Friday, March 19, 2010

Sandra and Jesse


I know I shouldn't, don't have time, but I have to throw my two cents in here.

Every morning, Monday through Friday, although some weeks more than others, I watch the morning news. Local, national, international. I can't help it. I like seeing people moving on teev while easing into the day with my morning coffee.

And all week long, nothing but talk of Sandra Bullock and Jesse James. Remember that spread in People, had to be over a year ago? How happy they were?

Since her recovery movie, 28 Days, I've been a fan of Ms. Bullock. And as a fan, it hurts to hear that Mr. James cheated on her. She deserves better. She didn't cheat on him.

We hear it's ego, you know. The spouses of several "best actresses" in recent years have cheated on their starlet wives, seeking to beef up deflated egos. Jesse James (gotta love that name) isn't the first spouse of an Oscar winner, and he won't be the last, to feel threatened by a woman's power, popularity, fame, and beauty. The girl, if she's the best, will be in demand.

Best actresses have egos, too, which can be a problem. Everyone loves them, they feel their guy does, why wouldn't he? The doc tells us that stars should worry about this, that their men have egos and these egos will demand attention. If she's on a shoot for eleven months, someone will fill in the emptiness. This is what it's about, ego and power, and now we're hearing, loneliness, chaval (rhymes with duh-doll, Hebrew meaning a shame).

The family therapy take? Cheating is transgenerational, at least it can be. Your dad shows you the notches on his belt, gives you permission. Alternatively, if he says, "That's not what we do," you listen, usually. Not always, of course, but some do. The psychological dope on cheating is that it's some form of passive-aggression, anger, some sense of deserving. The affair is usually never as good, by the way, the sex is not as good, as it is at home.

The most important variable, the one not spoken, is commitment. It's when the commitment is gone, or when the commitment was never there, that at least one of the two partners is vulnerable to extracurricular activity, regardless of sexual identification. This is why, when you do that initial assessment, commitment is the first thing you talk about with a couple, along with that transgenerational stuff.

And you do it in individual visits, too, not when they're together all cozy on the sofa.

The good news is that a person can re-commit at any time. Those re-commitment ceremonies are cheaper than divorce and everyone loves them. You get presents.

But yeah, she'll take that grudge to the grave, honey. You can count on it. Famous or not.

therapydoc

Monday, March 15, 2010

World View

That's Jihad Jane.

Let's talk. You should know we're only talking because my 9:00 forgot about daylight savings time. Do I charge? Would you?

So Saturday I'm walking to shul (rhymes with "pull", Yiddish for synagogue) and it's wet out, the air is wet, wet to the degree that you flip up your hood if you have one, which I don't. And there's no sun, and you wonder: Why am I doing this? Better people than I don't. They stay home and pray if they want to in the privacy of their living room, or not at all. What is this compulsion?

Upon arrival it's no better, but why fight it, you know, because it is what it is. Half-way through the service is the reading from the Torah, the Holy Book, painfully inked in Hebrew by a religious scribe, and I read along in English, even though I could read the Hebrew, am captivated by what other people certainly find very boring, for we read the same readings year to year. This particular parsha (rhymes with Marsha, means chapter) is about the architecture of the traveling synagogue that Jews carried with them in the dessert, having left slavery in Egypt*, and the donations they gave to make sure the tent was magnificent, worthy of a very powerful, beneficent Resident. Reading it reinforces why I'm here, adds meaning to the things I do by rote, reminds me I'm not crazy.

Some of us take comfort in meaning, having a place in the sun, an identity, and religion fills this void very well. If you have one that is really old, that claims authority and irrefutable tradition, then you're really set.

So we can't really blame people for seeking that.

On the cover of the Wall Street Journal is this front page eye-catcher: For the Love of Islam


Ms. Paulin-Ramirez, looking for something to hold onto, has tried Christianity, returned to her books and found them lacking. Islam works for her. She finds a religious community on-line, falls in love with a Muslim man, and before you can say Jihad! is wearing a burka. Her mother and stepfather are beside themselves. Jamie runs off to Ireland with her son, ostensibly planning a murder/suicide attack against a Swedish cartoonist who draws cartoons about Mohamed that don't make everyone laugh.

Enough to make me wonder what drives this behavior, preying on the vulnerable, people like Jamie, just looking for meaning, a self to call her own. Jamie finds a mentor whose translation of Islamic holy books is radical. She's linked in a murder plot, along with Jihad Jane, Colleen R. LaRose from Philadelphia. I remember studying cults years ago, wonder why there isn't more discussion about this in the news. We could call them Religious Predators.

Then today, never mind, they're all free to go.

Jamie Paulin-Ramirez isn't guilty, or has finagled a plea bargain and nobody's telling us. According to WSJ online,
Ms. Paulin-Ramirez's case is the second this month involving American women who converted to Islam, only to wind up attracting attention from law enforcement.

An indictment was unsealed this week against Colleen R. LaRose, 46, a suburban Philadelphia woman who authorities said used the Web alias "JihadJane." Ms. LaRose was accused of plotting to kill the cartoonist and attempting to recruit jihadis via the Internet.
They're free to go, although we are made to understand that they are not sure where to go or why. Perhaps they'll have time to read other translations.

You wonder, at least I do, how anyone could be swayed to murder someone else. There has to be something very pathological going on there. A person with Antisocial Personality Disorder doesn't have to be persuaded. The Jeffrey Daumer's, the John Wayne Gaycy's, people who commit murder after murder-- nobody's twisting their arms. It has to be a very vulnerable person who commits to a belief system that advocates an antisocial behavior. We can change children who have been fed terrorist propaganda in school, but changing a Daumer or a Gacy is much harder.

A story, how some people change: (details are fictionalized, down to the Lady Gaga reference)

A patient in her thirties, who has been slowly analyzing her depression and behavior over a lifetime, her miserable relationships, tells me she's angry at herself for being so narcissistic, narcissistic from the get go. She sees herself more clearly now and no longer wants to be special, no longer cares if people think she's great or talented. She's worried, even, about making other people uncomfortable because she's so smart. She hates that she used to gloat, loved it when they failed.

We go through the many variables that can contribute to narcissism:

(a) being a favorite child
(b) being treated as if you can do no wrong
(c) being told you really are better than other people
(d) being abused (how this loads is the subject of a different post)
(e) having narcissistic family members

She tells me that she hates herself for the years she spent in self-worship. She's terrified she'll lose it, her new-found focus upon others, that she'll slip back to thinking she's superior. She's found the only thing that works, the thing that keeps her straight, is prayer.

Prayer? She doesn't look especially religious. More like Lady Gaga, is the truth.

Right. She's praying more and thinking about the things she's learned now that she's read some really good Christian literature. It has brought her back to the idea that there is a power outside of herself who is in charge, who has a destiny figured out for her, and that destiny isn't tied into her being the center of attention, necessarily, certainly not her thinking that the world should revolve around her, and that if people don't admire her, they're stupid. "I'm just like everybody else," she tells me, "and I'm going to start acting like that, take an interest in others. I'm going to be like everyone else."

But what will you do with your talent, I ask? She is an immensely talented person.

"I can still use it, of course (silly). I just have to remember where I got it, and if someone compliments me I tell that person that if I have a gift, I had nothing to do with it, it's a gift. A person has to say thank you, too, publicly, for a gift."

Pushing the envelope I ask, But isn't it narcissistic to think that you have been singled out, gifted? Wouldn't it make more sense to say that it's an accident? A genetic stroke of luck?

"I've thought of that, but is it possible that humanity can be an accident? We do amazing things; someone is creating something amazing every day! A gorilla could be a fluke of nature, maybe, even a killer whale, but not the brains that put a man on the moon or created prostheses. To think that individuals are in charge, to think we're really special, that there's no higher power? That's narcissism. When you keep that in mind, you begin to see other people, the worth of each one. You're back in the world again."

Whatever works, is the truth. Well, maybe not whatever.

therapydoc

*The festival of Passover is not the "Jewish Easter." It is a celebration of redemption from slavery in Egypt.

Thursday, March 11, 2010

Chat Roulette


In my day it was called Russian Roulette. You loaded a pistol with just one bullet, flipped the cylinder (see above), aimed at your head, and pulled the trigger. Don't shoot yourself dead and you win.

I had heard of it before, but am pretty sure I saw the execution of Russian Roulette in the movie The Deer Hunter. Chrisopher Walken played a young soldier in Viet nam (link to summary of the movie). You wonder, when you watch such a thing, who in their right mind . . . would play that game?

Thus the intent of Chat Roulette. Play it if you dare.

I read a blogger, a well-educated blogger, an author of social media books, who discussed the merits of meeting strangers on the Internet using a web cam. Chat Roulette is the perfect social experiment, really, albeit as a dissertation project would not pass through the Office of Protection of Reseach Subjects Institutional Review Board) (OPRS-IRB) at my school.

The social media blogger, however, maintains that the live chatroom desensitizes people, and that this is a good thing, builds social confidence. You open yourself up to meeting, at least viewing, whoever is in the room. Live (rhymes with jive). If you don't want to chat, you click and move onto the next new person. You learn, in this process, not to fear others just because they have different skin color or different clothing. You learn not to worry if people are even wearing clothing, is the theory.

And this is supposed to be a good thing, desensitizing to nudity and pornography in this social learning process. At first I considered the odds of seeing an exhibitionist, that perhaps they are very low. Then I thought, no. The multi-billion dollar, reaching trillion-dollar international child-pornography industry gets help from somewhere. You know where. Here, on the Internet.

Best, perhaps, might be to get to know the people that you already know. Increase your intimacy skills within the system you live. How many people really know the people in their neighborhood? I found it fascinating that when people visited me after my father passed away, that they knew very little about me. You know more about me than the people in my neighborhood. And obviously, there are two sides to this. I know very little about them.

A Swedish study found that 80% of Internet users are in it to find romance. There's an interesting statistic! Looking for love. And we know that it can be found, too. The dating sites, the Match.com's, the eHarmony's. You can even find someone who is just like you, who fits your psychological profile, which has to be good.

I like the question on one of the dating surveys, "How important is cleanliness to you?" This is an important question.

But ChatRoulette is different. It's about face-face, body-body social interaction with no pre-interview survey, by camera, any time of day, with a random individual, someone online at the same time, in the same room, or rectangle. You walk into a different random social interaction, not unlike sitting in the waiting room to see your medical doctor.

Wait a minute. It's very unlike meeting a random stranger at the doctor's. In the waiting room, the likelihood is that both of you are fully clothed.

Ah, but here, on ChatRoulette, you will meet very different people, people from different nations, different spheres of influence, different worlds. It's a student exchange program without the application fee! So what if they don't speak English, you can pigeon English your way through a conversation and this opens up a world of new experience, life outside your bubble. Talk about sensory arousal! New people, no fear of home invasion or guns. Nobody can hurt you. All you have to do is push NEXT and you're onto the next human being, up close and personal.

Maybe too close and personal.

At an Internet Safety workshop for high school kids in Atlanta, we discussed whether or not it is something they want to do, walk into a chatroom like ChatRoulette (it was described, not named). Remember, these are high school kids. They want to test limits, they have the confidence, they feel the omnipotence. They take risks. But they're not stupid and they get it, post-traumatic stress, acute stress disorder.

ChatRoulette is described like this. Two rectangles are on the screen. You are in one rectangle being filmed live by your webcam, like on g-vid or Skype. To start, another visitor pops up in the other rectangle. All you have to do, if it isn't the kid from India or Spain that you had hoped to meet, is click and you're onto the next person in the room. If you could go to a chatroom like this, would you?

Well, why not? It's totally anonymous. You don't even register with more than a fictional screen name. Sure, they can see you, indeed can capture your video, but you're dressed. Not that someone can't Photoshop a naked body to your head, maybe, and blackmail you. But let's not get paranoid. Is it paranoia to think this way? The state's attorneys offices don't think so.

But back to the fun. So the first person you see is a Japanese business man in his forties in a suit. You're not interested, click to the next. The second person is an elderly Moroccan athlete. Next. The third is a 20-something micro-biology geek. You talk a minute, move on. The fourth is a sexual predator completely naked holding something in his hand, leering mischievously at you.

Sure, you move on. You're not interested in watching this live, pornographic movie. But what do you do with that picture in your head? You think it just goes away?

I tell the story of a kid who walks her dog and a guy in a car stops to ask directions. She doesn't want to get any closer, but her dog is huge and is growling at the guy in the car. So she gets closer to give him directions and she sees where his hand is, what he's doing. And she sees the look in his eye, when he sees that she sees.

We call that a paraphilia, exhibitionism. He gets off on her fear, her surprise. So common. Harmless? She doesn't ever forget the look in his eyes, or what she saw.

So I'm thinking, why would anyone invite this kind of snapshot memory? Are we so desensitized? Should we be? That's the goal? Seems to me that if we desensitize to pornography we open the door to further sexual exploitation.

Every day I deal with someone's victimization. Every single day.

So we worry, me and the state's attorney's offices all over the United States, all over the world, about sexual predators, and what people will undoubtedly find, when it comes to ChatRoulette. The snapshot picture doesn't just go away.

Somebody close that thing down.

therapydoc

Sunday, March 07, 2010

The Importance of Transgenerational

You know, it's all so fresh. I went to a conference last week, a really good one, and three-quarters into it realized my family had buried my father only two weeks past to the hour. I have no idea what happened in the third quarter of the presentation.

Later today somebody called me, left voicemail for me to call back. I totally thought it was about business, but all he wanted was to call, to see how I'm doing. That just threw me.

My dreams scare me.

I go through the usual words with people: It's hard. I find myself crying at nothing. I have a headache. I'm cold. I have a stomach ache. (Somaticizing isn't hard, but it is an art).

And it's very different, not what I would have thought it would be.
You get a break and it comes back. You're surprised every time.


Heck, I had four months to get used to the idea that my father was living on borrowed time, and we had some very intimate moments. Dying is very intimate if you share it, and it occurs to me that maybe some people have an extended dying just so they can be intimate.

Probably we can never be prepared, can never predict what it will be like, no matter the type of relationship we have had with a parent. If you take a hit, you shouldn't be surprised, and if you don't, it's okay. The books on death and dying recommend that if possible, grieve as a family. Discuss your different trajectories, mark important days, discuss memories. Let the emotions roll. And spread it out, talk to all kinds of people if you feel like it.

Meanwhile, here I am at work as if nothing has happened and it really feels this way at the moment. Gotta' love the brain.

A follow-up on eulogies:

I started out mine about my father admitting that before writing the eulogy I looked up the rules of eulogies in one of the rule books. There, in black and white and a little Hebrew, it said:
You can exaggerate. Not that much, but if there's a question, you can. You can err on the side of the positive.
Now this is incredibly important information. I don't know anyone who can't stand to be idealized a little bit in life or death, do you?

A story:

A man was dying. He had lived a full life but was clearly, undoubtedly, beleaguered with not one personality disorder, but with features of several. He hoarded, he was narcissistic, he stole on occasion, and his jealousy was completely, totally irrational, bordered on psychotic at times.

His son, let's call him Eugene, went to the funeral of a friend's father. His friend spoke glowingly of the deceased, tearfully, and as Eugene listened, he panicked.

"I'm ____ed," he moaned. "What in the world am I going to say about my father? My father was such a nothing compared to this guy. So selfish! And he's not going to make it through the year! He could die any day now!"

Eugene went home and quickly wrote a eulogy emphasizing whatever good he could find in his father's life. The focus was entirely on his father's good qualities, and he made some of the bad sound comical, not dysfunctional.

When the time came, when his father died, Eugene stood up in front of the crowd at the chapel and delivered a wonderful eulogy, had people in tears of laughter and love, and everyone said what a wonderful man his father must have been.

Eugene didn't know what to do, didn't want to correct anyone who said, Your father sounds like he was such a wonderful man. You were so lucky to have had him; what a wonderful family it must have been to grow up in. So he would disclose just a little now and then.

"My father was difficult," he might say. Or, "You couldn't correct my father, if you did he would call you stupid."

But this bothered him, made him feel guilty, besmirching the name of the dead, his father, the man who gave him life, for better or for worse. So he stopped it and let the positives of his dad's life eclipse the negatives. He could talk about the truth with his wife and his mother, for they knew this man. They grieved who he hadn't been, too, and their emotions were plenty rich. With others, however, he took one for the team.

He found that he was really angry and his anger wouldn't quit. Unable to shake it, he went to therapy. Here he learned that this is normal, being angry at someone who didn't treat you well, who could be irresponsible, difficult. Eventually he would be able to let it go, who his father really was, even forgive.

Perhaps it's not much of a story. But let me tell you how some of us would work a therapy like this, thanks, in part, to what we know about mental illness.

For sure we'd aim for acceptance while working through the full range of grieving, the sadness, the anger, the guilt, the denial, the shame-- the Kubler-Ross stages of grief. And some of us might even bring in other family members.

Family therapists will sketch out at an emotional family tree, inquire about the suicides, the mental illness, the infamous experiences in the extended family, reaching back in time. We want to know who left town and never came back, what became of the black sheep, what the norms are in the family about differentiation, and why. We inquire about how anger is expressed, and sadness, and who set these rules, and why. We want to know the meaning of success to those who are no longer living, and the meaning of failure.

To investigate, to get more of the story, patients are encouraged to interview living elderly relatives, to find photographs, letters. The job is to uncover, if possible, the good in the family, but also the mental or behavioral disorders, too, and the quirky, if not always so pleasant, personalities.

Based upon this, some of us will proffer a tentative individual diagnosis or three, defining, psychologically, members of the family who may have long since passed away, at least labeling the features. This may or may not make people feel better, but it is what it is and it's something to consider, something important to talk about, something to grieve.

"Is it genetic?" patients ask about a particular diagnosis.

We'll say yes, if we think so, or admit we don't know. Maybe, maybe not, depending upon who is fertilizing whose egg. But it's a good thing to know, isn't it, that if an ancestor has features of a disorder, that descendants might have these features as well?

For whether or not things are genetic, everything behavioral can be learned and passed down. All of us struggle with our nature, and we fight how we've been nurtured, too. Both are likely to be transgenerational, even dysfunctional in some way.

I like to think that we can fight both, that much of personality can be shaped and confronted in a nice way, and that most mental illness can be treated. We may have to change how we define success and failure.

The kicker, the part that is most difficult for many patients to buy in this psycho-educational family therapy, is that it's good to "out" our mentally ill, personality disordered, addicted relatives. Out them to the children, mainly, expose those who, dead or alive, have or had issues, or were perhaps differently-abled.

Certainly when it comes to mental illness, rather than attempt to erase a person from the family tree, own the mishigas, (rhymes with wish-ih-moss, Yiddish for craziness) and vaccinate the kids, empower them.

It's so funny. When you tell your kids about the colorful people in the family, they get it right away. And no, they don't want to be just like them. The research on self-fulfilling prophesies has always been a little light.

All that said, you don't have to roast anyone at a funeral, not unless you know your crowd.

therapydoc