Sunday, December 18, 2011

More Snapshots: You Is Kind, You Is Smart, You Is Important

1. Recycling

I approach the bin, a huge black plastic garbage can, with trepidation. It's getting too full. I'll never get the mega-sized clear plastic bag to the car. Someone else will have to do it, so I walk away.  But I want that stuff out of my house.

It occurs to me that recycling, although it should be a workable intervention to relieve hoarding, never works. You would think that if someone can't throw out a perfectly good cardboard box, but knows it has to go, that recycling would be solace, a certain consolation, knowing that a perfectly decent box isn't going to landfill.

But OCPD, (Obsessive Compulsive Personality Disorder) is one of our more intractable disorders. And with all of the presents, all the good boxes coming our way, sufferers are going to feel the stress.

2. Holiday Social Skill

This time of year I usually set you up for a good party. Most people find at least one party to mark the holidays, and cluster around the guac.

Let's say Billy meets Sally approaching the guac, and they can't help but say something to one another while dipping. Sally asks, "So what's going on? How's work treating you?"

Billy has a really good work story to tell and he begins to tell it, starts to really get into it when someone else joins them, jumps in with some kind of declaration, maybe news of a new baby, or a story about Newt, a joke.

Sally turns from Billy to the new arrival because she hasn't got much choice, or doesn't see a choice, and that's the end of Billy's story.

We would call this an interruption, and interruptions are bad, everyone knows this. In the process of interrupting, the interrupter is supposed to catch himself and say, "My bad! I'm so sorry! I interrupted! You first. Finish what you were saying."

But that doesn't usually happen, maybe because people are high in these situations, or nervous. If Sally had finer social skill, she would somehow get the microphone back to Billy, or at least return her personal attention to his story.

She could gently inform the one who has interrupted, "Hold on, Billy's telling a story, let him finish."

Or she could wait out the speaker, then get back to Billy. "You were telling me about something when we were interrupted." Delicious, delightful social skill. Better than the guac.

Why is it so important? Why is this process considered social skill, on par with refraining from interrupting?

Because it puts Billy back in the room.

3. Gave It to You

I walk through the front door after a long day's work singing, belting, "I got chills electrifying. And I'm losing control, . . . ." It's from that song, You're the One That I Want from the musical, Grease.


My kid gets up to greet me. He's a young adult, he should. He says, "Do these songs just run through your head all day long?"

Seems like it. But give it to someone, and you don't have it anymore. No one knows why.

4. You Is Kind, You Is Smart, You Is Important

My mother asks me if I want to see The Help. It's playing in her building and she fell asleep when they took her to the theater to see it a few months ago, channeling my father. This is a second chance. She'll go without me, of course, but it might be fun, seeing it together.

Things are often more fun in twos.

I'm pretty sure I don't want to go. I don't like sitting more than I have to sit. It is an occupational hazard, sitting too much, hard on the back muscles. And there's so much to do. But the book was great, and the movie has to be a feel good movie. Why turn down a free one of those?

Abileen, the "colored" maid, raises the children of her rich white employers. These women tend to abdicate the job of parenting to their maids. Worse, they criticize their children mercilessly for being children, behaving like children, being messy, inappropriate, and honest.

Abileen uses persuasion, positive messaging, as her parenting style. She has her little girl repeat after her, You Is Kind, You Is Smart, You Is Important. (The green You Is Kind. . .etc., links you to this priceless scene.)

I is kind, I is smart, I is important, repeats the little girl.

I think of a thousand patients who didn't have anyone like Abileen in their lives and it makes me want to scream.


5. Less Holy Matrimony

Apparently there's a PEW poll (like Gallup, survey research) that is showing fewer Americans are getting married.
In 1960, 72% of all adults ages 18 and older were married; today just 51% are, a record low.
Sustaining marriage does seem like an impossible goal for many people, and getting married, a risk so many just won't take.

And who can blame them? It's so hard to accept people for who they are, to love them anyway.  Love can be a thankless job.

But I look around my mother's retirement community and the loneliness is palpable. It's like a college residence hall, except that most of the rooms are singles, not doubles.

But there are a few couples, and they touch one another. Publicly. They may have issues, maybe old issues, but they have one another, and they're grateful for that. When bingo is over, they leave together.



6. Tebowing


I just loved it when I heard that Tim Tebow gets down on one knee after playing football, gives thanks to the Old Mighty. (For those of you who are new here, this is how my grandfather of blessed memory, an immigrant who taught himself to speak and read English at the age of 16, referred to God.)

Tebowing has come to mean praying on one knee, but not just praying, taking the pose in strange places under unusual circumstances.

What's interesting about this is that in Israel you see people praying all of the time, true, not on bended knee, but everywhere, especially on buses and in airports, mumbling while staring into prayer books written in a funny language. So Tim didn't make it up, but he's still pretty marvelous.

The thing that struck me about the Tim Tebow story (Saturday's Wall Street Journal, all about the good deeds he's done, his charity) is that people are really hoping he'll fail, that he'll start to lose games for Denver. They want him to fail, want to see how he behaves when he loses, if he'll lose his faith, starts using drugs, or is caught with his pants down. Clearly unclear on the concept, his detractors.

Happy holidays everyone, no matter what your language.

therapydoc

Snapshots: Masters of Destiny

Wow, that was depressing, the last post, the one about the crash, the "nervous breakdown." And long.

I know they've all been too long lately, these posts, and promise, bli neder (rhymes with see-header, Hebrew for no promises) to tighten them up in the new year.

Here are three short pre-holiday snaps to make up for it. 

1. Masters of Our Destinies

Years ago, after my uncle passed away from cancer, we heard that my cousin, his son, decided to specialize in oncology.

FD said to me at the time, "We only think we choose our professions."

And me, being a therapist, got that right away.

A couple of weeks ago, I get an evite to a birthday party for a friend of my mother's. The invitation is really for mom, not me, but mom can't get to the party on her own, so they grandmothered me in. (The two older women are in their eighties).

At the party I'm chatting it up with D., a friend of my late older brother's, who is now a doctor closing in on retirement. We reminisce about my brother who passed away a young adult, over forty years ago.

D. tells me that he has a sub-specialty in my brother's childhood illness.
Why am I not surprised?

2. Knowing Your Limitations

My birthday is in December, and my son asks his girlfriend to help him pick out a present.

He has the red-green color blind gene from my father and he knows his limitations.
My father, on the other hand, wore insane colors together, refused to believe us when we told him they didn't match.

Sometimes things aren't transgenerational.

Nice, right? Matches my coat, and soft.  No, I won't tell you my age.




I also scored an infinity scarf that my daughter-in-law taught me how to wear, and those gloves with the mitten flaps. And chocolate. They bought me chocolate.

No, we're not finished.  Before my birthday,  FD happened upon this cashmere scarf (no softer than the acrylic above) for $10.00 at a medical conference.

All of the docs crowded around the stand, and FD asked the vender how he got the gig. The man replied that he answered an ad in the New York Times.

Do you believe him? Whaddaya think?

Best gift ever, my grandson's message in a card, telling me that I'm the most funest, smartest, happyst, . . . and a few more good things . . . .bubby, ever.

3. Victimizing Himself

Let's switch gears, get a little psychological.  A gang-banger, working on not being a gang-banger, describes the feedback loop of his life. He tells me to tell the world, maybe it will help people.  His feedback loop is an exercise, an illustration of behavior, thoughts and feelings reinforcing one another.


Inside the circles it reads:

Father beats son, calls him a loser at a young age for minor infractions, i.e., spilt milk →
Son develops low self-esteem, thinks he’s a loser →
Son self-medicates, gets addicted to substances →
Father beats son, calls him a loser →
Son has low self-esteem, thinks he’s a loser →
Son self-medicates, gets addicted to substances
and around and around we go, until the son either gets it together, or hits bottom and either dies or stops using.

We go over the sequence and fill in the blanks.  Although he has broken the cycle, the feedback loop described above, the patient still sees himself as a victim.  He sees people as disrespectful to him, mean, always attributes negativity to the actions of others.  (Twelve Step people would say this is because he hasn't worked a program, and they would be half right.  He's also never worked on this in therapy.)

He may be sober and law-abiding, but his approach to people still tends to be on the defensive, and when he feels offended, he lashes out aggressively.

The more relevant feedback loop addresses this:   

Young man gets addicted, self-medicates discomfort, steals to support drug habit →
He justifies it because he's had a rough childhood, needs drugs to self-medicate →
He beats the drugs, becomes somebody he likes, an upstanding citizen, at least more upstanding than before →
But he still reacts offensively when he feels insulted, disrespected, which is often  →
The perceived insults manifest as aggression   →
Fighting, even verbally, hurts him socially, and hurts his bottom line in business.  Failures drive him to drugs  →
He relapses, gets stoned to self-medicate,  →

But this time, rather than self-justify, he owns his behavior, gets it together much faster, recovery time is short.  And he doesn't steal, is determined not to become a victim of his own psychology.

4. Gangbanging fish 

I buy a new fish, the orange one below, thinking that an angel is going to be angelic.  I put him in an aquarium with other angelic, peaceful fish, and the rumbles begin.  It's worse than West Side Story.  Fish are circling one another, tailing one another, banging it out. It's ugly.

I move him to a different aquarium, one with more aggressive fish. (It's an addiction, tending to aquariums,  but a nice addiction). There, in the aggressive culture, he's chased, beat on, and learns empathy for those he has bullied in his past.  Over time, because he's a survivor, he's accepted into the gang.  There they are, below.  Things are going swimmingly.




therapydoc

Monday, December 05, 2011

My nervous breakdown, not yours

Because we're all entitled to at least one nervous breakdown. It can't be, Let me tell you about my nervous breakdown, and someone else chimes in with a story about their own.

What is fascinating, in our tolerant, (almost) anything goes culture, is that there is still shame in having one at all. But there is, probably because mental illness can be debilitating and burdensome, so much so that when we are in the middle of a nervous breakdown, people fear the temporary debilitated and burdensome as symptomatic of something more permanent. But it usually isn't.

Not that a nervous breakdown isn't mental illness; it is. And we're all predisposed, vulnerable to something, under the right circumstances, some biological fever or another. What manifests to whom, and how-- that is the question.*

And another dissertation question of the week: Is the stigma we associate with mental illness due to  unfamiliarity, fear, helplessness, or a combination of all of the above? Or is it about anger, having to shoulder all the work. Somebody has to get the kids to school.

Somewhere in the Stuff That Makes Us Sick section of this blog, we talk about how there is no designation, nervous breakdown, in the Diagnostic and Statistical Manual of Mental Disorders. The DSM defines episodes of depression, all kinds, mania, too, and an entire nosology of dreadful symptoms associated with anxiety. But the syntax nervous breakdown is nowhere to be found.

It is most familiar to the generation that relates (really relates) to Mad Men (the TV show). In the fifties you had to have one to get attention for feeling mentally ill.

We omit it because it is defined by better differentiated disorders.  Yet, that perfect storm of anxiety, panic, blinding fear, and catatonia, an inability to communicate well, a feeling of shutting down, symptoms of several Axis I disorders all rolled into one isn't close to feeling healthy.

And it happens to many, if not most of us, and for some people, it happens at the worst of times, the beginning of a new job, the birth of a baby, making a wedding, graduating high school, college, moving away or moving toward.  Certain diagnoses are more likely to manifest at certain ages.

There's never a good time, is there?

If it is ubiquitous, and symptomatic of some type of mental illness or a combination of disorders, then perhaps the stigma about the nervous breakdown isn't about misunderstanding or unfamiliarity, rather it is born of a sense of dire helplessness in the face of the collapse of another. Not knowing what to do, wanting to help and not knowing how, we displace our anxiety, judge, blame the victim. And the victim isn't doing much around the house, is the truth, which can make us very, very mad.

Caregivers who come to the rescue will need therapy themselves if the fever of their partner, friend, or family member doesn't resolve soon enough, or keeps recurring. They deserve more than the tee shirt, I'm Working on Surviving His (Her), My Mom's, My Kid's Nervous Breakdown.   But a tee shirt is a nice gesture.  The one who crashes gets to wear Lost It

So many opportunities to lose it in a lifetime.  There's little chance of coasting without being affected, if only temporarily, little chance of not hurting to the max emotionally.  No longer grounded, sanity is penciled onto the loss list,  if only temporarily. (I have my patients write one, everybody has to grieve, tee shirts aside.) Here's a short summary of family developmental steps that threaten ours.**


(a) Pregnancy

By far one of the most pathological conditions known to man, hormones shifting, bodies changing. Yet people make comments about size and weight gain, comparisons to animals (whales, mainly). It is one thing for me to describe my pregnancy as capable of filling out a hula hoop, quite another if you do.

A woman carrying a child needs nothing but love, as those of us who have survived it know. Carrying alone is justification to kvetch, we don't need much advice or personal solutions to the inevitable problems. There's enough information on the Internet to reinforce our insecurities. Ask benign questions, smile at pregnant people. That's all they need.  The looming fear of parenthood will go away, if only temporarily.

(b) Better out than in, owning an infant

Babies cry so much, and sometimes they're sick, and their sleep schedules are unpredictable.  Their insecurities (I'm so small, hasn't anyone noticed? Why did they leave me alone in this crib?  It's freezing in hear and they don't care.  Life has changed for the worse!)

Their insecurities are contagious, and parents feel a loss of control.  Sleep deprived, reality isn't real, lovers become enemies. Decision-making is compromised.  Life is all about four little words, Is the baby okay? When both parents are up all night no one feels good and self-pity or blaming the other natural.  The best fights begin. Happiest times of our lives, for sure, those moments with the little bundles of joy.

Infancy is relatively short, and if handled graciously, with few preconceived expectations, can be delightful, delicious, and unforgettable in a positive way.  It is obvious we forget how bad it can be because we keep on doing it, some of us, live to repeat the mistake.  Someone's teleological trick.

(c) Parenting toddlers

The diapers, seriously, as babies morph into little people who walk, make us sick, and we feel a sense of failure as the little one, all of three years old, (usually a boy, most girls train sooner) refuses to use the potty.  The pleading cry of infancy has matured to a respectable tantrum.  Things break, fly across the room.  Bites happen.  Parents feel they must be able to control this cub-like behavior, and surely they should, but how?

And if a child is sick, has a disorder of some type, perhaps isn't progressing or begins to slip developmentally, that sense of failure becomes identity without support from friends and family.  Support is of the essence and it isn't always there.  Neighbors run from problem children, hope someone else is picking up the slack.

(d) Having children five and under

Little people, little problems, but no, not really. Children are complicated and because their verbal communication skills aren't perfect yet, hard to read. We send them off to school expecting them to behave, and they look around and find other little people wearing better clothes, with better phones, and better manners, or they are bullied. Their teachers are critical and not always good at what they do.

Under all kinds of pressure and social stress, missing home and picturing Mom or Dad with the new arrival, little people act out, have even better ways, demand, or sulk and hide in their rooms. We don't know how to respond to their nervous breakdowns except to say, Snap out of it or no doughnuts. This usually works.

(e) Having children in latency

Freud named the elementary school years latency, pre-puberty, a stage of development theoretically sexually dormant. Children in his world (who were these children?) settled into academics, worked hard at school. Erickson called the stage Industry.

Now, of course, there is no latency and the age of puberty has dropped, probably due to the sexual stimuli in our world or nature's way of demanding we recreate. The stress doubles as parents return to work, children aren't supervised, homework isn't done and food isn't on the table. Perhaps, by now, the slightly alcoholic tendencies of our twenties manifest as truly alcoholic, and sober partners shoulder a disproportionate amount of stress. Marital conflict warms up. Kids get symptomatic, take the hit for everyone. Good times.

(f) Parenting adolescents

By now we have shown our true colors to our partners and whatever marital issues we have, or what is thought to be a mid-life crisis, is a movie the kids have seen at least once. One of us has abandoned the other emotionally, or physically.

Divorce is imminent or discussed in front of children and friends, anyone who will listen. The stresses of money, keeping up appearances, aging, coping with the ghosts of our own childhood-- all of this crescendos as the children smugly look on and get stoned. Who has the nervous breakdown? Any or all of us.

(g) Launching

The kids are off to college or getting married, traditionally the best time for mental illness to manifest. Oh, wait. Nobody's leaving home anymore. Now the nineteenth nervous breakdown*** is about everyone living in the same house. Nobody's off to college, and if some of them managed to go, the parents are in hock for student loans they will never pay off.

Launching, when it does happen, traditionally tips the relationship system in the family, not always in a good way. The suicidal mom, you know, is a kid-magnet, ruins a perfectly good launch.

Oh, we could go on and should, but that's enough for now. The first thing the therapist is going to tell you, if you are lucky enough to get one, is that you are entitled, or you were entitled, to your nervous breakdown. And we want to know if somebody was there for you, what happened at the time and what happened later. Because frankly, the aftermath is so much more important than the crash.

therapydoc

* Jews thought they had no alcoholic gene until recent history. Our ancestors didn't drink to excess, not only because they were too poor, but you can't learn anything when you're drunk! So there was no such thing, in most families, as drinking for fun. You have a glass to toast to a new baby or a marriage, or to bring in the Sabbath. But now, as a culturally assimilated people, we drink along with everyone else. And what are we finding? Alcohol dependence! Crazy, I know.

**By no means the full list. We have to quit while we're ahead, at about the time the kids start having kids of their own. That softens some of the pain of impending sickness, coping with aging parents and helping our children who have new problems, similar to our very own, that sandwich thing. Hardly worth talking about.

***Ninteenth Nervous Breakdown is an old Rolling Stones song.

Tuesday, November 22, 2011

U-C Davis

I just don't get it, and I'm supposed to get everything.  If you saw the video, you saw kids lined up, sitting in a line on the ground, heads between their knees, and policemen spraying them with pepper spray.

Many of you are therapists, but you don't have to be one to know this is sick.
Someone enlighten me here.  It feels way too much like WWII, and those policemen, the Gestapo. Too much interface here, maybe, on my part, but this is unbelievable.

Not to brag, but my fair city, Chicago, handled protests with aplomb.  Maybe 1968 taught us something.

Thanks,

therapydoc

Sunday, November 20, 2011

Snapshots: Being Thankful

Glenn Hasard has a song, Falling Slowly. I woke up singing it today.

Every Saturday I walk over to visit my mother, and each time, pass a crack in the sidewalk, a rise about three inches high, and make a mental note:  Somebody should complain about that, an accident waiting to happen.  Then yesterday, it's me.

Walking with my son and his friend, we pass a rabbi and his family walking a little too slowly, at least for us.  We greet, pass, step up the pace.  I'm looking up at my kid (there's no other way to talk to him) and suddenly find myself flying forward, hands in Superman mode, terrified, falling fast. It's cold out and although they are bulky, my thick gloves brace the crash.  I survive the dive with a light blow to the forehead and a scrape on the nose.  At home, it's something to talk about, my clutzieness.  I wake up today with a slight headache, humming the song. Could'a been worse.

This kind of thing isn't worth mentioning, except that for me it's about empathy for abused women, really feeling some of that pain, a blow to the face.  My son jokes, "Just tell people that Aba (his father) smacked you because you got out of line."  But it's not funny, his joke, and he takes it back right away.

How about a few more not so funny snapshots, then a little Thanksgiving cheer.

(1) Dirty heroin:  A high school senior dies of an apparent overdose.  He's 18.  Four other boys witness him inject the drug at a park and watch helplessly as he falls unconscious.  They drag him into a car and drive around aimlessly for awhile, looking for someplace to be high.  That's what kids do when they get high.  They drive around.

The driver ends up taking the unconscious young man home with him to an apartment described as sheer squalor.  Many children will be taken into protective custody the next day when it becomes obvious that Griffen Kramer is yet unresponsive and isn't going to be responsive, not any time soon. Someone calls 911.

Griffen is believed to have been dead for several hours before the call, according to the Los Angeles County coroner's office.

The story is only news because the loss is a loss to a retired NFL quarterback. Griffen Kramer is the son of someone famous. Most of us don't hear about deaths like these, but in some circles they aren't big news. Only sad news.

(2) Touched: The Jerry Sandusky Story is a biography,  published eleven years ago. The book is now going for over five hundred dollars on Ebay. Some people are wishing they had read between the lines when it was first published.

An unforgettable Sandusky reference:
"I've loved trying to do the right things to hopefully make a difference in kids' lives and maybe make things better off for them. I'll never regret being called a 'great' pretender."
I think he regrets it already. 

In his biography Sandusky describes his childhood as so happy that he never wanted to leave the small mining town in Pennsylvania.  Remembered for his pranks (not favorably), he stayed fairly aloof, distant from others.  No one would have described him as a leader. He had a developmentally-disabled best friend.  Those of us in the research professions think of persons with developmental disabilities as vulnerable to exploitation. 

The profile mentions no girls, except his wife and his daughter, Kara, and that he and his wife adopted six children, five of them male, three of them  foster children, at least two from the Second Mile, the charity he founded to be help kids.

The profile-- aloof, inappropriate, building opportunities to take advantage of children--  misses having been exposed to pornography as a child, or having been victimized sexually as a child-- the primary variables associated with pedophilia.  We just don't know about that biography, do we.

It bothers us, too, that one child told the grand jury Sandusky called him 100 times, even after he pleaded with him, Leave me alone. Dependent, needy, cloying, desperate. An emotional mess.
"I'm an overgrown kid," he says in his defense.
Time to grow up, I suppose.

(3.) Modern day JesusThe man who opened fire on the White House last week tells us it's not just a coincidence that he looks like Jesus.  He is Jesus, a modern day Jesus.  Oscar Ortega from Idaho Falls begs Oprah to put him on her show.  He wants an audience.  Will we see more of this with deeper cuts to social services to the mentally ill? I'm afraid so.

(4)  The Thanksgiving Interview.

I read more snapshots before closing the browser. Herman Cain preaches from a pulpit a few times a week, and when he travels, takes his minister along. Is he working a program? (Referring to sexual improprieties, here, 12 Steps might be useful.) Can't help but ask.

An Egyptian blogger has chosen to go nude on Twitter, refers to feeling more free, thumbing her nose at repression. This doesn't feel free to me. Someone explain it to her, the bit about objectification, stealing with the mind.

After the story of the naked blogger it was time to seize the day, go feed my fish. The little guys thank me, as they should, for this is thanking season.

Thanks to all of you who read my blog, who comment or don't, but support the effort, don't beat on me for the stream of consciousness, knowing that a Freudian, truly, I am not. Not even a pretender.

Many of us, not just my tropical fish, will count blessings on Thursday.  That's what Thanksgiving is all about.

Thanksgiving posts here on Everyone Needs Therapy tend to be about how hard it is, getting together with family, how many of us dread the whole thing.  So much dysfunction for so many of us! The scenes feel worthy of the big screen, and they are.

But this year it makes more sense to me to emphasize social skill, spin a little social advice.  Most people don't know it, but the real social lubricant is intimacy. Sharing real things, the ups and downs we've had recently, sometimes makes dinner or cocktail conversation not only tolerable, but absolutely rich.  Sure, it can be too much, too much information, so we have to watch the responses. It's a skill, too much or too little, and handling it, smiling and moving on, is a skill, too. A simple "Wow!" will do.

There's nothing stopping us, really from asking, directing conversation toward more intimacy. Nothing to fear but fear itself. Like this probe,
"So how is everybody in your family? How's the health?"
allows someone who has gone through radiation or chemo the opportunity to talk about it.  And if they don't want to talk, they won't.

Or,
"Anything amazing happen this year?"
Amazing things do happen to people.  They get promotions, their kids get good grades.  It isn't all gloom and doom.  And if it is, and someone wants to share that, then wonderful! 

The people who have the least fun on Thanksgiving, or so I'm told, are the people throwing the party. They're busy getting the food on the table, cleaning up between courses, directing the traffic, finding the coats, thanking for the presents.  It's really hard hosting Thanksgiving when there's a big crowd.  I'm thinking that the structure of the dinner, the serving, the putting things away, needs to be less important than the people. The best part of the evening has to be sitting down and talking to guests, getting a really good interview.  When they leave, if you can't put your finger on something about everyone, at least one thing said, maybe it's not been such a successful evening.

It's a value, you know, saying these things, that there can be, there should be, intimacy in Thanksgiving; even suggesting we make it a social wellness experiment, a bonding thing.  Is it really therapeutic, sweeping grudges under the carpet, glossing over all the history, whatever it might be, dismissing the narcissistic injuries to another place, another time?

I think so.  It is the risk we have to take to connect, you know, kicking it up a little, the depth of conversation.  See what happens when you ask, "So how are you anyway, really?"

Emphasis on the really.  Most of us don't like pretending all that much, is the truth.  It's a lot of work.

Happy Thanksgiving to all of you.


therapydoc

Saturday, November 12, 2011

Paterno-Sandusky

File this one under Things That Make You Feel Bad.

BuzzFeed photo http://www.buzzfeed.com/gavon/the-reason-joe-paterno-was-fired

Joe Paterno


Depressed for about a week, I buried myself in work, pushed off talking to friends, and told FD, "I have a headache."

And I did.

Appetite poor, everything physical that usually hurts, hurt more.  I started watching old episodes of The Office and Modern Family.

Not even associating the emotional low grade fever with the Penn State child abuse scandal, I thought it odd that I hadn't devoured the newspapers to learn everything possible about the  case, and worse, hadn't blogged about it. Usually when a story like this breaks, the keyboard heats up right away. Someone like me gets rabid to throw in her two cents.

Maybe it was that rape in the shower that got to me, that picture of the rape in my head. We have to call it a snapshot reconstruction because it isn't a memory, as in a snapshot memory. We weren't there to see it. But we form snapshots in our brains, reading the paper. We picture a grown man, a large grown man, raping a small boy in the university shower. And that picture is traumatizing.  No one reading about it, no one reconstructing it, could feel anything but . . . bad.

If you really think about it, if you think about the exploitation of children, any kind of exploitation, there's no other way to feel.  Except maybe angry.

A younger man, Mike McQueary, perhaps an assistant to an assistant coach ten years ago, witnessed the rape in the shower. He tells the head coach, the now infamous ex-head coach Joe Paterno what he saw, and the head coach forwards the information to the athletic director, Tim Curley, who tells then Vice President Gary Schultz, who tells President Graham Spanier, and trail stops there. No one calls the police.

Every social worker, every teacher in this country, every nurse, every doctor, every childcare worker, everyone but the officials at Penn State, apparently, knows that even the suspicion of child abuse means a call to a state agency like the Department of Child and Family Services or Child Protective Services. If you don't know the phone number, you call the police. Paterno didn't know, or didn't want to know, and neither did anyone else in the know at Penn State.

So yes, I buried this story, or tried to repress it, because sometimes things just make you too sad to talk about them. Then yesterday at the office I'm chatting with an older middle-aged couple, two people who like to spend at least a few minutes philosophizing about politics, religion, and social class injustices with me, important topics, before we say goodbye. Not seeing it coming, they pull the oh-by-the-way-doc.
Hey Doc, about that Penn State story. How does this happen? How does a man get caught in the act and then, nothing?
As of this morning, 21 felony counts for Sandusky, the ex-Penn State football coordinator and coach. Two perjury charges against university officials who may have lied about what they knew. Joe Paterno, history.

A mother talks about her child's trauma on ABC. "I want him locked up," she says.
Me, too.

There are so many reasons these things stay under the radar, I apologize to my friends. There just isn't enough time to talk about all of them right now.

Then I spend the next ten minutes talking nonstop. Maybe somebody paid off the family. Maybe the family didn't want to traumatize the child more, thinking the investigation a second rape. Probably the family didn't even know. Child victims are paid off in many, many ways, and troubled kids come cheap, with cheap gifts. They don't always have a male role model who loves them, they don't understand love, and they know far too much about sex. They hear that anything goes. They are blackmailed, their lives are threatened, the lives of their families threatened. Children fear authority and Sandusky is a big guy, imposing, intimidating. He doesn't seem like the kind of guy who takes no for an answer.

We don't know what happened. Maybe Sandusky got down on his hands and knees, cried and begged forgiveness, vowed he would get help and change, would pay for the kid's education.

He's a pedophile.  This is pedophilia.  You can call it a sex addiction, if you want, but let's narrow it down, pedophilia. It's about children, and it is sick and criminal. Most of us can't say that about our disorders.

Bernie Madoff robbed hundreds of investors of millions, billions of dollars. We were sickened by his actions, disgusted, appalled, and he's in jail for life. People will argue, but losing life savings isn't even in the same ballpark, or should we say on the same football field, as losing innocence, integrity, and person-hood. Add to this that it is hard enough, working toward the goal, some of us have this goal as children, of one day establishing a loving, happy, satisfying, enjoyable, intimate, ever-lasting sexual relationship, maybe even with one partner. This is hard enough. Mix it with memories like these, and oy vey. It is complicated.

Therapists see the victims of child molestation and abuse decades later, usually, well after the fact, and we find our patients still aren't "over" it. Most haven't had the therapy they needed, of course, and stay stuck, developmentally, to the age of the assault, which is why perpetrators who are caught pay for this, therapy for their victims, for years. And they pay for the victim's formal education, something that is interrupted, or never begins, when you don't feel you are worthy of one, that you matter.

Sandusky probably had good enough health insurance to pay for his own treatment. And he spent years at college.

That he probably never sought help feels criminal to me. But denial, deception, and criminality characterize, if not define, pedophilia. Treat it in the family (when it presents as incest), and the prognosis for the offender isn't all that bad. When the offender strays beyond the boundaries of home, it is a more intractable disorder, harder to make go away.

That Sandusky founded a nonprofit agency, Second Mile, to "help" vulnerable, troubled boys, isn't surprising. The old adage, If you want to hunt pedophiles, go where the children are, applies.

Now, because this is a sensational story, joining the ranks of thousands of professionals and para-professionals who work with children, will be coaches, assistant coaches, head coaches and athletic directors. Everyone on campus, certainly, will be reading the university handbook, or will attend a workshop. They will learn, hopefully, that they can't let it go, can't pass the buck to their supervisors to call the police and sit tight, hope for the best. It is everyone's responsibility, protecting children.

Call it manning up.

therapydoc

Sunday, October 30, 2011

Multiple Personality Deception: Sybil Exposed

Debbie Nathan, a writer, has exposed Sybil as a lie.

For those of you who don't know about Sybil, she had 16 different personalities, according to Flora Rheta Schreiber the woman who made her famous in the book Sybil.  Everyone in my generation watched the movie with Joanne Woodward and Sally Field. It was on TV.

Like watching the Three Faces of Eve, seeing what appeared to be real mental illness is scary.  As a kid you think, who could fake this?

Now along comes a journalist determined to find the real story, and like any good investigative reporter, she digs in and gets Shirley Mason's (Sybil) true modus operandi.

We thought Shirley had suffered a childhood trauma, developed "alters" to cope with her terrifying world, but lo and behold, her psychiatrist, with the help of a  writer, milked a case of pernicious amnesia to make a lot of money.  Anemia isn't nearly as sexy as Multiple Personality Disorder.

For the clinician, the study of personality development is always of interest.  How we behave, how we come to respond differently in different situations, why one person is extraverted, another shy, these questions drive research, make up the soul of therapy.

We all have alters, we all have multiple personalities, and most of us know it. Most of our behavior, including breathing and turning off the alarm clock, is unconscious. So why should acting the part of someone more competent, someone more sexy, someone more youthful, someone more distinguished, someone more angry, someone more manipulative, someone more talented, be such a stretch?

And there are so many more roles, so many facets of personality that we try on never thinking about it. Nobody used to say, Just saying, five years ago. Nobody used to say, It's not all about you. Our language is picked up unconsciously, half the time we're not sure from which television show. Indeed some psychologists feel that over ninety percent of what we do, what we say, is unconscious.  That should scare us all into watching what comes out of our mouths.

Why wouldn't personality vary, and vary dramatically? Why not have several personalities?  And under severe circumstances, behaving differently is the only choice, just saying.

But Carol Tavris's review indicates that Multiple Personality Disorder (MPD), or Dissociative Identity Disorder, as we refer to it now, is all a ruse! The story, and then the movie, inspired thousands of more fake stories!  And from this, a classification born.

Now that makes sense.  Thousands, not one or two, copy cats.  Read with me.
By 1980 so many psychiatrists had begun looking for sensational cases of MPD in their own troubled clients—and finding them—that for the first time it became an official diagnosis in the "Diagnostic and Statistical Manual of Mental Disorders." MPD was a growth industry; eminent hospitals, notably Rush Presbyterian in Chicago, opened MPD treatment centers. By the mid-1990s, according to some estimates, as many as 40,000 cases had been reported.

Yet Sybil's story, which started it all, was a complete fabrication. Sybil, whose real name was Shirley Mason, did not have a childhood trauma that caused her personality to fragment, and her "personalities" were largely generated in response to pressures, subtle and coercive, by her psychiatrist, Cornelia (Connnie) Wilbur, whom she wanted desperately to please.
All well and good, a fake exposed. But to toss out rigorous research, the underpinning of diagnostic classification with the swipe of a pen?  She doesn't stop there.
What, then, did Sybil suffer from? Is MPD "real"? Yes and no. MPD is what some psychiatrists call a culture-bound syndrome, a culturally permitted expression of extreme psychological distress, similar to an ataque de nervios (an episode of screaming, crying and agitation) in Hispanic cultures and "running amok" in Malaysia. . .

. . .the promulgators of MPD do not seem to have learned anything. They changed the label to "Dissociative Identity Disorder," but a skunk by any other name is still a skunk. 
Oh dear! Promulgators?  Now they're promulgators, not teams of mental health researchers rigorously investigating the presentation of a disorder.  And to compare Multiple Personality Disorder, or Dissociative Identity Disorder to ataque de nervios, a cultural (Hispanic) panic disorder, is a bastardization of the process, we call this the scientific method, behind the Diagnostic Statistical Manual of the American Psychiatric Association (DSM IV-TR). Call it what you will, and the DSM is under it's 5th revision, but each diagnosis is researched to be determined exclusive.  We don't rely upon case study, we frown upon idiopathic research, anecdotal data like the story of Sybil.

To jump from an individual presentation (be it ingenuous or not), to an entire class of mental illness, isn't how diagnostic classification happens.  There are no promulgators.  And to disseminate it at such is clearly sensationalism, fraud.  And to say that those who present with the features of Dissociative Identity Disorder (DID) or Multiple Personality Disorder (see my post) are faking it, is a total disrespect to the thousands who suffer the disorder.

Those of us who treat mental illness do find cases of the disorder, and they are severe, and they usually have roots in childhood trauma.  Those who have been profoundly abused usually don't seek help, certainly can't afford the type of psychiatric care afforded to Shirley Mason.  They haven't the resources, their lives have been altered, and occasionally, their personalities, just like yours and mine are altered, but in a more pronounced fashion.  They are clearly mentally ill.

Call a skunk a skunk, I say.  But it isn't the psychiatric profession that stinks here.

therapydoc

Monday, October 24, 2011

Snapshots: The a.m. and the p.m. hug

(1) I understand that New York therapists take off the entire month of August.

But my habit, being a Chicagoan (as opposed to a New Yorker) is to take off Jewish holidays and an occasional mental health day.  Or week. 

This is Jewish holiday season, which includes: (a) the Jewish New Year (Rosh HaShana) contemplations, regrets, mainly, about the old year; (b) the Day of Atonement (Yom Kippur), that fast we'll talk about later, and (c) a couple of lesser known chaggim (hard "ch", festival in Hebrew),  Succot and Shemini Atzeret, or Simchas Torah.  So I haven't been to work all that much this October.  Anyone trying to reach me at the office heard a variant of this:
Hi, it's Dr. ____. I'll be out of the office until __(date)___.  You'll hear from me then if you leave a message.

If this is a life threatening emergency, call 911 or go to an emergency room. Have someone contact your primary care physician.

If you feel it's urgent, but it is not an emergency, you can call
_(first name) (last name)__ and ask him to call you back. (First name)__ is on call for non-emergencies.  Thanks so much.
In other words, See ya'.

As a younger therapy doc, the only way not to make a mistake in this recitation would be to read the message from a scrap of paper, not unlike scripting a phone conversation with a patient suffering from social anxiety waiting to hear about a job or a date. 

Reading from a script only empowers a person so far.  In my case, the wrong inflection requires re-recording the message as many times as it takes to get it right. The tone of the voice-mail can't sound too happy or too glib, and certainly not self-satisfied.  The only humane way to get it right is to try to empathize with callers, to guess how they'll respond.  My hunch is many respond like this:

Uh, duh! Like I don't know about 911?

Or

No freaking way I'm calling someone I've never met just because it's "urgent".

Or

What's a primary care physician?

Or

She never told me she was going on vacation!  The chutzpah!  (Chutzpah rhymes with puts-the, hard "ch", Hebrew for gall, or nerve).

(2)  If you know me, then you know I never take real vacations, not the kind where you go whitewater rafting or see monkeys in rain forests; not kicking back vacations, drinking margaritas or whatever the cool drinks are these days, or sight-seeing in Peru or Italy.

Having successfully launched most of our children, FD and I think of a vacation as seeing family, feeding them or being fed, and taking the little ones off on urban adventures.  Or just playing cards. The cards are tossed in the trash after the kids visit because we find them everywhere.  Without the kids around, there's no point in trying to make decks.  And my father left me an entire duffel bag of unopened decks, anyway.  No fool. 

Combine the family vacay or in this case, stay-cay with a Jewish holiday or five, and you have many, many people, most of them first or second degrees, under one modest roof, with visitors.

The toughest decision I generally have to make is this: Do I go to services? (Meaning the synagogue).  Or would it be better to whip up batches of pancakes and french toast?  This decision all depends upon the seriousness of the particular holiday. The pancakes are blueberry, the french toast pan fried with the brown sugar, butter and maple syrup.  

This year the kids visited us, meaning that cooking, sweeping, straightening up, and throwing an occasional baseball or tennis ball occupied most of my time.  If you do this with a  future major league pitcher, wear gloves.

(3)  Just to switch gears, before I started writing this post I glanced at AOL news to find that experts are okay with patients taking a break from ADHD meds (we call this a med-vacation).  

That the online expert is only okay with the med-vacay is disheartening.  The thinking, never mess with what is kind of working, paired with a long list of possible physical, social, and emotional consequences for messing with it, essentially marries the patient to medication.  And it makes a baseline comparisons impossible.  Over the years, who knows what normal is anymore?

That said, if you are considering going off medication, of course discuss it with your doctor first.  But keep in mind that how you feel at any given moment depends upon a host of variables, like maturation, events (history), things that may have nothing whatsoever to do with whether or not you're taking medication.

And that laundry list of warnings (in the AOL article), the dire consequences that might transpire should you go off prescription medication, is bloated.  Anything can happen and probably will, but it may have nothing to do with missing doses, although it is possible, which is why you first talk to your doctor. Find out what anything is, if you can.  Maybe it's not so bad, and maybe it is something you need to work on.  And talk to your doc.

My most memorable adult patient with Attention Deficit  Disorder was a middle-aged male who had been on ADD meds his whole life.  He had no life, not one after work.  First visit he fell asleep on my sofa, didn't budge for 45 minutes, a 5:30 pm appointment.  When at last he woke, he complained to me that he usually falls asleep on a sofa at home by 7 pm, literally waits out the night until morning when he can dose up again to face the next day.

More than one med-vacay might have served him well. 

There was no keeping me quiet forever.

(4) We do love our drugs, and that can be a good thing.  Most of the time it is.  Here's a Facebook status* I posted before taking off for the holidays.
:

Today, at noon, it seemed like such a good idea to make that pot of coffee (5 cups, half caf, choc milk for creamer) and drink it all.   Now I'm not so sure.
At 2 a.m., if anyone read that, the third batch of vegetarian gumbo tasted just right, much better than it looked.  We would need it for the coming onslaught of eaters.


(5) As long as we're talking about eating.

Let's talk about Yom Kippur, the Jewish fasting holiday, 25 hours, no food or drink

Parse out the word, holi-day, and you get it.

It can be annoying, especially not drinking any water, but by the end of the fast, the following evening, the light-headed, feint feeling, the emotion, the chorus of hundreds of voices, one of them is yours, everyone is singing, everyone in tennis shoes**, light on their feet, voices rising, rousing the most serious cynic to return to the fold, this has to be the most powerful moment of the year, certainly for some of us.  Sheer soul.

Probably all religions have this, some kind of parish sing along, but on the Jewish high holy days, the greatest hits, for us, are second to none.  There's healing in the community choir, and of course an incredible rendition of a song you only sing in the church, or the synagogue once a year, has to make you happy.

A cancer survivor told me she can't even go to the synagogue, it's so emotional. (Jewish kids grow up on  Barbra, *** who does a nice job with Max Janowski's Avinu Malkeinu, Our Father our King.)  Not as powerful as hundreds of voices live, but it will do.

On the way home from the airport on Sunday morning, the first run, alone in the car, I flipped on the radio to hear a mass.  Mr. Bach understood the power.  

Oh.  And FD reminds me, every year, that the day proves that we all eat way too much every other day.  We really don't need it.   And he's a doctor.

(6) Accountability

The whole thing about the serious holidays, the Jewish New Year and  that crazy fast day, is that we're supposed to introspect, retrospect, and consider our flaws.  We're supposed to think, Hey, I'm really NOT that good of a person, not nearly the person I should be.  I should change! 

Not a bad concept, truly, unless you already have low self-esteem.  And even then, doing things to raise your self-esteem, consciously making an attempt to do better deeds, be a bigger person, a better person, can't be bad.

A few days after those high holidays, at an early morning circumcision (a new baby, he'll pay dues!), I was yenty-ing (rhymes with gently-ing, Yiddish for chatting) with another friend when she noticed a piece of paper on the floor.  She picked it up and we studied a list of things someone actually considered changing about himself in the coming new year.

We were blown away.  People do this! They even write it down, they don't just give it a passing thought, change. So if you lost it, take heart that you inspired at least two people, which has to be a good thing.

(7) Apropos of Hugging: The a.m. and the p.m. hug

Cooking the gumbo, on the Adelle station Pandora blasts a song by Christina Perri, Arms. Here are some of the words.
You put your arms around me
And I believe that it's easier for you to let me go
You put your arms around me and I'm home . . .

I hope that you see right through my walls
I hope that you catch me, 'cause I'm already falling
I'll never let a love get so close
You put your arms around me and I'm home

You put your arms around me and I'm home
It's another one of those walls song! But that's not why we're talking about it today.  The song made me think of an intervention we use (okay, I use) in couples therapy.

It is a common complaint in therapy that our culture focuses way too much on sex in relationships, and that simple touch, affection, is interpreted as a prelude to sex.  And it shouldn't be that way.

Sex isn't what everyone wants.  Some, maybe most people prefer pure, unadulterated affection.  Not that sex isn't nice.  But it shouldn't be the only thing, and maybe shouldn't even take precedence over physical affection.  Not all of us learn it at home, and many of us are afraid of rejection, afraid of looking wimpy, even. But as an added relationship seasoning it can make everything feel better. Kiss the proverbial emotional boo-boo, we all have at least one by the end of the day, surely.

But the intervention isn't a kiss, it's the twice a day hug, morning-time and evening-time, if at all possible. This is a standing, full-frontal, full body hug with a main squeeze, partner, lover, or mate. If you have no partner, hug yourself, and keep the intervention, or relationship-skill, if you will, in mind for when you do.

(8) Fall in Chicago 



It's here. And I'm back to work, crazy as that feels.



See ya'.


therapydoc

*I don't use Facebook for anything but communicating with family.  If you're a TherapyDoc facebook friend, it's because I never got around to deleting that account.  When I remember the password, I'll get to it.

**We don't wear leather on this holiday, or gold and silver, either.  Why some people lost that part of the observance is a mystery to me.

***I'm not obsessed with Barbara Streisand, but acquired every song, every album, as a kid, and for some reason, I learned every word.  On Sunday, visiting my mother at Independent Living (for lack of a better word, we need a  contest on this) heard someone belting it out, Don't Rain on My Parade.  I went to the common room to hear a cabaret singer who did a really nice job.   The whole place was hopping.

Back A 'Cha

For the uninitiated, this is a reciprocation post thanking bloggers who link to my blog, and exposing them for who and what they are, generally awesome.

If you wrote me and I lost your email, please write me again so that I can include you in this post and others like it.   You won't see them very often anymore, but I still like the reciprocity of the blogging community, still find bloggers kindred souls, and want to do this.  Intention counts for something, doesn't it?

For some reason, the movie people have found me.

Mother's Red Dress -- a film I haven't seen but would like to-- it's featured at The New Social Worker. Karen Zgoda, MSW, LCSW, an ABD doctoral student, pitches the film, a tragic love story about a young man suffering from amnesia, trying to piece together his past.

To see trailer or rent film online: http://norestrictionsent.com/mothers-red-dress/watch-now

Before It's News features me, so that says something, not sure what.

Nurse and Hospital Stories linked to me, called me a favorite, and that has to make at least one of us smile.

A Mother In Israel accidentally g-chatted with me, which freaked us both out, but reminded me how nice it is to hang out with people thousands of miles away.

Barbara Kivowitz, In Sickness and in Health, has an op-ed piece in the Chicago Tribune about Pat Robertson's huge faux pas about Alzheimer's (which made fantastic dinner conversation, btw).  She's got an upcoming book, In Sickness As in Health.  So cool, Barbara!

 How about Jack's blog, One Man's War Against Depression?  We call it the enemy, but really, substances have first place locked in solid.  These are the kind of blogs that make the world a better place, just because people cruising the Internet stop feeling so lonely when they visit.

I have to mention Cheryl at Uppity Crip, naturally, so behavioral, as long as we're looking for great examples.

Kartemquin Films, a Chicago outfit (who knew?), has a soon-to-be released documentary that sounds fabulous, A Sister's Call, about a woman on a journey to help her brother, a man she had disappeared in 1977, suffering from severe paranoid schizophrenia.  This sounds like a film I'd like to see.  This reconstructing the past thing is big in film now, as it should be.

Now.  A relatively new genre of blogger, the infomercial-er.  Six years ago you rarely saw this kind of thing, a blog that capitalized on the search engine concept to find readers.  It's definitely a good idea, but loses some of that personal touch, that which makes blogging so different from any other type of writing.  Nevertheless, for career info, this is the way of the future, and we need this, career information.

And who needs EBAY, seriously, when you can sell your stuff, even professional wares, directly online?  If you're a recruiter, what better way to reach potential students or employees?  And the only cut they have to give is a link to an idiot blogger's blog!

Oh, as long as we're talking idiot.  Has anyone seen MY IDIOT BROTHER?  This is a wonderful movie, don't let anyone tell you anything about it, don't even watch the trailer, the link above.  Just go.  MY IDIOT BROTHER isn't about someone with a learning disability, it's about a really good person who can't help but get into trouble precisely because he's honest.  My favorite kind of person.

But back to info-bloggers.  These give you a taste of what you can do with your professionalism.  You're used to seeing cooking blogs, fashion blogs, media blogs.  In this down-economy, get used to seeing academic and employment sites like these, because they're free and Google loves them. And ya' know, getting a degree is going to be the key in the future.  It didn't hurt me none.

Psychology majors considering career options might take a peak at PsychologyMajor.org


Online Degree gives us more about Alzheimer's, and 10 famous people, and 9 surprising people with honorary degrees.

Masters in Psychology lists the top 40 professional psych job sites, and the Top 50 Social Work Web Forums.


Yet another blog-infomercial of import, Human Services Degrees.

Friday, October 07, 2011

Do the Walls Come Down

This is a situation that therapist's see often enough; you might see yourself here.
Switch the she to a he, the he to a she, do whatever you want with the genders.  We'll get to Carly Simon after awhile. 
File this under empathy training.

A woman comes to therapy because she thought she had a great relationship with a man.  She has invested much time and emotional energy to make it work, and it did work, for over a year.

Now she finds that she's not sure about the two of them as a couple anymore. Something has happened. He did something, or hid something, has disappointed her somehow, and she feels very, very angry, although expressing anger is hard. She's not an angry person, and she's not the type that gets depressed, either.  So she's strangling, basically.

We discuss childhood, rather than what actually happened, aside from the bare facts, because we're interested in how she turned out as she did, someone who can avoid depression, someone who tends not to get angry. 

Sometimes placidity is what we get out of a functional family of origin, sometimes it is learned when the family is anything but functional.  Possessing calm is considered a genetic trait.  And sometimes, truly, one's defenses simply haven't been tested.

Not surprisingly, we hear that she had at least one physically abusive parent and no protector.  The patient's life lesson, her world view, is that it is admirable to be tough, smart to brace for pain, and best to breeze by things you cannot change, quickly. Get your coping skills in a row and use them.

As children, people like her study hard in school.  (One of the better things about being a child, for some of us, is that gift of concentrating even when as plates fly in the next room.)  Study is an escape from the fracas and it has its benefits: recognition and respect for good grades, fame as an achiever.  Self-esteem is salvaged from a dysfunctional childhood all thanks to esteeming educators.

We hear that our patient did excel, earned her degrees, and now earns a good living. She's a problem solver and a fixer in relationships at work, at home, and with friends. But he, her gentleman friend, has erred, and this is a problem she cannot fix. Only he can fix it, he says, and he is working on it.

Neither can escape the fact that his mistake has caused them distance. She won't throw him out, but she isn't warm and fuzzy, either. She wants to make it work, but can't generate any affection, has no desire to touch or hold him, even though he has apologized and is changing before her very eyes.  She can't trust the change, feels she has wasted time, a valuable commodity.

You can't wish away anger, is the truth. It has a mind of its own, has to be worked out over time, discharged not with words, necessarily, although these are good, but in our sleep, over television, at work, with each passing day.  Anger is invisible negative energy expressed, for some silently, over time, until it is gone.

She can't wish anger away because he deceived her and she trusted him, and trust is not her strong suit.  Well before he came around she learned that people disappoint and don't care about the disappointed. Disappointed now, her walls* are up, good, solid walls.

They can be so solid that even the builder can't tear them down, not at will, which is exactly why we say that anger has a mind of its own. Unresolved anger and disappointment are the equivalent of abandonment and loneliness.  She didn't sign up for this, didn't commit to it. And who says he won't do it again?  Fool me once, shame on you.  Fool me twice, shame on me.  Better to be alone. There's happiness in a predictable, sensible, good life.

She is in a place she has never been before.  Irrational, even to her, she still wants to protect her investment, so she self-reflects, wonders what she is doing wrong.  He has been told in therapy that he should talk to her more, should vent, complain, share his feelings. Except that she sees his complaining as self-pitying and childish. She offers solutions to his complaints and he shrugs, walks away, tells her she doesn't understand.

She feels that if anyone has the right to complain about, it would be her, she suffered far more in life. (She may not even voice this in therapy unless you ask, too ashamed of the family dysfunction.) His complaints about his boss, traffic, his sister not returning his calls, whatever, sound lame. She thinks he needs coping skills.  She wants someone autonomous, like herself-- a man.

You tell her, "He's human.  Bi-peds like to kvetch (rhymes with retch, Yiddish for complain).  It is healthy.  Part of being a partner is putting up with a little of that, maybe a lot."

"But he won't listen to my advice." 

"Did he ask for it?"

"No, but why bother talking about something if you don't want to fix it.  All he wants to do is complain and not fix anything."

Why bother talking indeed.  Because it feels good, and quells anxiety, dismisses scary thoughts, at least for a little while.  And it gets a nice response, if we're lucky:
Hey, that must have felt terrible!'  
Therapists say that about fifty times a week. You pay for that emotional validation. 

"But he's handling it all wrong!" she cries.

"And he's not ready to hear that."

"Adults want the truth." 

Not really.  Maybe we'll hear suggestions, stomach the truth, even begin to problem solve, after we are validated.  Maybe, if at all.

Think about it from her perspective.*  If you were hit as a child for not listening to your parents, or even if you did listen, then you might become quick to respond to the suggestions of others.  It is a conditioned response.  Those whose opinions mattered aren't so quick to have to change for others, or to please.  We want to express our thoughts, uninterrupted.  We want to be truly heard.

The psycho-education in a case like this is empathy training, working with the patient to find the missing piece in her interactions with others.  It is usually empathy that is missing, the good kind, the one that feels, senses the pain of others, emotional empathy. The other kind, intellectual empathy, is good, too, but it is not as good.  To intellectually empathize is to recognize the feelings of another, identify them, but not feel them, not personally.

The better empathy is the one that is emotionally involved, truly affected by the experience of the other.  Feeling the pain along with another may feel bad, but you glom on on anyway.  The boundaries between the two of you get gooey, and neither of you cares. This is love as a process, a verb, and it isn't only something between intimate partners. It is just love.

When you tell people about the two kinds of empathy, those who only intellectualize get a blank look on their faces.  But most of us feel something, faced with someone who is clearly emoting.  Probably the more others empathized with us as children, the more we will empathize with others.  But not necessarily.  Some say it is all in the genetics, and there is good reason to believe that to be the case.  Empathy can be learned regardless, but it will be harder for some than others.

What should she do, she asks you.  Her work, at least initially, isn't complicated.  She begins by listening patiently to her partner, noticing when he stops ranting, then says, Hey, that must have felt terrible! 

Nothing more, unless it is to mirror back what she heard.  So he really said that to you, that you probably should consider finding another job?  How awful!

For some of us, this is a foreign language. Growing up hard you learn to keep your mouth shut, or life will get worse.  Bow your head.  Keep quiet.  And whatever you do, get things done, and do a good job, avoid too much attention, you'll avoid harassment. And fix something.  problem solve.  This is the survivor's mantra.

Then along comes a partner, and what he needs in order to grow, to feel better, at least initially, is the option to do the very opposite, to do nothing, to talk out loud.

therapydoc


*Do the Walls Come Down is a Carly Simon song. I'm linking to a video with her singing it produced by Frequency

** Seeing something from the perspective of someone else, by definition is intellectually empathizing.

Sunday, September 25, 2011

Behavioral Zen

I’m having lunch with one of my married sons and his wife, and they tell me that they visited my mother. “You should see her zipping down the halls in that new walker! Wow! It’s scary!” cries Cham.


“Is that thing even safe?” asks my son. He picked up his grandmother’s worry gene.

Well, we hope so.

“She sure seems to love it,” his wife adds.

Yes and no. It is snazzy, and it is red, and she does love it, to a degree. The silver one they sent with her from the hospital last year has two gliders instead of a back set of wheels (the red one is a 4-wheeler) and the gliders slow her down.

The physical therapist calls the silver one the very best, however, because there are so many ways to arrange the wheels, the height.  You can even exchange the gliders for wheels. One visit with a physical therapist or an occupational therapist, and your whole way of looking at things changes. These people are geniuses.

THE STORY

FD and I took Mom to a wedding tonight. Dear friends of ours married off a daughter to a wonderful young man, and seeing people we haven't seen in many, many years, makes me delirious. My mother had a great time, we all did, and I took her up to her apartment in her independent living facility afterward.

On the way up she tells me the many different things she had worried about before the wedding, and how none of her fears materialized.  (Crazy, I know.)  "They seemed so happy to see me!"

Well, yeah. 

As she settled into her nighttime rituals, I noticed she didn’t use either of her walkers. Not the trusty silver one with the gliders, not the new red one with four wheels.

“This is an accident waiting to happen,” I spit out. “They told you that you have to use your walker ALL of the time.”

“I don't want to become dependent,” she tells me. End of the matter.

Dependency is bad.

“It’s not like taking drugs. It’s good to have one or two of these things to depend upon.”

She gives me that look, as in, Well, some of us disagree.

“Would you rather be dependent upon a caregiver? Because all it takes is one good fall and this independence thing is over, a thing of the past.  Maybe for good.”

She looks sad. I don’t want to turn a wonderful, warm, intimate evening with friends into a sad night. Bubble bursting is not our thing. But I can't help myself and continue.

“Think of it this way. Has your doctor told you , 'S.  You should really try not to use that walker. Use it for emergencies, or when you go out, maybe, but it is better to avoid using it all the time because you might become dependent upon it.'
Has any health care professional ever told you this?”

She shakes her head.

Nu?” I ask. (Nu, rhymes with Jew, Yiddish for So, already? or maybe What do you say to that?)

We're on a roll here.

“They all say, as a matter of fact, Keep it close to you. You need it. At your age, you need it. Everyone expects you to have one. No one expects you to still be here, pooh, pooh, pooh, at your age, and not have a set of wheels.”

She looks at me incredulously, for only six months ago she surrendered the car keys.  The rant goes on.

“Think of it as a part of you. Think of yourself and the walker as one. It is an extension of you, the walker. You and the walker, one person.  My walker, myself.”

No expression. Blank.  No idea if she’s copping to this. I turn from her to set up her medicines for the week, she gets on pajamas. When I finish she is standing behind me. She’s holding onto the silver one.

therapydoc

Sunday, September 18, 2011

Out of the Darkness: Suicide Prevention

One more and I'll leave you alone for awhile.  I promise.  (blee neder*)

April Jervis shares this email with me.  I thought I should pass it along:
(italics mine)

This week the Center for Disease Control and Prevention just released 2008 data for leading causes of death for the nation (http://www.cdc.gov/injury/wisqars/leading_causes_death.html).

For 2008 there were 36,035 suicides and a suicide rate of 11.8.
Suicide ranked 10th as a cause of death, while for many years previous it had ranked 11th.

Looking at age groups it is the 3rd leading cause of death for ages 10 to 24, the 2nd leading cause for ages 25-34, and the 4th leading cause for ages 35-54. These are shocking and upsetting numbers.

(In the eighties, the elderly had top billing. We thought, Well, they're in pain, they suffer with so much physical disability. But these numbers indicate mental illness, depression specifically, is on the rise.)

You can help stop this sad trend. If you haven’t already made plans to, please join us next week for the
Out of the Darkness Chicagoland Community Walk. 
As you know, this event raises funds and awareness for the American Foundation for Suicide Prevention (AFSP). There is no registration fee or minimum fundraising requirement to participate. Registration and information can be found at http://afsp.donordrive.com/event/chicagoland

Please tell a friend, family members, neighbors, colleagues, & everyone else you know about this important event.


Thank you in advance for your support and participation.


Sincerely,

April R. Jervis, MBA, Illinois Area Director

You're welcome, April.

therapydoc

Out of the Darkness Chicagoland Community Walk

Saturday, September 24th Check in at 8 am | Walk at 9 am
Busse Woods Forest Preserve, Level 4, Elk Grove Village, IL

Please Register Online Now at

There is No Minimum Fundraising Requirement and No Registration Fee to Participate in this Event!

Walk Program:

+ Walk To Save Lives!
+ Walk to Raise Awareness!
+ Help reduce the stigma of depression, bipolar disorder, other mood disorders, and suicide.
+ Walk to Honor a Loved One!
+ Walk to Support the American Foundation for Suicide Prevention!

Help Us Spread The Word:
Email This Invitation to Your Friends & Family and Post Our Fliers!

Thank You for Your Support & Participation!
blee neder* Hebrew, rhymes with Gee, get her, means, no promises.