Monday, March 30, 2009

Missed the link

Did the last post on the fly, and now, reading it from my phone, here at the gate waiting to fly stand-by, I don't see the ColdPlay video I wrote about.

You might need to see it to optimally understand the post.

If that's the case, if it didn't post, and I'm not sure of anything right now, on any level, go to youtube.com and search for The Scientist by ColdPlay.

The story is in reverse, the ending unexpected, and this explains the regret, the loss, differently than the words to the song as I understood them.

Sorry about that.

therapydoc

Nobody Said It Was Easy

Not to overdo it with the music videos, but sometimes video gives a whole new meaning to a song. It's like doing therapy. As soon as you get the rest of the story in therapy, a person's life makes more sense. You get it when you get the whole truth, the history.

ColdPlay has a song that I like, The Scientist.

I listened to it over and over again, which I do, like a four-year old, if I like a melody. After the tenth time on this one, I thought I had it figured out.

A couple has a fight, The Big Fight, and in The Big Fight they break up. ColdPlay bemoans the break-up in the ballad.
Nobody said it was easy

It's such a shame for us to part

Nobody said it was easy

No one ever said it would be this hard

Oh take me back to the start
.
He wants to try again, go back to the start. Take Two.

It's what we do in therapy, really. We go back to the start, take a look at what went wrong, try something different. Generally the try something different is called an intervention, a part of a treatment plan. We determine which intervention by putting our heads together. It helps to have a therapist armed with dozens of these things different.

Trying something different, being somebody different is much harder than it sounds. Change is packed with difficulty. And it feels like a risk, usually. We like things the same.

But I got it wrong, the meaning of the song. It's not about The Big Fight, the one that you never forget, hard as you try.

The Scientist by Cold Play

Come up to meet ya, tell you I'm sorry
You don't know how lovely you are
I had to find you, tell you I need ya
And tell you I set you apart
Tell me your secrets, and nurse me your questions
Oh let's go back to the start
Running in circles, coming in tails
Heads on a science apart

Nobody said it was easy
It's such a shame for us to part
Nobody said it was easy
No one ever said it would be this hard
Oh take me back to the start

I was just guessing at numbers and figures
Pulling the puzzles apart.
Questions of science, science and progress
Don't speak as loud as my heart.
Tell me you love me, and come back and haunt me,
Oh, when I rush to the start
Running in circles, chasing tails
coming back as we are.

Nobody said it was easy
It's such a shame for us to part
Nobody said it was easy.
No one ever said it would be so hard
I'm going back to the start.



Surely about regret.

And whether or not it was his fault is immaterial. He wants to roll back time.

When something bad happens, something unexpected, something out of the ordinary, life threatening perhaps, there are emotional stages of grief. We think that for most of us, these are unavoidable, quintessentially human emotions.

We want to turn back the clock, do something different.

Forget ColdPlay for a moment.

Say you've been told you have cancer and have only so long to live (not the norm, that kind of news, but it happens). You'll grieve your future loss of life. Even if you've been told that your prognosis is good, that you'll be fine, that it is not life-threatening, your mind will play tricks on you. You'll still worry. You'll regret not having lived your life to the maximum, you'll think you've done something wrong, that you're being punished for the disease.

Forty years ago Elizabeth Kubler Ross (1969) let us in on the ways we grieve, even when we haven't lost anything yet. Anticipating loss can make us sick, just as having lost someone or something (money, for example) can make us sick.

I read her wonderful little book, On Death and Dying, in high school, and felt as if I had been let in on some big secret. Someone recommended it to me when I was dealing with my brother's death. It is probably still required or recommended reading for most graduate students in mental health fields, for mental health is all about holding it together. And loss wrecks our equilibrium. Maybe by now undergrads read it, too, high school students even.

Kubler-Ross defines the five stages of grief work, but there are more. We can thank my son-in-law for reminding me about guilt and self-blame. Kubler-Ross would have filed those under depression:

denial (this can't be happening, it isn't true);

anger (this is SO wrong, I don't deserve this);

bargaining (I'll give more charity, I'll be a better person, just change the decree!);

depression (no point in even trying to be happy here, life is meaningless now);

and acceptance (It is what it is, keep cool and play it out, stay in the moment, don't catastrophize, don't make it what it isn't just because you can, just because you have an imagination).

Acceptance tends to be the baseline for emotional management, but it's a goal, not a given. That's why Kubler-Ross puts it last. I would call it a mediating variable. Without it, no matter the intervention, the resolution of the problem isn't likely to happen. We'll still feel we're in the grieving process.

Acceptance underlies one of the lesser known cognitive-behavioral treatment modalities, Acceptance and Commitment Therapy (ACT) . Here acceptance is the springboard, the starting point, the place from which the real work in treatment begins.

Obviously you can't rush it, you're going to have to feel all of those bad feelings first, you have to, it's the way we're made. If you don't, you will eventually. They come back to bite you. But the idea in either case is to shoot for accepting things as they are.

Impossible. It really feels that way. Impossible.

So in therapy we try to make it possible. You work through the stages, the emotions, try all kinds of interventions, and at some point, miraculously, over time, if you don't rush it, you're there. Or you accept that you can never accept. That's accepting, too.

We'll talk more about ACT another day. It can wait.

But let's go back to the start, to ColdPlay. The fellow in the video, the one who regrets his part in the accident, is going to be stuck feeling bad for quite awhile. By making a video, turning grief into something creative, he has worked a fabulous intervention, something therapists forget to recommend sometimes. Stimulating another part of the brain like that, creating something new, if only for a little while, relieves some of the pain.

Unless. . .

he took Ecstasy the night before the accident, or maybe had some other drug in his system at the time. In that case, in therapy he might be encouraged to work a program* of some sort, commit to changing something about himself. We would stress behavioral change in this case, shoot beyond acceptance. Some kind of program.

I'd say, one that puts his science where his heart is.

therapydoc

*Working a behavioral program is not exclusive to the Anonymous programs for individuals with substance abuse problems. The 12 steps are really just a form of treatment protocol. You can see how they "work if you work them" at The Second Road).

Thursday, March 26, 2009

Since U Been Gone

I'm in L.A.

Even though it seems like I'm always traveling, it isn't true.

Well, maybe it is. But this is a business trip.

You know I did a lot of my research in rape and pedophilia, that sort of wonderful stuff. Knowing how bad this is for children, rape and pedophilia, I'm compelled to do what anyone would do as a community activist, a person who believes that an ounce of prevention is worth a ton of cure. If I have to travel to educate communities and schools, to be sure that people are clear on the concept, so be it.

You just can't hide your head in the sand, is the truth, no matter where the sand might be.

But let's not talk about that, sexual abuse. Not now.

The Story:

The guys are up at six a.m. and have to be in the car at 7:15, and if you've ever tried to get little kids fed and dressed in 75 minutes, you know it's a challenge.

But they're good, and do you want to know why they're good? Because there's a carrot for every stick, is why. Every kid has his price. I do the unthinkable, introduce them to YouTube. It had to happen eventually.

There's no turning back. Getting ready, even if you are only four years old, is a snap because. . .No breakfast? No Kelly. Don't get dressed? Forget Estelle. How I ever let them watch Estelle, I'll never know. But things happen.

So they get dressed right after Since U Been Gone. And we're out the door. Bye bye, Mommy.

And this is grand, because here we have a 6 track CD changer, something I've always wanted. Yes, I'm behind. I know, I know.

Anyway, we're tooling around on the 101 in my kid's Honda (should have bought a Honda) searching for music with the amazing 6 CD Disk Changer. My daughter has quite a bit of music stored and ready at the push of a button if you happen to be in the front seat of the car.

And as the lucky elected driver for the week, I'm spending a lot of time in the front seat, driver's side. If you've ever lived in L.A., you know how lucky this is.

The guys are in the back seat arguing about what I should play. I hit or miss and something kind of slow and easy comes on, a keyboard guy hits the same chord about a thousand times. It's good. Chills me down from the morning rush to get ready.

The big guy says, "Leave this song! I like this! I like the sad songs."

The little guy says, "I hate this Bubbie. Turn on the Mika song. I want to hear the Lollypop song." He's kicking the seat.

I have now heard the Lollypop song about fifteen thousand times and know all the words, not that I ever needed to know all the words, or any of them for that matter. But he does. We can only hope he doesn't do a rendition at school.

His older brother shouts out, "You like the sad songs, right Bubbie?"

Uh, well. . .

The little guy argues authoritatively, "No she doesn't. She likes the happy songs, like the Lollypop song. Don't you Bubbie?"

You're both right.

In this situation it's best to turn off the radio and let them argue with each other and kick and scream for awhile, which is what I do to give myself time to think about tomorrow's presentation, how to present it, what to say.

At some point the kids have compromised on Since U Been Gone, Kelly. You probably know it.

Lyrics, Since You Been Gone

Here's the thing we started off friends
It was cool but it was all pretend
Yeah yeah
Since you've been gone

You dedicated you took the time
Wasn't long till I called you mine
Yeah Yeah
Since you've been gone

And all you'd ever hear me say
Is how I pictured me with you
That's all you'd ever hear me say

But since you've been gone
I can breathe for the first time
Im so movin on
Yeah yeah
Thanks to you
Now I get
What I want
Since you've been gone

How can I put it? you put me on
I even fell for that stupid love song
Yeah yeah
Since you've been gone

How come I never hear you say
I just wanna be with you
I guess you never felt that way

But since you've been gone
I can breathe for the first time
Im so movin on
Yeah yeah
Thanks to you
Now I get
I get what I want
Since you've been gone

You had your chance you blew it
Out of sight, out of mind
Shut your mouth I just can't take it
Again and again and again and again

Since you've been gone
I can breathe for the first time
Im so movin on
Yeah yeah
Thanks to you (thanks to you)
Now I get
I get what I want
I can breathe for the first time
Im so movin on
Yeah yeah
Thanks to you (thanks to you)
Now I get (I get)
You should know (you should know)
That I get
I get what I want
Since you've been gone
Since you've been gone
Since you've been gone


Not real deep. Suffice it to say that we had watched the video only minutes before and our girl, Kelly Clarkson, spurned, is furiously pitching everything her ex ever touched, ever breathed on. She's breaking picture frames and CD's, tossing the shampoo, his deodorant, his aftershave. The bedding, the pillows, feathers are flying, furniture crashing. She tackles the closet; his clothes are history. She's really angry.

The guys are watching, mesmerized. Here's an adult throwing an adult-sized tantrum, the likes of which they have never seen. And I'm thinking,
Is this permission? Are they learning that this is okay?

What have I done?
So in the car, after the song, I ask them if they get it. What happened to Kelly? Why is she so angry?

They're pretty sure it's about the guy, they tell me. He did something.

They're not sure exactly what. But it had to be bad.

therapydoc

Sunday, March 22, 2009

Natalie and Monk


You probably know that care-takers get a bad rap. It's bad to be one, you tend to focus on others, put yourself last, burn out, lose self. You deny other people the joy of taking care of you. I could go on and on.

If you're familiar with the show then you know that Monk is a famous detective with Obsessive Compulsive Disorder, and Natalie is his assistant. Monk's disorder is so severe that much of Natalie's job is watching out for him, making sure he is safe. His concentration on cleanliness (germ phobic) and order (symmetry) make Monk something of an absent-minded professor. He bumps into things. He gets hurt because he's more worried about the order of nature than his own safety.

But Natalie saves him, usually, from things like walking in front of a bus.

I tape the show and always have to hear the song, It's a Jungle Out There, will sing along with Randy Newman. What can I tell you.

Anyway, because I tape much more than I watch as a rule, I have a huge assortment of shows to choose from. One night I choose Monk and the Magician. I try to get FD to watch it with me, but as soon as he realizes who the murderer is (first ten minutes) he sees no point in watching anymore. Guys are like this unless they're watching recaps of sports.

So he goes out to do some guy thing or another and I have the remote to myself. I buzz through to where I've left off, and it becomes very obvious that the magician is a very, very bad guy. Monk figures it out right away, not as fast as FD but fast.

FD returns as it's just about to end and I rewind, make him join me. "Watch this!" I command. This is a good part so he can't complain. Monk is in very serious danger, I'm getting very worried. Pazowie! Abracadabra! Natalie shows up with the police and saves him. She throws her arms around him and gives him an emotional hug. I would have, too. This was a really close call.

My pulse eventually returns to normal and FD says to me, "She seems to really have feelings for him. That's not exactly appropriate for an assistant, is it?"

"She's his care-taker," I say. "Her job is making sure he's okay."

"He really needs that much care-taking? It's just OCD."

Just OCD.

"Honey, it's never just OCD. And no matter what the disabling disorder, we tell people to find someone, if at all possible, to check in on them, maybe even coach or take care of them, pay for it if necessary.

Some people really need shadows. In tribal societies this has always been understood. In our industrialized, independence-is-valued-to-a-fault society, too few of us have people to watch out for us, to make sure we' don't kill ourselves, don't drink or stick needles in our arms, who will brush the crumbs off our chins, tuck in or cut off our tags, make sure we've eaten, know where we've dropped our keys. It would be nice if we could always have it together, but most of us can't. And is it all that necessary, anyway? Always having it together?"

I can't help it, I'm on a roll.

"And this doesn't apply just to people who are a little less than functional due to some disorder or another. A person can be perfectly independent and still need a little help now and then. It's ridiculous that we blow off our parents so early, now that I think about it, so dramatically, find it necessary to bark things at people who are just trying to help, like that woman on a television commercial from the seventies, the one who said, Mother please, I'd rather do it myself."

This is the end of the rant.

And you know it's true, we can't help but do this when we're teenagers, even as children or young adults. It is very normal and very good to blow off the caretakers, to glory in our independent choices, our autonomy, at any age, really. Then, we're not sure when it happens, all of sudden it's not so bad to let someone else lend us a hand.

I tell FD, "You'll take care of me, I imagine, one day. When I get old and can't find my glasses."

"Uh, why would I do that?"

therapydoc

Friday, March 20, 2009

That Circle of Life

For transliterations and definitions of phrases in this post, skip down to the end.

My Uncle Max passed away just the other day at 88.

He was a stalwart of this Chicago family, a proud American with a good name, a name known here and across the ocean for good deeds and charity, a legacy we could all emulate. Proud spouse, proud father, proud grand-father, even prouder great-grand-father, I saw him flirting with the very youngest in the family, a very little one, only a few weeks ago.

Carl Whittaker, a father of family-therapy, when training young clinicians would always say:
This work can get emotionally trying; flirt with every infant you see.
It's safe to generalize from treatment to life most of the time.

Original Chicago frum, my uncle seemed secure in his place in the secular world and secure within our little ghetto without walls. Most of us in the family are like this, and most of us have stayed in Chicago and have lived here a long time, unless we've wandered in post-matrimonially from another town, in which case the family does its best to make a person feel as if he's never lived anywhere else. Not the most numerous, surely not few, we're just your run of the mill people-people. We cover home-makers, social workers, lawyers, doctors, psychologists, teachers, administrators, principals, writers, directors, stock-brokers, book-keepers, artists, scientists, insurance brokers, recruiters, and kashrut-mashgichim. No baseball players or soccer moms, as far as I know. I'll probably get into trouble for leaving someone off the list.

An organic system, we do our best to be there for one another for happy occasions and sad ones, too, and when we neglect to do that, try to give one another the benefit of the doubt. For none of us are perfect and family is a good place to practice this sort of thing, giving the benefit of the doubt, which, I'll say it right now, happens to be apropos of nothing in this post, but is a Jewish world view that applies largely to marital therapy and relationships. So I tend to throw it in when it works, the benefit of the doubt, even if the directionality of that relationship within the family or the tribe, for that matter, has yet to be empirically established.

Anyway, I remember when my parents reached my stage of life, how they started going to a lot of funerals. They had a funeral to attend a week, it seemed. The parents of their friends were passing on, and they had to deal with the funerals of their own parents, my grandparents, too.

As they aged, their health and the health of their peers declined. My mother would say, "Do you remember So and So? He's in the hospital again, and when Dad and I visited him, his wife_____ was there, and she's not doing so well, either."

Your parents slowly, systematically run out of friends their own age, and before you can blink, you're going to more funerals, too, more often than you once did. You're in the same boat, and not immune, and you start to think, Pretty soon my kids will be here, too, and it'll be my generation they're talking about. Death happens, strikes a family, and there you are in the shoes of your once middle-aged parents.

First one of your mother's siblings might pass away, then another. Then another. In my family, when the third maternal sibling passed on, I heard my mother say to my father, "We're really starting to lose numbers, Sid."

And a baby would be born.

I got the news about my uncle while sitting in a snack shop on Burbank, eating lunch (grilled fish sandwiches) with my daughter, my son-in-law, my son-in-law's sister and his mother, my machetainistah. We're in this shop, sitting at a table by the window because all we have is ambient light, daylight streaming from the window. You never know when the electricity is going to go out in Los Angeles.

It's uncanny that when I'm out of town. I won't get any calls unless I'm sitting down to eat with a bunch of people that I haven't seen in six months. But I take the call today anyway, because I've left more than a few rather distressed folks back in Chicago with these words: They have phones, I have a phone, where I'm going.

Patients know I want them to call me when certain stars are in alignment. So I answer the phone and it's my mom.

Lemme call you back in an hour? I ask.

She says no and tells me that Uncle Max has passed away. Max is her sister's husband. This is a shock, although he's 88 and sure, he's been sick. With the news my face drops, the way faces always do when they get the news that someone has passed away. My mother is telling me to please inform the family, to tell everyone by way of a family email shout-out. Give the cousins the details of the funeral.

I assure my mother I'll take care of it. Everyone at the table in the snack shop understands; they have heard the, Oh, no! caught the whisper, Uncle Max! and they want details.

I have no trouble telling over a few things about my uncle at the table, describing his way with the family, his passion for Israel, his professionalism. My appetite is gone and I don't really want to finish lunch, but it feels wrong not to eat, not to pick up, change topic, for we had been talking about choices in life before this interruption, something happy, something important to my son-in-law's sister. So we jump back to that and in minutes the mood is light and good.

I have a rabbi who says that a Jew has to be ready to jump from a wedding to a funeral, from a funeral to a wedding, to switch from happy to sad, from sad to happy, on a dime. True enough, all well and good, and he knows that that works-- as long as you're not suffering from some disorder or another.

We bury our dead quickly, so the next day, while my daughter is driving the kids to school, I'm in the front seat making plans with FD to broadcast the eulogies from his cell phone. The idea is to get to Coffee Bean after we drop off the kids, wait for the call. My daughter notices me get upset and asks about it. I hate not being at the funeral, I tell her. Predictably, the broadcast doesn't work out. Reception makes it sound like FD is on the subway, not in a synagogue.

After I give it up, my daughter wonders about my relationship with my uncle. We weren't close, especially, it seemed to her, didn't run to visit him and my aunt every week or anything like that when she was little.

And she's right, of course. It's all natural and good, his passing, the way things should be. I remind her that she hasn't known her aunts and uncles for as long as I've known mine. Just as they've watched me grow up, I've watched them grow older, too.

We're all in this, none of us avoids this rich, if depressing process, the many colors of aging. What is important to us as young people is less important in our later years when we inevitably obsess over the physical gifts we've taken for granted, lost. And yet we find that some of the things we always treasured still reign supreme, indeed are the only things that become important in the end.

When I last saw him he was sitting in a chair in his room in the rehabilitation center praying a very long afternoon service. One of his granddaughters had come to visit from New York to see him and to attend a different family funeral. He flashed that huge smile of his when I walked through the door, the smile I think of when I imagine him walking through the door of my childhood home, when he and my aunt would come to visit.

I had to leave to get the work before he finished his prayers.

therapydoc

Chicago frum rhymes with Chicago BOOM, and refers to the orthodox Jewish community.

kashrut mashgichim- This is Hebrew, rhymes with GOSH-ROOT SLOSH-WICK-HIM, plural for the food specialists who certify that an eating establishment is really kosher. I'm not going into what kosher means or how to pronounce it.

machetainistah I think it's Yiddish, rhymes with GOTH-EH-RAIN-HISS-DUH, and refers to the mother of your son or daughter-in-law.

Saturday, March 14, 2009

There's No Pill for This Kind of Depression

When you start a PhD program, the first thing you learn is that there is a world of difference between journalism and social science, and that difference begins with the way you write. Journalism is wet. The goal is to sell newspapers, to get to readers personally, to capture their interests, hearts, and emotions.

A lot like blogging for some of us.

And social science is dry. Research is dry. It is steeped in exacting, replicable findings, appeals to the side of the brain that demands significance, validation, logic. Science.

Some of us like both, and I happen to love Peggy Noonan, a political journalist for the Wall Street Journal. She is the Catholic sister I never had. I have Catholic sisters, Lutheran sisters, Episcopalian sisters, Muslim sisters, Korean sisters, Jewish sisters. We're all seriously middle-aged and own a perspective, a way of seeing we earned while toiling at books, people, and life. We've lived so we get to talk about it.

Generally Peggy spins a yarn as only she can (see last week's on the octuplets, just great) but today she dropped a stitch, providing me an opportunity to spleen about what to expect from medication and what not to expect. As a journalist I can't blame her for throwing her thoughts out there, for they're really easy going down, as always.

but they're wrong.

There's No Pill for This Kind of Depression
is the title of the essay, page 9, section A, Saturday-Sunday, March 14-15, 2009.

Her metaphor about the economic blows we're suffering are perfect to a fault.
The heart-pumping drama of last September is gone, replaced by the drip-drip-drip of pink slips, foreclosures and closed stores. . . .

People sense something slipping away, a world receding, not only an economic one, but a world of old structures, old ways and assumptions. People don't talk about this much because it's too big, but I suspect more than a few see themselves, deep-down, as "the designated mourner," from the title of the Wallace Shawn play.
Ms. Noonan asked a friend of hers, a psychiatrist, if he sensed pervasive anxiety, as if everyone is "on thin ice," and he answered in the affirmative. We've talked about that here.

She goes on to tell us that the sale of antidepressants and anti-anxiety drugs is widespread. (Big news, here). She feels that drug seeking behavior has become more common in New York since 9/11. Where she gets her statistics who knows. She doesn't need them, this is journalism, and opinion, no less. And you, the reader, should believe her, this goes without saying. You read it in the Wall Street Journal.

Fine, fine, fine. No harm done. But the following, Peggy, forgive me, begs an argument. As my sister, the one I can't wait to read on Saturday mornings, you should have called me, seriously, before writing this, referring to psychotropic medication as a cause of the crash.
We look for reasons for the crash and there are many, but I wonder if Xanax, Zoloft and Klonopin, when taken by investment bankers, lessened what might have been normal, prudent anxiety, or helped confuse prudent anxiety with baseless, free-floating fear. Maybe Wall Street was high as a kite and didn't notice. Maybe that would explain Bear Stearns, and Merrill, and Citi.
It would make a nice dissertation thesis, perhaps. But honestly, ill-conceived.

What would Ms. Noonan suggest? The half-glass of bourbon that Denny Crane and Alan Shore (the hot shot lawyers on Boston Legal) make look so psychologically appealing? America's favorite drug? Because that's so safe, after all.

Allow me this.

(1) Anti-depressants don't get you high. If you're lucky, when you take these medications properly, the weight sitting on top of your head disappears and you can get out of bed.

And suicidal people? They're less likely to shoot themselves in the head on anti-depressants, and less likely to take others down with them. Caveat here, of course, for some anti-depressants, taken by some people, can trigger manic episodes. But a real physician, one who performs an extensive evaluation before prescribing anything to anyone, knows this.

(2) Anti-anxiety medication that is taken as prescribed, does not interfere with reality testing. People who are on these medications as prescribed are still anxious, they still think about things that worry them. They still worry. But they can get to work. They learn, in therapy, not to obsess about what they cannot control, and we teach them how to do that. But prudent thought is not disabled with medication. And if you're on medications like these you are discussing what is prudent, what is not, with your therapist.

That's all I want to say. Depression, anxiety-- crippling disorders. Medicine helps people function, helps them manage their emotions. Therapy can, too. Together it all goes a little faster, is all.

I will grant that it's possible that the dayans of Wall Street may have used amphetamines and crack to stay awake, to keep up the energy necessary to be a mover and a shaker, a Master of the Universe (Ms. Noonan refers to Tom Wolfe). This will mess with a person's judgment, cocaine and dex, derivatives of amphetamines, anything that increases mania and a sense of omnipotence.

And hey, that's interesting, too, and sells newspapers.

But it might not pull at you, might not reach as large an audience, pull at as many heart strings, as only Peggy can.

therapydoc

Wednesday, March 11, 2009

Leave Me Alone


That's Greta Garbo.

Every once in awhile I'll see someone who says she's fed up and wants to be left alone. I think it's a Greta Garbo line, I 'vant to be alone, but it's not hers exclusively. Greta doesn't own it.

A person can have a million reasons for wanting to be alone, but one of the more interesting patterns I see in therapy tends to look like the one below. We'll keep it simple, give you a snippet of a typical conversation with a hypothetical new patient.
Patient: I just wish everybody would leave me the ____ alone.

Me: What's the feeling behind that, wanting to be left alone?

Patient (doesn't have to think hard): Anger.

Me: Do you feel angry often?

Patient: Yes. A lot. People think I'm a real b___. They can tell when I don't want to be bothered.
This type of interactional sequence is almost always with a female patient, eldest in her family of origin, sometimes the only girl. She is expected to keep a degree of order and cleanliness in the home, even as a young child and isn't given the freedom to explore the world beyond that home, either.

As an adult, usually an outwardly independent person, she's developed a sometimes testy, irritable nature, and gives overt signs to others that they had best not try to get too close to her. She says No, more often than not, to social events, but she isn't phobic. She's just not interested, she will tell you.

A nice way to describe this personality is off-putting. Another way is to say she's threatening. I like her right away, as soon as she walks through the door. I've seen her many times before.

I give her a cryptic once over after she's used the "b" word, for she describes herself this way. I'll give it a pregnant pause, wait, eventually make empathetic eye contact. Then she sees a smile. We both laugh. It is the laugh of understanding, relating. Empathy.
Me: Well, we all have our days.

Patient: Some people have more than others.

Me: You got that right.
Her story tumbles out, first in the present tense. This is about all the idiots out there who make life miserable; how there's so much stuff to have to take in life, on the job. So much aggravation.

Eventually she'll get to the codependent song* I'm waiting to hear. It goes something like this. . .

Patient (describing her life): And my family in . . .

(Fill in the blank, Poland, Puerto Rico, Mexico, Guatemala, Viet Nam, China . . . )

depends on me for money. And I send it, but the money goes to things like drugs and alcohol. And my uncle just sits around and does nothing. And my sister does nothing. And my brother does nothing except he eats a lot and does nothing and he lives with my mother, who does everything for everyone. And did I tell you that my brother uses drugs, too?

Me (anxious to get treatment under way): You know, there are alternatives. . . You don't have to . . .

Patient (cuts me off): I know, I know.

But tell me, doctor, on another subject, why do I get so upset with people? I have this feelings, all the time, like I'm to blame, like people are blaming me. And I'm the good girl. I'm the one who does everything good. I don't drink. I don't smoke. I don't sleep around. I work. I send money home to my family. I do everything right. So why, when someone says something about me do I always assume they're insulting me, accusing me?

Why does just being with people make me feel guilty?

This confession of personal history signals Psychoeducational Lecture #72 (these are arbitrary numbers, don't Google them) . When innocent people feel guilty it's often because as children they were accused of doing bad things that they didn't do. Or they were accused of wanting to do bad things they never wanted to do. These accusations happen repeatedly throughout childhood until the patient gets out of there, free from family imprisonment.

What follows them, unfortunately, and exacerbates their problems, is that they've been undeservedly punished, usually severely, for these things they didn't do, didn't want to do. The punishment is often violent, accessorized with homemade weapons. We call it child abuse.**

Patient: Oh, man. I got hit. Did I ever get hit. I got hit with belts, paddles, and I was kicked with boots, slashed with electrical cords. I was beat bad.

Me: I know.

Patient: How do you know?

Me: It's my job to know. Sometimes people like you, the victims, survivors, call it what ever it is, hardly recognize harsh punishment like this as child abuse. You don't even own your right to feel angry about it. What good does it do you anyway, you think, to be angry? So you aren't conscious of the connection. You have what is called unresolved anger. And the guilt is unresolved guilt. We have to resolve it.

We therapydocs explains that we have seen it many times before, the eldest female's involuntary role of responsibility, taking care of little siblings as a little child herself, unprepared, the parental child syndrome. This pint-sized, ill-equipped parent is rarely appreciated and is treated badly. She'll try to please, try to keep Daddy or Mommy from getting angry. It's a lot of emotional work.

Meanwhile, her parents don't understand parenting. If anything, they think it's okay that she feels guilty for the behavior of her siblings. They think it's okay to make her feel guilty for talking to a boy, even if she doesn't like him. They are trying to protect her. They think they are doing a good job, instilling in her what I call an overdeveloped sense of responsibility.

And too much responsibility makes us angry.

At some point in therapy she'll want to know that the reason others can afford to under-function is that she over-functions.

If I hadn't heard so many Wild-Person stories I might not have copped the likelihood of abuse in a case like this. The Wild-Person will abuse and blame everyone, all of the children, usually, but there is one child, often the oldest girl, who gets the brunt of the rage. And alcohol is usually the fabric of family life, so well woven that it is hardly mentioned in the history.

Me: They do it for your own good, the beating, the isolation, the insistance that you come right home after school. It's all so you can turn out all right. GOOD. And look. You did.

Patient: Ha! More like a wreck is what turned out. A crazy person.

Me: So you're an emotional wreck, but a good emotional wreck.

Patient: That's the whole thing, all so I should be a good girl. Meanwhile, how many times do you think I got molested as a kid by some drunken relative?

Me: Of course. And you wonder why you want to be left alone.

Who needs people when the ones who say they love you, who should love you, beat the ___ out of you and forget to protect you?

Better to be alone.

therapydoc

*For more on codependency, visit The Second Road. The writing over there is terrific, and every week or so I'll post there, too. You might want to read about what I did yesterday, for example, on The Drinking Holidays. The post is about religious days like St. Pat's, Purim, and Passover.

**There are many reasons to be angry, child abuse is only one of them. A post like today's is supposed to highlights associations between a few different variables. There are many more, of course.

Thursday, March 05, 2009

Snapshots: Way Beyond SADS


MORE than a little wing, there.

We’re at the Midway Park and Fly for an overnight check-in and Chris, a man-of-girth parking attendant, has lifted my carry-on to the shuttle.

"Wha’cha’ flying?" he asks FD.

"AirTran."

"AirTran it is."

Yes, AirTran has wooed us away from American, at least when we fly south. And we do this so often that the Park and Fly knows our name. They reserve us a special angle parking spot against the garage, Aisle J.

I’ve blown off a Sunday full of patients and FD has a new baby in the hospital, so both of us have misgivings about the trip. But we’re Bubbie and Saba* and we have a job to do.

It’s supposedly snowing down south. We land and it’s not snowing. It’s driving snow. Someone up there is pelting us with snow. There is snow on the ground, at least two inches, and the kids in the row in front of us are saying, Yeah, we’re getting four inches, for sure. Maybe more.

This isn’t why Chicagoans fly south.

The city is up in arms, freaked out, at a standstill. They don’t own scrapers in the south. What’s a snow scraper?

They don’t know about salt. There are no in-service workshops teaching Streets and Sanitation that if you salt icy streets, magic, snow will melt.

I look out at the ground crew scratching their heads. A minivan with a miniscule plow at the bumper weakly pushes snow along the tarmac. "That’s what they use to plow runways," I crack to FD. He chuckles.

"So glad you’re in a good mood," I shoot back.

Our son picks us up from the train. The city has a nice public transportation system and you know I love trains. He looks good, our boy, as all young people look good to us, but he seems to look better than most. He tells us our granddaughter has her wish, this wish for snow, and I’m thinking . . .Marvelous, should have brought my skis. We pull into the driveway and there she is building a snowman with her aunt.

And everything changes.

The endorphins rush from the walls just seeing her. FD is out of the car in a flash, building a snowman, too, searching for a nose. Of weaker stuff, I slowly gather my things, wave to the kid, and head indoors to see her sibs and stretch out a bit. It's a long time in that sardine can they call an airplane.

These other grandchildren are edible, so I eat them, mostly visually, the camera snapping away. My beautiful daughter-in-law is laughing as I brush snow off my sleeve. She's apologizing. "We didn’t ask for the weather, honest, Mom, you have to believe me."

Sure I believe you. I continue to eat her children, three months old, six months in all. We do multiples in our family, not quite on the scale of the octuplets, but doubles aren’t that unusual. And for me, having had twins over thirty years ago, having one of these small people father very new multips--well, watching him and his lovely wife juggle the two of them, it’s déjà vu all over again.

They try to feed us, but we’re too busy with the entertainment.

None of us wants to go anywhere and there’s ICE out there, you know, and people can’t drive in this, some of it could be black ice. We're led to believe southern drivers are all homicidal maniacs; we believe what you tell us.

At some point FD thinks of the obvious way out of the cabin fever that has followed both of us from the airplane and gingerly suggests, "Let’s go to Target!" Well, this is an acceptable field trip, nearby, and there’s always room for diapers.

Before we go, my granddaughter reminds me that I'm supposed to make her warm milk and honey, some weird tradition she associates with me, so we do this. She’s sipping, searching her brain. "Remember those kids at your house. . ."

"Your cousins! Yes! We’re all going to be together again soon, for Pesach. (rhymes with grey socks and it's Hebrew for the Passover holiday coming up). And you’re going to see all your other aunts and uncles, even the one who JUST became editor in chief of law review and it’s not based on looks. . ."

"And, and, and. . .play with the kids."

"Uh, huh."

“What’s this?” she asks, tugging at the tangerine silk blouse I have under a pale orange cotton sweater. Neither is warm enough in this unexpected cold, but surely better than the silk kimono on a skinny fellow we saw rushing off the train. Did you see that? A kimono! He must be freezing!



"Do you like it? It’s my tangerine blouse. Want me to get you one, too?"

And we’re off to Target. I buy her mother a book, Look Me in the Eye: My Life with Asperger's by John Elder Robison. It comes highly recommended, although I haven’t read it myself. This is my cheap way of getting books. I buy them for Rac, she gives them back to me to read when she's finished, then I send them to the next bidder in the family who shows an interest.

It's that or the library, also a good thing, but they charged me $2.40 for an overdue book the other day, and I swear** to you, I renewed it on time.

Anyway, it’s pretty hard to find our favorite three-year old a tangerine shirt, so she opts for a dress, navy and kelly green, although she really wants a frilly, lacy, yellow Easter frock that just doesn’t work for me. We find a Size-Me chart and she stands up next to it.

"You’re a 4-Toddler," I say.

"A FOUR!!!! I’m a FOUR!!!! My mommy says I’m THREE! But I’m really FOUR!!!" As in, I knew it.

We put in a solid couple of hours shopping and eating, meeting her mother and sibs at the pizza shop, and everyone behaves incredibly well. We return home for bath time and I'm elected to do this, which only makes sense, since I bought the new rubber duckies, the yellow ones, you've seen them, with the big momma duck and her three babies. I have also donated a fourth duck, a brilliantly engineered species that is really for testing the bath water to make sure it's not too hot. There's a sensor on the duck's underbelly and the word HOT will turn white if the water might roast your kid. The idea is that you put the duck in the water before the kid.

Anyway, the kid is swimming and splashing and I’m washing her, amazed at my good fortune, and it’s a good time overall, even hair-washing goes very well. At some point I sigh and say, "Maybe we better get you out of the tub now. I have to go."

She gives me this incredulous look. “You’re going?”

“Well, Saba and I have to get back to Chicago early in the morning.”

"You’re going?"

"You’re coming to visit soon!"

"Maybe I’ll come to Chicago with you now," she reasons. "And I’ll see Blue*** I want to go with you now. On the airplane." Done.

"But you’ll miss everybody, you’ll cry within minutes, as soon as you realize your mom isn't with us. You'll miss her, and your daddy."

"No I won’t."

"You’re only three."

"I’m four."

"Come on, let’s get you out of the tub into pajamas."

"No. I’m coming with you."

"Ask your mommy."

She lights up. Idea. She wriggles out of her towel and works the idea over with her mother.

Rac gives me a look to kill, as in, how COULD you?

But our little three/four year old is in pajamas and she knows she can’t go. But it is sad, and there's no getting around it, I've failed her. She thought we had a chance.

Next morning there’s hardly any more snow on the ground. Things melt quickly in the south. FD and I are back on a plane and the pilot’s telling us what to expect weather-wise in Chicago. We have a little snow.

He also tells us we’ll be taking off in ten minutes. A half hour later FD grumbles, “Good thing the pilot’s not a surgeon.”

“Huh?”

“You know, Uh, lady, the surgery only takes ten minutes, you’ll be out of here in no time. Oh Mr. Jones, that surgery went just fine, just great, you won’t have any pain (sic)."

FD is in a hurry, hates wasting time. He wants to discharge that baby and AirTran doesn’t seem to care.

I’m marveling at my view. Usually I sit in front of the wing but somehow couldn’t get that seat, and now I’m right here, on the wing. I look down and see the wing is made of several pieces and shapes, and one of them has arrows.



“What’s the story?" I ask anyone in hearing range. "They don’t know how to put the wing together without the help of arrows?”

Something to do with airflow. I change the subject.

“I can’t wait to see my fish. I hope they’re all okay. Number #4 takes good care of them, which makes sense, since food is a priority for him. But you know, a mother worries.”

I ramble on, FD seems to be listening, maybe. “I worry a little about Blue, you know, I really do. He's my favorite fish and he’s grown so big so fast. Maybe he has heart trouble. How would we know if he has heart disease?”

“Don’t worry,” FD quips, totally deadpan. “He swims every day.”

We land with a thud and I’m pretty sick, stumble out off the plane. Chris, our driver recognizes us as we take a seat on the shuttle. “Didn’t I drive you here just a couple of days ago?”

“It was just yesterday,” FD tells him.

“How could you go for just one day?” Chris is flabbergasted.

“Gotta’ get back to work,” I offer weakly.

“And this weather,” he continues. "To go from there to here. . ."

He lets us off at our car and before we can blink Chris is sweeping the snow off the car with a huge rubber snow scraper. This is not your average snow scraper, it’s more like an industrial push broom.

“Where did you get that?” I cry enviously. “I must have one.”

He mumbles something, but I’m thinking: If it keeps up, this global warming, this climate change, call it what you will, then there’s a new niche in the south.

Think . . . . scrapers.


therapydoc

*The Wall Street Journal did a piece about a month ago on grandparents and how people in my age group hate old-fashioned names like Bubbie, Nanna, Gramma, Tatti, etc. The labels make them feel old. They want their grandchildren to call the Fred, Sally, Gert, Debbie, Jim, etc.

Who ARE these people?

**blee neder, meaning I don't really swear.

***Blue, my favorite fish, is a Niger Trigger. He's from Nigeria and builds things out of sand when he gets bored.

Sunday, March 01, 2009

It's Over

Okay, the reign of terror is over, no more depressing posts for awhile. I have a good one on checking that I can post when I get around to it.

Checking is an anxious habit, one of those symptoms in the anxiety disorder family. Maybe you have this symptom. I check for a lot of things. Like I check to see if every door is locked before I go to sleep, even if I know I locked them. And I'll run home to check to see if I turned off the stove. These are no-brainers. Who wouldn't do this?

So, I'll post on that very soon, and we'll steer away from the sad stuff for awhile, for as long as we can, and keep it a little lighter.

No promises.

Because EVERYONE'S depressed. Everyone I see, either at work or in the community, is depressed.

And they're showing a little anxiety, but not the type you get from too much responsibility. Well, that's not altogether true. The people who are doing the job of three people because two have been laid off are pretty stressed from too much work and responsibility.

But lots of people aren't doing as much anymore, not bringing home the bacon (forgive me) and they're thinking bad thoughts.

The thinking bad thoughts can get you into trouble, you know. Gracie Slick of the Jefferson Airplane said it, in her way, in the sixties. Gracie was lead singer, the song White Rabbit, I think, (who knows if she's still alive). But she advised that you feed your head.

She recommended drugs like LSD, which we now know are bad for you, but the idea of feeding your head isn't all that weird. We really do feed our heads, we do this all the time.

Feeding your head negative thoughts over and over again, basically nourishes a neurological pathway to tears and sadness. And the opposite is true, too. Try the humming, counting and whistling stuff, and you're brain goes to happy. Unless you're really sick and then it won't, and you need stronger stuff, maybe need to see a therapy doc. Certainly don't use LSD.

But if I tell you, It's what you have that matters most, not what you don't have, sure it's a world view, and it's mine, and I go there fifty times a day if necessary. But it's also a way of saying, Don't pave the unhappy pathway. Don't feed your head junk food.

It's what you have, not what you don't have is a mantra, mine, and maybe everyone needs one. The men and women of my mother and father's generation had some kind of saying for every situation, every circumstance.

In English,

Men make plans, G-d laughs.
A good neighbor is better than a distant relative.
A person has to be happy with what he gets in life.

(often there's not much choice, is there, except to feel sorry for yourself, and how boring is that?)

Of course, the mantras of my parents generation were in Yiddish, and everything sounds funnier in Yiddish.

therapydoc