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Monday, September 29, 2008

New Years Greetings, Jewish Style

Just a quick post before the holiday. I left another over at the The Second Road , if you're interested, where I'll be guest posting once a week.

Here's how I ended my first entry (Commitment)
Hey, I could have gone anywhere with this post, and probably did. I wrote it on a plane, going over it in my head in hypnogogic sleep, eyes closed.

Thanks for having me, Second Road.

May your site become the GPS of recovery programs.
Sounded right at the time. But here's what I really wanted to tell you before I forgot, before taking off for the holiday.

Jewish or not, in the next couple of days, you might be hearing people around you saying,
Have a happy, healthy New Year.
Or,
Have a happy, healthy, sweet New Year.
This is because Jews like sugar. We really do. We'll dip an apple in honey on the holiday this week just to make the coming year sweet. If we eat sweet things, the year will be sweet. Like on Star Trek, Captain Kirk says, "Make it so, Suloo." We try to make it so.

It's a belief that by saying it, doing it, putting ourselves through the motions, we can make things happen. Change things. This is one of the secrets of behavioristic religions like mine (we're all about doing). And social scientists generally also subscribe to cognitive-behavioral interventions, and surely, hypnotism. Making it so is a little of both.

So...

Have a happy, healthy, sweet new year. May there be no more suffering in this world, and if there is, we should have enough honey to go around.

therapydoc

P.S. For those of you who want to know what the Jewish people are praying for in the next couple of days, the reason your Jewish friends won't be at work, won't be taking calls, won't be publishing comments, etc., take a look at this.

Monday, September 22, 2008

Water, water everywhere: David Foster Wallace

This is where the waters meet the sky.

If you look really hard you can see buildings and seashore below, the Atlantic Ocean meeting Fort Lauderdale. But from above, it's the horizon that's truly sensational.

I have the window seat and the African American mother to my left is teaching her three year old to recognize words in a picture book. The three seats behind us are all empty, so Mom packs up the crayons, books, and child, and moves. I can put up my feet if I like.

After learning a little and saying a couple of prayers, I'll get comfortable and do that, put up my feet.

The son of a close friend is now married to a lovely Miami girl, the reason for this short trip. I actually asked his mother, "How would you feel if I missed it? It's going to be hard to get away."

She looked at me as if to say: Fine, so I'll hate you forever. Miss it.

Gotcha'.

The day before that Sunday wedding, I took a walk over to see #3 son's latest additions to the family, the new Grandfish. He bought me a couple of new fish, too, baby clowns.



It's a new tank and not yet furnished. We take time buying furniture around here.

My son is now best friends with every salt water aficionado on Craig's list in Chicago, and gets us fish at rock bottom prices. When he was in high school he started a micro-business as an aquarist, set up tanks for people, helped maintain them. He called it Rock Bottom and we had fun making the business cards. Rock Bottom didn't exactly take off, but we've always found a certain reliable joy in this family hobby. Keeping fish alive ratchets down the anxiety for those of us who lean toward Type A.

So when he called to ask if I wanted the two clowns, of course I jumped at them. They huddle together and dance in the corner of the tank in the family room. They seem very happy, and yes, are eating well, for those of you worried about such things. (They looked like babies when I left. FD has done a nice job feeding them out of their infancy in my absence).

This is the late David Foster Wallace, a picture from the Wall Street Journal. He knew about fish, too. You can read DFW's commencement address to the 2005 graduating class at Kenyon College online. It begins like this:
There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, "Morning, boys, how's the water?" And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, "What the hell is water?"
Born February 21, 1962 in Ithaca, New York, Mr. Foster died September 12, 2008, a suicide. For more biography, read Richard B. Woodward or Whitney Pastorek's features online. Books about him must be in the making, perhaps they're already in the stores. This gentleman who took his own life (not unexpected, we hear) authored 8 books, including novels and critiques of American life, and one on infinity, as in math. Wildly popular, literary magazines cleared space for David Foster Wallace, as much as he wanted.

Writers worship him.

Mr. Wallace tells over the fish metaphor about consciousness to the graduates at Kenyon College and continues, unless I'm interpreting the speech incorrectly, to say that water represents everything outside our immediate consciousness, that our awareness is hopelessly bound by our self-centered (through no fault of our own) perspective, and that none of us can be anything but wrapped up in ourselves, as much as we try to get out of our heads, thus we don't notice the water until we are older, and even then it is on the cusp of consciousness, and noxious.

Rather than the usual commencement pep talk:
Seize the world, you're all young, good-looking, and above-average,
Mr. Wallace tells the class, basically,
Good luck, suckers. Life is a bear and then you die.
I finished reading the speech, put down the newspaper and thought to myself,
"This is what it is to be someone like DFW, impossibly stuck in the world inside his head, stuck in words."
And I related just a little, as perhaps you do, too, as a writer. But what a terrible waste of a beautiful mind, one that surely couldn't take the madness of it all, so many, many words. Then perhaps, all of a sudden, none. Or none of them good, none of them gratifying.

When I was in my late twenties, a friend of mine called me with a post-partum depression. She said that everything she saw, everything she read, became exaggerated somehow. Things that should be upsetting, but only marginally, now distressed her, terrified her. She couldn't watch the news or pick up a newspaper without dissolving into tears. She didn't want to hold her baby for fear that she would drop him.

These can be symptoms of a pending catatonia, the worst of the depressions imaginable, a psychotic withdrawal into the recesses of the mind. Medical intervention is critical, will save such lives, preserve the parents of the next generation.

David Foster Wallace will be the subject of many a thesis, but to me his decision to suicide, the ultimate withdrawal from life, withdrawal from the water, makes him a casualty, another person I would have wanted to shake, to scream at, insisting, "Just try another medication! There's an agent for everyone!"
Or even a little electricity, just a little.

If I didn't believe in the impervious power of mental illness,* I would say that he needed meaning in his life, too. When he saw the water, and he did, he knew he existed in there, but saw no purpose, not enough. You could say that to him, his pond was more than half empty.

As prolific and productive as he was, Mr. Wallace either didn't want to connect to life, or couldn't, hadn't the energy to make the effort necessary to swim, until finally he found it, the energy, and used it to take his own life. At the age of 46.

With the best years, for a writer some say, yet to come.

Although I haven't read his books, I'm guessing, from his speech, that he failed to see meaning, characteristic of depression, and that hurried his decision along.

To some of us, it is so simple, meaning. Go out there. Do your best. Say Yes when you can, say No when you really know that Yes will come at too great a price.

Give, give, but not too much, and the self will feel worthy, satisfied on more than one level, will know where and how to rest comfortably. The self is that which we can never escape, you see, even if it is not always obvious to us and operates subconsciously; changes imperceptibly, with every sensory impact. The brain, interpreting sensory data, is our first reference point of awareness and self. It is the brain that subsists in the water, or swims, if you prefer, in the sea, the self tucked inside.

We do things as people, and our self-images, what we think of when we say our selves are interwoven into consciousness with our actions, our roles. We call this stunningly complicated weave our identity. Self is separate from the water, but inevitably connected, more or less, depending upon how busy we are. We're going to get wet, regardless, when the waters get rough.

Consciousness, whether it is involved and interacting in life or not, is the water, and it can be unbearable. Our awareness is ours, no one else's. It is private. Our realities are all different, some more negative and disengaged than others. Dr. Wallace understood this, probably, but could not change that experience, couldn't find a more comfortable pond, because of his illness, through no fault of the Pond-keeper. If he were alive he would say, I don't like living in the sea of humanity. It is too hard.

The plane is heading northwest now. I no longer see the ocean, but the memory trace of that place where the ocean meets the sky will basically keep a person like me happy for a long time. Just that sensory data is enough.

And I'm going home, did I tell you? Because Nemo 1 and Nemo 2 are probably looking for me. The impact of little fish, oceans and sky, people in our personal worlds, things we must read and do, the mentoring of our children, sharing life's bookmarks, our missions, meaning, make all the difference. Our commitments shape this thing we call meaning; they guide us, help us move the furniture, improve the clarity of the water in the tank. It can be about as simple as that.

Unless we're really sick. Then there is absolutely nothing simple about the water.

For a real look at DFW and what we've lost, read Carol. She embedded video.

And a writer writes about the writer, Mark Caro, Chicago Tribune.

therapydoc

*In his case, Bi-Polar Disorder, read the comments.

Wednesday, September 17, 2008

Those Appetites

"I hate it when you're depressed," says FD.

"Me, too. But I hate it more when you're depressed."

He smiles. See, everyone gets this way.

Some of us still assess depression times three. "X 3 or times three" means no appetite for food, sex, or sleep. If a person can't eat, has no interest in sex, and can't sleep, we can safely say, Depressed X 3, unless there's another organic reason for those symptoms, maybe a medication that's responsible.

I know, I know, you're going to say that it's also common to do the opposite, have an increase in an appetite for food and/or sleep. And you're right.

Anyway. I had an exhausting day, including a meeting with a new advisory council in the community. It's an advisory council for an agency that educates educators and administrators in the community about a topic that tends to be depressing in general, childhood sexual abuse.

I'm new here (thanks so much, RZ) although not altogether new. When the community zeroed in on a childhood sexual predator several years ago, I helped break down the collective community denial. But I had to quit. When the going got tough, the tired got out.

But RZ got me back in as of a few weeks ago, and I went to my first meeting of dynamic, incredible people who are teaching safety to school and camp administrators, a first step. Teaching the kids, obviously, is the second.

I learned something new, too, about a website for mandated reporters in Chicagoland. It's online training for mandated reporters Virtually everyone working with kids is required to know this stuff in Illinois.

The meeting in the afternoon sort of drains me, as it might drain anyone, but I zip back to work afterwards (I have the car, these things do come in handy now and then) and see a bunch of people.

Home late, feel fine until the phone rings. The call is about an old issue I still haven't resolved, preferring conflict avoidance (who doesn't!). But now someone wants it resolved. It has to be resolved, and it has to be resolved soon. By me. The story, the players, the whole thing is full of spleen and basically knocks me out of the ring for the night. And unfortunately, I can't tell it.

I hang up feeling the worst I've felt in months psychologically, go to bed by nine, something out of the ordinary, with a Robert B. Parker book, Hundred Dollar Baby.

If you know Robert B. Parker, he writes page after page with dialog on the order of this:
"How can you eat tongue," Corsetti said.
"You know how intrepid I am."
"Oh, yeah, I forgot that for a minute."
"You make first yet?" I said.
"Detective First Grade?" Corsetti said. "You got a better chance of making it than I have."
"And I'm not even a cop anymore," I said.
"Exactly," Corsetti said.
The coffee came. Corsetti put about six spoonfuls of sugar in his and stirred noisily.
"Is it because you annoy a lot of people?" I said.
How hard is it to concentrate on this? (One Hundred Dollar Baby is about prostitution, by the way, or is it better to say Escort Services or even Sex Workers).

FD comes home late and I tell him about the new old issue and he tries to help me work it out, but he can't. Not really. None of his thoughts on the problem work for me, and my thoughts don't work, either. But it's comforting knowing he's got my back.

Sometimes when you're problem solving you have to accept that there may not be a good imminent solution. Sometimes the answer has to be to accept the problem for what it is, something annoying and stuck.

Except that I never really accept things as unresolvable. I'm in the profession of resolving.

Death I get. That I can accept. Illness, too, but not always. Other stuff? There has to be a way.

But, no matter how many heads you put together, just because you want to solve something doesn't mean it's going to happen. Like the problem of sexual abuse in a community. There we are, twenty-some smart people, no where near solving the problem. But we're closer to something of an answer now than we were ten years ago.

So I sleep on it, wait awhile, brainstorm again, mostly in my own head. Until something's right you're in no man's land, just feeling badly. But you rock on anyway.

Morning comes and FD's pushing breakfast on me and I'm gently saying No since it's only been a few hours since that feeling of probably never eating again. That's when he says, "I hate when you're depressed."

Technically the crisis is only 10 hours old. And it's not like I'm grousing or complaining or anything, either.

He lets it go, warms up a muffin, splits it, takes half, leaves the other for me. I snub it, go upstairs, do a little paper work, take a nap. I didn't sleep well the night before.

Before I blink it's 11:00 and I've got to go to work. I'm staring in the mirror wondering how to improve what I see when I hit upon a solution to the crisis. A quick and dirty, perfect solution, if only temporary. I feel a little better, jump into my biking clothes and pack up to leave.

But first I stop in the kitchen, wrap up the muffin. FD sees me. He's scavenging in the cupboard.

"I'm thinking PBJ, on rye. Not toasted. Marmalade." I say, "To Go."

"A fine choice," he agrees.

therapydoc

P.S. Now if we could only think up something for those guys on Wall Street, right?

Mandated Reporting

Well, I guess I passed the test because the website
gave me a certificate. Mine didn't print out very well because the printer's almost out of ink or I'd show it to you.

The test is on mandated reporting of child abuse, who should do it, why, and how. Child abuse, for the record is something that is going on in a kid's home, or maybe in a close relative or guardian's home. If the person allegedly abusing the child isn't family, it's not abuse. It's a crime.

This comes up because school's in session, so teachers in Illinois, who are mandated reporters, are being asked to go to the DCFS* website for training on mandated reporting.

But teachers aren't the only ones who are mandated reporters for child abuse and neglect.

Maybe you are, too.

Here's a quick list of professionals required by law to inform authorities about suspected child abuse or neglect. Anyone, even non-mandated reporters, can make a report however (anonymously if you like) by calling 1-800-25-ABUSE.

Go to the the DCFS** website to find out more about the signs of child abuse, things that should make a person suspicious about maltreatment.

But quickly, mandated reporters include people who work with children, and they are required by Illinois law to report suspected child abuse. The list includes, but is not limited to teachers, school personnel, doctors, nurses, clerical people in schools and community agencies, child care workers, law enforcement officers, social workers, social service administrators, firemen, and clergy. There's an extensive list on the site and a cute interactive puzzle. Take the time to visit. Have some fun.

The training and testing took me a half an hour, and I learned things. You can get 2 hours of continuing education credit, too.

You also get nifty downloads if you want them. The decision tree is interesting, tells you what happens after you've made a report, and for those who feel uncomfortable with the whole business, there's a great one from the child's perspective, should you have the privilege to gain a child's trust:

DEALING WITH CHILD ABUSE OR NEGLECT DISCLOSURE TIP SHEET
• Use words I will understand
Always use age-appropriate words.
• Never say you'll keep this a secret
Never promise the child that you will keep what they tell you a secret. Explain to the child your role is to ensure she is safe.
• Don't tell everyone
Although you cannot promise to keep the information a secret, you should assure the child that you will not share this information with her peers or anyone who really does not need to know about it to keep her safe.


• Explain you still care about me
Reassure the child that what she told you will not change the way you feel about her. Children are often afraid that you will think they are bad, or that what happened to them was their fault.


• Disclosure may be difficult for me
Always keep in mind how difficult it has been for the child to tell you this.

Remember:

They may have been threatened not to tell.

They may feel embarrassed or ashamed.

They may have tested others and decided it was not safe to disclose.

They will be watching your reaction very carefully. As often as possible, try to keep the child informed about what will happen next. She will likely be very anxious. If appropriate, let the child know you will be calling DCFS and explain that it is the job of DCFS to keep children safe.

• Find out answers for me
The child will probably have lots of questions about what will happen that you cannot answer. Don't make up an answer. It's OK to tell the child that you don't know what will happen. It may help to tell the child that you know this is hard for her.


So getting comfortable with approaching and listening to children is the objective, here. And following the law to the very letter. It's the least we can do.

therapydoc


*DCFS is the Department of Child and Family Services, a state of Illinois agency.

Sunday, September 14, 2008

No Hitter

Here I am on a Sunday night doing something really important (beating a game of Spider Solitaire, it's my third start, same game, but I beat it), when I get a call from Number Three Son.

"I just thought I'd let you know, since you and my little brother are the only Cubs fans in the family, that Carlos Zambrano is three outs away from a no-hitter. You might want to turn it on."

Well, sure.

And I do, except I worry, What if I jinx Zambrano? What if it's me watching the game that somehow ruins it?

But it doesn't! Indeed, in the ninth inning Carlos Zambrano finishes off Houston like a hurricane (that was mean I know, forgive me) with two bounces in the infield and the last batter down swinging.

Z one and only falls to his knees first thing, thanks the Old Mighty.* Gotta' love that.

I listen to the television interview and how awesome is this?
I hear there hasn't been a Cub no-hitter since 1972. 1972!

And I got to see it. Such cheap thrills. Thanks Three!

FD walks in, a little surprised to see me taking it in and says, "I told you that rest from all that time off for bad weather would help Zambrano!" (Everyone takes credit or blame for these things.) Then he flips to the weather channel for information about our collective futures and we're looking at people wading through the the streets of Houston and Chicago.

"My patients walked into the building today and literally shook the water off," I say.

Mr. Answer Man reports, "We had 10 inches yesterday, 8 inches today, a record. What we saw today, believe it or not, was the actual hurricane, just the rain, not the wind. The storm made it to Chicago from Houston in about 24 hours. Can you believe that?"

Little One does the math, figures the weather system traveled 33 miles an hour. That's fast for a storm.

The light to Blue's tank pops on and the fish gives me the eye. "Ya' gonna' feed me, or what?" He's so snide.

"Blue's telling me he wants to eat," I inform FD. "He's such a smart fish."

"Are you kidding?" FD laughs. "Blue is looking at the TV and saying, 'Wow, take a look at all that water!'"

therapydoc

*The Old Mighty, for those of you new to this blog, is how my grandfather, Z"L (of blessed memory), an immigrant to this country who slept on park benches for a couple of weeks before finding a relative in Chicago at the age of 16, referred to the All Mighty. We sort of think it makes sense, covers both bases.

Thursday, September 11, 2008

Generalized Anxiety Disorder

FD is about to leave the house and I look at him and say, "Maybe we should have my brother take off that skin tag on ___(one of the kids)."

He looks at me, furrows his brow. "Have him look at it." He's looking into my eyes. It's early in the morning.

I explain, "I have to have something to worry about. It's what I am."

He says, "It's the GAD."

"Huh?" (I know what it is, but don't want to believe he's even be saying this, even though I'm pretty sure he's joking).

"Generalized Anxiety Disorder."

"Uh, duh. Like I don't know what GAD is? I invented GAD."

On that exaggerated note, how about taking a look at the symptoms of GAD? What's the worst thing that can happen? You'll worry you have it?

Diagnostic criteria 300.02 Generalized Anxiety Disorder *

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)

B. The person finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep difficulty (difficulty falling or staying asleep, or restless unsatisfying sleep
D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.

E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g. hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

See, to diagnose stuff, you really have to know the entire DSM-IV like the back of your hand. Wait a minute. What do I see there?

therapydoc

* The diagnostic criteria listed about come straight out of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994 (DSM-IV). We're all anxiously awaiting the DSM V.

Wednesday, September 10, 2008

It's September 10th

It's September 10th. This is what Microsoft Outlook tells me. It's what my phone tells me, and my computer. September 10.
Why am I scared?

It's beautiful in Chicago. Low 54, High 73. The sun is coming down and I'm riding through the park on the bike trail, on my way home. Nothing could be nicer. I'm not even turning on the radio. The birds are chirping, the traffic is light on the streets, only a few soccer players dot the park and middle aged walkers are owning my path.

A man is walking my way, but he's looking up at the sky. It's just the two of us, really. I follow his gaze. He's looking at a big white airplane with red markings on the wing.

The airplane is flying low. It's gone in a moment.

It's September 10th. Why am I scared?

I'm a person of faith so I'm not. I'm not scared. Although traditionally, it is a season of awe and fear for the Jewish People. So I should be scared. We believe that everyone's life, and you don't have to be Jewish here, is in balance during the High Holidays. He/She determines the future for the whole world, sorts through our thoughts and actions in the coming month, sort of like we pick through vegetables and decide on a menu.

But right now, whatever He/She has in mind is going to have to be all right. September 10 is slipping away, anyway, like any other day, and tomorrow, September 11, will, too.

I get an email from Smooth Stone who requests a link. This is well worth the read. It's a tribute to Welles Remy Crowther, a hero on September 11. His greatest ambition in life? Help others.

He's gone.

On a happier note, I just watched Randy Pausch deliver The Last Lecture on the Public Broadcasting Service, WTTW in Chicago. That's something we should all support, PBS.

You're supposed to ask, "Isn't that the guy who died of pancreatic cancer? How could there be a happy note here?"

Indeed, this vibrant, brilliant, fun-loving engineering professor isn't with us anymore. But you can watch his last lecture on YouTube. What a wonderful human being, a person who really understood what it meant to enjoy life and to live it well. And he knew it before he got sick. You have to see him to believe him.

Here's what the sidebar on YouTube tells us:

Carnegie Mellon Professor Randy Pausch (Oct. 23, 1960 - July 25, 2008) gave his last lecture at the university Sept. 18, 2007, before a packed McConomy Auditorium. In his moving presentation, "Really Achieving Your Childhood Dreams," Pausch talks about his lessons learned and gives advice to students on how to achieve their own career and personal goals. For more, visit www.cmu.edu/randyslecture.

He says he did it for his children. Something about head fakes and football.

therapydoc

Sunday, September 07, 2008

Complaining

The Jewish word for complaining, you might know, happens to be kvetch-ing.* But you don't have to be Jewish, obviously, to kvetch.

There's therapeutic value in it, and paid listeners spend the good part of their day in pursuit of the productive kvetch.
Meaning, if a patient can complain to a professional and get results, either feel better or resolve a problem, then it's probably good for that person to kvetch, and a therapist is doing a real service, just listening. It's what we do, among other things.

Even better is to orchestrate it so that the patient complains to someone in the family, builds an alliance there.

But forget about the therapeutic setting. Anybody with a friend or partner can complain just because it feels good. I suppose in certain religious circles this is frowned upon if it presents as gossip or involves casting of negative aspersions.

But let's not get all spiritual here. I'm pretty sure there are ways to complain to friends and lovers that are less gossipy or damaging than others. Talk to your local clergy-person if you have any religious questions about the right way to complain. Generally, you're allowed to do it in therapy to solve a problem, serve peace in relationships.

This comes up because a blogger wrote me to complain that he had blogged and let it all out, told a story that clearly felt good to tell. He disguised the people he wrote about as best he could, but worried that he had embarrassed someone.

He asked me, "Well, isn't the therapeutic value of getting it out of my system worth the slim possibility that I might have embarrassed someone, who, by the way, really injured me?"

Uh, no.

It's not going to be therapeutic in the long run if you're already feeling guilty about it. Maybe pull the post.

That's how kvetch-ing comes up in the blogging world. (I can just feel collective guilt festering all over the blogging universe right now as you read this.)

In the therapeutic world and the world of friendship, marriage or partnership, one person's proclivity to stuff it, as opposed to complain to, communicate with another, can be a problem.** Some people really do need to work things out, perhaps talk out loud, feel heard to feel better. But they won't. Or can't. People don't all have the words, or the clarity, vision fogged over with fears of exposure or conflict.

For some of us, complaining as children just wasn't allowed. Only the parents had the right to complain. So we learned not to. For other people, complaining feels horrible, like being exposed, raw, so out there, so vulnerable to criticism, rejection, and abandonment.

And then there are those of us who don't see that it will make any difference, complaining, don't think it will help, who can see kvetch-ing doing more harm than good, risking intimacy that will ultimately be lost, potentially create conflict, hurt feelings.

The emphasis on this blog, regarding communication, has always been

(a) You don't take away an umbrella until it stops raining.

In other words, if that's a person's psychological defense, not talking, you don't take it away. You don't make someone talk, you can't make someone talk, until that person feels safe in the relationship. Then it will be a natural thing, talking. Maybe. With a little work here.

And

(b) You want it to stop raining because intimacy, not distance, is valued in a relationship.

To me, one of the advantages of a committed relationship is that it lends itself to intimacy. Same bag of bones every night. You know each other's stressors, you know each other's outlets. You know if it's icecream or beer, and encourage watermelon. You encourage one another to share, because at the end of the day, only the two of you are living under that same roof, only the two of you can solve your problems. And if you have children, it is the two of you who will be accountable for their upbringing.

And the sharing feels good when you aren't punished for what you have said, rather have been rewarded with understanding. That feels very good, especially if it is a safe bet.

So we can talk all we want to our friends, complain all we want on the Internet, but if we have a significant other, the real juice is the emotional intimacy of complaining to him, to her. It's painful to listen to it, that's for sure, so often. We're tempted to feel we have to fix it, and sometimes we can, sometimes we can't. Problem solving, in relationships, is a different type of intimacy, requires different skills.

But listening is really the first order of business, the first course of intimacy, served up exclusively with a helping of words from someone else, words that fall, until further notice, on silence.

You notice, you really do, if someone isn't sharing with you, if a person is holding back, has things to say and isn't saying them. If you're sensitive, you can tell you're the only one who has been talking lately.

And for people like me, who don't like to let it all out, who would much rather read newspaper headlines aloud to bide the time, or tell Jewish jokes, or ask what's new in the community, the treatment is really less complicated than it looks. You tell people like us,
Just give me a little. Throw me a crumb. I won't ask questions, and I won't try to fix it. Just a couple of words, will do. Let me in. What's going on in there?
If you're lucky, and if you really refrain from trying to fix it or asking questions, it's likely you'll get some results.

Then maybe, if you're lucky, you'll feel you know this person. You can stop complaining about the lack of emotional intimacy.

therapydoc

* A kvetch is someone who complains all the time, but we use it as a verb, as in, lemme kvetch.

**This is where some of us have what is called interface, and have to talk to our therapists or push our finger nails into our palms to keep ourselves from saying something egregiously idiotic like, "ME TOO! I CAN'T COMPLAIN, EITHER!"

Thursday, September 04, 2008

About Those Nasty Sporadic Posting Habits

I apologize (why am I always apologizing) for not being consistent about posting. I used to publish something for you every day, sometimes twice a day, and it was fun, it really was.

Then #2 daughter-in-law* at one point noticed, "Hey Mom, you're not posting on the blog much anymore! What's up?" and all I could do was shake my head.

"This hurts me more than it does you," I sighed.

But I'm getting other things done this way, and I'm still writing, haven't stopped like some rabbis I know.** (

But not writing on any given day is almost impossible; I'm nowhere near the bottom of the barrel of Stuff to Teach. So I write during the week and then try to polish it up (you'd never know) and eventually get to publishing two or three posts all on one day, all at one time.

But they're dated on the days I started them, so it gets confusing, and the last thing I want to do is to confuse anyone. Life is so confusing as it is.

Maybe the only way around this conundrum (for those who find it annoying) is to subscribe to the email subscription at Feedburner. There's a blank someplace on this blog. The email goes out around 4 PM, unless I'm not ready and change the time. But it does let you know when there's something new here, so it's not a waste of time to visit.

If I publish twice a week, like I'm doing right now, you get a second email, obviously, which can be annoying, too, so many emails and all. So there isn't any great solution, here. Although I'm open to suggestions.

So confusing, sorry.

(Okay, I'll try to stop, but the apologizing season is upon us. I'll explain another time).

therapydoc

*Only #2 daughter-in-law by order of marriage. As my mother used to say, I love you all the same. How this is possible, I'm not sure, but it feels right, and it is right, so go figure.

**Not a rabbi, not judging, just kidding, should you think that crack was about you.

Wednesday, September 03, 2008

Blowing Kisses

It's been a great biking summer, but tough on the bike. Yesterday I had a flat tire two blocks from the office. Two new inner tubes later, life is good again, but you never know what tomorrow will bring.

I left for work early hoping to make it there well-ahead of a new patient, not wanting his first impression of me to be

me shlepping my bicycle through the waiting room, looking like I need therapy bad.

And flats happen and school is in session, meaning there will be unusually heavy traffic, more buses, more pedestrians, many more shapes and sizes of young people walking in pairs, three and four across on the sidewalk, unlikely to make room perchance I hop a curb to avoid colliding with a truck.

In the summer the sidewalks by schools are virtually pedestrian-free. But not anymore.

This is boring, isn't it? You don't need to know about bike traffic. You want to know about blowing kisses, the title of this post, not blowing tires and dodging silly children who don't smile. (They weren't smiling yesterday).

The Story

Maybe it's because my granddaughter threw huge kisses to us on Skype last night that this is on my mind. She's two years old and famous for her one-liners.
"What's that in your hair, honey?"
"Oh, that's just tomato sauce."
I'd share more, but it's stealing material.

Or maybe it's because of the smacker Barack Obama gave Nancy Pelosi at the convention. To be fair, he kissed all of the women within reach after his speech (maybe the men, too) and I'm pretty sure that John McCain will be in an amorous mood, as well. But that public display of affection feels a little extreme to me and unnecessary. My ethnic-cultural bias, for sure.

So this morning on my bike, about a mile away from home, I reach my first traffic-congested intersection and am seeking eye contact before crossing in front of a car. It's a good idea to do that because most drivers won't intentionally run over people if they've made eye contact first. I get the nod and flash a smile even as she's creeping closer and closer towards me.

And moments later, there's an encounter with my first school bus; the poor driver is really working to make it through traffic. He's not giving me any green-light looks, no looks at all, communicating that if I cut ahead of him, it may be my last conscious decision. I wait, edge up carefully. And then, out of nowhere, he looks down condescendingly and waves me on.

This is going to be a super day, if you believe in omens. I wave back.

Finally, at the most congested intersection ever, one without any stop signs or traffic lights, another driver sees me waiting at the curb for a break in the traffic, stops on a dime and waves me forward as if to say, 'Go! We're good!'

This is so unusual. This driver doesn't have to do this. She's got the right of way and I'm waiting patiently, not daring to expect a courtesy from anyone. She (maybe it's a he, must it matter?) doesn't mind at all, has literally stopped traffic for miles! For me.

What do I do?

Overcome with emotion, I throw a huge kiss, delivering it by my hand, drawing an invisible forcefield, a one hundred eighty-degree arc in the air that says, I love you.

Then I die of embarrassment. Did I just do that? Throw a total stranger a kiss? Isn't flashing a smile enough? What's this world coming to when total strangers throw kisses?

A few blocks away from the high school an African American policewoman is directing pedestrian traffic at the cross walk by the gas station. I stop and smile, take in the traffic signals, then say under my breath, "Do I go or do I stay?"*

She's heard me. "What?"

"Aw nothing. I'm just waiting for a green."

She smiles and warns, "This is the worst corner. You better be careful. The cars will ignore the pedestrians right here, right where we're standing, because of the curb cut. They'll mow you down just to get to the gas station to avoid the light."

"You better be careful, too," I say.

"Oh, I am. I am," she nods, seriously.

"I've never seen you before. But then I'm never this early for work. Do you work this corner every day?"

"Oh, I'm here three years. Replaced the last lady. She died." She lowers her voice. "Cancer."

I sneak a glance at the stoplight, the Walk sign is flashing, but decide to wait a minute longer.

"Wow, that must have been bad."

"It was. It was. But life goes on, you know?"

"I know. It sure does."

And I get the craziest urge, such a strong one, but I can resist it, I don't throw her that kiss of appreciation as I take off. It just feels way too loose to me.

"See you around!" I cry.

therapydoc

*Do I go or do I stay is a recurring theme in family therapy.

The Monogamy Gene

Right.

I don't think so. The morning news team wants me to believe that there's a gene that makes some people more monogamous, perhaps more dependent, more connected, more loyal. There are people genetically predisposed to commitment and marriage, who are more in it, than others.

Maybe it's true. They say men with two copies of RS3 334 were more likely to be unmarried than men with one or none, and if they were married, they were twice as likely to have a marital crisis..

Fascinating stuff, but very hard to believe. And yet, if it's true, it could affect the way we do therapy.

I can tell you, however, that I've talked to men whose fathers literally put notches on their belts to indicate the numbers of women they have bedded, and yet, would never have considered leaving their wives, the idealized Madonnas of the family. These sons can be conflicted about their own extramarital affairs, yet they still have them.

But maybe that was their genetics talking, not what they really wanted or valued. The ironic functionality of the extramarital affairs in the above example, is that if he's happy (and why wouldn't he be, so many women, so little time), she's happy (no job of sex necessary, phew! Switch genders if you like.

The proud notches on the belt tell me fidelity is learned, no matter the genetics. Fathers give permission to sons.

Boy, but stuff like this makes it easy to question everything you know, doesn't it?

therapydoc

Tuesday, September 02, 2008

August Back A'cha

Wasting no time, here's the short list of bloggers who linked here last month, I think. Let me know if I missed you.

Let's dive right in with Melissa at the pretty GoodPracticeInstitute in New Jersey. She says that not every therapydoc takes a full month off for vacation out East (but many do). I had to ask, How does anyone get away with this? I mean, without punishment. Her other blog address is at Hope Forward.

Over at Her Family Blog they appreciate a good enmeshment story, the one about teaching the class and spilling the glass of water. What would people say if I said I made it up? My mother-in-law tells me to believe half of what I read. Should you guys?

Kathy with a K works with kids with autism and she is a ballet dancer, too! She writes The Fringe, and has some terrific recommendations for children's books. I also love the lay-out of her blog. Check her out.

Isle Dance
liked my post on therapeutic boundaries. I'm pretty sure, living on an island, she's got her own.

Oh, You're a Feminist is still at it, giving us the news about the news.

Master of Irony's suffered some tough times. And grandma's not doing so well.
A speedy recovery.

Sprittibee's into home schooling. I sure hope they have recess, although they're definitely making the most of education indoors and out.

All Rileyed Up is very cute. Her five steps to problem resolution are a must read.

Fighting Monsters is grousing and observing the opening day of grousing season. People hunt. Who knew?

Leora liked that post about the little girl and has some great thoughts on the subject, the Little Girl Syndrome.

Keith is a 40-something Registered Nurse, and he says he's happily married. See there are a few out there and mostly they're happy because they're spouses let them blog. Anyway, he's hot on the blogging trail, writing early and often, and making sense at the same time (although he's terrified we'll all be in senescence at the same time).

Syd likes the Cubs so we love Syd! Yes, it's that simple, ladies and gentlemen.

Gossiperia
is, well, gossip about celebrities. But it's good gossip.

Modern Parent is our latest addition to the mommy bloggers. What happens when they grow up? Do you become Modern Grandparent? I sure hope so.

Little Frumhouse on the Prairie is my favorite place to check out how late I am for Shabbas. She's a wealth of Chicago information and, uh, news about people and things. One of my fave Jewish bloggers.

Another blogger, In the Pink is getting used to having a smart phone. It's like having a smart kid, Pink, you just have to keep up with it.

A Room of Mama's Own is renaming herself, or thinking what she would have named herself, if she had the power, which she does, of course.

Some bloggers are obsessed with lists, and being a person who has running lists of all sorts posted in all kinds of places, I admire them. Here's a list of 100 health-related blogs from Online Nursing

So I did a couple of depressing movie reviews and there are links to those at Missy's Window (you can find other movie reviews there, too.)

The Movie Guru also threw me a crumb.

The Weight Master took me seriously about Wall-E, included that post in a fitness carnival. Thanks, WM.

And those crazy business marketing people over at Network Marketing included Faking It til You Make It in theirs.

Another awesome new social work blog. Welcome Just When I Think I've Seen It All!

And the Lethological Gourmet suggests that you do not throw your bike. How could I not link to a post like that? Thanks, LG.

Treppenwitz (and everyone and everything else) is making me miss Israel.

New writers (well, honestly, no idea how old she is) to watch out for: In the nuthouse, stories of my life so far. I like the one about bird-watching and the Assistocat.

And one of your more psychologically sensitive mommy bloggers, Shosh, Living, working, mothering, One glorious day at a time. Notice the mothering is last on the list, although I know it was just for lyricism.

Antisocial Social Worker is taking a family therapy elective! I can't wait to see what she learns. Anti, you HAVE to share the wealth.

That's all folks.

therapydoc