Tuesday, December 25, 2012

What Jews Do on Christmas

I'm in the kitchen, stirring a hearty vegetable soup so it won't catch, singing Have Yourself a Very Merry Christmas, trying to sound like Judy Garland. It is embarrassing to say how much I love this music.



Judy Garland's Have Yourself a Very Merry Christmas


I didn't always, but the seasonal songs sound so much better now than in years past. Pa rum pum pum pum, orchestrated, mastered.

At this point in the essay the rabbi is throwing me into cherem (gutteral ch). Cherem is for Jews who do and say inappropriate things, things that are patently not Jewish, not a real place, like, say, Oklahoma.

But how can I lie? And he knows I'm just kidding.

Have Yourself a Very Merry Xmas  is from the 1944 musical  Meet Me in St Louis about a family that almost moves away from St. Louis because Daddy has a great job opportunity somewhere else. That’s the whole plot.  Judy Garland, of course, is unforgettable, the song, a heart-stopper. All this escapism while rockets fire, people die in Europe, WWII. Not so very merry.

It wasn't just that movie that took us all in. It’s a Wonderful Life, White Christmas, A Christmas Carol, -- Elf—   people gathered around their televisions during the holiday season, those innocent years before cable. There never were too many Chanucha or Kwanza flicks. We could use some, (add in any holiday you wish).

Jewish people, not being Christian, don’t celebrate Christmas as such. It is a national holiday, however, a work holiday, and we have no religious obligation to make a huge meal or to bake a fruit cake. With nothing to do, the city at our fingertips, some of us follow a tradition to play cards and order in Chinese food, rather than venture out or stick with the standbys, watching old movies in black and white. 

The history behind cards and Chinese isn’t clear, but it seems a fairly old tradition, although the card playing, poker in particular, isn't that old. Chess is more traditional. Having fun would seem to be the objective, but it could also be that Jews had to be on guard, only a century ago, had to stay awake on Christmas eve. Who knew what the Cossacks might feel like doing with a belly full of rum or vodka.

Pogrom*, pogrom, pagrom, pa rum pa pum pum.

Thus on Xmas eve, some observant Jews consider it wrong to engross themselves in learning the holy books, usually an activity they try to do day and/or night. Some do, in fact, play cards.

The Chinese food? Nobody knows how this tradition started or how far it dates back, but my guess is only about sixty or seventy years. (Someone correct me if I'm wrong). The kosher Chinese take-out place in my local Jewel has Xmas specials. If we didn't have such great Shabbas left-overs from Friday night, that feast we enjoy 52 Friday nights a year) it might have been a consideration.

This year seemed the right time for a new tradition. From the start the idea threatened to fizzle, badly.

I thought, How nice! It is Christmas and all of my Christian friends are going to church or home eating Christmas dinner, opening presents. We have the town to ourselves, really. And Les Mis is opening! (See Five Things You Needs to Know about the French Revolution a dynamite review).

So I called a few of my friends and suggested that they grab their spouses, and convinced my brother-in-law, who is visiting, too, that we all go to the opening of Les Mis. We'll sing the songs for weeks to comel.  I Dreamed a Dream, Master of the House, Do You Hear the People Sing -- these are songs that compete for mind space, heal any inner conflict, deserve a whistle. Shower choices, most definitely, even good for the locker room.
Hugh Jackman, Jean Valjean and Isabelle Allen, a young Cosette

Only a few deigned to join in, but before they committed not to commit, my anxiety set in. Critics panned the movie, at least had plenty of negative things to say.  It's too long at two and a half hours, they kvetched. They pouted that the voices are the voices of actors, not people who can sing, not opera stars. The bloggers wrote: Who said Hugh Jackman, Anne Hathaway, or Russell Crowe could sing? They can't! 

Oy vey. I'm toast.

Having nagged people to come out, stealing their valuable time, time they could have spent playing poker, eating Chinese food or tooling around downtown or the better-heeled suburbs looking at lights and decorations, I thought: What if Les Mis is terrible! What if it is so terribly long, so boring!

I obsessed over this, then text messaged everyone: If you don't want to go, or you don't know the music, or you have any doubts, I won't be mad. It's okay. It's really long. I don't want you to feel you have to do this for me.

People got defensive, no question: (a) everyone seems to know the music. (b) nobody cares how long it is supposed to be, they will go or not go for other reasons, mainly that so and so is or isn't going.** 

FD tries to calm me down, rational as always. It is an opera, honey. Operas are long.

Oh, we love the opera, the two of us, and this made so much sense, made the length of the film an asset, not a liability. So off we go, guilt free.

The show is mobbed. The lines are long. We buy tickets online but are still sit in the fourth row from the screen, this because we're late. For any other movie, being in the fourth row might have been a deal breaker. I might have walked out, fearful of vertigo, neck strain. 

But Les Mis is fabulous, and even seeing every pore of every actor, disturbing as that can be, didn't feel that disturbing, and the dirt, the grime of France in the early 19th century, the misery! But they are supposed to be miserable, are they not? It is in the title of the Victor Hugo novel.  So they are miserable and often we feel miserable, seeing how miserable they are, but face it, none of us live in this kind of squalor so we walk out of the movie counting our blessings, clean, happy, and singing songs.

Which totally beats poker and Chinese take-out.

Have yourselves a very merry Christmas, dear friends. My hunch, your left-overs will be pretty good.

therapydoc

*a pogrom is the pillage, massive slaughtering and rape of a particular ethnic group, usually huddled in fear of clubs and bats, either  in small villages, or urban settings in Europe in the 1940's.

** my friends aren't really like this, it is a joke at their expense (sorry)


Sunday, December 16, 2012

Adam Lanza and Asperger's Disorder

Adam Lanza (Elite Daily)
I knew this would happen, that someone would slap Asperger's on Adam Lanza, a child so shy, so withdrawn, that he clung to the walls of the school. His mother took him out of school, home-schooled him.

She also told a babysitter, when he was a young teen, "Don't take your eyes off of him for a minute."

Mrs. Lanza kept a pristine, perfectly ordered home. People will say Adam was angry at her for that, or because he was enmeshed. At age twenty, two years after his last contact with his father Peter, he snapped, bought a gun, and became a mass murderer. Some will say it was about that. Others will say he was a bully, that he picked on people younger than himself. He attacked children.

And then there is always the sociopathic diagnosis, but Adam doesn't fit that as it appears in the DSM IV. He wasn't charming and he didn't con people.

We might have thought he had a severe version of Intermittent Explosive Disorder, except that these murders were premeditated, not a result of a simple tantrum.  It was a complicated tantrum.

Most people are saying that schools need better protection. I envision bullet-proof doors and intercoms. Even then, even after gaining admission to the building, visitors will first pass through a metal detector, with no one else in that lobby (this is my imagination on autopilot) and if they don't pass, won't be admitted through the second set of doors.

We can't afford to lose school guards, principals, psychologists to people who have lost all control, who are listening to voices in their heads that tell them, "Do it! Kill everyone!"

Life is precious. We are all in tears over this.

The Wall Street Journal posted excellent advice, what to tell your children, how to discuss these murders. They need to talk, and all week, this week, hopefully they will have that chance.

When the discussion comes to diagnosis, every child with Asperger's will be hiding under their desks!
It shouldn't be this way. It is not a violent disorder. Paranoid Schizophrenia-- that's a violent disorder, and Schizoid Personality Disorder, typified by aloofness characteristic of Adam Lanza, is sometimes premorbid to that.

The history we're hearing does not indicate any prior sociopathy. We're hearing he was shy, wore black.

I wrote about this when Cho Sueng Hu massacred 32 students at the Virginia Tech five years ago. Most professionals agreed that he suffered from Schizophrenia, Paranoid Type, and perhaps had Schizoid Personality Disorder, too.

For the record, since the DSM V (the American Psychiatric Association's diagnostic and statistical manual) isn't out yet, we're stuck with the DSM-IV. Here are the features of the disorders I think are relevant to Adam Lanza. Of course, I could be wrong. You be the judge.

Asperger's Disorder, 299.80

(I) Qualitative impairment in social interaction, as manifested by at least two of the following:
    (A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
    (B) failure to develop peer relationships appropriate to developmental level
    (C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
    (D) lack of social or emotional reciprocity
(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
    (A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
    (B) apparently inflexible adherence to specific, nonfunctional routines or rituals
    (C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
    (D) persistent preoccupation with parts of objects

(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.

(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)

(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.

(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.



Schizophrenia, Paranoid Type 295.30

The DSM IV-TR doesn't paginate, the following four all merge into one in the bible. Actual symptoms, that check list, won't help you at all.

The essential feature is the presence of prominent delusions or auditory hallucinations in the context of a relative preservation of cognitive functioning and affect. Symptoms characteristic of the Disorganized and Catatonic Types are not prominent. 

Delusions are typically persecutory or grandiose, or both, but delusions with other themes (e.g., jealousy, religiosity, or somatization) may also occur. The delusions may be multiple, but are usually orgnaized around a coherent theme. 

Hallucinations are also typically related to the content of the delusional theme.

Associated features include anxiety, anger, aloofness and argumentativeness.

The individual may have a superior and patronizing manner and either a stilted, formal quality or extreme intensity in interpersonal interactions.

The persecutory themes may predispose the individual to suicidal behavior, and the combination of persecutory and grandiose delusions with anger may predispose the individual to violence.

Schizoid Personality Disorder 301.20


A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following:

(1) neither desires, nor enjoys close relationships, including family
(2) almost always chooses solitary activities
(3) has little, if any, interest in having sexual experiences with another person
(4) takes pleasure in few, if any, activities
(5) lacks close friends or confidants other than first-degree relatives
(6) appears indifferent to the praise or criticism of others.
(7) shows emotional coldness, detachment, or flattened affectivity

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder, or another medical condition.

Schizoid Personality Disorder is found premorbid to schizophrenia.


What did people say about him? Everyone has something to say. 

therapydoc

Tuesday, December 11, 2012

Snapshots December 2012

You know that therapists have to be out of their minds to go on vacation this time of year.  It borders on unethical.

And yet.

Off we go. Some of us.

And since you can't always rely upon your therapist, and many people don't even have a therapist, and considering that holiday anxiety starts before Thanksgiving (for some at Halloween), and that we spend the week after Thanksgiving processing Thanksgiving, consider reading Elizabeth Bernstein on Dysfunctional Family Bingo.  Amy Johnson, a doc in Detroit made up the game.

You play it with the people you would never have friended on Facebook if they hadn't been first or second degrees.

(1) Sandwiched

My grandson, age ten, has the window in Row 16 to my right.  He's taking his first trip to the South to visit his cousins. A well-mannered young man in his thirties has the aisle.

The one who just hit double digits is playing Shark Attack on his Ipod. He's tilting the device in four different directions, probably at least five times a second. A tilt. The shark will not eat tonight.
Shark Attack With Fewer Calories

Bike Race
The young man on my left is playing a similar game on his Ipad, except that he is tilting even more vigorously.

He's deftly steering a bicyclist down a mountain, then across a desert, trying to avoid that predictable ending, the crash.

The whole experience, being in the middle of this energy makes me feel old.

(2) On Feeling Old

My mother says that if you're past fifty and you don't hurt somewhere, you're probably dead.

It's a decade birthday for me and it has been wonderful-- best presents in years, the best cards.  But it still feels sad.  You look back and you wonder. . . look back. . . wonder.  Mostly look back.

My brother texts me:

Happy Birthday!  All birthdays are good birthdays.

Love,

Your Much Younger Brother

(3) Addicted
Spider Solitaire on the Computer, too

I can't talk about the kids and their gaming, not when my Spider addiction in full-throttle. I hate that I choose Solitaire before bed lately over reading real books.

I hate this volunteering to dumb down.

But it always works, numbs me.

But having it on my phone, I can see, something has to give.  I'm using during the day! And denial has set in, is telling me that writing about it, the jones will go away.

Most likely, nah.  So what is next?! Do I need to join a support group?  Perhaps create one? Now there's something to add to my Psychology Today therapist profile.

I could open the meeting, start with:
Hi. I'm therapydoc and I have a problem with electronics, mainly my phone. (pause)
I have texted while driving.
Anyone running such a group should emphasize these four dynamics:
(a) Empathy for those who are not addicted to electronics. These people are often insulted when we take calls in the middle of a conversation. They are deservedly hyper-sensitive, assume we think them less interesting, less intelligent, less important than an incoming text, an email, or whatever it is that is beeping or blinking in our pocket.
(b) The draw is precisely this, attention. Needing and seeking attention, applause. The ego is starving, craves the love, the beep, the ring. We're social animals, fairly helpless when it comes to wanting to be noticed. 
(c) It is important to let go of enablers, friends who are like us, who don't bat an eye at what some would consider egregiously poor social etiquette. Enablers are forgiving, more than happy to see another addict imbibe. You feel better about yourself, a person who also can't resist staring at an electronic device over looking into someone's eyes.  You are in good company.
It's like, I'm drinking in the middle of the day, you should too!
(d) Finally, if you must answer the phone, try, "I'll call you back later, I'm pretty tied up right now, can't talk."
Tied up?  Living, is what we used to call it.

 (4) The Naked Eye
Sea Anenomes

We're at the Georgia Aquarium, an amazing museum, and if you know me you know that nothing makes me happier than a salt water fish tank with a couple of healthy fish swimming around. It totally takes me in and there's nothing electronic about it, unless we're talking electric eels or filtration systems.

But I have an electronic device with me, my phone, so I'm snapping pictures constantly, want to bring home my memories.

In other words, I'm at the aquarium thinking about a screen-saver.

Jelly Fish, therapydoc

Salt water fish Screen-Saver

Sea Dragons, therapydoc

(5) Putting Kids to Sleep

There are so many wonderful things about life, and grandchildren are at the top of the list. When you visit them you relish them, life itself. Blessings, you think. You get into a seriously grateful mode.

My oldest granddaughter seems to really like me, and when it is bedtime, I get the honors.  She insists that I tell her a story, sing her a song (my pick!) and say the bedtime prayers.  There is perhaps nothing more delicious than this.

So we're in her bed and she's under the covers and I'm on top of the covers, but we are eye to eye. Hers are so large it is nothing short of intimidating.  We have a discussion about teeth and brushing. The song, the story, the ritual is over, and she's supposed to go to sleep now.

She grabs me around the neck, hugs me tight. "Don't go. Don't go now and don't go back to Chicago tomorrow.  Stay one more day.  Miss your flight."

This is an old routine. She's been doing it for years. She's not yet seven, so not too many years. But she's good.

My job is to tell her I'll stay a little longer, and she's content with that.  She's very tired. She did walk that entire museum and her little legs worked double time.

As her eyes close, mine are looking for my phone.  I see it on her desk and get up to grab it. She sees me, pounces.  "You said you would stay!"

I did, indeed.

So I stay. And it occurs to me that in this special moment, a once in four months moment at best, a big part of me just wants to check my phone.

This is not living in the moment. It is not living rich at all.

When we're about to leave for the airport, the carry-on bags are packed, much lighter now.  She is hugging her cousin. "Don't go! Stay another day!" A true drama queen.  He smiles a little smile, doesn't quite know what to say. He's only 10, looks to me for advice.

"He'll Skype with you!" I cry.  "We'll all try to be better at that, call and video-chat once a week."

In a couple of years they'll be saying, "See you on Facebook!"

We can only hope nobody needs a 12 Step program.

therapydoc

An Oh By the Way Post Script:  When Facebook took off, Ther Apy Doc had a page. But it got scary (you know I'm not very tough, have those home-invader thoughts, hate conflict, bullying, etc. ). My thinking, being terrified-- this will somehow come to no good. So down it goes.

But a few years (a few years!) later, it appears I have toughened up and the page is back up! TherapyDoc is still anonymous, too, despite the Facebook bias that if you can't identify yourself, if you're not man enough to tell the world who you are, then you probably don't belong in most clubs.

An admitted voyeur, one who loves looking into people's lives, this feels authentic. Therapists have that interest in the way people live, the way they think. And their faces, their clothes, too.

In Chicago when it starts to get cold, you look for friends.  Most of them are hibernating.  It takes very little coaxing to get them to go out for dinner with you. When they do, you feel you out-ate them since everyone is on a diet. Still, it is a great way to hear about the best sales.

So another way to find friends and not have to face the cold, would be Facebook. Nothing better than a good regression. Do you remember being very young and asking someone, "Will you be my friend?"  It took guts!

This could be a lot of fun.
Or it could be I'll have to take it down again.

Seems a good way to get book and movie recommendations.

Or show off pictures from an aquarium.

New name:  TherapyDoc Doc  (Doc is a last name, apparently).  Here's a movie of a few jelly fish.  My grandson took it with my Iphone..

video

Tuesday, December 04, 2012

Conversion Therapy and California Law

California, always a progressive state, outlawed conversion therapies for people under the age of 18. But the court put a hold it, is reconsidering the issue.

A conversion or reparative therapy is a hotly disputed treatment designed to change sexual orientation.  The therapies consist of a hit or miss tool box  of interventions, as in:

(1) psycho-dynamic therapy-- The assumption is that something went missing, or wrong during early childhood;

(2) cognitive-behavioral therapies, or strategies, including but not limited to: 
(a) desensitization to the ego-dystonic (dreadful) thought of heterosexual sex 
(b) flooding thoughts about sin, where it leads, ultimately
(c) dating heterosexually
(d) exhaustive bible study
(e) in vivo exposure to normal, or heterosexual culture, literature, photographs, movies, even pornography
(f) hypnosis
(g) self-hypnosis, and
(h) aversive therapies that punish homosexual thoughts or behavior.
 But there's more, apparently.  CNN:
The therapy techniques described in that lawsuit included having participants strip naked in group sessions, cuddling and intimate holding of others of the same sex, violently beating an effigy of their mothers with a tennis racket, visiting bath houses "in order to be nude with father figures," and being "subjected to ridicule as 'faggots' and 'homos' in mock locker room scenarios."
 There are so many things to try, it could take years of work in treatment and never make a dent in anybody's sexual orientation.

Conversion therapies are not about conversion disorders, keep in mind.  A conversion disorder is the way a person manifests a symptom.  I might be agoraphobic, for example, but instead of being conscious of it and treating it by making myself gradually leave the house, maybe take a daily walk to the curb, I'll get a very sharp pain in my ankle each time I think about getting out about the town, one so sharp that I can't possibly go.  The doctors will find nothing wrong with my ankle.

But we're not talking about conversion disorders here, unless the State of California wants to call therapists who try to convert gays disordered.  What the state legislature wants to say is that these therapists, the ones who practice conversion therapies, are out of line, unethical even.

Conversion, or reparative therapies have metastasized over the past fifteen years.  The goal?  Change a person's sexual orientation.  They popped out of nowhere because parents feared religious proscriptions against same-sex romantic/sexual behavior, and their kids were coming out to them, risking getting tossed out of the house for an honest relationship with their parents. 

It didn't seem, not at the time, the late nineties, that greed had anything to do with it. Many a minister, pastor, or priest suggested sexual orientation change therapies to worried parents of sexual minority kids.

Not only Christians bought into it. Jews did, too.  They looked for answers, ways to turn their kids back to heterosexuality, to get them to leave the lifestyle.  Project JONAH is under attack right now as disappointed hetero-hopeful sue the organization.

For Christians, Exodus International was the mainstay, the anchor for unhappy religious parents who hoped their kids might someday change. Their support group, Parents and Friends of Ex-Gays, (PFOX) is now rethinking their philosophy.  Empowered adults who suffered through reparative therapies as children are filing suit in droves for damages. Parents paid any amount of money to therapists who promised they could could change the sexual orientation of their children, make then heterosexual.  Ka-ching.  Now everyone is thinking twice. 

The American Psychological Association and the National Association of Social Workers abjured conversion and reparative therapies from the start, discouraged parents from subjecting their children to these cruel, misguided approaches to the "problem" of sexual orientation. Embrace your children, therapists advised.

Those filing suits against conversion therapists are saying the treatment hurt them much more than it helped. Conversion and reparative therapies are associated with the child's growing self-hate, self-doubt, a lack of self-acceptance, hopelessness, worthlessness, drug and alcohol addiction, suicidality, depression, anxiety, chronic doubt-- almost every negative symptom imaginable.

The lesson, clearly, is humility. Professional humility. Some things we can't change.  That's all there is to it.  Mental health professionals are so talented, have so many tricks of the trade, so much insight into what does work, that this is a hard concept for many of us to grasp.

What turns people on seems to be in that mix.  Changing one's appetite is nearly impossible. I want ice cream, not tuna fish, sorry. And desire, the desire to love and to be loved by someone, no matter the biological sex, is either there or it isn't.

PFLAG has better advice.  Find a parade.  Consider pride.  It won't happen over night, but it can happen, that feeling, pride, if you work on it (therapy can help that, actually).   

That's change that is possible.

TherapyDoc


Friday, November 23, 2012

The Happy Family

The new version of Anna Karenina is out.
That means that Tolstoy's best line will be on everyone's lips:

Happy families are all alike; every unhappy family is 
unhappy in its own way.



Not that each individual is happy in a happy family. But we focus so much in therapy about how to get through the holidays, we almost forget that there are happy families.

There are happy people.  Not that they couldn't use a little therapy (smiley emoticon here).  Everyone could.

In therapy we refer to these people, these families, when we talk about what not to do, or why what one person wants to do is the opposite of what people in happy families do.

There are many combinations of unhappy childhood.

For example (Obviously composite players, not particular people ever seen in therapy, at least not by this therapydoc): 

Two people meet at a bar, fall in love and marry.  Jim neglected, Sally sexually abused, both can only guess at what a happy childhood might look like.  They can get it on television, but in reality, it must be fiction.  Sucked into one for whatever reason, they become very confused.

These two have therapeutic issues need both individual and couple therapy.  They work hard, but will never be buying a house in the suburbs. Their marriage has been turbulent, a difficult climb out of almost all of the isms, sexaholic-ism, foodaholism, and the usual, drug and alcoholism.

But they trek out to the suburbs for the holidays, let Jim's more functional siblings do the planning.  Both of Jim's brothers, despite the same upbringing, overcame their biggest ghost, the absence of nurturing parents, and put themselves through school.  They rose above the poverty, drink moderately. Not that they can't be obnoxious under the influence.

Jim, the black sheep, isn't close with them, but still likes to get together once a year.  He likes having a drink, eating in a good restaurant, even if he feels a little out of it.  His sibs and their wives have made all of the decisions about where to go, who is invited.  As their more functional families grow, more and more people are coming to holiday parties.

Although Jim doesn't mind it, this is a little overwhelming for Sally who is shy, who really doesn't even understand why so many people have to be there.  (You see, says the therapist, in happy families, everyone is included.)

Sally hates it.  She hates that there's alcohol, and she hates that it is at an expensive restaurant, and she hates that there are so many children.  She sees Jim's family as condescending, and controlling.  The big fight in therapy is about going at all.

Jim is willing to wave the white flag, to tell his family that he and Sal are taking a pass this year, but Sally keeps the argument, a marital therapy discussion, going.  No, she wants to go, but she wants to be a part of the planning committee and Jim's brothers and their wives won't let her into that circle.

Have you tried? is the question the therapist always asks.  Have you talked about this with them?  

Well, no.

In happy families they do that, the therapist will say, they discuss things like this.  And if the answer really is that you won't be joining them this year, then it will be okay.  The holidays have to be personal, meaningful.  Why bother joining in if it only stirs up resentment?  Find another solution.  Maybe meet with each family separately, visit during the afternoon.  Get to know new-comers, even sibs in smaller, more intimate settings.

On the other hand, the communication idea is still relevant.  Until a person has at least tried to express needs, desires, issues, problems, these will continue.  The relationship, the resentment will continue. It is called maintaining a bad system, not good for anybody.

This could be the recipe for a happy family, expressing needs, desires, issues, problems.  Not that it's an easy recipe, and recipes by their very nature are as good as the ingredients.  So those missing communications ought not be sarcastic, snarky, accusatory or blaming.

Have fun.  It's a little late for Thanksgiving, but we're nowhere finished with The Season to be Jolly.

therapydoc 

Sunday, November 18, 2012

What to Do About Differentiation

A young Julie Andrews, 1959 nostalgia. The Sound of MusicHow do you solve a problem like Maria? How do you catch a cloud and pin it down.  She's always late, except for meals. She's a nun and she's happy, maybe that's the problem. But Maria charms the sisters, they get her, and everyone sings about it, which is why some of us would prefer life to be more on the order of a musical.
Maria in Sound of Music

Differentiation-individuation, is considered to be a developmental milestone, key to mental health.

At first, we're symbiotic, at one with our nurturers, especially that one who gazes down at us at the breast.  Then we slowly grow psychologically apart.

Young children are enamored, in love with their parents (if we are nice), and they like how things are done in their families of origin (again, assuming we're nice). The family way-- habits, beliefs, traditions-- serve as a compass, a map to a child who is essentially looking for order in a chaotic world.  The world, to children, is sheer chaos.

Exposed over time to different ideas, to different people, it is expected that children will change, individuate, become the people they should be, the thing closest to who they have to be, to the person that nobody else really knows.  The child will become Me, myself. He, himself.  She, herself.

Not that others aren't on our minds.  But nobody else knows or understands our personal conflicts, or needs, as well, certainly not beyond adolescence, that stage of life that sets us up for identity. Parents think they know their children, but think, usually, is as far as it goes.  We might be right, too, but we can't dictate, can't enforce our reality, how we feel someone else should live, on anyone else, not even our children.  Not when they are of age to make decisions themselves.

We might be hurt about differentness, we might feel rejected.  It is the risk we take when we take on the job of parent, even the job of friend.  As parents, no matter how empathic we may be, our children still have their own feelings, thoughts, and self-awareness, to the degree that one can be self-aware.  That self-awareness is comprised of many aspects of self, all that enters into personhood.

Personhood, much different than childhood, even adulthood, which are stages of life.  The stages never end, whereas personhood sort of coalesces, congeals, even as it changes along the way.

Those of us with all kinds of dogma in our heads, with many shoulds, go bonkers at this, that our kids might not walk the walk, whatever that might be.  It is where lines are drawn in the sand, where the shoulds become the battleground.  You should be this, you should be that.  Messages aren't only from family.  Shoulds come from everywhere.

I'm at the pool, election day.  At the end of a lap I stretch at the wall, stop to catch my breath.  A woman in the next lane sees me and waves.  I know who she is, but we've never talked.  She's all excited.  "We're voting today! Obama, right?!"

I must look puzzled.

"It was you.  We talked yesterday.  About voting Obama, right?"  That expectant look.

We never spoke outside of today.  Actually, this is our first conversation.

"People mistake me for a lot of people. Sorry.  Not me."  And it's off the wall, literally, for another lap.

Disappointed looks abound with wrong answers, when we're not who we are supposed to be.  Not that I ever tell anyone who I'm voting for; nobody's business, right?

But psychologically speaking, the reason that you can't talk politics or religion and still keep the conversation at the party civil (ah hem, these are coming, holiday parties, just smile) is that if you disagree with people, they get upset, feel threatened.  If I'm not just like you in my thinking, then one of two things might happen:

(a) I might push you to rethink your own beliefs, always a pain for both of us,
(b) We can't merge, enjoy our sameness.  One of the things that makes us close is having things in common.  So it follows that if we have things different, we won't be close.  Not that it should be that way, just saying, just is.

So what do we do about differentiation?

Certainly if it is simply a matter of socializing at that party, we smile and celebrate it.

When it is a teenager who is drinking to oblivion,  his parents might want to take him to rehab.  But a family therapy is probably what is needed, especially if they are tea-teetotalers.  They need to understand why the need for over-kill, the need to drink to excess.  The family needs to explore this.  There is often a secret tucked in here somewhere.

Often the problem is that when it is stressful to differentiate even just a little, then differentiation goes viral, gets extreme. If a kid can't drink at all, and he really wants to drink, then it is likely that when he does, he will overdo it.  And if a kid comes from a family that doesn't drink, it is likely that the family has chosen that path, tea-totaling, in order to differentiate from a family that drank too much, their own alcoholic families.

Something like ninety percent of children of alcoholics will either become alcoholics (won't differentiate from alcoholic parents) or won't drink at all (will differentiate to an extreme).

Wise-man once say:  Moderation in all things.

So what do we do when the course is unclear, doesn't look healthy?  What do we do when the course of a child clearly isn't copacetic to the family ways, is clearly different, perhaps even verboten?

Well, fighting it won't usually work.  The human being trying to become himself, once set free, is likely to stay the course, continue to become himself, no thanks or commentary necessary, thank you very much.

Accepting this from a child, even a friend, might not be possible.  We can't always fake how we feel about people, and we are our behavior.  We can't always join, open our arms, accept, and we don't have to.  Just because someone makes a choice, everyone doesn't have to come along for the ride.  They lose out on the ride, is the thing, and the child, the friend, will lose people he adores, never meant to harm, just being himself.

But it isn't our job, as therapists, to insist that people accept the unacceptable, no matter what that might be.  It won't make them happy, accepting the unacceptable.  Acceptance has to be one's own, it is a form of individuation, a process.  It isn't possible, when you can't, to simply follow the lyrics of a  sixties song,

Come on, people now, smile on your brother, everybody get together, try to love one another right now.  

A typical scenario, much worse than what we're talking about, happens when an adult with a mild developmental disorder, perhaps high functioning on the autism spectrum, makes a partner choice that is seemingly wrong.  This person who is independent yet not particularly worldly, is an easy mark, apt to be conned.  Others easily take advantage of a seeming lack of sophistication.  One can be swept off to marriage, one that isn't acceptable to the family, perhaps even swept off to another country.

If the parents don't accept the union they may lose touch with their child forever, although the calls for money are likely to break up the monotony.

The therapeutic approach to a disaster in the making, even to lesser disasters:
You can't accept the relationship, that is understood . But maybe at one point you might want to accept, might want to see your kid.  Stay open to that.  And in the meantime, burn no bridges.    
This burning no bridges idea, in general, is a good one.

And make no assumptions, not ever, about the way people will vote.

therapydoc

Sunday, November 11, 2012

Whose Mind Is This Anyway

I’m trying to swim on a Friday morning but intrusive thoughts are dampening the fun. Is it too much to ask to exercise and relax (to me this is one in the same), to pretend that this is an outdoor pool, that it is a warm and sunny day, and that the pool is all mine?

In reality it is full of lap swimmers and we’re all indoors and it is in the forties and cloudy outside, although it is supposed to warm up to fifty by noon.

Impossible, this imagined pretense about sun.  The list of things to do, for all intents and purposes, is full of unwanted, intrusive thoughts, and it expands with each splash. I am grateful that it is a list, not a conversation, that it isn't a script, one that will never be enacted, but probably should be, in vivo, a manifestation of conflict, that thing that keeps the analysts and Woody Allen in business.  

The to-do list, for us sandwich generationers, is endless.  It is only 9:05 but my day started at 5:15, almost four hours ago.  I dropped FD off someplace and am scouring the grocery store.  Thirty minutes pass and at the automatic checkout, things go well.  The system works, no need to call for a store manage for "unwanted items are on the belt." My self-esteem is much improved.

By eight o'clock two grandchildren are in my car, on their way to school. The angst of having no grandchildren in town has magically dissipated, as if it never was, since our daughter and her family moved from California to Chicago months ago. Change can be good, you know.

I drop the older boy off at the school his uncles attended at his age and wave from the car to  the principal at the curb.  The once young rabbi now sees me as old.

I sing Frere Jacques with the three-year old on our way to my apartment. We park and lug up the groceries in a cart at the service elevator (he pushes the up button).  Moments later he is mixing his second breakfast, baby pancakes. He doesn't start school until nine.  The pancakes go in a plastic bag because he won't eat a single one.  I test them.  They are excellent.  He will leave them in his schoolbag where his mother will notice them and toss them, maybe, late at night or perhaps the following day when she packs new lunches.  As in therapy, for a three-year old, life is all about the process, not the content.

In the parking lot at the nursery school he swipes his index finger on each and every car we pass, holding my hand with his other hand.  I tell him his finger will be dirty and it might end up in his mouth which isn't cool, eating dirt.  He stops drawing on dirty cars, seems to understand this word, cool.  

He marches merrily inside the community center where his teacher has all children wash their hands before breathing.  She tells me it is Picture Day.  Did his mother fill out the form?

I know what is in his backpack and there is no form for Picture Day, no check.  I only have a few dollars in my wallet, nothing else.  I text his parents:  Do you want pictures?  There is the matter of the form.  Yes!

The answer doesn't matter.  Clearly the other grandparents in this family will want them.  It occurs to put a reminder in my phone to revisit SnapFish or to look for some other service like it to print copies of good digital pictures.

My son-in-law chimes in from work, texts that he will give me a check, to stop by. He’s excited at the prospect of school pictures.  We arrange the pick-up.

Before leaving, Conference Day sign up catches my attention.  I scribble his parents in for a 6 pm, the latest time still available, hoping it will work for them.  The evening for this nursery school teacher is otherwise full. That there is a need for conferences about a 3-4 year old is interesting.  Don't these teachers work a long enough day?  And must my grandson progress?

It is time for me hit the pool, same building. Almost immediately, mid-first lap, intrusive thoughts attack, those things to do, that second shift stuff of life that is really first shift for me, discretionary time before office hours.  Details gather, no, pummel into my brain.  To control them I begin a mental post for this blog, this very post, thinking that by doing so, at least the verbiage is productive.

But surely most of it will be forgotten, my voice lost before hitting the showers.

Realizing that trying to control life while paddling in water is ridiculous, the brain's executive manager (we all have one, some are better than others) proceeds to the cognitive strategy that works best for her, a stopping technique.  When one is not doing backstroke, a good thought stoppage technique is to clap one's hands as loudly as possible.

The chosen intervention is word review, using new words in sentences, words and sentences direct from the Kaplan GRE Vocabulary I-phone ap.  You are never too old to learn words like abjure, abscond.  This works, stops the obsessive thinking.  The reason it will always work is that the brain cannot consciously parallel process, cannot comprehend two sentences at the very same time.  When you try to hear two people talking at the same time, no matter at cocktails or a business conference, you will fail to comprehend either.  

Starving, I go home and have breakfast, oatmeal that is now three hours old and doesn't taste good.  I bake some cookies because these will taste better, and we are expecting guests for the weekend.  By evening I will be too tired to do anything productive like this.  My machetainista (rhymes vaguely with bucket-rain-ist-uh, short for my daughter-in-law's mother) is a much better baker than I.  Hopefully having one of my cookies will boost her ego.

True cookie people all agree that once a cookie has cooled off it isn't as good anyway, perhaps isn't worth eating.  Take this as a health tip.

Also, one of my married sons will be visiting and he likes cookies.  He is coming to collect his collectibles, rooms full of them at my old house, the one his sister now occupies.  He finally has the space for his stuff, a real home of his own.  If you wait long enough, there is progress in life.  You may find a place for your stuff.

Or you may get rid of it.

The subtext to much of this is that I am worried, am becoming more than a little upset.  Six weeks ago the condo two floors directly above us flooded, something about a refrigerator hose, and each of the units below, all the way down to the first floor, suffered water damage.  I heard our bedroom wall crack, watched as water seeped in, kept seeping for days.  Management has known about this from the start, informed us that it isn’t safe to sleep in a potentially mildewed, moldy bedroom.  They moved some of our furniture into our guest room while we vacationed in a far-off land. 

But nothing was done to fix things.  I suggested to the building manager, at first gently, then a little more assertively, that this is not cool, the crack in our bedroom wall, losing a bedroom.  We are overcrowded and I wear a mask, try not to go inside that room, and I worry about my clothes.  Some of them are now in FD's closet in the guestroom. We are elbowing one another constantly, arguing over space under the bed.  Shoes have to go somewhere.

For weeks the response has been, We are waiting for insurance.  

This key word, insurance, makes me feel guilty.  There are people who lost their homes in a hurricane and here I am, worrying about a crack in a bedroom wall.

How can anyone make any kind of move in life without insurance?  Apparently it is impossible.

When I suggest that since the condo association must wait for insurance, they will also wait for rent, (we are test-case renters, an experiment) I get a new response: Next week for sure.  Monday!  But this must have been a dream.
Condo flood

Daily I visit her, the building manager, to remind her that this is not what I signed up for, moving into this place.  She gets that deer in the headlights look when there are any complaints from us, must always consult the board, has never had anyone rent here before.  Procedure is fuzzy.  I do not tell her that I am considering starting a blog to satirize condo living, Someone Was Seen...

Conflict is not my style, however, so I take some of my newly baked cookies, still warm, and put them on a paper plate, cordially bring them down to the building manager. 

“Is this a bribe?” she asks suspiciously. But she has something of a smile going.

“No!  Heaven forbid!  I remembered you like a good cookie, thought you might think of me as you chew. They aren’t my best, are a little too soft.  Rush job.  Lots to do today."

“You know,” she says, “butter is the answer to everything, makes cookies crunchy.”

I agree (would I argue?) but must go.  No time to talk ingredients.  Toodaloo.

The race is on.  In one hour, the following, erased:

1.  Pick up check for Picture Day from s-i-l.  Admire amazing new office.

2.  Shoot over to BBB (Bed Bath and Beyond) to get the canister for Soda Stream (device that makes carbonated water, favorite drink of old Jews).

3.  Drop in at Office Max to find carbon paper.  They still make it!

4.  Drop off the Picture Day check to the nursery school administrator.

5.  Take pic of Conference Day schedule on classroom door so daught can switch hers with someone if necessary.  Shoot it over to her.

6.  Pick up afghan from the cleaners that machetainista crocheted for us. Looks like new. (Add bring in down jacket to to-do list).

7.  Drop check off at auto mechanic, have the following conversation:
“Gary, you must hate me!”
“I love you,” he offers back.
“It’s so late!  I’ve had the check in my purse for weeks!”
“No problem!”  
He's smiling like he means it and the smile carries the morning.

8.  Back at the apartment, switch to biking clothes.

9.  Ride over to mother’s apartment.  She is going to a dinner tonight and needs help putting on jewelry.  This takes only ten minutes and she is unbelievably grateful but perseverates on the dangers of riding a bicycle to work.

10.  Ride to work.

11.  Ride home in the dark, scare a raccoon, maybe.

That night, picking up my mail at the house, my daughter shows me her Google calendar, how she has different colors that remind her of her many things to do.  My work calendar is about all I can take, adding things to it would probably mean someone gets double booked.  The Reminder Ap on the phone works best for me but means I am always, forever, tied to the phone, can't tell my left shoe from my right without it.  

Still, it is better to rely on this, to know that it is there, with an ever-changing list of things to do, than to give the never-ending list attention while swimming. If the errand isn't on the phone then it probably isn't very important. Lightning will not strike, either (cognitive-rational thinking) if something isn't done, is lost in the shuffle.

Now if only there were an ap to eliminate obsessive dialogue.

therapydoc

Post script: The maintenance engineers are working on the bedroom!  Eitherthis had to do with no rent, or maybe, just maybe, somebody is worried about the blog.  

Friday, November 02, 2012

How to Have an Afffair

I wanted to read more about the Congressman caught in his second affair last week, but couldn't remember any details. So I Googled affair and half-way down the first page found, "How to Have an Affair,"  subtext, "And Not Get Caught."

Turns out the Tennessee congressman's name is Scott DesJarlais. It is an ugly story, probably only half true.  (My mother-in-law tells us that we should believe only half of what we hear, and in this she is probably correct.)  We can only hope.

Google landed on How to Have an Affair, however, and crazy thing is I had no interest in reading the article, assumed it a teaser for an e-book.  I'm all about the affair being between two committed partners, preferably married partners, but not necessarily.  This is satisfying, too, and less time-consuming.

The usually tepid, if sometimes torrential, intramarital love affair has no beginning and no end, mitigates conflict naturally, and is not as rare as people who have extramarital affairs seem to think.

No need to elaborate much on the benefits, but marriage has  many inherent stresses, and the intramarital affair buffers stress, as it is designed to do.  The sense that one has a dedicated-to-exclusivity-with-a-vengeance  life-partner, one who works at love (because this takes much work) under any and all circumstances, even if it doesn't feel like love all of the time, even when communication seems to indicate the opposite of love, even when a person has no clothes on, perhaps even more for that, is highly rewarding.

It is more rewarding still if one can whip a lackadaisical partner into shape, not literally, not unless that is what he or she desires, rather can shape said partner into the role, for lack of a better word, of true partner. Meaning get him or her to wash and put away dishes, serve once in awhile, perhaps fix a broken bicycle or hire someone to fix the doorknob.

I prefer reading about this sort of thing to reading about behavior that jeopardizes this sort of thing.

It doesn't take tremendous imagination to see why people still want to have extramarital affairs, however, and do so, and to see why they don't want to get caught, although wanting to get caught is likely the impetus for the affair in the first place.  Why would anyone want to get caught?

Still working out cutting school is why, or not cutting school, not having pushed limits enough as children.Or still working out the identified patient role.  Children misbehave, they act out, to get caught.  They want to draw their parents into therapy, at least get them to talk to one another, to bond, if necessary, over the problem at hand, their errant child.

Being a problem child can be about expressing frustration over bullies, abuse, difficult teachers, learning disabilities, Pediatric Bipolar Disorder, Diisruptive Mood Dysregulation Disorder, or a host of other childhood issues, but it isn't always.  Often it is about looking to fix their broken families, expressing the pain of the family, or merely needing more time and attention.

As the saying goes: Any attention beats no attention, even negative attention.  Negative attention being an angry response or punishment from a parent.

So getting caught is the objective.

And we get better at it, acting out to get caught, as we age and need to individuate, to be our own persons.  We do it by stretching parental limits, by saying, "You're not the boss of me," and breaking rules,  getting away with breaking all kinds of rules, especially the ones that matter most to their parents.

Fast forward.

therapydoc

Friday, October 26, 2012

Tina Fey and Competitive Gymnastics

(1) Wish I could embed Tina Fey's very short rant about "legitimate" rape. You'll have to follow the link if you're interested.

The part about how merely repeating something that is "dumb" can essentially "dumb" a person down is something to think about.  It's why your momma tells you to watch what you say, and why your therapist will suggest that you think it don't say it, or write it don't send it.

http://news.yahoo.com/video#video=30959493

As a reminder, this isn't a political blog, and linking to Tina Fey, not a political statement.
As if there is a way to communicate in the world and not be political.

(2). Should we talk about Halloween instead?  How it is the dentists are the ones to score, not the kids?
Making my mother an appointment, the receptionist says, "Oh!  Wednesday!  Halloween."

Bonus time, perhaps.

But here's a dilemma.  What if you leave the country, go far, far away, and all your grandkids ask from you is to bring back candy from a tiny middle eastern country?

Do you say no?

Candy is a universal language


Pressure.  I say it is the parents' job to teach them to brush, no?

therapydoc


Sunday, October 21, 2012

Disruptive Mood Dysregulation Disorder

Disruptive Mood Dysregulation Disorder (DMDD) is about emotional-behavioral management in children.  Reaching for more user-friendly semantics, FD refers to it as Calming Disorder, a seeming inability on the part of the child (hence the parent, too) to calm down.  DMDD is likely to be the latest flavor of the week, yet another label for children who are oppositional.  Willful.

We suppose that as these children age, as they grow into adults, they will be diagnosed as having Intermittent Explosive Disorder and treated with anger management.  Why we couldn't have used Intermittent Explosive Disorder with qualifiers: refer to children with a 1, adults with a 2, and a 1,2, or 3 to indicate the severity, is a mystery.  Perhaps the reason is that the temperament is chronic, not intermittent.

Here's the abstract.  I'll get to the article this week, but want to offer up a few thoughts regardless.  After all, they did ask me to be on the team to rewrite the DSM IV-TR.  Is it my fault that the page froze after checking "other" when asked for "type of license"?  I have two, and there was no way to communicate that. Calling in I was redirected, sent a new email.  But the link to the application didn't work a second time.

And life gets in the way.

Look for the article in PsychInfo if you have an academic affiliation. It might be on sale somewhere online if you don't.


Emotional dysregulation in disruptive behavior disorders.
Cole, Pamela M.; Zahn-Waxler, Carolyn
Cicchetti, Dante (Ed); Toth, Sheree L. (Ed), (1992). Developmental perspectives on depression.Rochester symposium on developmental psychopathology, Vol. 4., (pp. 173-209). Rochester, NY, US: University of Rochester Press, xix, 396 pp.


(The authors) present a view of disruptive behavior disorders as affective disorders and, from that perspective, discuss the emotional characteristics which are associated with the development of aggressive, antisocial behavior 
provide an overview of the disruptive behavior disorders, the history of the traditional segregation of behavior disorder from affective disorder, and the evidence and arguments for comorbidity of affective and disruptive disorders / consider possible developmental trajectories leading to these disorders / focus particularly on the role of emotion in early childhood and its implications for the development of deviant and aggressive behavior later in childhood and adolescence (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Seems to me we are looking for the prodromal, or warning signs of sociopathy, a disorder that defines what we have referred to as almost psychopathic in previous posts.

Parents are right to worry when their kids have symptoms of DMDD: uncontrollable tantrums, aggressiveness, an inability to manage emotion, an absence of empathy.  When they are cruel.  Dr. Cole has published on empathy in the past, and I think she is on the mark if she is thinking we have to teach children, all children, empathy.

We're talking about it right now because the DSM V is due out in 2013.  Teams of researchers, revisionists, are making all kinds of changes to what we commonly call disorders.  For example, Asperger's, childhood disorder in the current DSM IV-TR, has been known for decades to be characteristic of adults, too.   It is thought to be a spectrum disorder, on the spectrum of autism, and may lose its status as a disorder exclusive to autism.

According to yesterday's Wall Street Journal (Shirley S. Wang), "Aspie's" are up in arms about being subsumed autistic.  Not everyone likes the thought of being autistic, even if it is high functioning.  Yet, most of the "Aspie's" I treat tell me that they are very much in their own world.  They see the point.  More likely however, Adult Asperger's Disorder will make it into the DSM V, at least that is my hope.  Just a guess.

But back to our new flavor.  When we first recognized Bipolar Disorder in children, it amounted to medication, usually too much.  Manic kids were oppositional, hard to control by definition, and they suffered swings, clear signs of childhood depression.  Thus meds saved the day, theoretically, although those of us who work with a family model are generally reluctant to make that referral.

Children with Disruptive Mood Dysregulation Disorder are likely going to be over-medicated, too.  It doesn't take much to over-medicate children.  They are growing and changing all of the time.  And they are mini-emotional time-bombs under normal circumstances.  Having a motor that tends to puff and smoke at the worst possible times, it is understandable that parents are looking for help, lots of help, from that god of psychiatry, Big Pharma.

Thus we can only hope that parents remain patient, able to calm themselves, and bring little Joey to therapy.  If you are such a parent, stay in the room and learn strategies from the doctor/therapist.  The tried and true holding technique, grabbing the little tyke and holding her tightly (without hurting her) until she calms down, works for some kids, but as one reader puts it so well, restraining the child is:

 a tried and true way to exert dominance, lose the child's trust, and create permanent emotional scars.

I think we had both lose the phrase, tried and true, unless we can qualify them well.

Make sure no one is hurt no matter what you do.  Corporal punishment won't work, will work against you.  And although we are capable of holding, able to restrain children, being three times their size, we have to be careful. Not every child responds well to that.  If they are older, best to work on communicating in words, or in art, or play if holding is violently rejected.

There are other ways to treat DMDD.  Engage other siblings, certainly a second parent if one is around, or grandparents, aunts and uncles.  Use friends.  Use your people.  If you have none, find a support group.  Call the National Alliance on Mental Illness, NAMI.

Lose the idea that this is something shameful.  Get more into the idea that it takes a village to raise a child, because it does.

Behavioral modification won't always work, but try it early, start very, very young.  Even a two-year old needs to know the power structure in the family, that he is not the boss of you.  As a parent, you are the boss.

All of this assuming that marital dynamics lend themselves to the therapy, that the child isn't learning aggression in the home, a very big assumption.  And that the dyad at the top, Mom and Dad, or Mom and Mom, or Dad and Dad, have to have something of a working relationship themselves, must communicate, agree on a treatment plan.

It is most likely that children who will be diagnosed with DMDD, unfortunately, are identified patients, that their families are the patient, really, and that only a fraction, a tiny fraction of the children diagnosed in nursery, kindergarten, or elementary school, whichever system has booted them out, have the disorder.  If you hear the news: This child needs a psychiatric evaluation--it may not mean Disruptive Mood Dysregulation Disorder, no matter who slaps on the label.

I'll put myself out there and suggest that as a first line of attack, families need to find a good family therapist, not a psychiatrist, and leave the primary care physician alone about medicating the child.

When it is obvious that a child is dangerous, on the other hand, a team approach is surely necessary, with a primary care doctor, a child psychiatrist (go find one, good luck), and a therapist.  Sometimes  even hospitalization might be necessary.  Or so they're saying in the news today.

therapydoc

Wednesday, October 10, 2012

One Last Snap: Insect Phobia Corrections

Jet lag isn't that bad, assuming you don't mind sleeping at inappropriate moments anywhere, anytime.  A therapist has to be prepared to take a power nap.  It is why we have a comfortable sofa.  And you though it was for you.

With jet lag, however, you doze off in the afternoon, and then, late at night, find that your brain is on Central Standard Time.  Still.  Meaning it is really late afternoon.

One night I'm reading myself to sleep, something that has always worked in the past, doubly so upon learning that the reticular formation in the back of the brain stem expects, no wants, desires, demands that we lie down, enable additional blood flow to accomplish this seemingly elusive state of being, sleep.  Lying supine, an easy thing to do, a familiar buzz in the ear sets off an alarm.  

I swat at it, a mosquito.

"We have mosquitoes," I inform FD.

"You didn't know?"

There was a rumor.

This relatively small insect lands on page 433, The Corrections, Jonathan Franzen.  Is it not insult enough that the rain in Israel occasionally carries red mud, and a light drizzle through a bedroom screen has initiated this book, one that I do not own, but could not leave in the States?  Once I begin a Franzen novel, there is no stopping until the last page has turned.  (For the uninitiated, be prepared for much unrestrained, very raw, literary pornography; an unapologetic obsession on the part of every primary in a Franzen novel, at least the two I have read, add Freedom, with s-e-x.)

I swat at the mosquito.  Miss.

"Excuse me," I tell FD, climbing over him.  "I must find him."  I stand up in bed, survey the room, and flash back to a distant memory, a child of five years old, myself,  in the same position, too many years ago to count.

The child cries for her mother, her father, anyone who will rescue her.  "There's a mosquito in here!"  A kind woman, a mother in a thin nightgown, offers advice.  She seems very tired.

"You won't sleep until it is dead," she says, the voice of experience.  "Let's turn on the light, kill him."

The child agrees.  The two search the walls for an insect.  The walls are white.  There are none, however, no mosquitoes with bent spidery legs clutching walls, regrouping, thinking.

"Do you want to try to sleep?  Or would you prefer to stay up and wait?  It is okay with me if you stay up and wait, kill the mosquito.  If you don't, that buzzing in your ear will keep you awake anyway."

The child agrees to do this, lie in wait, alone, for the pest.  The woman kisses her good night, leaves the room.  The light isn't bright; there is a dimmer on the switch, and the child is tired.  But suddenly she sees it, a mosquito on the wall.  She takes destiny into her little hands, and with one blow, ends the life of the enemy.  She goes to sleep.

"My G-d!"  I exclaim, waking FD again.  "This is why I've never had any insect phobias!  I learned at a young age how easy it is to kill them!  This is how it feels to play Master of the Universe!"

Unwilling to lose valuable page turning time, I slip back into bed and read for a few minutes, hoping my nemesis might return to pages 444, or perhaps page 445, when an unmistakable prick stings my forehead, just above the bridge of the nose.  With all too much enthusiasm, I adroitly slap at my head with the palm of my hand, a hard but quick slap, not a smashing slap.  The mosquito falls onto my pajama top, slips down toward my belly, curls into a tiny ball of thorax, the proboscis no longer an issue.  Marveling at this skill, confidence returns.  Nothing can harm me now.

I sleep like a five-year old.

 
therapydoc

Tuesday, October 09, 2012

Vacation Snapshots

1.  Get Out of Town:  Literally

I can count on one hand how many times I've shared pics of myself, or my family, or my home. Actually, there are none.  And we're not about to start now.

For years it's been really hard getting away for vacations, this year worse than ever.  All summer long patients talked to me about their trips, things that went wrong, what went right.  Rain forests.  Africa.  Mexico.  I'd listen and wonder, "How do they get to do it, get away like that, and I can't?"

The rule has been that when we do go, our vacations aren't vacations.  FD is on the phone with patients, other doctors, nurses, lab techs.  I'm checking messages, too.  We have micro-practices, and although there's coverage, letting it all go never seems possible.

Plus, the get-away is to see kids, grandkids, in-laws of kids, an exertion that simulates a vacation in many respects.  But isn't.
United to Israel


To air out more often, it seemed prudent to start a business with a psycho-educational mission.  Educate people in other cities about abuse and neglect, what a number it does on one's mental health.  Not exactly getting away from it all.

My nephew made it possible to get away, however, by not staying single. If you have a chance to go to a nephew's wedding, you don't blow it.

You try not to blow it.   To say that we almost blew it is no exaggeration.

But we got on that airplane above.  When you leave the country, travel very far away, even if it is to see relatives, you are on a real vacation.

If you're me, reunions make you just a little self-conscious.  Friends and family, people who haven't seen us for years, are probably shocked to see so many more creases in my skin, a little bit of a craggy look. Without "work" it can happen to anyone.  Whereas FD still has baby skin.

People are forgiving, in any case, don't mention things like this.  I've always said that by not looking good, other people think they look good.  What better gift than that?

2. Will He Make It 30 Years?

Even far away, news travels.  Jerry Sandusky!  Going to jail for the duration!  30 -60 years.  He'll die in jail!  And still, he tells us, he's innocent of abusing young boys.

Jerry Sandusky, throw away the key

We can only hope that those institutions with "everything to lose" (seriously?) under the pall of a scandal like his, think twice before covering one up.

3. Stripped of Sir

Jimmy Savile, not a Sir
Speaking of falls from grace.  It is nice to know that another sexual predator, "Sir" Jimmy Savile, has been outed as one, although he's quite dead.  The Brits can't strip Jimmy of his title for his crimes, but as they lowered him below the earth, he automatically lost it.

Technically we don't call people who sexually abuse adolescents pedophiles.  A pedophile is an adult who is sexually interested in children under the age of twelve.

Jimmy Savile was an ephebophile, an adult who is sexually obsessed with and sexually assaults young people between the ages of 13-17 (18).

Consider that your psycho-education for the day.

Savile, a British television star, is guilty of at least 30 counts of sexual assault, and more appear to come to light daily.  First women came forward, now men, too, are saying that he raped them as young adolescents.  The story is too gruesome to repeat on a clean blog like this.

If I stayed away from television, from stories like these, it would be okay.  But seeing Law and Order and CNN with foreign language subtitles is a nice way to reinforce a second language.

4.  Losing Ground

Why not just a little more about me.

Before leaving, no question, the nerves were frayed.  No day a good day.  The feeling?  Like I'm slipping.  A descent, a loss of grounded-ness,  Being grounded is everything to a therapist, it is the essence of Yoda.  When problems build up, as they do in middle age, sandwiched, as they say, we tend to sense it dissipating, as if the ground is literally crumbling beneath our feet.

We become less like Yoda at the end of the day.  And everyone depends upon us to do an imitation, certainly, during the day.  Being grounded is why they come.  Why bother with a therapist who isn't?

Don't ask questions when yours tells you she needs to get away, even if it sounds like an extended absence.
Throw her a party.

And don't envy the money she will spend to go.  She's supporting the world's economy and the economy of the United States, each and every day, with her taxes.  Nobody in this profession ever gets out of the middle class.  The first candidate to fix this gets my vote.  .

5.  The Western Wall in Jerusalem

Ah, there is nothing better than walking toward, approaching, coming close to this.   Perhaps you understand, have an idea.
The Western Wall-HaKotel
This is the holiest place in the world. Thousands come here to pray.  They put names of sick friends on little pieces of paper, squeeze them into ancient cracks and crevices of the Wall, hope their prayers are received, then answered.  It is a local call in Jerusalem.

Only a few hundred yards away, people eat and drink, buy and sell religious objects. Things probably went down differently well over two thousand years ago when millions made holiday pilgrimages.   Kings, queens.  Everyone had to see what was happening here.


The Judean Hills at dawn


6.  The Land

Those are the Judean hills on your left. Pretty obvious why cultures clash over this land.

 There used to be a commercial for cigarettes that referenced Marlboro Country. And a beer commercial about God's Country, maybe Wisconsin, probably.

They got that one wrong.

Electric Car






7.  Going Green

The pic on the right is what you see on the dash when you charge up your electric car.

Why isn't Israel polluted?

People actually buy electric cars, not just hybrids. Of course, the tax exemptions help.  It is like driving a real car, without the exhaust or the noise.

But don't get stuck in traffic.  That's all I'm going to say.
A Kosher McDonald's


8.  Don't Super-size Me

If you live in this country you have to join the army after high school. There you learn to stay in shape, and to eat right, generally, which is why everyone, young and old, seems thin and can eat at McDonald's.

McDonald's in case it is lost on you, is not kosher anywhere else in the world. I don't think.

And no, I didn't eat there.  Are you kidding me?

9.  Coming Home

Sure, sure.  I'll come home.  Just not yet.  You wouldn't want your therapist insufficiently, not totally, grounded. 

therapydoc