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Friday, May 30, 2008

Back a' cha May 2008

I'm a little rusty at this and apologize in advance if I forgot anybody. Please forgive me if that happened and shoot me an email. And try not to be too angry, okay?

And if you've ever felt insulted in any way in the comments, believe me, it's not intentional. Ever.

The Back 'a cha' is the place I traditionally link back to the bloggers who link to me. Sometimes you get on the sidebar with a hyperlink, but that sort of thing takes a lot of time away from the things we should really be doing in life.

Like the stuff some people remind themselves about soon after they wake up, before that first hot cup (the old Eastern European way of saying hot water, tea, or coffee):

honoring parents (seriously), doing acts of kindness (why not?), welcoming visitors, visiting the sick, escorting the dead, prayer, learning, establishing peace among people. That sort of thing.

Don't click off now, I'm just getting going. People really do this.

Linking to other bloggers has to be in there somewhere. So allow me to direct you to several stellar individuals, people who waste less, more, or as much time as I do in this idleness:

First, there's Beyond Blue, who shares her personal journey and was kind enough to tell her readers, Check out that CNN article about blogging and group therapy!

Pink Hollyhock bemoans the lack of hats (great pictures here, if you happen to like hats). Check her post on high tea.

Eclectic blog is a nice personal blog and she's got a baby, always a draw.

Letters from Exile is catching up on her sleep. (Well, she was when I started this post, a few weeks ago)

I found Blog Rhetorica on Technorati (where I drop 50,000 points a day, lately, so officially, I don't care or like them anymore and am dropping them from my fave 5, whatever that is).

Add an "a" at the end of most things good or bad and they are better. Try it. Fantastic becomes fantastica. Horrible, horribla. Tremendous, tremendousa. We could go on all night.

Emeritus, at Parallel Universe (very cool pics), is a physician and hosts the Change of Shift blog carnival for nurses, which is nice.

We have to spend big bucks to visit islands, but Isle Dance lives on one.

Moonmaid's baby's kicking. (These are the kinds of things I take away from posts) B'shaah tovah (it should be in the right hour).

And Psychologyistics actually reprinted the CNN article, which is cool. At first, when I saw it, I thought Anna Jane Grossman, the journalist, had her own blog. So if you go there and think my comment makes no sense, that's why.

Jirel is always being positive, over at positive and successful, so if you prefer negativity, pass.

And they chose me as the top post at this carnival, You Finish Rich.
As we say, from your mouth, to His ears.

If you know French, this is great. Franck, writes about the CNN article in French. I'm not really sure what it says, unfortunately, but I said thanks anyway.

Which brings me to the Japanese translation I threw into the Jerry Springer post. I had copied the translation from a Google link, posted it, and Pam, a blogger who translates Japanese for a living , pointed out that what I had copied was actually a request for blog posts, not the translation of Treasure every encounter. . . She sent me the correct Japanese. Thanks Pam!

Maybe it's because I get all excited about hobbies and music, but this blogger has found 50 places to take music lessons on-line. So if you're interested in giving guys named David a run for their money next year on American Idol, check it out.

The best are you wonderful people protecting me from cougars (the naturally furry ones, not the older women hitting on younger men). Angie and April, at A Great Leap in the Dark, thanks.

Speaking of cats.

And Kabbage has dogs.

Educators visit here, and I visit there, and occasionally post at their carnivals. Here's a really good one.

Mazal tov to budding professionals who graduated this year.
We have a news anchor! News Anchor Mom, thanks!
And therapists of all kinds, TherExtras, for example, tres intelligent.

Dr. Deb is AMAZING, always, a virtual illusion.

And check into The Pasadena Therapist, lest we forget California. I'll be there soon.

Try this new one, Psych 101, as long as you're tweaking your mental health.

And Jeanie in Paradise (How do you get there Jeanie?)

More on pets, The Modulator

We let lawyers into our party but they have to be on our side.

We can't forget Jack, constantly singing happy birthday to Israel. Thanks, Jack for keeping up the mo, and MomInIsrael, too, and Leora. Not to mention Conservadox, Ilanadavita. On the other hand, let's mention her :)

Of course, I love bloggers into recovery

And the young bloggers make me happy, for sure.

Talk about making lemonade out of lemon juice, or is that lemon juice out of lemons, make mine pie, Joyful Seeker's spouse asserted and bam! the boss gives him a better job.

And I love the happiness going around in The Life and Times of Sancho Knotwise. Two months until the wedding and they don't seem worried at all!

It was a good month. For the most part.

therapydoc

Thursday, May 29, 2008

Telescoping

There's this concept called telescoping.

Telescoping starts when you're in your sixties, usually, but it can be the fifties for some of us.

All of sudden, you look back in time and see things. You remember things that happened to you in years past. And they're real, you know they are. They're not false memories. They are snapshots, clear as day.

I bring this up because it's a little disconcerting, memory. We tend to be upset that we can't really remember what happened to us when we were kids. Some of us can't remember what happened last year. Or yesterday. Honestly, I don't think it's such a big deal. Getting through today is hard enough.

But there's good reason to want to remember and good reason, for some of us, to want to forget. I just thought I'd let you know, if you're one of those concerned that you can't remember things. Just hang on.

Maybe hang on tight.

therapydoc

Wednesday, May 28, 2008

Once and A Fine Romance


Once is the Academy Award 2008 Best Foreign Picture.

The film's featured song, Falling Slowly, won an Oscar, too. (It can drive you crazy, I'm telling you, once it gets in your head).

The film is a vehicle for Glen Hansard's music, and a good one, too. It also reminded me that we haven't talked much about cheating on this blog.

Warning: May contain spoilers.

A melodious, poetic, tragic rocker works a busy street corner for change in the city of Dublin. He sings the songs of other artists, thinking: No one will toss coins into my guitar case if I sing my own songs.

A fresh and optimistic female hears him one night. She boosts his confidence. She is also a musician, his perfect complement, a sensitive pianist with a good voice.

This is an endearing love affair, what Dorothy Fields would have called A Fine Romance* (with no kisses).

She's married, but separated, living with her mother. He's getting over a girl who cheated on him. His woman has gone off to London, perhaps a response to his pain, and he lives with his pop.

His response to his ex's cheating is very realistic, the kind of thing we see in therapy quite often.

We'll use the male gender for the sake of convenience.
I see four basic types of guy:

The guy who is so angry that he pounds his pillow or the wall (breaks his hand) or breaks bottles. He can't sleep, stays up all night writing songs and poems, watching movies or drinking. He'll have sexual problems if he doesn't work this out.

There's the guy who has grown used to this, losing his women, and expects as much. Some men are convinced that they're losers in relationships, having lost so often, and become depressed and stay this way. They seem "depressive" and often will take a year or two before beginning to date again. Maybe three or four. It gets annoying being hurt again and again.

There's the guy who gets back in the saddle and hits on every woman he can find. This guy may identify with the aggressor, hurt back before he'll commit to a relationship.

There's the guy who doesn't grieve, doesn't talk about it, just moves on.

There are other variations, whole other categories. It doesn't matter.

I like them all. But the guy I like the most has the guts to say to the woman who spurned him, Why don't we work on this? Be honest with me. Let's talk about this and let's make our relationship work. I can change, you can change.

Will she say Yes, sure, we can work on it? Reverse the genders, change the sexes. Will he say Yes. Why not? We can get through this? So many things to consider when we talk about infidelity. But honesty is the variable that makes the biggest difference.

How much does he or she want to know? How much can the cheater tell him and not regret it? This is a fine art, really, this type of honesty. Sometimes it's really enough to say, I did that. I cheated on you. And that's all you get to know. Sometimes even that doesn't have to be said, it can be communicated with a certain look, a shrug.

Then we can get to real couples work, begin to find out what is wrong. It's something that begins with something in her or something in him, something that needs discovery, light. There's something in there that allows that to happen, a new relationship, a triangle, some intimacy fear or narcissistic injury. It's not the femme fatale. It's not her lover's Gucci suit.

A person walks into a relationship with issues. We all have them. Most of us haven't any idea what in the world they are.

therapydoc

*In case you don't know the song, here's the first verse:

A fine romance, with no kisses!
A fine romance, my friend, this is!
We should be like a couple of hot tomatoes,
But you're as cold as yesterday's mashed potatoes.
A fine romance! You won't nestle!
A fine romance! You won't wrestle!
I might as well play bridge with my old maid aunts!
I haven't got a chance.
This is a fine romance.

Tuesday, May 27, 2008

A Lesson in Civility: Keiara Bell

She's thirteen and she took on a Detroit politician. One pol called another pol a "Shrek."

The YouTube clip is in the thousands and The Wall Street Journal's Katherine Rosman made this front page news.

According to WSJ, the pro tem President (who may think about anger management now) repeatedly interrupted City Council President Kenneth Cockrel Jr. as he tried to question a witness. Mr. Cockrel banged his gavel and asked the pro tem to be quiet while he had the floor. In the video she shouts back at him angrily:

"You not my daddy, you do that at home, not here. OK? Exacly. (spelled as it's spelled in WSJ). So treat me with respect because I'm tired of that. . . Shrek."

Mr. Cockrel is bald as is Shrek in the movies. Most of us know what Shrek looks like. He's green. Not too pretty. A troll, I believe.

"Shrek? I will call this to adjourn!"

Mr. Cockrel says that the video speaks for itself. He thinks Ms. Bell is awesome.

Keiara had an opportunity to discuss this with the woman who threw the insult.

Keira said, "But you didn't have to call him a name."

And the pro tem, in her defense replied, "But now you're telling me what I should have and should not have done."

"You're an adult," replied Miss Bell. "You have that choice."

"I'm what?"

"You're an adult. You had that choice. . .Sometimes people need to think before they act."

Fabulous. Words hit as hard as a fist. Tell the world, Keiara.

You're an inspiration.

And shrek is, of course, Yiddish. It means "monster".

therapydoc

Monday, May 26, 2008

Following Directions

My parents have always been amazingly good at taking jokes at their expense. To me this is the epitome of good humor, humility, and self-confidence. I only pray they haven't changed.

About a year ago my mother's sister passed away. My cousins had a dedication for her at the cemetery to put up the stone. It's a nice tradition, brings people together. And the stone is very beautiful. My aunt would have loved it.

I like these things much better than barbecues.

As soon as my cousin announced that the dedication would be on Memorial Day, I called my parents and said, "I'll take you."

They're in their 80's and still drive short spurts, but it's a long way to Waldheim and there's no point in everyone driving. "We'll come to you," Mom says, meaning they'll drive their car to my house and then come with me.

"There's a sale at Macy's in your neighborhood. I'll be by you anyway."

"Uncle M. needs a ride, too."

"No problem. The more the merrier."

A few days before the dedication Mom calls and asks, "What time are you picking us up?"

It's a 10:30 ceremony and she thinks she’s the only one that hates being late.
"I'll be at your house at 9:45."

"Come earlier. I don't want to be late."

"We won't be late."

"Come earlier."

"It's a 40 minute drive."

"If we're late, I'll kill you."

Already I doubt myself. What if I make them late? But I've been to this cemetery many times and being a therapist think in terms of time and increments of time. When I visit people in general my visits tend to be 15 minutes, 30 minutes, 45 minutes, or an hour. On the money. It's uncanny. I don't even have to look at my watch. I don't even wear a watch.

That morning I wake up and try to pick out something to wear. Ordinarily this isn't that hard, but I'm thinking, “What would my aunt like? What would she say?” She always noticed what people wore and she always complimented them. She liked cute things.

So I tried to be cute. Not an easy feat at my age.

Mom makes the call the night before. "You won't be late, right? This is very important."

"It's all good, Mom."

"Just be on time."

Because she's so nervous I put aside the stubbornness and decide, I'll get there by 9:30. But I don't tell her that, which is a good thing. Nervous, I take ten minutes to print out directions and get there at 9:40. Now she has me nervous that we'll be late. This is the subtext, of course, in these situations.

Between my father, my uncle, my mother and myself, we all have to use the bathroom. This steals at least ten minutes, completely blows my early arrival, and adds to my stress. Yet they seem to be okay.

Everyone piles into the car. "Seat belts," I command.

They're compliant!

"Personally," I say, "I hate them. They're so uncomfortable. But you have to wear them, right?" My father doesn't even grunt. He's resisted seat belts in his youth, but gave in at some point, I can't remember when, exactly.

Then it started. I knew it would.

"Which way are you going to go?" asks Mom. "How do you want to go?"

From my uncle in the back seat, "Take Dempster to . . ."

"I was going to go to the airport, pick up 294, then take the Eisenhower to Des Plaines Road," I say.

My uncle tries again. "I think you can get it on Dempster, the toll way."

"Oh, that's a great idea!" I exclaim, remembering this is indeed a good way. I'm a little worried about the construction by the airport, too.

My mother's not so sure. "I know there's an exit north, but I don't think there's an exit south."

My father authoritatively commands: "Take Dempster."

This throws me, what my mother has said about there not being a south exit on Dempster. What if I go all the way west to the toll way and can't get on? It's a long shlep for nothing.

I get on the Edens Expressway to the airport.

"NOW where are you going?!" Mom cries.

"I'm going to take the Edens to Cicero to the airport spur and pick up 294. Trust me. You'll be okay."

"I wouldn't do that," she says, very irritated. "Just take this downtown and take the Eisenhower. I know how to go from there."

I really don't want to say it, I just want to distract them somehow, perhaps talk about people we all know and surreptitiously get us to where we want to go, sneak the trip in without anyone noticing. But I say it.

"No way. That's the worst way. It might work at 4 a.m., but it might not be a good idea today. It's a holiday. Memorial Day. Maybe there's something going on downtown, like Bike the Drive or Taste of Chicago."

"I don't want to be late," she says.

Then (sorry for jumping on her, she is getting up there in age), "Mom. Do you really think they would start without you? You're the sister! There's no way they would start without you."

"Really? Do you really think so?" (My mother is so wonderfully, honestly, self-deprecating.)

"Uh, huh."

Dad pipes up. Get off at Cicero and take it to . . . no, never mind."

Phew.

"But if you take the toll way," Mom continues, "Well, I'm not so familiar with the toll way."

"We won't be trapped on the toll way and end up in Indiana, honest," I say, and hear this as possibly being rude or impatient, become angry at myself for showing irritation in my voice. The truth is I know where I'm going. "I know where I'm going."

"Well, it's a good thing. Because I sure don't," Mom says, laughing at herself.

"It's what you pay me for. It comes with the cracker jacks, directions." I toss her the printed handout, the directions from the cemetery's website.

Dad's asleep. We get there in record time and greet all the cousins and in-laws and friends. It's a beautiful ceremony.

When it's time to go home, Dad's awake. He turns to me, serious.

"When you go home, take Ridgeland all the way. Don't bother with the highway."

"Dad, I don't want to slug through city traffic."

"Its faster. Do you have any idea how many times I've commuted back and forth to the city in my lifetime?"

I think I'm going to find out. He starts multiplying, 40 years, twice a day, no, 50 years, twice a day, times 365 days, no, make that 300 days.

A nicer person would have said, “Fine. Let's take Ridgeland.”

A better daughter would have said, “You know? You're right. Let's do it your way.”

But I'm a tired person. I get up automatically at 5:30 every day and although we're only half-way through the day, the first trip was long and not stress-free, the ceremony emotional. I'm a little tired and could use a little refreshment, and it is, no question, at least a 40 minute boring drive home. So I say nothing and get on the highway; do it my way.

About half-way home he says, "If you would have done what I told you to do, we'd be home by now."

"You're right, Dad. I just can't stand the stop and go of city streets. But you're right." We're flying, by the way, there's no traffic on the highway.

"I know I'm right."

"I should have listened to you."

"Yup."

"My old man knows a few things."

"Yes he does."

copyright 2008, therapydoc

Directions to Waldheim Cemetery

From Downtown (Approximately 10 miles from the Loop)
EISENHOWER EXPY W / I-290
Take the IL-43 / HARLEM AVE exit- EXIT 21B- on the LEFT
Turn LEFT onto HARLEM AVE / S HARLEM AVE / IL-43
Turn RIGHT onto ROOSEVELT RD
Turn LEFT onto DES PLAINES AVE, end at 1400 Des Plaines Ave.

From O’Hare and the Northern Suburbs (Approximately 17 miles from O’Hare)
I-294 S toward INDIANA
Take EISENHOWER EXPY E / I-290 E toward CHICAGO
Take the DES PLAINES AVE exit- EXIT 21A
Turn RIGHT onto DES PLAINES AVE, cross ROOSEVELT RD
End at 1400 Des Plaines Ave.

Friday, May 23, 2008

Definition: ADHD

Okay. Maybe we will get into should you drug your kid or not?

Attention-Deficit/Hyperactivity Disorder
There are different types: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and Combined Type. It's either a 314.01 or a 314.00.

We'll not split hairs on diagnosis, though. Not today.

Did I ever tell you this story? (Let's change all the details, so even if it seems like it's you, no, it's definitely not you).

The story goes back to the early eighties when I was a young therapy doc. No idea what I was doing. That's how it feels all the time when you're a young therapy doc.

A couple of alcoholic parents come in with two little boys, ages 6 and 8, wild and crazy. Seemed to me, happy. The parents say, "The school insists we put our boys on medication. At least J, the older one. They'll wait on H."

J is eight and he has been a problem for as long as they can remember. Born on the move. These days he probably wouldn't have survived first grade without a drug to slow him down.

"But," the parents tell me, "We're alcoholics (in recovery for ten years) and we don't want to use any medication. We want to teach our kids how to behave and how not to behave. Can you help us? We'll work with you a hundred percent."

Well, sure. Glad to help.

(I quake, Uh, how should I know if I can help you?)

Meanwhile, the kids are literally climbing the walls of my office, swinging from the rafters. This is how I assess ADHD with hyperactivy. If they're climbing walls, standing on top of your desk, jumping on the sofa, then MAYBE there's a hyperactivity problem here.

We go to work on it. Both parents enforce the behavior modification program, my first, developed on the spot. Been using it for years, I say. (At this stage of my career, I have been using it for years. One day I'll make a video* demonstrating how it's done. You'll see me. I'll be the one talking to you in a ski mask.)

The teacher worked with us.

The grandparents had us covered.

The babysitter came to the therapy.

And it didn't take all that long for them to become new kids. Unrecognizable, nice kids. Productive, good students.

It's surely what someone used to say It takes a village stuff. She's totally right. But this isn't a political endorsement of any kind. It's an ecosystem endorsement.

Find your people and use them. Is that always possible? Aren't there other variables? What if people in the family, parents, especially, don't get along or have mental illnesses, personality disorders? What if? What if? What if?

Most likely that's the case, right? Everyone needs therapy. The specifics are what we call the big confounders. They make therapy more difficult. But not impossible.

All I'd like to suggest in this post, really, is that before the physician prescribes even the newer, better medications, that a good psycho-social history is in order.

More than once in the past few years I've seen an overweight adolescent girl who says she just developed what she is sure is ADHD.

She wants me to tell her pri-care to prescribe Ritalin or another drug to help her focus in school. A good student, a girl like this now has a boyfriend problem, or parent problems, and oh, definitely a weight problem. And trouble in school, a new problem. But if I get to know her (we talk girl talk) it's the weight that's freaking her out. I get it. She wants drugs to kill her appetite, slim down. Good drugs.

There's all kinds of prescription medication abuse going on out there.

Should we give children speed for obesity? Medicate children for carrying the emotional intensity of their family systems? It can be hard to differentiate hyperactivity from anxiety. But it's not my call. I'm not an MD. And neither are teachers calling for the med-evals, insisting, sometimes.

Maybe for some kids it is genetic and there is a need for medication. I don't know.

But I humbly suggest that a family assessment is in order before a doctor writes a scrip, and that parents look hard into other strategies of behavioral change.

Hyperactive kids can be nervous, angry kids, too. Treat them. Treat their parents. Get it all done the first time around. Shop for good therapists.

Parents should address all of the problems in the family, and all of the problems in the eco-system (school, church, etc.) that might be contributing to symptoms in their children.

It only makes sense. Of course, medication is so much easier, right?

therapydoc
* blee neder no promises

Thursday, May 22, 2008

Season Closers: Friendship

Warning: May contain spoilers.

Like many of you, I've been watching way too much TV this week. It's the end of a very short season.

So to make up for it, I thought a little extracurricular cleaning might help. Having emptied the refrigerator this morning, I yanked the blue plastic trash basket from under the sink. You have to toss the science experiments. Underneath the pipes I saw a little rust and definitely, crud.

The kitchen was already in disarray. It couldn't hurt to attack the cabinet, too.

It's not rocket science, understand, so your mind drifts off. Mine drifted to the two shows I watch religiously, Desperate Housewives and Boston Legal.

Last week's cringe on Desperate upset me so much that I almost swore off the show forever. A little girl emotionally blackmails step-mom Lynette Scavo (Felicity Huffman). Lynette, always the sympathetic character, will go to jail for child abuse in the closer because of this manipulative, unlikeable kid (Rachel G. Fox is perfect) .

She really creeped me out, even though her character and the story line didn't ring true. So I didn't want more, but I said to myself, You're tougher than this. Watch the finale.

The truth is that television is kind of new to me. I watched it as a young person, as a little kid, then checked out. We had shows like Leave It to Beaver, Andy Griffith, Lassie, Mr. Ed, and Father Knows Best, shows that reflected the hopeful mores of the time. Plots didn't vary much. A kid gets into trouble, the parents (or animals) help resolve it, and everyone whistles at the end.

When I checked in again, television was mostly people taking off their clothes or shooting at one another, and nobody rode a horse or loved a dog. So what was the point?

A couple of years ago a patient, an adolescent, talked about Gilmore Girls. She really wanted her mom to watch it so her mom could become more like Lorelai. Empath Daught also liked Gilmore so I checked it out and found the relationship between mother and daughter interesting. Rory could see right through Lorelai's issues, and there were many.

So if I watched the show I could say to the kid (or to my daughter), "Did you see last night's Gilmore?" and we could talk about it.

And I loved the stuff with Rory's grandparents. Lorelai had cut them off because they didn't accept her as different, or so she always thought. Lorelai stayed angry at Richard and Emily, so that conflict kept my attention; that and counting everyone's drinks. (Edward Herrmann and Kelly Bishop are totally watchable and wonderful actors, which certainly helped).

So yeah, I got hooked. It was the entry drug.

And sure, I broke down and watched the two-hour season finale of Desperate on Sunday night. I set the VCR so that if I couldn't stand the cringe I could tape the show and watch it another time, fast forward through the stuff that upset my equilibrium. But the show was pretty good, the ending a real winner.

The enactment of spousal abuse, the whole Katherine sequence (Dana Delaney, so good) is amazing. You can watch this at ABC.com whenever you want.

And last night, well, my mother reminded me that Boston Legal would be on, so hey, who am I to lose the recreational intimacy of discussing that with Mom?

So there I am, cleaning under the sink, and I realize that both shows ended (stop right here if you don't want to read the spoilers) with messages about friendship.

Look here! the networks are telling us. You people are getting better. You want friendship in your lives. Sex and violence? Sure, we can provide that, too. But what you really want is friendship and we know it. So we'll give it to you. You get it here. We'll give you friends. Live vicariously.

What we want are friends.

Listen to this amazing dialog on last night's Boston. Background, first.

Alan Shore (James Spader) is in a huge disagreement with his best friend, Denny Crane (William Shatner) and they're about to go head to head in the courtroom on opposite sides of a case. Alan, in the hallway, overhears their mutual partner, Shirley Schmidt (Candice Bergen, my hero) tell Denny that Alan is very competitive. He's so competitive when it comes to his work, and this case is work, make no mistake about it, that he will take no prisoners. He will crush even his best friend to win.

After the commercials Jerry Espensen (Christian Clemenson, brilliant as the lawyer with Asperger's) argues with Alan about something immaterial. Alan has always been Jerry's arch support. But lately, they've drifted apart.

Alan, always the mentch, has already tried to make peace with Denny and failed. Now he wants to make peace with Jerry. He alludes to the fact that they have drifted apart over the past year. They're not as close. He misses him.

Jerry makes light of it. You can tell he's very nervous but he tries to play it cool and says, "Work! It's work! I have so much work, and you have so much work. We're both busy working and that's just the way it is. Back to work."

Alan doesn't move. He thinks awhile, then says, "I never thought of myself as a person who put work before friendship. But it seems I do."

Jerry looks up. He gently replies, "Friendships are like little gardens. We plan to tend to them but always seem to put them off until next week."

Pretty good writing for television, no?

Alan and Denny make up, too, at the end of the show, and leave their scotch on the balcony to go fishing, perhaps camping, who knows? They can do what they want. They can work on their friendship if they want. It is their choice. The two of them walk arm in arm in the streets of Boston in the middle of the night in their Coast Guard jackets and those silly plastic or rubber pants you wear when you're about to walk into a river to fish.

It is a great scene. The type of scene that makes us wistful for that sort of freedom.

That, only days following the Desperate closer. The Desperate epilogue takes place five years later, following the drama, and the wives are seen playing cards, Gabby (Eva Longoria, such a star) has gained a lot of weight and has two little plump daughters, maybe two and five. Susan (Teri Hatcher) is married to a hunk we've never seen before (I haven't). Lynette's children are older, more difficult. Bree is back with Orson. And Katherine is among them. She's one of them now.

We know that the writers will start next season with these themes, children who are out of control, sex, family tension and desperation. We also know, that they know, that we're glad these housewives have each other.

So there I am, under the sink, going over this stuff. I finish up the scrubbing and get to cleaning up the mess I've made emptying the fridge. I toss an almost empty Dannon yogurt (vanilla, if you must know) into the trash then fish it out. I've used the yogurt as a starter and made my own, surely more fattening and worse for you, but better.

Rather than throw out the container, I'm thinking that I should wash it out and use it for my yogurt. Then, when I see it in the fridge, I'll know it's yogurt, not mystery food.

Somehow (so me), while washing it out, that foil at the top slices my left index finger.

No panic, no pain, I move to the bathroom. The blood drips into the sink (you're reading popular media so you don't mind a little blood, right?) and with my good hand I get out the BandAids. It's getting a little difficult. The paper on the first BandAid sticks to the adhesive and the second BandAid gets wet. Things aren't going so well.

In my head I'm wondering, sheez, do I need a stitch? I begin to really regret this stupid idea, using a Dannon yogurt container when I have a houseful, no joke, a house full of Tupperware.

Then somehow, I remember Lillian.

It's her fault I made yogurt.

When I was in college as an undergrad, Lillian taught me two things. She taught me to make bread, and she taught me how to make yogurt. These are invaluable skills and may have exceeded in utility far beyond whatever I learned in the classroom.

We lived in a university student co-op (all women) and I was the R.A. She was one of the only really mature kid in the house, although I loved them all the same. Lillian, from a tiny farm town in Illinois taught me how to make bread the old fashioned way, no dough hook. I use one now and bet she does, too.

So here I am, thinking about Lillian probably for the first time in many, many years, wondering where she is, what she's up to, wondering if she's married, has children, maybe grandchildren. For all I know, she's no longer alive.

I let her go. I just let the friendship go after school let out. No idea where she is now. I think I remember her last name, but there must be a thousand women with that name (last name starts with an L, maybe you know her).

So I ask myself, and you probably do, too, How do we let this happen? Don't we know as much as the television producers when it comes to the importance of people?

You have to wonder.

therapydoc

Wednesday, May 21, 2008

The Speaker at the Funeral

I'm not obsessed with death and dying, I'm really not. But I'm in that age group. The parents are getting older, some are passing on. So there are more funerals than there used to be, more survivors of lost loved ones to visit or call. Sometimes we hardly know them, but we visit anyway.

So much worse than losing a fish, parent loss. Let's be real.

When you visit people in these circumstances, you avoid saying stupid things. You try not to say things like, It's better this way, a timely loss, if ever there was one; he suffered so much.

Not for us to say! The survivors know what went on in the hospital, they know the history of the illness. They know what it was like care-taking their parents, or not care-taking their parents. Is it ever timely? For whom? Best to assume not.

We visitors know nothing, virtually, so when we visit, we try to listen and learn, practice waiting for a mourner to talk. Maybe ask a few questions about the deceased. It's an art, a meaningful shiva.

I understand that a wake is a very different experience. At a wake (correct me if I'm wrong, please) one raises one's glass. It's a very different type of send-off, more cheerful. The purpose is for everyone to "move on." If that's possible.

Survivors have a million decisions to make, no matter the culture. Like who's going to speak at the funeral. Functional families resolve problems well, so decisions like this one aren't that hard. Yet, there you are, grieving a loss, and you have to decide, Who's going to officiate? Who's going to speak? These are things to think about, and they're not simple.

It's more than who's speaking. In some cases, it's how Who is speaking.

My friend lost his mother last week. I missed the funeral but wanted to visit him. I hesitated, had only one free day, and that day wasn't exactly free. When would be a good time?

That morning I had bolted out of an IRB* meeting at 10:00 a.m., grateful that we finished up and no one sustained a fatal narcissistic injury. I got out of the meeting ego in tact, full of love and compassion for humanity (really) and had to make a choice.

Do I pay the visit right now? Or do I wait an hour or two? I didn't have to be at the office until one o'clock, but had plenty on my plate. Maybe my friend wanted to nap. Maybe he wanted a minute to check email. Maybe he was eating a late breakfast.

But I dropped all the rationalizing and drove over.

It was just me and a rabbi visiting, a man little older than me, someone I'd known all my adult life. He had officiated at someone else's funeral earlier in the morning. At his age (those ten to fifteen years he has on me make such a difference) it's funeral to funeral, literally, or funeral to shiva, or shiva to shiva, visiting people in their week of mourning. Occasionally you get to do a wedding, too, if you're a rabbi, or other happy occasions.

But the rabbi has already been visiting here awhile, and he gets up to leave, and it's just the two of us. My friend, who has lost his mother, is joking, complaining that it's kind of boring sitting shiva. You can't work. And you can't play, really, although you might sneak in a game of solitaire on your phone. You can't watch t.v. Oprah is out. Many more can'ts than cans, in the spirit of the event. You're mourning.

Since I missed the funeral he regales me with praises of the young rabbi who spoke. The rabbi is his son. His son, he tells me, worried that he couldn't officiate at the funeral, not because he didn't know the protocol, that they could teach him. He worried he couldn't do it emotionally. He loved his grandmother so much.

My friend told him,
When you get emotional, just look at me. Look at me. I won't be crying. Look at me and Zaidie at my side. We won't be crying. It'll be okay. We don't cry in public. We won't be crying, Zaidie and me. And you won't cry, either.
So powerful, I thought. Look at me. I won't be crying.

And the kid does fine, of course. He's better than okay, better than fine. He rocks. He speaks with sensitivity and gratitude. He conveys who his grandmother is, he brings her to life in this way. This is her. Bubbie.

My friend is still glowing from his son's speech days later, from this person, the man he has become. And I'm thinking, Well of course he's wonderful. Look at his parents.

"Sorry I missed it," I say. "That's what it's all about. Conveying who the person is, that essence. And you're amazing, giving him that tip. Look at me. Look at Zaidie."

So much to learn here.

Those of you who have been reading this blog might remember a discussion we had on stoicism. My position is generally against it. From what I've learned about grieving, from the books and my years of practice, crying is good. Too much holding it in, too much dignity, bad. All is relative, of course, but if a person is on the fence and wants to err on the emotional safe side, if it's time to grieve, grieve.

So someone like me will say, Go ahead, grieve openly if you want. Tell people why you cry. Tell the world. It's okay to cry. If you don't cry, it'll catch up to you. Not that that's bad. But it can be inconvenient.

As my friend's story illustrates, however, grieving doesn't have to be public, and shouldn't necessarily be public. It's okay if it is, sure. Who among us hasn't been to very, very, very sad, weepy funerals? They're fine, and they do us all a world of good in this crazy way, the way that grieving is good. We should feel bad when we lose people. While we grieve the deceased, we can throw in a few tears for other people, too, even for ourselves.

But it's fine, too, to hold them in for awhile, those tears, especially in public if you think you're going to look pathetic.

It all depends, and I imagine you're about to tell me all those depends, when you comment, depends on many things. But public displays of almost everything can be contagious. You know that. And maybe the deceased doesn't especially want that contagion. Maybe the deceased would prefer a wake.

Getting through that speech without breaking down isn't stoicism, it's good public speaking. The young rabbi, while delivering his eulogy, knows that for him, this isn't the right time to cry. He waits for the right time. He can wait.

Like everyone, stoic or not, there really is plenty of time to cry.

therapydoc

*IRB stands for Institutional Research Board, and is often called the OPRS, Office for Protection of Research Subjects. It's the ethics arm of an institution, there to protect people who might participate in university approved research protocols.

Tuesday, May 20, 2008

The Great Cougar Cover Up and Animal Rights

This is not Wisteria Lane. It's Chicago, Illinois.

I hesitated to ride my bike today. They say that cougars are only a danger to us at dawn and at dusk, and I'm finishing today kind of late, surely dusk, so who wants to be some big cat's dinner?

But I rode anyway.

Last night the local news broke a big story, one important to people like me: The Great Cougar Cover Up. Apparently our lone Chicago cougar didn't have to run 950 miles to get Chi-Town from South Dakota. He and his friends generally roam around southeastern Michigan, not all that far away at all.

There have been over 1500 cougar sightings in Michigan in recent years, and they get little press, if any. Every cougar should have his 15 minutes of fame, I feel.

But beyond that, when faced with the evidence- a video and photos of two large cougars stomping around a Michigan farm, government officials told the farmer that she had footage of house cats.

A photography expert superimposed two real house cats into the picture alongside an image of a six foot tall male human. If you look closely, the house cats are barely visible, the human is clearly tall, and the cougars, well, they're obviously cougars.

Experts in the Department of Natural Resources say that the reason there's no publicity on this is that the government really doesn't want the public to know. If the cats are on a list of extinct species, shooting them would be a federal crime. And the animal rights activists, too, will become very angry.

Which brings us to, Now What? If they're hungry and they're visiting Chicago . . .

In Israel, when you drive into into certain areas, a security guard will stop you and ask, Yesh neshek? Are you packing? FD, in his beard and shirt sleeve shirts looks like he could be a "settler." So it's a logical question. But no, neither of us ever considered getting a gun.

I'd consider it now.

But of course, getting a gun is a ridiculous idea. I would sooner get pepper spray. I would sooner do nothing at all.

This isn't really a therapy issue, is it? It's really not, unless we go with the question, Are they angry, cougars, or just hungry? But that's irrelevant, the experts have spoken, they're hungry. So the question is why bring it up, why harp on this business about the cougars?

I do it because I'm a person, and cougars eat people. They prefer a good piece of coyote, but who's to say where their tastes are going to go? Twenty years ago not very many people ate sushi.

So I'm really asking the animal rights activists out there, What should someone like me do, supposing I run into a cougar on the bike path? I'm a human and humans are mammals and mammals are cougar prey. And did I mention that I have grandchildren in California and that there are cougars there, too? They're everywhere!

Let me know. Should we all be packing pepper spray, or guns that shoot blanks, or perhaps yesterday's hamburgers? What should we do? Would that really work, hamburgers? How old can they be?

therapydoc

Monday, May 19, 2008

The End Stage

I think I told you that I took the kids to the airport. What I didn't tell you was that they put me in charge of the grandfish.

D said, "I think the Butterfly fish is sick. I don't know. He may die while we're gone."

I'll take good care of him, dear. Go and have a good time.

There are three fish in his modest tank, one more beautiful than the next, each with a different personality. Blenny, who hides in a rock lest Humah eat him, is skinny, about three inches long and half an inch wide. The anorexic model of tropical fish, Blenny resembles a long, flat, blueish-silvery worm, which is why he can escape into a rock. I'm very fond of him, as is Cham, his primary care-taker. Humah, the Picasso trigger, is virtually a person, he's so big, the Labrador retriever of fish (likes to be pet), or perhaps a pit bull, when hungry.

The Butterfly, delicate and quiet, has never really responded to me. We haven't particularly bonded.

Things looked pretty good there for awhile. I'd drive over, or walk over, once or twice a day and feed them. They were so happy to see me. Humah always acted as if he hadn't eaten in weeks. I felt like I was feeding that plant in The Little Shop of Horrors.
Feed Me.

But yesterday I got there late. I dropped in after lunch. After my lunch.

I'd skipped breakfast, pedaled to and from the office to see patients from 9-1:30 that Sunday. At home I grabbed a bite before running over to feed the fish. As I parked the car I thought,

I'm so glad they gave me this job. No one could love these fish more than me. We're developing that certain closeness. And yet, I should have come here before work, not after. They've got to be starving.

But Blue, my fish, manages on very little, like a certain minority of people I know.*

I took the stairs the short five flights, just because they're there, and my heart beat a little fast as the key to the apartment clicked in the tumbler. My head turned to the tank and immediately I sensed: Something's wrong.

I didn't see the Butterfly.

He's been murdered! I thought. Humah couldn't wait. He killed the Butterfly to eat him. The pig!

(You have to understand, says FD, these are essentially wild animals. Or was it my son, B who said this, the original family aquarist, the one who got us started with this fish nonsense. A good friend of mine, a psychiatrist, Michael, so impressed with how B,at that time a very little guy, took care of his fresh water fish, gave my son his huge salt water tank and all of the equipment, the filters, the pumps, even some fish I think, because he was upgrading to a better tank. Wild, indeed. Michael should have warned me of the heartache, being a mental health professional. He knew.)

And sure enough, as I watched the show, Humah pulls the butterfly out of a rock to show me the corpse. He drops the dead fish in front of me on the rocks as if to say, Either get him out of here, or he's lunch.

All kinds of thoughts run through my head. I killed him. I killed the Butterfly. I should have fed the fish first, before myself. I should fast. I can't be trusted with fish. Why oh why would I take on so much responsibility? They could have had someone else do this, someone who lived on their floor.

I composed myself. I had to arrange for the funeral, obviously. I called the father of the fish, expressed my condolences.

"I think I told you he was on his way out," D replied upon hearing the news. "Yeah, he was sick. Fish him out and if you don't mind, add some of that de-nitrate stuff to the tank."

"You don't sound upset."

"I expected this," he said.

"So you go out of town for a good time and leave me with a dying fish?"

Essentially.

"But he looked so good yesterday!" I cry.

He wasn't.

I fished him out with a net and dumped him into the toilet, wished him farewell. Then I returned to feed the other two. Before leaving the apartment I decided to check to see if the Butterfly made it to fishy heaven.

NO!

I flushed a second time. He wouldn't flush. He was clearly too big for this tank. Irony of ironies!

I got the net, fished him out and bagged him, took him with me. But where do you put a tropical fish? Where do you put a dead tropical fish in a Ziplock bag?

The trouble was, I was late. I had an appointment in a suburban office and this was Sunday and traffic impossible. I put the Ziplock on the floor in front of the passenger seat and headed north.

At work it's easy to forget my troubles. But after the appointment, as I'm about to start the car, something on the floor catches my eye. The dead Butterfly! I pick him up gently and throw him into a dumpster in the parking lot. Bye Bye.

That night, over dinner (we do not have fish) I tell FD everything, very embarrassed. Do I fast? It's my fault. Even if he was dying, I'm sure Humah either scared him to death or took a fatal imperceptible nibble out of him. If Humah hadn't been hungry. . .my voice trails off.

FD reassures me.
You took care of an end stage fish. It's not your fault. Have you any idea how many people drop off their parents to me, all in the last years of their life? As a family practitioner I'm prepared to care for them from cradle to grave, and I do, when they're my patients, established patients. It's the drop-offs that are hard to manage, when all I get is grave.

They send them to expensive specialists for the good years, and when it's finally time to give up, they choose me to become the pri-care. And more than half the time I review the care they've had and get upset, disgusted, or both.

It's called care-taking the terminally ill. And it's not fun. And it makes you worry constantly, caring for the terminally ill. You have no control, really, because the pathology is out of control and the patient is not going to get better no matter what you do.
I still feel badly, I say.

I know.

therapydoc

*Blue, my fish, will go 24 hours and not complain. Such a mentch. But I won't let him go that long, usually. He eats pretty well.

Sunday, May 18, 2008

On Copland

I know I make typos, but spelling someone's name wrong isn't nice.

It's Aaron Copland, not Copeland.

Maybe it was the therapist in me.

therapydoc

Friday, May 16, 2008

Jerry Springer at Northwestern University Law

It's not the best picture. Sorry, Jerry.


Northwestern University is a prestigious place, and it's not inconceivable that graduates might aspire to the office of presidency.

As in, the presidency of the United States.

Not that my nephew has such aspirations, but he graduated on Friday and I took the day off to be sure I could make the ceremony. Jerry Springer was to be the keynote speaker.

I'm not a fan. Nevertheless, I like graduations, probably because I missed most of mine with the exception of kindergarten and eighth grade, and we know which one of those mattered.

As much as I like the idea of pomp and circumstance, when it comes right down to it, you have to be in the mood for all that brass, the crowds and commotion.

Although the gowns aren't bad. And the hats are hysterical, let's face it. I'm in it, really, for the speeches. Anything inspirational drugs me.

The Arie Crown Theater is a shlep for us, and as is the nature of our family, we got there an hour early. We're not the only neurotic Jewish family in Chicago with someone graduating Northwestern University Law School, so I had a chance to catch up with some people I've know since kindergarten, people I hadn't seen in thirty years.

None of us look the same, but we all say we do.
(You look the same!)

The show started with a graceful young graduate from Japan, Koki Nomura, who talked about food and quoted an old Japanese saying,

Treasure every encounter, for it will never recur.

一期一会

read "ichigo ichie".(Second part is read ichi-eh)*

This I liked. Who wouldn't be in it for this?

Then an obvious rising star, Suneel K. Gupta, a young man who truly may become the first Indian-American (meaning his family is from India) President of the United States followed Koki. Marvelous, such a delivery, and he quoted his mother. Jerry Springer would quote his mother, too.

Mrs. Gupta is the first female engineer to have been hired by the Ford motor company. She let her son in on the following story, appropriate for graduation, one that speaks to launching. You get the short version.
A priest found three birds who couldn't fly and he thought, I'll teach them.

He brought them inside and taught them to flap their wings, to soar, to dive. They lived happily in the rectory, flying to and fro, until it was time to leave.

They left, but outside the confines of the rectory, couldn't fly. So they returned to the rectory.

And that is where they stayed.
The implications for graduates are obvious; you really can fly beyond the world that taught you how. Don't settle for walking, keep trying. Fly.

For family therapists the lesson is severe. Silly priest. You let them back in.

Suneel received rousing applause, but everyone wanted to hear Jerry Springer. Actually, many people didn't want to hear Mr. Springer. The students protested his appearance because he represents what not to do with an education, sell out to the sleaziest type of journalism, sensational television.

He didn't wait a minute to address that.
I've been everything you can't respect: a lawyer, a mayor, a journalist, a talk show host.
Then he talked about ethics and said that no matter what a graduate ultimately does with his or her life, ethics will be a challenge. He gave concrete examples of how ethics are in every vocation, every profession, there, waiting to be violated.

Despite the words, he seemed apologetic to me. He never said, I'm sorry for selling out. Instead he told us his history, bits and pieces of his life. He reminded us that when he graduated Northwestern University Law School, forty years ago, that the world was in turmoil and his future a blur.

He treated the subject of ethics rationally, and yet, when he spoke of ethics, seemed, how shall I say it? Ashamed.

And then:
I am not superior to the people on my show, and you are not superior to the people you represent.
And finally, the great equalizer. We learn how he lost his entire family in Nazi Germany, and whatever they had, how a tree became a single vine, and how he immigrated to America on a boat, the Queen Mary, at the age of three (or maybe five).

The ship passed the Statue of Liberty and everyone made a big deal, LOOK! Look at that!

What are we looking at, Mama? What is this?

Ayin tas alles, she said.

This is Yiddish, and I think I heard it correctly, someone please correct me if I got it wrong. Mr. Springer translated it to mean, One day you have nothing, the next day, Everything.

"This is how a person like me," said Mr. Springer, "Can go from total annihilation to ridiculous privilege. All because of a silly show. One day nothing, the next day everything."

A silly show? Is that what it is? He sees the crowning point of his career as some silly show? We're dismissing it now. It's a silly show. But who even remembers him as Mayor of Cincinnati? Who even knew he had graduated Northwestern until today?

It came off as, Forgive me my privilege, my wealth. This is America and this is how some of us earn it. We make our decisions. We choose our destinies. Don't judge me. I suffered. My family lost everything, everyone.

That's the subtext. When I met with him outside the auditorium, he virtually hung his head, his demeanor truly abashed, humble, as if to say to me and to anyone listening, Please, people, I know I'm a shmuck, but I'm really not so bad, not deep down. Let me be with you. Let me be one of you. Sure, I'll take a picture with your son, your daughter. I'm not so bad.

It seemed that this particular exercise of self-reflection, addressing a law school convocation at his alma mater, speaking to hundreds of bright, hopeful, intellectually honest, and critically thinking scholars, lit something different in this American immigrant. Self-effacement.

Although I could be wrong.

So here is what I suggest, and it is with no disrespect, seriously; it took great courage for him to appear at that convocation. But I would humbly suggest that now, now that he has alles, now that he has everything, he drop the sleaze.

Stop the show and don't look back, Mr. Springer. Tour the country and tell the people of America,

"Actually? I made a mistake. I should never have sacrificed my ethics for money. I should never have participated in 99% of the shows that have aired with my name, with me. It was a shallow enterprise and sometimes morally bankrupt. Wrong."

We could use men like you, Jerry, to talk about ethics. You quoted your experience in the sixties, how difficult it was to graduate in 1968 to a world full of turmoil not knowing what you would become, where you would go. You graduated at a time of protest and unrest and had no idea what was in store for you. Like so many graduates today.

Who would ever have predicted that you would host a show like the one with your name on it?

So maybe you've looked at life from both sides now, as that song from the sixties goes, Both Sides Now. Remember Judy Collins? Joni Mitchell**? I'll bet you even know the words. Be honest with us next time, though.

Tell us all about it.

therapydoc
*thanks Pam for the correction on the Japanese text!
** For a more mature Joni, (You look the same!) see this video

Wednesday, May 14, 2008

The Drive to the Airport.


Cham writes and say, Hey Ma! We need rides to and from the airport. Any chance?

We can do both trips, Cham.

Yay!

See, in Chicago the trip to the airport isn't a big deal. Maybe it's more correct to say that it hasn't been until the past month. We have two seasons in Chicago:

Winter and Construction. Winter is over.

In New York you have to take taxis. Nobody ever volunteers to pick anybody up. That really would be stealing time.

And that's good, that the taxi drivers have a shot at making a living. I only recently discovered the Van Nuys shuttle to LAX, and for $3.50 I can get from the airport to Van Nuys in style (it's a luxury bus) and the kids can pick me up from this very cute terminal with friendly employees who are dying for something to do. So they'll talk to you about anything and everything. The Van Nuys welcome wagon.

Me taking that shuttle is a lot easier on the kids than having them shlep to LAX to pick me up. Saves them a couple of hours.

Total time in human hours lost otherwise three. Two for them, one for me. But mine is already a loss.

The thought of being trapped in the car with my adult kids, who often bring a child, is a reminder of carpool days. Many of us have carpool stories. For me, carpool always seemed like such an elegant idea, a conservation intervention, like recycling.

But being a professional with a bunch of kids, it was really hard to get in on the ground floor. I was always the mother hunting around for a carpool when so many others had theirs on hard copy the spring before the fall semester. (No, sorry, we're totally full. No, if anything, we need someone for the Thursday 5:30 pm, but there aren't enough seat belts, so even if you could do that. . .)

I get it.

And then FD and I would somehow become part of an elaborate, extremely complicated carpool that required an Excel program to figure out the who what and where. And the kids would be mean. Sorry, if you're one of those grown children now, you didn't know any better, and I forgave you right away, but no, I can't speak for FD. These things cut deep.

A kid would say, "You're LATE! We're going to be LATE!!! My mommy said. . ."

To tell you more isn't necessary, I feel.

Anyway, at some point FD declared, I'LL DRIVE THE KIDS, NO MORE CARPOOL (code for WE'LL drive the kids). And life became less manageable but more intimate, and in some ways, less stressful.

I began to look forward to that quiet time in the car, really getting to know the one or two other kids who chahpped a ride (Yiddish, soft, gutteral "ch", means grabbed) in our relatively empty little automobile. And I liked listening to my own children, too, getting my final instructions (Mom, send that check for the pictures. . .Don't forget to fill out the form for the class trip. . We need ice cream. . .)

This became the time to really communicate, to find out about the stresses of their lives, hear about their academic nonsense, their social angst. And listening in, hearing how they communicated with the other kids, priceless.

So I said to Cham, Sure we'll take you. Sure. Seriously. Not a problem. We'll talk.

Wouldn't you?

therapydoc

Tuesday, May 13, 2008

Relatively

I knew I should have posted about prom week. Now I'm in trouble.

I said, only a couple of days ago,
Relativism is the one (intervention) we can’t ram at you for fear you’ll think us not empathetic. Yet we hope. . .
In other words, Give it a shot.

And you voiced objections, of course. You said, basically, that when you're depressed, the relativism doesn't click. It works when you're feeling okay, but when you're depressed you don't care about the suffering of other people. Letters From Exile said it best, Misery is relative. My misery is my misery, and it feels pretty darn miserable to me, no matter how it compares to yours or anyone else's.

Of course.

And it breaks you. As I've said before, depression, misery's first cousin, is the enemy.

So me telling you that many Holocaust survivors think relativistically probably won't help you if you can't get out of bed. And anyway. Who's to say that they're happy?

It's not something I personally would ever say in therapy, You should think relativistically. There are others in worse situations than you. But it surely comes up.

It comes up from you.

You say to me, from your position on the couch,
Not only don't I care about people running for their lives in the Congo. But I feel guilty for not caring .
So many times have I heard this. Not about the Congo, but feeling guilty for not caring about things. Mainly other people.

So. Not only do I agree with your objections, but I'll see you (your objections) and raise you. . . (Why, oh why, do poker metaphors pop out of my mouth at the most inappropriate times!?)

I'll raise you by saying, Relativism is evil. Counter-productive. Salt in the wound. It makes things worse.

And yet. (Nicole Krauss, author of The History of Love, is fond of saying this, And yet. Ms. Krauss writes much like her spouse, Jonathan Safron Foer. You can just hear their pillow talk if you read their books).

And yet, if you're not suffering from depression, if you only have a low-grade fever and are a little on the down side, thinking relativistically does sometimes help. It's a cognitive behavioral strategy, and although there are surely more powerful strategies, comparing one's lot to others in worse straits isn't the worst intervention out there. When you've got nothing to do. And you're watching the news. It kind of depends upon, I suppose, where you're at. Where you're holding.

Relatively speaking.

copyright 2008 therapydoc

Sunday, May 11, 2008

Mother's Day


I know you think of me as a family person, being a family therapist.

And we've talked about the sandwich generation; being a mother, meaning having a son(s) or a daughter(s), and being a child at the same time, having a mother, a father, or both. And me having two slices of bread, (k"h).*

So you would think I'd like Mother's Day, being the bologna in the sandwich.

But I have to tell you. It makes me uncomfortable and a little angry, too, this day.

I try to work on Mother's Day, as much as I can, not because I don't love my mother (we have plans for the evening) but because for many people, it's just another day. They don't celebrate it. And they come in. Predictably, there's always one patient who does celebrate it and comes in and says to me, as if I'm committing some kind of crime, Working on Mother's Day?!

Like you'd rather I didn't?

But I'm respectful. I say, It's all good. Have a seat.

The Hallmark holidays are emotionally unbearable for a lot of people. I almost feel like I should be doing group therapy on Father's Day, Mother's Day, Valentine's Day, and Sweetess Day. There are more of these days, I guess, but these touchy feely ones are the ones that come to mind.

And I've never said this, really, not wanting to bring anyone down. But you have to understand, these days don't go unnoticed by people in difficult relationships, or those who may have lost someone. Not everyone thinks of the Hallmark holidays as warm and fuzzy. And it's not as if they volunteered to grieve on a day with potential to be one of those early sweet Sundays of spring, full of blossom and hope.

They remember
abandoment,
abuse,
neglect,
disappointment,
anxiety,
anger,
booze.

Stuff like that. And forgiving, forgetting, well, it's not always possible, or if it is possible, is an objective not yet met. We'll get to that this year, people think, that forgiveness piece. Maybe.

This is not to bum you out, seriously, if anything, I'm thinking, those of us who have good relationships, or passable relationships, even (you be the judge) are the lucky ones.

So the sentiment for many of us is like, I'm thankful I have this. Thank you for all you have done for me. It's because of what you do, of what you have done, that we have this.

If this fits.

But I must recommend that when you do say to people, Happy Mother's Day, that you do it with a lot of sensitivity. And with some people, think about it first. Maybe don't say it at all.

therapydoc

*k"h, kineyinharah wards off the evil eye. If you're new here, one of the benefits of reading is you get to learn some Yiddish.

Thursday, May 08, 2008

When CNN links to you

What do you do? I wasn't even going to tell anyone, seriously. Is that so strange?

When Anna Jane Grossman interviewed me I was terrified and I begged her, Please, please, please, don't use my name. Nothing good can come of it. If you must identify me, if you absolutely must, use a first name. Use that. But don't, don't, don't even do that. Try not to even do that.

So she did.

But I'm so grateful that she limited herself, really, so thankful. And it's a very nice piece. I think real journalists (I never took a writing class, got a low B in rhetoric many, many years ago) are pressured to reveal their sources, that legitimates them. But the Wall Street Journal often uses the language, People close to the matter, which is very elegant, I feel.

Anyway, after thinking about it, I emailed the kids. Then later, told Mom.

But blog on it? Whatever for?

Well, there's a rule, I think, in cyberspace, which is a culture, that you link back. You give credit. You thank. You don't plagiarize. And you do try to boost up others. It's a non-compete clause, so to speak, at least blogging is. And as one who truly hates competition (see posts on baseball games), I feel it's a nice ethic.

So THANKS, CNN, especially Anna Jane. And here's that link, friends.

You gotta' love 'em.



therapydoc

Myanmar and Relativism



I felt like writing something about the news, and because I watch CBS Morning News (I like the whole team), had to choose between Positively Prom Week or

Myanmar.

I picked Myanmar over Prom Week.

I know, I know. You wanted Prom Week. So check this website (sure, they're selling stuff, but it's still cute) for a Prom Dos and Don'ts list. Maybe we'll embellish it later.

But.

A cyclone wiped out nearly one hundred thousand people this week in an impoverished country, Myanmar (think Burma, Monks, Thailand, that little cranny of the world). The military regime blocked humanitarian efforts at rescue and support, too, strangely enough. Food, medicine, water, all turned away by the junta. The alternative for the people of Myanmar is salt water.

Today the junta let U.N. rescue efforts into the country, and Turkey promised a million dollars in relief assistance.

Why should we care? It’s so far away.

Maybe it helps us put our own stuff into perspective.

Ironically, I tell depressed people not to watch the news. And I mean it. If everything depressing makes things worse, then turn off the teev. (Television has everything depressing, even funny can be depressing when you know it's funny but you can't laugh).

For those of us who can take it, the suffering of our race, the human race, I mean, not the race divided, watching the news is simply what we do. Although depressing, scary, and sobering, events near and far away tickle at our sense of relativism, assuming we we let our defenses down, release ourselves from our self-protective comfort zones.

Relativism is that healthy perspective, the one that mental health professionals often talk about, the one we can’t ram at you for fear you’ll think us not empathetic. Yet we hope that at some point you’ll come to own it, too. Really own it and find comfort in it.

You can still be depressed. It's okay.

Relativism means:
There are others worse off than me.

There but for the grace of . . go I.
It could be us in Mayanmar. But it isn’t.

So we give charity and lobby for our government to help the suffering nations of the world. And for a moment, from our armchairs watching digital H-D, that hot cup of coffee at our sides, nibbling on a croissant, wondering, What should I make for lunch, from this heaven on earth some of us ask, How did I get so lucky?

Holocaust survivors think this way every single day. Clean drinking water and food? Gevaldik (delicious)

Not everyone has it. It's salt water in Myanmar. That’s what they’ve got.

Asleep as Cyclone Nargis hit, people woke up to the sound of high winds, roofs flying, trees falling, some on their own homes. I can't imagine.

therapydoc

Tuesday, May 06, 2008

To Cut Risks of Sleeping Pills


Don't take them.

Melinda Beck, in today's Wall Street Journal, suggests hiding car keys, unplugging the phone, preparing for impending disaster. That's if you must take the new-generation of sleeping pills.

She's referring to the NBZs the nonbenzodizepines, especially Zolpidem (Ambien). Ambien knocks most people out like a 2 x 4 at the back of the head. But some people, under the influence, do things they regret.

There are documented cases like this one: A person takes a pill, has a beer, then decides to go out for cigarets, forgetting to open the garage door before backing out the car.

So we might suggest, too, as Ms. Beck does, don't use these drugs with alcohol.

Obviously some people need sleep medications and I'll be the first to suggest a medication evaluation from a medical doctor. When I say, (above) Don't take them, it's really you, initially, who has to determine if you're in the Some People Really Do Need Them category. If you think you are, a medical doctor still has to agree with you.

It's a medical decision, prescribing medicine.

I would still urge you first to try Ms. Beck's alternative advice before you nag your pri-care for a script.

She recommends, on the front page of WSJ's Personal Journal, First try exercise, stress reduction, and avoiding caffeine.

I'd add,

And for sure, get therapy.

As long as we're adding, let's go for it.

Develop an evening wind-down routine. No more eating or drinking after dinner, except for a cup of tea or another hot liquid, maybe soup, but nothing too creamy. Sugar arouses us and everything we eat breaks down into sugars.

Call your mother, father, sister, brother. Or friends.

Undress, bathe. Read. Learn something. Create something. Creating really tires you out.

Watch television, the great soporific, but not too late.

If you go out, don't stay out to late.

Dispatch anything work related to the recycle bin. Oh. Can't do that?

Have sex.* Make love. Discuss love. Embellish the meaning of love.

And if you're still unable to sleep, plan a cat-nap on your coffee break the next day. And skip the coffee altogether, if possible. Maybe, since that may be impossible, unfeasible, a ridiculous suggestion, strategically plan one cup. And eat really light.

You'll make it through the day.

yawn.

therapydoc

*Sex, as you know from previous posts, (did I post on this?) is the natural tranquilizer.

When You Fall Out of Love

A short post, call it Therapydoc Unsolicited.

Jack writes about a friend of his who has fallen out of love with her spouse. She's having difficulty, as one might expect, having sex. But she does it anyway.

Which is martyrdom, not that martyrdom is bad or good. That would be a contextual thing.

I commented on the post:
Jack, she's lucky to have you for a friend. But please tell me that you told her to get a therapist, right? One who does marital, too. One who can get her boy in the room.

You don't always love your spouse is the truth.

You don't always anything over time.
Life, especially the life of a relationship, is much too complicated for that.

therapydoc

Monday, May 05, 2008

Captive

You know how it is. You're at a dinner, seated with people who kind of know you, but don't really know you, and you don't know them.

Like last week. I'm at a wedding. The woman to my left asks me, So how did you get to be at the cousins' table?

Um, I'm the groom's cousin? His mother is my first cousin?

We had this same conversation at the last family wedding about six months ago. You can't make this stuff up, seriously.

Anyway, if people don't know exactly who you are or what you're up to, you have the social advantage and can make up virtually anything you want when they ask, What do you do?
I sell flowers.
Therapists can have a little trouble leaving work at the office, so we try to keep our conversations outside of work manageable.

The truth is that I don't mind working when not officially working. Sometimes, maybe more often than I care to admit, it seems there really is no turning off the therapist inside. So why try? Without proffering advice, we all see the wheels spinning.

It's sort of like being an off-duty policeman. The cop isn't going to watch someone bleeding and not intervene, if only to get an ambulance. Our professional boundaries only go so far.

It's irresistible, I think, when we're intimate with people, especially professionals, to discuss personal things, the things that simply go on in life, more so if they bother us.

Therapists, medical doctors, lawyers, sportscasters, virtually everyone is fair game for professional boundary violations. We're going to go after opinions from the experts. My brother, a doctor, will be sitting at a restaurant and someone will stop by his table and literally unbutton his shirt.

FD can't make it through a morning religious service without a member of the congregation asking him a medical question. And those are relatively short services. He's often interrupted at the most inconvenient times. They should only know.

And yet we say that violating boundaries is really a So what? So people ask professionals for free advice. Really, we don't care that much. It's the time we're jealous about. Make it a quickie.

What prompted this post, ironically, is the idea that professionals also steal time. In someone else's office, we're all captives.

Take an open mouth in the dentist's chair, for example. Or an exposed leg at a podiatrist's. We're in compromising positions (think pap smear). Or there are funny electrodes attached to our chests. Because we're waiting for the doc, he can get whatever else he needs or wants accomplished on our time.

And for some of us, that might mean finding someone to talk to. If a doc hasn't seen me in a long time, he feels he has every right to tell over his entire life story before giving my chart a second thought.

And I'm in that stupid gown, let's not forget.

But it's fun catching up. Life is one big soap opera, you know.

No question it's the time thing that's most annoying, especially if a person is used to saying,
Oh, I'm so sorry. Those 45 minutes are up. See you next week.
And yet someone like me won't want to cut short the doctor who might be doing surgery on me someday. Let him talk about his vacation if he needs to talk. I want him happy and grounded and ready to work when he puts on those gloves.

I left an appointment with a doctor today really late, narrowly missing a parking ticket. In my head this should have been a 15 minute visit but it's gone over an hour. I see the meter flash red and a policeman making a U-turn. Luckily, I get out of there fast enough, avoid the ticket. I check my phone at the stop light, read a text message from FD:
WHEN ARE YOU GOING TO PICK ME UP!!@?
I text back:
He just stopped talking. I should be there soon.
Driving fast (for me) I make all the lights. My guy is in the car moments later. He's smiling.

"Who charged who?" he laughs. And without waiting for an answer, "You have to write about this. Therapist held captive. Escapes."

It's always this way. (I'm making all of this up, okay? Don't spleen me). Waiting for a dentist to tell me the names of every person he saw at a benefit that I shouldn't have missed. Or perched on the exam table, legs dangling, waiting for a tennis elbow cortisone shot as the orthopedist fills me in on the details for the funeral for his dog.

Or at the beauty parlor, where it's supposed to be the other way around, when I'm supposed to be the one to do all the talking and she's supposed to be the confidante, I get the update on the drug problems of my stylist's fiancé.

Would I have it any other way?

No, guess not. But I do like those dinners when I can say that I'm a legal secretary for all anyone knows or cares. Or that I track animals for the Department of Forestry in Morton Grove. Or I teach meditation or better yet, yoga. Even if it's all in my head.

copyright 2008, therapydoc

Sunday, May 04, 2008

Different Children

Get yourself a cup of coffee, maybe cut up some fruit. Then come back. Don't forget the napkin. And kids, remember. Your teachers can check online for that plagiarism thing.

We've talked about the trauma of childhood, how personality is shaped by things said and done.

Different children are shaped in some of the same ways. One child can come out of an abusive childhood forever needy and clingy, not having established basic trust in people, life, or himself, Don't Leave Me, Please, a song for a lifetime. No, make that a whine. This adult child wears his fear of abandonment like a badge.

Whereas another grows the proverbial chip on the shoulder; paranoia the flavor of anxiety. He's easy to anger and will attack first; a partner had best know that.

The acquisition of such personality traits is not a given by any means, or an either/or. Understand, there are many variants of children born to abusive circumstances, and many variants of abusive circumstances. But these two products of child abuse are often seen together as a couple, attracted to one another, repelled at the same time.

So we'll look at their dynamic, consider a male-male relationship, just to shake things up a bit. We could easily have chosen a heterosexual example.

Bad Boy, now in his late twenties, has suffered verbal and physical lashings from both parents and has internalized negative messages about himself. But he's not stupid. He knows that parents should never be mean to their children, even as they say, We do this for your own good. They are lying.

Some children, like him, have built in deception receptors; they sense that the people hurting them are not of stellar character. And they know that despite those reassurances that this is for their own good, that they will lose more than they gain in the process of "character development." Bad Boy still smarts from the words of such people.

Good Boy has suffered fewer personal attacks than Bad, but watched a good deal of parent on parent violence. He has also taken in his fair share of negative communication, insults, and abuse. His parents, locked into one another, wasted their personal best on their own conflictual relationship, while he identified with the victim, his mother, bleeding with her tears. He hurt when she hurt; he hurt past her being hurt. He was more vulnerable than she, only a boy, after all.

He's not stupid, either. He knows parents should be attentive, that they should be there for their children, should answer to their children's fears and emotional needs, and that his couldn't. He knows he's been cheated of a healthy childhood and he knows that his dependency, his insatiable needs from a lover, dominate his interaction in relationships. He can't help his need for feedback, his craving for love.

Love is Good Boy's drug. His lover is of a different psychic make-up, more prone to avoidance, more likely to abuse substances, enjoy rough relationships, and avoid closeness. This is unfortunate for both of them. One really can't help the other without some sort of intervention, some cognitive change.

Neither is whole, neither feels quite right. Bad Boy, the more aggressive young man, is less mature, lashes out under pressure to be emotionally intimate. (We think of intimacy as mature, but measured). Good Boy, in touch with his own desperation to be in-relation, shares all, intimate to a fault. He endangers himself.

So different! What are they doing together? The simmering one, his anger palpable, actually feels safe with one who wants him, needs him, adores him, and he has talked with him about his childhood. He's talked some, not a lot.

The one who craves intimacy isn't happy with the volatility of their relationship, but feels safe, ironically, with someone who seems so strong. Tough. Strong. Same thing?

The dynamic is captured, frozen early in their relationship.

Bad Boy knows that if anyone metes out punishment, it will be him. Good Boy is willing to risk that, knowing there's little he would do to endanger his lover's favor. He'll keep the conflict to a minimum, and the dynamic is just that, conflict at a minimum. The verbal sniping is uni-directional, from Bad Boy to Good Boy, never the other way around. To both of them it is relatively tame compared to what they had as children. But painful.

Bad won't work to please Good. He's not going to change, he says. This is me; I won't commit. I'm my own man. He has that edge, well-hewn over a lifetime.
The most important people in my world were never there for me. I don't need them, or you, or anyone else.
He thinks he has overcome his dependency needs and is annoyed at the dependency of his partner, although he needs him to be this way, dependent, to feel safe.

Such a conundrum.

Then it sometimes happens that Good Boy is let in, sometimes for quite awhile, and things get very affectionate. This is when being in-relation for Good Boy is wonderful, but most scary to Bad Boy. The intimacy tweaks at his primitive, unconscious, failed familial relations, which is where it gets dangerous.

Feeling violated by the intimacy, Bad has to stop the tweaking. He's entitled to his privacy; the rule is he gets to be secretive, gets his space. So he lashes out when violated in the name of intimacy, pushes Good Boy away.
Good: Where have you been?

Bad: You don't need to know. You have no right to know.

Good: Oh, sorry.
These games may be described as dances in the various self-help books at Borders. Go there and read them before they close all the book stores and you can't get an education for free off-line anymore. I personally prefer the feel of books to the glow of the screen.

But back to our story:

Bad Boy becomes mean and immature, aggressive and spiteful when Good wants more of him than he's comfortable giving. Bad Boy becomes abusive like the people who raised him. Transgenerational? No question.

Good Boy takes it. Ironically, he's perceived by his aggressive partner as smarter and more accomplished, and he is, but insecure.

Bad, even though he's less educated, less accomplished, even though he feels inadequate by comparison, is only safe because Good is this way, insecure. Bad Boy benefits by association, too, with an accomplished partner, and owns some of that accomplishment (in-relation).

And he stays on top by sniping when his partner is most vulnerable, when he says, Don't leave me, please.

It's a hot button. You don't own me, his refrain.

Some of us see relations more as opera than dance.


It is the needier, sadder partner who comes for therapy. Tougher, perhaps more wounded people, the bad ones, don't voluntarily risk exposure, the stuff of therapy. It's an art, of course, therapy, peeling back all those layers, and takes forever sometimes. Exacted carefully, it shouldn't hurt, but not everyone knows this.

So angry people like Bad Boy mostly come to therapy when they're court- ordered, or when Good Boy can take it no longer, forces the issue and leaves. And he's not likely to want to take that step, so in love.

It's the needier sadder partner, who comes to understand (in therapy) that his tough lover really needs his sweetness, his warmth and tenderness, but in small doses.

Affection can be overwhelming, a reminder of what a person didn't have as a child. And as a child, Bad learned, Don't get sad, get mad. He's a master at putting on the brakes when reminded of what he didn't have, when he begins to grieve, unconsciously. He reflexively pushes tears and all tenderness away.

His defense,
I don't have to tell you.

You have no right to know;

you don't own me
completes an emotional feedback loop. Only a strong person can say things like,
Because, that's why.
Good Boy could never talk back in this way, it's not nice. Good Boy's greatest mistake is that he misinterprets that resoluteness as strength, and he associates strength as potentially protective, as often happens in child abuse.

Nevertheless, he'd like a way into his lover's psyche. How do you gain entry to a gate that's been locked, double locked, triple locked, then locked again?

Couples therapists label the interactive dynamics for Good Boy, who comes to treatment. We'll do the psychoeducation, draw the feedback loops, assist in highlighting the childhood relationship systems of our patients. (It's what you pay us for.)

But when one partner is in therapy and the other is not, it is expecting too much to send the attendee home to teach, especially if the other is already on the defensive and doesn't want an education.

So we'll say to Good Boy,
When he's mean, tell him, 'I know what you're doing, and I just want you to know, you don't have to do this.'
Good can get even more specific and say,
'I know you need to push me away. It's okay. I just want you to know, I won't hurt you. I would never say those things to you, those things your momma/poppa said to you. You know that by now. Don't you?'
Changes in these relationships, these homeostatic feedback loops so deeply rooted in the psyche, can take years, literally, with therapy. That's why most individual therapists will say, Forget him. Change you. Become independent. Don't be so desperate. Find someone nicer. All good advice.

And so easy, right?

copyright 2008, therapydoc

EDITS: Things I took out of this essay for one reason or another, yet feel are still relevant.

In adult relationships we become the mothers, the fathers, the sisters, the brothers, the best friends and enemies of our significant others. For better or worse. Recognizing where they need to be better, how they feel worse, this is the essence of a couple diagnostic.

The types of loving parents you read about on the Mommy Blogs are as illusory as fairy tales in the minds of abused children.

In couples treatment, when we suggest to the healthier partner that he or she model positive parenting, it can be a huge stretch, very difficult to enact, and the audience is booing, scoffing.

It's always that trust thing.

In individual therapies the therapist can take on the role of the good parent. Or the bad parent, when therapy is stressful. Or when we take a vacation.