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Friday, June 29, 2007

The Working Date

I've been waiting for this.

Sue Shellenbarger (Wall Street Journal, 6-28-07, Personal Journal, Work & Family) titles the story, Dinner and a PowerPoint.

She tells us, in case you aren't in the know, that for powerful people, dating now means bringing along the laptop, or more commonly, staying in, having dinner and perhaps a little wine, then working for a nice satisfying stretch before perhaps going out for ice cream. Sex included if agreed upon.

The date, interestingly, is mapped out, which I've always thought a good thing, so that prime-thinking hours aren't wasted. Ms. Shellenbarger quotes Beth Schoenfeldt, co-author of "Ladies Who Launch," saying that entrepreneurs don't really separate work and life so it's best that they find dates who don't stop working, either.

Sounds like a good idea. Matching a date's attachment to work means probably having compatible needs for psychological space, which can work well in a relationship. Of course, I'm always pushing to decrease that need for space, to increase the need for intimacy. But oh well. High powered people might not have time to see a therapy doc, either.

WSJ quotes Ian Kerner, a relationship therapist (my team). who feels that a work date says a lot about a person's inability to put a relationship first in life.

My feelings exactly.

Work is a quest for Money

Not that I'm down on money! It's good, it's important. Work is creative and expressive, too, and it makes everything else flow, except, of course, if a couple's relationship is lacking in other areas. But being able to share work hours can be phenomenal.

It's when one is watching another who can't stop working, it seems, that there's a problem. But when both are happily clicking along?

I think about back to back computing with FD, monitors aglow, only three feet apart, our chairs potentially touching if we move to get a bite to eat. It's a type of work for we're sharing what we know, but it's fun, and we can talk if we want to talk, and we do talk.

So don't get me wrong, I'm not totally against being able to share the same space to do something solitary, as toddlers do in parallel play, by the way, before learning that playing TOGETHER is much more of a blast.

My take is that work is that it's wonderful and necessary, and that all kinds of work, including stay at home work, are equal. Work and academic pursuits amount to the same type of time commitment. If 8-16 hours of a person's day is tied up in work or school, then there's much to talk about.

The real focus in intimacy, however, isn't the screen that's glowing on the table, it's talking. Is it a good thing to relegate your best talk hours of the day to a screen?

Wouldn't it be nice to spend at least half of that time, the better amount of time on the date, talking about families, past experiences (if they're not too embarrassing), issues with George Bush, preferences on toothpaste (don't use some overseas brands, apparently they're tainted), difficulties with friends and co-workers, dreams or fears about having children, fantasies, thoughts about future avocations or vocations, sharing funnies in the New Yorker, or singing?

I'm thinking if you can LIVE together, as in really LIVE, the relationship has a much better chance than if you mostly work and sleep together. Money comes, money goes.

There's only so much time, you know, before time's up.

Copyright 2007, therapydoc

Wednesday, June 27, 2007

Dream Production 101

Anonymous asked if my spin on dreams, that everything and everyone in a dream is the dreamer, is research based.

Not that I know of, and I don't know who first presented it to me this way. But try to think of it as follows.

A dream is ALL yours. You're the only one "creating" the dream. It comes from your head, or perhaps your dinner.

Steven Speilberg did not direct it, neither did George Lucas, even if ET or C3PO make star appearances as themselves!

So every movement of every actor, every word that is spoken, every nuance is conceived, directed, and produced by the dreamer. It's a DreamWorks Production, so to speak.

We are our art in that way. Everything I write, for example, is a reflection of me, the way I feel, think, or behave.

So how can the therapist in your dream be anyone but you?

The real art of therapy is exactly that, too.

copyright 2007, therapydoc

Tuesday, June 26, 2007

About It's Fictitious

Already the email is coming in, folks worried that their comments made me uncomfortable, like people are talking about the therapydoc family.

Like we're so important. Sorry about that. Let me clarify a little.

a) I love comments, there isn't a blogger out there who doesn't, except maybe one and I know him. The only exception would be if comments are "inappropriate" or I feel in any way immodest, I won't post or respond to them, likewise e-mail.

b) Gossip was the wrong word and too harsh! I wouldn't suspect my readers of that, honest. I meant that I'm not gossiping, exposing anyone.

(It's not about you.)

So I'm editing that part out about gossip. If you haven't read it already, the last sentence will say,
take it as a learning experience, a creative learning experience
As long as we're sharing and talking creatively, did I tell you I didn't make it as an art major? At UIUC I took about every type of course imaginable and chose art as a major because it was much more fun than anything else (tennis was good, too). I loved design and got A's but could not draw. There was a time you had to draw to be an artist. I called home in a panic, for at some point you really do need enough hours in one particular subject to graduate. Mom suggested social work.

Thanks Mom.

But of course, had I chosen art, you'd have a much better looking website to visit. No regrets.

therapydoc

Monday, June 25, 2007

It's fictitious

At the top of this blog, under EveryoneNeedsTherapy, it says,

This social work blog reflects my multi-disciplinary scholarship, academic degrees, and all kinds of letters after my name that make me feel big. Patients wanted more feedback, but it's morphed, so you get how I cope, too. If you're in a warm, sunny climate, I'd consider guest lecturing at your institution, topic your choice. The blog is not to diagnose, treat, or replace legal or medical advice from a licensed professional. All references to people, named or otherwise are entirely fictional.
Or should that be, entirely fictitious. Any English majors out there? I'm reminding readers right now that indeed, even if you think that a presentation on this blog brings to mind situations or people that you know, they're all entirely made up. Or they're about me. Or they're about me making me up.

You know, occasionally I get tagged for memes, these Tell us 5 reasons you blog. . .or something else, Or Name 10 things that people don't know about you. . .or Name 100 things. . .

I've resisted them most of the time, mainly because I don't feel like it or don't have time, really. I have to be in the mood to blog and when I do it's because I have something that I want to say, something to teach, even if it's by metaphor or via a story about me.

I'm going to share something now, however. Sharing about self for a therapy doc is very, very weird. It's not something that we do easily, and we're VERY protective about sharing things about other people, too.

So just a reminder, the stuff you read in EveryoneNeedsTherapy is pure fiction. Or is that, purely fictitious. Whatever it is, take it as a learning experience, a creative learning experience.

therapydoc

Lying Down

I once had a patient who told me this dream. He dreamed about me.
"I was driving you somewhere, you were in the back seat. I don't know why I was driving you somewhere, but I deliberately went in the wrong direction. I didn't want to take you where you wanted to go, and I didn't want you to know that we were going in the wrong direction. I was deliberately misleading you."
Fascinating, isn't it?

I always push people to give me their interpretation first, then I'll discuss the other alternatives. He continued:
"I try to hide from you. I hope I can mislead or deceive you, not let you see the real, horrible me."
But of course we talked plenty about the real horrible person, and he's not horrible at all, simply a little disabled.

And he worked pretty hard in therapy. We had designed a treatment protocol, a difficult therapy, honestly, and he resisted it and I knew that. But he agreed with it and wanted to do it, and for the most part did do it.

I think maybe I'm perceived as much more exacting than I really am. That could be because I do call people on their stuff (if it won't hurt them, sometimes I'm totally fine with a person lying to me, as you know from reading other posts).

We talk all the time about compliance or lack there of, especially since a treatment plan is designed with the patient's input. At one time we both thought it would help.

But if a person doesn't want to work on the plan, or if the plan is too hard, then that person is tempted to hide or to lie about what he or she did outside of treatment between visits.

Some people call that lying resistance, but I call it good communication. When they 'fess up, which usually doesn't take long, we have much more to talk about. Nobody really wants to keep up a charade. It's very boring and unproductive and we talk about the process.

Not working a plan tells me more that a person is either burdened or it's too difficult or both. And that's okay, we can dial it down.

Now the dream? The cool thing about dreams, as I've said before, is that they're ALL about the dreamer. If you're the dreamer, then everyone in the dream is you. The therapist in this man's dream is him, not me, because face it, I'm at home in my bed, not with him. He looks a lot like me in the dream. He's the driver and he's TherapyDoc.

So if you dream that you're hiding from your therapy doc?

I would say that means that you're hiding from yourself. A little silly, no?

copyright 2007, therapydoc

Saturday, June 23, 2007

At What Age Do You Start to Teach about . . .

The other day I went to see a cringe movie, Knocked Up. I'll explain why I cringed so much when I post the 3rd Carnival of All Substances in mid-July. It wasn't the gratuitous bad sex, strangely enough.

Anyway, I was doing pretty well. But at the end of the movie the camera pans an air shot of the Pacific Palisades . This is where I take my grandkids when I visit them in California. So it broke me up that there I was, figuratively speaking at the Palisades, but not with the kids.

Could've threatened to make the evening un-salvageable, not that every evening can be salvageable. And I didn't behave. I started ranting about missing them, which made me feel worse.

You see, expressing emotion does not necessarily make a person feel better.

No one could make me feel better, really. There was nothing to say.

Got home and called the kids knowing they were already in bed. But I love talking to Empath Daught, and in truth, of her crew, I miss her the most.

Empath Daught answered, juggling her second shift, cooking Friday night dinner. We talked awhile, then A., the 2.75 year old got out of bed. I could hear him through the speaker phone. "Hi Mommy. " He's not a great sleeper. There's so much to do.

"Let me talk to him," I said.

She put him on the phone and he talked non-stop for 20 minutes. It was amazing. He talked about his little cousin, HH, and he talked about his older brother's grateraton from nursery school (or is it pre-nursery, what is it at 4 almost 5?). He talked about Michelley, the girl in his class who doesn't share her chips, and about Shadow, the dog everyone loves to hate, and about his Daddy and his mother's neck.

"And I tried to kiss Michelley but she didn't like it."

"A," I said, "You always have to ask permission before you kiss a girl, you have to ask her, Is it okay if I kiss you?"

Pause. Long pause. I could see the wheels in his head turning.

"Oh. I will do that next time," he said. "I will try to remember to do that."

Ya' gotta' start 'em young.

Copyright 2007, therapydoc

Thursday, June 21, 2007

Therapy = Cognitive Behavioral Therapy

First there was B.F. Skinner, the behavioral conditioning guru. A few years later, the rat in the maze concept didn't sit so well with the intelligentsia and Albert Ellis's rational emotive therapy got the nod.

On Ellis' heels, Aaron T. Beck engineered a fusion of the two that he called cognitive behavioral therapy or CBT, the Lexus of all individual therapies. We now feel that ALL talk therapies are really forms of CBT because talking is a behavior and listening is cognition.

But there are forms and there are forms. Is a dodo bird a dodo bird a dodo bird?

The relationship therapy I push here on the blog is heavily laced with old fashioned CBT. Using a relationship therapy to reinforce cognitive behavioral therapy is like having a freaking Rolls Royce.

I like driving the Rolls, but totally will accept CBT, the Lexus, if that's all they've got at Avis Rent-A-Car.

The National Institute of Mental Health knocked off the big study on affective disorders and determined that the best way to treat depression is to use a combination of psychotropic medication and cognitive-behavioral therapy (CBT).

Of course.

So you should learn it. You'll get better. You'll stop spleening me, Why aren't I better?

It's an interactive therapy that requires the patient to think and behave differently. One would think they're all like that, all therapies require you to think and behave differently, but this one has a nice structure to it, so anyone can learn it. No huge amount of psychobabble, no tricks. I use it to manage emotions. Yeah, mine, too.

So it can't hurt you to know the basics of CBT to help control your anxiety, anger or depression.
Everyone needs help with at least one of those. Tell me you don't.

The emphasis in CBT is on rationality.

Rationality
is not nearly as sexy as emotionality so people resist it like crazy. But at some point you have to grow up.

The path to staying rational is countering irrational beliefs that make us emotional, especially those nasty core beliefs. Irrational core beliefs are deep. They're what makes us deep, all of us. People discover them in therapy, or if they're lucky, when their significant others and friends wriggles them out in intimate conversation.

Sometimes it's perfectly obvious to us, that a negative core belief is disabling, dis-empowering us. They're the windows that slow down our computers, the ones we forgot to close years ago. There may be only one or two programs running back there, using the ram we need for other things, but they're a real pain to shut down. They slow up the whole works.

Sample core beliefs: I'm a loser, I'll never amount to anything, I'm a charlatan, a fake, I'm not a good person.

Such beliefs (thinking) trigger automatic negative feelings. The feelings (always bad) don't let up. They feel unmanageable.

So there you are, feeling down and looking for something to do to feel better, searching for some coping strategy, some behavior to make you feel better. The chosen behavior, unfortunately, driven by uncomfortable arousal (anger or anxiety) or grinding depression, and negative thoughts, tends to be dysfunctional.

Sample dysfunctional behaviors: drinking, over-eating, sending a letter that shouldn't have been sent, having a tantrum, missing work, beating the spouse or kicking the dog, buying a boat.

The dysfunctional behavior fuels a feedback loop. STAY WITH ME HERE. IT'S NOT THAT HARD.

I'm a loser (thought). I feel bad because I'm a loser (feeling). I'll eat a pint of ice cream (behavior). I'm such a loser (thought for having eaten it), I feel bad I'm such a loser (feeling). . .repeated over and over, reinforcing the core belief.

The therapy is as simple as A-B-C.

A stands for affective, or feeling.
B stands for behavior,
C stands for cognition, or thinking

Intervene ANYWHERE, but intervene.

Docs like me have you go home and analyze the events of the day using the A-B-C s. I make you write stuff down, go over it, argue with your thoughts, think twice about your default behaviors. The doc's your worst nightmare, the new program in that computer.

But the doc disappears over time and you take charge of your life pretty soon. You do the therapy yourself. You won't just do it in your head, by the way, you'll have to put the ice cream back into the freezer and find something else to do. But you will challenge your beliefs, become your own advocate, the best lawyer in the hood. Your own best friend.

That said, it helps to have someone else, a friend or a family member help you. Or get a therapy doc. I'll give you some more examples in future posts, I hope. I'll leave out the ice cream, go for the nail biting, pen smashing. Maybe.

The therapy is always about thinking, feeling, and behaving, and how these processes constantly reinforce one another.

Doesn't matter where you begin. Begin anywhere. It'll be work. Sorry about that.

Any questions?

Copyright 2007, therapydoc

Wednesday, June 20, 2007

Attached

Sunday we had guests for dinner and an elderly woman walked home after the barbque with my son D, and my daughter-in-law. The young couple has moved back to Chicago and they live a brisk walk away from us, not far from our guest.

The three of them strolled south, not at all briskly, and suddenly our guest took a spill on a crack in the sidewalk. She hurt her arm. D called FD for advice.

That's what they do in our family. They call FD whenever there's a medical crisis or even just a fever, they call him because no one else has gone into medicine, and he really doesn't mind.

(No one ever has anything emotional they want to share with their mother, so I'm off the hook.)

Actually, they do share things, sometimes.

Anyway, the very next day I saw a patient who had been in a car accident. Emotionally upset, scared, she'd been pretty traumatized. But basically, she's okay. She said to me:

"You shouldn't ride your bicycle to work."

"It's okay," I said, "the trip home is 3/4 bike path along the river." (It's less, really)

"No, it's too dangerous on city streets. It only takes one idiot."

I know, I know, don't remind me.

"You really shouldn't ride."

At home that night FD and I glossed over the details of life, shared a salad and some guac. I asked him about our guest.

"She's okay, she's fine. But you know. . . " He paused that pregnant pause.

Yeah?

"You know, when people get a little older they lose their balance easily, they have to hold on to something. And you know. . ."

Yeah?

Well, you won't be able to ride your bike forever.

"Oh, right. I know. I'm sick of this. Like walking is safer!" I scream (for me).

"I know, it's not so safe. But you'll try to hold on to someone."



Copyright 2007, therapydoc

Sunday, June 17, 2007

Father's Day Humor

My father's the guy who has everything. He's not a real needy guy, and like some immigrants, maybe most, doesn't buy to buy. It has to be wholesale or better yet, cost.

And my discretionary time, despite what it looks like here on the blog (she must have a LOT of time or how could she waste so much time blogging), is used up, gone, non-existent, an illusion.

So shopping for Father's Day or birthdays is a real drag and I do it on-line or wait for something I like and Grab It.

Thursday afternoon a building decorator knocked on my office door selling lithographs. She had nicely framed merchandise at rock bottom prices. I didn't like any of them, but one caught my eye. It was in black and white, a view of the mountains (I think Jackson Hole) covered with fog.

"I'll take it," I said. It looked like something my father would like. It looked like something we would have seen on vacation together as a family on those long summer road trips.

So today I picked up my parents and we drove out to see my brother and his family in the burbs. FD had to work. We all stuffed ourselves silly and ate too many sweets. The guys were watching the U.S. Open when I was quite ready to get the show on the road.

Laundry, bills, stupid stuff that needed to get done.

My brother walked us out to the car, and I said, "Hey, do you want me to put your name on the card? I got Dad a lithograph, one of those things you get from decorators trying to unload stuff to doctors. "

He related. "You can get good stuff," he said, "But no. It's okay."

Dad piped up. "Do I get to see it, this picture?"

I'd wrapped it in colored tissue paper with ribbon and it was a little hard to get the ribbon off.
"I like it, " he said. "But I honestly have no place to hang this. Take it to your office. I'm sure your patients will like it, too."

I was afraid of that. My parents really have no wall space. "You sure?" I asked.

"100%. Please take it to your office. But I really do like it. It's a very nice picture. You have it."

My brother, quick to the punch, said, "That was the fastest re-gifting I've EVER seen!"

And my mother, even quicker, said, "Happy Anniversary, honey."

(It's next week).

Aren't they a riot? That's adult humor.

Copyright 2007, therapydoc

Alcohol and Your Therapy Doc

This one is for you budding therapy docs.

But it's really a response to one of you who commented saying that I'm awfully harsh about alcohol consumption.

There's transference, then there's outright permission.

I feel that I can never give permission to a person's potentially dysfunctional behavior. Therefore, when I talk about alcohol consumption with patients (or with you on the blog), the subject is sobering.

And I'm sober.

And that's the message that you need to communicate, as well, to your patients, clients, etc., to be sure that you have not, in any way, enabled, encouraged, contributed to alcoholic drinking. You don't drink. You don't use drugs.

Then there's the whole sex thing. You can't be seductive, either. Not in any way. You have to watch how you dress, watch what you say.

These are things you should learn in your graduate school training, but just in case you don't, I thought it important for you to know.

As far as your patients are concerned, You don't drink, and you don't use drugs, and you'll probably live longer for it (you hope).

Now, seduction is something we can talk about.

Like drinking, it's safest in moderation and at home with somebody you love, preferably a committed partner, not a blood relative. And talking in code is good, assuming both of you know the code, that is.

Copyright 2007, therapydoc

Saturday, June 16, 2007

China Rescues 'Slave' Workers

When I was a kid and my parents didn't want to throw out food they would say,

Eat your dinner. People are starving in China.

This made an impact, and I resented that I had to eat because other children were starving, but the thought of it, children barefoot and hungry, did the trick and I ate. Years later, my parents bought a dog and the dog took care of the leftovers and we didn't hear much about those kids in China anymore.

Gordon Fairclough (WSJ), with the help of Tang Hanting and Ellen Zhu has shaken me from my reverie.

It's happening again. They're stealing children and forcing them into slavery, this time in China. Chinese bloggers have a substantive presence on the Internet, enough to scare their own government, enough for this story to grab the attention of other news wires.

Have you ever received Chinese e-mail or scanned the Chinese blogs on Technorati? There are literally millions of them. And for good reason. There's a lot to kvetch about in China.

Bloggers exposed the story. After all, when was the last time you read The People's Daily?

Underpaid, under-aged workers in China are lured to work at brick kilns with false promises of food and pay, then held against their will, some mentally handicapped, forced to work long hours for no pay and inadequate food, sometimes beaten severely if they can't keep up the pace for production.

More than 45,000 police fanned out across Henan and Shanxi provinces to crack down on brickyard owners because the Communist Party has a vested interest in polishing the country's international image before next year's Olympic Games in Beijing. More than 150 people have been arrested, according to the Wall Street Journal report.

Parents search for children who are moved from brickyard to brickyard by captors who manage to keep just a step ahead. It's a bad movie. The countryside is mountainous, the trip is long. Success isn't guaranteed.

A labor-rights activist, Han Dongfeng told Mr. Fairclough that forced labor is prominent in brick kilns, coal mines, and small garment factories. A Communist party official's son, implicated in one of these travesties, said that he began employing children provided by human traffickers after falling into debt and being unable to pay local recruited laborers.

So EVERYONE loses in this enterprise.

The on-line campaigns by the parents of missing children prompted action by the government for the crack-down and arrests.

Social workers and human rights activists are well aware of our global problems of kidnapping, forced prostitution and rape. Slavery, of course, is something that should and did make the financial times.

But if the rest of the world is going to be rightfully apprised of stories like these, schools had better be offering more than French and Spanish to our kids (I think they are, actually, in the private sector and perhaps wealthier suburban districts).

Someone in the family is going to need to read those blogs.


therapydoc

Thursday, June 14, 2007

The 7-Yr Old Kentucky Smokers

I've never been wined and dined by a drug rep before, but FD has, and it's generally an opportunity for me to watch TV or blog uninterrupted. He comes home and tells me what he's had to eat, I tell him I missed him not at all.

Remember, I went through medical school, internship, and residency years with him falling asleep in his soup. Independence is my middle name. (And you thought I was so in love).

The last time he went out to an elegant dinner with drug reps and other doctors, he listened to the lecture, ate better than he would have here, and came home rather late. He put his hands on my shoulders (I was staring at the computer screen, reading something or another), and said, "Dr. E's wife came with him."

"WHAT?!?!"

"Yup, I guess you can bring your spouse if you want."

"Really."

See, now it's crunch time. Would I rather stay home and blog and watch mindless television, perhaps cook for Friday night or bake some cookies. . .or go out for dinner at Shallots?

"Are you saying you want me to join you next time?"

"I am."

FD is by far the more social of the two of us. I talk a good game, but would rather not have to hold any conversations at the end of the day. Face it, I do active listening as a professional, and there's just so much active a person can listen.

"Well, okay."

So tonight I joined the group. You have to understand. When I'm out socially I can try not to be a therapist, but being a therapist is so much more entertaining to people than not being a therapist that I'll usually start off saying something about a person's profession that intimates that indeed, I am onto them.

Tonight I was less than subtle. The leader of the presenters introduced herself to me, a sincerely lovely blond with lots of zip and personality, yet very sensitive and intelligent. I loved her immediately. I said something profound like, "Oh, man, I treat drug reps. YOU GUYS WORK SO, SO HARD! HOW DO YOU DO IT?"

"We all need therapy," she said.

"I can imagine."

Soon it was just another girl's night out, because Dr. Z, a female family practitioner in the hood dropped in and sat next to me. We talked about dating, sex (I always end up talking about sex, I don't know why, mainly about how it should be the last thing people do together in a relationship, yet it seems to be number one on the dating list of things to do.)

The women talked books and television (of course I'm the only one who watches, or admits to watching) and FD and the guys were talking politics and a discussion of restless leg, one of the symptoms that Boehringer Ingelheim's (our host) pramipexole (Mirapexin®/Sifrol®) apparently controls quite nicely, "with 15% less nausea." It's good for your bi-polar patients, too," one of the drug reps said.

"I can't even suggest a drug to a patient," I reply kindly. "Malpractice. I can suggest an evaluation, but not a drug."

Saying that, Dr. Z and I relax and compare bike rides to work.

Then I heard the following from E., a drug rep at the other end of the table. It blew my mind.

The average kid in Kentucky begins smoking tobacco at 7 years old.

I asked her to repeat that 3 times. I couldn't believe it. I thought maybe I heard it wrong. I didn't want to believe it.

When I got home I looked it up. See, it helps to look things up, to think critically. A story from NewsMax.com Wires,Tuesday, July 19, 2005

LOUISVILLE, Ky. -- Kentucky ranks among the unhealthiest states - a plight that's largely self-inflicted due to smoking, eating fatty foods and not exercising enough, The Courier-Journal reported in a special section published Sunday.

Chronic poor health threatens lives and hits all Kentuckians in the pocketbook through taxes and insurance premiums, according to the Louisville newspaper's special report.

On almost every health measure, Kentuckians fare poorly - second worst nationally for cancer deaths, fifth worst for cardiovascular deaths and seventh worst for obesity, according to the paper, which published a special eight-page section on the state's poor health.

Kentuckians die at a rate of 18 percent above the national average, the newspaper reported. Its report said residents of all income levels are disabled and killed by cardiovascular disease, cancer and diabetes _ chronic illnesses that are linked to smoking, poor eating habits and sedentary lifestyles.

"We don't have to worry about foreign aggressors," said Dr. Baretta Casey, a Hazard physician and University of Kentucky professor. "We are killing ourselves off."

Poverty is at the center of the problem. . .
Where is the word 7-year old? Nowhere.

Next story, a story on 5-7 year olds with ADHD who also have sleep disordered breathing (SDB) in Pediatrics concludes with the following:
We present additional confirmatory evidence that symptoms of SDB are frequent in 5- to 7-year-old children and that the risk increases when parents snore or smoke cigarettes. In children with significant symptoms of ADHD, REM sleep disturbances are more frequent and may contribute mildly yet significantly to neurobehavioral function
I suggest that these two stories, the one about Kentucky's populace having the worst health in the nation and the one from the pediatric journal on parental smoking and SDB blended to create this marvelous new urban myth.

But you heard it here first, folks. It really is an urban myth. (If I'm wrong, please show me the research.) Kids in Kentucky don't light up. They probably do, however, breathe in more secondary smoke than the rest of us.

Now that makes sense.

Thanks for dinner, Boehringer Ingelheim. And sure, I'll be happy to do it again.

Copyright 2007, therapydoc

Circumcision Debate Rages On

If you're interested in a medical response to my post on the circumcision, check out Bunk. Here's the link.

therapydoc

Wednesday, June 13, 2007

Other Therapy Docs and Marital-TX

I went hunting for other therapy doc blogs and found this story.
It's a short post by James F on Gather.com. Here it is:
Freudian Slip-cover
by James F.

I was nervous; never been in therapy before. The diplomas on the wall intimidated me. Assuming humor to be a good ice-breaker, I said, "So, Doc, ever been on this couch yourself?" He slammed down his pen and snarled, "We are here to talk about your marital problems, not mine."
There were a few comments from his readers putting down a fellow doc of the cloth, and rightly so. The doc's proper response should have been to flip his pen upwards and back, preferably with a little spin, not to slam it on the desk. Slamming a pen is very unprofessional, I feel.

Thanks James,


therapydoc

Doe a Dear

After I put out all that serotonin to post a blog like yesterday's, I get all warm and fuzzy and just want to talk about FD.

Our Sundays are work days since we don't work on Saturdays, which means that the day as in, day off, doesn't begin until late afternoon. I get home around 3:00, starving, make us some sandwiches, check email, and take a nap, not necessarily in that order. FD is in there somewhere, usually the sandwich part.

We love national holidays because for sure nobody wants to see the doctor on a national holiday. NOBODY is sick when there's a barbeque, root beer, or a better offer. So we'll pack up a lunch on those delicious Mondays off, rack the bikes to the back of the car, wave at the neighbor's kids on our sidewalk, and drive off into the sun to find a state park or a paved-over railroad that the Illinois Bicycle Association has recommended.

These paved trails go on for 5-10 miles through farmlands and small towns. They're the yellow-brick-roads for grown-ups.

No, you're right, that's not enough exercise, but okay. At least we get away, and there's a culture to adapt to with this kind of trip. Mainly, you have to smile at bike riders coming at you from the opposite direction on the other side of the line. Better yet, say hello.

MEMORIAL DAY:

A blue bird-- royal blue, never seen the likes of it before.

Several very nice butterflies

One dead cicada that I bagged for my grandson, E, and sent to California in a plain #10 envelope. E told me last night that the cicada arrived, quite smashed by the postal service, probably from canceling the stamp. Pity.

And a doe. Or two does. Or is that, two doe. Two sightings of one doe. I don't know. What does a person do with two does? Here she is.


The ride was deceptively easy. For example, there were path markers to tell us how far we'd gone, but it seemed the mile markers were off. I would never have believed that the "mile" was really a "mile." Maybe it was 3/4 of a mile. But not a mile. Yet if that were the case, then why I crashed physically, like hardly ever before from a bike trip (it's like child-birth, you just don't remember the pain) when I finally got home that Monday evening is a mystery to me. But I did. Sleep, I mean. Much better than usual.

I always want to tell people with sleep problems, try moving your body a little. Move a few muscles. Quit asking us for drugs.

Are you waiting for the adventure? Kankakee State Park is not an adventure. It's a hilly park along the Kankakee River and Bambi lives there, along with a couple of birds, butterflies, and mostly dead cicadas. The kids who took our picture had never used a camera before, which is why all you get is Bambi.

We did the 20 miles in a couple of hours and left the park for home. FD really wanted ice cream, and lucky for us the liquor store in town had. . . Ice cream! Ben and Jerry's yet! Cherry Garcia, Chocolate Fudge Brownie in cute little one-serving containers with spoons attached to the covers. Only two hundred calories per serving.

My kind of town, Kankakee.

FD had the wheel and took the long way home, passed through Joliet.
Motto: If it's fun, it's in Downtown Joliet.

At some point I break into that Stevie Wonder song, I Believe if I Fall in Love with You it Will be Forever. Remember that song? Talking Book, I think. I can see FD thinking the notes out in his head. He'll play it later at night on the piano and he'll have the song just right, even though he's never heard Stevie sing it and it's not in my range.

A sign says Romeoville, and although I've had patients from Romeoville, I've never been to Romeoville.

Used cars, The Place for Ribs, Laser Wash, Dunkin' Donuts, Speedway, On the Rock Bar & Grill, road kill, Big Old Coon, Route 53, White Fence Farm, La Grou Trucking, Montana Charlie's Flea Market. We're still an hour from home.

I've got patients who work at La Grou, he says. And so do I, probably, I think. It strikes me as strange, however, that we're way, way far away from our offices in the city and people will drive that distance to see a doctor.

But that's what happens when you get attached to people, you'll drive a ways to see them. Or you'll drive that far to get away on a holiday.

Father's Day will be this Sunday. I'll miss my nap.

But lunch is made, and because my bro doesn't live in the city, there's a good chance that Bambi might be there!

Copyright 2007, therapydoc

Tuesday, June 12, 2007

Empathy, Changing the Guy, Teaching the Child

I haven't been true to my word, haven't done that post on Asperger's Syndrome.

But I have done some research on it and three things, three findings teach us something important about people who have Asperger’s and people who don’t have Asperger's.

Remember, “findings” are about group norms, not individuals.
1) Empathy is difficult for men and women with Asperger's.

2) More men have Asperger's Disorder than women.

3) Women with or without Asperger's have more empathy than men.
It's nice to find research that validates what is called "practice wisdom." Let’s just focus on the idea that the odds are that a woman will be more empathetic than her man.

I only brought in the Asperger's research so you'd not think me a total slacker, because I really have done a little reading on autism, although I prefer “chick lit” to put me to sleep at night (have you read Jonathan Tropper?) and my hero is Jonathan Safron Foer (his second book is my favorite of all time, how does a person this young understand love so well, not to mention depression) but still get a kick from critical thinking. It’s the latter that keeps me up at night.

Practice wisdom, by the way, is the knowledge a therapy doc gets by osmosis, just by staying on the job, watching one couple after another get into the same type of awful argument. Different details (content), same process.

People do pick up dysfunctional fighting from their parents (as a group, not as individuals). Why would our parents teach us wrong, after all?

I just saw a new patient last week whose spouse hits her when she gets emotional. His father hit his mother. "Isn’t that what I’m supposed to do," he asks me, "to set her straight?"

He’s serious. I wish I were making this up.

Therapy docs see dysfunctional interactional sequences so often that we just want to scream, Can't you please get it together and stop doing this?! It's so disturbing, so not Zen.

But that screaming bit doesn't seem to work, as it probably doesn't in your relationships, either.

Definitions:

The definition I've used on this blog for empathy:
the ability to feel how another person is feeling, being in someone else's shoes,an affective process.
But I’ve since learned that there's a second way to define empathy, which is
having the ability to put into words how another person is feeling, a cognitive process.
Some people have one of these gifts, some both, some neither.

It's possible that there's a genetic marker for empathy. I know that it can be taught to most children. I think we learn it best when we're young because that’s when we learn language the easiest. Empathy is a communication process.

We wouldn’t want to stress a child with Asperger's, by the way, a person challenged in this area. Making a child feel deficient and bad, making ANYONE feel deficient and bad for not having empathy,is psychologically damaging. Not very empathetic, we could say.

Of course, I’m down on parents who shame their children for virtually anything, shame is so toxic. There are better ways to teach children. Not as efficient, but better. Teaching the child empathy is one of them.

But stressing a child without Asperger's to be empathetic can save that child's future relationships. The lesson's a good one at any age, but if we're talking adults, it's likely going to be a woman's job to do the teaching (unless you're in therapy, in which case perhaps the therapist might take over).

This is in sync with what my significant other tells me about me.

FD tells me that I feel it's a woman's job to find a man to change him.

Sorry for the heterosexist bias, here. It’s more efficient to write about my heterosexual relationship with FD than to find Jack and Jill, or Jack and Jack, or Jill and Jill. Please change genders if appropriate.

See, FD knows how I feel since he's an empathetic guy. He's right, of course.

But not every guy has an empathy deficit, remember? Statistics, as I’ve said before, do not mean that individuals don't deviate from the norm, only that a difference in the group's norm or other measure of central tendency is statistically significant.

My son-in-law, for example, is EXTREMELY empathetic. He's unnatural, I feel, but it's a good unnatural.

So, although men are less empathetic as a group, a particular man can be as empathetic as a woman.

Everyone, clearly, even those of us who feel we're empathetic can learn to listen better, be even more attentive, try even harder to understand everyone else, even if it's really much harder for some of us than others.

But since men, as a group, are less empathetic, then perhaps . . .

Perhaps rather than search forever to find one who scores high on the empathy tests? Perhaps it might be simpler, really, to change the one you've got.

Is that SUCH a terrible idea?

Copyright 2007, therapydoc

Monday, June 11, 2007

Staying Connected

I'm not going to get too wordy here because it's Monday and the implications are scary, so much to do. But the lesson here is worth a quick post.

The "he" in the story could be a female or a Martian, there are no true identifying features in this post.

Several years ago I had a professional acquaintance who called to give me a head's up that she had referred her father to me for therapy. Her father's sister committed suicide and she worried her father was at risk.

He called that day, and I couldn't get him in immediately, told him it would have to wait a couple of weeks (!). Could he wait? Sure. I've waited this long.

He presented with two Axis I disorders, severe anxiety and dysthymia (ever-present depression, the low-grade fever thing). You would think the two can't co-exist, but they can. You're never depressed ALL of the time. You're never anxious ALL of the time.

His sister had just committed suicide. I should have done that a long time ago, he whispered

Would you want this case?

Past retirement age, our guy still worked, very responsibly, even though each day he felt inadequate.

He had been in and out of therapy for over thirty years.

His crippling anxiety, which surely did come from severe childhood emotional abuse, made parenting (and partnering) very difficult. His wife left him while the children were small (she took them with her), and he never had any meaningful contact with the kids after that, even though they begged him to talk to them, to be a part of their lives. He just didn't have the social skill to listen or to talk. There were four children. Four children, no contact. It really does happen.

Never had anyone discussed repairing his cut-offs with his children. The therapies, according to him, all addressed his relationships with his parents, his marriage, and his childhood problems, his lack of sexual/relationship attachment.

See, it's not that difficult, this case. There is a universal need to be loved by one's parents, and a universal need to be loved by one's children, and that can be repressed, of course. But it's there. And it has to be addressed if meaning in life is at all important.

Tiny steps, of course, he had to make the first moves, the calls, the visits, the toys for the grandchildren, the birthday cards and gifts. He didn't have to really talk very much at all to anyone in this therapy, but he eventually did, all on his own. It's a behavioral family therapy. Say hi, visit, go to the grandkid's baseball games. Quick guerrilla visits. Hi, Bye.

Put yourself on the map. You don't need to be a star.

No idea what those other therapies were about. Don't care. He did so well.

It's just an example, right? Anyone could see the need for that kind of intervention.

Was he still at risk? I thought so. You know how it is when people feel a little better. They have the strength to hurt themselves, whereas they hadn't before. But the thought of hurting the little ones like that, the grandkids, served as a deterrent. He said as much. And I lay on guilt big-time when it's deserved.

But I kept an eye on him over the years.

What's lovely is that I never even had to bring any of his children into my office to do that family therapy. The family system was in the room, everyone was in his head.

That's how you need to think.

Copyright 2007, therapydoc

Sunday, June 10, 2007

The 2nd Carnival of All Substances










Now, you may know I'm into recovery stories, and that's why I started this carnival, but I'll post everyone else, too, as long as the post or the blog host is not offensive (to me).


THE best post I've seen in ages was a post about CHOCOLATE. The carnival submission had these incredible pics of a candy display case full of chocolates, dozens upon dozens of them, you keep scrolling, and scrolling, virutally drooling.

At the very end the blogger tells you how many calories you've just consumed.

I was all set to make this THE pick of the month, but decided to take a look at his other posts. The blogger's very, very smart, and funny, but he's cavalier about serious subjects, like. . .rape. So I'm sorry, friends, I can't link to anyone who is cavalier about that. And I'm sorry, too, since this blogger's picture was so much better than the ones above. Imitation is the highest form of flattery, though, right?

THAT SAID, WE DO HAVE SOME TERRIFIC POSTS FOR YOU TODAY!

Let's start with one of my favorite recovery bloggers, ERIN, the author of Twenty-four Hours A Day at What Winners Do. Erin says, "The out-patient program taught me one of the fundamentals of addiction recovery…stay in the day."

You think that's easy? Try it. Try not looking back and not looking forward. Good luck.

Meg at You and Me are Floating on a Tidal Wave writes a fabulous post about The Little Prince (starring herself as Fox). If you haven't read the prince, you should, and if you haven't read Meg, you should read her, too. Here's the link.

Then we have an Anonymous Blogger who tells us how to overcome a pain pill addiction which has got to be valuable advice at Addiction Recovery Blog.

She has another post on the subject, adding that people who use prescription drugs will punctuate the high with alcohol (yup, tends to kill you, too).

Hueina Su thinks she can help you reconnect to your authentic self. I'm guessing she's assuming that if you're drinking and 'a drugging that you've NOT connected to your authentic self. So check it out. She might actually be in Hawaii. But I could be wrong.

Kbaggy is a new mom at Babylune and likes a very, very small drink now and then. But she's worried she'll smother the kids if she takes them into the bed and warns, Don't drink and co-sleep! Perhaps this is a British thing. Please tell me.

Anonymous blogger at Addiction Recovery Basics. tells all about being a dry drunk. Thanks. Can't be easy, we're sure, but probably even harder to live with one.

The Junky's Wife writes about the Drunky's Wife at her site, The Junky's Wife. What else? Faced with a choice between a heroin addict and an alcoholic, life's not simple. She's asking you to vote. Hmmm.

TwoDogsBlogging has a couple of great stories to share. The first one is how you really have to watch out what you pray for. Even though I'm a very rational, logical therapydoc there's a spiritual part (I know, you're just shocked) that assumes the Old Mighty is listening at all times, that He/She has nothing really more important to do, than give the nod when a person least expects it, so we may as well ask for it all, go for broke. Dogs says, Be careful.

Two Dogs has a second post about her family and how grateful she is that she straightened out her life. At AA meetings they talk about "watching the parade" which means (I think) watching people drop out of the program before they get sober, wondering why some make it and some don't. They listened to Bolero in her family--maybe that helped. (I wish I were joking-- these things matter, washing dishes with your mom while listening to Bolero matters. Oh, just read it.)

MouseTrapper at Med Journal Watch reminds us that candy cigarets are really devices to lure little children to the dangers of real cigarets. Don't buy them for your kids! Thanks, doc, for a great post.

Virginia shares her truama (dad killed mom, then himself, pretty powerful stuff) at the Centre for Emotional Well-Being. She recovered from trauma and alcoholism and shares a video interview with her son, a military officer with PTSD and alcohol on the path to recovery.

Then there's my friend Rohit over at Darpan who has words of wisdom, if nothing in particular to say about substance abuse. I like him, though, so read what he's got to say about Arthur Ashe. I think Rohit once sent me pics of the homeless in Florida, but I can't find them anymore on his blog. Maybe it was someone else.

Tracee Sioux at Go Sioux Me let's you know how easy it is to get addicted to legal medications for anxiety. She watched the second plane hit the tower on 9-11.

Tracee also tells us how she quit smoking (on her OTHER blog, Blogfabulous. She did it for the kid. Way to go.

Definitely worth a snootful is Nancy's post at the Centre for Emotional Well-Being shares an opinion piece about celebs in rehab, the "Lohan" Phenomenon. Nancy's an LISW, LICDC, an actual substance abuse counselor, and she knows what she's talking about. A pleasure, honestly, to hear the straight talk.

Phil, at Phil for Humanity (does he mean, fill???) has the Secret to Happiness, I kid you not, on his secret post. He's thinking that enthusiasm and good health are the key. But frankly, I think Phil is really smart and that makes him happy.

That's all folks. We'll do it again July 10. I'll keep you posted.

Thanks to all of you who participated. Just so you should know. When I came in from work (it's a 4 mile bike ride) I filled my glass with ice, pomegranite juice (thanks, FD) apple juice (ordinarily not my favorite, left over from Passover), a splash of lemon juice, and water. And I am in such a good place.

Oh yeah, i zapped a chocolate chip cookie in the microwave. Did you know that cookies should be served hot? There's a qualitative difference in flavor.

To your health,

Copyright 2007, therapydoc

That carnival

The Carnival on All Substances (must I define this?) . . .

should be up this evening. So I'll accept stories until tonight, then we're up and running.

You can associate with my motley crew by submitting a recovery story or something 12-step related, at Here's the Submission Form.

If you use words like "motley" you had better prove your undying loyalty to program somehow.

Cheers! (not)

therapydoc

Friday, June 08, 2007

What's this?





These aren't that great (the pics, that is, the candy's just fine).







I had wanted to upload them for yesterday's post about me teaching high school A P Psychology (you'd have to read the one below this to understand the connection between candy and teaching psychology.) But I had some trouble.

So here you go, just a taste.

And one correction:

The business name might be FANSTASIA chocolates. The nuts are from ILLINOIS NUT. Whatever. Better pics will be up on Sunday along with the Carnival of All Substances.

Chocolate, you see, is a substance.

See you there!

therapydoc

Teaching

Did I ever tell you that I taught high school?

No, I'm sure I didn't since it's been out of my working memory for a few years, now.

Rabbi of the school: Have you ever considered teaching psychology?

Me: No, never.

Rabbi: But didn't you once tell me that you thought community service is a step on the self-actualization pyramid?

Me: Must have been someone else.

Rabbi: I'll send you the contract. We start August 23. You have all summer to read the book. You'll do fine. There's a teacher's manual.
There's a lot more to tell.

There's the whole going back to high school thing.
There's the I don't have the foggiest idea how to teach thing,
There's the this is the last class of the day, thing,
There's the these are high school seniors! thing.
There's the I don't do meetings, thing.
Assistant Principal: Faculty meetings, third Sunday of the month, 6:30 p.m.

Me: Uh, huh.

Assistant Principal: They're mandatory.

Me: Well. . .

Assistant Principal: There will be food.

Me: I see (but nice try, seriously).
There were enough variables to doom the year to failure. But I did it for two, had some fun, and for sure could have got a 5 on the AP test. A couple of kids did get 5's, but not very many of them, and I felt guilty about that, and after the second year told the principal that there was no way I would come back again, he had to find a real psychology teacher, and he said,
I already have.
Well then. It bothered me for years that not much good came out of the community service experiment.

Then something happened. Today, something happened.

I was in the candy store. You have to understand. I don't buy candy. I rarely eat candy. I've got a bowl of hard candy (coffee) on my desk at work and have had 3 pieces in 4 months. Ice cream, yes, especially with hot fudge. Frosting, for sure, I'll leave the cake. But generally, not candy.

I had it in mind to go to the Illinois Nut & Candy Store on Dempster Street in Skokie to take pictures for my blog carnival this Sunday, the Carnival of All Substances.

You do know that chocolate is a substance, correct?

But as long as I was there I had to buy something. I bought some salted almonds, cashews, and chocolate covered pretzels. I'm eating them right now as a matter of fact (the pretzels). Anyway, one of the counter people looked at me and said,

"I know you from somewhere."

Well, I didn't know her, but she looked like a really sweet kid, blond and blue-eyed, the type you see on Happy Days or the Brady Bunch, or that Christian dramedy about the dad who's a pastor and has a bunch of gorgeous young adult/teenage kids who are gorgeous but have problems.

This kid was maybe 24.

"I know you from somewhere." She says again.

I'm busy taking pictures. White chocolate, candy-coated apricots, chocolate covered raisins, swizzle sticks, mouth-watering candied bark. This is all before lunch.

I don't even see the kid, really, I'm so busy snapping pics. The candy's so beautiful at this store. "Nah," I say, not looking up.

"I do, I know you, I really do. Were you ever a teacher? I think I was in your class."

I whirl around to get a better look. My brain kicks in. "Why of course!" I gasp. "But what's your name?"

She tells me. "Of course you're ____. You were so nice! I mean, are so nice. We have to get a picture. This is great!" I say. Then a little embarrassed, "That wasn't such a great class. Sorry."

"No, it was fine. It wasn't your fault. The class was just a blow-off class. We weren't there to learn anything. But YOU ARE THE REASON I'M MARRIED TODAY! YOU'RE THE REASON I HAVE A BABY!!"

She's married. She has a baby.

"Me? How so?"

"Remember Brad ____?
"I think so." I'm picturing a tall, skinny good-looking kid. Smart.

"Well, our relationship started in your class! You gave us the chance to pass notes. We fell in love in your class. You never got angry that we were passing notes. And now we're married, and we have a baby, and it all started in your class!"

Well, of course. Who was I to get in the way of romance?

And to think all these years I had thought it had been such a waste. You just never know.

Copyright, 2007 therapydoc

Thursday, June 07, 2007

The reality of lying

I don't know who brought this to my attention first, it might have been either FD or Empath Daught but one of them told me that my grandson, E., who is 4 years old has been lying.

They're a little concerned.

I let stuff like this pass through me, sort of like my body's not really a solid but a vapor and information passes right through, hardly registers. My family complains, sometimes, accuses me of not paying attention, but it's not that.

I hear it all right.

I'm just sort of a tolerant sort; it takes a lot to ruffle me. And when it comes to kids lying, it really is a So what, More power to them.
There's a post on this blog about kids lying and you can look at that too, if you like, but it's really a very simple thing.

A kid will start to tell a story. (Remember, kids are new to words and the process of talking to communicate the thoughts in their heads, well, it's all new!! )

They'll start talking and their sentences get longer and longer, and the creative parts of the story rank more and more attention, and their telling ultimately has very little to do with reality, and the story indeed, in the end, is quite far from the truth.

See, kids see the option to make a story a better story and they choose the better story.

To kids, editing really gets in the way! It's so boring to them, what actually happened. Editing to the truth is so limiting! Children understand this.

Even adolescents understand this. They're a lot like very little kids in that way. That's why it's best, when you catch kids in a lie, even when you catch adolescents, to try to thread back to the source of their thinking. Why did they say that? Why did they choose those particular words?

How incredible the fiction!

But be esteeming here. Give them credit. Rate them well. Good story. Credible. Three stars. Or perhaps, Four stars. Sometimes a story is a FIVE STAR STORY! Tell them!

But if it isn't, you can say,
Not bad, not a bad explanation, but it could have been better, seriously. If I were to write this fiction (you have to think up something now) I would have changed it like this. . . made it really good. You think this is good fiction? You're capable of so much more. Work on this, dear.
Mainly, why be so upset with kids for the way they present reality? The thing to keep in mind is that the way they present their reality to you personally may say more about you than it does about them.

Kids write for their audience.

Is it fair or even nice to deny them a chance to make you happy?

Of course not. Now, if you're really interested in your kid, then you are interested in your kid's reality, what it means to him, why he (or she) put it in those particular words. Sure, if it's about you, then you need to discuss that.

Isn't that what you really want, to understand where your kid is coming from? So you wouldn't want to stifle communication with an aggressive approach like You're lying!

It just seems a little mean to me.

More productive would be, Fascinating!

It's the same basic approach with adults, you know, although we would love to hold them to a different standard. Note I say different, not higher, for I think that talking creatively is the essence of having a sense of humor.

With adults, however, the standard is different. Another post, not for today.

But stifling a kid's creativity? That's beyond me, honestly. Passes right through.

No lie.

Copyright 2007, therapydoc

Wednesday, June 06, 2007

Summertime

In the summer when I was a kid my parents would pack us into the Oldsmobile and we'd just drive, usually head west.

My father would begin his part of the preparation in the spring by asking, Where should we go this summer? He was hoping we'd say, Let's go west! We didn't disappoint.

Then he'd ask, Well, southwest or northwest or just west? and we'd say,

To the mountains! Where else? West!

My mother, a very well-organized sort, would pack us up efficiently so that we could stay overnight in a Best Western and they would only have to pull out one duffel from the trunk in case it was raining, the "overnight bag."

We all shared one hotel room, I had the cot, the brothers got one of the two double beds. As soon as the three of us kids hit the pillow, we slept like babies. I can still remember that sleep, the way nothing could have jolted me awake, nothing.

In the morning my mom would ask, Did you guys hear that TRAIN? Or, Did you hear all of that honking last night? I wonder if that was all she was wondering we'd heard.

We heard nothing.

In the car the next day I would sit in the front seat with my father and navigate, read the maps while my mother would sit in the back with my brothers and nap or read. My father would see a "scenic view" coming up. He'd announce it.

Does everyone want to stop and see the scenic view?

Of COURSE we want to see the scenic view, Dad, I'd say, thrilled to be seeing the scenic view.

The groan came as a chorus from the backseat. They were a little sick of scenic views. I couldn't understand it. But I think it had to do with the sheer height of the mountains out west. My mother's basically a Chicagoan and the mountains scared her, as much as she loved them. If you've ever pulled over to the side of a road on a mountain to see what's below, then you understand.

Back in the car it did get a little boring, especially in states like Iowa and Nebraska. Most of the time I was in the backseat and my mother would be saying things from the front seat.


Sid, I think we should stop now. You've been driving 4 hours. Let's get a root beer or find some ice cream.
. Okay.

Sid, do you know where you're going? I think you made a wrong turn. I know where I'm going.

We were lost.

Then he'd burst into song. He sang Summertime by Gershwin, and tell jokes and he'd laugh and ask, Do you get the joke?

My mother would groan, we'd all groan. We get it, Dad.

At dinnertime they would order a drink. A Manhatten. It was the only time I ever saw them drink, except maybe at a wedding. Dad would occasionally have a beer watching the ballgame in front of the television. He'd share it with me.

We didn't have digital photography in those days, and don't have very many pictures at all. My father's hardly in any of them, since he took the pictures. He taught me how to hold a camera steady. If it were up to him, of course, we wouldn't have a single family album. Mom took care of those things.

It's funny how you remember stuff from so far back.

When I woke up in the middle of the night, only a few hours ago, I had it in mind to write a post about alcoholic drinking in college. If you have read post below, The Commencement Speech You'll Never Hear, then you know that I'm more than a little down on under-aged drinking, and especially worried about alcohol related accidents.

It's horrible treating nineteen year old alcoholics. The stories can be pretty sad. I'm good with kids, but they break my heart.

When I did that rape research I learned that there's a correlation between alcohol and acquaintance rape. I was also working on a high school sexual assault prevention program and one of the people I met in the process had put together a video about the consequences of alcoholic drinking.

The video shows kids talking about getting drunk and vulnerable to sexual assault. They talk about losing friends to auto accidents or aspiration, basically choking to death on their own vomit. Nobody even finds a kid who aspirated until the next day. That happened to her son.

In that commencement speech I mention an alcohol-related snow-mobile accident on a campus that killed two kids this year, two beautiful kids. The tradition on that campus is bon-fires and snow-mobiling and alcohol abuse. Great tradition.

I don't know how many of you read the archives of this blog, but I'm pretty sure that I define alcoholism for some people developmentally.

I say that it's almost a rite of passage to drink alcoholically in college. Almost, because MANY kids never drink at all, certainly not to the detriment of their grades or social lives. If you drink and use drugs in college, I'm almost believing (again, almost) that it's virtually irresistible for you, there's so much social pressure, so great a need to self-medicate, so much glamorization of alcohol and drugs in our culture.

But when you leave school, in my world, you stop. If you squeak by those four years it's one thing, but if you don't stop after graduation, or at least after you're married (or in a committed relationship), or after you've finally landed a decent job, then your development is at risk.

The other kids will pass you by in law school, or engineering school. Your drinking will wreck your marriage (usually due to an affair) and may wreck your chances for promotion. Your kids will use your drinking as permission to drink at younger ages.

Maybe these things won't happen in your twenties, but surely heavy drinking will catch up to you.

I think of these things because in the summer, perhaps contrary to other professionals (except dermatologists) I'm swamped at work. The teachers all have a lot of free time (this is NOT a stress-free profession, teaching) and the kids are back from college or out of school. I could work from sun up to sun down, if I wanted, and it's my favorite time of year.

My point is that when you're cracking open that first beer on these hot summer days, think about it, okay? I personally suggest cranberry juice, mixed with a little apple juice on ice, and water. And maybe a slice of lime.

Copyright 2007, therapydoc

Monday, June 04, 2007

A 2007 Commencement Speech



That's the short version of a commencement address I saw in May. Here's mine.

A COMMENCEMENT SPEECH WE’LL NEVER SEE

Last night I had a dream. Don't tell me that you haven't had this dream or that you haven't heard about this dream or some variation of it. You have.

If you're a woman you've probably dreamt it, if you're a man you've heard it from your mother, daughter, sister, aunt, grandmother, or a female friend. Men have this dream, too, sometimes. Here it is.

I'm at my own college graduation in a small town in central Illinois, but in the dream the small town is at the outskirts of the city of Chicago, maybe it's a near western suburb. There is a big party at a huge hall; the hall might be a sorority. I feel I don't belong and take my bicycle, ride across a field thinking I'll ride home, ride home to my home in Chicago, which is about 15 miles from the party in the dream.

I'm tired. The riding has made me tired. So I get off my bicycle and start to walk, pushing the bicycle. I'm still much, much closer to school than I am to home. I am only a few short blocks from the field that separates the sorority from the city, when a car pulls up next to me and a wiry, greasy man with sharp features rolls down his window.

"Tired of riding?" he asks.

"I'm okay."

"Did you come from the graduation?" he leers.

I know that I have to get on my bike and ride very fast to get away from this guy who has now cut his engine and is getting out of his car and is walking towards me. But my legs are leaden, and I can't get on the bike. The best I can do is run while holding on so that I am running with it, running as fast as I can.

He is running after me. I'm running fast but he's closing in.
I wake up.

This is a secondary trauma dream, meaning I've heard so many rape stories that it's rubbed off on me, I’m traumatized from the trauma of others. I know too much. I hear too much as a therapist. And little things like statistics scare me. For example:

Did you know that between 20-59% of all college women have been sexually assaulted between the ages of 16-24?

Or that the National Institute of Justice findings indicate that at least 350 of every 10,000 females are raped on campus annually?

Approximately 93% of the perpetrators of rape are male acquaintances known to victims from classrooms, dormitories, fraternities, bars, and parties. They aren't strangers. They look no different than the young men before me today.

If any of you out there happened to cross the line at this school? Then I'm hoping you'll be leaving that behavior behind you. You are older and wiser now. If you didn't know it then,

No Means No.

This is the law. It is a felony to take advantage of someone sexually because you have misinterpreted what she has said or because you think you know what she wants. It is a felony to have sex without informed consent.

Informed consent, among other things, means that neither of you are under the influence of drugs or alcohol when you have sex. If she said “yes” under the influence it won’t hold up as valid in court if she says she meant “no” later on.

Most acquaintance rapes on campuses like ours occur in fraternity houses. There is an association with athletic team membership, too. You've read the news. Thus the workshops we set up to educate new students during Orientation Week target that male population, the one, ironically, that doesn't generally pay much attention to workshops.

Do you remember the day you arrived? Do you remember that first week?

I do. Each September I walk around campus in total admiration. Many of you, as first year students stand out from the crowd, eager and starry-eyed, happy for the chance to learn, excited to leave childhood behind.

My co-investigator, Carolyn Jenkins at Xavier University, made me identify freshmen as first-year students—it’s more respectful, face it, a “freshman” can be in her forties. We did the first on-line university survey to investigate student experiences with sexual assault, gender bias, sexual minority harassment, and racism.

Because of that study Xavier has a state-of-the-art social service response team for students in distress. Other schools are catching up.

Do you remember that first week on campus? Not all of you actually were fresh and naïve. You might have already formed demeaning attitudes about women, thoughts of dominance and disrespect that you learned well before you accepted your admission to college. You assumed that if a girl let herself drink too much, then, well, she wanted sex. You assumed that if she dressed a certain way, and you were aroused, then, well, she wanted sex.

You believed what we call rape myths. If you had attended rape prevention workshops you would have known better.

These things happened in the past four years and some of you are sorry for some of the things you’ve done. You might want to get a little therapy this summer. This is a good time to look back, seriously, before you look forward.

Even if you came here with issues, you're open today to a new beginning. The future will be brighter because you have had a college education. It's okay to stare into that bright light.

You're lucky. Not every student can.

The Virginia Tech massacre taught us that we must work double time to make schools safer places. We have to protect your younger brothers and sisters.

The job is getting trickier and trickier. Students can buy fire arms.

We throw around ideas. Maybe metal detectors at the entries of every residence hall and building. Perhaps mandatory mental health evaluations for new students. Make it mandatory that students agree to treatment if they are found in the least bit to be dangerous to themselves or others.

It is a proverbial “slippery slope.” We’re talking about individual freedoms here.

Colleges nationwide, thanks to the Cleary Act of 1991, do provide preventive education to raise awareness about the dangers facing students. We are painfully aware that alcoholic binge drinking, too, can result in death, and strive—on paper, at least—towards zero tolerance of under-aged alcohol use.

We need to enforce state laws. We have to prevent senseless deaths due to accidents or aspiration. These things happen when people drink too much. Two families lost children this year in a snow-mobile accident. One, the driver, was intoxicated. His passenger was not. Beautiful young people.

Even if your brothers and sisters are warned about the dangers of substance abuse and sexual violence, even if they see a mental health professional, we will still know only so much about the inner workings of their minds.

We really don't know if we will ever be able to protect them or ourselves, for that matter.

We will do our best, however. Maybe resident advisors will be trained to recognize the warning signs, will recognize students with certain genetic predispositions that are lying in wait for that significant stress over-load that will tip them over, trigger the first manic, depressive, or psychotic episode.

Maybe students will take better advantage of student services and professional help on campus to treat mental and behavioral disorders. They have to ask. Maybe we have to encourage them more to ask.

Just as rape prevention programs are offered to students in some high schools, perhaps we can teach young people about mental illness, too. Why not? At some point in their young lives every student on campus should know the warning signs of mental illness.

We all need to be watchdogs. None of us should have recurrent dreams of rape or violence. This isn’t the way it’s supposed to be in a caring society.

This really is a commencement, a beginning, an end. If you’ve suffered trauma, or witnessed trauma, like the kids at Virginia Tech, it is a part of your history, something you can not erase, not yet, not until we invent some type of laser that aims at a memory and poof! It's gone. No such technology yet and no drugs that specific either.

But we know that life is a straight shot forward in time, and that you can move on. You don't want to stay stuck, psychologically. You're young, you're strong. You have what those of us who look down at the bleachers and the stage don't have, your whole lives in front of you. Make them matter.

Go from strength to strength, and may G-d bless you.


Copyright 2007, therapydoc

Sunday, June 03, 2007

Women in Pink

This is the year of the cicada in Illinois. They're here en masse every 17 years, a noisy lot, much like crickets.

The local news people show us how to fry them up as appetizers and marinade them as side dishes, but it's not something we would actually do. Even though they're supposedly here every 17 years, I see a few annually and send them to my grandsons via USPS. That makes them 41 cent cicadas.

Today was HOT and there wasn't a cicada in sight. But we looked, took a little walk in the neighborhood. We were working off lunch, stopping to admire the weird things people leave on their front lawns, and admiring flowers. Chicagoans put a lot of effort into beautifying their yards.

That's why Chicago is called the garden city.

I let FD do the beautification thing and mainly concentrate on the task of removing tricycles and Razors (scooters), courtesy of the neighborhood kids, from our sidewalk. I'm assuming that when somebody trips and breaks a hip in front of my house on one of these things that it will be me that the personal injury lawyers will hunt down.
Lady, is this your scooter?
No.

Prove it.

It's not, honest.

Then why was it in front of your house. I have a client in traction and it's your fault.

Sorry.
Anyway, we were walking the neighborhood and we looked up and there they were! No, not the cicadas, the women in pink!You can't actually register here. I copied the picture from the official Avon Walk for Breast Cancer website. If you're not already aware, Avon holds the weekend fund raiser in various cities across the nation at different times of the year.

Every June Chicago Avon walkers limp through our neighborhood on Saturday in cute pink tee-shirts (sleeveless this year), jogger shorts, and cool pink or green baseball caps.

FD and I never miss them. He's a little embarrassed to be staring, but they're impossible to miss. Last year, or maybe it was the year before that, I think we caught up with them on a walk in Skokie. We're in awe, of course that people are dedicated to a cause and actually go out and do something for it.

It's always hot as blazes in the summer and our walkers gather in groups of 2-5, looking tired and dehydrated, but happy.

I said to FD, I should blog about this.
Go talk to them!

No, what would I say?

I don't know. You talk to people every day! Go talk to them.

Okay. But you have to wait for me. Don't walk ahead. Wait for me.

Okay.

What will I say?

I don't know. But you're already wearing a pink shirt. You'll fit right in!

Right.
I was wearing a pink blouse so I approached two attractive women and asked if I could walk with them, ask them some questions. "I'd like to put this in my blog," I said.
Sure! (huff puff)

You two are amazing! How far have you walked?

26.2 miles today, 13.1 tomorrow. We're almost finished for today. Only another half mile to go.

What? Did you say 26.2 miles and what? Why the weird numbers?

There are 26.2 miles in a marathon, so we did that today. And 13.1 in the half marathon we do tomorrow.

Wow! That's a lot of walking! Why are you two personally doing this? Uh, I mean, why do you think most of the women are here, I mean, uh. . .
Now I'm freaked. So insensitive! For all I know, one of these women has just lost someone she loves to breast cancer and I'm asking her to tell me about it?! I'm beginning to feel nauseated.
Well, my mother had breast cancer (OH NO! I was right!)

Did she survive, I hope?

Oh yes, she's doing just fine!

(Phew) Thank G-d. So is that the case with most of these women? Do you think most of the women who volunteer for the walk are related to or know someone who's had breast cancer?

For sure. Who doesn't know someone who's had breast cancer?

Right. Of course! That's true, isn't it? Listen, thanks so much. I've got to go. Tell me your names!

I'm Anne and she's Kim. (Or was it, I'm Kim and she's Anne).

Thanks so much. You're wonderful. Google the Avon Walk for Breast Cancer-Blogs tomorrow and you'll see your names in my blog.

Great.

Okay, bye now. Good luck.
I spotted FD and crossed the street to meet him.

That went well, I said. (I told over my two minute conversation). He asked why I ended the interview so quickly. I told him that I'm not a journalist and it felt very much like I was invading their privacy to meet my own selfish ends and that my line of questioning could have gone badly.

He totally understood.

He told me that 1 in 11 women are diagnosed with breast cancer in their lifetimes. We went over the names of people we knew personally. Some survivors, some not, some surviving.

So I thought that you should know:

The Avon Foundation is busy supporting:
breast cancer education and awareness
screening and diagnosis
access to treatment
support services
and scientific research into the possible cause, prevention, treatment and cure.
The walk that takes place in different cities from coast-to-coast raised more than $100 million between 2003-2005.

Sounds like a very good cause to me.

LaBriyut walkers!

(rhymes with La-Tree-Loot)

or To Your Health,

therapydoc