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Wednesday, January 31, 2007

That Bruise on the Face

Let's start with color.

At first there may be no change at all.

But maybe you touch your face and it hurts, but maybe only in one spot. You can tell it's a deep hematoma (bruise) by the feel, that sharp ping to the touch gives it away.

Immediately you hope there's no damage, no chips to the bone.

But the color's still good, so you think. . .well, maybe this won't be so bad.

But the next day there's a soft yellow pigmentation that's creeping across half of your face. And the day after that, it's turned to ochre.

And the day after the day after that, a horseradish mustard. It's so dark that make-up's not quite working the way it should. Then the mustard morphs to light olive, then olive.

You feel like a freaking painter's pallet.

Oh, and it hurts. Yes, it hurts. It hurts a lot while you apply make-up, and while it's healing it can itch, and you want to touch it but you don't want to destroy your make-up and you SURELY don't want anyone to see you or even to know or ask about this.

Why?

They'll think he hit you, of course. You can hear the jokes, too.

Ha, ha, what happened? Did you say No? Ha, ha, what happened? Did you say something about his uh, . . . mother? Ha, ha, what happened, take the remote control?

And 9 times out of 10, I would think that, too, that it's from a whack to the punim (yiddish for face) but I'd never say that or make fun. That kind of cringe "fun" makes me nauseous.

It's a pretty natural deduction in our violent world to think that a person with a facial injury might have been hit. But when you get one of those things and you weren't hit, well, you can get really confused and can go through a lot of strange vibrations all because, well,

You have a bruise on the face.

When I had that indomitable virus last week it sucked a lot of fluid out of me, that's the running theory and truth, I'm pretty sure. The cough, the mucous, the fever. I didn't keep up, although I had been trying to drink water, de-caf tea, lemonade, etc.

And my empathy level shot up for people I'd seen with these symptoms the week before, people who had cancelled appointments.

The addiction to caffeine was in high form, however, like every other blogger's is, natch, on any good day. But that's not a good thing when you're sick, even if it's only 3 or 4 cups a day (like mine) and half-caff at that . So I woke up one of those bleak febrile mornings and jumped into my usual drug-seeking a.m. routine.

See, routine is everything. My psychologist cousin, Peter Rosenzweig has a bunch of interesting platitudes, like certain people need a lot of oil, and 99% of what we do, we do unconsciously.

So the routine is the unconsciously thing.

I did my routine upon awakening, thanked the Old Mighty for bringing me to consciousness when I opened my eyes, then bolted out of bed to see if F.D. had made the caffeinated juice.

He hadn't and he was in the shower.

I got to the kitchen and felt light-headed. People do. I ignored it and started grinding the beans. Felt VERY light headed and within seconds, received "You are passing out you idiot" signals from the brain, but the wiring, the hard-wired program of routine wouldn't quit, the wanting to get the coffee started.

Didn't matter how high the fever. Had to get the coffee started, then sit down and rest, a task easily accomplished, thought I, before passing out was even possible. Who passes out?

Then the, "You idiot, you waited too long to sit down" message kicked in. Tried frantically to dive to the safety of my fave living room chair, only a seven-foot sprint away.

But I didn't make it. Woke up where?

Under the piano. Don' know how.

Where am I?

Right out of the movies. Terrified, weak, dizzy, confused. And a very loud message I HAVE TO MAKE THE COFFEE still buzzing. How strange is the brain on fever? PRETTY strange.

Since face didn't show any change in color I didn't ice it. Didn't even think of icing it (Chicago-in-the-winter blindness). Ice a potential bruise immediately, okay?

So I was stuck trying to hide this for over a week until the thing faded.

But it made me more more thoughtful, more aware that at this moment, as you read this, that there are dozens of women getting the blank kicked out of them. Below I threw together a bunch of statistics for your light reading pleasure.

The green in this doc's face is just about gone, cheek kind of looks like I've been drawing with charcoal and forgot to wash up. Only a few people have noticed it through my efforts with make-up and paint.

But I made a few changes, take it a little slower in the morning, think a little longer about what I'm saying when thanking the Old Mighty for having brought me back to consciousness.

And I've let F.D. make the coffee the last couple of days. He does a better job anyway. (as of this post this is no longer true, but it was true when I wrote it, natch, the homeostasis of behavior is one strong current, plus I'm up earlier, the real reason).

P. S. This was never a post I thought I'd write. Even after it happened, such a rich source of blogging material, rich potential for humor, pathos, color, I still had NO intention of writing about what happened.

But F.D. said, "Of course you should tell that story. It's all about the bruise on the face. How could a person in your profession just let that go?"

I think I felt some shame. In my head there was this Maybe People Will Think I Did Something Wrong to Deserve This message. That was a real gut reaction, one that made the experience all the more surreal, no matter the lack of reason or rationale.

And that IS what people really do think, at least at some point, when they've been victimized by something, someone more powerful than a virus.

But when I've seen people with obvious red flags, signals that something just might be seriously wrong with their lives, like black eyes, arms in slings, cut lips, I personally have never thought that way. I've assumed abuse, but not blame.

Who blames a victim anymore?

It's worth a discussion, right?

A few stats, either from the American Psychological Association's Intimate Partner Abuse and Relationship Violence Working Group or the National Coalition Against Domestic Violence.

28% of the violent crime against women is intimate partner violence,
perpetrated by a spouse or significant other, like a boyfriend or even a date.
(NCADV, 2001).

Depending upon the survey, either 1 in 4, or 1 in 5 women have reported
being assaulted by an intimate partner at some time in her lifetime, versus
either 1 out of every 14 men.

Intimate partner homicides has accounted for about 32% of the murders of female,
4% of the murders of males in some studies.

Prevalence cuts across racial, economic, and sexual minority lines.

In the previous 12 months, 1.3 million women and 835,000 men had been
physically assaulted by an intimate partner. However, women were 7 to 14 times
more likely to experience serious acts of partner violence, and were
significantly more likely to sustain injuries than men who were victims of
intimate violence.

And I haven't even discussed sexual abuse. We're mainly into battering, here.

Solutions? What can we do?

The National Coalition Against Domestic Violence recommends that you
contact members of Congress to support additional funding for domestic violence
programs through the Violence Against Women Act, the Victims of Crime Act Fund,
or the Family Violence and Prevention Services Act.

You can also work with policy advocacy groups to influence your state
legislature to pass progressive domestic violence laws and ensure local programs
fund prevention and intervention.

Or you can work at a DV shelter as a volunteer, or translate for a
local agency.

The APA working group wants professionals to get out there and teach these
statistics.

That's what we're doing today. Learn ONE stat and mention it at the next cocktail party, wedding or Bar Mitzvah. That'd be doing something, believe it or not.

You'd be raising awareness, which is cool.

Copyright 2006, TherapyDoc

Writing Nancy

I did it and think maybe you should, too.

Just write her and tell her you read about the wage injustices in American Samoa in the face of human rights violations and think it's terrible that there is no economic equity for women in the territories.

The Honorable Nancy Pelosi
United States House of Representatives
235 Cannon House Office Building
Washington, D.C. 20515-0508
DC Phone: 202-225-4965
DC Fax: 202-225-8259

Or, if you're from Northern Cal,

The Honorable Nancy Pelosi
Speaker of the House of Representatives
450 Golden Gate Avenue, 14th Floor
San Francisco, CA 94102

http://www.house.gov/pelosi/contact/contact.html

sf.nancy@mail.house.gov

Tuesday, January 30, 2007

Why politics, why ethics?

Soon after I wrote about Slave Wages, a patient boldly said to me, "Doc, why are you doing this? Why are you going political on us? You don't have to, you know. You can keep your blogs about mental health."

Translate: Doc, keep your politics out of your blog.
Or: Stick to mental health.

Anyway, the answer is that unlike some mental health professionals, I am a social worker. True, I'm a clinical social worker, a licensed clinical social work doc (LCSW), and am a licensed marriage and family therapist (LMFT).

So I spend most of my time as a mental health practitioner with a relationship specialty.

But social workers have conscience. We have a code of ethics. I'm not saying other professionals don't have their codes, they do, but I only know ours.

So I thought I'd share just a bit of what social workers, the ones I admire, are about. I put the stuff I liked in bold:

The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty. A historic and defining feature of social work is the profession's focus on individual well-being in a social context and the well-being of society.

Fundamental to social work is attention to the environmental forces that create, contribute to, and address problems in living. Social workers promote social justice and social change with and on behalf of clients. "Clients" is used inclusively to refer to individuals, families, groups, organizations, and communities.

Social workers are sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice. These activities may be in the form of direct practice, community organizing, supervision, consultation, administration, advocacy, social and political action, policy development and implementation, education, and research and evaluation.

Social workers seek to enhance the capacity of people to address their own needs. Social workers also seek to promote the responsiveness of organizations, communities, and other social institutions to individuals' needs and social problems.

The mission of the social work profession is rooted in a set of core values. These core values, embraced by social workers throughout the profession's history, are the foundation of social work's unique purpose and perspective:

service
social justice
dignity and worth of the person
importance of human relationships
integrity
competence
.

This constellation of core values reflects what is unique to the social work profession. Core values, and the principles that flow from them, must be balanced within the context and complexity of the human experience.

See, that's why I write about politics, that's why I expect ethical behavior and advocacy for ethical behavior from the government that has been elected by the people, for the people.

According to this? Those women in American Samoa are my clients.

And the blog? My way of disseminating information, educating an international populace. It would appear, according to my professional code of ethics that access to such a public venue (blogging) may make it INCUMBENT upon people like me to give back more in this way.

You can always scroll down to my sillier posts, you know, for fun.

Copyright 2006, TherapyDoc

Turandot



Or why TherapyDoc didn't blog or post Comments or ANYTHING last night.

You know, I talk about how sensuous stuff changes your brain. Your brain on depression is bereft of seratonin.

That neurotransmitter that zips from neuron to neuron to make you feel energetic , we interpret this as "happy" sometimes, is trapped in the walls of nerve cells, or neurons.

Our brain literally has billions of cells. So to trap seratonin in those walls is a terrible thing.

But what that implies is that there may be ways to jiggle the seratonin out of the cell walls outside of medication. Perhaps a person isn't depressed ENOUGH to need medication. Then sensory stimulation can do that jiggling we're talking about.

Sometimes. It won't work, probably, for a more serious condition, as in the south pole of bi-polar disorder, but for your average Joe?

It's good.

So F.D. and I go to the Lyric Opera House once a year just for the fun of it and to take in as much sensory stim as is humanly possible in the dead of a Chicago winter.

We save our co-pays and we go, or we wait for a generous donor.

We get great seats.

Generally an elderly well-healed couple, let's call them the Dobsons, will have decided last minute to give up their tickets last minute. They call the Lyric and "donate" the tickets back to the opera company. Then working stiffs like F.D. and myself will call, the day of the performance, precisely at the right time, to score them.

If we wait too long then someone else is sure to beat us to the punch.

If we get a box, the other box seat owners, regular octogenarians, will usually say something like this:

Oh. You're not the Dobsons.

F.D. will smile and say, No, we're not.

What he wants to say is, Didn't you know about the Jewish nephew? But he doesn't.

Once they find out he's a doctor we're off to the races. He talks medicine and I talk about good chocolate.

So we saw Puccini's Turandot last night, as we had planned to do all winter. We were excited about it as soon as the original Lyric flyers and advertisements started to overwhelm our mail carrier last summer.

The P.R. for the Lyric is pretty good. I probably recycled an entire tree.

This performance was so amazing, so colorful, so rich, so deep. I just can't tell you how visually beautiful it was. And costumes. Wow. The chorus is huge in Turandot, which is set in Peking, so peasants, priests, monarchs, guards, kings and servants are dressed in finery or peasantry, whichever, galore.

The music?

Astounding.

Had a Bad Day, it's not, no disrespect.

Anyway, I should have brought a camera because mine really does take photos in the dark, but I didn't. If you click on this, however, you can see the final set of the opera in pretty decent resolution. It's a current Lyric ad but it MAY change.

The pictures at the top of this post are NOT from the production I saw. But they're typical of the grandeur of opera.

Click here for a look at the Final set of Turandot at the Lyric

I also found this pic for you on the web that a paparazzi took from the previous production of Turandot at the Lyric in 1991. I saw this set and it was amazing, just amazing. The picture doesn't do it justice.

You can go here for snippets of the music, but you won't get the full enchilada, or shall we say, the entire cataloni by going to this site. But any collection of the best of Puccini or Turandot hits will suffice. Buy it for $10 bucks.

Live a little.

I'm going to be humming, no make that breaking into song for weeks. That's just the way it is.


Copyright 2006, TherapyDoc

Monday, January 29, 2007

Cleaning up the House with Slaves

The reason I write so little political commentary is that I doubt what I read in the paper and basically assume that almost (not all) but almost all politicians are corrupt and beholden to the people who put them in office.

So as soon as I put up my 3 cheers for Nancy Pelosi as Speaker of the House post about the Woman who might actually CLEAN UP the House, I knew I had to be wrong about her. I just knew it. You get that feeling in your gut.

But we'll give her a chance. She couldn't have made it if she weren't one tough woman. We'll let her show her stuff.

But read this.

This editorial in the Wall Street Journal killed me. I'll paraphrase, but most of it is dirct from WSJ.

"Slave Wages."

Nancy Pelosi led the House effort in her first week in office to increase the minimum wage from $5.15 to $7.25. (So far so good.)

But the wage hike is exempt from the Marianas Islands, where in American Samoa companies like StarKist and Delmonte can tuna, where the going pay rate is $3.26 an hour. (Nanci's constituency is in San Francisco, so it still kind of makes sense, even though it's unforgivable. But read on).

A woman can get that kind of change unless she's been enslaved, in which case she might have paid $5000 a garment manufacturer for the luxury of working for them. Nutricious food, resort-style lodgings, swimming pool, and good wages were supposedly built into the contract.

But really the deal is that women who signed up for this were crammed into a poorly ventilated, humid hallway lined by tiny bunk beds with half-inch mattresses, no privacy for bath and toileting facilities that didn't work, and access to a pool filled with garbage and green slime. Of course women workers were physically and sexually harassed, used, and abused.

The proprietor of the facility, Kil Soo Lee, has finally been sentenced to jail, having lost his appeal. The now governor of this territory, American Samoa is the very same person who, as Lieutenant Governor, helped Mr. Lee set up the factory that made designer clothes. He made the company essentially tax exempt, meaning the "taxes" went somewhere.

The Wall Street Journal asks the following of our new Speaker of the House, the first woman, the first Chanel-suited, Prada-toting female to preside over the State of the Union at the President's address last week:

Is it honest to exempt American Samoa from the minimum wage requirement, especially with documented human rights abuses? Is it "advocating for the workers" to ensure that their pay is kept considerabley lower than their counterparts in the U.S.? In addition to House speaker, Ms. Pelosi can add "ethically challenged" to her resume.

See. This is why I hate politics. I can't stay romantic. I can't keep to Camelot very long when I read crap like this that I know is true. It makes me so down, so embarrassed to be an American when I want so much to love this country and EVERYTHING we stand for.
Come on, Nancy. You can do better than this. You have to do better than this. We're counting on you.

TherapyDoc

Sunday, January 28, 2007

Changing Lanes : Alcohol and Anger

I forgot about "Movie Friday".

Can it be Movie Sunday, please, this week? Let's go with the elastic is better, concept.

As the shrink in the movie Ordinary People once said, and I paraphrase,

We Therapy Docs aren't so into control.

But since today is Sunday and it's a day that a lot of people sit around and watch sports and drink beer (or commercials for next week's Superbowl game--can you believe those Bears?!) I'm going with this post.

Not an A.A. expert, I still appreciate much of the Alcoholics Anonymous program and I know a lot about it. I automatically recommend it to my patients who are problem drinkers based on the success rate in my practice. I've met dozens of people who got sober and stayed sober with A.A.

But it's better with therapy. The therapy part is key for certain issues, one being anger. In A.A. meetings people talk a lot about rage.

Therapy docs do, too. I used to want a vanity plate that said Get Therapy to speak to the road ragers. Can you understand getting angry behind the wheel of a car? Does THAT make sense? But there were too many letters in G-E-T-T-H-E-R-A-P-Y.

Which brings us to alcohol, anger, and pretty soon the movie Changing Lanes.

A.A. sponsors, the closest thing to therapists for many people, are not licensed, trained therapists of any kind. They're fabulous people, have usually survived their own sobriety, give generously of their time, and just like in the movies they can be unbelievably heroic and often step in with the proper language and interventions that makes the difference between a sponsee's decision to drink or not to drink.

But successful sobriety is all about the sponsee's (the person working the program) committment to sobriety, work on the 12 Steps, and meeting attendance. Sponsors aren't supposed to be therapists. My understanding is that they are people who can help you work the steps and they don't want to be therapists. They generally recommend therapy, as long as it isn't a psycho-pharmacologic therapy. Unless things have changed, A.A. is a little down on meds.

But a lot of people don't go to therapy because they get so much out of A.A. and similar programs. A.A. is free. (You can go, you know, to the community mental health centers or many university clinics and pay for treatment on a sliding scale and still go to A.A. if you want. Maybe should.)

The A.A. program was developed in the 1930's, well before we had a decent scientific understanding of emotions and the brain. In those early A.A. meetings people sat around and talked about their dysfunctional families, and people who had ragers in their families had the best stories to tell.

Even now, at some meetings people talk about the rage-aholic(s) in the family as if it is understood that this is a genetic disease, raging.

A rage-aholic is theoretically a person addicted to anger, consumed by it.

It is true, people may seem to be rage-aholics, unable to control their anger. It may even be true, that some people are so emotionally handicapped that they need something to calm the wild beast. For A.A. people that "something" would be community service, a relationship with a higher power, working a program. Therapy docs would recommend medication, cognitive therapy, family therapy, even psychodynamic or ANY kind of therapy along with lots of psycho-education.

Face it, sometimes incarceration is the inevitable resolution of the State for people with anger control problems.

Therapy docs look at "rage-aholics" as folks who might also be mentally ill, might suffer from bi-polar disorder, paranoid schizophrenia, a severe personality disorder or three (certainly sociopathy), eating disorders, alcoholism or other substance abuse disorders.

Or they may have been raised by individuals with these diagnoses, people who raised them with rage, in a sense communicating "permission" to be a rager.

So saying someone is a rager doesn't say very much to a therapy doc about how to treat that person. There's so much more to know.

It says (it should say) to the average Joe, Avoid that Individual.

Or get that person to a therapy doc for a diagnosis and treatment.

So recently I watched Changing Lanes again on cable. I loved it in the theater, remember not liking William Hurt and his sponsoring style--punitive, a style I've heard about more than a few times as characteristic of sponsors, along with a touch of shaming .

I've mentioned before that shaming is destructive. No good can come of it. Among other things, a person who has been shamed becomes less communicative, less emotionally available. Self-esteem goes down, self-destructive habits go up.

I hope if you're a sponsor and you're reading this and disagree with what I say about A.A. or sponsors that you'll let me have it between the teeth in the comments. Make that,

I hope if you're a sponsor and you're reading this and disagree that you'll write me a Comment and assert yourself. You can be anonymous :)

But the alcoholic in the movie, Doyle Gipson, played by Samuel Jackson, is working very hard to become a stable human being, one who is not affected by the poisons of alcohol. He goes to A. A. meetings and his "new leaf" behavior is generally deliberate, the type of moral, thoughtful, considerate behavior that A.A. teaches so well.

See, one of the amazing things about this form of rehabilitation is that the language of A.A. inspires positive behavioral and personality change. The language reconnects with the best messages your parents ever taught you, the ethics you learned in school. It syncs nicely with major religious teachings, the emphasis of life being best lived with kindness, patience, and putting out good karma (what goes around, comes around).

So Doyle is doing that in the movie and we like him much more than his anti-hero nemesis, the rich, white, lawyer (played by Ben Affleck) whose fancy car collides with Doyle's beater on a highway during bad weather the very day of Doyle's Big Day in Court.

The Ben Affleck character storms off without leaving identification or insurance but forgets a most important file. Doyle is stuck with "better luck next time."

Doyle misses his hearing because of the accident and loses his wife and children who will now have court permission to move to the other end of the country. But he has that file.

The plot gets pretty good and the tension between Samual Jackson and Ben Affleck becomes palpable, the anger, the rage, the revenge fascinate. How will they resolve this and will Doyle lose his sobriety?

He has already turned into a "dry drunk" before our eyes, meaning his behavior is unpredictable, unstable, and his wife and children are afraid of him again even though he's sober.

THIS is the pattern I see so often, this "dry drunk" thing, acting drunk (irrational and emotional) while not under the influence of alcohol. Program thumpers will say that of course, if people do not work a program, that they WILL NOT CHANGE even if they get sober. They will behave the same way they did as drinkers, uninhibited and lacking in empathy for the pain they cause others. ANGRY.

There is no hard evidence to support this contention, mainly because it's hard to measure A.A.'s interventions in outcome research. It's an anonymous program.

We do know, however, that alcohol is associated with wild, uninhibited behavior because it has that disinhibiting effect upon the limbic system. Without alcohol, behavior should be and is under better conscious control for most of us.

But there other variables, like the ones I mentioned above, like mental illness (the Axis I disorders), personality (the Axis II disorders), family culture and dynamics, and the ecosystem (everything else that affects our minds and bodies).

And we know that anger per se isn't just a function of being drunk. We all get angry. Many of us are less in touch with our anger than others, especially if it was frowned upon in the family, or if only the parents were allowed to be angry. I'm certainly out of touch with mine, and I'd like to think it's from years of cultural proscription against anger and violence, a collective memory phenomenon, in the DNA.

So no, you won't be hurling insults at one another in my office. I don't need that, nor do you, so you'll have to learn another way to communicate with one another. Oh yeah, that's MY job, to teach you. Touche'.

But depending upon how we've been socialized to express aggression and our individual character traits, anger can come out as violence, either verbal or physical. Or it can be repressed. Or it can present anywhere on the continuum below.

[By the way, I see both physical and verbal violence as forms of emotional violence. The center, where I put the slash, is assertiveness, speaking dispassionately, rationally, about just the facts of a situation.]

I won't give away the ending of the movie because it's worth watching.
But if you're a person who has trouble controlling your anger, or if you live with someone who is unstable in that way, it's certainly a good idea to get therapy for it, to learn how to be assertive and when.

Left untreated, the violent expression of anger can be unforgettable, dire. We do have medications and psychotherapies to treat it, so there is really no need for the pain. Both people are hurt within an angry interaction. The aggressor loses the respect and real affection of the victim. The victim may believe he or she deserves maltreatment.

Suggestions about anger in relationships:
1. If it is you that is angry, don't talk to anyone until you're not as hot. I can't emphasize enough the importance of this time to distance and calm down BEFORE having ANY conversation with anyone.

2. If you do talk to someone while you are angry, make sure that person is someone who will be unconditionally supportive and will let you vent. Be sure there's no way you will become violent under any circumstances in any way (emotionally/physically/verbally).

3. When you are direct with the person you're angry at, don't be accusatory or blaming, stay assertive. (Read other posts)

And if someone else is angry?

4. Wait until that person is NOT angry to talk to him/her. And even then, be careful and have an exit strategy in place if that person has been violent in the past.

Is that so hard to do? Yeah, actually it is. So therapy, Al Anon (the program for family members of individuals with alcohol addictions), ANY outside support that strives to eliminate domestic violence is pretty key.

5. The best advice? Don't handle a partner's or your own raging alone. Get help on this one before someone gets hurt.

Copyright 2007, TherapyDoc

The "Ask me, uh-ho-ho, ask me" Meme

Author and performance artist Amy Guth asked me the following questions for the "Ask me, uh-ho-ho, ask me" meme:

1. When you were little, what did you want to do for a living when you were grown up?

I answered this one in the Why I Relate to You and Self Disclosure post.

In 6th grade the teacher asked the class what we wanted to be when we grew up.

I said a psychiatrist.

She raised an eyebrow. Wow. That teacher just looked at me like, IS THAT EVER COOL OR WHAT?

She was probably thinking: This kid has issues.


2. What politician would you most like to be locked in a room with for one hour?

Hands down. George W. Bush. He needs so much therapy! We could work on the alcohol, the speech thing, his lack of assertiveness, the girls and their boozing. A close second would be Senator Edward Kennedy.

Both of them, seriously, HUGE sources of referrals.

3. What was your best vacation ever? Where did you go?

F.D. and I had been planning a dream "year" in Israel for many years and finally pulled it off in 1997-1998. Walked every mile possible, met many wonderful people. I get pretty misty when I think about this.

4. If you could be a man for a week, what would you want to experience?

Why, S...s...s....s....Studying, of course, studying the Holy Books, ala Yentl.
Nah, not really, not at all. If I wanted to do that I could and I would.

Being a guy hasn't got a lot of appeal, frankly. My heart goes out to the species in general. What, I would want to lift heavy objects? This is fun? No thank you.

5. What moment scared you the most?

The parenting moments scared me the most, at least one thriller per kid. I'll share two. With my youngest (now 18), we were at Home Depot and he was an infant. I had bought something really heavy and when I yanked it out of the shopping cart to put it in the trunk the little guy went kaboom on the concrete (the cart tipped with him inside). I screamed at the top of my lungs. Apparently He heard. If the kid could be any smarter, he'd be dangerous. Lost about a year of my life.

The female child had a habit of falling out of bed as a tot, eyes rolling around like she was something possessed out of the Exorcist. Thanks, sweetie, for those times.

These things turn you grey. Not that I'm grey, of course.

Well, that was painless, Amy. Theoretically, if any of you want to participate in the meme, you ask me to ask YOU questions, then you post the questions and the answers on your blog.

Thursday, January 25, 2007

Breaking up

It's hard to do, like the song says.

But there's an original thought on the subject. I think it's mine, okay, but the way I'll teach it is inspired by Indexed. If it's somewhere in her blog, please forgive me Jessica and someone scream at me and I'll take this down immediately. I haven't read very much over there. She's a new find. I'll ingest it all in time.

Let's say it's a woman who has broken up with a man. She knows he's not good for her. Say they're married a few years and the part that isn't good is ascendant and will clearly continue to ascend.

She tells him, "It's over."

He says, "Suit yourself." He takes it like a man. He IS a man and she LOVES this man. She loves very much of this man. She just can't take certain really difficult traits, problems, drama. And they're not going to get any better.

He cooperates with her. They file for divorce. He lets her idle awhile. She's learning to live alone. Her family and friends are supporting her. Even her work is more exciting lately. She comes to see me and she's thinking, This will be okay.

But he knows her so well. He starts with an occasional text message, then the phone calls when he knows she'll answer, and finally, the big, plaintive, I'm not WITH anyone. You're in my heart. I love you. I've always loved you.

But he doesn't say, Take me back. Don't let me go. She takes it, correctly, that he's not going to make this divorce emotionally easy. If he hurts, she should, too.

Remember, SHE can be a HE, or they can both be HEs, both be SHEs.

But assuming our patient is female then it's a problem for her that he, because we're making him a he, didn't work for her. He didn't extend himself very much to keep her. She's bothered by that.

But really? She's more bothered that there's a part of her that can't simply let him go. She says it defeatedly. As if the job of letting him go is the goal.

Does it have to happen overnight? Does it have to happen at all?

I say, "Well, you can't let ALL of him go. Why would you want to throw all of it away. You get to keep the good. You should always think about, remember, hold onto all of the good. . .forever. Didn't you earn the feel-good?"

Then because she's a math person and because I've thought in set theory since 6th grade, I add the following picture.
Is that so terrible, I ask, to hold onto that little football, the piece inside of you that represents him? You aren't him. He isn't you. You're very different, complicated people, who share an approximate 8% intersection at best. Can't you just own that? To myself I'm thinking, there's not much choice, in any case. Too many snapshots. Too many body memories.

But is it therapeutically necessary to make oneself lose the other, perhaps it is for sake of the next relationship?

I think not. Absolutely not. She, certainly, will continue to grow. Her circle of self will get bigger and bigger. And that slice of him that she cherishes will seem smaller and smaller over time.

She won't forget the good or the bad very soon, anyhow. Why not focus on the good? It's not quicksand, not really. A person might initially get caught into remorse, the seller's remorse. But it's pretty easy to remember all those reasons for leaving. Try forgetting those. Good luck.

Copyright 2007, TherapyDoc

Wednesday, January 24, 2007

I'd Grown Accustomed to Your Face




ARTIST: Alan Jay Lerner and Frederick Loewe
TITLE: I've Grown Accustomed to Her Face
Lyrics and Chords

[ Cdim7 = ; Edim7 = ; E+ = ]

/ C Cmaj7 - C6 / Dm7 G7 Cmaj7 C6 / Dm7 Cdim7 C - /

/ F Edim7 Dm7 G7 / C Cmaj7 - C6 / Dm7 G7 Cmaj7 C6 /

/ Dm7 B7 / C A7 / Dm7 G7 E+ A7 / D7 Fm / C Em7 / Dm7 G7 C - /Whatever that all means.

[TherapyDoc's adaption of the song from My Fair Lady]

I'd grown accustomed to his face
He almost made the day begin
I'd grown accustomed to his hiding, to his camouflage
and games
His spots, his fins, the predatory
whims

Are second nature to me now
Like breathing out and breathing in

I was so used to his excitement when I'd approach his 5 gal tank
He loved a little halibut, some shrimp, tho it was rank

He'd eat his vegetables too,
I'm feeling kind of blue
Accustomed to his face.

He was serenely independent
And content before we met
Surely he could always have continued that
and yet

He's swimming somewhere else these days
He's in another phase
The Grouper's lost his gaze.


Yeah, you guessed it. The Grouper went belly up on Wednesday, January 24, 2007. Or maybe the night before. Am I taking the blame? You bet. But a person has to learn not to get too attached. . . to a fish.

Copyright 2007, TherapyDoc

The Paradox

For this, you should pay.

But okay.

What's a paradox? A mental paradox is a situation in which a person can't help but do the right thing because having exaggerated the wrong thing makes the right thing seem, well, right.

There's an irresistible, hypnotic quality to a paradox, so of course, therapydocs watered in this treatment venue, who see the paradoxical quality to life anyway, will "paradox" you whenever they can. And consciously or not, you'll like it.

My mom and dad hate it when I do this to them, but it always makes them laugh.

It is also what makes good treatment painless.

When I learned about the paradox it wasn't presented this way. A paradox was a carefully thought out strategy with the power, not necessarily the magnitude (it's a brief family therapy technique), to create change. When I was in school I had the feeling that Jay Haley, the father of this kind of treatment, and his strategic team left the family, walked out, smoked, talked, and conspired. The family waiting for help was for sure, putty, powerless against such intellect.

But for me these kinds of things of situations arise serendipitously. I'm rarely on the look-out or even consciously working it. Here's an example.

A couple has an issue with trust. But it's an irrational issue. Both partners are true blue, loyal, fidel, love and respect one another, would never, ever cheat. But one of them trusts no one, really, except the family, and now that he's married (we'll make the distrustful partner, the jealous partner a he, but this is always gender/sexual orientation irrelevant. A he can easily be a she.

So call him Harry. Harry's always putting it out there that he's a married guy, a happily married guy. When he married Felice he was the happiest guy alive, found her the sexiest, most intelligent woman on the planet with a great sense of humor, his very best friend, too.

But Felice didn't make him the center of her universe. Not as much. She worked and had difficulty juggling the idiocy around her. Sometimes she felt that just getting through every day was a challenge, and when she got home she vegged out. She related to him like her mom related to her father. They had dinner, watched television. Crashed around 11:00 p.m.

Sexy though he thought she was, she wasn't all that into it by the time they'd turn off the teev.

So their libidos didn't match precisely (rarely do they ever, peops, except in the movies) and he worried about her love for him. Did she even really love him? He worried especially when he noticed that she missed chances to tell people, upon introduction, Oh, and by the way. I'm MARRIED. You should know that.

Isn't that how you're supposed to introduce yourself? I'm supposed to say, How do you do, nice to meet you. Yes, in case you were wondering, I AM married and happily, too, to a guy I call F.D. Got it, dude? Lose those dirty thoughts.

Clearly a Freudian doc or a psychodynamic doc or a Jungian doc or a Gestalt doc or any other kind of doc could have a field day and spend hours upon hours working with Harry and his issues, and maybe working with Felice on hers, too. If the couple would keep on paying.

A family doc might discuss family traumas, past affairs, even incest.

A STRATEGIC family doc does something like so:

We write new scripts, preferrably with with the couple's participation. LAUGHTER IS KEY, HERE. If they're not laughing, if they're not into it, it's harder. But it can still work very well. Here was the set-up to the new script for Harry and Felice.

TherapyDoc: So what will happen when Felice returns to work tomorrow?
Felice: He's going to call me and ask, Any cute new guys there this semester?
TherapyDoc: And you'll say. . .
Felice: I'll say, Just shut up. I'm sick of this.

(Harry laughs, seems embarrassed)

TherapyDoc: Could you be a little nicer, Felice, on the phone?
Felice (with attitude) : You mean, like I should say, Harry, I only have eyes for you, you're my guy? I do that all the time. It means nothing to him.

TherapyDoc (to Harry): Really?
Harry: Talk is cheap, man.
TherapyDoc: Indeed. So this is what you're going to do. We're going to change tomorrow's phone conversation. Good idea?

They're captive. We spend some time scripting it, mainly me scribbling, them telling me if it'll work or not. All of us are nearly on the floor, in tears it's so funny.

The Final Product

Harry: Any cute guys at work?
Felice (serious) : I just got here, give me time to look around.
Harry: I dare you.
Felice (a lot less serious) : I need the whole day, Harry, to case the place out, look around, really look at them. There are a lot of guys here, hundreds and thousands of men in pants. I won't know if there's anyone to have an affair with until I'm ready to leave, so be patient, and when I get home I'll tell you if I'm going to have an affair. Don't bug me til I get home.

Harry: Ha! Well don't even talk to me, then, because I'll be so angry by then that I'm going to need a lot of space from you. You better stay the (expletive "f") away.

Felice: No, no, no. When I get home I want you naked in a bathrobe, babe. I'm going to so want to (expletive "f") you, I'll have missed you so much all day. All DAY, Harry, without a kiss from you. How do you think that makes me feel? Don't you dare not be naked by the time I get home. Oh, maybe answer the door for me. . . in a towel.

When I made the last suggestion Felice said, Well, he'd want to do that every day!
Of course, this is a terrible price, right, to get a guy to trust you. Making love.

But I reassure her, Most couples don't make huge changes, every day changes. But if you two can make a once-in-awhile change? Some kind of wonderful.

I would imagine, in fact, that a feminist look at this treatment would be disapproving, but you should know that indeed, the woman in this case IS always in charge. She's always on top, if you will.

The paradox, of course, is that he's forced to think of her on the hunt the whole day, or at least to think of her saying that she'll be on the hunt all day, and he really can't see her in this light. It's laughable. He says, I dare you, but inside he's thinking, she's putting me on, she's not looking at guys. She has a difficult job. Her job is demanding, it's stressful. She's not out there looking to replace me. She's not even INTO sex all that much.

He's forced to see the reality, not his catastrophic fears.

Well, I liked it.

Copyright 2007, TherapyDoc

Monday, January 22, 2007

Divorce no divorce-your kid

Let's take the case of Ellie. (all names, all ages, all identifyers are made up in this post).

She's 9. Her parents divorced when she was 6 because they argued about everything and occasionally couldn't control themselves, pushed and shoved too much. Her father grabbed her mother's mother and bruised her badly in the final event that ended the marriage.

But Ellie thought all along (as I've said in other posts on parenting and divorce) that it was her fault that her parents divorced. Many of their arguments, and she heard SO many, centered around her. Drawing conclusions at that age isn't as hard as you'd think.

Well, Mom and Grandmom moved far away, taking Ellie with them, which is not at all unusual. Dad had to work the legal system hard to get his little girl back in Chicago. He still only had visitation every other weekend. But at least Ellie was here, living with Mom and Grandmom, and oh, yes, and Mom's significant other was never far away.

If you're thinking family systems and are not automatically villifying Dad, assuming he's a violent monster, then you might see that Grandmom played an inordinately large role in that marriage. In this case it was her advice about raising Ellie that conflicted with Dad's, and Mom could not extricate herself from the conflict, couldn't side with her boy.

There were other things going on, too. Usually divorce isn't a consequence of just one variable, especially not the enmeshment variable, which seems so normal to people. Couples will more likely blame their relationship problems on outside relationships. Other significant others are usually a function of relationship/family problems, like . . . enmeshment.

Knowing that Grandmom played a large role in the marriage, you can assume that she also will play a large role in the couple's post-divorce conflict. Divorce rarely ends the conflict, not without lots of smudging and dirt.

Should you bring Grandmom into the therapy?

She has an overly large presence in the narrative so certainly you want to see if and how Grandmom enmeshed Mom and how Ellie is also discouraged from developing into her own person. You can test that to a degree by finding out how well socialized Ellie is with other children, whether or not she does anything after school except homework and television.

But I'd bring Grandmom in just to confirm my guess and watch her in action, give her power to decide that Ellie needs more running room outside the family and how that should happen. Rather that fight a system, I work with it.

I'd try not to see her too often, though. She wouldn't be one of my favorite persons and she's not my patient. I'm not changing her or her world view and wouldn't begin to try unless she really wants to work with me. I really don't need her to get results, but she could, ultimately, really help the situation if she were amenable.

The judge ordered therapy in this case because Ella stuttered and was failing in Chicago, even though she did quite well in school prior to her move back into town.

I taught her some assertiveness, encouraged her to speak her feelings to her Mom, Grandmom, and Dad, more often, to make it a general habit.

See, and people wonder, why don't you do much play therapy, Therapydoc? I feel guilty stealing, is why. Most kids need social skills training, not to play with a grown-up person, unless it's their Mom or Dad. Truthfully, I will do play therapy when a kid isn't verbal, but Ellie could talk and wanted to talk.

I coaxed her to ask her teacher for help. When the teacher said, Try it first on your own, she was to answer back and say, I already tried. I just don't get it. Please help me. That worked, by the way. It made the teacher more aware of Ellie as a person, put her on the map.

How do I know? Systems therapists talk to teachers who are key players in a kid's ecosystem. I don't get it that other docs can't spend ten minutes on the phone with teachers. You know who you are. Sorry if this is becoming a rant. Ignore me.

But don't ignore this.

I titled this post Divorce or no divorce-your kid because I'm sure Ellie would have stuttered and had problems in school no matter her parents' marital status.

Just being married is no lock on your kid's sense of security and well-being. You have to be on top of that as parents. Security doesn't come with the umbrella of "marriage" or even "committment".

I bring this up here because one of the things Ellie told me in private was that her father didn't call her very often. Dad SAID he'd call to help her with school work twice a week, but he forgot. And Mom didn't have the skills to help her and very much left the job of teaching to the school. She also had a one-year old baby.

So when Ellie would be sitting at her desk and the teacher would pass back the homework and hers would have a big ZERO or a big fat F at the top, she would cry there silently, then force herself to smile and to try to socialize as if there was nothing wrong.

And at the end of the day, her Mom or Grandmom might ask, I really think they did, How was school? How were your grades? But Ellie wouldn't share that experience with them.

After all, how easy is it to talk about failure at any age?

Then there's Dad, forgetting to call. Yeah, I could have strangled him. He was the one bringing Ellie to therapy. He was the one with insurance, a house in the burbs, the better communicator.

So here's the real universal parenting truth, Divorced or not divorced, your kid needs that emotional check up at the end of the day.

Like you, your kids need to hear questions like, Did the world give you a beating today? How are those kids in your class? Any mean ones? Anyone mean to you? How 'bout that teacher. Nice? They're not all nice. Are you scared to ask for something if you need it, like a pencil?

If you act like you care, they'll answer you honestly. That doesn't necessarily mean you have to run right over and fix the problem. But you have to take your kid's emotional temperature. Then you can go from there.

By the way. Start this while they're young and you won't seem like an alien to the kid during adolescence, all of a sudden going, Why in the world are you hanging around with THAT kid!

For kids, learning to talk about their lives, their day, is liberating and intimate. That's why once they get into it, they want a PHONE. Academic (work) intimacy is key and it's your job as a parent to foster the process, the skill of communicating events and feelings.

We don't all do it naturally, you know, talk about ourselves.

Copyright 2006, TherapyDoc

Sunday, January 21, 2007

High School Musical

Nobody likes being sick, but it's a good excuse to watch a lot of teev and eat ice cream. (unless it's a G.I. virus, then it's clear liquids, read F.D.'s post scroll down to it)

F.D. told me last week that he would be telling patients that if they weren’t sicker than he was, they didn’t really need to be there.

That's probably what he WANTED to say. He probably said no such thing. I know he said no such thing. You should hear the stuff he tells me he wishes he’d said. But he’s way too nice.

Having a touch of a virus that steadily gained strength (we're talking strength) in this old bod' over time, I worked last week. Didn't kiss any patients, not my style under healthy circumstances, passed out all new pens to people who needed them to sign checks, and didn’t shake a single hand.

But got home and slept and slept, and by Friday night, surrendered.

After a 24-hour slumber felt BETTER (notice, no antibiotics, people, yeah that's in F.D.'s blog somewhere, too. What doesn't kill us, makes us stronger).

Showered, went straight to the family room to check out the night on cable, and lo and behold, there it was, High School Musical!

The very same movie a kid’s mother had brought up in family therapy last week.

That mom couldn’t understand her son’s need to watch it over and over again.

The last movie a parent made me watch because of her kid's obsession was Thirteen.. If you haven’t seen that one it’s about a teenager’s obsession with drugs and dark depressive activities that ultimately might lead to self-destructive behavior like cutting and nasty scarring, scarring that from what I’ve seen in adult borderline cutters really will not fade away without some serious plastic surgery.

So I HAD to see High School Musical.

I know, I know. Fridays were supposed to be movie review days and this is Sunday. But I've little self control and there are so few feel-good venues to recommend (in my line of work it's hard to find them), that when I come upon one feel I must share it. This is on the order of a feel-good venue, but you need the Disney Channel.

No question. People can fault this musical It has derivative songs. It’s so highly formulaic and derivative, that unless you see it as camp you might not even like or appreciate it. I appreciated it as much or more than The Beverly Hillbillies, one of my all-time favorites, and a totally under-rated film. I think. It's been years since I saw that and by now it's surely not P.C.

So you don't need to watch it.

And why watch High School Musical, especially if you'll probably need a shot of insulin first?

The MESSAGE(S) are good, even if you never intend to become a parent.

But first Here’s the quick Wikipedia summary. It’s a quote:
High School Musical is an American made-for-television musical film, produced and distributed by Disney Channel, and was released on January 20, 2006.
The Emmy Award-winning television film was one of the most successful Disney Channel Original Movies ever produced, with a sequel confirmed and soundtrack that is certified triple-platinum, making it one of the most commercially-successful records of 2006.

High School Musical is a story of two high school students: Troy Bolton, who is captain of his school's basketball team, and Gabriella Montez, a shy transfer student who excels in math and science. Together, they try out for the lead parts in their high school musical. Despite other students' attempts to thwart their dreams, Troy and Gabriella persist and inspire others along the way.
Wikipedia’s summary caught the inspiration thing. The kids decide that they can no longer support the status quo, that they have to be themselves, young people growing and becoming in touch with their natural talents. The decide they’re not going to be what everyone wants them to be.

Wikipedia doesn't even tell you that there's no sex or violence in this movie and you don't want any, that it’s a HAPPY movie, on the order of GREASE. There are happy songs and people, young and old, break into song and also, DANCE. Here are the songs as they appear in the movie:

1. "Start of Something New" (Gabriella & Troy) – 3:16
2. "Get'cha Head in the Game" (Troy and the Wildcats) – 2:27
3. "What I've Been Looking For" (Sharpay & Ryan) – 2:03
4. "What I've Been Looking For (Reprise)" (Gabriella & Troy) – 1:19
5. "Stick to the Status Quo" (High School Musical Cast) – 4:28
6. "When There Was Me and You " (Gabriella) – 3:00
7. "Bop to the Top" (Sharpay & Ryan) – 1:47
8. "Breaking Free" (Gabriella & Troy) – 3:27
9. "We're All in This Together" (High School Musical Cast) – 3:51
10. "I Can't Take My Eyes Off Of You" (Gabriella, Troy, Sharpay, and Ryan)
11. "Get'cha Head in the Game (Pop Version)" (B5) – 2:43
12. "Start of Something New (Karaoke Instrumental)" – 3:31
13. "Breaking Free (Karaoke Instrumental)" – 3

Where in the world have I been that I didn’t know about it? Not that I’d watch it again, but I can see why kids would want to watch it again and again.

Here’s sample dialogue and I’m totally paraphrasing since I was drinking tea, not writing down dialogue:

Troy’s father: You can’t sing. Why would you want to be in a musical? You’re a playmaker. You play basketball. Now get focused and lead us to the championship.

Troy (storming off): What makes you think I can’t do both?

So Message One- Let the creative person inside come out, don't be afraid of what others will think.

Message Two:

At the end of the movie, everyone is singing and dancing and everyone is on the SAME TEAM. There’s plenty of conflict between the teens and even teachers throughout the movie, but it magically dissolves at the end because:

People get that conflict based upon jealousy is stupid.

Let it go, get along, cheer one another on. Life’s too short not to like and support each other.

Thirteen , friends, it’s not, and we’re so glad.

Let your kids watch this one over and over again.

Copyright 2006, TherapyDoc

Tuesday, January 16, 2007

The Queen

Social scientists see most events as random. So although waking up several times last night to check the time so that I wouldn't miss my 5:15 a.m. ride to the airport wasn't random (I always do that), the delay at Bob Hope Airport was.

No big deal, usually, but this flight was to connect to another in Dallas with only 50 minutes of wiggle room. An hour delay meant I'd miss my connection.

Oh, you want to know why the delay.

A flight crew person didn't show up to work.

I could easily rant that because someone tied one on the night before that one of my patients, a person who really could have used some help, got bumped from my patient list in the process.

I can't be flying and doing therapy; no technology to do that, not yet.

But let's not rant. The random GOOD part of this was that when I landed in Dallas (on-time in the end, tail winds) having no idea when I'd get back to Chicago, I learned that American had already booked me on another flight, not trusting tail winds to speed us along, I guess.

No ordinary flight, either. This plane was a 777, meaning it was the size of a football field, probably ultimately headed overseas, via Chicago-New York.

So that meant that we had our choice of movies to watch on those little 8 X 8 inch television monitors etched into the backs of the seats in front of us.

AND, since this flight was also delayed (engine trouble, so reassuring is it not) I would be able to see the entire flick, well, almost the entire flick, since the officious voice of either a flight crew member or the pilot interrupted the screening about a dozen times to remind me of the lousy weather in Chicago or to talk about smoking engines or to urge me, please, to fasten my seatbelt. Like I wouldn’t.

You might not wish to read on if you plan to see The Queen any time soon, although I won't give away all that much. But I think we'll make either Fridays Film or Book Review Friday following this. I'll give you a heads up on what I'm going to review in case you go out on Thursday night and skip Ugly Betty and Grey's Anatomy. Oh you'd never do that? So never mind. It's okay.

I saw The Queen on the airplane and couldn't believe this good fortune. The movie is so appropriate to review right now as it follows along with our theme of death and dying (last post). Talk about random events that feel so not random.

The movie is about Queen Elizabeth II's way of grieving the loss of Lady Diana, the People's Princess.

If you recall the beautiful, charming Lady Diana Spencer's marriage to Prince Charles was already in dissolution at the time of her death. Diana was no longer a member of the Royal Family following that tragic car crash in Paris. It was rumored that perhaps the Royal Family even had a hand in that accident, there had been so much bad blood between the royals reported in the press.

Queen Elizabeth II (an unbelievably great performance by Helen Mirren) steadfastly refuses to go public about the death and wants nothing at all to do with a public funeral. She makes no public statement, rather tells Tony Blair (also a wonderful performance by Michael Sheen) that she is shielding her grandchildren from the press so that they can grieve privately. She cloisters Diana’s children, her grandchildren, on the family's 40,000 acre estate outside of London, nowhere near Buckingham Palace where the British throngs are crying, bringing flowers. She has protected the children, ostensibly, so that they will recover from the trauma.

This recovery is not exactly a discussion of feelings, the kind of recovery we're used to in the therapy doc business. We see none of that. It is simply being out in the open air. Where people hunt. This is healing, you see.

The Queen is fried by the international media for her heartlessness and deliberate detachment from her subjects. The British are grieving, mourning, and long for a word from their monarch, yet their queen is in hiding. She is silent.

She does not fly the flag at half-mast. She makes no public statement, no appearance. She refuses, initially, to have a public funeral. If it were up to The Queen, there would have been a graveside service or some other minimalist marking of Lady Diana's passing. It is as if Diana were no different than any other commoner, had no other status in the British, no, World's psyche, this lovely, charitable, effervescent, charismatic figure many of us remember so well.

Now you may not know it, but I'm really not into giving away movie plots and will stop right here to entertain some hypothetical ideas. This is a terrific film, deftly directed by Stephan Frears. Helen Mirren is simply incredible, as I've said. I could not take my eyes from her performance. She communicates SO much with very, very few words.

Let it be a lesson.

Let us say, however, that the Queen is silent on Diana’s death not because she held anything against Diana, but because the queen's concept of grieving was different. If she had her way, and she did, the Royal Family would have been silent on the issue and would have had that private ceremony, as opposed to the elaborate one we all saw on television, attended by millions.

This is a dignified approach, not splaying emotion all over front pages and television sets of millions across the globe craving a Royal Response.

Is it so bad? Is it so bad not to express one's feelings about a death? Haven't we talked here about not taking away an umbrella until it stops raining? And yet we've also talked about the importance of remembering and talking about a person's life, that this is the optimal way to grieve.

Thus it is time to discuss what real stoicism means.

No question, it CAN be highly dysfunctional. But there is a place for it. Some people aren't ready to talk about a person's life in death. Their needs have to be respected. Others truly feel that expressing negative feelings (tears, sadness, anger, guilt, anxiety--you know what I mean) just brings everyone else down. Still others want to grieve privately, alone, to themselves. This helps reestablish a sense of control. Cry into a pillow when no one else is around helps them.

Sure I could talk about intimacy and posit that crying alone into a pillow has its limitations. It does little to help other mourners who might need to grieve in tandom, socially, like children, perhaps.

Mourning alone can be related to a lack of trust or empathy, also, not simply maintaining decorum. Those who do not trust, and those who have difficulty empathizing or showing vulnerabiltiy might have difficulty expressing emotion to others.

And some people really do not know that feeling bad is always a temporary condition and will pass, whereas the moment ripe for sharing may not come again. These people will prefer silence.

Still others, like Queen Elizabeth II perhaps, do not feel that someone else's death should be about them. Their own personal feelings are not primary.

People have their different reasons for different grieving in different ways.

They're all fine, friends, these different ways of grieving. It's important to respect individual differences and not to impose our own values on others. We don't really know what a person is going through. It is virtually impossible to truly be inside someone else's shoes.

That's the lesson I got from The Queen.

Copyright 2007, TherapyDoc

Monday, January 15, 2007

Saying Goodbye

F.D. and I don’t take “getaway” vacations, not in recent history. We take "visiting" vacations, which are a real mixed bag. We visit my parents, we visit our children and grandchildren. There are many cities to choose from and many combinations of people to see.

When my parents first bought in Miami many years ago I would visit them for a couple of days then slip back to Chicago, my absence virtually undetected by my patients. At some point F.D. would see the sun on my face and think to himself, What a dolt I’ve been. I could go, too..

So he’s been joining me for a few years now, and since two of his elderly aunts had lived only a few hours north of Miami, we would take the opportunity to visit them, too.

Well, this time we hoped to visit Aunt Sherry. F.D.'s cousin told us that she wasn’t doing very well. At 95 that’s not uncommon.

On the day we had planned to visit her up in Lake Worth, F.D.’s cousin Kenny called to say that she was doing really badly. In fact, she was nearing the end.

“Well at least we’ll say goodbye,” was our thinking.

Except that when we got there Aunt Sherry was in a coma.

She was lying peacefully in her bed. We approached slowly. F.D. took her hand and checked her vital signs, asked his cousin Rita about things like "oxygenation." He tried to ask Aunt Sherry things, too. Aunt Sherry, do you hear me? Can you open your eyes?

She didn't respond.

I felt very uncomfortable. I didn’t know if I should talk to her or not, and certainly didn’t know what I’d say if I did open my mouth. Being quiet in serious situations is a good thing, I always tell myself, but I was fond of Aunt Sherry. I wanted to somehow “say goodbye.”

At some point I blurted, “Hi Aunt Sherry, it’s me, Linda.”

Joanie, another cousin, gently corrected me. “Even if she hears you, she won’t know who you are. She hasn’t recognized any of us for a week.”

“Oh.”

We all slipped out of the room except for Rita, Aunt Sherry's daughter, and tip-toed around things to talk about. Rita joined us and wept for a second, squeaking out, “Who am I going to talk to now? Who’s going to listen to my complaining? Who will help me with my problems?”

Pretty impressive, isn’t it, that Aunt Sherry was still the person her daughter talked to every day for support, turned to for advice about life all the way to the end?

We left that one rhetorical and looked at pictures, took some digitals of old ones, commented on family resemblances. F.D. continued to check on Aunt Sherry. He never lost his “serious look.”

When you know someone for over thirty years you know their “looks” and their “faces.” I particularly like F.D.’s piano face, the one he makes when he’s working hard to get a piece right.

Anyway, I got a little worried that we were actually waiting for her to pass away. I was willing to wait, of course, if that was what F.D. wanted, if he thought that he would be helpful somehow.

But the more information he collected, the more convinced he was that this family was well prepared for whenever the worst would happen. At some point he said for all to hear, I guess we better be getting back before the traffic gets too heavy.

We went over the obligatory turnpike directions (had already had a great time on the 95 coming up from Miami) and took off.

In the car F.D. turned to me and asked, “When are you going to blog about death and dying?”

“Do you mean end of life when it’s expected, like this one?”

“Uh huh.”

“Oh, I don’t really have much experience in that,” I said.

“Really?”

“No. It’s funny. Personally I’ve never seen anyone quite this close to death before, in a coma like this.

And professionally, although I’ve certainly talked to people who’ve gone through this, it hasn’t made it into my secondary trauma registry. It’s not like the unexpected deaths, the gunshots, the stabbings, the overdoses, the hangings.

A peaceful death like this one has never registered distress. I mean, I empathize for sure, but my personal experience falls short, makes me feel a little shallow, honestly. I don't have hospital privileges or it might have been different, maybe. But I haven't got a real fix on this, you know?"

“So you’re saying you’ve never seen anyone in a coma?”

“Not near death.”

“Hmm.” He paused. “So what did you think?”

“It’s very sad. Are they all like that? Do people generally close their eyes really tight like she did today, as if they’re retreating from the light, running away from this world, saying, Just Go Away?”

“There are many different presentations. But this is one of the more common ways of dying, yes.”

“I found it so natural. I don’t know. It did seem right to me. Anyway, I still don’t feel I know enough about this to write about it.”

“Okay.”

“You should though, F.D.,” I told him. "You've seen it so often."

“Yeah, but I write about bunk on health. That’s the only thing I’m going to write about right now. The dumb things people think are true about medicine drive me crazy.”

“Okay.”

We drove back to Miami and took a walk on the beach, got back early enough to get ready for dinner with some close friends. F.D. got the call that Aunt Sherry had passed away. He had warned me in the car that he was sure it would be today, that it she was hours, if not minutes away from expiring. He’s rarely if ever wrong about anything medical so I wasn't surprised when he gave me the news.

The next day he was leaving for Chicago and I was staying on another day. I drove him to the airport early in the morning. As many times as I’ve been to Fort Lauderdale International, I always worry that I’ll make a wrong turn, get lost, and that someone will miss a plane (usually me). It took only minutes to get there and before I knew it we successfully accomplished Kiss and Fly.

After he slammed the car door I zipped into airport traffic on my way back to Miami. I wanted to get back on the beach to walk and take some pics while the sun was low in the sky. But as soon as I zipped into traffic I started to feel really badly. The saying goodbye thing made me cry. Probably like most people, I appreciate people more as soon as they're not with me. And to make matters worse, I realized that I hadn’t done my look back thing. I hadn't watched him as he walked away, watched until he disappeared into the airport

Usually when someone that I love is leaving me I wait and watch. I wait for that person to disappear into the school, or the house, or in this case, the airport terminal. I get that one last look.. I create the snapshot picture of the person walking away.

It's just what I do. A lot of people do this, I'm sure.

When we left Israel following our Sabbatical I burned images into my brain, my own images. I could have looked at photographs of the kotel, the "Wall,” or bought postcards of the beach in Tel Aviv or referred back to my own photos. But I wanted the images in my head and stared at the wall and the ocean long and hard enough to create them in my head.

So I kicked myself for not getting that last one of F.D. as he left me in Fort Lauderdale. It just didn’t seem right at the time that I neglected to do that, silly though it may sound.

So I took a few pictures of the ocean (like 70) and watched the terns for quite awhile. It's a long winter in Chicago. Here's one.



Copyright 2007, TherapyDoc

Wednesday, January 10, 2007

That Bagel and Cream Cheese

I was cutting a bagel the other day to make a sandwich.

Truth is, I don’t eat very much, but I do like a good sandwich when there isn’t any pressure to stay awake. A good sandwich is also nice thing to have before taking a walk. I was going to be doing just that, taking a walk, and happened to be in the process of making what one might call a very high sandwich when I got into trouble, potential relationship purgatory.

To my left was the cream cheese, sliced tomato, sliced mozzarella. I had the option of lox and onion, slab of lettuce, cucumber. I opted to skip the onion and lox in favor of salt and peppering the tomato and cucumber, and I desperately needed that mozzarella, which was definitely kosher, by the way.

But I skipped the lox and the onion because I just didn’t want to need that mandel brot for dessert to clean my palate. You know what I mean?

Anyway, as I was about to top my bagel, meaning put the top of the bagel on top of the half with all the fixings, when someone gave me a very funny look.

A look like, What ARE you doing?

I was a little surprised. “What’s wrong?”

“Well, the bagel. . .”

“The bagel?”

“Well, the bagel goes the other way.” Then he proceeded to point to the proper way, the better way to place the top on top so that it fit the bottom half of the sandwich.

You see, if you have two halves of the SAME bagel, when you put them back together they should look like a bagel that hasn’t been cut. The bagel should look whole.

A whole bagel should look neat.

Except when you build up a sandwich on a bagel, face it, it’s not going to look anything like a WHOLE, NEAT bagel.

Now, the beach was awaiting, friends, and I am a beach-walker and I like the morning sun on the ocean.

So although I’d love to expound on the virtues of having some, but not all of your ducks in a row, or better yet, the pain and dysfunctionality of Obsessive-compulsive disorder, the morning is passing by way. Time waits for no sandwich.

I will, however, leave you with a thought.

This may look like Obsessive-Compulsive Disorder (not mine, silly). But true Obsessive-Compulsive Disorder is a serious, debilitating illness. Just like I posted about Bi-polar Disorder and how most of you actually do NOT have it, despite the fact that your hyper-caffeinated, stressful lives and sleepless nights stretch into weeks of difficult days, most people are not bi-polar or even uni-polar, for that matter.

Similarly with OCD. Perfectionists do not all have Obsessive-Compulsive Disorder (OCD).

So if you have a friend who doesn’t like the way you make your sandwich, don’t go out of your way to make that person feel uncomfortable.

Don’t call your friend obsessive-compulsive, overly-perfectionistic, or controlling.

It’s not nice and it only gets you into conflict that isn’t necessary.

Smile and say,

Oh, it’s very obvious that you have never TASTED your bagel this way. You see, if you leave some of the cream cheese hanging over the edge deliberately, then when you take that first bite you get more cream cheese.

It tastes a LOT better. You have to try it, seriously.

And be convincing. You’re right, of course.

Copyright 2007 TherapyDoc

Tuesday, January 02, 2007

Mr and Mrs Smith

So I'm really behind on the movies, and I haven't even finished this one yet and it's been out well over a year.

But since it's obviously following the formula

couple fight
couple finds a common enemy
couple unite

I really don't have to hurry to finish it.

What I'm thinking is that if you need a really good example of how important it is to have that work intimacy plate spinning in your relationship, this would be it.

They're both assassins in the movie and can't tell each other what they're doing with their day-light hours. They have "secrets."

So of course they're on the verge of breaking up, the movie opens with Angelina Jolie and Brad Pitt seeing a marriage therapist. The focus for most of us might be the enormous cloud of deception.

Righly so. The important lesson, the only reason I'd even suggest anyone watch a horrible movie with SO much gratuitous violence, marital violence at that, is to demonstrate by exaggeration that deception and lack of communication irreparably dilute intimacy.

What the marital therapist said in the movie isn't true. All marriages do not ultimately become disengaged, less communicative over time.

Only dysfunctional marriages do.

So go home and talk about your day with your partner if you have one. Rattle on, it's okay.

And don't, by the way, think all that physical violence between Mr. and Mrs. Smith is sexy. IT'S NOT.

Not if you want a sexy loving relationship. Beating on one another is the antithesis of "loving."

Is that a value judgement? Don't care if it is.

Copyright 2006, TherapyDoc

Monday, January 01, 2007

forgot something

I forgot one of the most important parts of that last post.

So if you're reading this and you didn't get to the part about what a person's death means, go back to Grieving Right and scroll down to the end to get I forgot at the post script.

How's this happen? How'd I forget one of the most important parts?

Grieving Right

Grieving right

Thought I'd bring in the new year with a few words about renewal.

Many of you have been to the movies this past week so undoubtedly you've seen that preview for the movie Freedom Writers about the kids in So-Cal who are in school and have a new teacher who makes them face their feelings about losing friends to gang warfare.

She asks, "Step up to the line if you've lost one friend to gang violence."

They all step up to the line.

"How many have lost two?"

Nobody moves.

"Three?"

Nobody moves.

"Four?"

This is a subject that touches most of us because these are young people we're talking about who shoot one another, mainly out of stupidity.

It affects yours truly who hears only a couple of stories like that a year, but they're a couple of stories too many. What I see is that it's very hard for kids to grieve. They don't like it and they don't know how to do it right.

And since so many of them are already using drugs and alcohol, they're able to avoid the whole nasty business.

But it's NOT a nasty business, really.

Grieving even has it's own diagnostic classification. Sure, it's one of the various "depressions" (I've talked about the fact that depression varies.) But it has its own name, Grief Reaction.

I'll say. Most docs and clinicians treat it altogether differently than we treat other depressions.

Although docs like me prefer to treat the other depressions using a cognitive-behavioral therapy, meaning we LOOK FORWARD, attack irrational thoughts, and encourage behaviors that shake up the seratonin in the brain,

grief reactions require that patients to LOOK BACK. We exacerbate, exaggerate the grieving. We INCREASE the feel bad.

INCREASE the FEEL BAD?

Well, yeah. We kick it up.

See, you CAN'T kick it down. No matter what you do, outside of numbing yourself with drugs and alcohol which will retard both you and this sublime process.

Barring that, you can't avoid feeling badly when you lose someone you love. It's why many of us avoid recommending anti-depressants, too, during the first year following a loss.

You can't avoid feeling badly because you have too many memories. This is how we're wired, by the way. It means

(1) We have too many neurons attached to visuals and other senses associated with that person, senses like touch. Being alone means not FEELING that person anymore.

(2) We have too many sad thoughts to avoid feeling bad, including memories of events, guilt about things we did and didn't do.

(3) We have other emotions that squeeze into our psyche, like anger and anxiety for having been abandoned.

All of that gray matter, the sensory memories, the thoughts, the memories of events, the onslaught of emotion add up to an intellectual conclusion of LOSS.

You're going to feel bad.

So you can't avoid it. What else can you do but surrender?

Family therapists have always encouraged family members to get together to REMEMBER.

We tell folks to talk about those who are no longer with them and to establish rituals to that will help, like calling one another near the birthdays and anniversaries of the deceased, calling each other on their own birthdays and anniversaries, writing virtual letters to the person who passes away and reading them to each other, visiting the cemetary, giving charity or establishing other remembrances.

Most cultures already have such rituals in place.

It's particularly healing to work on relationships within the family, to renew or to establish, sometimes for the first time, some family intimacy. I tell the children of a widow, for example, to call their mother more often, and to call one another more often. Just check in. It'll feel good.

Ironically, many things can interfere with the grieving process. Things happen that take us away from our grief, like work and school. And psychologically, people can't focus on remembering the deceased all day and all night.

Sometimes they even find themselves happy.

This really messes with their minds.

They feel guilty. "How can I be happy? We just buried him last month? How can I be laughing?" Then they'll make themselves feel badly about feeling good, which is pretty easy to do, face it.

TherapyDoc's philosophy here may seem a little on the edge, but hear me out.

Like I said, you can't avoid grieving. You can't avoid feeling badly. You're going to grieve for the rest of your life, on and off, for those who have departed.

It's okay to feel good.

It's MORE than okay to feel good. It's GOOD to feel good if you feel good.

Don't worry. You'll feel bad. There's time.

You want to feel good (when it happens you know it) because when you're depressed, really depressed, it's hard to do anything productive. It's hard to live decently. That's okay for awhile. I mean we can all go a few days without bathing, and we can all stand to lose a little weight, and it's no big deal if we blow off school or work for a little while. Some of this is inevitable.

But grief work, which is somehow keeping memories alive and using those memories in a positive way, requires social interaction. You can't start a foundation if you're in bed.

So really grieving right requires a little effort and energy, and it's hard to have both when you're depressed every waking minute.

Grieving right implies remembering, making phone calls, talking to others about the deceased, reviving a person's life so that it has meaning and can be remembered by others with honor.

Grieving right is continuing as a positive force in the social universe when someone else is unable to do so. Because where there is life, there's hope.

And maybe it's good to communicate that to others, ultimately help others who suffer in one way or another. We're still here. What are we doing with our lives?

So I don't know what Freedom Writers is going to be about, but I'm hoping it's that. If you're still here, if you're the survivor, it's an awesome responsibility.

And no, being that positive force in the universe won't happen over night, but it will if you have it in mind that that is what you want to be.

The P.S. I forgot this part. I've been wanting to write this stuff for a long time and indeed, Freedom Writers gets the credit for pushing me to do it. But there's something else about grieving that people often get wrong.

They attach too much meaning and time to WHAT HAPPENED, the how's and wherefores of a death. Especially if it was tragic or violent. Tragic, violent deaths make GREAT copy. Folks can talk about the event for years and years, never once mentioning the life.

Death is horrific enough, rarely dignified and certainly not glorious. We can analyze the last hours and days an elderly person suffered in a hospital ad nauseum at a wake or a house of shiva. It's amazing how many times survivors tell the story, and it helps them, I'm sure, to integrate the loss in the psyche.

It helps distract everyone, really, from describing who that person was which is harder, much more difficult.

Distraction is good to a point. We don't take away the umbrella until it stops raining.

But it's a person's life that matters, not the endpoint. It's everything up until the end that is worth remembering. That's what I like to think about.

Copyright 2006, TherapyDoc