Friday, December 31, 2010

Sexting and Mental Health

The Brett Favre sexting case has been bothering me, mainly the thought that since he sexted, Mr. Favre has had nothing but bad luck.

It's probably a huge stretch, but I'm going to throw an idea out there anyway, wondering exactly how wrong I am. It's on my other blog, so here's the link.

Have a happy, healthy, thoughtful new year, everyone. See you in 2011.

therapydoc

Thursday, December 16, 2010

The Holidays and Business

Housekeeping:  There's another poll on the sidebar, take a minute.  And this post feels long to me, so grab a bite to eat and come back.  Settle in.

"Last year you weren't nearly this busy," FD corrects me.

I had told him that I'm beginning to feel the effects of nonstop holiday happiness.

"Who can remember last year?"

I remember blogging about this once, getting ridiculously busy in October, the drama, the sadness, the relentless desperation not letting up until after New years. I wrote that it had something to do with the stress of planning, how planning extended lengths of time socializing with family brings back memories, and they aren't usually the good ones. Heaven forbid we should remember the good ones. 

The thought of Uncle Al getting wasted, Cousin Ina slamming the door, swearing,  "Okay, that's it, we're getting a divorce!"  This type of family dysfunction-- boozing, screaming, slamming-- anger-- even passive-aggressive anger, "Good to see you, too," especially this-- tends to be a downer.

Add to that the happy family script: We're supposed to like getting together as a family.  You've seen the commercials, especially the one with the cousins getting away from their parents to a restaurant for dinner, just the cousins.  Delightful, but how often does this happen?  Great when it does.  I think it was Leo Tolstoy who said, 
"Happy families are all alike; every unhappy family is unhappy in its own way." 
Anna Karenina.  He was right, of course.

A prescription to manage the anticipatory anxiety:

a) plan as little as possible, wing it
b) label dysfunctional patterns, but don't argue; discuss
c) have an escape plan
c) expect little
e) accept a lot
f) and when the catastrophic expectations materialize, laugh about them.

Because after all, they were all predictable, the catastrophes.  We know our family members well enough to predict their nahrishkeit (rhymes with bar-ish-kite, means foolishness).

So clear the snow off the getaway car and check the availability at the local hotels.

But getting back to FD. He is right. This season has been the worst in years. Something in the air, something other than poverty, although poverty, and the anticipation of poverty, doesn't help; it is bringing people down.

The social scientist in me says it is entirely random, this year, and I'm different, too.  It is the luck of the draw, the draw of my particular patient mix, and really, mine is great, but this is work, not cocktails.  If you accept a lot of new patients, the complexity, the responsibility, will overwhelm. Never launch them, is the answer.  And take frequent vacations.

Maybe, however, there's a global confluence of variables at work, too. The unemployment, terrorism, the economic collapse of governments, the senseless murders and suicides hashed over repeatedly on the ten o'clock news. Kids voluntarily foregoing childhood, sexting.  War in Iraq, no pay raises for military families.  Riots.  Explosions in the Middle East.

Business as usual? Maybe yes, but these nagging toothaches add to what we already have, pain in our own ecosystems, in our own families, somewhere there is pain.

So avoiding the worst of times* is the prime objective.

We could start with ourselves, logically. Others might act out, Uncle Al, Cousin Ina, but we're affected, too.  Under the spell of what is supposed to be intimacy, I think the healthiest among us regresses. Where else can we be ourselves, the ones we used to be as kids, if not with family? 

We're a little different when we're with them, our siblings, parents, grandparents, aunts and uncles, cousins.  We slip into old patterns in the same context, eating and drinking with them, the same dinner table, hearing the same snarky jokes at somebody's expense.  The context triggers the synapses, old nerve pathways, thoughts and feelings of childhood come alive, like some ghost of holidays past.

Once we're there, we lose our more mature defenses-- intellectualization, rationalization -- the ones that make us think things through, forgive; and we regress to the childish ones, denial, projection.  The ones that blame.  The fun started with planning; being together finishes us off. 

You might think it isn't worth it, going home, but I think it is.  It's worth watching how this happens to us, and better even, it is worth labeling what is going on, appealing to the intellect of others in the family, the ones who might get it, who work programs or have had some therapy, or maybe caught on years ago, as children.  Also appeal to the heart of the family, the place in each of the first degrees, second degrees, thirds, that wants this to be a happy family.  Enjoy the best of everyone, and fight the regression to denial, projection.  Stay adult.

Just don't referee.  That's what you spent money on the tune-up to avoid. 

Not everyone goes home, goes anywhere is the truth.  If we didn't have good holidays as children, if there were no presents under the tree, if there was no tree, if there was no dad, no mom, if nobody filled in, if there was no Santa Claus, if someone died,  then for sure, no matter if we have reinvented ourselves, now have a functional family, a home, it is still sad, remembering. And if we haven't reinvented ourselves, if we have successfully abandoned the dream of the happy family, then there is no reunion.  No matter, sad.

And if our parents didn't make it as a couple, if there was violence in the home, if there is violence in the home now, then LOSER is written all over us, we're sure.  Adult Children of Losers, ACOL's, and sadness. And the expectation that our spouse should have helped us correct this by now, by the holidays, for crying out loud, and didn't, then the blame game is in full swing, and it can be a very loud game.

Conflictual couples conflict the most before and during the holidays (probably associated with license to drink/use). It is wishful thinking, peace on earth.

My son asked me, "Why do you think this is, that people lean on their therapists more during the holidays? You would think they would be busy baking cookies. Eventually everyone needs cookies."

He is thirty-two, responding to my late office hours. I tell him that time's running out.  Fix it now, fix it now, people tell themselves.  Count down. . .Ten more days . . ., nine more days . . ., eight more days . . ., seven . . .

And the days are getting colder, and darker, and what we really want, all of us, is to snuggle up close with people we love, or one person, maybe by a fire, and sip something warm, maybe hum, turn on Johnny Mathis, sing.

That would be the goal, I suspect. And by the time we get to December 24, some people pull it off.

therapydoc

*Different author, Charles Dickens, A Tale of Two Cities.  Bring one of these, a good book, on vacation.

Thursday, December 09, 2010

Elizabeth Souter: The Editor

Oops! Housekeeping: I forgot to tell everyone to please check the sidebar and vote.  It was an impulse post, and once someone votes you can't edit it.  It should read:

__M-Th between 7-10 pm, CST
__Sunday 1-5 pm, CST
__M-F 9-12 am, CST
__No Thank you.

The lectures are about intimacy regulation, what else.

Onward.


A few months ago, a Harvard educator contacted me and asked if she could take a stab at editing a few posts on Everyone Needs Therapy for free. Of course I jumped.

Free? The only thing anyone has offered me for free is a set of screwdrivers from Home Depot. Which I declined. First accepted, then declined.

But this? A dream come true. We talked while I waited for the good people at 7-11 to make me a pot of decaf (between patients, don't think the phone ever stops), and I told her that I barely pulled a C in Rhetoric in college, probably because I didn't understand the meaning of the word, rhetoric. They assume you know what it means when you're in college, the name of the course.

Anyway, Elizabeth, tzideikat, (rhymes with lid-ay-not, means a female saint) took a red pen to my work. It got pretty crazy, reading the edits,


but she was nice enough to also show me how it looked edited, which is what you got.  After the second pass.

Plenty of bloggers are really writing for themselves, as they should, because as you know, writing can be therapeutic. But if you write for an audience, you're talking performance art, and everyone wants a good performance. Most of us need a good coach for that to happen.

A few months ago I watched my granddaughter's ballet class, and the patient coaching of Miss Vanessa, well, it was a thing of beauty watching her work with those kids.  Not that the raw performances weren't amazing, and let me tell you about my granddaughter. . .

That would be a digression.

So Elizabeth -- professor, writer, editor, and blogger at Motherhood is Not for Wimps – was kind enough to doctor a post or three, and the five-year old in me gazed up and said, Plie' away.


She teaches blogging at Harvard Extension School, so she's probably bleary-eyed at the end of the day, and I hated to overtax her. Still, she asked for it, and she took my scribble scrabble, delivered line-by-line feedback, evaluated how I write, the voice and constructions, my strengths and weaknesses. (Two of the edited posts are up, one will require a lot more emotional energy from me before you'll ever see it.)

Of course, it was like good therapy. Lots of encouragement and validation, things to think about, stuff to work on – enough to jump start the critical thinker in anybody, planted firmly, as you well know, by some previous mentor you surely merited along the way, probably by a first degree.

But the results of those critical introjects!  You have to thank the coaches, the moms, the dads, the teachers, the sibs, the neighborhood folks, that guy at Little League.

Thanks Elizabeth.


therapydoc

P.S. If you want to work on your blogging, strengthen your voice and the quality of your work, Elizabeth Souter tells me that she is not too wiped out too take on another client. (She writes, too, is a published author). Check her out at Motherhood is Not for Wimps, but for an editing appointment, check out her personal website.

Wednesday, December 08, 2010

In Treatment Versus 30 Rock Chain Reaction

Having only watched the 45-second HBO web clips of  In Treatment, I don't have a right to judge.  But these are fairly delicious.

Dr. Paul Weston (Gabriel Byrne), a dark, Jewish Dr. House-ish parental child with abandonment issues and at least three seasons worth of conflict, explores his feelings openly with a therapist, hits on his therapist, is hit on by his patients. What could be more compelling than this?


How does it happen that in over thirty years of doing therapy, no one has hit on me? I must be doing something wrong.

In Treatment surely grabs us where we want to be grabbed-- emotionally, of course-- fully engages our empathy sensors. Someone told me the show feels voyeuristic, as if we're watching true stories, the scripts seem so real.  I took a look at the Wikipedia recaps and no surprise, the stories really do match the kinds of narratives we hear off screen in therapy. 

As time passes for a therapist, stories like these lose their edges, blend in with one another.  Patients I haven't heard from in ten years will call and ask, Remember me? I do and I don't.  But I remember them as soon as they plug in their key words: drug dealer, death of a family member, affair, domestic violence, rape, cancer, cut-off.

So much is universal.  Sometimes telling over bits and pieces of case studies here on the blog, changing the names, gender, race, location, etc., feels like overkill.   So much trouble just so that nobody can exclaim, Hey, you told my story!   Just not that special, is the truth, our stories.  At some point your story, like my story, is just like the story of somebody else.  There's a Jewish expression, Ain chadash tachat hashemesh.  There's nothing new under the sun.  Ecclesiastes, I think. 

Arguable, no doubt.  The way things present, the way the stories play out, the infinite variations of a theme, the content, the details, these are new.  The variations of narratives, like jazz, keep people like me in the game.  They are why people like you like to hear about therapy, talk about it, share the compelling, heart-tugging details of your lives. Every story really is special.

But back to teev.  The TV docs do have fabulous offices, don't they? At first I thought Paul Weston had an amazing office, but then I learned that his patients come to his apartment for therapy.  Dr. Jennifer Melfi, (Lorraine Bracco) Tony Soprano's doctor, he's not.

Still, he's compassionate, handsome, engaging. And although he really needs to get an office, just to be sure he doesn't get too comfortable with his patients, something tells me the show will have a very, very, nice run.

Chain Reaction: Mental Anguish, a 30 Rock episode is completely different. (Spoilers coming up) It's a comedy, for one thing. Liz Lemon (Tina Fey) can no longer deny needing therapy but has no time. So sunny Kenneth -- God gave us two ears and only one mouth because listening is more important than talking-- fills in at work.

Liz lies down on the couch to talk it all out- the betrayal, the lies (Santa)- and Kenneth grabs a pencil and a legal pad to take it all down. A therapist really only needs an ample supply of legal pads, fine tip pens, and a good sofa to go to work, much more important than tea or coffee service. These tend to distract. What, no latte machine?

Listening to Liz brings up unresolved history for Kenneth, which starts the chain reaction. Liz, having told her story, feels better, but Kenneth, the listener, feels sick. So Jack Donaghy, their boss, (Alec Baldwin) steps up to play therapist for Kenneth, and of course, he's next in the chain reaction.
Jack's the one in the suit.

Everyone helps everyone else is the idea. Any one of us can be a pretty decent therapist, given the opportunity (interface be damned). It is why so many of us do dinner with our friends, leave our families behind so that someone else can listen. We may not lie down, but there's something about the process.

The lay therapists on 30 Rock are really funny, of course, at least everyone in my family room laughed out loud. But I couldn't (well, not so much), not because their timing was off, not because the lines weren't funny or didn't fit. They did. But there were too many of them, words. Certainly for a first visit.

If you go to dinner with friends for therapy, you know, to make it work, you really do have to pencil in as many hours as there are eaters. And choose your friends carefully, make sure they know how it goes, the rule not to monopolize. And no need to punctuate, not really.

Leave that for the guys on TV.

I could stop right here, but did read some research on therapy in the media, and learned is that it is variable. Sometimes what we see is spot on, sometimes not. But one thing's for sure. If most of it is like what I've seen lately, it is narrow.

They all seem to do the same thing! It's all a talk therapy, so 1930's, so forties. Whatever happened to the fun therapies of the fifties, sixties and seventies? And what about now, now that we have the Internet? Do you think I don't log on with a patient at least once a week? Look at somebody's facebook page? A single's profile?

There are probably as many different styles of treatment, as many therapy "aps" as there are therapydocs. The personality of the doc is a force of nature, and as hard as some try to be blank slates (the better to read your transference, my dear), it's just not fun, isn't always effective, and it takes forever.

Much more powerful to listen as a kid reads his poetry, or recites a rap, snapping his fingers. Nothing better than this. Or let a patient put someone in an empty chair, describe this imagined larger than life influence, often a parent or a boss, and scream away, express feelings in a safe venue. Or assert, learn to say it nice. The old Gestalt techniques of Fritz Perls are still powerful.

So is Joseph Moreno's psychodrama, literally playing out domestic scenes with family members, real dramatizations of power and control, conflict.

Virginia Satir, a mother of family therapy, had parents standing on chairs, pointing down at their kids, berating them. Virginia made parents feel ridiculous, acting as dictators.

We could go on, and on. Just wanted you to know. TV therapy? Enjoy. But it doesn't compare to the real thing.

therapydoc

Thursday, December 02, 2010

Sexual Harassment and Some Older Guys

My father, a very macho man, but one who considered himself enlightened, still liked the differences between men and women.

Age 89, we're in the car on the way to dialysis, he has difficulty breathing, walking.  Just living, really, is difficult.  Not much daily desire to flirt with anyone.

As a Navy guy he likes nothing better than a good joke, any type of joke, has no idea that the 'blue' jokes can be a form of sexual harassment in the wrong company.  In years past he and his friends swapped these on the Internet, printed them out to read while playing cards. You can't trust your memory at some point.

I tell him a joke about being old and losing your memory.  These, to my dad, are hysterical, even if you're in a ridiculous amount of pain.  Then I share with him about a new business, working with a lawyer and a few other professionals to teach sexual harassment prevention, relationship safety, make the world a safer place, safer for women and men. It's an empathy thing, relationship safety.

He gets it right away that men, too, can be sexually harassed. As a businessman, a guy with his own store, he never liked it when anyone harassed a minority, any kind of minority. People are people. No one gets that better than storekeepers. You meet all kinds of people minding the store.

He's excited about the new venture (not so new), and very curious.

"I used to tell the women how pretty they were-- at work, anywhere-- I complimented women all the time." He stops and takes a breath. "Was that sexual harassment?"

Maybe. Knowing you, Dad, probably. Even if you didn't mean it, if they didn't like it, you might not have been able to tell, so you would continue doing it.

"But it made them feel good! I was just making people feel good! There never was any doubt about me wanting anything other than that. And your mother worked in the store.  I told her she looked good.  I told you that you looked good."

You flirted with other women right in front of her.

"So is that bad? She knew I wasn't doing anything."

Words are everything, poor guy has to hear from his daughter, at his age.  They matter, especially from the boss. If a woman tells you to stop flirting and you don't, then you're harassing her.  You can be breaking the law.  It's harassment before she tells you to stop, but all the more so after she tells you to stop. It's not about you, not about what you think, it's about her, how she takes it, how she feels.

"I just thought . . . She smiles.  It's a compliment.  She knows me, there's nothing wrong with that."

We're telling guys, and women, too, I tell him, not to comment on new clothes, not to say anything about how an article of clothing fits someone, or how their make-up looks. Stay away from anything that might make a person think you're coming onto them, or you find them sexy.

"I'm glad I retired in time," he tells me. "I couldn't have changed."

He's on his way to dialysis, and there are women who are going to be prodding and poking, helping him in and out of the chair.   They like my father.  We both know that they've probably heard worse.

therapydoc

Sunday, November 28, 2010

The President and Sportsmanship

"It's unbelievable," FD says, "this guy elbowing the President.  You don't just elbow a guard, especially if the guard is the President of the United States."

"He said he was sorry," I offer.

"I just don't get it."


The President, playing basketball with friends and family, walks away from the fun braced for twelve stitches to the lip. If you have ever had twelve stitches in the lip, and most people cannot say that they have, all I can say is, it hurts.  The stitching, the healing, none of this feels good. You don't want to know what I did to be awarded mine, only that it was not due to the usual suspects, domestic or intimate partner abuse.  That  would leave falling, tripping, or stray rocks.

But this is not about me. Rey Decerega, director of programs for the Congressional Hispanic Caucus Institute, accidentally elbowed President Obama. Decerega tells us the game was all in good fun,
"I learned today the President is both a tough competitor and a good sport. I enjoyed playing basketball with him this morning. I'm sure he'll be back out on the court again soon."
I sure hope not. This is likely a minority opinion, but Michelle might agree, and there have to be others, too, who are upset that of all places, our Commander in Chief has been injured on a basketball court, playing a game of hoops.

A person should be more careful playing basketball.  Whenever FD leaves the house to play alumni basketball for a school that he never attended,  I shout, "Be careful!"  It comes out more like, "You're old. You shouldn't be playing basketball."

He goes anyway, because he loves the game.  And it is a wonderful game, as only those who of us who run back and forth, back and forth, back and forth, or once did, gasping, drenching our shirts, purging the poisons, could possibly know.

I mainly worry about crunched digits.  FD plays the piano.

It is the emotion of the game responsible for our leader's split lip, the drive of adrenaline, not even his adrenaline, is the irony.  It belonged to a director of one of his programs.  The director's competitive spirit is responsible for the trouble the President will have next week talking to diplomats of other nations. 

"I'm good," is probably what the President said, after the injury.  He won't plot revenge or jail the fellow.

Can we do that in this country? Can a President jail someone for a foul? No, of course not. But he might have a long memory.

The ultimate lesson of all this should be directed to the children, and the President should be the messenger, for he really shines when he talks to the kids.  (See his first day of school speech).  He might say something along these lines, but more eloquently,
It's just a game! Save a little of that aggression, that competitive attitude, for your homework.  You're going to need it, too, when you have jobs, when you ultimately move into the workforce.  The point of sports is control, precision, moving the body gracefully to reach a goal.  You shouldn't have to poke, gauge, or gash anyone to be a valuable player. 
Is that so naive, telling them to work at skill and avoid brutality?

While you're talking to them, Mr. President, when you have recovered the gift of painless speech that is, tell them to pass the advice along to their parents.


therapydoc

Wednesday, November 24, 2010

Snapshots: The Day Before Thanksgiving

Usually I take pictures when I do snapshots, and usually it is after a vacation, a rendezvous with my kids, the people that I let go, why, I'm still not sure. Something to do with autonomy, individuation, growth.

And no family business to fall back on.

Today I had absolutely no intention of posting, but when you go through a trauma, hey, you have to tell your friends.

The morning was okay. I started getting ready for an impulsive, fairly ridiculous Black Friday garage sale in my front yard, an event surely to take place in really, really cold, maybe even snowy post-Thanksgiving weather. It's set, the time and date, no turning back, but we're not. This is to divest of the many things my father left behind, New Old Stock from his gift shop, stuff people only use for Xmas, and being Jewish, how in the world can I possibly use any of it? Xmas plates, Xmas bells, Xmas figurines with kids on sleds. Stocking stuffers. By Friday afternoon we should have some remarkable deals, Black Friday virtual give-aways, minus the late night TV advertisement glitter. I have promised not to keep these things. A person has to let go.

Anyway, after sorting and bubble-wrapping, I take mom to the beauty parlor for a touch up, and while they all touch, I shop at Jewel, the Albertson's of Skokie. I buy things I never buy, things she needs, like Witch Hazel, something she never used when I was a kid, and a pencil sharpener, Kleenex, paper towels, bananas. Your usual shop.

Then off to score three dozen bialis and a dozen bagels at Bagel Country (don't ask why so many, not sure, these will go into my freezer, the winter is long). I drop off her slacks and sweater set at the cleaners, and wouldn't you know, she calls; she's ready. And wowzers, she looks great.

Everyone at the beauty parlor is thrilled to see me.

I drop her off at her senior living spa in time for lunch, shlep (you know this one, rhymes with rep) her stuff up to her apartment, unpack it, steal a piece of Fannie May from the freezer, and take off for work.

No surprises here, sad people, ordinary lives, my people.

I had had a little trouble turning off the car, actually, before getting to all of that pre-holiday angst, and this is a really busy street, where I work, the last really busy street with free parking, but it adds to my stress, cars whizzing past at forty miles per hour. Mine is a vehicle with a very cool ignition system. It's called keyless entry, but it seems a little funky, the system, like it's misbehaving. Ordinarily you push a button, the car starts. Push it again, the motor turns off. Leave your key in your purse, always know where it is. Like power windows, you don't look back.

But today, after turning off the car, the dash still seems lit in the mid-day gloom, not a good thing, but hey, you know who is important, not the dash, not the lights, but my 1:30 appointment. People, not dashboards.

There are days, honestly, even cold ones, you wish you rode your bike. Sure, we're taking a detour here, but bear with me. Picture it. The seemingly brainless biker in three layers, although how could you know this, nylons, flannels (could be pajamas, not sure) under rain resistant pants, skirt, a parka, a hat, another hat under a bike helmet. It's not so crazy. People ski and nobody says, "But it's so cold! You're crazy to ski in this weather!"

Today would have been that day.

So I leave the office at 6 pm, cold, because it really is sleet, I think, coming down, although it melts as it hits the street. A really thick, delicious, hearty soup, I'm thinking, nobody needs more than this. If soup is on by 7:00, it will be ready by 9:00, and this therapist will be in dreamland by 11, because it's been a long day.

But of course, the automatic car door does not automatically open, not as the automatic lock on the door of an automatic vehicle is supposed to do, and the cars really are whizzing by now. It is rush hour. I worry immediately, because it is rainy and sleeting and the wind threatens to blow me away, and how will we jump this car in the middle of this very busy street? At some point I reason, Try the old fashioned way, put the key into the lock. Except there is no key, only a button on a very expensive oval transmitter, we call a "key".

G-d is good, somehow the electronic ticket is cashed, somehow I get into the car, which of course, does not start. None of the other doors open, either, and I am afraid to let the driver side, the only door that is open, close. Because what if I get locked in the car? So I wedge a coffee cup between the door and the frame of the car, and it is really, really cold, that air that whistles inside. And the airfares to those people I let go, the ones in warm places, have burst through the atmosphere.

Needless to say, this comedy becomes ridiculous, and you don't need to know but I'll tell you that I lose the key altogether (find it later in a hidden pocket of my parka) and my son rescues me with jumper cables, his. Mine are in my trunk, a place inaccessible when all things electric go funky in a vehicle like this. And the driver of the lone SUV, the one parked in front of me, when I ask him for help, perhaps he could help me jump my car, condescendingly tells me: You just turn it, the key, two times. Turn the key like this (he demonstrates) and then like that. Two times.

Oy vey.

All this crazy car needs, we come to find out, is an electric pulse, a kiss on the cheek, really, not even a jolt. We don't even turn on the ignition on the Rescuemobile and my kid's electrodes send some special message, telepathy, perhaps, but affectionate, that reaches my battery terminals, the positive and negative, and a current, not even a spark, and the dash lights up like Xmas. It never looked so good, my dash, against the night. The door locks work, the car starts with the push of a button, as it should, as other cars, I suddenly begin to feel, never would, never could, not without the sacrificial groan, that ugly rev of the engine, that painful moan of the Rescuemobile. But mine does. What an automobile! What a vehicle! Gotta' love it. Better even, than a bicycle in the rain. Are we ever thankful!

Right?

Happy Thanksgiving, dear friends. Soup's on.

therapydoc

Friday, November 19, 2010

Intimacy Regulation

The last post, Therapy Abuse, was confusing to many of you, and I apologize.  Ironically, I started out writing a sweet piece, Forget the Pickles which morphed into a long, serious piece full of big words about simple concepts, replete with examples of feedback loops and homeostatic processes.

Too much raw material to dump on anyone, not even patient, long-suffering readers, Nancy Grace somehow took over.  It must say something about me, posting on Nancy Grace, maybe that I want an authority figure to yell at me, or maybe I want to have Nancy's chutzpa, maybe secretly want to yell, having repressed all kinds of negative emotion over the years. But none of that makes much sense.

Whatever the reason, Nancy apparated into my post, and I was thinking my literal imitation of of her was fairly hysterical. FD validated me and said it worked for him, I posted and the post fell flat.

Which means either (a) nobody else jumped out of their chair, (b) I've finally lost it and worse, FD is senile, (c) none of you watch Nancy's show. (My editor offers a third option, a sacred rule of writing apparently, which is that if you laugh out loud at your own work you should stop drinking while working. Except I can promise you that I don't drink and write at the same time, which could be why I rarely laugh out loud at my own work.)

For those of you just tuning in, Nancy Grace is a prosecutor turned judge for Swift Justice,  a popular people's court daytime television show.  She verbally bullies and belittles both plaintiffs and defendants to get to the root of the problem, to get to the truth. The post was to spoof that. What Nancy does isn't right, not for therapists, but we all wish we could do that in our professional lives, just once would work, probably, for some of us.

I had hoped, too, that more than one reader might come out and say,   
That's right! I like it when someone calls me out on my stuff!  I won't own it otherwise! 
A lot of people are like this, won't admit their personal guilt or character defects until they're backed into a corner, have hit bottom, lost everything, everyone,  no place to go.*

The post apparently hit a chord because many readers do relate to having difficulty showing affection, not exactly an unusual issue. One thoughtful writer even wrote her own post on the topic to make up for the brush off nature of mine.

So let's give intimacy regulation the attention it deserves this time around, for it is intimacy regulation that is driving behavior that distances people from one another.

Reasons Some People Are Less Affectionate Than Others:  A Short List

(A) No modeling of physical affection as a child.

People say that we don't know miss what we never had, which is partially true.

If you are raised in a disengaged family, that will be the life you know, but you will notice that other families do things differently. Something is missing for you.

The chilly family isn't always chilly, but physical affection is minimal, and really feeling the love, using skin as the operative organ, is important for psychological growth and development.  Have You Hugged Your Kid Today is all about  self-worth, making kids feel they are worth something.  If they are not worth enough to be hugged by their parents, why should they think they are worth anything to anyone else?  And why dare to ask for it?

(B) Family Worldview and Religion

Some families really think that it is wrong to be loving to the child, feel that it spoils a person, too much love, builds too much confidence.  Humility is the world view in such a family, humility keeps us in touch with others and our position in the universe.

Touch is discouraged in other families between opposite-sex relatives and friends, for fear that it will lead to sex, which should be reserved for marriage.

(C) Fear of Rejection and Exposure

With little experience in the actual behavior, touching for the sake of kindness, to express love, a person who hasn't tried it might be afraid of screwing it up, doing it wrong and being rejected, ridiculed, found inadequate.  You don't want to do this wrong, affection, or so goes the thinking.

(D) Incest and Sex Abuse

There really are ways to do it wrong-- touching a child, as incest and sexual assault survivors will attest. Victims of sexual abuse do sometimes push away their intimate partners, not wanting to experience intrusive memories associated with touch.

(E) Anger

The real culprit, however, the one most therapists can assume is floating everywhere when a partner has stopped expressing affection, is anger.  Physical intimacy issues, no surprise here, are associated with someone being really angry with someone else.

All that in mind, have a look at a fairly typical homeostatic feedback loop between a heterosexual couple.

He either does something or fails to do something that she feels is important.  This happens systematically, on a regular basis

She behaves judgmentally, criticizes him harshly, often, for being a slacker.

He feels badly, knows she is right. He owns being a slacker, apologizes, admits that change is hard, but commits to trying.

She wants to believe this and stays positive, lets the subject drop.

He slips back to the old behavior, maybe did try, maybe didn't, but reverts.

She does the slow burn at first, eventually explodes, criticizes him harshly, behaves judgmentally, verbally attacks again.→
They have come full circle.

Eventually partners come to me and one of the first things we do is establish ground rules: no criticism, no judgmentalism. It kills intimacy, kills the marriage.  And the hardest yet, no blame.


But if you can't criticize, if you can't be judgmental, if you can't blame, then how can you make someone change?

The answer lies in the light bulb joke.

How many psychologists does it take to change a lightbulb?  Only one, but it really, really has to want to change.
Does this mean we shouldn't even try to change people, shouldn't even try to change for people?  Not exactly.  In the process of trying on functional behaviors, some of us come to like them.  Give it a try, you might like it, is a great approach.  You notice there are no accusations, no sharp words, in Give it a try.

It helps to stay with the big picture, to go back to the courtship, when we fell in love, why. In therapy this discussion is emotional and rich, full of sensory memories, and as such can be therapeutic, or potentially dangerous. The good old days clearly aren't here anymore. We can't will them back. So it is a sad discussion and has to wait for the right moment. It is the art of therapy, the right moment.  Enough right moments and couples learn to trust there are more to come.

I think that deep inside, most of us want to change when we commit to someone. Most people are thinking it under the magic of the chupah (rhymes with hoo-pah!, hard "ch" like Bach) the wedding canopy, gazing into the eyes of perfect love. We are impressed, very impressed, and with that impressed-ness we want to be new, to be better, be like that idealized partner.

But it is so exhausting, trying to be someone else, to live up to that idealization. So we give up, over time, or immediately, which is fine, and we settle into being who we are, and that's the way it should be. If we partner well, commit to someone wonderful, there is an implicit desire to please and be pleased, to join, to work together, and self-improvement is in there. Somewhere.  In the best of all relationships, each of us sees, within our intimate partner, our best self.

It is anger that we have to watch, really.  A million things, normal things, events that have absolutely nothing to do with our dysfunctional childhoods or our mental illnesses, can and will get in the way of intimacy if we let anger run our emotional template.  Get angry, sure.  Stay angry, then yes, our relationships will suffer.

Considering how emotional we all are, how stressed, how irritated, the real mystery is how anyone can be intimate at all?  How to be nice and still be grumpy at the same time, now that is the question. How is it that some of us do that so gracefully, whereas others never even try?   

A trunk full of groceries, worries about the future, bicycles in the driveway, pets unattended, it is hard not to slam the door after a long day out in the battlefield, hard not to holler.

Affection, sex, going, going, gone.

So a couples therapy addresses all of these things, and we'll go there next time, no promises.

therapydoc


* It works well in 12 Step programs, too, is fundamental here, for in a 12 Step group people talk about character defects and the need to work on them, wanting to work on them, needing others to help them change. The person with an addiction wants to change, really, really does, and the group, or maybe it is the sponsor who does this, reflects back, confronts with a very sharp mirror, but only when asked. Lying in a 12-Step meeting is just lying to yourself, doesn't help you at all.

Sunday, November 14, 2010

Therapy Abuse

In the last couple of years some of the men in my practice have complained that their partners, generally women, but they could be men, aren't as physically demonstrative as they would like them to be.  They tell me they want kisses as much as sex, although sex would be nice, too.  You know the old joke:   
How do you cure a nymphomaniac?  You marry her. 

We could talk about the joke forever, right?  But my editor tells me that I have to focus, so let's do that, focus on this problem, the disappearance of affection.  I'm thinking that if men are complaining, it means that they have finally caught up to women, feel more free to talk about their feelings in the twenty-first century.  And it's a good thing, not a gender issue so much as a windfall from the Women's Movement.

Women can ask for love and sex.  Men can ask for sex and love.  Just say something, please.

When it's brought to my attention in therapy that a partner in a committed relationship has become painfully avoidant, unaffectionate, emotionally distant and cold, I want to shout out, act like Nancy Grace of CNN fame, now the vigilante judge on the new daytime Fox TV show, Swift Justice. I want to verbally beat on the ostensibly withholding partner, glare at the poor, unsuspecting soul, and make harsh, judgmental faces while bellowing:

What were you thinking when you got married?  That you could let it go?  Do you think that just because you have a ring on your finger you don't have to show love anymore?  Do you believe that just because this person (I would point at the beleaguered spouse) signed up for life with you  that you can do your own thing, turn your mate into chopped liver?  What's wrong with you?@!@!?  Do you think people can go through life, day after day, week after week, with no kisses, no hugs?  Don't lie!  Don't lie to Swift Justice!
Men, women, doesn't matter which gender is the stingy party.  When it comes to affection, I (and Judge Nancy, we're thinking) take no prisoners.

But that's so judgmental!  So not therapeutic, ranting in this way.  It is what lawyers do, not therapists.  Most people don't see a therapist to be beaten up verbally and emotionally, what might be considered therapy abuse.  When we go to a mental health professional we're hoping for calm, relaxed, half-asleep doctors who explain the psycho-dynamics to us, the whys and wherefores.  We want to know why a partner is unwilling, unable to show affection, maybe.  Or we want to work on change, changing our partner, sure, but maybe changing ourselves.

Most of the time that's the case, and it is a slow, healing, sensitive process.  But some people are just dying for us to let loose, give them hell.  You can tell when they want someone to sober them up.  And quite honestly, when that happens with my patients, when I launch into a critical and judgmental tongue in cheek rant, for it had better be tongue in cheek, then that person is likely to love it, and will want to come back for more.

You could say, and you would be right, that this is dangerous water in which we tread at this moment.  A therapist on the Internet  probably should not be giving young, impressionable therapists the impression that it is fine to beat on patients.  Suggesting this, even whispering it, begs a lawsuit, screams professional suicide.

So don't do it without an amazing relationship with your patients, okay?  That would be unprofessional. And make sure they know you're kidding, or at least make the case so that they strongly suspect you are kidding.
If you're lecturing a patient, no matter how badly he or she deserves it, make that delivery tongue in cheek,  and act apologetic as the insults roll off your lips.

At this juncture it is best to reinforce what tongue in cheek really means.  Find a mirror, gaze at yourself in this.  Push against your cheek with your tongue.  Push that cheek way out. Go ahead. Do it right now.  We'll wait.

Could anyone possibly take you seriously if you look like this before, during, even after a rant?  Preferably during the whole show? 

Yes, it's possible, you say,? Your rendition of tongue in cheek in the bathroom mirror looks serious? Then that's bad.  Bad because the more concrete, the more literal among us take us at our word.  Best not to do this intervention with terribly concrete, literal patients.  And to be sure you are not misconceived, consider utilizing the other cheek, too, alternating the process:  Tongue in the right cheek, push.  Tongue in the left, push.

Return to the mirror and practice this, and for good measure, try raising your eyebrows up and down a few times.  If you are still worried that someone will feel abused when you rant in this fashion, be sure to tell them that you were being facetious. Confess, 
"I was just kidding.  You have good reason, seriously, to withhold affection.  Let's talk about it." 
Then go into it with the patient, find out what that good reason is. Because how should you know, otherwise?

We would call this giving somebody his day in court, presumably. Or just good therapy.

therapydoc

Sunday, October 31, 2010

Joel Pollak and Political Signs

Here’s how a politically glazed-over, non-political, tea-party-vulnerable blogger pitches a political candidate


On Wednesday afternoon I get an urgent call at the office from a friend, an invitation to Saturday lunch. Shabbas lunches tend to be festive affairs, meaning we all dress up and the food is great, but I'm routinely declining invitations this year because of availus (rhymes with duh-pay-loose, Hebrish for availut; Hebrish being a cross between Hebrew and Yiddish words.  If you're just be tuning in, try not to worry about it).

Technically, being in availus means mourning the loss of a parent for a full calendar year, avoiding parties and new clothes, good times in general. We don't need to discuss the  emotionality, psychological, financial or anything other than the technicality of availus right now, or if I need therapy for such a condition.

Anyway, I ask my friend if she's having other couples over because technically, according to Jewish law, FD and I could go to this luncheon if we're the only other couple in attendance.

But alas, there are two other couples invited. We know one of these couples well, but the other is new to us, and there's something unique about them.  The he,  Joel Pollak, is running for the United States Congress, and the she, the lovely Julie Pollak, is running, too, in a sense, for they are both out there, in that totally non-socially-phobic, confident, supremely intelligent way that tells us they themselves support their place in the universe, their agenda.  They're on speaking tours, kissing babies, charming all of the 9th District with romantic unaffected South African accents.

I have to ask the Rabbi, I tell my friend. This is the kind of thing that requires a little guidance, going or not going, even if it is an exceptional thing, having lunch with a political candidate and his bride, married only ten months.  You learn these things at lunch, and how he proposed, if you ask.

Because generally I feel very removed from politics (mostly out of sheer laziness, not so much hopelessness), and because eeny meeny, miny, moe is the way a person like me sometimes chooses a candidate in the voting booth, I call the Rabbi right away.  I want to go.  Maybe it is time for better decision-making therapy in the booth, time to become more involved in the cosmos.

The Rabbi is out of town, of course, which could be a good thing, or a bad thing.  But my friend, wants to know by evening if we're coming.  Who could blame her! If we turn her down, surely someone else will take our place.  This, too, is a rule of therapy.  If it isn't you, it will be someone else; might as well be you.*

I tell her, We'll be there.  When I get a call back from our spiritual leader another question will surely come to mind, perhaps something along the lines of a new winter coat.  Having worn out my old one last winter, tore the lining, it is not shayich (rhymes with my-lich, hard ch, meaning: becoming, or appropriate), this coat, for a person that others pay for advice.

I'm a little nervous because I haven't been out socially in quite awhile, and the last time we did go out, supposedly a simple Friday night dinner, others joined unexpectedly.  The hosts couldn't exactly throw them out, and it just felt wrong. When you're used to following rules, breaking them kicks at your cognitive sets, messes with your head, and it's not good.

But maybe it was too early, too soon, that dinner, too soon emotionally in the calendar.  Accepting this time, months later feels weird, too, even under these exciting circumstances, so I warn FD that an emergency escape might be imminent, that someone might suddenly remember leaving something on the stove.  He furrows his brow, tells me unconditionally, in a tone he rarely takes, "You can't do that."

There's a psychological rule that if you dread something, expect that it will be annoying, upsetting, etc.,  it is likely that it won't be nearly as bad as you expect it to be.**  In fact it's best to dread things. Dread away! Better to dread, for the more you dread, the less you'll regret it in the end, not having dreaded a possibly dreadful situation. But if it is fairly well-dreaded, the situation, it is unlikely that it will be dreadful at all.And you will laugh at it if it is, for you have predicted it.

The rule is that if you expect less, you will get more.  It is the Satisfaction Quotient taught to medical students at Loyola University Medical School; the credit goes to Domeena Renshaw, MD (psychiatry).  Divide Achievement (A) by Expectation (E) to get Satisfaction (S).  The theory goes you'll be satisfied with any result over the number 1.0, but less than--you're in therapy.

Take spelling tests.  A person correctly spells (A) five out of ten words.  But he expects (E) to get many more than five, perhaps expects to get a ten.  The quotient, Achievement over Expectation, 5/10, one-half, does not cut it, is not above 1.0.

How could anyone be satisfied with only a half?  And it isn't his fault!  Except that this person's expectations were too high.  Better to keep them low.  Expect to get a two on the spelling test (E = 2); that way anything over a two, say even something lame like a five, is golden.  The quotient, 5/2 or 2.5, is higher than 1.0, the not so loneliest number.

Lunch, of course, was fabulous. My friend is up there with Julia Child, although she complains vociferously, indeed grieves that the pumpkin muffins stick to the muffin paper, and she has forgotten the nutmeg. She serves beautifully, we eat and drink, and you know how it goes, talk of many things, including politics.

Joel Pollack, the candidate, can't help but be political, but he is theoretical and philosophical, too, applies the concept of limits to something we're talking about.  He's very into this concept of limits, something that therapists are forever waxing on and on about. After much deferring in the conversation, I can't help but advise him.
"Joel. Use the word boundaries, not limits. Seriously, everyone loves this word now. I'm sure Oprah has done five hundred shows about boundaries."

He listens! He gets it right away!  You see the light bulb.  He is a natural, and if you read more about this guy, you wish that they, the other politicians, all had his personal attention to scientific detail (I quiz him about recycling, natch), his education (Harvard), his energy, integrity, good sense, interest in others.

So lunch was great, and I learned that I should probably get more involved in these matters, politics, blog less and listen to the candidates more, especially if they are bright and promising like Joel Pollack.  Probably many of them are bright and promising, although it is unlikely many bring a copy of the Constitution with them on the circuit, but they should.  This candidate does.

And for the first time in my life, it is happening, no promises,  I am getting a sign for the front yard supporting a candidate.  It had to happen sometime.

therapydoc

*This is a statement dependent upon context, of course.  If someone is passing you a joint, for example, it might as well not be you.

**Just because a person wants to do something, go somewhere, doesn't mean there won't be a layer of dread.  This is one of the many double binds,  paradoxes of the human condition.

Friday, October 29, 2010

Dude

Simple and inviting, if not particularly elegant, n'est pas?


FD and I have a few friends, what you might call a little micro-system, a social group in social science language. The guys meet once a week, the women like each other, and when one of our kids gets married, everyone chips in and helps out. Tonight someone drops off paper goods for a dinner party to be given in my home for a couple of newlyweds.

The guy at the doorstep is shlepping in the soda, showing off the paper goods.  His spouse is out of town so he's doing the shopping, or she certainly would.  We have roles in this particular club.

I glance at the offerings, raise an eyebrow, but don't say anything, smile, thank him.  I'm thinking,  There are no dinner plates. But hey!  Maybe I just didn't see them. They must be in the bottom of the bag.

But no. So as FD seasons chicken in the kitchen, a guy thing, he tells me, I'm setting the tables.  Finally unable to contain myself, I cry out:
"There's no way people can eat dinner on a lunch plate!"

FD doesn't quite get my meaning, but when I show him the eight-inchers, he reluctantly agrees. He shrugs me that je ne sais pas or Whatcha' gonna' do lookIt is 11 pm, there is no time to buy plates.  I'll be leaving on a jet plane, won't be at this party, have to get out of town.

"I'm using china," I tell him.  "Sorry to disappoint anyone.  If I were going to be here, there would have been no paper plates, no way.  Not here." 

He shouts from the kitchen. "Forget it! This is a party where we throw everything in the garbage at the end, wrap it up, throw it out.  No dishes.  Please."

I proceed to ignore him, to set the table with an assortment of nice plates, not our best stuff, but nice.  I use the plastic lunch plates our friend brought us as chargers for the soup.

Then I see the plastic cups. "We can't use these."

The cups are about six inches high and will tip with a glance or the first ounce of soda to hit off-center.

"We're going with glass," I tell him, "not crystal, but glass.  Wouldn't want to upset anyone."  Silence from the kitchen.

The napkins are fine, and they're recyclable. I love our friend's choice of napkins and there are enough to go around, which at first doesn't seem possible.  But they need reinforcement, seem lonely, so we add a second, this one white, tucked inside the first, for effect.

Now.  Do we use the Sam's Club plastic forks and knives? I have service for twenty-six, for sure, in silver-plate or even stainless. It doesn't all match, the silver-plate, but so what? At least when you cut your meat, the fork doesn't break.  The knife works as a knife, not a challenge.

He's asking Do we have any oregano?

I tell him to go outside and pick some fresh basil, he planted it.  I share the difficulty I am having with the plastic-ware.  Exasperated, he gives in.  "Whatever you want! You're the boss. I'm just going to tell them, it's your house."

I won't be around to empty the dishwasher, to sort the silverware, so it's one for the weak side.

"We're going with the plastic. To show respect. But everyone gets two forks, and we'll write a note, A third fork/knife is an option if you break either or both of these."

He smiles, tries to explain to me that most guys, at least the guys he knows, if they find themselves making a dinner party for a bride and groom, are going to be totally lost at table setting.


"You can't help it, dear. You're dudes."

FD does not know that I know this word. He laughs the laugh of surprised.  I respond to this.

"A dude can't be expected to buy stuff for a party and not get something wrong. It's how dudes are. They're just . . ." and I can't think of another word, want to say clueless, thick, but these don't apply at all to our friend who is sensitive, smart, with it. The shopper.   "You're just dudes, is all."

"When did you learn this word? Have you even seen the commercial?"  He speaks of a Pepsi commercial, and no, I have not seen it.

I reveal that years ago a patient insisted that his biggest problem was his dudeness. He needed me to take the guy in there, the male in his head, and cure the blindness, help him do/say the right things in relationships.

"And could you do that?"  FD is fascinated.

"Yes," I admit, a little embarrassed.

The only thing I forgot to tell him, I confess to FD later, is that you start . . . with the tablecloths.

therapydoc

P.S. The tablecloths were fine, truth be known, matched the napkins.  Who would have thought brown would be just right?  A dude, obviously.

Wednesday, October 13, 2010

Our Humanity

A typical Sunday morning, and I have burned the last piece of French toast, the one with that extra bit of yellow, not quite enough for another whole piece, but enough to make this one really good.

What do you do with a burnt piece of French toast? Do you just leave it there in the fry pan? Do you put it on the serving plate, charred side down, hoping no one will notice? Will anyone eat it? Can you throw it out?

You try the squish of egg, the one hanging off the crust, knowing it is burnt. And it tastes that way.  

Now what do you do? Logic dictates: Throw that piece out. But if you're a waste not, want not kind of person, like some of my green friends, then that's not so simple. You don’t just throw things away.

So you set the disgraced toast tenderly upon the platter with the others, perhaps burnt side up to show respect.

But there is another option, as there are in most things. A person could slide open the silverware drawer, select the sharpest knife, slice away the chaff and knuckle-ball it to the garbage. I choose this option, and predictably my brain rebels.
That wouldn’t have been thrown away in a concentration camp. And here you are, throwing it away.
You might suggest that this obsessing over toast is really about saving and recycling, brought on by my mother's impending move, having to move so many material things out of her house. In the eight months since my father’s death, she has lived alone. We, her children, are herding her into a new living facility, “independent living” it is called. My mother-in-law, still in her own apartment, calls what we are doing the warehousing of the elderly.

We think of it as hedging the odds, safety. And company.

Mother, too, fights the move for as long as she can, and summoning my father's ghost, digs in her heels. Ultimately, to get us off her back, she agrees. As the months of emptiness fill her hollow home, by time the house is sold, she is more than ready to go.

Nothing is easy, and the process demands some remodeling of my house, too, all for the best. I absorb some of her furniture as she down-sizes, and pack things away for garage sales, Ebay on a rainy day. At this point, both of our homes qualify as disaster zones. We need hard hats, seriously.

In the wreckage, my radio -- a two speaker mini-monolith -- is dissembled. It is hard to make breakfast with no one to talk to, so I wrestle with the wires until I hear Krista Tippet, NPR, crooning. She is interviewing a man who grew up fast in a concentration camp in French-Indochina, now Viet Nam.

Xavier Le Pichon* has become a famous geophysicist, the man who discovered plate tectonics, and that the frailties and flaws of the plates beneath the earth are essential elements in living geological systems. His writing is not just theory, but a world view. Frailties and flaws are essential to humanity, too. What makes us weak also holds the keys to our development, our psychological growth, our humanity.

I whisk cream into eggs, captivated.
“Our humanity is not an attribute that we have received once and forever with our conception,” Dr. Le Pichon explains, “rather it is a potentiality that we have to discover within us . . . progressively develop or destroy throughout confrontation with the different experiences of suffering that will meet us through our lives.”
As I set an embarrassingly charred griddle to the fire, Le Pichon waxes on about the plight of the elderly.
“The way to build a society is to integrate people in a way in which they interact,” he says. “Each of them can find out that each of them can have their place, that their life has a meaning; that they are needed by others. So often I found that older people have the impression that they are not useful, nobody needs them, and they opt to . . . go. They opt to go.”
He sighs. He is thinking that under severe mental and physical stress they can lose the motivation to go on living, do not see anything positive about frailty. It is depression he is talking about, the longing to die.

The conversation shifts to the economic down turn. Le Pichon isn’t impressed with the American struggle, the whining, perhaps, something we see as natural, even functional. He might agree that the verbal expression of our pain is good for us, but has another perspective.
“I was in a concentration camp and life was hard. All the babies were dying of hunger, but we were together. . . even under stress if you find a way to create a community that makes sense to your life, then it (your life) becomes extremely important.

My mother was a strong woman. When they would get the message from the Japanese governor of the camp, when he would let us know he planned to shoot most of the people the next day, my mother said, I don't know what's going to happen tomorrow. But today you have to learn your lessons, so come.

Who could help but smile? She sounds like a Jewish mother. Maybe strong mothers are all like this. No excuses, not even genocide; what happens tomorrow is immaterial-- today a person should learn. My mother will like this story, my kids will, too.

We get together, me and Mom, as it happens, later in the day. I have picked her up for dinner; we’re ordering Chinese, something she loves. But I want to get to the recycling place before dark. We have collected four huge garbage bags of plastic, metal and paper, and the bags look terrible in my living room. My daughter-in-law, who has popped in to see what’s going on, is about to leave, but she volunteers to stay with Mom for awhile until I get back.

My mother glances over at me, commands her beloved granddaughter, “Go with her."

I make a face. “Why? She likes being with you.”

“It might be dangerous over there. I don’t want you going alone.”

“It’s in the parking lot of a city golf course, Mom. It’s fine. Nothing’s going to happen. Maybe I’ll get hit by a golf cart.”

She thinks awhile. “Okay. But be careful.”

The crazy thing is that after I leave the recycling place, slowly crossing a very busy intersection, I hear the horrible scream of peeling rubber, a horribly loud, pre-horrible about-to-crash sound that I have never heard so near, so loudly before. It is so very, very close to me that I think. . I’m going to die. I can’t believe this.

The screech goes on for probably fifteen interminable seconds. I will still hear it in my head, days later. And then, nothing.

I have pulled over somehow to the right hand lane, and a car of kids, gangbanger-looking kids, smoking, laughing, shoots past me. My heart consumes my attention, beating to get out of here, maybe move to another country, and I’m dizzy, stop to collect myself; determine not to tell anyone. After all. Nothing happened.

Then why do I feel so bad?

The irony is that I have been trying to convince my mother to give up driving. She won’t need a car where she’s going. The community agency takes residents wherever they want to go, even the suburbs, the malls, Old Orchard. I’m a whole five minutes away. But she wants to take her car with her. It is a symbol, something else we want to take away.

“I can drive,” she says. “I can drive.

“I know. But it’s such a hassle,” I say, not kidding. “And city traffic isn't suburban traffic. It is life-threatening, being on the road these days. There's a reason for those insurance premiums.”

“But I need my independence. I don't like the thought of relying upon you to drive me around."

And then she says it, "I don’t want to be a burden.” Which infuriates me.

“Burden!?” I blurt out. “You don’t want to be a burden? Let me tell you what’s a burden. Me worrying that something will happen to you, or to someone else, while you’re behind the wheel. Now that's a burden. Worrying that I’ll have to deal with your pain and suffering. Worrying about the financial stress of two or more lawsuits that I won’t have time for.

"And let’s not forget," I continue, voice rising, "people will whisper, behind closed doors, What was wrong with those people? Why didn’t they take away the keys? What were they waiting for?" The tirade ends.

She is silent.

This begs an evolutionary solution, a humane solution, one that determines our humanity. But it seems to me, to evolve, to be humane, we both have to stay alive.

therapydoc

Dr. Le Pichon


* You can get the download of the interview on American Public Media
On the website we learn that Xavier Le Pichon and his wife raised their children in communities of the disabled and mentally ill. He is professor emeritus at the Collège de France in Aix-en-Provence, resides at La Maison Thomas Philippe, a retreat for families struggling with mental illness.

Sunday, October 03, 2010

My Generation

For better or for worse, the new TV show, My Generation, is canceled.




As it turns out, this is a tremendous sociological coup for everyone, the cancellation of My Generation, a show marketed by ABC in such a way that a person of acute sensitivities and sensibilities did not need to see.

Watching the show was not on my to-do list, did not make it to Google Alert, did not even rate a  'don't forget to record this one' on a napkin, but someone told me it was already legend, had a huge following, which I guess, in the end, it did not.

A couple of weeks ago I took a walk and passed a bus stopped at a stop light.  And on that bus,  splashed across the entire length of the vehicle, drawing one's eye in such a way that nobody can look anywhere else but, is an advertisement that hypnotizes in the way that the Calvin Klein underwear ads once did, perhaps need not anymore. The riders, human faces of all sorts, excellent faces, staring at us or into Iphones only a foot above the ad, framed in cloudy but in the right light, decipherable glass, are insignificant. (This is a process statement for those of you who study process in your family therapy or psychology classes, laced with content for those who ventral process).

The enormous face on the ad, in a knowing pout, is a seductive brunette.  
You may have his hand, but I have his heart.
The caption is a glorification of the art of seduction, validation that partner-capture is okay, indeed it  is a competition, who knew, and may the best woman (sure, it has to be a woman, perhaps the networks first mistake) win.

Nobody could like this I'm thinking, knowing that that's not true..

But, you might think, if a person is in a good marriage, rests comfortably in a safe, secure, supportive relationship, the best of all possible s-words, and the r-word, why then, how can, a bimbo, threaten this? More to the point, why be sickened by a media event that explores relationships like this? Shouldn't someone draw attention to the fact that all marriages are vulnerable because people are human? 

THE ANSWER:

There are marriages that are secure and solid, safe, the rubber bands so thick that the literal death of a mate does not affect the integrity of the relationship, not in the mind of the survivor. And then there are the rest.

It is the rest that we need to talk about, if only for awhile, and no, we're not going into everything, not even talking about abusive partners who cheat and brag about it, or mentally torture, or suffer huge character deficits (AA language) or as we way in the biz, personality disorders that will take forever to turn around.

When one partner opens the marriage, even covertly, with no intention of hurting the other, perhaps, for this is usually the case, but the other finds out, for the other inevitably will find out, there is permission, a big fat letter from an unapproachable court, no appeal,  a din, (Hebrew, rhymes with tin) a judgment, that this is something that we do in this relationship, we have sex with others. The seemingly irreparable crack is reparable, but the scar remains.

And when the extra-marital relationship has petered out, the other woman, the other man gone, the thrill, the glitter in abatement, the fissure might still fizz, crackle, and the jury is out, if either partner will now feel free to indulge in extra-marital relations, for this is only beginning, a new marital norm, and sometimes there's no stopping this boulder of a rolling stone.

You may have his hand, but I have his heart?! #


therapydoc

The Post Script:  The truth is that most marriages survive infidelity, with or without therapy, and some defined as open marriages seem to work out quite happily.  We're dying to hear more about these.  It is the subject of much hard work in marital therapy, repairing relationships that have cracked under the strain of too many intimates, and it only takes about a year for both partners to feel that the marriage is on the mend, barring those severe character defects mentioned above, and a lack of desire to change them.

Saturday, October 02, 2010

It's Not You, It's Your Bedbugs

It’s hard for me to relax, you know, sit and watch teev, read the newspapers. But Saturday mornings I catch up with many of these, newspapers, a week’s worth of WSJ, even if it’s just to scan the headlines. When you skim it all on a Saturday morning before shul (rhymes with bull, Yiddish for synagogue), you reduce the odds that whatever you read will upset you.  There's just not enough time.

Today, however, by the time FD and I catch up after our respective jaunts into the community, I'm still upset from what I have read, and greet the poor guy with
Did you read that incredibly insensitive piece in the Wall Street Journal about bedbug phobias?
He has not.

And it is likely that you have not either. It seems that my favorite newspaper is reaching to satisfy the populist psychological appetite, which is fine, the more the merrier; the reviews of academic findings can be captivating.  A new regular, Jonah Lehrer, for example, specializes in decision making, reminds us that if decision making is hard for you, it is because you are actually mature.  You see all kinds of alternatives, lots of gray.  Gray is something we like, the people of my cloth.  Lots of gray, lots of leeway, as much as we can live with.

And I like that he recommends (this week, Kant on a Kindle) that we read things that make us think.  He differentiates between processing with the ventral route versus the dorsal stream. Chick lit readers go the ventral route, it is correct to assume, don't like to have to reread many sentences.  Those who prefer Kant, however, flex the dorsal muscles, mixed metaphor not mine, don't spleen me.

Anyway, Amy Bonnaffons passed her editors with a tongue-in-cheek dig at variants of both Obsessive Compulsive Disorder and other serious anxiety disorders, phobias.  She writes a Dear John letter to her ex, Mark, technically a Dear Mark letter, page 13, section A.

The piece, I'm sorry, doesn't belong in a newspaper that professes serious journalism and a mission, apparently, of psychological edification of its readership. Tongue and cheek is fine*, but when it comes to being cheeky about disabilities, not.

Ms. Bonnaffons writes:
Dear Mark,

This is really hard for me. My hand is shaking as I write. . . Mark, I don't think we should be together anymore. It's not you—it's your bedbugs.

I know they've been gone for six years, but since you told me about your 2004 infestation I can't get it out of my mind. . .

You have to be patient with me. Yes, it was perhaps excessive to require your grandmother to wrap her sofa in plastic before our visit and to put on that hooded poncho and face mask before I hugged her. . .She has so many health problems already that she might not notice a little itch here or there. . .

I won't even ride the subway anymore. Who knows who might have sat there before me? It's exhausting to commute on foot every day. . . especially when I need to sidestep constantly in the more crowded areas to avoid accidentally brushing up against a stranger's clothing. . .

You get the idea.  Is this funny?  It isn't for those of us who have treated people who suffer with these thoughts, behaviors.  Can you imagine having a germ phobia and reading this?  It could be that Ms. Bonnaffons really does suffer from obsessive thoughts, and that she has compulsive behaviors that are dysfunctional, so dysfunctional that they distance her from others, obliterate her potential for intimate relationships.

I doubt it, somehow.  But it's my job to tell you, Amy, it happens, and funny, it isn't.

therapydoc
 
*For an example of fine, in the same paper, on page 11, section C, by Joe Queenan suggesting that bloggers deserve stimulus money. If the government forks a few bucks our way, we’ll surely buy “more IPads and Droids, netbooks, and tickets to see Pavement.”

Tuesday, September 28, 2010

There's Advertising, and There's . . .

I shouldn't be doing this. No time for this.

But a public service announcement is important. People need public service announcements.

And therapists have a mandate to warn.

Like if you tell me that you would really like to kill your sister I am mandated, by none other than the State of Illinois, to warn your sister. Yes, to give her a jingle, a poke, and say, "Watch your back. Your sister's intention is to kill you." Or tell the cops to do something of the sort.

Because anyone can get a gun, a sword or some other household weapon. You never know. It is why some of us ride with the principle that it is best not to make anyone angry. Do not ruffle. The less ruffling the better.

THE STORY:

I get up before FD and nudge him, announce that I will make the coffee and get started on lunches, which, if you must know, consist only of bagels with cream cheese, a large slice of tomato, small slices of cucumber, and green onion. You really don't need lox if you have green onion.  Oh, and a couple of chocolate chip cookies.

But while the java's dripping, a concoction of hot water, lemon juice, and honey will feel good.  This is a transgenerational tradition-- although my father often used fruit preserves which he jarred himself, instead of honey. As the water boils I mix a Metamucil aperitif. You get used to the taste.


At some point in this otherwise boring routine, the fatal attraction to email becomes overwhelming. I pop open something from a man representing a group of therapists. It is his second try. He would like to pay me to advertise his website on Everyone Needs Therapy. His website might be legitimate but his spelling is atrocious. And I doubt the veracity of the whole thing, frankly, suspect a scam. Not accusing anyone here, just worried is all.

Here's the pitch:
. . .could you please give us the best price for a small summery to add your . . . site for a period of Monthly . . . We will make payments Via PayPal so if interested, please mention your PayPal id.

Regards, ________
Regards to whom? And my PayPal id. Really? ID in lower case?

FD is getting dressed in the closet complaining that the size he wears in undershirts is always out of stock at Target. He is an average man, he tells me, and this is wrong. They shouldn't run out of the size that most men wear. That's what average means, you know.

Disregarding this, I tell him there's a new Internet scam, one that could hurt bloggers, my people.

FD goes on about the undershirt situation which he will do until he feels the empathy, the love, which I accomplish with further inquiry into the undershirt situation.
"You're an average-sized man, but you wear a Large?"

"Yes."

"Well this makes you a Large man, not an average man, as you say.
He cannot argue with this reasoning nor cares. But the same logic, in reverse, explains why I am a size 4.

"Do you think I need a shower?" I ask him. I'm not in the mood but it is a tradition, showering in the morning, and traditions are important. My hair has grown out of control and needs conditioner. Since I discovered that Suave (translate cheap) is a fantastic conditioner, doors have opened. This is confirmed, that doors will open for you, too, in People Style Watch. The shiny ad for Suave claims to be as good as a salon conditioner!



See. Now that's a product worth advertising on your sidebar. A conditioner for crazy hair. Or Metamucil. Another fine product.

FD does seem happy that I've decided to shower. After all, he fixed the furnace (they usually need thermocouples) and having heat in the house makes the idea much more attractive. I tell him about the blogger scam.

"Just your PayPal id?" he laughs. "Why not a copy of your birth certificate?"

Then one of us comes up with the idea, one that all of you might consider if you're tapped in this possible con.

You write back to Seth, or Paul, or John, or whoever it is who taps you, and you ask for his PayPal ID (capital I, capital D). Ask this person to please fill out the following form:

His
Name:
Birthday:
Address:
Cell:
City and Hospital of Birth:
SS#:
Driver's License #: (and a copy, with pic, natch)

and any other identifying information that you can forward to your cousin, who works for the FBI, not that he need worry.

I'm calling PayPal.

Regards,

therapydoc

Monday, September 06, 2010

The Repost on James J. Lee and Schizophrenia

For those of you who never saw the post below, I brushed it up.  Please let me know if you're still not receiving the emails from Feedburner, btw.

James J Lee, Schizophrenia, and the Population Explosion


Old Yiddish Saying:  When things come in threes, it is likely they are blogworthy
 Yes, I made that up
            therapydoc
 

I’m riding my bike to work, pass a woman in her ninth month talking to herself.  Surely she has a Bluetooth in her ear, but from my angle she really looks like she's talking to herself.

And just last week, after shopping, loading groceries into the trunk of my car, a friendly young man parked next to me remarks with a huge smile:
“I swear, I thought you had some kind of mental disorder, talking to yourself like that in the store. I thought, 

Someone should tell her kids! Do they even know!?'

Then I watched you, kind of followed you a bit, and I could see that you were okay, that you had to have been on the phone."
That's reassuring.  Not suffering from schizophrenia, just on the phone.  Thanks for your concern?

When I was a teenager, a mobile phone, or "communicator," was something that Spock used to reach McCoy, the stuff of science fiction,  the technology of Star Trek.  Off television, however, even to an untrained mental health observer, an animated conversation with an invisible other someone, indicated psychosis.  Something very wrong.

And it was a little scary, seeing that psychosis, for every once in awhile a person is going to see a naked person in the middle of the street, or someone walking, gesticulating wildly who is not on the phone. We are afraid of this because intuitively, we tend to be afraid of what we don't understand.

The irony is that the person with a psychotic disorder can be much more afraid, more anxious, fearful of invisible dangers, the voices speaking only to him, shrieking, spewing hate and rage, negativity.  And under the influence of fear, like most of us under stress, that person is capable of lashing out, usually to self-protect.

A couple of summers ago, riding home from work,  I caught the eye of a woman walking toward me.  She was on the sidewalk wearing mismatched brightly colored clothing.  (I'm drawn to bright colors like a moth to a light.)  When she sees me looking at her she flashes a ferocious glare; I feel the fire.  Then she spits as far as she can, misses me by a foot. Violent psychic energy, aggression.  Strike first.

Believe me, as soon as I caught that look in her eye, differential diagnoses were clear in my head.  I didn't need a DSM. 

A person with severe mental illness who is lashing out violently is more often than not doing so in self-defense.  She  might even be hearing threatening voices.  Tell everyone or you will die!  Show the world!  Make a difference!  You scum, prodigy of scum, you filthy human!  Show your worth!  Very rough on the sense of self, having your thoughts interrupted.  Most of us have trouble with our negative thoughts.  Magnify that intensity by fifty or a hundred.  That's how it is with very severe illness.

And we do have to be better at recognizing this, befriending people who are suffering, finding them resources.

James J. Lee, the gentleman who marched into the Discovery Channel building in Silver Spring, Maryland last week,  had explosives on his person.  He listed his demands on a blog.  He demanded that the Discovery Channel  agree to change its programming, that the station become more environmentally sensitive, more green, more inventive, proactive about population control. He thought humans filthy, babies the ultimate source of destructive pollution, the giraffes, the lions, benign.   From his blog: 
Humans are the most destructive, filthy, pollutive creatures around and are wrecking what's left of the planet with their false morals and breeding culture.

. . .  It is the responsiblity of everyone to preserve the planet they live on by not breeding any more children who will continue their filthy practices. Children represent FUTURE catastrophic pollution whereas their parents are current pollution. NO MORE BABIES! Population growth is a real crisis. Even one child born in the US will use 30 to a thousand times more resources than a Third World child. It's like a couple are having 30 babies even though it's just one! If the US goes in this direction maybe other countries will too!

Also, war must be halted. Not because it's morally wrong, but because of the catastrophic environmental damage modern weapons cause to other creatures. FIND SOLUTIONS JUST LIKE THE BOOK SAYS! Humans are supposed to be inventive. INVENT, DAMN YOU!!

In therapy we might say, You sound angry.

Most of us don't need a prophet to know that our world is in trouble. The heat wave across these past two months should tell us something.

Back to our Neo-Yiddish, the threes.  We have:

(1) Many of us seeing schizophrenia everywhere, or so it seems, like new psych students who have just learned about different psychotic disorders,

(2)  Some of us impulsively labeling James J. Lee soon after the Discovery Channel lock-down last week.  It was suggested, in that short post, that students study his blog, Save the Planet Protest, and the news stories that unwittingly review the variables that perhaps contributed to his last selfless act, for he was gunned down before he hurt anyone, i.e., homelessness.

Down came the post before most of you read it, for after all, James J. Lee's disorder did not have to be schizophrenia.  He might have suffered from a different psychosis.  The blogger feared activists and nihilists who might misinterpret remarks, and she had no emotional energy to argue.  The psychic energy that can be characteristic of psychosis, untreated, is remarkable.  The psychic energy that can be devoted to a cause, not all that dissimilar-- without a psychotic disorder.  No need for resistance exercises at the gym.

Mr. Lee will be remembered, at least by me, as the Angry Prophet of Doom.

Then, a few hours after taking down the post, I called a friend for book suggestions, started reading   (3) One Thousand White Women, The Journals of May Dodd.  Libraries are full of good things.

What is this?  One Thousand White Women is a novel by Jim Fergus about life in the United States in 1876 (really 1854).  The Cheyenne, determined to make peace with urban sprawl and the pollution of white men, offered Ulysses S. Grant an option for assimilating the red-faced with the pale-faced. 

Suffice it to say that it is a biological solution and I just can't spoil it for you.  I just started the book, but it is captivating and very funny.  And then there's this quote!

Little Wolf, the Sweet Medicine Chief , is speaking to a specially appointed commission of Congress on behalf of the Cheyenne:
The People are a small tribe, smaller than either the Sioux or the Arapaho; we have never been numerous because we understand that the earth can only carry a certain number of the People, just as it can only carry a certain number of the bears, the wolves, the elks, the pronghorns, and all the rest of the animals. For if there are too many of any animal, this animal starves until there is the right number again. We would rather be few in number and have enough for everyone to eat, than be too many and all starve.
He goes on to say that for this reason his children must become members of the white man's tribe, thus offers his modest proposal.

His ideas about population growth, actually, are not all that different from Mr. Lee's.

So what makes Little Wolf an environmentalist and Mr. Lee a person suffering from schizophrenia, a man who just thought he was an environmentalist?

Little Wolf contains his anger, is very controlled, even when the men on Capital Hill practically throw him and his entourage on a train back west, rejecting his amazing suggestion.  He's tried to be empathetic, to give the white man the benefit of the doubt.  He is educable, this white man.  An empath, Little Wolf is highly evolved.

The Sweet Medicine Chief reaches out to a culture clearly foreign to him, a people who leave a wake of upheaval and destruction, who ravage fields and the habitat; a people out of touch with the balance of nature, uninterested in learning, particularly, capable, the Cheyenne believe, of empathy and change.

Quite a book.

Unfortunately, without that-- lose empathy, lose the ability to intuit the feelings of others, and lose the sensitivity it takes to look within, to see the enemy inside, rather than blame, and we're all clueless, out of touch.  Or more to the point, sick like  James J. Lee,  spewing hatred and negativity on his blog in an insular psychotic rage. 

We don't know if Mr. Lee had been treated for the illness, or even if he heard voices. We don't know and never will, probably, if anyone told him to call attention to the problem of population growth and the destructive nature of human beings, or not. But he probably had it, 295.30, Schizophrenia, Paranoid Type. A tough disorder to live with, or another delusional psychosis.

I know it like in the same way that I know why that woman spat at me when our eyes met.

And what that means, I guess, is that as a society we've got to be doing more to recognize and help people who have mental illness.  No, I don't know how.  But we've got to try to do more.

Lee's website: http://www.savetheplanetprotest.com

And the Discovery Channel, Discovery Communications


therapydoc