" the marital dyad cried in unison.

Yourselves, silly.

Indeed. They looked at me incredulously and said, "Like we're going to tell the kids we. . ."

smoked, drank, shot up, slept around, gambled, cheated, lied (add to the list) . . .

Well, yeah.

(Laughter).

So you're all thinking, TherapyDoc is out of the TherapyDoc mind, or couldn't possibly mean this. (That's what my patients thought). No, I really mean it. You don't have to tell all, of course. But something. Say something.

You do it when they're old enough to appreciate the pain and consequences associated with those behaviors. That's usually early adolescence, maybe even earlier, depending upon the child. The hard part is determining the child's readiness.

In the case above I could suggest that the couple bring in little Joey or Joleen to see me (not real names) so I could make that determination. If you don't have a family therapist you're really stuck making the call on your own. You could ask friends or relatives their opinions. But they may not know your secret, either, and frankly, it's none of their business.

If you tell a child your secret, beware, do it judiciously. You can beg for confidentiality, but need to be ready to lose it. That's why it's nice to have this orchestrated by your local family therapist who can assess the child's capacity for that. It's generally limited.

But say you're not in family therapy and don't want to be. Then I'd suggest that the best time to tell kids about something embarrassing is about the age when kids are beginning to really struggle with individuation. Early adolescence. Between 12 and 14.

At this age they're already seeing their friends grasping at feel-good opportunities and they want to grasp at feel- good opportunities, too.

It helps to have the kind of relationship with your child in which he or she actually talks to you about peers. Then you already know which heroes are only acting out to try to feel good because they really feel bad.

And you can discuss with your child how those friends feel worse, eventually, as a consequence of trying too hard to feel good. Yet don't know why they're feeling worse, usually, and before anyone can spit

they're cutting, using "better" drugs, and complaining that they're REALLY depressed.

"Wanna' go that route?" you ask your kid, and continue, "Of course not. So learn from my mistakes. Doing (such and such) can hurt in so many unpredictable ways. There are the

body memories
flashbacks
whispers of others
pregnancies
self-recriminations
overdoses
unwanted tattoos
traumas after traumas

and other inevitable consequences."

Sounding like great family therapy stuff to me, all that tempting unresolved baggage.

So back to television. You surely want to know what happened on that season premiere that got me going here.

Since I don't catch every episode and taping is always an experiment (yes, too cheap to pop for a digital TV and Tivo) I don't know exactly what's going on in the show. Like why is Bree pretending to be pregnant? These are things I count on you people to explain to me.

Still, I did manage to tape the season opener and Lynette has cancer and she's bald.
(Felicity Huffman is simply amazing in this episode, it's really worth watching just to see her. You can probably go to abc.com and watch this spot on your computer, of course.)

Anyway, in the opening sequence Lynette is in bed and wakes up and grabs for her wig because one of her kids is At The Bedroom Door and she doesn't want them, or anyone else for that matter, to know about her cancer.

She's been hiding it for months. At one point she's so sick from the chemo that she vomits in another parent's purse at a school production (she thought it was her mother's bag). The other parent had been nagging her to do her fair share of the work for a third grade PTA project (I may have the details wrong here and elsewhere). Lynette takes on the project rather than admit to this woman that it will probably be too much for her or why.

Later on, at a barbecue, the other mother accuses Lynette of still not doing the PTA job. She will hear no excuses, she says, pointing her finger at Lynette and blathering on about her own migraines and knee surgeries. Despite her problems, she does her bit for the school.

Lynette can stand it no longer and blithely removes her wig.

I have cancer, she says. Trump.

Reaction shot, "Oh. I'll find someone else." Exit. Stage left.

Lynette's friends have been looking on all the while. They're shocked, confused, upset. Hurt. How could she not tell us? Doesn't she know we love her? How could she keep this to herself.

Lynette tells them that she likes their friendship as it is, fun, special down-time. She enjoys the heck out of them, she doesn't want to become an object of pity. She wants to be with them and simply have a nice time. She uses them as a respite from her cancer.

Again. They're hurt. This is unacceptable.

They make a pact. No more secrets. We're friends. You couldn't have talked to us about this?

Secrets are a theme in the movies, dramas, comedies, and reality TV (I'm guessing about the reality TV; I get enough reality at work). And they're a theme in the therapeutic literature, too. And surely, I am suggesting thoughtful sharing of secrets with children.

Parents are people, not saints, not usually. Our kids know that. They suspect that. They want to know our histories, probably so that they don't repeat them. They want different lives. Not necessarily significantly different, but different. But more than anything, they want the respect that says, I trust you with my secrets. You're saying, I was ashamed here, don't shame me more. I trust that you won't. That's tremendous respect.

And they don't violate your trust. It's an intimacy thing. They're flattered. They feel closer to you. They know you.

Am I saying emotionally incest your child? Overwhelm a child with your problems? No, No, No. Obviously you have to be careful. You have to be sure to communicate that you're okay, that you're an adult and that you have worked through your childhood, and you are not laying an emotional trip on him to psychologically entrap him, damage him.

You have to be sure you're not doing that. You have to be sure, when you do this, that this isn't something that is going to interrupt your kid's studies, personal growth. Your life can't become your child's obsession.

So it's complicated, isn't it? But worth the discussion, perhaps.

There's a book by some family therapists on this subject, I think by Walsh & McGoldrick, who are family therapy "mothers." The book is about shame. I read it years and years ago. The point of the book is that there's something predictable about a family secret. If it doesn't come out in one generation, it will manifest in the next. It's one of those transgenerational things.

Your children really might repeat your mistakes if you don't discuss them.

So are you perfect? Or are you human? And will they love you if you're not perfect but are perfectly human? I think so.

By the way. October is Breast Cancer Awareness month. Find a pink ribbon somewhere.

Imperfectly-in-so-many-ways yours,

therapydoc

Obsessions

I have to be honest, I'm a little bored of the Carnival of All Substances. Let's move onto a more general theme, obsessions.

YOURS, NOT MINE! You have to write the stories. It's a Carnival. Maybe I'll add a few of mine, too.

I don't care what you're obsessed with, as long as it's not sex. I'm just not interested, sorry. Go to your local anonymous meeting for that. I won't even read the posts.

Love? Of course.

And hobbies.

Thoughts? Sure. If they're not objectionable.

Nothing VIOLENT. I reserve the right to dismiss any story that disturbs me, too. If it disturbs me, forget about it.

You can submit these things at the blog carnival link. Just follow the instructions.

It'll be interesting.

John Lennon and Role Models

I was driving #3 son's car home from the airport, when that Beatles song came on, the one that tops off the first side of Abbey Road-- I Want You. The song runs about 7 minutes , then ends abruptly.

Like John Lennon's life.

You and I were just talking about Britney and the other celebs, and how much we prefer to hear about them than to watch wars and other serious things on teev, when I had this idea for a parenting post. One of the goals of parenting (I think) is to establish a home where children learn about life and how to live it well, primarily by example, and still enjoy their time, enjoy being with these people, their parents, their role models.

And perhaps that's what all the star gazing is about. We want to spend time with these attractive, seemingly interesting, fun, successful people who can teach us about life. It's certainly why we choose our peers. We assimilate new data about life from others.

But back to our story.

FD and I needed to drive #3 son's car, the Ford, to the airport to pick up our car, the cliche' beater, the Olds. Obie Wan had parked the Olds at the airport for a couple of reasons: (a) the cost at remote parking is a fraction of a cab ride, and (b) the cabby might be late or forget the car seat.

So we were off to retrieve the Olds which has seen a lot of abuse lately. The kids in the neighborhood stole the lug nuts last week, we're not even sure which day. But when FD pulled away from the curb on Sunday, the tire pulled away from the car.

What a surprise. Great way to start the day and SO funny, obviously.

His friend cheered him up with a dirty joke that I'll share. No, I generally don't tell dirty jokes or even listen to them, but there are exceptions to everything. BK told him that we had better get a hubcap for that tire or risk arrest. (The hubcap is gone now several months. It was the replacement hubcap from a previous theft).

Why would we be arrested for no hubcap?

Exposed lug nuts, of course, replied BK. (Did I tell that so badly?).

Moving right along, last night we hurried to pick up the Olds at the airport. We were carping a bit at one another, not our usual fashion, but neither of us needs to be rushed to get somewhere at the end of a long day, and FD was in a hurry. I dropped him off at Remote Parking Lot F, where he managed to retrieve the car but only after playing Scavenger Hunt for the parking stub.

You need the ticket and $9.00 to get out of the lot. Not unlike the dry cleaner's. Soon we'll need a computer chip embedded into our skin to prove that we are who we say we are.

FD took the Olds home and I drove the Ford. We had special time, me and the Ford. I kicked up the radio after returning 7000 calls, but had trouble punching in a station to my liking. #3 and I have different tastes in music. Eventually I found 97.1 and wouldn't you know, I Want You, that last cut on the Beatle's album had just begun.

May as well turn off the phone. Can't hear both.

I flashed back to when Abbey Road came out, how my older brother had brought it home, all excited, to show me. We still had phonographs in those days. Imagine the scene, how he exclaimed,

This is an amazing album. You're going to like this more than Sergeant Pepper's Lonely Heart's Club Band!

Well, I worshiped my brother (O"B"S-- he should have risen up in peace, by now) . So, Of course this transcended a bad day.

But honestly, I never liked the song, never liked the repetition or the He's So Heavy business. Maxwell's Silver Hammer was more to my liking, and Julia.

And the Blackbird song and the Goodnight Song. I know, these were probably on different albums, I'm guessing the White Album. All of my kids fell asleep to the Goodnight Song, and I understand that my grandsons did, too. Could Empath Daught have actually remembered? Seems unlikely, but she sang them the Goodnight Song. I heard her.

Having a choice between I Want You, however, or some horrid heavy metal stuff, I chose The Beatles. And as I listened it occurred to me that John Lennon had really been senselessly assassinated, murdered by a madman, ostensibly a fan.

He could have died in any number of ways. He didn't live "safe." He was not a great role model. Wonderful artist, but certainly he used drugs and glorified them in music.

Then Mark David Chapman killed him.

Last week an angry blogger asked, "Where is Mark David Chapman when you really need him?" I thought, What an idiot! No matter how strongly we disagree with someone's politics or way of thinking, we have no right to even think it is a good idea to have him killed.

On the other hand, if someone had killed Hitler. . .

This is why moralizing is something for the philosophers, rabbis and priests. Anyway, today John Lennon would have been 67 years old. As I listened to the whole cut again, I have to tell you. I loved it. From beginning to end, it was wonderful. An amazing piece of music. Tastes change.

And the lug nuts? There's more to the story. FD sped ahead to shul and #3 son took me in his car to get my car back. FD would walk from there.

When 3 spotted the Olds in the parking lot he sighed said, Uh Mom, I hate to tell you this, but I think you're missing 2 of your lug nuts on the front passenger side of the car.

Crud. (this is an expletive from my youth).

I took the car to the nearest Auto Zone to learn that indeed, this is what the kids do these days. WEEKS BEFORE HALLOWEEN. ARE WE IN FOR SOME FUN in the next few weeks, or what?

You can't keep lug nuts in stock, the clerk told me. I was lucky to score six of them for the Olds.. A smiley woman at the register saw me looking over the pepper spray. I told her I couldn't see myself ever using it on anybody.

"Or using it on a dog!" she cried. "I love animals so much. I wish they had a different item at the register, and I have something in mind."

Yes?

"Well, we have a new product. It's not expensive, either. It's a whistle that repels deer from the highway."

I WANT IT! I cried.

"You're joking."

No, FOR SURE I want it.

So now I have 6 new lug nuts and 2 deer whistles, and apparently can't be trusted in an Auto Zone. But it had been an interesting evening, I thought, noting the car vandalism, and remembering that we lost John Lennon who would have been 67 yesterday, who died for what?

When I got home FD told me that Obie Wan had called to tell us that he and his beautiful Rac and our granddaughter arrived safely in New York. Rac's uncle, still not doing well, is resting and the family is watching, waiting. That's why the kids went to the airport, that's why they left the car in a hurry.

Obie tells the following story. Rac's uncle spent the last five years of his life with an illness that weakened him, paralyzed him. Yet he used his remaining time to raise money for charity.

It's the kind of thing that you don't hear about very often. Then Obie told us this. I'm repeating it here to illustrate what it means to live a truly heroic life, to be psychologically sound, strong, and happy to the end.

Rac's father, together with the legendary Uncle M. enjoyed the following conversation:

Rac Dad (bedside): So, bro? Tell me. Are you comfortable?

Rac's Uncle M without skipping a beat: I make a living.

Can you imagine keeping your sense of humor like that? Staring death in the eye and making other people laugh? Say yes, you can.


therapydoc

The Fifth Carnival of All Substances

THE fifth. Not a fifth. As in, I plead the fifth.

Okay?

Let's start out with something a little different.

Anabolic steroids and other drugs are part of the arsenal of any competition body builder. . . body builders are at risk for health problems and shouldn't be dying at 30 years old so says Mike Hart who tells the story.

If you're in need of a "centre" spelled British style, there's one in British Columbia that Isabella Mori's enchanted with. I'm waiting for the stats, but check out her enthusiasm, curb only if you must.

I'm not a particularly organically oriented person (it makes me think of dirt, mainly, when someone says, It's Organic). But Live Life, Organics and Your Health has some links about drugs that might interest you. If it's not organic, then it's synthetic, right? Does it all comes down to how you dress in the end?

News Syndicated tells us how one town is handling meth addictions.

All this wellness nonsense is now contaminating television, apparently, my last refuge. But if you're really into it, and why wouldn't you be, wellness, I mean, since sickness really is not fun, then check out Wellness TV on the Dish Channel. (I hope I got that right).

As strange as this may seem, a blogger (Money Walks) writes about the merits of this automobile gasoline versus that gasoline and she's walking this carnival as we speak (or perhaps driving a hybrid car). I said that ethanol wasn't exactly the alcohol I was talking about, but okay. It's hard for me to say no to anyone who takes the trouble to RSVP to an open blog carnival invitation.

The Fit Shack is still kvetching about sugar addictions. (I say this while eating a Hershey nugget, toffee, no disrespect, FS)

Quit Coping should be clapping herself on the back for quitting smoking, reinventing herself for her kid. Now that's inspiring.

Health Plans Plus is looking out for you, making sure you don't just accept the verdict that your kid needs pharmaceutical intervention for ADHD. It's an interesting piece.

Is Negativity a substance? It is now. Problem is, I don't see anyone getting high on being negative. Again, how can I say no to these bloggers? Are you people going to tell me I need to be more assertive?

Okay, I'm assertively emphasizing:

THIS CARNIVAL IS FOR STORIES, preferably RECOVERY STORIES, as in Recovery from SUBSTANCES.

That's exhausting, emphasizing like that. Who said assertiveness would be easy?

See you next month,

therapydoc

I just called to say . . .

I probably haven't gone into too much detail about the holidays that I keep, but basically they can last 2-3 days or more. There's no driving around in your car. No shopping. You hang in the neighborhood, see friends and relatives who live nearby. You don't talk on the phone or use your computer or do anything work related. Nope, no teev, either.

By the time the holiday is over you've either gained 5 pounds or there's something seriously wrong with you.

I did my share.

Anyway, after sunset the day is officially over so I volunteered to take my 19-month old granddaughter off to the bathtub so she could go for a swim. R, her mother, waiting by the telephone to hear about a sick uncle, was happy for me to take over with the little tyke.

The kid's very talented and showed me her latest boating maneuvers and an impressive front float, head above water. Ours is a standard 1950's lime green bathtub. We're not talking a jacuzzi here.

I checked phone messages as the kid tired herself out. There was nothing on voice mail nearly as complicated as floating and not getting your hair wet. I had finally convinced her that hair can get wet and nobody gets hurt when the phone vibrated. It was my sister-in-law.

She never calls on a Saturday night.

I got nervous. Bad things have been happening lately. Last week, just before the last holiday, we lost a family member, a young man, only 50. He'd been ill, but no one expected that call. And now R's uncle, also a young man, is really not doing well. These are my peers. People who could have gone to my high school.

S-i-l wanted a recipe for my apple cake.

After I got the baby to sleep on my shoulder while reading aloud from a professional social work book marketing brochure, I went downstairs to do some dishes and call my mom. I never call her on Saturday night. There's something about it, Saturday night. It's always been date night in my head, even though FD and I rarely go out. But my parents used to get baby sitters and go out on Saturday nights.

They're in their 80's (K'H). Dad answered.

"Yello," he said.

He seemed happy to hear from me, but not surprised or anything. Nothing fazes my father. Hardly anything.

"Hi Dad, how're you?"

"We just walked in. We were out with Lenore and Sammy," he said.

Well, of course.

"Did you have fun?"

"Sure, we just came home for a bite to eat."

Sure.

"I'll let you talk to Mom."

You can tell by the way she answers that she's happy that I called.

"How was yuntif (the holiday)?" she exclaims. "How are the kids? It seems like so long. It feels like a week since I've seen or talked to any of you."

It's been 3 days. They're long 3 days.

"Yuntif was great by us, how's by you?"

I'm working on my Yiddish accent. You know that as a Jew ages a Yiddish accent becomes mandatory.

"Very nice. Lenore and Sammy are over."

Of course.

"I'm so glad you called," Mom said. "You and I never talk on Saturday night."

"I know. I just called to say, well, to say hi. You know."

"That was so nice."

"So you guys are okay?"

"Sure. We're fine. It was great that you called."

There's more to that conversation. We were both pretty animated, but still, I don't want to bore you with the details. Basically, you probably know the punchline, why I wrote the post. Right?

It's one of those Don't Hesitate posts. If you think you should make a call, don't hesitate.

You don't think twice.


therapydoc

Britney Spears and Breaking News

Obie Wan, one of my sons visiting more often lately, warned me, "Don't post about the media, Mom. There are millions of media pundits. Why are you doing this? It's not what you're about."

Well, to be socially responsible. To make a statement. Statements.

Jake Halpern in last Thursday's Wall Street Journal tells us about being bumped from an on-air CNN appearance to discuss his book. The book is about why we're so obsessed with celebrities, and ironically, he says, he was bumped because the station had a more pressing "news-breaking" story.

Britany lost custody of her kids.

But there's really little irony in that he broke his story on the editorial page of WSJ. So who's the opportunist?

Britany's heartache has been the feature on Larry King Live, Anderson Cooper 360, Nancy Grace, and Showbiz Tonight, according to Mr. Halpern. She rates.

I'm not criticizing, honest. How can I? I'm at the end of a 500 something page chick-lit novel about powerful women (Lipstick Jungle, Candace Bushnell, real junk, or as the kids say, brain candy). One of a female power triumvirate is losing custody of her kids because she's the working, as in absentee, parent.

Not exactly the same, but still. I'm opting for brain candy by reading that, right? I could lie, tell you that I'm reading Barbara Wertheim Tuchman. She's in the pile by the bed. And I do, I do. But when I'm tired I reach for the sweets.

Concern for Britany is pouring out from compassionate stars who relate to her dilemma, writes Chris Lee of the LA Times. He tells us,

And judging by her curious behavior -- like going shopping instead of attending a divorce court hearing -- the singer seems compelled more by impulse than reason.

The stars, including Dr. Phil, blame her vulnerability to addictions. Shopping's one of them. You'd think he might rule out various other Axis I diagnoses, no?

Then there's Tatum O'Neil.

Speaking to "Entertainment Tonight," O'Neal, the Oscar-winning former child actress, likened her experiences as both a young mother and a recovering heroin addict to what Spears is going through. "I relate to her and feel really sad for her," O'Neal said. "I did everything . . . that she doesn't want to do. I did the drug testing. . . . It was very humbling. . . . I wanted those kids in my life."

It must be like group therapy, hearing these stories, Britany.

Come on, Obie Wan! How could I pass this stuff up?

I bring it up here mainly because perhaps the media does have a responsibility to bring us what appeals to us. We have to sit through the commercials. Surveys project that we're into people. We want to know about private lives, much moreso than rape, violence, murder and genocide, unless we know who's doing the dastardly deed. We need a face. Like OJ.

Except the We isn't universal is it? Some of us would rather know about Darfur, for example. We go to the Huffingon Post and read Mia Farrow's blog.

I, for one, like to know the news behind the news, too, as in exactly how did the French press fool us into believing that the Israeli army deliberately murdered a young Arab child, (otherwise known as the Al-Durah hoax). France-2 doctored hours of videotape to "prove" that Israeli soldiers did this, then sold the lie to millions of viewer seeking news-breaking news.

Natan Sharansky's story is quite impressive.

It's like corrective surgery. But it'll never make up for that first impression, thanks to France-2's bastardization of what could have been real news. There's a story in there somewhere, but millions won't ever hear it and certainly won't forget the original story. They'll never hear the correction and will always think, when they think of Israeli soldiers, that they kill Arab children. And like doing it.

It's indelible, you know. Imprinting takes on new meaning in the media-world.

So no matter what we read about, we really have to wonder about the veracity. Anyone who has ever been in a PhD program knows that the news is full of outright lies, that it's not based upon research, and even stories about research tend to be poorly conceived.

Which is why Mr. Halpern's not so shamelessly veiled plug for his book on the editorial page of the WSJ doesn't really bother me. At least he brings to our attention that network television is just a consortium pandering to our cravings.

And he works for a periodical that for the most part reaches for newsworthy if not news-breaking nuggets, and foregoes the candy. Somebody has to keep us straight.


therapydoc

Stealing from the Closet

It was a little chilly in California, no surprise. It's always a little hotter or colder than I think it's going to be. But every time I pack, Empath Daught will tell me, Pack light. You can wear my clothes. Which I do.

We were going to spend some time outdoors so I said, "Honey, I could use a little jacket, or a sweater."

She got involved with the kids and I was thinking I'd have to hunt something down on my own, when she turned up with this white jacket. It's a little heavier than it looks.

She said, It looks great on you, Mom. See how it hits your shoulder? That's how it's supposed to fit. It's a little big on me. Keep it.

I felt a little funny about that.

"I took a jacket from you on my last visit, too. The jean jacket. You'll run out of jackets. And it's crazy. YOU should be stealing from MY closet, not the other way around."

Don't be silly, she said.

"But I feel bad about it."

Don't. I'll be happy knowing that when you put it on, you're thinking of me.

Which of course, got me in that place that everyone likes to be got. Does every time I think of it.

And I got to thinking that when they're little, it's about you creating them. You make them. First of all you put half of your DNA into them if they're biological. If they're adopted, you go through endless paper work, time and expense, interviews and "proofs" that you deserve to be a parent.

Then you spend the next 18 years dabbing finishing touches to personality, aptitudes, and spend thousands upon thousands of dollars for schools, medical expenses, food and shelter, and watch as they develop into selves.

And finally, you blink, and they're creating you. They're doing it with the help of their sisters and brothers-in-law, if you're zocheh, meaning merit it (Hebrew), and if you can handle it. I'm suggesting here that you do that, when it's your turn, that you handle it.

Some things, or should we say transitions, are surely are worth the trip.

therapydoc

Dependency and Sabatage

So we talk all about independence, and how behaving independently, making our own decisions, doing things all on our own, all by ourselves, the younger the better, makes us unique, confident, powerful people.

And how parents, when they deny children opportunities, simple decisions, complex peer relationships, and alternative voyages out of the nest, undermine that process, generally in the name of protection.

One thing to talk about that with kids. Quite another to see how it plays out in marriage, years later.

Someone like me will see a patient who had been programed as "overly" dependent by parents transition into someone "overly" dependent upon a spouse. This might feel sexy in the beginning (she/he NEEDS me) but it gets boring in time.

The two will come into couples therapy for any number of reasons, but the dependency tends to manifest itself as angry, childish, jealous, unlikeable behavioral traits, traits you see in people with personality disorders.

And our white knight is generally not a white knight, really, but someone who likes the idea of a romantic, traditional marriage, one that values family relationships and "white knight-ness." If he marries her because she's close to her family, he is often very close to his-- or wishes to be close to a family.

That's not bad. I'm not saying that's bad. But it enters into the conflict as soon as the sparks fly. It falls in the unresolved matter of relationships. His/her family of origin fills the need to be needed, admired.

See, it's more than dependency. This is about applause, too.

So at some point dependency can become terrifically dysfunctional and the couple might even separate, often following a violent interaction. They'll go back to their own families of origin. And I'll be working with both of them, building that sense of self, those unique wonderful individuals who really wants to operate independently, deep down inside.

And wouldn't you know? The seemingly more independent partner will inevitably undermine the process, telling the more dependent partner (not in my presence, usually) that he/she is making poor decisions as an independent soul, shouldn't be spending money this way, shouldn't have said this or that to one of their parents, shouldn't have decided to go, all alone, on a vacation.

And that always happens, by the way, as soon as the "more" independent, functional partner skips out of therapy, misses appointments, supposedly glad that the "less" independent, functional partner is getting better, separating from family, growing.

The two of them were never more or less. They were always on the same level, the same page when it came to at least that one very important dynamic.

That's what we mean by an emotional system.

Things are rarely as they seem. You know?


therapydoc