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Sunday, January 22, 2012

One for the Weak Side

It happens quite a bit, and we’ve talked about it before, that the weak get weaker and the strong get stronger. There’s a Harry Potter metaphor in there somewhere.

What happens is that a perfectly wonderful individual, one who would give the shirt off his or her back to help a friend, gets a reputation for giving. And some people use people like this, prey upon them to get things done.

My father used to call the guy who drives 90 mph on the expressway a pigeon. He’s the guy that’s going to get the ticket. We get to drive at 75 mph but for the grace of the pigeon. No pigeon in sight, don't speed.

He would see someone who is being used, in general, as a pigeon. But that isn't a nice way of looking at it at all. I just see them as nice people who can't say no.

Nice people do come to therapy because they are exploited by others. When it becomes a pattern, they tire of it, burn out, even get depressed. This is exactly the kind of person that those who practice Brief Family Therapy love to get their hands on. No need to go back to childhood, get to the solution. Personally, I think going back to childhood, going into the reasons, is very, very useful. But let's try Brief Family Therapy right now.

It’s surely a disrespect, a dismissal, and a put-down when a perfectly capable individual asks a good-hearted, less assertive person to do their dirty work. We parents do this all the time, ask our kids to do our bidding, but we're teaching them life skills, obviously, when we ask them to take out the trash.

Consider adult to adult relationships instead. At the beach a good-hearted soul gets up to get drinks for everyone. (S)he will self-sacrifice for the sake of friendship, might go back and forth on the hot sand, if necessary, to serve everyone. This same individual, at some point in life, gets sick of it.

In therapy she'll learn to ask, “Does anyone want to come with me to go get us all some drinks?” There’s usually another volunteer. If there isn't, she gets a drink for herself, tries that out, feeling what it's like to take care of Number One. It doesn't feel that bad, really.

The relationship issue is that the good one, the thoughtful one, gets resentful of the thoughtless, even come close, at some point, to feeling a terrible emotion, hate. The burnt out exploited person is crying more often, suffering panic attacks at the very thought of hate, which means giving up the relationship. Before, by saying Yes, there was an element of control, predictability. Lose that, the predictability, the relationship for better or worse, and abandonment anxiety bubbles over. It is a situation becoming of the Pink song, Please Don't Leave Me.

If the crisis precipitates therapy, some of us would suggest we work on one-liners together, the baby steps of assertiveness. Assertiveness is always the facts, dispassionate.

(1) Really? You can’t do that yourself? Really? Are you kidding?
(2) Why would you ask me? You always ask me, ever notice that?
(3) I'm starting to feel used here, and it isn't feeling good.
(4) You’re a big girl, seriously, get more into the role, you'll like it.

And then there's the situation specific response.

(5) You’re out of your tree if you think I’ll be your alarm clock. Buy one. And no, don't ask me to buy you one.

That sort of thing. Responding dispassionately, saying No, empowers us, strengthens. It's a great skill, and we grow stronger every time we flex the muscle.

We learn that it can be great fun, too, seeing the expressions, the surprises looks.

My suggestion? Practice with a friend.
On the second thought, it might be better to practice in front of the mirror.

therapydoc

Monday, January 16, 2012

Martin Luther King

Why write about Martin Luther King on this blog?



Because he tried to kill himself. Not once, but twice. And we can learn from that.

Time tells us this in the "Man of the Year" article about Dr. King. (The excerpt is quoted in A First-Rate Madness by Nassir Ghaemi, reviewed on this blog last year.)
Twice, before he was 13, he tried to commit suicide. Once, his brother, "A.D.," accidentally knocked his grandmother unconscious when he slid down a banister. Martin thought she was dead, and in despair ran to a second-floor window and jumped out--only to land unhurt. He did the same thing, with the same result, on the day his grandmother died.
I read a few more accounts of the story, about young Martin seeming quite dead, then rising and walking off like a child who had been clobbered by a baseball. It made me wonder, frankly, if he just jumped, as a kid, off trees, perhaps. Kids jump.

But it does seem to have been overwhelming despair that drove him to the ledge. Most of us would point to it as a strong indicator of childhood depression, rather than a grief response. The depression came first.

Ghaemi tells us that by 1966, after Dr. King had accomplished his goals, voting rights for blacks, and desegregation, that he initially felt empty and depressed, even thought he should resign. But Black Power, radical (violent) politics, the very opposite of civil disobedience troubled him, and so did the Viet Nam War.

He spent his last few years fighting for both of them. He did what he could to guilt Lyndon Johnson into ending the war, and he arranged meetings with the powerful radicals, those who believed in revolution. He didn't sleep, worked feverishly through the night, through his depression. A closer read of Ghaemi's biography finds Dr. King's personal struggle to be yet another example of an individual who struggled with mental illness-- his whole life-- and yet, what a life. What a legacy he left us all.

And he didn't take that life in the end. He didn't jump.

therapydoc

Friday, January 13, 2012

Progress Not Perfection

This might be a spoiler if you didn’t see last Sunday’s Desperate Housewives.

We’ve been watching Tom and Lynette fight for years, and now that Tom is successful in advertising, he’s leaving her. He has found the perfect woman, someone who doesn't criticize him, who thinks he’s marvelous, and loves him just the way he is.

And she's a doctor, no less.

The couple is separated for several months, and a crisis brings Tom home. He helps Lynette through it and it is clear that the two of them are getting along, even seem happy together. Tom suggests he bring home a pizza and a DVD, that the family does pizza and TV night like they used to do in the past. Lynette jumps on the opportunity to be a family again. The children aren’t thrilled with his educational DVDs, but they go along.

The pizza is ripped open. Lynette makes a face. She doesn’t eat deep dish. She’s been telling him for years that she likes thin crust. He hasn’t been listening to her and she tells him as much. He tells her that this is exactly what he’s talking about, that nothing he does is good enough, he shouldn’t have even tried. She responds by saying that by now, after so many years, it wouldn't kill him to actually listen to her. She needs validation, too. He could care about what she wants. It would be a nice change.

He hands her the point, says he’ll try harder to do that.

An "Ah ha" moment. And she doesn't even have to get to the source, the reason why he ignores things she says, why he doesn't attend to her needs. But this is progress.


That’s television. In reality, people have reasons for not listening and it's nice to bring the unconscious to consciousness. That's called psychological growth, or insight.

The reason I like most is that not listening is associated with narcissism, being unable to see beyond what we want, seeing our needs as primary. For example, in any addiction (and you could say we all have one) the addict is dysfunctional because he disregards the needs and wants of everyone else in order to get his drugs, his drink, sex, whatever. It doesn’t matter, the promises. What matters is satisfying a craving.

Immature? Narcissistic? Sick? The 12-Step programs probably go with sick and selfish. Older 12-Steppers, people who have been sober for years, bop new addicts over the head, tell them, Grow up, be a human being. It works sometime.

The addiction metaphor is only good because addicts are selfish by definition. It can be true in mental illness, too. People don’t have to be, and that’s what recovery is all about. Rising above all that self-absorption and pain.

But take someone like Tom Savo, the guy who doesn't think to keep his wife’s preferences in mind, even when the two seem to be reconciling, a guy who isn’t an addict. I want to say that in his excitement, coming home, bringing home the pizza that makes him happy (and we can assume the children, too) he simply forgets to have her in mind. Oh yes, and a few slices of thin crust for my wife. He missed it, the opportunity.

If that is all it is, being excited, forgetting, it isn't even that dysfunctional. What is dysfunctional is when her needs are never important. When it is systematic, when forgetting his wife is a regular problem. He takes her for granted, doesn't bring home the thin crust because she hasn't made a big enough issue out of it. And even if she does, complaining makes him feel rejected, unloved, and angry, so it is likely to trigger defensiveness and an argument.

The real dysfunction is not when one partner forgets what the other wants, it is when the other's wants are dismissed. Lynette is never really in the picture. Without empathy, without feeling her sense of rejection, he can't address it.

Our relationships go to garbage without empathy.

How does a person get this way? Why are some people more empathetic, more considerate than others? You could say breeding, surely, and you would be half right. Parents can teach children to share, to care about others. It's more important than teaching them to be sure to flush, although that's a two for one. But self-centeredness is functional might help us accomplish things, meet our goals, sometimes. Being goal oriented, keeping our eyes on the prize (or just winning a game) to the exception of all else, others (who distract), we get more done. Or so it seems. There's surely loss, however, when others feel excluded, a social price.

So it could be nature, survival of the fittest. Selfishness could be something Darwin talks about. I haven’t read enough to know, but that makes sense to me.

Take a different example. A guy’s parents are very controlling. He grows up and is determined to run his own life, to finally have it his way. He marries a woman who is giving and selfless, reinforcing his need to put himself first. Except that she does have needs, and when she asserts, he ignores her.

But it depends upon the need, whether or not he ignores her. If it is for something permanent, perhaps a new dress, something she will look at in the future and think, Oh, he gave that to me, what a wonderful husband, it’s a go. He buys it for her. But if it’s something temporary, like a vacation, something intangible, he forgets. He learns that some memories are permanent. It is why we take pictures.

This couple frequently winds up in therapy, and beyond going back to childhood to determine the roots of selfishness, some of us push that 12-Step adage, Progress Not Perfection, because frankly, if we strive for perfection we we're going to be frustrated. We might even give up.

therapydoc

Sunday, January 01, 2012

Please Don't Leave Me

He's Just Not That Into You--It's not a new movie, and a lot of people said they were Just Not Into It.

But the topic had me at hello.

The cast is stunning, for one.  I watch chick flicks for many reasons (they're sedating, primarily), but a pleasant looking cast is at the top of the list. You can't talk about deep subjects all the time and not have a really shallow side somewhere deep down inside.

FD didn't bother with it for 30 seconds. He went to bed. But he was tired, is the truth.

Gigi Haim, (Ginnifer Goodwin, above, bottom right below) desperately seeks a boyfriend. It's the desperate part we don't like.  A woman (or a man, this movie could easily have been about a desperate man) should strive for a little more pride, more independence. Hanging on for dear life when someone is pushing you away, stalking restaurants and bars to catch the prey unannounced, feels like high school.  I know it's hard not to do it, and that for many of us, it's hard to have the kind of self-control necessary to go it alone.  But we've got to try.  That said, we can work on this for years in therapy, and we do.

Gigi anxiously waits for telephone calls, checks voicemail a hundred times a day, even when her first dates don't go well, which is always. What she wants, what she needs, is beyond her social intelligence. The social IQ should tell her that a little mystery, a little challenge, is attractive in relationships. And if the attraction isn't mutual, let it go.  But we're made up of much more than social intelligence.  Our emotional lives tend to rule.

She's rejected often, but nothing ventured, nothing gained. And Gigi's obsessive thinking, her compulsive man-chasing, doesn't hurt anyone. She's obsessed, but she would not be diagnosed with OCD, Obsessive Compulsive Disorder. She doesn't want to be alone, and although we might suggest she feels empty, she doesn't have Borderline Personality Disorder, either.  That's the one we think of when we associate fears of abandonment with mental illness.

She's just not getting it, can't read the signs when it's so obvious that it's never going to happen. Men read the neediness in her face instantly. They politely suggest, “Call me," a nice way of saying, "I’m not interested enough to call you, so I won't be calling you, but knock yourself out."

The film is full of examples of these types of metacommunications, communications about communications. It is worth seeing for that alone. But remember, the epiphanies of a chick flick aren't usually rocket science.

Gigi's social disconnect, her persistence in knocking when the doors are all closed, is a remez (rhymes with them-pez, Hebrew for hint, but hint just doesn't quite say it as well) to the drive that makes some people successful in this world. They know what they want and get it, don't take no for an answer.

When it comes to relationships and love, unfortunately, that kind of persistence and drive doesn't usually pay off. Forcing ourselves upon others only makes us less attractive, less likable. Gigi's manhunt turns out to be the exception to the rule. It's romantic comedy, after all.

Contrast this to Pink, and her violent music video, Please Don't Leave Me. I can't even link to it for you, it's so violent. Pink bloodies her boyfriend, beats him senseless so that he can't get out of the apartment. She's a sociopath, clearly, a violent, antisocial individual. I mean, rock star.  Not that rock stars are violent.

When I first heard the song, the lyrics isolated from the video screamed Borderline Personality Disorder. So I checked out the video at YouTube to see if it would work as a teaching tool for high school kids learning about abandonment anxiety. (They teach kids about that, right, in your high schools?)

Here are the lyrics:

Da da da da, da da da da
Da da da, da da
Da da da, da da

I don't know if I can yell any louder
How many time I've kicked you outta here?
Or said something insulting?
Da da da, da da

I can be so mean when I wanna be
I am capable of really anything
I can cut you into pieces
But my heart is broken
Da da da, da da

Please don't leave me
Please don't leave me
I always say how I don't need you
But it's always gonna come right back to this
Please, don't leave me

How did I become so obnoxious?
What is it with you that makes me act like this?
I've never been this nasty
Da da da, da da

Can't you tell that this is all just a contest?
The one that wins will be the one that hits the hardest
But baby I don't mean it
I mean it, I promise
Da da da, da da

Please don't leave me
Oh please don't leave me
I always say how I don't need you
But it's always gonna come right back to this
Please, don't leave me

I forgot to say out loud how beautiful you really are to me
I cannot be without, you're my perfect little punching bag
And I need you, I'm sorry
Da da da, da da

You say I don't need you
But it's always gonna come right back
It's gonna come right back to this
Please, don't leave me

Please don't leave me, oh no no no.

What's interesting to me is that both women, Gigi and Pink, are desperately in need of a relationship, both concentrate all of their energy to keep a relationship, even go to extreme measures. But they are such different women.

Engaging Gigi in therapy would be a snap. Teaching her rubberband theory, exploring her insecurities about being alone, she'd grow leaps and bounds in a single visit. Well, not a single visit, but a few for sure.  It's hard to let go, and managing neediness in relationships can take a lot of therapy, it's true.  Yet Gigi's not that dysfunctional. She hurts only herself.

Whereas someone like Pink would be self-mutilating in my office and throwing rocks at home.  I'd call in a team to work with her.

The differences in the two women, both so needy, underscores the importance of not diagnosing based upon a single symptom, not even an extreme symptom, although the no sleep thing in Bi-polar Disorder, and the hallucinations or delusions in Schizophrenia are fairly robust indicators of disease.  But even then, there are things to rule out before making a diagnosis. Like speed, acid, other physical disease, brain tumors. Things.

I looked already. Nothing's on tonight.

therapydoc