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.