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Friday, June 27, 2008

The Dream, The Sub-text

I try to keep my text messaging down because AT&T is taking me to the cleaners. But the other day I sent this one to Empath Daught, couldn't shake the image in my head. Recurring memories are symptoms of Acute Stress Disorder, but we didn't make all the criteria here, thankfully.
Last night I had a dream that a dictator of a southasian country took me captive and locked me into a small box.

U were with me and also in a box, but somehow you persuaded him to let us have bigger boxes.

Between you and me, I think Aba was hogging the bed.

Love you, mom
Aba is FD, of course, her father. You might read all kinds of things into this, but dreams aren't always that complicated. On the other hand, I'm not taking a vacation any time soon.

therapydoc

Thursday, June 26, 2008

Smack

Alternative title, How Much Do You Ask Your Kid?

I talk a lot about giving kids space, especially teenagers, letting them make decisions, even if they might be the wrong ones, especially if the decisions really won't make much difference in the Big Picture, and most don't, most are innocuous decisions.

But face it. Some are more innocuous than others, and kids will get themselves into very bad situations that they could have avoided had we only reeled them in, in time.

So I'm just going to throw out a little public service announcement here. It's summer, and the kids are home from school. They're going out late, breaking curfew, and sleeping late in the morning.

Even if you're up at 2:00 a.m. to get their scent, you know very well that it's possible your kid is smoking pot, or drinking, maybe even using cocaine or designer drugs, but by the time they get home, the look is less than trashed, less obvious, and short of drug testing, you rely upon what you see and hear, and face it, you're hoping for the best, giving the benefit of the doubt, wanting to avoid conflict, but more to the point, hoping there is nothing to worry about.

Closing your eyes to make it so.

And your kid is being a normal adolescent, not talking much to you except to ask for the car keys, especially ignoring intimate questions. So you're doing what you have to do, which is giving him or her space and time to grow up, to think things out, to decide the best way to go.

Nevertheless. I think it's worth it to ask about heroin.

Of course, within the guidelines of respecting boundaries, you still warn your kids about all of the other drugs, too, and about alcohol, and share some of your personal experiences (you must). You do ask questions, pointed questions, all the while giving space, not intruding too much, and respecting this growing organism's right to grow towards the sun. But if you don't ask, you don't care.

In any case you can't assume the only drugs out there are "soft" drugs. There's no good illicit drug, don't get me wrong. But there are the softer entry drugs. And there's heroin. And an overdose with heroin, or taking in bad heroin is a really bad thing, the end of the experimentation, the end of testing the limits.

When you ask, your kid will respect you more, maybe even tell you the truth, that it's out there. Why? Why would you get the truth? Because kids are scared, too. And it's your job, frankly, to scare them, so they can be even more scared.

Do they blow us off? Do they ignore us? Yeah, sure they do. But they still hear us talk, flapping in the wind; they hear words like, "I hear there's some bad heroin out on the street from Columbia and someone died, a young kid died from it. Is it going around? It's tempting, I know. I was a kid."

You can lie, here, about it having been tempting to you, or not even use the line. But if it is tempting to your kid, the kid will look at you like, HUH? And maybe be honest with you. You never know.

Just tossing it out there. For discussion.

therapydoc

Wednesday, June 25, 2008

June back a' cha

This is your not-so-monthly monthly round up of some of the bloggers who have linked to me on their blogs, a thank you kind of thing, and a welcome to my world, even if you've been out here longer than me, and many of you have.

It's a community. If we wanted, we could probably attend religious services.

If I missed you this round, sorry. I'll get to you another day, blee neder.*

You know I have a soft spot for the wild creatures and have mentioned Bambi, who apparently is a male, and it was nice of you not to correct me in a previous post, although I wouldn't have minded. Deer don't seem very wild to me, not really. Time Thief tells us about the deer totem in a sad true story that reinforces how little I know about animals.

For those of you interested in medicine and nursing,
Nurse Ratched can break your heart.

Feminists who link to other feminists are my friends. Check out FeministGal.

Personal bloggers would be, Friday's Child, Amanda's Blog
and Simple Harmonic.

And you have to read Spontaneously Combusting Onions (how's that accomplished?)

Check out Magan's Blog Spot for really nice use of color and family musing.

Educator bloggers include the Adjunct Professor. In case you don't know, adjunct means too much work, too little money, and a tiny, if any, modicum of respect.

More therapy bloggers: Myshrink.com reads ENT and has plenty to say about you, and maybe her, too, getting therapy. . .We all have our stuff, she says. Read more on therapy and being insecure at Joylene's blog.

You bet.

We got a nod for that homosexuality post at Pink Hollyhock. I don't think I ever mentioned, but those flowers grew like crazy in our backyard for years when the kids were growing up. No idea why they stopped.

And I can't stop thanking CNN for writing about me and keeping my anonymity, too :)

As far as recovery goes, I love Syd's blog, and it doesn't hurt that gray background is so easy on the eyes.

Dave Pollard's got a recipe for How to Save the World, fascinating, captain.

To feel what it's like to live in Israel, read Elms in the Yard, coping with successfully with fever, never fun, and noise from the street party.

And there's Barbara, spleening about intimacy, so not alone.

And there's sex, of course, specifically the Carnival of Sex and Sexuality.

Have fun and be safe,

therapydoc

*blee neder is a reference (in Hebrew) to not making promises, just in case you don't keep them, which is bad, usually.

Thursday, June 19, 2008

Pre-marital counseling: Goin' to the chapel and we're . . .

How anyone goes into marriage without it, premarital, is still a mystery to me.

I don't know about you, but I, for one, have a lot of weddings to go to this summer. And sure, I’ll try to get over to Bloomingdale's (online, naturally) to buy presents, but just in case I don’t . . .

This one’s for you. Maybe it will save you time and money in therapy, or buying those books at Borders. On the other hand, it's not such a bad idea, buying books. And it makes for a nice date, good stuff to talk about.

Because marriage, commitment, is complicated. Two people, two very different egos, two very separate selves who come from two very different families (they're all different), with at least two different sets of expectations. Children from divorced, or blended families inherit multiple collective minds, each of its own culture, with different social, religious, political and economic biases. Add the well-differentiated siblings, and that's how many ways of doing there are to think and talk about.  That's how many, some not so silent, egos are in the room.

But young people who are marrying for the first time often look askance at their families of origin and the way they do things, because they assume that they're going to start their own, which they should. They should create their own couple identity. It's virtually impossible not to, which is why you may as well make the differentiation process conscious, becoming an entirely new social unit, or creation.

What trained (check out the certification before you see it on the wall) couples or premarital therapists, pastoral counselors, see that other people don't

Usually we're looking at people who think they know themselves pretty well, who think they know what they want, who think they know where they're going, or hope so.

We see individuals, even diagnose both, get a thumb nail of the family systems of each, and picture the two sharing the same family-room or dinner table nearly every single day for a lifetime. And if we do it well, we can see how all that certainty about identity and future might change. It has to change, but it would be nice to know that the changes will be in sync with individual goals, and that change is manageable, even welcome.  Not that we can actually control very much in life, is the truth.  But we want to try.

Some therapists (we like these) advise that the couple look into the past to predict, or better prepare for the future.

It is much more than one plus one equals two. Sure, there's talk of individuality, a couple discussion of personality, compatibility, as frank as you can make it. But if you've dated for a long time, done more than watch movies and eat sushi, then it is time to take a good hard look at families of origin, as well as the blended family. 

Now we're prying, seriously, but how can we not? Some say that people will never get married if they dig this deep, this far, but we do marry the family, not just a person. Parents and step-parents, adopted parents-- anyone significant-- can crawl into bed with us at the worst moments.

Not to get too oedipal. That's not the point. It's about the influence of the family, and the genetics, and what to do about it. Rather than close those baby blues and hope for the best, therapists encourage couples to look at certain things precisely and to genuinely consider how they'll have to cope with what they see in the future.
Things like:

(1) world view-- the way each family looks at life. Is it a bowl of cherries? A picnic? Sheer torture then you die? Should we really give ten percent to the church, or maybe more, and do the poor really matter? Are ethics important, honesty? Is it okay to marry outside the faith, will it make for a better life? Is it best to stifle emotion, to take life on the chin, rather than emote and blather? Do we have to dress up every day?

(2) strengths and weaknesses-- this includes mental illness, the skeletons in the closet, the arrests, the lies, the certificates and diplomas, skills and aptitudes, being stubborn, proud, unyielding, or overly giving. Giving in all of the time tends to bite us in the end. Resentments, like weeds, tend to fill vacuums.

(3) family ways of doing*-- this includes who cleans the refrigerator, and shlepping the garbage every day so that the spouse with the sensitive nose isn't subjected to foul scents, never romantic. This includes time for bed, and loneliness, touch, affection, and how that is addressed, what time to wake up, work ethic, and the ways extended family should be treated. It includes compulsions, things that won't give, and religious rituals, and whether or not two ways of doing can really live comfortably under one roof, i.e., a person who interprets the 10 Commandments to mean that even being in the same place with an idol is a sin, might not do well with one who worships in front of a statue. In other words, this is huge, should occupy your thoughts as a couple for more than one date.

(4) how emotion is managed-- is anger okay, is sadness, are tears a signal that the conversation is over, the person who is crying wins, or are the tears, is the anger validated, discussed rationally. This includes phobias, fears, including social phobia, and what to do when a spouse really should be at that office party but can't handle it, and it includes drug and alcohol abuse, including prescription drugs.

(5) ways of communicating, talking, answering one another. If working through issues means tossing insults to make a point, then the relationship might not work, not in the long run. This would include avoidance, not communicating verbally; or talking too much, to the degree that work isn't finished; validating thoughts, letting the other dream, plan, without bubble bursting. It also would include problem solving, which is a process, and generally requires very clear, empathetic communication.

(6) past trauma, or heartbreaks, as well as success stories, and family successes and failures, as far up the family tree as anyone can climb. Indeed any family stories are helpful, intimate, important. People don't share because they are ashamed, sometimes, but if a partner can't be trusted here, what will happen in the future? We marry a family, but we live with our partner, can't assign guilt, and probably shouldn't blame anyone in a family for anything. People have their reasons. It is the potential spouse who matters, his, her learning from what happened in the past that matters.

Throw in the na'rishkeit** and shtiklach,*** idiosyncrasies, too, and you know what you're getting into.

I think it's nice to know in advance. It's the what to talk about, the stuff that brings you closer. This type of interviewing is intimate, disarming.  Having the conversation without the therapist or pastoral counselor, reassurance of confidentiality might be necessary. 

And nothing can be used as future ammunition.

But if you're going to marry someone, why would you pocket information for harm? If you think you'll need ammunition, perhaps don't get married.  Marriage is about love, not war, being in love is being kind all of the time.

What happens when the premarital history is disturbing? More discussion, is all, no deal-breaker, hopefully. If the dialogue happens without the safety net of premarital therapy, then it might mean the couple really should seek professional help to work through fears about the future, to help them with that genogram, or family tree. History doesn't have to repeat itself.

There are such things as transgenerational problems. Family therapists change the proverbial writing on the wall. It is what they do best, predict the dysfunction, address how to manage it.

Take notes.  Write things down. Throw 'em into the wedding album.

therapydoc

original post, copyright 2008,

*I don't think you'll find this precise phrase, family ways of doing, in a textbook

***na'rishkeit in Yiddish means nonsense, childishness

***shtiklach are best described as idiosyncrasies

Wednesday, June 18, 2008

Dissociative Identity Disorder

Well, hopefully it doesn't apply to you,Dissociative Identity Disorder (D.I.D.)*

But it might. We used to call it Multiple Personality Disorder. Some people think this label applies to Schizophrenia, but because you read this blog, you know the difference.

People who suffer from Schizophrenia may hear voices, but they don't usually have multiple personalities. These are both Axis I disorders, by the way, not personality disorders (Axis II).

And this is not Depersonalization Disorder, either, which is getting some press because Adam Duritz of Counting Crows (a popular rock band) is said to have it. (Read Dr. Deb). Depersonalization Disorder features persistent or recurrent experiences of feeling detached from one's mind or body, as if watching the self as an outside observer.

I first came upon Dissociative Identity Disorder when I met a client who had been a victim of incest, we're talking about 1984. (If you're faint-hearted you may not want to read on. I'm changing all the details for you, so this is total fiction, and it's a quick read, but nevertheless. . .upsetting).

The patient, age 40 at the time, recalled being a child of about six years old laying helpless on a sofa while her father molested her in every way imaginable. She grabbed onto a lace tablecloth that covered an end table and twirled it in her hand while he did this, all the while imagining that she was someone else, another child, complete with alternative personality, looks, parents, name, toys, friends, etc.

She played her fantasy so well in her head that she didn't feel (as much as she might have otherwise) what was happening to her. You can see why she did it, tranced out like that. She came to like this other self, so much in fact, that she often referred to herself as the other girl, used the other's name.

The patient became the other girl, too, had multiple selves. After all, the other girl didn't exist except in her head. And as confusing as this sounds, she could switch off all the time, unconsciously or at will. She experienced reality at different times as two different people.

Since that time I've treated only two others with this disorder who described similar circumstances, one sexual abuse, the other physical abuse. This ability to dissociate, to separate the self or ego, from what is happening in "real" time, is obviously the ego's defense system operating in a most sophisticated fashion.

Sometimes a person develops several personalities, in which case they are called, multiples. One identity suffers, so it helps to have a few who do not. Understudies.

Treatment's remarkable.

Anyway, I thought you'd like to be able to diagnose this for real, just in case you sometimes wonder,
Am I? Is she? Is he?
Here you go. 300.14 Dissociative Identity Disorder
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).

B. At least two of these identities or personality states recurrently take control of the person's behavior.

C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.


therapydoc

*You can read more about it in the Merck manual.

Thursday, June 12, 2008

Don't Super-Size Me: The push for calories on menus

I didn't see the movie Super Size Me, to tell you the truth. The thought of watching someone gorge on super-sized portions just didn't appeal.

IMDb (where I get all of my movie facts) tells us that movie filmmaker Morgan Spurlock embarks on the most perilous journey of his life. He can't eat or drink anything that isn't on McDonald's menu; he must wolf down three squares a day. He must consume everything on the menu at least once and super size his meal if asked.

Just not pretty.

In my two dozen plus years as a therapist, I've shied away from specializing in eating disorders. By not specializing, I do very well in this area, weirdly enough. I won't specialize because frankly, everyone is sensitive about weight (everyone). And weight is very hard to treat, even with "specialist" written before or after your name.

Because it's such a universal, when people tell me that they want to work on their eating I say, "You'll have to find another therapist if that's all you want to work on. I'll work with you on everything else, your behavior, your thoughts, your relationships, your organizational skill, your emotional management, anything almost, except for eating, and certainly not eating disorders. I won't set out to treat those. If they happen to change over our time together, great, but we're not setting out to cure them."

Why? (a) I like success in my work, prefer to see change fast, and (b) These are the hardest disorders to "cure." So put (a) together with (b) and you get my drift. Oh, and did I mention the paradox in all this?*

The truth? Eating really is an emotional affair. How can it not be emotional? It's about how we look and feel; it's so emotional that no matter how you slice it (all puns in this post may be intentional, I'm not sure yet) until you get yourself emotionally grounded, which can take years, it can be very hard, excruciatingly hard to control one's eating.

This is the essence of anorexia, by the way, control. You can't make anybody eat.

And far be it from me to try.

And you can't make anyone lose weight, either.

My patients lose weight, there's no question about it, without focusing on food as a therapeutic issue, perhaps by not focusing on food as an issue. When we spend a year (okay, more) on the emotional stuff, the pounds tend to peel off slowly, but still. It is a lovely thing to see. Two of my patients in the past year have lost over a hundred pounds each. Both had seen me for nearly three years before they started to lose.

No, it's not science, but it does seem to be a pattern in my practice, maybe is for others, too. Get therapy, take it seriously, and you'll get a handle on your life. Eating is a part of life.

I haven't tackled this topic on the blog until now because it's so huge, and I have so much to say about it. The only way is to begin a discussion is to focus on something in particular, and since WSJ offered me the perfect entree, let's start with Page 2, July 10, 2008, The Wall Street Journal, The Push for Calories on Menus.

Apparently some states are passing laws (or trying) to force restaurant chains to list the caloric and nutritional value of items they serve on their menus. Stu Woo tells us that the California and New York state legislatures have joined a movement approved by health advocacy groups such as the Center for Science in the Public Interest. Other advocates for content disclosure include the American Cancer Society and the American Heart Association.

These organizations agree that if we tell consumers what they're eating, they'll be less likely to eat as much.

Menus with caloric and nutritional information might make some foods less tempting, obviously, something restaurateurs are leery about. And they pay taxes, too, which is why state legislatures are keeping their sights low, only targeting large chains with 8 or more restaurants. Advocates believe these measures, posting calories on walls and menus, are a step towards addressing the country's obesity problems.

A May report by the Los Angeles County Department of Health indicates, based upon "conservative assumptions" that posting calories on menus might result in approximately 10% of restaurant patrons ordering reduced-calorie meals. Changing the eating habits of ten percent of anything is amazing.

And it sounds cheaper than years of therapy, so I'm all for it.

Because at the end of the day, weight control is all about calories in, calories out. If you eat more food than you use in a day, the rest goes to the thighs; or wherever your body feels most comfortable storing it.

But wait a minute! Here's another novel idea (not so novel, okay). What about learning the caloric content of food, cooking for yourself, eating from your own kitchen?

I realize it's easier to pick up the Weight Watchers meals (the only diet I ever recommend when pushed to opine). But there's really something very satisfying about seasoning your own food, sauteing those lean meats or vegetables in just a little olive oil, tossing out the egg yokes. Who cares how rich they are in vitamins?

But when I talk like this in therapy, when patients get me to talk weight control, to talk about exercise (they see my bike) and healthy eating (my sandwich), all I get back are blank looks that say, Why would I ever do that?!

Exercise regularly? Cook? Prepare food? Insane!

Which is why I don't treat eating disorders. Although I could steer away conversation about my bicycle, it would be impossible for me to not talk food, not to impose my palate, not to suggest the ideal sandwich. And a patient might think I'm not empathetic to the situation, which is totally not true, patently unfair.

And yet, just a little olive oil and some garlic, throw in a half-inch of fresh ginger, but don't forget to discard it before you eat. . .it's such a good thing. . .


therapydoc
*a paradox works paradoxically, meaning if I say I refuse to work on this with you, you're probably really going to want me to work on this with you.

Sunday, June 08, 2008

Keeping the Pace

I don't know if it's me, or if it's being a therapist. Therapists are in tune with people, certainly the ones they treat, or they should be. They get the energy, the feelings, the intensity, that urgency for speech, and hesitation; the pause we talk about. I think, honestly, like other artists, maybe, dare I suggest actors, we're into timing.

There's a certain sensitivity to other people and what they need Right Now that defines the better therapydocs, that and a fine education.

But maybe you don't need to be a therapist at all to have that sixth sense. I'm sure you don't. I know you don't.

Anyway, this little aptitude can get in the way when there are competing bodies needing something different from us Right Now, when the Right Nows are in competition. This is very much the dilemma of family therapy when the therapist doesn't set a solid boundary, which can happen when the therapist is human and not a stone. And to be effective a family therapist wants to be one of those, a human, and can't help but become a part of the family system. The salubrious part, ideally, the one that discusses the parts, the players, and the system.

We're the conscience in some families, the ego in others. Sometimes the id. Add the community system that refers you to us to that mix and we can totally lose our personal identities. Want to feel enmeshed and dissociated all at the same time? Become a family therapist.

Feeling torn between competing bodies happens more often, really, when we deal with our own families, our children and our parents. At least it does with me. I'm pretty strict about boundaries with everyone else.

So here's the story.

FD and I got on an airplane on Friday morning, cruised airspace (I got a great deal in April) for the nearly four hours it takes to touchdown in Los Angeles. United was great, by the way. I don't know why, but we had more room to breathe it seemed, on that 757 with 38 rows, 3 seats abreast, music, a movie (terrible, I only watched a little, but still; FD never glanced up) and snacks galore if you're into that sort of thing. In the middle seat you take what you can get in terms of cheap thrills, and well, you know me.

My son picked us up at LAX, wouldn't hear of our taking the shuttle, and I popped into the backseat of his old Presario next to my granddaughter who was sound asleep in her carseat, slumped over so I couldn't even see her face. There's plenty to talk about with my son and last Friday was no different, so I forgot about her.

All of a sudden I hear, "Bubbie?!" I turn. Huge, huge smile.

I'm in. Anyway, we had a very nice chat about the bugs on the mountains and she couldn't wait to see the lime green ballet slippers I bought her. When we arrived at Empath Daught's house, my daughter had timed it perfectly (is this genetic?) and she drove up right behind us, just seconds later, with the boys.

Heaven on earth, surely, so much to catch up on, and Where are the Toys is still a fresh scene out of a Disney movie, no matter where we get the toys or what we pay for them. They need so little, kids, when it comes to help with playing.

Anyway, I don't travel as well as I used to, and didn't get my nap. The weather was beautiful, warm and sunny, dry like a desert should be, low 80's. Playing most of the day into the night is fun but I'm pretty wiped by dinner, which is so late on Friday, almost 9:00 pm. Dinner's an elegant affair, a welcome for the Sabbath bride, we're almost second to her arrival. It's unconscious the intensity of preparation, replete with the Oh, we forgot to feed you epiphany and No, we didn't want to eat lunch. Everyone's fresh and clean and dressed, and last I remember of the dinnertime conversation is my granddaughter saying, "Bubbie's sleeping," and it was true.

Some therapists are awake even while asleep, something to remember when yours dozes off, but I'm not.

I've got Rac on my right playing the most remarkable game with my granddaughter. The kid is on her lap, and I am in awe. In Stage I sleep I still hear the game, which goes something like: I love you, Mommy; no I love you, No I love you; no I love you, and they can go on like this for hours. If there's a break in the action by Rac, granddaught bursts into tears, so Rac, being an empath, doesn't allow for a break, lets the little one be the one to stop the game, for she started it, after all.

I awake next day to small hands and giggles, and since I'm not great before my second cup, suggest they stay with me for five minutes and let me wake up slowly. They are already on top of me, clawing at my flannels, so this suggestion thrills them immensely. We all fit just fine in the twin, like a glove, until one of them says, "I'm smushed," and it's over.

We roll out gradually and they take my hand, lead me to the kitchen where I pour the apple juice. (What is it with kids? Don't they ever outgrow apple juice?)

They find the mini yogurts in the fridge (horrible, horrible things), and while they eat these I have a chance to talk to FD who has found himself a comfortable spot on the sofa to drink his coffee and learn a little. He says, "You'll take them to shul (Sabbath morning services)."

Oh, I don't think so.

"No, you should. They should go to shul."

"Don't hold your breath, sweetie."

"If their parents want them to go, you should take them."

"Oh, for sure. If they're parents. . . sure. . .but. . "

I feel bad for controlling the vertical and the horizontal, because he's got to go, has to be on time, but I've never been great with strong suggestions. If he begs I can't say no, not usually, but here we are, me and the kids, just getting cozy, and stressing to get dressed up, walking to shul, having to socialize, losing them to the multitudes, well, this isn't going to happen.

I learned long ago not to even try to dress my grandsons.

But I get dressed. They want to play a game inside but there's a sunny backyard and although it's early, this seems like a good place to be. I open the sliding door to the patio and take my siddur (prayer book) with me to say a few words to the Old Mighty in the sun.

The boys are already there, of course. You know how it is when you open a screen door and the pets dash outside? This feels the same to me. My grandsons are checking under rocks for bugs and are throwing an avocado to see how far, exactly, one can throw an avocado. Can you imagine having avocados just fall onto your lawn, no grocery bag need apply?

After awhile they make it over to the new swing set, which is awesome, it's green and brown with one of those little forts on top near the slide, not as expensive as one might think, assuming you're able to install it yourself. I hear them calling me. "Bubbie, Bubbie! Push me, push me!"

I look up from the book, wave the, Just a minute index finger at them, finish my conversation, and stroll over to do the honors. The youngest needs a little coaching on how to pump, and although it's not something I feel is necessary, teaching him how to swing higher, I'm tempted to see how he'll handle suggestions and explain that trying to touch the sky with your toes on the way up, and bending them back at the knees on the way down really helps the game.

He does it, too, pumps more efficiently, but his brother makes a crack, "You're never going to get as high as me."

"Yes I can."

"No you can't."

"Yes I can."

"Not."

"And I'm faster."

"No you're not."

"Yes I am."

All this while I'm getting a bit of workout, pushing. I'm kind of getting into it, though, thinking that if need be, I can do this all day, push the kid on the swing. The sun is out. The birds are singing, the windchimes occasionally join in.

"Higher, Bubbie. Higher!"


copyright 2008, therapydoc

Thursday, June 05, 2008

Homosexuality

A friend of mine wants to know if there's a reason gays and lesbians need to get married. Heterosexuals, he says, get married for the express purpose of making a family. Why would anyone else care?

They want to make a family, too, I say.

An ah ha moment, hours later, having discussed this for hours over dinner. Hours later there's an ah ha moment.

There are a few things a person should understand about this subject, I think, a few basic things.

We could start with homophobia.

There's a Boston Legal episode in which a judge presents himself as a plaintiff because he has spent $40,000 to have his SSAD cured and he is NOT cured. He's suing.

What's SSAD?

I, too, wanted to know.

What is SSAD? asks Dennie (William Shatner) of the judge who is afraid he has it.

Same Sex Attraction Disorder.

The judge thinks there is something wrong with him because he is attracted to other men. He doesn't think he's gay. He can't possibly be gay. He thinks he must have a disorder if he has these feelings for men.

Sure, it's a send-off, a comedy, very funny, and highly recommended, but people do feel this way even in our more accepting society, a society that is slowly legalizing gay marriage, albeit regionally. Some people have very unsettling feelings about same-sex attraction, like they personally are bad for having sexual, emotionally charged, loving feelings for people of their own biological sex. This is called internalized homophobia, and it can start very young.

There is no Same Sex Attraction Disorder in the DSM-IV*. Never had one (not with that specific label, homosexuality sufficed); never will.

The medical establishment defines homosexuality as a sexual orientation, having a primary emotional/sexual attraction for individuals of the same biological sex. It is not a choice, and it is not a disorder.

Upon comprehending that they are supposed to get married one day to girls, many little boys are terrified at that realization. They panic, feel revulsion. Sure, certain little boys who are not gay will also express revulsion, too, at the thought of marriage to little girls. But when they get older, they're not in conflict about it anymore.

A boy who knows he likes boys won't express his true feelings, won't tell people about them, if they are obviously culturally taboo. He is likely to have self-esteem problems, too, if being gay is considered something bad in his community. Girls in love with girls have the same problem, conflicted feelings, sometimes shameful, and no one to talk to about them.

The beginning of the nightmare. You don't have to explain homophobia** to many young gays and lesbians who still, for the most part, are coming of age in heterosexist cultural environments. But this is changing, if not everywhere.

About half-way through the show, in my second mile (I walk slowly on the treadmill, jogging is for people who are in shape) Alan Shore, another lawyer, warns Dennie Don't fool yourself, Dennie. People feel that homosexuality is a treatable condition, something that can be changed if one has the will, the faith, the right tools, the time, and puts forth the effort to change.

Patently untrue.

In 1973 the American Psychiatric Association threw homosexuality out of the Diagnostic Statistical Manual (DSM-II, I think). The medical profession determined that having an emotional/sexual desire for an individual of the same biological sex is not associated with any mental pathology. There is nothing inherently sick about being gay or lesbian, bisexual, etc.

Like any heterosexual, a homosexual might surely have Axis I or Axis II disorders, such as depression, anorexia, alcohol or other substance dependence, narcissistic personality disorder, borderline personality. Just about anything in the DSM is possible for gays and straights in equal measure. But being homosexual per se is not being sick. No more so than being heterosexual alone makes one sick.

Kinsey first discovered that in fact, emotional/sexual attraction, what we now call sexual orientation, falls on a continuum, like other individual traits.

There's everything in between to two poles.


A person who has primarily (mostly) homosexual emotional/sexual attraction (left half of the continuum) is thought to have a sexual minority orientation.

Among other things you should know, especially if you are going to become a therapy doc, is that mental health professionals are liable to come under intense professional peer review if they tell students or clients that they can change their sexual orientation.

Think about it from the perspective of heterosexuality. Could you (assuming you consider yourself a heterosexual) will yourself to a primary emotional/sexual attraction to someone of your own biological sex?

Probably not. It might happen. You may have some same-sex attraction, everyone does, probably in their life-time, although they won't call the papers. Sexuality is quite fluid. But you can't will it to happen.

Likewise for people whose primary emotional/sexual attraction is toward individuals of the same biological sex. They can't will their brains to light up for opposite biologically-sexed individuals.

But if that brain lights up for someone in an intellectual, spiritual, emotional, and physical way, and there's that certain compatibility, certain comfort level, warmth, and assured security that this person should share a bed, become a partner, an executive committee member of a family, related, partnered in this way forever and ever? Then marriage is certainly one way of putting that into writing.

Marriage is a contract, and people like a deal.

What is interesting about it for someone like me is this: Having fought so hard for the legal right to this contract, one that includes the benefits and trials of marriage, will gays and lesbians have a lower divorce rate than heterosexuals? I think heterosexuals are closing in on fifty percent, have been for twenty years.

I know, I know, too many variables to tell. But we'll be watching.

copyright 2008, therapydoc

*The American Psychiatric Association publishes the Diagnostic Statistical Manual. We're now in the fourth edition, patiently awaiting the fifth.

**This is called internalized homophobia, when a gay or lesbian begins to fear being himself (herself).

Sunday, June 01, 2008

Cholent

It wasn't like Memorial Day wasn't memorable; it was. We had the dedication of my aunt's stone at the cemetery. And then there was Iron Man.

Iron Man! The kids surprised us, picked us up to go out with them. It's great entertainment, especially if you want to become an engineer. It's a movie that illustrates the symbiotic relationship between energy and creativity. And Gwyneth never takes off her heels.

But we pay for those short weeks, taking off for Monday holidays.
Tuesday, Wednesday, Thursday and Friday killed me. I know I beat on this subject, but when people spend too much time with their dysfunctional families, they feel it and we therapy docs take the fall out. I'm not complaining, just restating the obvious, and Memorial Day, especially, is no joke.

And then there's the opposite, too, not having enough time with anyone on a holiday, having no family around. Your friends are with their families and you're stuck with time, too much alone.

So we're all happy when things get back to normal. Yesterday I went to shul in a pretty good mood and heard the rabbi talk about how people should recognize their flag, should go out and work their strengths, do it before it's too late. Contribute to the world. Be someone. Put your best stuff out there, whatever it is. (I think this is what he meant)

You bloggers and people who comment do that. The Rav does it differently, plays a different field.

Anyway, I sit in the balcony of my synagogue and gaze down at the sea of taleisim, men in prayer shawls. In the balcony the women aren't really very far removed from them, not by a long shot. It's been engineered so that we don't have to climb a million stairs to get to our section. In fact, the men are downstairs, and we're on the main floor. We have the better seats. It's really very nice.

We get to see the little kids playing in the aisles below. Orthodox synagogues aren't usually stuffy places. The decorum, some might say, leaves much to be desired. There's no organ, no choir, nobody even to tell you what page you should be on. You never know who's going to lead the prayers or what tunes they're going to use.

Yesterday the tunes were really good.

As much as the shakers and movers in Orthodox Jewish synagogues would like to keep the kids out of the sanctuaries (they can pay handsomely for youth group leaders and babysitters), we really don't mind them running around a little. We like them to see the Torah, we like them to touch it then kiss their hands. There's always a candy man or a candy woman passing out chocolates. We want them to experience what we experience, just a little awe.

And they learn the liturgy this way, too, just listening, hanging around and bouncing super balls, reading picture books, occasionally checking in with their dads.

So I'm upstairs, front row, looking down. Three of the cutest little guys, all between three and five, wearing blue shirts and over-sized yalmukas are strutting around during the cantor's repetition, poking at one another.

It made me miss my grandsons in the worst way. I really tanked.

Pretty soon the service ended and I asked my mother-in-law if she was coming over for lunch. She said no, but she wanted to stop by the house for a minute. She also wanted to stay in shul for the kiddish, the herring, the shnaps and cake, the cholent (cholent is a hot dish of potatoes, beans, meat and unidentifiable vegetables).

It's soul food.

I said, "I'll wait for you outside."

Feeling this bad is irrational, of course, because I'm going to be visiting the kids this week. In a few more days I'll get on an airplane and they'll run full speed into my arms and it'll all be good.

Outside I found a comfortable spot in the sun to wait and to warm up. It's always too hot or too cold in shul, and today it was too cold. So there I am, soaking up the sun, and who should almost pass me by?

Tante Fela.

She stopped to ask me something, some after-thought that you ask a stranger, and suddenly she realized it was me.

Tante Fela is as short as I am tall, meaning she's about two feet shorter than me. She's a Holocaust survivor in her eighties and we paired up on a Jewish holiday for services and have been best buds ever since. (You can read those stories at the links below*. But I never see her, hardly ever.

"How are you?" she cries out. "I never see you!"

I bend down and give her a kiss on the cheek. "I know, I know. I sit on the opposite side of the shul."

"You should sit by me!"

"I know, I know. But my mother-in-law is on that side, and you know how it is. She would be insulted."

A friend of mine sees me and comes over, interrupts. She wants to know why I'm wearing a jacket when it's so hot outside. I ask her, "What do you think, why do you think I'm wearing a jacket?"(Last time it was, Why the earmuffs?). Then immediately I am sorry for beating on her and apologize. She laughs.

Tante Fela is ready to move on. "Good Shabbas," she says to me sincerely, "See you soon, okay?"

"I sure hope so."


copyright 2008, therapydoc

Edits and Out-takes from Cholent:

My mother-in-law joins me with another friend and the three of us are walking towards my house. While those two talk, I trance out a little and wonder, What is it exactly, that so gets to me about Tante Fela? Most people get to me, but this is something else.

And I think, It's being in it, in the relationship that begs relativism, that's what I love about it.

Maybe it's the only way that relativism actually works, a person has to be in the comparison, feel the comparison. If there are six degrees of separation from troubles, who cares?

But it's different when you're looking into the eyes of someone like Tante Fela. They're not six degrees away at all. You can read them.

She has lost most of her family, seen terrific atrocities, woken from a nightmare that she can't forget. It's different when the person has became someone and something from nothing, the stuff Jerry Springer's mother talked about on that trip from Nazi Germany to the United States. Ayn tat alles.

Someone like Tante Fela loses her spouse after sixty-five years and she's alone, but you don't hear her talking about joining him. She only has one child, and he doesn't live all that close, but she's so grateful she has him.

She saw people tossed around with pitchforks like hay.

Yet she's still happy to see the light of sun reflect off the grass, to make new friends.

You say to yourself, to be like this! You should, no question, have cholent with a person like this before the entire generation is gone and forgotten and can't repeat it anymore, all that stuff about man's inhumanity to man. Even if you generally avoid cholent, can't stand cholent, perhaps you make an exception, just for the zchus (merit) of having had cholent with a survivor.

And barring that, take out Paper Clips or KinderTrain or Schindler's List at Blockbuster.

therapydoc

Tante Fela posts started in 2006 with Yom Kippur

Then One Year Later

Self-denial and fasting

and now this one.