Tuesday, November 25, 2008

Help Desk Closed

That last post was awfully long. I apologize. No time to edit, it's busy season. And I wanted my little friend to get a good grade. (smiley emoticon here)

Everyone have a great Thanksgiving. I'm sure there's something to be happy about, something to be thankful for, if you think on it.

One of the things I'm thankful for is all of you.

All the best,

therapydoc

A Chandlers is Safer

There's more to this concept about blogging being therapeutic. Before words in previous posts are taken too far out of context, maybe it's a good idea for us to take a closer look; get out the x-ray vision, see what's lurking beneath what apears on the surface, at least, to be a marvelously good time.

Not that we need x-ray vision. If you've blogged awhile you might have come to realize that almost everyone is a little vulnerable, almost everyone is socially sensitive, at least to a degree.

Kids are particularly at risk for harm in social contexts. We think of them as more sensitive than adults. We professionals think of kids as a vulnerable population, in fact.*
And they blog, too, a very social activity with potential risk.

So this post is for them.

A high school student writes to me from North Kingstown High School in Rhode Island, asking if I would mind participating in an interview about blogging and its relationship to therapy.

Not willing to out myself with a phone number, I ask her to send me the questions. For sure I'll answer by email or write a post about it. She can copy, paste, interpret, disagree, then cite me as a reference for her paper.

Citing where you get your information is the kosher thing to do, both on or off the web.

Cyber-safety, you'll see, is the important variable to consider if you're answering the research question, Is Blogging Therapeutic? It's the confounding variable, for those of you who understand what that means.

If you put yourself in danger emotionally when you blog, the experience is not going to be very therapeutic.

Okay. Here we go.

1. How long have you been blogging?
Two and a half years. I can't believe it myself. All I wanted to do was teach. Now you know the color of my . . .

jacket.

2. Do you feel that blogging can have the same therapeutic benefits as keeping a journal?
This has everything to do with who is reading the blog, who is reading the journal.

Let's take a look at a journal, first. It is hard copy, pen and paper, or maybe an electronic file on a computer, a CD, or a flashdrive.

You might leave a paper/pen journal in a drawer, or inadvertantly make an electronic file accessible to others who stalk around the house.

That leaves your mother, father, sister, brother, grandmother, house-keeper, or friend an opportunity to find it, read it, make a copy, blackmail you, send it half-way around the world, for all you know. Or perhaps have a heart attack (that would be your mother or father).

So in some ways, blogging knowingly for all to see on the Internet might seem safer. You can make a blog totally private, theoretically, so it is accessible only to those special people you invite. Of course, if you invite them and they don't read your blog, that might hurt.

You can get hurt you with the teeniest bit of criticism, too, open yourself up to all kinds of bruises to the ego as a blogger.

Bloggers can wait for weeks and nobody stops by, which hurts because the expectation, the hope, is that someone will comment eventually. Whereas journals aren't set up for comments. (Although some teachers have students write personal journals as writing exercises. And they might comment; I don't know.)

As far as blogging goes, however, even if it's by invitation only, any guest can copy and paste and show others what you wrote.

But let's just say, you're tough.

You want to blog, even if it leaves you vulnerable to mean comments, blackmail, expulsion from school, that sort of thing. Assuming you know how to clear your browser of cookies and don't allow comments to go to your email, assuming that you blog anonymously and no one knows who you are, then there is a slim hope that your confidences on a blog might be safe from exploitation.

Confiding, expressing deep thoughts, is a variable that makes blogging therapeutic. The writing process, however, is another.

Expressing yourself and getting things off of your chest with a journal OR a blog can be a huge relief, very much like talking can be a huge relief in therapy. On the other hand, if people read what you write and identify you, show your story to all of their friends, well, consider your life public record.

Not everyone wants to be an Ashley Dupre, not even Ashley Dupre.**

Let me make up a fun example to illustrate how blogging, in particular, can backfire.

Journaling can backfire when someone you don't want to read your journal finds it and reads it. The same thing happens to some bloggers who think, who hope, they're anonymous. This example speaks to the kind of stuff I see at work. You'll see that kids, in particular, don't always get the therapy they think they're getting when they blog. But they might wind up in therapy.

A couple comes to therapy and tells me that they have found their daughter's blog and read it regularly. She is a good writer, they have learned, and from reading her blog, they realize that she is very much into it, feels her blog is a fantastic place to just let it all out, all the junk inside.

The kid has netted a host of new friends, too, in the process. She has no idea that her parents are reading her blog.

She freely posts about her sex life and her many relationships. The comments on her blog also reveal that she has quite a bit of experience with older boys who praise her body.

She is thirteen.
You might think this is a good thing, perhaps, that her parents have learned about her promiscuity. You might even wonder if her whole reason for blogging, perhaps, was to out herself, to get caught, get help.

Maybe. But maybe not. You can't count on every parent to leap to therapy for the family. And not everyone parent is going to be able to resist losing it, reading that sort of stuff. There is such a thing as child abuse.

So it's about who is reading it.

3. Do you feel that blogging acts as a type of group therapy?
Sure. But let's first look at the active agents in real group therapy, face to face group therapy, the type you see in Bob Newhart's office on television, or whoever the latest TV group therapist is these days.

The active agents are all about feeling accepted, even loved, supported, and understood. A therapy group is a place of trust and safety. You can be yourself. Other group members might call you on your weaknesses, your faults, but there's a therapist there to keep it safe.

It's encouraged, too, that group members lift one another up, say positive things. You can learn social skill, including how to take criticism in real face to face group therapy. Then you're better prepared to face the great outdoors.

The one with a real sky. Sunny? Cloudy? Stormy? You can cope.

If you're blogging to get the same benefits, it's likely you are trying to establish yourself as a member of a small virtual community. And you can be one, too, if you visit other blogs. People comment, lend support, express love on one another's blogs. Even if only a few bloggers comment, but comment nicely, it feels good and feeling good is therapeutic. So it can feel very much like group therapy.

There really is potential to establish good relationships here in cyberspace as a blogger. Just don't get in denial about the downside.

4. Is there a specific age group/or personality that you feel would benefit most from blogging?
It's not as much about age, as it is the ability, the maturity to edit. And editing curbs your self-expression, as such potentially robs the process of that therapeutic agent. If you aren't careful, at any age, your secrets are open access.

And unfortunately, anonymity, as cool as it sounds, might really be impossible. (Here's that downside). You want your friends at school to know what's going on in your head, and you want certain people to read your blog. But those secrets of yours, on a blog are potentially out to anyone who stumbles upon it. At any age. Forever, really. Even if you try to keep the blog by invitation only. Life is full of betrayal.

In my humble opinion, it may not be possible to have that community and friendship and stay anonymous. There are people who might betray you, but you might out yourself in a weak moment. The temptation to tell people you blog is HUGE. It's overpowering. And if you don't watch what you write, self-exposure leaves you vulnerable to embarrassing not only yourself, but your family, your friends, or anyone you even remotely refer to in a story.

And it surely takes some of the fun out of the whole thing, editing.

But therapy, to tell you the truth, isn't always fun.

On the other hand, you can get the benefits of a community, without getting so personal. You can do that by writing only what you don't mind the whole world reading, and by visiting other bloggers and commenting appropriately on their blogs. They'll return to visit you, to say hello. Maybe often.

5. Are there negative aspects to blogging? If so, what are they?
Well, we've mentioned a few. Aside from the potential disclosure of unbelievably personal experiences to millions (potentially) of strangers, one of the negative aspects of blogging is possible trauma to the blogger, to the degree that it can become post-traumatic stress.

Toxic comments can do this to you.

Most bloggers enable comments. Unless you keep a blog private or don't allow comments (ask your techie friends how) you open yourself up to input from heartless individuals who say some very cruel, insensitive, derogatory, even vulgar things.

Some people can manage or delete comments like these and shrug them off. A kid, on the other hand, might have trouble forgetting the mental images that racist, homophobic, misogynistic predators leave behind.

In other words, you might need therapy from this process of trying to get therapy from blogging. It can be really ugly.

The cool thing about blogging, obviously, is that it brings people together. The downside, unfortunately, is that it opens you up to spammers and cyber-abuse, your average insecure, vitriolic human with nothing better to do. Blogging is not for the feint-hearted. Trust me.

6. Do you feel that it is beneficial to use a blog as an online diary?
I know people do it and I think it could be a really good thing as long as they don't publish it. Using blog space as free cyberspace is a great way to establish a diary, and it is secure. Save your diary as a draft. Don't publish it. It's still a diary, a record of your thoughts and feelings at a certain time of life.

You can write whatever you want, and if you're the only one who knows your password, no one else will read what you leave in cyberspace, assuming you leave it up there as a draft. When you want to read your diary, you can open the draft up, read it, and save it again until you're fifty and nostalgic.

No one else need know. And it's still on-line. Safe from the house-keeper.

therapydoc
*Researchers worry about the effects of their studies on vulnerable subjects, or populations.

**Ashley Dupre, a.k.a. Kristin, is the name of the nemisis of Eliot Spitzer, former governor of New York, who hired her for her "escort" services. He didn't know who she was and she, according to her interview, had no idea who he was.

Wednesday, November 19, 2008

With Feeling

See the yellow fish? He doesn't look too good.

We were talking about truth in blogging, and I felt conflicted that I have to be in this position of reminding you that when I make up an anecdote, that I'm making up an anecdote.

Ordinarily bloggers are honest. But a therapist never wants to reveal case material publicly, for fear of breaching the privilege of patient-doctor confidentiality. To avoid that, I patch together random interactions, invent stories, create personalities.

But when it's about fish, I can tell you, the stories are true.

Sometimes I wonder if fish can be empathetic. I know that dogs are, and cats, maybe. Probably those elephants we talked about have some empathy. I'm not a pet psychologist, so I'm clueless here. Feel free to help me out.

Therapists are empathetic, or they're supposed to be. But even an empathetic therapist can and should be able to detach. If a therapist doesn't intellectualize, doesn't lead with the head and not the heart, then everyone in the room is going to be an emotional wreck. People don't go to therapy for that, to increase their perception that life is basically chaos.

So I can detach when I work, detach with my friends, detach even, from my family.

But as a hopeful therapist, a person who sees improvement in just about every thing, every one (although it can take some time), and every type of situation, the thing that still throws me is death. Not leading with the heart here isn't an option.*

The Story:

FD tells me that my fish jump to attention when I walk by the tank. They swim a little faster, breathe a little harder. Of course they have eyes, you know, so it is not out of the realm of possibility that they recognize me, associate me with frozen krill and brine shrimp, Formula One and Formula Two. Who wouldn't jump, just thinking about yummy stuff like that. Mmmmmmm.

So I can relate, I guess, to fish developing relationships, in their way, with people. We just talked about elephants a few days ago, and I imagine that elephant keepers (keepers?) commune with their pachyderms, whereas if someone like me spent a week with an elephant, it's unlikely we'd have much of a relationship. The beast would sense my fear, my disrespect when it came to his bodily functions.

But pretty tropical fish that swim around in water, well, we attach emotionally to them, and it would be nice to think that they care, somehow, too. When I come home from work I go straight to the tank to say hello, to see how they're doing. When I get up in the morning I'm quiet, so as not to wake them. In exchange for this, they swim around and look pretty, try not to die.

I had Blue, just Blue (don't panic, he's fine), for over a year because having one healthy fish was fine to my liking. But as you might remember, he got a little too big for the tank, so I asked FD and Number 3 Son to move him into larger quarters. A little construction, no small task, actually, and Blue had the ocean to himself.

Such a large tank all to himself did seem silly, or so they all told me. So with the help of my son-in-law (a real fish nut, you should see his tanks), we created a community for Blue. He did pretty well, too, once he established his territory (the conch) and seemed to enjoy the company. I was really worried since Blue is a fish with really sharp teeth, and fish like that, should their appetites kick up. . . well, you just never know. But he never gnashed at the new fish.

One night about a week ago, I got home, hung up my coat, and took a hard look at the tank. The yellow tang, a little guy (you usually see humongous ones in the stores) looked sick. He had a brown spot where one would guess his heart should be, and he was leaning against a rock on the floor of the sea.

I tried to hand feed him, but he didn't look interested. He didn't even sniff at the food. I called my son and reported the symptoms. "Brown spot?" he replied with a sigh. "You may as well fish him out and put him in a plastic bag and freeze him, Mom."

Why the freezer, I don't know. But I couldn't do it. I had just watched a Boston Legal episode on euthanasia* and it made me consider the whole business of assisted suicide, even when it comes to fish. So writing this I let Little Tang gasp for life, holding onto a thread, and felt more than a little sick, myself.

When he passed on, he would go the way fish are supposed to go, downstream, I thought. And it would take me awhile to get over him.

Soon Little Tang gasped his last breath. When I discovered him he had wedged himself under the rock, making it difficult for me to fish him out with a net. I stuck an algae scraper into the water, a long stick. Usually Blue runs from it, hides. But this time, when I tried to poke the tang out from under the rock with the stick, his protexia went nuts. Blue bit at the stick, swimming around frenetically, as if to say:

Haven't you done enough damage for one day?

I felt blamed. Yet it did seem that Blue cared about his little buddy. And he wasn't going to let me show any disrespect for the dead, or as someone insensitively suggested, steal his midnight snack.

I gave it a rest, came back and fished out the dead fish. Again Blue objected. But he was powerless.

I knew it would be hard for me to sleep. FD came home and I told him the story and shared that the other fish might be at risk. When one fish goes. . .He said, "Maybe you need to syphon some of the water. Aren't you supposed to change some of the water every couple of weeks?"

When the kids lived at home, it did seem that they made a huge mess syphoning water relatively frequently. But since it's been just me and Blue for so long, we had it so that once a month was just fine. And miraculously, it never got messy.

So I got a little defensive, but FD put the bug in me. Although it was late, after midnight, I started a water change, just 10 gallons, but enough to keep everybody safe. And the next morning, no question, the three remaining fish seemed healthier.

So.

(a) I was right to feel guilty,
(b) taking responsibility made everyone feel better,
and
(c) whether or not fish have feelings is still anyone's guess.

therapydoc

**You can argue that every type of loss feel a like a death, and you would be right.

**The Boston Legal episode I'm talking about has the best treatment of parents cutting off an addicted child I've ever seen. Episode listed on the ION station as WCPX 13, it's about Shirley Schmidt being best man at her ex-husband's sixth wedding, assisted suicide, and an amazing treatment of addiction in family relationships.

I think it's the episode responsible for hooking me on this show, which, by the way, is awfully preachy this year. And for Republicans, insulting. I posted on the cut-off in families with addictions, if you're interested in this at The Second Road.

Tuesday, November 18, 2008

SADS is back

From thisTo thisin only a week.

I can't believe it. It seems like I just terminated with my SADS patients for the spring and summer, and already the calls are coming in. The days are short, the nights are cold. And the bloggers, like Master of Irony, are worried.

But come on, Chicagoans! The sun peeks out every so often, and although it might be cold, the wind doesn't always whip up, it's not supposed to tomorrow, and we live for tomorrow in our neck of the woods.

Get out and jump in some leaves. Put on a heavy sweatshirt, get a pair of warm, fuzzy, boots at Target. Black ice in Indiana? Who cares! (Well, those of you who commute to or live in Indiana do, I suppose, sorry about that).

So a quick check list on battling November thru March seasonal depression:
A brisk walk every day (or if you're me, a bike ride when there's no precip or wind chill). Just do it. Bundle up and do it. Don't worry what you look like.

Turn on the lights when you get home in the evening, all of them. Pay the electricity, but spare the depression. Ditto about the heat in the house, if only for an hour or two, get warm.

Make soup. Big pots of thick, wonderful soup.

Don't think about the weather. Think about anything but the weather.

Make it your business to get out and visit someone who is shut in.

See how much it might cost to buy some used skis, or snowshoes, a sled or a tray. If you can afford it, consider an exercise club membership. There should be some deals coming up.

Take hot showers.

Get creative, not drunk. Make your holiday cards if you can, and make them meaningful.

Don't even think about spending a lot on presents this year. Everybody gets it that times are hard.

Sing.

Learn to whistle.

Call a friend. Play a game. Write a book. Move the furniture.
This isn't a comprehensive list. I know there's another one on the blog somewhere. I just thought you should know, it's not your imagination. The weather does affect mood, probably because we're simply receiving less by way of sensory stimulation. If we choose to stay in we make matters worse. It's a challenge.

What's this I hear about Wii, anyway? Should I go see someone who has it? I've always wanted to play drums.

therapydoc

Sunday, November 16, 2008

Wild Things and Translocation


We pushed away momentarily from an informal dinner on paper, talked out. I suggested a little television while we digest a bit and flipped through the cable guide, found Wild Things. Knowing FD likes to learn anything about anything, I pushed the "Okay" button on the remote.

Rhinos. Have you seen it? The story made news in February.

Pretty interesting TV viewing, for awhile there. But I am eating, digesting. And the large animals are rubbing parasites off of their hides, lolling around in mud. I came in late, so am not sure why the animal authorities in South Africa have trans-located rhinos and elephants, but it has something to do with preservation.

They show an auction for zoos, another way to preserve them. I'm surprised that kids aren't afraid to go to zoos. After all, if we can put large mammals and pachyderms behind bars, how hard would it be to contain Little Joey?

I felt pretty sick before long and excused myself from the table, but wandered back as my stomach settled down. (Cookies help here.) Anyway, there on the tube, a young elephant is bullying a small rhino. The narrator explains that if the rhino doesn't get free, the elephant will pin him down with his knee and gouge him to death with his tusk. This is a common thing in Africa, a little like certain school yards in America.*

Interestingly, the reason for this unusual aggression, and, apparently, excessive unusual sexual behavior of the elephants, too, has to do with their age at translocation. These elephants are teenagers.

We all know that this is not a good time to move kids. Teenagers need some stability in friendship. Separating friends at this most emotional time of life can be a terrible thing, psychologically, a terrible loss. Loss makes us angry.

The scientists returned to the native territory of the aggressive young pachyderms and sought out a few elderly elephants, grandfatherly elephants, to translocate them, too. The teenagers settled down as soon as they had a little supervision. Having grandparents around stopped the aggression and the hyper-sexuality.

Now. Seems to me that this is a call to grandparents everywhere, not to go to Africa, but to get more involved with their teenage grandchildren.

You might say it's a call to the wild.

therapydoc

*An exaggeration, for those of you who are not living in America. It's true that it can be dangerous in certain places, like alleys in the wee hours of the morning, certainly at night, but this depends upon many things, primarily your zipcode.

Saturday, November 15, 2008

The Babushka

We had a scholar in residence at our synagogue this weekend, a very distinguished Jewish historian. I recommend his books highly, if you really want to know what we've been through as a people.*

Berel Wein is also an esteemed rabbi and a lawyer, although he gave up law for the higher calling.

FD and I used to listen to his Jewish history lectures on cassettes, audiotapes, ages ago. He's funny, bright, insightful, and old. I don't mean that he's old physically, but he's got an old Jewish soul. He's old enough, he'll tell you, to tell you what he thinks and not care at all what you think about what he thinks.

So you can see why I like him.

Anyway, we had some guests on Friday night, and as we wound down the meal, had to make the decision, Do we go to the lecture? Or do we go to our respective comfort zones and read and doze, read and doze, break things up with another cup of tea?

Either my allergies are kicking up or I've got a virus. So I'm thinking I shouldn't go out. But Berel Wein! I excuse myself, get ready, and join the party. What's the worst thing that can happen? I fall asleep?

We get there just in time for the speaker. The rabbi starts with a joke. This is how Jewish people are (maybe everyone is). We start with jokes.

But you would think he's addressing that post on falling asleep in shul, honestly, conceived at the pleasure of the presence of a different scholar in residence. Here's Rabbi Wein's joke:

A minister knows that one of his parishioners always falls asleep as soon as he starts to talk. He can't stand it. So one day he thinks, "I'll get even with him."

Everyone's in church, and he starts his sermon softly, in a drone. The fellow dozes off. When the minister is sure the guy is sound asleep, he rouses the rest of the congregation shouting, "Everyone who wants to go to Heaven, please stand up!" The congregation rises. The sleeping congregant snores.

Everyone sits down. The minister talks awhile longer, then he starts in again, shouting only the last half of the message at the top of his lungs,

"Everyone who wants to go to Hell. . .Please stand up!"

The sleeper is finally roused by the phrase, please stand up and he jumps to his feet, confused. Everyone snickers. He turns to the minister and says, "Reverend, I don't know what the cause, or what you're asking us to contribute, but you and me are the only ones in the room standing."

Well, I liked it. And with that he tells over his lecture about the relationship Jews have with money. He recounts the history of trade and virtual money, the arrangements merchants worked out so that they didn't have to load bushels of coins onto donkeys, risking life to robbers and thieves, in order to buy things and make a living.

If Yankel in London has a cousin Shloimie in Iran, then England will always have salt, is the basic idea.

I stayed awake for over half of the rabbi's talk and wanted, you have to believe me, to stay awake for all of it. But on a Friday night, if I close my eyes, even for ten seconds, it's all over.

I woke up to hear Rabbi Wein talking about his grandfather, not a rich man. But the rabbi's grandfather had a $10,000 life insurance policy, his only savings, and he cashed it in to give all of it to an organization in Europe to save Jews from the Holocaust. The relief fund saved over a hundred thousand lives.

This is the real relationship we have to money, Rabbi Wein tells us with pride. His Zaideh, his grandfather gave it away.

The rabbi continued, "A man's worth is as good as the respect of his children, his grandchildren. If they love and respect him, he is a successful man."

Jews are always judging successful living in this way, vis-a-vis our relationships. We assume G-d has standards, too, and that He/She loves people who are loved by others.**

Well, I knew I was in for it walking home. FD kicks up a few leaves, turns to me and asks, "What part of his speech got to you the most?"

"The part about his grandfather," I reply. "Of course."

"Right. A man who is respected by his grandchildren. Mine won't even know me, won't know what I'm all about, what I believe in."

It is very much like FD to get upset about the kids living in another city on an ordinary day. I try not to think about it, and since we communicate often in so many different ways with the children, I can fool myself into thinking that I really do have a relationship. But FD is the realist between the two of us, I think. Or am I?

I'm speechless, allow him his sadness. There's time to beat what I feel is exaggeration, if not illogical thinking out of him, to strategize with him about even better ways to stay in touch with the little ones, like making Skype more visually interesting, perhaps. Throw in a magic trick.

What FD didn't know was that Rabbi Wein got me thinking about my own grandparents and my relationship to them. They escaped Europe well before the Second World War to come to America, having suffered enough losses during WWI.

Blessed with both sets of grandparents. I was closer, strangely enough, with the grandparents that didn't live nearby. My father's parents were only a few blocks away, but we had to drive to my mother's parents, and we didn't have a second car for several years. You've heard bits and pieces about my Zaidee on this blog, but nothing about my Bubbie.

She was the kind of grandmother you could hold onto and she made cookies, but wasn't fat. When you're poor there's less of a chance for eating disorders, being too fat or too thin. You eat when your children have finished eating, and you're glad that there's food left over. My Bubbie and Zaidee, immigrants, had six children, considered six million during the depression.

They hailed from Austria. When FD met Bubbie he couldn't believe how she and my aunts enjoyed sweets. Nothing made them happier than dessert.

I remember her with long dark brown hair pulled back in a bun; she colored it until the day she died. I see that twinkle in her eye when we walked through the door to visit. She would pull out a cigar box of buttons, thimbles, and string for us to play with.

Sometimes my daughter-in-law marvels at my games, the ways I think up to play with her daughter. She says, "You pull entertainment out of everything ordinary, every day stuff."

I get it honest.

It is the unconscious learning when you're a child, that's so powerful.

When you apply yourself and learn things with effort or by rote, you might forget them or not. But those other things that you learn without knowing you've learned them, like playing with string, can come in handy years down the line, too. The things we learn without even knowing we've learned them, some of them really good things, might serve as links to our past.

This is the reason I tell patients, when they're ranting about their traumatic histories, Try to be more generous with your parents, if at all possible. You may not remember the good things you learned through osmosis. One day maybe you will. (I know. It can be hard to be charitable sometimes.)

The next day, I took my time before getting ready to go to shul (Saturday morning services), eventually got dressed. In Chicago you can feel the cold before you get outside; you just know it's cold in November, don't need to consult with a weatherman. So I wore a really warm sweater, one of Empath Daught's old ones, the hot pink one I sent to the cleaners to get rid of the little fuzz balls. And it felt very good, very cozy.

But I thought, I could really use something more on my head, you know? Like a hat, or better, a hood. But I don't have a coat with a hood, except for my raincoat. I stared into the closet and noticed a scarf on the shelf, a paisley wool scarf that I'd purchased at a Chinese linen store on Lawrence Avenue about thirty years ago. I bought it in three colors, different prints.

So I took the scarf and I wrapped it around my head. I remember my Bubbie wearing one like that, a scarf tied under her chin. All Bubbies wear babushkas. In the city I see them everywhere on Lincoln Avenue, women in babbushkas. It's never been my style, gotta' admit.

But before leaving the house I checked the bathroom mirror, thinking I'd take it off more than likely, that it would look soo old, but surprised myself.

Not half bad. How crazy is that?

therapydoc

*Berel Wein wrote these books, and dozens of essays, too:

Echoes of Glory: The story of the Jews in the Classical Era, 350 BCE-750 CE

Herald of Destiny: The story of the Jews in the Medieval Era, 750-1650

Triumph of Survival: The story of the Jews in the Modern Era, 1650-1995

Faith and Fate: The story of the Jewish people in the twentieth century

Fabulous coffee table books, great reading.

**Somewhere in a mishna some call The Ethics of the Fathers, Pirke Avot, always worth reading and rereading, memorizing, actually, no matter what your religious preference.

I use these teachings all the time at work, like when I'm teaching parents to teach their little kids how to control their tempers.
Who is a strong person? One who can control his passion.
It's easier, I tell them, to throw a punch than it is to stop, think, and respond assertively. It takes strength of character to do that, stop the punch. Any whimp can hit someone.

Wednesday, November 12, 2008

Pillow Talk



FD hates it when I do this, tell you what we talk about horizontal.

But it's usually not very interesting, and rare that I share. What we talk about, often, when it's just the two of us, is incompetency in the hospital (that can be the answering service) and very occasionally, the last patient the service had to call us about, woke us up about.

Here's a sample of the kind of ranting I get to hear early in the morning.*
FD will groan. Do you believe that guy? He tells them at ICU, No more, no thank you, I'm out of here. Then he stops the transfusion, gets dressed and checks himself out of the hospital! For this I've spent three hours talking to residents in the middle of the night, so he should walk out on a procedure that will buy him a few more months in the Land of the Living. You couldn't have slept through that.
Well, uh, no. I heard it all.

And continue to hear about it. Could have been an ER episode.
And that's okay, that he complains, lets off a little steam. It's healthy. And I'm a paid consultant. He gives me some of his stress, leaves it in the bedroom (not always the most romantic idea). He never uses names or identifiers, and since it's ER call, it could be virtually anyone, and is. If it's someone I might know, someone I'd actually want to hear about, he won't say a word, won't rant, but he might slam a drawer.

I tell him, throw shoes, pies, muffins. Save the furniture. When we recycled at the recycling center, we threw bottles. Now that was great.

It's nice if you have that capacity to complain, nicer still if you hold others captive to listen. (We'll get to nagging another day). As his consultant, had this been a real case, I would have told him that his patient probably came in looking for opiates and left the hospital looking for opiates.

So this morning I get up and don't even bother looking at the clock. I know it's somewhere between 4 and 5 and I'm telling my brain, Just go back to sleep, when FD murmurs, "Time to get up. It's 5:05." He's really telling himself to get up, not me.

"5:03."

I am up, so I excuse myself for a minute, but come back to bed. He's happy. Usually I don't come back to bed. "Why are you coming back to bed?" he asks joyfully.

"To be with you," I say. "I know you think our relationship is all about companionship, so I'm being a companion."

Immediately he launches into a complaint. "I can't get over that guy walking out of ICU the other day. If I ever see him again. . ."

I want to say, Get over it, it's not about you. But that's not therapeutic, you know. So I don't say anything, close my eyes.

Out of nowhere, total non-sequitor, I ask, "What percentage of your waiting room is composed of black people?"

I don't use the PC term, African American, because it's just we two and color, not ethnic origin, matters at this moment to my visual brain. Healthy skin is nice in any color.

"Some days it's mostly black."

"You're a magnet for people with soul."

"Must be. Or could it be the neighborhood?"

And then I tell him how happy I am that Barack Obama is going to be President, even though I was truly on the fence, and no, I won't tell you who I voted for. But I love the feeling of patriotism in America right now, love seeing Hope visit Washington, the White House, the national cemetary. I love that so many people came out to vote, that people, so many Americans, now feel that they are a part of the political process. It's been a long time.

"It wasn't only black people who elected the President," he says.

Right, right. But you know how it is. The Irish, when they weigh those choices for judge, vote for Irish first. The Italians vote for Italians. The Poles vote for Poles. The Jews vote for Jews. People do vote ethnic, I'm pretty sure, and when their candidate wins, it's a good feeling.

We had some company on Friday night, and in the haze of serving and clearing, picking at my tofu and stir-fry, here and there I caught some of the conversation. Someone mentioned this feeling, a ground-swell within the African American community. He thought it comparable to the wonderment within the Jewish community after the Six Day War, when the Israelis trounced the surrounding Arab nations. All of them.**

Triumphant, proud. People didn't like it, those who didn't understand, didn't mind so much the victory, as the pride.

Some of us are scared of people who get happy like that, people who strut, shout, celebrate a victory. It feels too much like power, face it. People are afraid of exhilaration when it's ethnic.

And yet we love those songs. Hold your head up, hold your head up, hold your head high.

Did anyone see Boston Legal the other night? Roe, 11/10/2008. If you didn't and you still plan on it, SPOILER ALERT. But I'll only spoil one plot, if that helps you any.

Jerry Espenson, (Christian Clemenson, simply brilliant) the attorney with Asperger's Disorder, is buying muffins and coffee with his dear colleague, Katie Lloyd (Tara Summers, I like her very much, too).

A smart-talking mortgage broker thinks the two lawyers are listening in on his cell phone conversation in line. The broker taunts them, calls them Mr. and Mrs. Snoopy. He makes fun of Katie's South African dialect and Jerry's tics. Jerry keeps cool, but he's getting visibly upset.

They finish their order, turn to leave, and Jerry accidentally bumps into the broker who subsequently escalates his insults, calling Mr. Espenson Dimento.

Katie takes her friend by the elbow to get him out of there, but Jerry has a moment of clarity. He glares at his nemesis, takes a muffin in hand, aims like a marksman (all in slow motion, just terrific work here) and deliberately pitches the pastry overhand, fastball, hard.

And whack! The muffin's on target, clips the guy's profile, smack dab on the cheek.

It gets wild, of course, and wonderful, and Jerry ultimately chooses to defend himself in court. He tells the jury that having had emotional issues and Asperger's since childhood, he has suffered abuse and bullying for forty years. He simply reached his max in that coffee shop, his passion, years of anger simmering inside, got the better of him.

He had to react, couldn't take another insult. He isn't sorry for what he's done, although he is sorry for celebrating with that little dance that he does.

There's more, and this is a great episode. I won't even tell you about the abortion subplot, which is almost as good. In fact, it's better.

The rise in pride in this country, surely muted by our economic woes, is not something we should associate with the rising frustration that drives someone like a Jerry Espenson to throw a muffin, although you could argue the similarity. These are very different tides. The political process is a constructive process.

Back to our pillow talk.

FD says, "You know, we're pretty much out of food."

"Yeah, I haven't been in the shopping mood so much."

"But just because you're not hungry. . . Okay, I'll go to the store after shul."

"No, don't. We have blueberries. That's really all we need right now."

This is a cue for me to make muffins. For some crazy reason, my goofy home recipe makes only 10 muffins. The pan with the first six went into the oven first, and I heard the timer, took it out in time. Perfect. Soft. Yum.

But the second pan, the one that went in later, I forgot about. And as I luxuriated in the shower, they burned, my first decimation of muffins since we got the new stove in April. It seemed a real waste and I felt badly, but the last four were hard as rocks. so I tossed them into the garbage.

FD thought they were salvageable, but you know.

These things can be dangerous.

therapydoc

*Anecdotes about patients on this blog, medical or psychological, are always sheer fiction.

** Wikipedia says, 1967 Arab-Israeli War, the Third Arab-Israeli War, Six Days' War, an‑Naksah (The Setback), or the June War, was fought between Israel and Arab neighbors Egypt, Jordan, and Syria. The nations of Iraq, Saudi Arabia, Sudan, Tunisia, Morocco and Algeria also contributed troops and arms to the Arab forces.

Friday, November 07, 2008

Conflict in relationships: Timing is Everything

I'm always talking about time. There's a time and a place for most things (not everything), especially communication about hot button topics, things that get people hot under the collar.

Dinner isn't one of these times or places.

Conflictual couples, actually, shouldn't argue at all. (If you and your partner fight and hurt one another, you're half of a conflictual couple.)

Conflictual couples shouldn't argue at all until they have learned not to be conflictual, because someone is going to get hurt, for sure. There will be blood, internal scars perhaps.

You wouldn't let your kids hurt one another. What's with the masochism?

So you can't argue if it's going to get ugly. But arguing with a professional referee around is okay.

After an initial evaluation, a therapist like me will send a conflictual couple home with instructions NOT to problem solve, which is ironic, since therapy is all about problem solving. I tell them to talk about why they fight.

That's all. If you're one of these conflictual couples, you can talk about anything parve,* like who you've talked to lately, who is sick, who has died, lost a job, whose kid is on drugs, what can be done for world peace.

But you really should work on why it is that you fight, and not fight, if arguing is hurtful. Later you can problem solve in a petri dish, a professional's office. Get that part figured out, why the need to fight, and you can problem solve like everyone else.

First, however, it's all about getting to the bottom of that mystery, or is it misery, the Why.

This is usually a dynamic grounded in psycho-social history, occasionally no more complicated than going at it in the ring of sibling rivalry, having garnered a repertoire of verbal sniping as a child. Sometimes the sniping is a learned whisper, almost inaudible, because Mom and Dad wouldn't let you physically whack one another or tease one another. And other times, there weren't any editors at all, or gloves to soften the wreckage.

Then, history in hand, in therapy we have a go at it, real problem solving. The therapist, a person who specializes in beating on people by gently reminding them to look in the mirror, tries to stay invisible.

And since you'll surely fight, your therapist will have to break form to break up the fight, force you to review your problems and stay objective. You see yourself as we see you and hopefully can laugh at yourself, accept that you have faults. Both of you work to change. This can take a year or two or more, and includes individual therapy, as well. But it's worth it.

The devil you know. . .

This accomplishes so much, this process, as painful as it can be at times, for most us don't laugh at ourselves. But in couples therapy we figure out:

(a)
why you're both so sensitive --there are roots to this, as we've indicated, usually seeded in childhood, genetics, and experiences with parents, sibs, teachers, peers

(b) why one or both of you tend to use dysfunctional, combative, inflammatory strategies instead of constructive, empathetic discussion. The reasons, beyond childhood tutelage, include but are not limited to a sense of powerlessness, frustration, alcohol and drugs,** or some combination)

and

(c) how to problem solve constructively.

I couldn't write this if I didn't know that the process works. This week I discharged three couples from therapy. Three! All giggly and silly and happy. All better.

Couples therapy is fun, it really is, can be, I should say, sometimes. Sometimes. That said, I pity Empath I, my poor colleague in the room next door who has to listen to it when the volume goes up in my office. I feel sorry for her, I really do, for the noise, but I tell her, it's GOOD noise. We're figuring junk out. And all of my lamps are nailed down now.

Anyway, one of the good things about postponing your fighting for therapy, aside from the fact that you pay for this and deserve your money's worth, is that you know that you're resolving things constructively. You get the knack of talking nice and bring it on home.

Discussion (a.k.a., arguing) in therapy should be timed, ideally, so that you can kiss and make up when it's over. While I check my email, you argue with one another, then I interrupt you and say, "Are you sure you want to say it that way? Can you say that differently, maybe start the sentence with how you feel?"

The coaching part of this job is awesome. "FOUL!" I cry, jumping to my feet and waving a flag when one or both are out of bounds.

At home a foul might mean someone slams a door or throws a dish or breaks a hand, some plaster. Here the worst that can happen is one of you storms out. Then you come back, feeling a little silly.

Happens all the time. I might send your spouse to retrieve you.***

Problem solving in therapy is all about focusing on one thing, one little piece of a problem or a slice of life, past, present or future. The goal is to understand one another differently and reach consensus about something. The agreement, sometimes is simply a temporary solution, something to try out. If it doesn't work, it's back to the drawing board, but trying something is better than doing nothing new. In time, something will work. And we time solutions.

Lately we're timing solutions for Thanksgiving, always a riot.

Timing is everything. When the system works, it works because you've timed your argument, measured your words. You've learned that rather than argue, it is more important to take care of feelings, negative emotions, physical ailments, if at all possible, at the very least try to be empathetic, sympathetic, and to give more than you take. Especially with time.

Now, I personally have worked on my timing and problem solving and am a big one for waiting until my partner is in a good mood before mentioning new shoes or the importance of a new sofa.

FD has pretty good timing, too. He tries to be sensitive to my particular personality quirks. He knows me and is fond of saying, for example, that I'm a bear when hungry. I'm conscious of it and a little embarrassed about it, but it is what it is. It's important to know yourself.

The story:

It doesn't have much to do with the introduction except that it is about the importance of timing and how to handle it when someone oversteps the rules.

We picked up some fast food from a restaurant a few days ago. Picture it. FD is driving. I'm in the passenger seat, the take-out is in a bag on my lap, and I'm starving, haven't eaten in days, an exaggeration, but okay.

FD, however, is not. He wants me to listen to a song on a tape before we leave the car to go into the house to eat. He's saying that one of our sons should use this song to try out for American Idol. No, he's not serious, but he's really pushing for me to listen to this song.

I'm hungry, okay? But I don't spleen him. I'm keeping my cool. Constructive problem solving here, obviously, is taking the tape into the house to hear it while we eat. But we haven't got a tape player in the house that works. We're working on throwing away things like cassette players that don't work and even, dare I suggest, cassettes.

So here we are in the car and I'm being patient while he's fast forwarding the tape, rewinding the tape, searching for the song. It's really getting hard to be patient. The food smells so good. I'm so grumpy. Finally he finds the song.

I listen to a minute of it and say, "Nice song. Can we go inside now?"

"But you haven't heard the whole song."

"And I don't want to, really. It's raining. I'm tired. I'm hungry. I want to change clothes. Can't I go inside?"

"Okay."

He's okay with it, me listening to only a little of the song, half-heartedly at that, and there's no violence. Falafel could have been de-bagged and utilized here, theoretically, in this situation. But no. No food fight, no battle of words.

We could say I made an effort at managing anger. Or was that hunger. Or fatigue? A long, day. See, there's a lot that goes into putting off conflict. You need anger control, impulse control. Your partner's timing can't always be perfect.

And one thing we know, it's even more of a challenge to problem solve at the end of a long day, when your emotions are virtually indistinguishable from your appetites.

It could have been worse, you know. He could have pushed me to listen to the whole album.

therapydoc

*Parve rhymes with Marv and means something that hasn't got either milk or meat products in it (vegan), so it's basically not going to upset the karma of anyone who keeps kosher. A parve person isn't a very exciting person, necessarily, but you can always tolerate having him around.

**If addiction is another variable in the equation, that has to be addressed as a problem and has to be resolved. This tends to slow down the therapy which angers the patient, another excuse for the patient to drink or use drugs. Don't buy it.

***At the Second Road I wrote a post about a woman who gets high (Dialing Back) and there's a comment by Retriever that's worth a look. Sometimes, honestly, you learn more from people who write in than you do from me.