Wednesday, January 26, 2011

Snapshots

Let's just catch up with one another, run with good old stream of consciousness. Because everyone likes Freud.

(1) Stream of consciousness reminds me of water, we can start with this. Mine was pretty dirty when I returned from a ten-day work-vacation, lots of brown algae covered the glass. The water hue had changed, but it wasn't  something that just called to me.  Mostly people called me.  Inspired by dialysis on Desperate Housewives,  I finally got to siphoning a couple of very pathetic aquariums after weeks of neglect.  When you get behind on the maintenance, when you don't siphon your water, you have no idea the guilt.  Hard to look your friends in the eye.



I'm so glad they're alive, seriously.

Meanwhile, at the office. . . listening to someone spill some serious issues . .  it occurs to me that there's a dead fish in the tank. (What did you think, there wouldn't be a tank at the office?).  Something on the floor of the aquarium looks dead. And the tail count of swimmers seems to be down by one.

It's hard to focus on my patient's problems, but I do, I get through the session, a little worried, but focused, more alive than ever with guilt.

Caption balloon over my head:
They starved while I was away  
One of them became the other's dinner.
I poisoned them, left the water unattended for too long!
The 45 minute visit ends and I rush to the tank to see--  Is he really dead? No!  Clown II is very much alive, treading water behind a rock. The lifeless matter on the aquarium floor is a piece of orange coral.

Between patients I change a fifth of the water, really fast, scrape some algae off the sides, dry up the evidence. Feed the goof-balls a few vitamin-enhanced flakes.  Take a deep breath.

(2) But down to more important things.


If you're a Chicagoan, the best news in months is not Rahm Emanuel running for mayor, it is the Bears making the play-offs. They compete against old rivals, the Green Bay Packers, and the city is stoned, has caught a fairly nice buzz at the very thought of Sunday's game. There's no way to describe what it means to Chicagoans to have a winning team.  Our serotonin levels skyrocket; people come to therapy and it's all about the Bears and how much better this is, winning.
What about those Bears! Can you believe it!   
Just a giddy bunch of urban bleacher bums. Makes no sense, but who cares?  Anything to make a city happy.

You know they lost, right?

But the loss, too, is thrilling, and most people appreciate the game, even me, a person not particularly into sports unless I can play.  I'm just happy that millions of sports fans can vent and bet and get their bad karma out of their system while watching men or women in pajamas and hats play their guts out. It's a fine use of displacement, one of our fairly primitive but surprisingly accessible defenses, give it over, whatever it is, to someone else, and how anger should be expressed. Shout it out about a play

Sublime.

Except for the domestic violence that follows after the game when people have had too much beer.  Other than that, spectating  is a brilliant coping strategy.

Even better is when watching the game with friends and family is like being a part of a support group.  People who would never go to therapy do this.  The best example I've ever heard comes from someone who tells me that his family is so serious about their team that they won't even watch a game with someone who is not a fan. They just can't stand the thought of the enemy so close.

I can totally admire this. This makes sense. Get together, bond over guacamole and a game that will be yesterday's news tomorrow.  Purge all the hatred and anger, the sadness out of your system-- as a group!   It is enlightened, and don't think they don't know it.  That's why you can't get in.

Even in defeat a group like this is empowered.

The Bear loss, unfortunately, means that the feeling is gone, the serotonin awash, even though Chicagoans know how to take defeat, we're used to it by now, builds character.  And do we have the Bulls, let's talk, and the Blackhawks.

What really blows me away about the Bears game, to belabor the subject just a little more,  is life imitating art. The night before the game FD and I had watched On Any Given Sunday, an Oliver Stone soap about a third string quarter-back, a nobody who saves the season. The top two quarterbacks are field carrion, massacred by other teams, and the third-string do-nothing is all the home team has left. He takes the ball and we see that long, long pass in slow-motion, the pigskin gracefully propelling across the field into the arms of the receiver.  Over and over again. We see this axis shot about five thousand times, but it's worth it because these are happy moments and he's the hero of the day! We need heroes is the truth.

Then at the playoffs, the very next day, Coach Lovey Smith is forced to play his third-string quarterback, Caleb Hanie, for the Bears. His two other quarterbacks are hurt. Hanie throws two quick touchdown passes in succession, almost saves the day.

Anyone who can save the day, however this happens, whenever, deserves our blessing. And all I can think is . . . until now . . . I didn't know there was such a thing . . .  as a third string quarterback.

I could learn to love football, not sure. So many underdogs.

The joke is that I thought I ordered what I thought was On Any Given Sunday, a DVD, because FD told me that I had to know more about football before presenting wellness workshops to football players. He tells me this and all I hear is Buy movie.  Tax deductible. On Any Sunday, or something like that.

Turns out On Any Sunday is about motorcyclists.  But that's what I got.

Which is why we have On Demand, only $2.99. Although I do sort of want to see the Steve McQueen movie at some point, can already hear the movie in my head, VvvvvRrrrrrMmm, can't you? 





A few inspirational quotes before we go, from the sage fictional football coach. We all need one of these in our lives, a sage coach.
On any given Sunday you're gonna win or you're gonna lose. The point is - can you win or lose like a man?

When a man looks back on his life, he should be proud of all of it, not just the time he spends in pads and cleats.

The game has got to be about more than winning. (Are we sure about this?  What am I missing?)

(3)


Before this whole football thing, before taking off for my work-vacation, Chicagoland felt pretty bleak.  Most people don't take advantage of the snow, don't get out on cross-country skis, traipse through the alleys and parks while talking to psych nurses on their bluetooths, marveling at powder.  Everyone seems depressed, cold,  broke, worried about  black ice.  Nothing to look forward to, holidays over, it's not good.  And because people are scrambling to figure out their insurance in early January, and the incredible emotionality of December has died down, I try to take off.

Without telling anybody.  I've learned that the best way not to abandon people is just not to abandon them.  Nobody needs to know much about what we do between visits, and we have this thing, it's called cellular communication.

And if you invested in your family, if you have managed not to alienate any of your kids, not so much, then where ever you go, you have people.  You have to see your people whenever you can, where ever they are.

(4)   So let's get to these.

In Atlanta the major attraction, for it is cold here, too, is the Fernbank Museum of Natural History.  There are some seriously large dinosaurs at the Fernbank.  You can imagine what goes on when the doors close.  Some don't eat meat, I understand.  Should we trust them because of this?  Would you not think, Hey, perhaps that fellow, that herbivore behind the little fence, you can hardly even call it a fence, wouldn't mind feeding somebody to a carnivore, sort of make a trade?  Were they nice dinosaurs, the vegetarians?  And the ones that ate meat, were they mean? And if they were, was it because they ate meat?  Has anyone studied this?

Of course, if you watch StarWars, or if your father watched StarWars maybe two hundred and fifty-nine times and counting, then you probably just look at creatures in a museum and think: George Lucas must have liked these.


We made some cookies using a StarWars cookie mold and they were very tasty, not just good-looking.  There are no calories in the parts that you cut away.  Everyone knows this.


(5)

Stinking Georgia flu.  That's as close as I get to cussing.
You know what they say, "If you have your health, you have it all."

Georgia's great, except that along with New York and Florida, it is host to this winter's flu epidemic. Whereas everywhere else in the country people suffered from:
ILI
What's ILI?

Influenza Like Illness.  See, they don't want us to know that they gave us the wrong flu vaccine.  So they're telling us:
Hey, it's not flu! It's a lot like flu, but you're way off if you think that it is flu, way off.
What I took from Georgia, carried along with me to Los Angeles, was not flu, not really.


(6)

"You did it. You gave me the flu. I hate you. Or I will, when the truth comes out.  Thanks for the memories."

So instead of catching the La Brea Tar Pits in L.A., moving as little as possible seemed like the right thing to do. 

But let's consider this.  What's worse?  Being sick?  Or feeling guilty about maybe infecting others? No matter how much Purell you use, you can't swallow the stuff.

The illness is really insulting, embarrassing.  You take the hot bath your doctor recommends to beat your chill, only to find your pajamas fall off when you get out of the tub and put them on.  You have literally shivered off inches.

Still.  You don't care if you're going to die, but you don't want to take everyone down with you and there are better ways to lose weight.

People who worry should be screened for anxiety before they’re allowed to get the flu.

Yes, in case you want to know.  I am the first person to ever have had the flu, the one with the cough.

When it’s over you feel so tough you want to wear a button or a tee-shirt that says,
I had the flu and survived!
Like the winter of 1978 tee shirts.

(7)   There's more, there's more.  But somebody's got to get back to work.

I apologize for not responding to emails and requests for things. You can link, copy to your heart's content, and if you let me know, I'll link back to you.  But get it in writing that it's okay to stream.  And please continue to shoot me suggestions, even if you might not hear back within your lifetime.  You have no idea. . .

It's been hard to get down to writing.  At some point you wonder if you even remember how.  Then you read stuff like this (check out the Erin Brockovich post, his first one) and although it's a little intimidating, you're inspired.


Fifty-five more days and counting until spring.

therapydoc

Wednesday, January 12, 2011

Loughner: Schizophrenia or Terrorist

a Glock 19—a lightweight, $500 semi-automatic commonly carried by law enforcement officials—to kill six people and injure 13 more, including Rep. Gabrielle Giffords. In 2007, Cho Seung-Hui used the same gun, a along with a Walther P22, to kill 32 people at Virginia Tech before committing suicide. And Giffords herself boasted to the New York Times in 2010: "I have a Glock 9 millimeter, and I'm a pretty good shot."

Readers beat me up for jumping to say that James Lee Loughner probably suffers from Schizophrenia, Paranoid Type, hears voices in his head, follows their directives.

I’m urged to read Slate,
Seena Fazel is an Oxford University psychiatrist who has led the most extensive scientific studies to date of the links between violence and two of the most serious psychiatric diagnoses—schizophrenia and bipolar disorder, either of which can lead to delusions, hallucinations, or some other loss of contact with reality. Rather than looking at individual cases, or even single studies, Fazel's team analyzed all the scientific findings they could find. As a result, they can say with confidence that psychiatric diagnoses tell us next to nothing about someone's propensity or motive for violence.
I'm reminded that most people with schizophrenia do not buy guns and do not shoot people. They try to get help.

As advanced as we are, that should be true.  But many of our homeless suffer from severe mental illnesses like schizophrenia and refuse help.  Suspicion of others, negative attribution, is the nature of the disease.  And the onset isn't usually until adulthood, so the premorbid space, when a person is beginning to get sick, is often overlooked as an adjustment disorder or depression, even individuation.

The problem is that the suffering of schizophrenia is incomprehensible to “most.” We're told to avoid people who talk to themselves, and that's probably not bad advice.  It is a very complicated illness, attacks cognition and emotion, feels primarily like anxiety. Behavior seems irrational to others, strange.  Thinking is different, careful, afraid, comes from a dark place.  This is a vulnerable population.

So the complaint is leveled.  How dare a therapist link violence and mental illness?  Such a gross injustice to millions who suffer mental disease.  Never my intention to claim statistical significance in any way.   These are idiosyncratic cases, off the charts, outside the norm.

And the real menace is that Glock 19.

This is not to say  that the individuals who perpetrated mass murders within the past three years in this country were not mentally ill. Two mass murders at large schools, Virginia Tech and Northern Illinois University, young assailants suffering from schizophrenia.  Access to guns.  Jared Lee Loughner seems familiar. Social profile detached, expelled from community college pending mental status exam, a lesson, no doubt, from past school attacks. The sheriff says, 20/20 hindsight, We knew about Jared.

But still, jump to a diagnosis of mental illness when so many other things predict violent crime, and mental illness is usually not one of them?

Diagnosis is what therapists do, sorry. We make initial, provisional diagnoses. We consider context, but at the end of the day, we see the individual and it's our job to assess what hurts. Schizophrenia is an Axis I disorder, which implies the illness isn’t a function of personality development, or behavior. The disease itself hurts.

Social context affects that pain, can even predict the course of an Axis I disorder.   But in the case of schizophrenia, environment doesn't make it so. It is in the genes. Of the contextual variables associated with schizophrenia, the one thing we know is that it gets worse, symptoms “flare up,” when there is anger in the room.We urge families to tone it down.

We also know that the onset of the illness for young men tends to be young-adulthood, when developmental stressors collide with coping skills. Crunch time: What do I do with the rest of my life? I can’t live here forever!  And my skills, my learning even, seems limited. 

More hearsay about the Loughner case:

(a) neither of the two parents socialize with neighbors,
(b) his mother buys two cases of beer, 30 in each case, with the family groceries,
(c) she is the only one in the family holding down a steady job,
(d) neighborhood kids think of father as an angry man who irrationally yells at them
(e) only son Jared is considered odd, has access to the Internet, obsesses about political conspiracies, seems dangerous and disconnected to others, seems to be in his own world, laughs when no one else is laughing. 

We might think Jared is from an alcoholic family, was neglected/abused, perhaps an unfair assumption. We might wonder how anger affected him. And sure, we might diagnose him on the many spectrums of mental and behavioral illness, including autism/asperger’s, and attach various personality disorders, Axis II’s, the personality disorders, considering his odd behavior.   Or bullied, alienated, like millions of others, he found comfort on the Internet and inspiration for assassinations. Unhappy childhood, solace in socio-politics, a decision to end a quiet life of desperation with a bang. Save the world.

Not necessarily schizophrenia. But do we ignore a diagnosis of schizophrenia because it isn’t politically correct? Isn’t it possible that in some cases it can happen that people do hear voices or receive Internet messages that tell them to kill a dozen or so people in a supermarket parking lot?

Group statistics are there to find central tendencies, describe groups of people, averages over thousands. The men who pull triggers on innocent people are hardly average. They are so few and far between that they do not dent central tendencies. We’re grateful for that. Group statistics de-stigmatize. Most people who suffer from mental disorders are not violent. Would that we could say that about the non-clinical population.

These particular cases of mass murder are unique. We wouldn't be very interested in them if they were not. This is why I’m so interested when it happens. It does seem, in these cases of mass murder, that the offenders suffered from Schizophrenia, Paranoid Type.

We're not doing enough to detect and protect the mentally ill.

More salient to the issue is that everyone has access to guns, not only people who have no rational control, whose minds aren’t functioning in our reality, who should be on some medication, in groups, therapy, rehabilitation. Killing is glamorized on television fifty times a day, and in the movies, as are theoretical concepts, ideas about assassination, terrorism, taking justice into one’s own hands.

I used to think

terrorist = suicidal bomber packing nails and bolts on a bus

But why wouldn't terrorists use automatic weapons? We don't label terrorists with mental illness, we call them social activists with an agenda. What is gleaned from Loughner’s indecipherable rambling on the Internet is that he is anti-government, a terrorist, essentially. He has an agenda.  Something out there made sense to him.

Or others found him, perhaps a group sponsored his gun, ala  Lee Harvey Oswald. That's surely what they're saying.

But I'm putting my money, sad to say, on his illness.

therapydoc

Monday, January 10, 2011

Jared Lee Loughner

He didn't look like a particularly healthy guy, but they sold him an automatic in Tuscon. No mental status exam, apparently. Indigent, he bought a $500 gun. You have to wonder. How does that happen? 

Gabrielle Gifford is hurt and six others murdered, 19 injured.  Glock 9, an automatic weapon, in the hands of a "mentally unstable" person.  Holds a clip of 15.  The whole neighborhood knew he was "very troubled."

We're watching the morning news and my daughter asks me, Should the kids really be watching this? Vampires are okay, werewolves, fine. But reality is scary.

He left us notes:  I planned ahead.  My assassination.  Gifford.

Lest we give the credit to someone else. 

Assuming he suffers from Schizophrenia, Paranoid Type, the credit goes to the voices in his head that told him to do it. 

But voices don't buy anyone guns. Someone has to sell these. And the whole town knew he was a time bomb. They were afraid of him, he was so odd, so disturbed. Couldn't someone have reeled him in?

Supermarket parking lot, people there to meet their Congresswoman.  Nine year old, Christina Taylor-Green. Dorwan Stoddard.  Federal Judge, John M Roll, just leaving church.   Phyllis Schneck.  Gabe Zimmerman  Christina Taylor Green, Dorothy Morris.

And the Congresswoman, a gun owning Democrat who married an astronaut, loves motorcycles is clinging to life, a bullet through her head.   The Tuscon tragedy is associated with her politics, left of the tea party.  But the shooter was a liberal. 



Judy Clarke,  attorney of the indigent, including the Unabomber, Theodore Kaczynski,  and 1996 Olympic park bomber Eric Rudolph, and Susan Smith, the South Carolina mother convicted of drowning her two sons by allowing her car to roll into a lake with the two toddlers strapped in their car seats will be representing Loughner, who will likely be diagnosed as mentally ill. 

So far the assailant hasn't said anything.  That will be something, his statement, although it is unlikely he will make one. Maybe he doesn't suffer from Schizophrenia. The violence in this country isn't limited to people who have Schizophrenia, although these mass, public murders do seem to have that running theme.

If he has other reasons, we're all ears. Antisocial Personality Disorder, perhaps, associated with most criminals who feel no guilt. Or werewolf, maybe.

therapydoc