Thursday, August 28, 2008

Historic Speeches

It's hard living with a guy who has to pun everything.

FD walks in on me cooking this morning and he says, "Whoa, what's this?"

"Tonight Barak is going to make an historic speech. This is the anniversary of Martin Luther King's I Have a Dream speech. It will be historic, important, I think, no matter who anybody's voting for.

So if I don't cook now I'll have to cook tonight. And then I'll either burn something or miss something. History in the making, baby."

"You would be a great President," he says. "You'd make a hysteric speech."

Groan. I can't believe I walked right into that one. But he's not finished.

"You'd tell the people,
'I've traveled near and far, the length and breadth of this country. I've talked to thousands of Americans and I can tell you, from the bottom of my heart,

This is one of the craziest places I've ever been. Everyone needs. . .'
It's tough, I tell you. Hysteric speech.

Correction

I think that post, Your Letters sounded way harsh and made it seem as if I don't want any input from anybody, no email, questions, etc.

Nothing could be further from the truth! I've got unmet abandonment issues like everybody else!

So sure, you can write me with your questions and if they grab me, I'll post on them, if not "do therapy." It's mostly about grabbing me.

This has to be fun. It just has to be. So if I don't answer, if I don't post on your email, don't feel badly. I may get to it eventually, or it might land in that pile of unfinished business at the side of my bed. You have one, right? Bills you've lost, 'zines, books you'll never read.

Thanks for understanding. I rewrote the post to soften it up. So if it made you feel guilty, badly, whatever, let it go, and forgive me. You're all wonderful.

therapydoc

Wednesday, August 27, 2008

Your Letters

I've told people who email me and ask for help with personal issues that I can't do this online. There are many reasons, but the most important reason is that. . .

I'm petrified that I'll make a mistake.

We're close, there's no question, and bloggers and blog-readers are a community and a close one at that, loving even. But there's no way to do a real evaluation from a letter, even from a blog (although they're revealing, no question!)

But here's the deal.

When a person contracts for therapy we sit down in a room, eyeball to eyeball, depending upon the capacity for eye contact, and I listen for about 45 minutes or an hour, depending upon what we've agreed upon from the start. Then I listen for another 45 minutes to an hour on another day, giving both of us time to think, and then maybe yet another 45 minutes, and then another.

So it's a lot of active listening, basically, all the while watching your body, your face, your dress, and all that listening and watching shapes a comprehensive extended socio-family-medical-sexual history.

Then we probably will add other people in the flesh to the mix, other important players in the system. The first person to have made contact is considered the "identified patient" in the system, usually.

Eventually, sometimes sooner than later, I'll make several psychological assessments, perhaps with the help of another clinician or medical doctor's input, also systemic, and add a few numbers maybe to a person's medical history via this lugubrious process we call diagnosis.

It takes more than a DSM IV, not to make a big deal about it. But assessment is half the battle..

And then there are HIPPA (government privacy) laws to contend with, confidentiality and privacy are critical, so how do we address that on the blogosphere. Even if someone broke into my building, picked the double locks on my doors, somehow cracked the ones on the cold steel filing cabinets, nobody could read my handwriting. But you can all read my Ariel, or whatever font this turns into when it's published.

This is my long way of telling you that using this space, this blog, to advise people about their personal problems just can't happen. You wouldn't want it, really; it's not what you want, a half-baked consultation.

I'll support you, even try to give you chizuk* (strength) but will surely recommend that you get real therapy when you write to me. Everyone needs it, if only to deal with somebody else. We humans are impossible.

But I'm thinking it is possible to answer generic questions here. It's risky because context is missing. So much context is missing when you ask me questions by email. And if you provided it, if you wrote me pages upon pages of detail to fill in the context, would I read it? Would I listen? Would you keep on working after work?

Probably not.

I'm sorry. Don't hate me.

But lets give a few questions a whirl. We'll do it right now. See how it goes. You add the context, color the meanings in your comments, and I can spin them back. An intellectual exercise, for teaching purposes, not therapy.

We'll consider two of them here, then in the post below this, you'll have a little more to chew on. I guess I can't let go of that topic of shame. Not just yet.

But let's start with an easy one.

Recently a reader asked:
How do you handle it when you have to cancel an appointment?
I say that I'm sorry, but I have a conflict and have to reschedule. Rarely do I specify what that conflict is, unless there might be some lesson in that, some therapeutic import. An example might be My family (parents/kid) needs me. Family is important, you know, sometimes more important than anything else, even work.

If I haven't given the patient 24 hours notice, then the next visit is discounted somehow. We figure this out. And sure, we talk about it if necessary. For about three minutes.

When a patient cancels on me, I don't want to hear more than that they were sick or had to go to a funeral or someone else was sick, and when can we reschedule? Unless it's face to face, during a visit. That's your time.

That was easy. Let's kick it up. A commonly asked question:
What should I look for when I shop for a therapist?
This is tricky and the answer depends upon what you need, obviously. But if I personally were looking for a therapist I would ask:
Will you be consulting with my primary care doctor?
I want a Yes. Or if the identified patient is a child,
Will you be talking to my kid's teacher?
Or, also, and
Do you also treat other members of the family? Do you think you'll want to do any family therapy?

How do you deal with my confidentiality if you do?

Did you get some family systems training in graduate school?
There's more to look for in a therapist than that, but those are some of the issues that surely matter. They're an indication of how a therapist thinks (and you're asking me).

Other therapists might say that warmth, humor, compassion, and the capacity for a therapeutic relationship exceed all. And they may be right.

But I'd look for someone who thinks big, too, who uses my world, not just his or her brain.


therapydoc

*Chizuk, chee, hard "ch" rhymes with "me"-zook, rhymes with book; this word chizuk means strength

Tuesday, August 26, 2008

History and Strategy

You might find this question and answer interesting.

A reader writes in response to the shame post, The Bistro and the Date (below). First he answers those all important questions* then asks
How can I keep my boundaries tight when my family tries to sabotage what I think should be a moratorium (a.k.a. cut-off ) for the sake of my mental health?
The reader worked for years to distance himself from his verbally abusive father, a man who denies his emotionally violent parenting to this day.

If I were the reader's therapist, I would explain that it is shame that is buried under those layers of denial, that his father and he may not be all that different. The difference is subtle but important. His father's shame is so tragic, so toxic, that it is no longer conscious, he has successfully defended with that most primitive of defenses, denial, unconscious denial, the worst kind. He has to believe himself a good dad. Anything else would destroy him. He hasn't psychic permission, he hasn't given himself permission, to be imperfect.

An identified patient like our reader will sometimes try to cut off communication with people in the family who were "dysfunctional" "toxic" "violent." He may try to hang onto one limb, to save a relationships with a sibling, the seemingly healthiest member of the family.

But this last branch, his only connection, will eventually become angry and resentful, may even threaten to cut him off unless he reconnects when parents become elderly and physically unwell. Siblings needs one another when that happens, when there's family work to share.

We're addressing cut-offs here, obviously. The reason people cut-off their families is not that they don't need them or feel responsible and connected to them, but their families became sources of pain. Families do abuse and shame, betray members. Mis-steps such as these (including addicted siblings who visit and steal the silverware) make us wary. We put up boundaries.

It's the permeability of the boundary that concerns me. Boundaries need to breathe.

Parents who emotionally abuse with words, who shame their children, who fertilize a child's self-doubt, sense of inadequacy, and unworthiness have to be sealed off for a little while. The fence needs some sturdy nails. Not electricity. No, I won't block the metaphor, let's keep it going.

See, you need a fence, because children who grow up with verbal abuse believe it and when it's a steady stream of negativity will join the dissension, believe the words, find someone else who will abuse them, or do the dirty work themselves, continue the lashing, cut, try suicide. Maybe succeed.

This is why therapists will advise conflicted patients to stay away from the source, to protect themselves from further emotionally violent communications with family. Heal.

But we're all human. We will want to cling to the healthiest member of the family, perhaps the one who saw the abuse, who may have also been a victim. And ultimately cut-offs fail. The family guilt and invasiveness is stronger than the average soul can stand. Therapists often get cases like these when they're sinking, shored up by a quick but ineffective hospital stay.

Sometimes during that stay the family has been involved. A family therapist like me will keep that going if I can, at discharge, will contact family members (with the patient's permission and release of information). I work to convince the family to let me take over for awhile, to give the patient less of themselves, not more. But don't worry. We'll be in touch.

And I stay in touch.

It takes time, but if a family therapist can work with the healthiest branches, things can change, really change for the best. Branches only need be a little green to grow. People change late in life, given the chance, given the relabel, the opportunity to be a hero.

But what do we do when it's too late for that, when the cut-off is fragile and not working, and Dad is sick in the hospital and our Identified Patient hasn't the strength to deal?

Not at all uncommon. The sibling, the one care-taking Dad, wielding the chain-saw (help me or you're no longer my brother/sister), is clearly of the tougher child variety. But even the tougher children wear down when they have to care-take sick parents. They look tough. But it's just for show.

Family therapists push for direct communication. First the identified patient has to be straight with his or her sibling(s), the care-taker(s), either by writing (under a therapist's direction and editorial skill) or calling (in the therapist's presence) to communicate something along these lines:
I'm going to call Dad or write to him and tell him what's going on with me. I'm sorry you're stuck with this, but for the time being I probably won't be visiting. I'm not quite healthy enough yet, but I'm working on it. Here's what I'm going to tell our father:
And here is what the identified patient would tell his or her father, either by telephone or in a letter, not face to face, something along these lines
I'm sorry that I'm too sick to reconnect with you right now, that I'm no good to you. Some children, the ones with big issues, get a little funky when parents get sick, and that's what I am right now, laid a little low, too depressed and withdrawn to get out of my shell to help out with you, visit with you.

I know you don't believe in mental illness, but you and I are different like that. You probably see this as a weakness and an excuse. So be it. It's real enough to me to make visiting impossible right now. I just can't do it. I hope that you don't hate me for it. I imagine you do.

One day I'm sure I'll regret this decision, not seeing you, not helping you. It doesn't seem fair to do this to you, especially now. But I don't see life as fair. A parent raises his kids, gives them his all, and just when he needs them, they're gone.

I have bad memories of us, and they haunt me (this is called chipping denial, you're not accusing him of anything). I have to work through things, mostly negative thoughts about myself, nobody else. You did the best you could. You tried to parent the best you could.

I feel like a bad person, a failure, for not meeting your expectations.

I'm in therapy, working on my own set of expectations, and how I'm going to live with myself when you're gone.

Maybe I'll get it together soon. Who knows? I don't expect you to forgive me for this or to really understand me. But despite your take on mental illness, I think everyone gets depressed sometimes. Maybe even you.
And then the identified patient stops talking or signs off (he doesn't have to write "Love" that's up to him) and hopes his father begins to talk about his own feelings, his own depression, his own childhood abuse, knowing he probably won't.

But he might. They sometimes do.

This is a strategic intervention, full of lies. The identified patient is not remorseful, probably doesn't even believe his father did the best that he could. The identified patient may never regret not talking to his father, cutting him off.

With good therapy, he will live with himself just fine once his father has passed on. He probably won't care. Some celebrate. It is survival we're talking about here. And you can't always sleep with a person you perceive as the enemy. You can't always go home just because they're ringing the dinner bell.

The therapy, surely, is about changing that perception, the one that identifies the parent as the enemy. If that's possible.

To do that, you need history. You need the extent to which the parent suffered abuse during childhood. If the identified patient doesn't know the history or denies transgenerational abuse, I make finding out a therapeutic objective. It's there.

He was criticized, abused, shamed. Not loved. Abandoned. The child who cuts him off finishes the job. It's the unkindest cut.

In family therapy you want to get to a point with an abusive parent that you can admit you're not so tough. You don't know how he survived his childhood. How did he do it?

Families can toughen us up or wear us down. The resilience variable is having a healthy adult around who counters the abuse, one who puts a hand on the abused child's shoulder and says, "You're a good kid, a wonderful kid. You'll grow up. You'll get out. Talk to me any time. Tell me everything."

We can get into calling authorities about child abuse another day. In a word, Yes. Call.


therapydoc

*Those questions include:
Did (your father/mother/guardian) call (you) lazy?
Retarded?
A loser?
A fool?
Stupid?
With gusto? With sarcasm? With hate? Disgust?
Were there tirades directed at making people feel badly about themselves?

Monday, August 25, 2008

Departures


The pretty security agent at Ohare glances at FD's boarding pass and looks up, cheerfully asks, "How are you today?"

Without skipping a beat he says, "I don't know. Ask her."
He points to me.

"He's a man," I say. "He has to ask a woman how he feels."

She breaks up.

We're on the plane, it's a decent sized plane, and there's a monitor hanging in the aisle. We're going to see a movie. I hear a woman in the row behind me ask the flight attendant, "Which movie are they going to show?"

"Young at Heart," she says, puzzled. "I haven't seen it."

I get all excited, shake FD's arm. "Young at Heart! It's supposed to be great! It's a documentary about senior citizens who sing rock songs in a chorus! They're real rock stars. They perform at concerts. The show is called Alive and Well!*"

"Well," he says, "I'm glad I have the window. You can watch it."

"Why wouldn't you watch it?" I cry. "It's supposed to be great!"

"I'm not a senior citizen."

"Yes, but you will be soon!"

He doesn't laugh, but the woman on my left at the aisle gets a good chuckle.

And Young at Heart is fantastic. Watching octogenarians rocking to Yes We Can Can, and the James Brown hit I Got You (I Feel Good) well, it doesn't get any better than this.

Except when they're cracking jokes on oxygen, literally on oxygen cracking jokes, oldies but goodies. Fred (of Fred and Barbara, the spouses in this documentary are better than the performers) talks about how he sang in the service from continent to continent until he became incontinent. You have to love him. He also tells the one about marriage,
"My marriage is based upon faith and trust.
She had no faith in me and I didn't trust her.
I think it was Fred who goes on to say that sex gets better with age. It takes longer.

Directed by Stephen Walker, this documentary tells the stories of the performers, destination Showtime. They don't all make it to the show, unfortunately, and the pathos is real; there's that battle with time that all of us might consider now and again, especially when we wonder if being productive is an option. It isn't always, or shall we say, may not always be an option.

Bob Cilman, the sympathetic but Let's get down to Business chorus director is delightful, and you say to yourself,
What a great job this guy has, but it has to be difficult.
It's not as if you can demand your singers to attend rehearsal. On the other hand rehearsal, for Bob's singers, is a top priority. Virtually nothing keeps them away.

Each one of these great-grandparents** has his or her own charm. Fans pack the house at the show-stopping end to hear them croon oldies like the Zombies song, She's Not There, and the more modern heart breaker, Coldplay's Fix You.

Fearless, they warm up on the busride to the local jail singing Road to Nowhere. They'll entertain the convicts as they belt out tunes like the Jefferson Airplane's Don't You Want Somebody to Love, and Can't Start a Fire.

FD whispers, "That's what's called a captive audience."
Groan.

There's plot, too. This group of seniors in Northampton, Massachusetts refuse to let age and ill health get them down. They'll make it to the performance. Or will they?

The message: If you can sing, even just a little, life's more worth living, even when it hurts to be alive. We knew that, but how often do we see it? How do we really know? Young at Heart prove it.

Five stars. Twenty-seven, actually, their names are listed below.**

Okay. The woman seated on my left is not only a flight attendant, she's a blogger, too. We talk more about her issues (she hasn't slept in days) than blogging, but it's the kind of thing that eases me into my vacation, that last bit of listening before I can relax.

And because there's that movie, and because I do manage to close my eyes for a couple of minutes, in moments we have landed and within seconds I'm throwing a baseball with my grandson. Time is everything, you see.

Empath Daught and Best Son-in-Law are in New York for a wedding, their first vacation without children in six years. They return for a weekend with us in L.A. before going back to work, before the kids start school again, before we all go back to business as usual, a mere 48 hours.

And in a flash it seems I'm back on the 405 to catch a plane for Chicago, no movie this time.

We're curbside at Departures, LAX, locked in one of those hugs that makes people stop and stare. She's beautiful, why wouldn't they stare, in her signature wider than average faded-brown floppy baseball cap, pony tail at the back, and a rich coral billowy empire blouse that she has found in three colors; she's told me this in response to, I love it, and a darker than powder blue soft-brush jean skirt unraveled at the knee.

"I'm going," I say. "Thanks."

"I'll be there soon. We're coming in September."

I'm about to break out in a chorus of
Bye bye, so long fare well. Bye bye, so long fare well. See you in September
It's a very old song that I have already taught my granddaughter, but I know my daughter won't get it.

"I know. I love you so much (I haven't let go of her). Watch yourself. Let them take care of you once in awhile. And get some rest."

Only a few hours earlier that day I'm folding her clothes into my carry-on. She's loaded me down again with things she can't wear, things that somehow, miraculously, look good on me.

"This sweater will look so pretty with your eyes," she says. "This suit hits your shoulders where it is supposed to hit your shoulders, Mommy. I just love it."

I do, too.

"And did you remember to pack that moisturizer?" she frowns. "It has sunscreen. Put it on every morning. I saw you sitting out in the back yard in the sun this morning, baking like a lizard. You must wear sunscreen. And put it on your arms, your hands. With that biking, you need it."

"Okay. " She gets away with telling me things my mother never could. "Well, if you guys didn't have to keep the house so cold, I wouldn't have to to defrost out in the California sun."

FD is lugging the carry-ons from the car. He hugs her, too. Then she's gone. I don't look back.

We get through security easily, not the droids they're looking for, and I'm upset, actually, that I have to go through this, security, upset at the people who started it all on September 11, 2001.

We pass a Duty Free shop and I leave my bag with FD. I do this every time, stop at Duty Free to try out a new perfume. It can't hurt. What's a tester for? This one is Dior something, maybe Cherie, powdery. I like it, think it's a real possibility. FD isn't sure. Anyway, it's a domestic flight.

He changes topic. "Did our daughter even notice that I washed the car? And vacuumed it? Did she notice all the groceries you bought and that I replaced the light bulb over the stove? She never mentioned the time I raised the fixture in her kitchen so that normal sized people don't bump their heads getting a banana."

"She thanked us. You weren't listening. You miss her already?"

"I guess."

"Too bad you don't fit into any of her clothes."

"I know."

"She liked that movie, you know, Young at Heart, saw it on her return flight."

"She would. I think it's a chick flick."

Something makes me think he should skip keyboard, go directly to singing. He's got a very good voice, actually.

therapydoc

*The Young at Heart chorus (Y@H) will be on stage at the Ellington Theater in Washington, DC, Saturday, September 6, 2008 @ 8:00 p.m.

**Cast includes: Joe Benoit, Helen Boston, Louise Canady, Elaine Figman, Jean Florio, Len Fontaine, Stan Goldman, Eileen Hall, Jeanne Hatch, Donald Jones, Fred Knittle, Norma Landry, John Larareo, Patricia Larese, Miriam Leader, Patricia Linderme, Brock Lynch, Steve Martin, Joseph Mitchell, Dora B. Morrow, Gloria Parker, Liria Petrides, Ed Rehor, Bob Salvini, Steven M. Sanderson, Jack Schnepp, Janice St. Laurence

Wednesday, August 20, 2008

The Bistro and the Dating Interview

I'm at one of those bistros with live music and I know one of the guys in the band. But we're entertaining cousins from out of town and I don't generally chat it up with more than one or two people at a time. So I'm not interacting with him. But when he finishes for the night and turns to leave, he looks my way and I wave. He smiles but walks off muttering,
"I just hope I don't end up in someone's blog."
What's that supposed to mean? I wrack my brain and decide that he means, "I hope I do end up in a blog and get some Free PR." Happy to oblige, dear. (And you need not have worried. There's no way I'd give you a bad review.)
Friends. Support your local restaurants, and if there are musicians in your neighborhood, give them reason to play. Applaud, praise them, on and off stage. Encourage the arts.

Go up to any musician you know and tell that person how much you like his or her music. It's the least you can do, and it shows good manners and good breeding, thanking people.

Don't ask for autographs, unless you have a pen in hand and a napkin.
Not much else matters, when it comes to social skill, more than sensitivity and good manners. But it's a fine art, a lost art in some families, making people feel good, not bad.

And we're in the business of feeling good, not bad, or why else would we be here on the Internet, when we could be in bed with a good book or hanging out at the beach?

Okay, here we go.

FD always complains that the family doesn't visit us. He's from a huge family, we're talking huge, something like 55 first cousins, who have been fruitful and multiplied. Most of them hold that Chicago is either (a) too cold, (b) too far, (c) too full of gangsters, or (d) not Baltimore.

But we got a nibble and plenty of notice to prepare. A cousin came to stay with us for the weekend and brought along a spouse and offspring, and we were ecstatic. Their miniature Al Pacino, the youngest, has launched successfully into adolescence, and almost as interesting, the three oldest, one more striking than the next, are ready for marriage (in my culture we still do this, marry).

On Saturday I let them pick my brain about what to look for in a marriage prospect, what to discuss on a date.

Then on Saturday night we all went out and I left the clean-up for the next day, knowing full well that leaving the clean-up is a real source of anxiety. But you do what you gotta' do in life.

And it was great, foregoing the usual stay at home, clean up the house, risk the unthinkable by renting a movie, get to bed at a reasonable hour options. But Sunday morning, in the closet, searching for something to wear, the flashbacks started, the conversations we had had, the ones between me and those young adult cousins, about what to look for in a partner.

And as words came back to me I realized I had forgotten to tell the kids something important, something else to check out when they're dating, not quite a quality as much an affect, something people don't automatically ask about, but which has great impact upon a future partner's self-esteem, and consequently, will have tremendous impact upon the self-esteem of future generations.

Shame.

A sense of shame is elemental to mental health. You need a little, but not too much. Too much affects your personality, and not in a good way. It can make you angry, or the opposite, self-hating, passive, withdrawn. Shame makes people lie.

The power of shame takes its energy from criticism in early childhood. As children we can't always advocate for ourselves against bigger, more authoritative people who have bigger, edgier vocabularies. Usually these people are our parents. Our powerlessness against their criticisms contains the seeds of unworthiness. And that unworthiness can settle into our chests for the long haul, the duration of our lives.

So among the many important answers you'll want to weasel out of the potential candidate for Partner and Other Parent of your Future Progeny, while waiting for your pizza at the bistro, might be:
How did they handle criticism in the family?

Did anyone shame anyone else? Did it happen in front of other people?

Was that considered okay, shaming in the name of behavioral change?
Sometimes it isn't so terribly pathological. We may call a children a mildly pejorative name, like slob, so that he becomes interested in not being a slob (untidy would be a better word) forever.*

Some children really catch on when they're called slobs, although if you do use this intervention to build character, it's best to use the word in a less personal way. You might say, I wish the people in this house weren't such slobs! This gentle shaming gives everyone a chance to triangle you, gang up on you, make fun of you for being so O-C, since you, apparently, are the only one who cares.

If it is more direct, however, but funny, as in, You are such a slob! One day you'll get it together, maybe, but I'll probably be dead by then, it might actually work. With direct, yet gentle shaming, the child has a chance at getting it together and becoming tidier. As neat and tidy, he** is highly praised, "Look how nicely my Johnny takes care of his room!" so that his fledgling self-esteem, swimming for life during slobdom, improves.

Out of the chest, into the head, I always say. Praise goes directly to one's ego. It's a good thing, in the Things that Make Us Feel Good category of life.

Horrible shaming, as in, You're an unbelievable, disgusting, good for nothing slob, and you'll never become anything, you unbelievable loser, I can't stand to look at your face, get out of my sight, is well within definitive shaming bounds and might do the trick, damage the child forever, contribute soundly to the development of various ugly and painful personality glitches and Axis I or II or both disorders.

So mainly, you want to find out:
Did anyone call anyone lazy?
Retarded?
A loser?
A fool?
Stupid?
With gusto? With sarcasm? With hate? Disgust?

Were there tirades directed at making people feel badly about themselves?

You want to know about that, you really do, you want to know if the shaming took the form of verbal abuse. If the answer is a resounding Yes, negative labels stuck pretty well, parents used crazy glue, then the next question is, "Ever get any therapy for that?"

And if the answer to that is a resounding No! you want to find out if your date made any promises to himself, like maybe conscious or unconscious decisions, based upon shame.

Like what he would do, for example, if he married, and his spouse accidentally insulted him or somehow shamed his children, even if it was gentle shaming?

Would he get very sensitive? Would he shut down?

Would he get angry and mean, insult back? Would he leave?

Or would he have the presence of mind to say to a partner, "I think you could have said that nicer. I'm sure you didn't mean to make me (little Johnny) feel so badly, but you did."

That's the right thing to say when another person hurts your feelings. "I'm sure you didn't mean to do that, to hurt me like that." You need to give people a chance to take back what they said. Right away.

And finally, Would he do that to you? To the kids? Talk down. Shame. Do unto others. . .

This discussion about childhood can naturally flow into how a couple will want to raise children if they have that in mind. How do you get children to behave, to do the things they don't do naturally like to do, like clean up? How do you do that without shaming a child?

It can be okay, sometimes, to shame a child, you can sometimes get away with it. You have a better chance at doing it with less emotional residual if it's done with love, a better chance, perhaps, if it's done in Yiddish.

But it's possible not to be received this way, as loving, under most circumstances. And it's remembered, for sure. Shaming can be a slippery slope, places a distant second to positive reinforcement. Shaming is the easy way, the slacker way. M and M's and Hersey's Kisses require trips to the grocery store and the dentist. Work and expense. But nobody said parenting would be easy.

So you want to talk about things like these, maybe before the engagement, before you plunk down 4 grand for the ring. These kinds of things are more important than, say, Does the whole family have to eat dinner together? Or, Can you play tennis?

Go right for the emotional stuff. Sure it can be a source of pain, but it is also a source of comfort, joy, and humor. Understanding one another is a happy thing. Where you find committed relationships that work, you'll find couples who have talked about at least some of the traumas of their childhood before their engagements. They knew each other, touched one another's souls.

So take your date to your local bistro, support the music industry.
And tell them to play a little softer so you can talk about what matters. Onions on the pizza? Or not. French fries? Oh, yes. Definitely!

therapydoc

*In Yiddish the word for slob sounds even worse than it does in English. Parents can get a fairly decent rise out of their children using the word shlumpf. Everything is more effective in Yiddish.

**I use the masculine gender through out the rest of the post, but there's no bias. Women are put to shame, too. Never a bias, really, with child abuse.

Tuesday, August 19, 2008

What a Wonderful World

I stepped out onto the sidewalk after a brutal day at the office, and before hopping on my bike, just marveled at the weather. That's what we do in Chicago when the weather is fine. We marvel. It just doesn't get any better.

And I said to myself, Why, oh why did I say NO to the ballgame? FD had an extra ticket to see the White Sox and he threw numerous hints at me that I should go, and I said, "No way, dearie, it's Monday." If it had been Tuesday, then it would have been, "No way, dearie, it's Tuesday." Just no interest in the noise, the drive down to US Cellular, the hassle to park the car.

And I'm a North Sider, a Cubs fan. FD's from St. Louis. What does he know?

So I hopped on the bike and on my way home, all of the problems of the world started crashing down. It was worse than missing a perfect night for a ballgame. It became an all-the-sick-people, all-the-sad-people, what-a-lousy-economy, when's-the-next-terrorist-attack, and damn-genocide-anyway night.

And I'm tired and hungry and there's nobody home to join me for dinner. And no energy to cook.

But I like left-overs, so it's okay.

I switched channels on my bike radio compulsively while riding and hated everything on that, too.

And then. Louis Armstrong, What a Wonderful World found its way into my consciousness from the tiny transistor speakers on the handlebars.

And at that moment, as if out of a Blue Cross Blue Shield health insurance commercial, I spy a couple walking on Sacramento Avenue towards the park, probably in their seventies, him with a shock of white hair, her in sneakers and white slacks. Holding hands. And neither of them looked like they'd had any work done from my angle.

The smile's back and I flash one at a kid on his bike who isn't wearing a helmet, and tap mine as if to say, Get one. He smiles back, sheepish, I know, I know. It's what I do.

It turned into a good night, all in all. And Olympic Project Runway was pretty fabulous, so not a waste altogether. At that moment the show was much better than the games.

And when FD got home he said, "Why did I bother with that? Why? Tell me! So much noise, so much hassle. I should have stayed home with you!"

And I said, "Right, honey. You should have stayed home with me. That would have been pretty wonderful."

But he'd never have wanted to watch Project Runway. I'm pretty sure.

therapydoc

Friday, August 15, 2008

Simon Wiesenthal


I had spelled his name wrong when I originally posted this. Sorry. Besides corrected spelling, you get a brief biography that I hadn't found before. It's at the end, thanks to The Columbia Encyclopedia, Sixth Edition.

Here we go.

I had just posted about Bruce Ivins, the anthrax murder suspect, and his split personality when the opportunity to watch a documentary about famous Nazi hunter, Simon Wiesenthal, came my way. If you can find it, I'd recommend it over say, Wall-E, or anything else I've seen recently. I Have Never Forgotten You, the Life and Legacy of Simon Wiesenthal.

What's interesting to me about this is the 68 year old question,
How could SS officers, obviously men who had lives, who had children and wives, who laughed and sang, who cared about others, DO WHAT THEY DID?
In case you're thinking that the Holocaust never happened, read CNN's piece on James Hoyt, a camp liberator who passed away Monday. Mr. Hoyt told everyone what he saw at the camps.

Richard Trank and Marvin Hier wrote the documentary about the Austrian-Jewish architect and engineer who turned to Nazi hunting after surviving the Holocaust. For a full synopsis of the film, click here.

Nicole Kidman narrates, if you need star power, and Ben Kingsley has one of his most powerful performances, just being himself, talking about what it was like working with Mr. Wiesenthal, being Mr. Wiesenthal in Murderers Among Us: The Simon Wiesenthal Story (1989) (TV). Mr. Kingsley's awe and respect for his hero are worth the watch alone.

But it will make you feel like you're not doing a heck of a lot with your life. I like that kind of motivation, personally.

It doesn't make any sense, the Holocaust. How did the SS officers don two caps? Murderers by day. Husbands and fathers by night. They weren't mentally ill like Bruce Ivins. Mr. Ivins could be a regular guy, too, a good man, a charitable, laughing individual, who wore other hats. But he was sick, we know that from his history. The Nazis, for the most part (there's always a bell curve, a normal distribution when it comes to populations) were not.

All this knowledge, and here I am, totally unable to grasp this. Someone help me. I really don't get it.

I watched two documentaries on Sunday, both totally recommended if you need a good cry and a reality check (that relativistic thing). Besides the Wiesenthal documentary, Scrapbooks from Hell, portraits of an SS officer, will give you pause. Carl Hoeker, a good-looking family man by night, chose which Jews would go to the gas-chambers and which would go to work, starvation, and a slower death, by day.

“It shows the killers as humans…this scrapbook forces us to look at the killers in a way that I think pushes our comfort level where we don’t want it to go.” says Sara J. Bloomfield, Director, U.S. Holocaust Memorial Museum on camera. National Geographic aired the documentary on April 27, 2008. They should run it again.

How about a little history?
The death camp at Auschwitz-Birkenau, and especially the year of 1944 is considered the epicenter for the mass killings during the Holocaust, a single camp of several where the Nazis and their collaborators murdered more than one million people.

Six such death camps existed: Auschwitz-Birkenau, Belzec, Chelmno, Majdanek, Sobibor, and Treblinka. Large-scale murder was conducted by poisonous gas and then body disposal through cremation was conducted systematically by the Nazis and Adolf Hitler's SS men.

Victims were deported to these centers from Western Europe and from the ghettos in Eastern Europe which the Nazis had established.

Millions died in the ghettos and concentration camps as a result of forced labor, starvation, exposure, brutality, disease, and execution.

This documentary reveals authenticated rare photos of Dr. Josef Mengele, The Angel Of Death, who possessed both a PhD and an MD. Mengele is photographed smiling at Auschwitz where he put his education to use by torturing men, women and children in medical experiments of unspeakable horror during the Holocaust.

It is historical fact that Mengele had put his victims into pressure chambers, administered various drugs, castrated them or froze his test subjects to death. Children were exposed to experimental surgeries performed without anesthesia
Thanks for that, Monsters and Critics . (The sanitized version, especially when it comes to Mengele's dastardly deeds. You can see the actual scrapbook, too.

It's distressing and none of it should be lost, which is why the Wiesenthal documentary, I Have Never Forgotten You is titled exactly that. Wiesenthal lost his entire family, with the exception of a few distant cousins, in the Holocaust. He was a survivor.*

Someone told him, at liberation, that now he could go back to creating buildings. He said,
How can you presume that anyone, after what he or she has just seen and experienced, can return to anything?
At liberation, he asked if he could help, probably weighing in at 75 pounds. The Americans wanted to laugh, but they didn't. They said, "Write it all down. You've seen so much."

He proceeded with an extensive list of Nazi perpetrators, their names and the dates that they perpetrated their heartless mayhem, the names of the Nazis and their exact crimes, and presented this to the liberators of the camps. This, the beginning of the career of the greatest, perhaps only, true Nazi hunter.

It is a mesmerizing story. And we still ask ourselves, Why did they do it?

Following orders, they said.

As I kvetched about this the other day, someone glibly remarked, "Why is this so hard to understand? The Nazis saw their jobs as we see our jobs. They thought they were only doing their jobs. More importantly, the job would only take a couple of years, and then they would move on, move up. Just like us."

Breathe.

My son says that at the Yad VaShem Holocaust Memorial in Israel he saw a poster that quoted an SS officer as saying, "It's hard at first (killing), but it gets easier, you know, once you get the hang of it."

I'm thinking I'd rather die. I'd rather die than take on any task that is egregious, unconscionable. How could they do it for a living?

Or is it group think? The same dynamic that characterizes gang rapes?

Someone tell me.

therapydoc

*The Columbia Encyclopedia also tells us the following

Simon Wiesenthal lived from 1908-2005. He was born in Butschatsch, Austria-Hungary (now Buchach, Ukraine), received (1932) an architectural engineering degree in Prague, practiced in Lvov, Poland/Ukraine.

Sent to a forced labor camp upon Nazi invasion, recaptured after an escape, Mr. Wiesenthal had been to several concentration camps by the end of the war, at which time 89 of his relatives had been slaughtered.

He devoting his life to bringing Nazi war criminals to justice, and established a center for this purpose in Linz, Austria. In 1961 he established the Jewish Documentation Center in Vienna. Mr. Wiesenthal located approximately 1,100 war criminals, many of whom were tried and convicted, and authored KZ Mathausen (1947), The Murderers among Us (1967), and Max and Helen (1982).

For more, see The Columbia Encyclopedia, Sixth Edition 2008

Thursday, August 14, 2008

Wall-E, Obesity, and The Magic Touch


My kids saw a preview of this movie about a month ago and insisted I would love it. But I just got to Wall-E last night, and I wasn't meshuggeh for it ("meshuggeh"-Yiddish for crazy about). See the trailer here

It's directed by Andrew Stanton, written by Andrew Stanton and Pete Docter and is very cute, but there isn't any real dialog for people who just need words. I think a lot of bloggers are really writers. You don't have to publish a book to be a writer, you know.

But here we have the muffled electronic voices of robots and you might have to work in order to catch their meaning, which turned me off, since I'm kind of lazy when I go to the movies. Don't make me work.

The relationships in the movie are priceless, however, worth the ticket alone. The love interest (there has to be one) is between Wall-E, a robot garbage compactor, and Eve, a complementary robot sent to a nuclear devastated Earth. Mission? Find life.

WARNING: No question, this post contains spoilers.

Although initially relationships on Earth in this film are between robots, it's their physical touch, that shy and gentle electric connection that happens when a person (or a robot) holds hands, that got to me, and surely, will get to anyone watching Wall-E. Finger to finger connectivity. It's primal.

Remember the Beatle song? I Want to Hold Your Hand? I was a kid, 6th grade, transistor radio (google that) in hand at recess, trading Beatles cards when I heard it for the first time (I think). Had they the rights, Pixar could have inserted that song in this film somewhere. Maybe not.

I Want to Hold Your Hand is an innocent song, and most of them were when I was a kid. People in my generation memorized every one of the Top Ten songs on the "charts." To me, that should tell you everything about how kids learn, but that's not the message of this movie, although the joy of innocence might be.

Back to our story.

The reason my kids wanted me to see Wall-E is that it features my favorite all time song, It Only Takes a Moment. This is perhaps THE most romantic song ever written. Below is a YouTube video of a production with Pearl Bailey, Jack Crowder, Emily Yancy, and Cab Calloway. Compare that to whatever heavy metal you're into these days.

But even with the song, even with It Only Takes a Moment, and marvelous animation, a lovely story and cool relationship models, I didn't really like the movie and wished we'd gone to the Dark Knight or Mama Mia instead. I just couldn't take almost an hour or more with virtually no dialog, with the exception of snatches of an ancient Hello Dolly video, one of the few things to have survived the nuclear holocaust that devastated Earth.

How do I tell them? How do I tell the kids? I can't. I just can't.

But wait! There's more. I really did like something else, although it took me awhile to figure out why.

FD found the treatment of obesity in Wall-E degrading. Up in space, cruising endlessly for centuries, humans have virtually nothing to do but wax fat, which they do, and they consume endless quantities of extra-large everything, and they, themselves are super-sized. But I didn't mind it, in fact, I thought this depiction quite charming.

As long as people shower every day (yes, it's a requirement in life, with few exceptions) I don't care how many extra fat cells they've encouraged on life's journey. An empath senses through all layers, but we're deathly allergic to bad smells.

I think I liked the whole of humankind obese because ultimately, they needed their fat. We learn that maybe it's okay to store up a little, maybe a lot of energy, if you're going to eventually use it. Because maybe you will need it one day. Ultimately we understand, thanks to Wall-E, that a combination of exercise and productive physical outdoor activity may be nature's most natural answer to obesity.

That, and starving until you grow some food.

therapydoc


This one is from Indigo 1045 on YouTube who writes the following. Thanks Indigo.
From the brilliant "Hello Dolly," starring Pearl Bailey and Cab Calloway, here we have just a "slideshow" of the play and some of its performers. Saw this several times, and will attest to the fact that one of the dancing waiters was none other than the amazing Morgan Freeman! He "may be" the young man to Pearl Bailey's right hand, on one knee. I know he was actually "named, featured and mentioned as Rudolph," in the LP/CD production.

Beautiful Emily Yancy and handsome Jack Crowder, (later to be known as Thalmus Rasulala,) are the two lovers singing here.

Monday, August 11, 2008

Therapeutic Boundaries

My telephone voice mail message asks that people leave their name, phone number, and convenient times to be reached. Patients get my cell phone for emergencies. I want to hear from them before they jump off a bridge.

And it saves me from hearing that complaint, "You don't return my phone calls." This way everyone knows the cell's tied to the hip. They can leave a message if they get voice mail and have a fairly good chance of reaching me.

Like many therapy docs out there, I have a solo practice. There is no middle person between me and my patients. Consequently messages have a fairly good chance of drowning in my work drawer. Occasionally I open it; this keeps me straight.

Thankfully, patients tend not to overuse the cell phone privilege. Everyone knows that minutes aren't free; there are limits to all good things in life, and I communicate therapeutic boundaries pretty well.

Patients know, for example, that we're not friends, unless, of course we are.* Everyone tends to feel like friends by the end of the day in therapy, unfortunately, so we have to watch this, hold to a fairly solid black line, a good boundary between us.

This is a lot easier than you might think. The limits of a therapeutic relationship are spelled out, often with words, words like, I don't like to talk on the phone. I need to see you to feel you.

And yet. . .it's not good to get too rigid about things in life. Sometimes the boundaries have to be permeable, and you know I'm all about elasticity.

The Story

One evening I had a definite need for some space from my practice, didn't want to hear from anyone. So before I even left the office, I made all of the calls that I knew needed to be made if I wanted any special uninterrupted time with the tube.**

I hadn't watched television in weeks. Nobody was home. I had the remote. It was exactly as good as it gets.

A good hour passed and there I was in the same position, water glass ready to spill, exercycle ready for a spin, should the spirit move, and yet another Law and Order about to start.

My phone rings.

It is the one patient I really had wanted to hear from, the one I thought for sure I would have heard from earlier. But here it is, 10:00 pm. This is against the rules, basically, for non-emergencies. Who can think straight at 10:00 pm?

I answer.

He says, "I hope it's not too late, I'm so sorry."

I go, "Well, actually, it kind of is. You think we could do this first thing in the morning? Maybe 8:30?" In the past he's called me early in the morning, earlier than 8:30 am.

He hesitates. "Well, all right. Maybe that will work."

But I read that hesitation, worry a bit. We hang up and a moment later he calls back.

"Oh, I was trying to reach someone else. So sorry."

And I go, "No, no, don't hang up. Let's talk."

"Are you sure?" he asks guiltily.

"A hundred percent."

All of a sudden the television has turned boring and inconsequential and the human in me kicks in, the one that doesn't separate from the therapeutic community very easily. This person is sedated in the evening with the blogosphere or less virtually real things like books, newspapers, magazines, friends and family. And occasionally, television.

The patient says something absolutely extraordinary. He tells me that someone in their family has had a medical emergency and he and his wife have been called in to babysit. He has finally put the last child to bed, otherwise he never would have called me so late. He is also sure that there is no chance in ___ he could have called me in the morning. Little children don't exactly let you talk on the phone. They're really distracting. A simple three to five minute phone call turns into torture.

So hearing this, I'm glad he's caught me, glad he had another call to make. We talk a couple of minutes and both feel better about how to approach his treatment plan.

A few minutes is usually all this takes. And yes, I have to be grounded, in the mood. I won't even answer the phone otherwise, not usually. Professionalism is about being nice.

Like everything else, therapeutic boundaries are best when they're elastic, flexible. Rules are made to be broken. We use our sixth sense to know when to break them.

Obviously, you still need to put up fences if you're a therapy doc. You need benchmarks. Boundaries need to be nicely drawn with wide-tipped, Marks a Lot markers, but we leave spaces, occasional perforations.

And you know, it's not necessary to suffer through another television show, just to make the point.

therapydoc

*You wouldn't think of giving your friends professional advice unless you've been in practice for about a hundred years.

**Televisions used to have these things called "picture tubes" so you might hear this expression, to this day, from those of us forever trapped in our time warps.

Olympic Sex


You can't help but admire the physiques of the Olympic athletes in Beijing. An anatomy student could learn a lot from watching them. Every curve, every well-toned muscle declares itself under smooth, youthful skin.

Not one of these athletes is in the least bit flabby, or, dare we whisper, old. And these gorgeous young bods are all out there, in full view; certainly they are in the floor exercise and swimming competitions.

So sexy.

And you can't help but wonder, one can't help but wonder, maybe, on some random occasion,*

What's it like, sex with an Olympic athlete?*

And the answer, at least the only answer I come up with off the top of my head is
On your mark.
Get set.
Go!
therapydoc

*Obviously not any of us, necessarily, would be thinking about sexual behaviors of other people, but some people do

WARNING, my friends. I'm not necessarily going to post comments that aren't in the spirit of uh, sports as we commonly refer to them.

Thursday, August 07, 2008

Bruce Ivins


Bruce E. Ivins, a microbiologist, killed himself on July 29 with an overdose of Tylenol. He had a history of mental illness. People blame his death on pressure from the FBI, accusations and "proofs" tying him to the 2001 anthrax murders. I blame it on mental illness.

Prior to 9/11, Dr. Ivins suffered what FBI court documents deemed "serious mental health issues." He had been in treatment and talked about it in emails that dated from 2000 to 2001. He wrote about his depression, his counseling, and his medication.

Reporting for the Wall Street Journal, Evan Perez, Siobhan Gorman, Gary Fields, and Elizabeth Williamson, paint a Chilling Portrait of Dr. Ivins.

In August 2000, he wrote,

"I get incredible paranoid, delusional thoughts at times, and there's nothing I can do until they go away, either by themselves or with drugs."
We hear that in late 2001, he emailed a series of short poems ruminating about what he called his split personality:

"Hickory dickory Doc - Doc Bruce ran up the clock

But something then happened in very strange rhythm

His other self went and exchanged places with him."
And then there's this one,

"I'm a little dream-self, short and stout,

I'm the other half of Bruce-when he lets me out.

When I get all steamed up, I don't pout.

I push Bruce aside, then I'm Free to run about!"
Sounds like Free is a name, does it not? The word is capitalized in the middle of the sentence. Free is another Bruce.

Dr. Ivins thought he had a split personality, but when we speak of such a thing, a split personality, we're really referring to at least two separate personalities, separate people within the same body that co-exist.

Each personality is whole, if not altogether well. Each personality may have multiple Axis I or Axis II disorders, or not.

This sounds like Dissociative Identity Disorder, what used to be called Multiple Personality Disorder. A person like Dr. Ivins, if he suffered from it, had at least one high functioning self, the doctor, the microbiologist who worked diligently for the United States government on a vaccine to immunize us against the deadly effects of Anthrax.

And he had a second personality, clearly disturbed, but also high functioning, one that escaped detection while under FBI investigation for three full years. He is the one referred to as Free.
Free could carry out destruction, wreak havoc without conscience. Free could even justify his atrocities, say to himself, If the government associates these deaths with a terrorist group, then surely I will have funding for my vaccine. The ends justify the means.

Perhaps he had a third self, the one who fell in love with a sorority girl and stalked her. With his counselor, Ivins discussed killing the young woman. From the Washington Post,
More than a year before the anthrax attacks that killed five people in 2001, Bruce E. Ivins told a counselor that he was interested in a young woman who lived out of town and that he had "mixed poison" that he took with him when he went to watch her play in a soccer match.

"If she lost, he was going to poison her," said the counselor, who treated Ivins at a Frederick clinic four or five times during the summer of 2000. She said Ivins emphasized that he was a skillful scientist who "knew how to do things without people finding out."
And yet a fourth, a religious Catholic:

. . . a churchgoing family man and volunteer whose mental health eroded -- culminating in suicide -- because of escalating pressure applied on him by federal investigators as they came to regard him as the prime suspect in the attacks.
Surely a troubled, angry, psychotic individual, a scientist who struggled against his admitted paranoia, depression, and mounting social and professional pressures, a man who lived with a voice in his head, a violent amoral voice.

That voice talked to him, I think.
I think Dr. Ivins heard Free, and that Free, as such, was a delusion, not a conscious perception of self, not him. But when the stress got the better of Ivins Free broke out. Ivins became his delusion. Then he had more than one self.

And when he looked back on what Free had done, assuming it is true that he is the man who committed the anthrax murders, he said to himself, This is the work of another person inside me, the bad me. I did all of that as Free. But the ends justified the means, and the FBI should have canonized me, not punished me.

Insanity reigned. People died.

So although it sounds like definitive Dissociative Identity Disorder, there is a second diagnosis, Schizophrenia.

I would bet that Free wasn't another self at all, not until he acted out. Until Ivins gave in, Free had been only a voice, one who mocked and scolded him for years. Then, when the time was right, when Ivins could take it no longer, he gave in to what he had been hearing for years, "Do it. And don't tell anyone about me."

Since he was a smart man, it is likely he knew about things like multiple personalities, perhaps from his treatment even. But he decided to not make mention of the voices to anyone, as is often the case in schizophrenia. He used his poetry to suggest that what he had was a split personality, for to him, schizophrenia, carried more stigma.

He carried the shame honestly. The illness went undiagnosed in his family, Dr. Ivins said. Read this Washington Post excerpt:
"The skeletons are all out," he wrote in one GreekChat posting from 2006.

"I'm having a devil of a time rounding them back up. Let's see . . . how about mom who was an undiagnosed paranoid schizophrenic. . . . Is that bones enough?"

Dr. Ivins was delusional. He suffered from paranoid schizophrenia, like his mother. And ironically, the FBI actually did follow this poor man with schizophrenia.

At some point, when a mentally ill person takes his life, perhaps, diagnosis becomes moot. It's a so what? Dr. Ivans died. He left two children. Other people died, no matter what the diagnosis. (See the comments section for a more thoughtful discussion of how the two diagnoses are related).

He was a scientist who shouldn't have passed a background check. And much worse, he did not get sufficient treatment for his mental illness.

You can read all about this at WSJ, The New York Times, the Washington Post, everybody's telling the story, so I don't have to repeat the details here. Suffice it to say that Ivins spent late nights in the lab, ostensibly cooking up the anthrax for delivery the following week. He was one of the world's foremost anthrax experts, according to news reports. He fooled the FBI for three years, switching anthrax samples on them, deliberately hiding the flasks with mutations that would have made a direct match. When it became clear he would be charged for the crimes, he killed himself.

I imagine that Free told him to do that.

I looked for childhood history but so far, nothing. He did work for the government, so perhaps his history is top secret.

I feel that the people he worked for should have picked up on his suffering, his severe emotional stress. Why treat only depression? His counselors, his doctors must have known he had delusions. Anyone reading his poetry (maybe they didn't) should have said,
"Dude, take off a month. Get into a hospital. Get the proper doses of the right medication. Get well. Shake off Free."
That is the treatment in schizophrenia, shaking off the delusion, muting the voices, ending their tortuous reign, by using medication.

People who notice strangeness in co-workers should get closer, not move farther away. We should wonder, when a person is cooking up Anthrax, What is he doing with that?

I know, 20-20 hindsight.

Yet I have to wonder. Where were his people? Weren't there people watching him slide? He did have a previous suicide attempt.

But then I think, mental illness is masterful. It can hide itself pretty well.

therapydoc

Tuesday, August 05, 2008

Kids Say the Darndest Things


Sometimes FD will be looking over my shoulder while I'm writing and say, "What's that got to do with mental illness?"

I shoo him away, whispering under my breath, "If I had to answer every question you ever asked me, our marriage wouldn't be very much fun, would it?"

But the answer, obviously, is that sometimes mental health bloggers just write about mental health, not mental illness. It's not that we're life coaches, not at all, but there can be differences between happy families and sad families, and as I've probably said a thousand times, Happy is Better.

I can't recommend his books, since I've never read them, but Art Linkletter wrote many probably funny books and he hosted a few television shows, too. The television show that I remember, People Are Funny, had a catchy jingle to that effect, one that's hard for me to forget to this day.

Mr. Linkletter symbolized to me, everything good about life. He could find humor in everything and it is clear that it was the humor in everything that made life for him.

Ours was a sexist and ridiculously romantic era, that relatively prosperous post World War II decade. You needed insulin to watch television, seriously, so we appreciated anything that smacked of more than a dash of irony. His interviews with children, Kids Say the Darndest Things, might have been scripted, meaning Mr. Linkletter may have told those kids what to say, but they're classics, and it's true. Kids do say the darnedest things.

In healthy families, it is the children who make us laugh the hardest. It's their sincerity, how they can say the funniest things straight-faced, that cracks us up.

Here's Bill Cosby introducing Art's show on YouTube. You don't have to look right now. I'm going to tell a quick story.

But before I do, just so you shouldn't think that all Hollywood television celebrities are born with connections and silver spoons, here's what nndb.com tells us about Mr. Linkletter:
Art Linkletter was abandoned as an infant, adopted and raised by a preacher. He first showed his entrepreneurial spirit by sorting through discarded lemons at a local fruit-packing plant, picking the least-obviously rotten fruit, and selling it door-to-door. He hosted House Party and People Are Funny both on radio and later on newfangled television, and is best remembered for his interviews with children, Kids Say the Darndest Things.
Well, we all know that it's true. Nobody can make us laugh harder than a very young short person speaking sincerely, telling us things that are obviously true, and often ridiculous. When they're parroting what they've been told, they're especially funny.

The Story

FD borrowed a slide projector and wanted to return it right away. But the person who lent it too him was asleep when he dropped by later that evening; the house was dark. So he waited until the next morning to try again.

Again, the house was dark. He knocked softly. No answer. Fine, he thinks, there's a storm coming, the skies are dark. They're sleeping. They have little kids. A person takes advantage of dark mornings like these if he has little kids, catches a couple of well-needed extra minutes of sleep.

FD starts to walk away, then he hears a noise. He turns to see a small figure peeping through the screendoor. A little kid, about three feet tall, is standing at the door, puzzled. FD takes the stairs to the porch once again, projector in hand.

The small voice. "Why are you knocking?"

"Are you the only one up?" he asks.

"What do you want?" the little guy answers.

"I have something for your Daddy."

Resolute. "Daddy's sleeping. Don't wake him up!"

Mr. Linkletter would have loved it.

therapydoc

The Chicago Cubs and Mental Health


If you're a Cub fan, about this time of year, traditionally, you're sad.

You're a member of that big extended Chicago Family of Cub fans, the Sad Family. By early August, without fail, the Cubs have bombed whatever potential they've had for winning a baseball championship. So it goes, we say, but we're still sad.

Back in the fifties, when I was a kid, we had a black and white television set. It took years before we moved up to color, but it wasn't a big deal. You didn't really need color to watch the Cubs, and the Cubs were on television every day! Those were the days when Ernie Banks, Mr. Cub, hit more homers than anyone in the majors, including Mickey Mantle, Willie Mays, and Hank Aaron.

I don't follow them closely anymore, but I do follow the emotions of Chicagoans, and I can tell you that one of the problems with being a Cub fan is that the Cubs haven't won a World Series since 1908. They're forever ending the season either in the basement or a step or two above it.

It has been 63 years since the Cubs have played in a World Series (1945), one hundred years since they have won one (1908). In one hundred and one years, the Cubs have only won eight times Major League pennants (1907, 1908, 1918, 1929, 1932, 1935, 1938, and 1945.) Not a one in my lifetime.

And now there seems to be a chance.

This may be it. The curse may have lifted. North Siders are saying, THIS IS IT! WHAT A TEAM! WE'RE GOING ALL THE WAY!

It amazes me how a team represents a city, how We become the team.

The team is good? We're good. The team is bad? We're bad, too. This is irrational, but it is what it is, which is some form of blurred identity disorder.

Chicago is a city divided, which adds to the confusion. Madison at State Street, downtown, officially divides us. South of Madison Street? The South Side. North of Madison? The North Side. And our two major league ball teams represent the sides, as if the city itself is two cities. The Chicago White Sox work the South Side; the Chicago Cubs, the North Side.

Never the twain shall meet, mutual enmity on both sides of the line. You really can't be a fan of both the Cubs and the Sox or you're suspect, a politician. You have no real understanding of life, or conflict. You are in Disneyland.

Me, being in Disneyland and a North Sider, have tried very hard to like the Chicago White Sox, the Chicago South Side team. My mother told me to like everyone. And after all, the Sox are a Chicago team, and I'm from Chicago.

Surely I must cheer for the Sox over the New York Mets! But when I do, when I speak positively about the White Sox, if I say, for example, that I like the South Side team, I get looks from people, looks that say, Who are you to sing Sox praises? Who are you to cheer for them? You're a Cub fan. Your address tells us who you are. Don't be a pretender. Deal.

This year people talk about a Subway Series. The Red Line connects the North Side to the South Side, the South Side to the North Side. People use the train to get to work, school, and the ball games.

So if the S_ _ win one pennant (I'm afraid to say the name out loud, not together with the W word, for I still like both teams, I don't care what anyone says), and the C_ _ _ (ditto) win the other pennant, then the two teams could play against one another in the World Series in October.

Some of us, the more neurotic Chicago baseball fans, or just the more neurotic, are really afraid to speak this possibility out loud for fear of jinxing the teams. People reading this right now are thinking, You're already jinxing them! It will be all your fault if either the Cubs or the Sox blow the pennant!

I respect this, but recognize that this is coming from deep-seated confusion and anxiety. Chicagoans are not used to feeling good about the Cubs this time of year. Feeling good is a foreign feeling, surreal, strange to North Siders in August. We've had positive feelings like this in May, even in June or early July, in years past. But they have never lasted this long. And the team has a roster of baseball greats, gorgeous, talented young men (K"H) including Derrick Lee, Alfonse Soriano, Ryan Dempster, Carlos Zambrano.

We're freaking out! We're so scared of disappointment, we're losing weight!

Nobody's counting their chickens, but I'm telling it honest. When the Cubs have a great night, when We inch a little closer, when We sweep a double header, people come into my office, sit down, look up at me slowly with shy smiles and whisper, "Did you hear?"

And I'll go, "I know, I know. Don't say it."

We're used to the Sox winning. They just won a World Series in 2005. But not the Cubs. The Cubs don't win. Cubs don't get to the World Series, don't get that far. But this year, We might. There really doesn't appear to be another team on the horizon that can take US.

Now if this happens, if the C_ _ _ win the pennant and even, dare We even think it, go on to the World Series, Chicago will be one very mentally healthy place. I will probably be out of business. I guess that's a little bit of an exaggeration, but it's exactly the kind of thing that I want to happen. I would be okay with this, the C- - - in the World Series. We really need a respite from chronic loss, our hearts can't take it anymore.

We need the unbeatable plus column, that reason for cheers and celebration, fireworks.

Of course, should there be a Subway Series, I'm predicting violence and insanity, mayhem on the Red Line, gangbangers shooting guns into the outfield.

Civil War.

Someone get me tickets.

therapydoc

Friday, August 01, 2008

The Kingpin

We'll just go right to the story.

A few years ago I got a call from a colleague who wanted to refer me a patient. Not just any patient, of course. A really, really difficult patient, a complicated patient (like there are people who aren't difficult, who aren't complicated).

The details and demographics in this post have all been changed, so no, this isn't about you or anyone else that you know; it's fiction, and even if you think you're the colleague, believe me, you're not.

We'll make the identified patient a teenager, a girl of 14 who acts more like a 4-year old with an advanced vocabulary. She's physically violent, verbally abusive, self-centered, infantile, and ALD, A Little Different, although I think my friend's exact words were,
"She's very weird."
Some kids can be a little weird. They're kids. I don't like diagnosing them or making them into outliers* because they're just kids. A little different is much better than a little weird, but we're colleagues, and when we get to talking we might get a little loose, may not always be so p.c.

But we like different. Or we should. Why go into this field if not to meet all kinds of people? Don't tell me it's to help. Help is the process, that's what we do. It's not necessarily our motivation for doing it.

I get these kinds of consults on occasion. The colleague will say,
I've never met anyone like her in my life!
Code for,
Surely you want to take her off my hands!
Sometimes, when I listen to the details of the case, I'll whisper under my breath, Marvelous. I'm not saying the case is marvelous or happy, or good. I'm saying: This is so interesting. And it is.

So I'll listen and then I'll make some suggestions, tell the doc what to try to do differently, maybe even take the case. But I try to avoid kids who are reputedly violent, unless they're under a medical doctor's care, as in a psychiatrist. And I need to know that the kid's been quiet for awhile, has moments of wellness, as this little girl, the one my colleague wants to refer to me, has when she's in school. And I need to know that the family is willing to pop the kid into the hospital if necessary.

Why would I be abused? One lamp flying at a person in a lifetime (by a nine year old, I ducked) in a career is enough. Kids can do that, beat up therapists, both physically and verbally. And they come in with weapons. We live in a violent world. Kids have showed me their weapons. I say, Leave your knives at the door, and they smile, take out knives, leave them at the door.

"Tell me about the case," I say.

The 14 year old has always been different, socially inappropriate, Asperger's-like, angry, sad. Whatever it is, the emotion that's expressed is always extreme. But that's only with family, rarely with peers, and it's escalated, her anger, her mood swings, her attention seeking, her non-stop dependent behavior and whining around her parents.

But in school she's under control. The girls in her class aren't mashugee** for her, but they don't socially ostracize her, either.

Let's say, to make it interesting, that she has four or five other siblings, two with severe developmental delays. One aunt has schizophrenia; her mother OCD, an uncle has bi-polar disorder, and her father has ADHD and depression. It's a vegetable soup of diagnoses, and this is just a phone consult. I've yet to ask a question.

My colleague has seen the patient and her parents in various combinations for over a year. The symptoms have escalated in the past few months. Parents get along with one another well, but they're both overwhelmed with their lot, their children.

"Any recent changes, deaths, perhaps?" I ask.

"No."

"Separations?"

"Uh, uh."

"Who pays for all the therapy?"

"Grandpa. He's loaded."

"And where does Grandpa live?"

She names a wealthy suburb.

"Is he involved in the patient's life?"

"He used to be, but since the kid got really bad, and since he read the psychological tests, he's distanced himself. The tests are packed with ugly diagnoses, a negative prognosis. And the kid insulted Grandpa, literally kicked him. Gramps can't take the disrespect. I understand the two of them were really close when she was a little younger."

"You have to get Grandpa into the therapy."

"They're afraid to stress him, afraid he'll stop paying the bills."

"They are? Or you are?"

"They're afraid of rocking the boat."

"So the kid does it for them. She won't get better without him. And with him, it's likely she will. There's your missing relationship. She needs him. Her parents are busy with the other kids. Sometimes if it looks like a duck, it's a duck. And they already love one another. Include another sib if you can, too. Maybe all of them in different combinations. People spend money on lesser things."

End of consult. I gotta' go.

It's funny. My father-in-law (OBS)*** believed that if you paid the bills, you called the shots. It's not true, though, when you have a sick kid, is it? When your kid or grandkid is sick, you can't will things to get better. You can't make a sick kid behave, make a kid show respect. You can't buy the cure.

But in a case like this one, the person who is paying the bills has some power, some leverage. He's left, he can come back. How hard is this?

He may have to change the way he is with his granddaughter, may have to change the way he talks to her, lower his expectations, add new ones. You're only a family therapist; he's the kid's grandfather. That's what you tell him on the phone. Who knows the kid better than him?

He's pumped up, respected. You tell him you're very sure that he knows how to work this kid, and you're interested in his opinions. People will obviously have to change the way they respond to her behavior, you suggest. Then you ask, Who should change what? How?

He has so much to tell you. He starts the ball rolling. You stop him somewhere in the middle. You say you have another patient. When can he come in? Soon, of course, he wants to continue to help. He makes an appointment.

Then the two of you strategize. He is the kingpin. You are a shlepper,**** a professional who knows nothing about this family system. We professionals are nothing without family input. The family has the answers. He, Grandpa, is your man.

More than likely you'll come up with this plan, or a variation of it.

He should expect to be called names. He should respond with kindness. "I won't reject you if you don't reject me," is his best response. He will need to say this over and over again, say it in different ways.

Everything, everything, depends upon his love. He can't give up on his granddaughter when she needs him the most.

You bring him into the therapy. You yourself, as a therapist, give him the respect he deserves. You engage that person who's paying the bills, who wants to call the shots, and you work the angles you know have to be worked, the relationship angles, the sweetness, the love.

You pull Grampa in and the kid has half a chance.

All that and a nickel, my father-in-law would have said, will get me a cup of coffee, which she owes me, come to think of it, my colleague.

therapydoc

*an outlier in a data set is a score that's Way higher or Way lower than the rest of the distribution.

**mashugee* is Yiddish for out there, but in this case it means, head over heels excited about, or wild about

***OBS is something like, Up in Heaven, or he should go up in peace

****Shlepper literally means someone who shleps, carries things, but here a shlepper is someone who is clearly not an executive.

July Back 'Acha

Your monthly recap of bloggers who linked over here, t'anks. If I forgot you, or didn't see your link, let me know and I'll catch your act at the end of August.

And the winner is. . .drum roll, please Shadchan Shadchan (Matchmaker), a must if you're in the mood for a good anecdote.

How about a new family therapy blogger? We need as many as we can get. Family thinking.

And if you just love corn, Amazing Love Stories. You can post your own, I think.

Isle Dance is putting up love videos. Islands, love. Sheesh.

Or stories from the field, the mental health field, I mean, Trench Warfare.

On the same turf is AntiSocial Social Worker who suggests,
every single person voted into office should have to spend AT LEAST a month working at a minimum wage job and living solely off their income
Honey, no one would go into politics, and you know it.

Blue Jean Social Worker won't dress up the part. Love it, BJ.

Nashbabe's world can be grueling, too, but she gets by with a little help from her friends.

Another personal blogger, Shea, can't complain about her guy. So boring, S., no complaining? Well, not today.

The Rebbetzin's Husband likes his denial. To which I say, We never take away the umbrella until it stops raining. He'll also link you to a place that rates your blog for objectionable content. We rate, peeps, over here, very objectionable, thank you, for using words like rape. Sigh. Rape, rape, rape, sex, sex, sex. Just driving up my ratings.

And just in case you've ever been just a little jealous of people who have hot tubs? Read day by glorious day on the jacuzzi. Or should that be, in the jacuzzi.

Talk about personal. If you've ever wanted to nurse a baby you'll have to deal with people staring while feeding (assuming you don't live in a cave), check this blogger.

On media we have A Record. Erin talks books and music, the finer things in life.

And over there in Highland Park, NJ, you can learn how a real photographer works her art.

Jack hosted a carnival . More Jewish, political/Israel stuff. Do we get tiresome? Do we run the media? Anyone see that one on Law and Order? Jack's great as a carnival host. Jack. You must see Cirque.

Chaos Theory says that my post on the matchmaking system makes a person want to drink heavily. I havet to tell you that for a Jew, drinking heavily means more than one shot, one beer, or one glass of wine.

For a more sobering look on life, read my old friend Marcella, who says that what doesn't kill you makes you stronger. She's talking about abuse, rape, stuff people don't want to hear about but should (her rating must be awesome for objectionable). Speaking of which, did anyone read that CNN story about the rapes of Muslims in Bosnia? How do people live with themselves?

Consent of the Governed has all kinds of links, but if you liked being a boy scouts or a girl scout (even if you hated it) you'll love the way Consent organizes them.

Oh, You're a Feminist tells us how to put our blab into action. And here you thought you could just blab, but no.

Crackers and Juice Boxes (remember those?) is in recovery from child abuse. It takes time, but there is no end in sight when you start with juice boxes. Pretty soon it's Slurpies, and Dairy Star, all kinds of recovery coping strategies. Great blog, CJB.

CoffeeYogurt likes a guy in a cowboy hat. Mmmmm

A Room of Mama's Own
fills us in on autism, parenting, sex addiction, and lots more.

MoriTherapy is always worth a look, a good critical eye, forever looking around for campy intellectual stuff.

And for FOOD, it's gotta' be IlanaDavita.

Don't forget:
Dr. Sanity (whaddaya think?)

NadNedNadNed (you have to read her to see what she means)

Okay. Back to work. I'm running late because of you. Joking, joking. Here are just a couple more then it's heet (see ya') for back 'acha til next month.

DC Boms

In the Pink

FitBuff

MizFit

and

I've Got a Little Space to Fill

And I'm all out of space. Have a great weekend.

therapydoc