Monday, December 30, 2013

Best in Mental Health (weeks of 12/16 - 12/28/13)

Well, to end the year with referrals (it is always nice to refer to others), inspired by another blogger's online research, you're getting a link-full of articles and information some about changes in provisions to mental health care in only the past two weeks, but mostly a dozen or so blogger thoughts, old and new. We probably need to keep up with the new ones, refresh the old.

There are links to social work and psychology sites, nonprofit and private practice sites.

So if you have some time, maybe while thinking up those New Year resolutions, cruise my new best friend Dorlee's suggestions. They might make good reading. Or make you angry.

That depends, as always, upon your politics, for some of these bloggers have strong opinions. One, for example, takes issues with the new DSM, a fairly long read, caveat emptor.

Happy New Year, drive safe or preferably not at all, and as you obviously already know, it really isn't cool anymore to drink excessively on New Years Eve.

therapydoc :

Here are a few of Dorlee's suggestions: Social Work Career Development: Best in Mental Health (weeks of 12/16 - 12/28/13)

From her long list, I recommend the following:
How Bullied Children Grow Into Wounded Adults
Avoidance in Trauma
Child Protection Lessons
Able Road  Ways to get around disability, really get around.
What a Shrink Thinks (nice to know the thoughts of other docs on anger)


By the way, not everyone agrees with the DSM-5 boycott. (one of the links)

Thursday, December 26, 2013

Internet Gaming Addictions and the DSM-5

Were it not for my practice, and now, the last section of the remarkable DSM-5, I wouldn't be blogging about this. It feels like such a scrooge-thing to do. A kid finds this awesome present, an X box 360 under the tree, and his mom reads ENT and warns. . .
Enjoy. But remember. It is a starter drug.
Like our first flip phone was a starter drug, too, right?

We can laugh, but couples do present in therapy, meaning they are in therapy because they disagree (fight) about one of them having a compulsion to play games online with friends. He isn't finishing his second shift responsibilities, and worse, isn't coming to bed at night. Every night is Christmas, up late waiting for an online Santa to lose.

Competition rocks, really raises those endorphins.

At the end of the DSM-5, page 795, we find a new disorder proposed for further study. Internet Gaming Disorder. No code yet.

Interestingly, Persistent Complex Bereavement Disorder is among these disorders under consideration. I have seen it in practice, had no proper way to diagnose the syndrome, other than to slap on Major Affective Disorder, Single Episode, Moderate. The patient's depressive episode felt severe, but different. Hopefully there will be a DSM-5 TR (text revised) or a DSM-6 coming up soon that includes Persistent Complex Bereavement Disorder, and provides an actual code, or number.

As you know, proper diagnosis has implications for treatment.

Not to get too distracted, sorry, but Internet Gaming Disorder, is among the conditions that haven't quite made it to prime time, are merely under consideration. But that is a big thing, implies we are certainly within our rights to warn kids, friends, co-workers about devices as starter drugs.

Here are the proposed criteria, paraphrased, for IGD, Internet Gaming Disorder.

Persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five or more of the following within a year:
1.  Preoccupation with online games, even past and upcoming games. Internet gaming is the dominant daily life activity.
2.  Withdrawal when Internet gaming is taken away, meaning irritability, anxiety, or sadness.
3.  Developed Tolerance-, needing to spend increasing amounts of time in play online.
4.  Unsuccessful attempts to control Internet game participation.
5.  Loss of interest in previous hobbies.
6.  Knowing it is creating problems in self and relationships, yet continuing to play excessively.
7. Has deceived others about the amount of time gaming online.
8. Uses Internet gaming to escape a negative mood.
9. Loss of relationships, jobs, or academic opportunity and success, due to Internet gaming.

Note: The above applies to nongambling Internet games, and does not include required professional use and is limited to gaming, not other recreational or social, sexual sites.

We will be asked to specify the severity, mild, moderate, or severe.


I, for one, am grateful that my particular obsession, blogging here, is back. Only yesterday Simon and Schuster sent me a book that is likely to roast everything we therapists do, Promise Land, My Journey Through America's self-help Culture, (note the grammar), written by a woman who has been through many different types of therapy none of them good. and probably is going to tell us that Everyone Does Not Need Therapy. Could be, but it sure feels that way.

I'm looking forward to reading Jessica Lamb-Shapiro's amazing read. The reviews so far are amazing.

Light reading, as opposed to the DSM. And let's talk. Until you've been to six AA meetings and hate them all, can you really say that AA isn't for you? Same thing with therapy.

Six therapydocs and you have the right to complain.

I'll get to it this weekend.

therapydoc

Saturday, December 21, 2013

Blogging (Writing) and Reading, Even When You are Grieving




First, I apologize for blogging so rarely the past six months. We say that writing can be therapeutic, but you do need a certain amount of neuro-transmitters, endorphins, serotonin, zipping around upstairs to put out. 

But that's going to change. After all, I've studied the new DSM 5
DSM 5
and there's much to say about diagnosis.


 Yeah, it was expensive.

But mainly because time heals.  I'm beginning to notice things again, like in the old days, when something, any random thing, would happen and I would tell FD: I must blog about this. That's happening again.

The job, when a parent passes away, as any therapist will tell you, is to grieve, but also, to get out there, be in the world .When you're running on empty, that can be hard. So for some of us the best therapy is to sit around and read, preferably in some yoga posture, learn new things. Or listen to the radio, watch TV.

Listening to NPR last week I heard two journalists talking about books that might make nice holiday gifts. Below are a few of my own suggestions. If any of you have others, chime in. They don't have to be all that educational. Nothing too violent, and really, no gratuitous sex. Emphasis on gratuitous.

My thinking, read to yourself or maybe even better, to someone else. A personal favorite, The Ugly Duckling.

If alone, and you're choosing from the the National Public Radio lists, be careful about the late night thrillers.
Where'd You Go, Bernadette?
The books below won't keep you up, guarantee, with the exception perhaps of  
Where'd You Go, Bernadette: A Novel Maria Semple's novel is wonderful, you'll read it in one sitting.


Blind Spot and the Harvard Racism Test
Just in case you don't think you're a racist, think again. This book not only teaches you everything you need to know about improv, but about our unconscious biases. Blind Spot

We've talked about John Elder Robison's book, but if you're new here, check it out. A man realizes he has Asperger's Syndrome and rises to success in spite of it. Asperger's is now officially on the autism spectrum, no longer a disorder unto itself.
Look Me in the Eye



Look me in the eye 

 Mr. Robison's brother, Augusten Burroughs writes about everyone's favorite drug, alcohol in DRY.



 Product Details
dry

And because you can never read enough about BPD . . .



Borderline Personality Disorder in Adolescents




A patient just the other day asked me, literally, "Is happiness just a myth?"  I had to flash the book at him and say, "Unfortunately, yes. But it is a nice myth."
 The Myths of Happiness

The Myths of Happiness


Men on Rape 
What you'll find fascinating about this book, and you may only get it used, is the treatment of language, how men talk about women, how they talk to women. Talking tends to be something we don't think about nearly enough.Timothy Beneke's book has been on my shelf for years. I won't lend it out.



Monkey Mind
Daniel Smith's (300.02 DSM-5) struggle with a different disorder, what some of us call screaming anxiety.
Product Details
That's what it is like to have a Monkey Mind. Not fun.

Language of flowers

 There are so many languages, but until this book, who knew that sending yellow roses means something entirely different than sending red or white roses. This book is worth buying for the glossary alone. It is an amazing story about foster care. As you might suspect, being punted around as a child from one home to another isn't always the best thing for a person. But some survive, and thankfully, they know how to either tell their story, or write about it themselves.
The Language of Flowers

therapydoc







Wednesday, December 11, 2013

Ten Survival Tips for that Family Reunion

Well, it isn't over until it's over, but as the first snowfall blankets Chicago, most of us are settling in for the holidays, glad to see 2013 go.
First snow, not so great

A patient asked me only yesterday when it occurred to her:
"Wait! If Chanucha is over early this year, then what do you guys do during the Xmas season. And what will you do on Xmas?"
She did look worried.
Poker on Xmas

On the day of, many of us eat Chinese food, play poker, or go to the movies, which sounds good to me.

And while others are making cookies, decorating the tree, and wrapping gifts in preparation, I'll probably do what I'm doing now, wrapping up therapy with sad people. Really, confused people. The holidays are tough on everyone.

Indeed, it was a crazy pre-Thanksgiving. The games began in October, well before Halloween. People worried about Thanksgiving in November. The family reunion head games.

Every year during this season to be happy and jolly, peaceful and thankful, at the top of the list of things to talk about in therapy is the question, a conundrum really:
"How In the h__(world) am I going to deal with my (extended) family and still manage to stay sane?"
We have stress without family reunions, to be sure. Some of us would rather skip the whole thing, use the time off of work as mental health days.

But invisible loyalties are very powerful, as is the guilt that drives our compliance, our trek across town, across the country to see family, perhaps to go to church like in the old days, visit old friends. We go, brave the stress. Even if the family isn't a particularly warm and fuzzy family, it feels right being a family. And we have so much to talk about. If only we could find a way.

There could be a fairly simple (not) protocol to consider, a humble strategy. Ten points.

(1) Begin by considering what you have, as not the absolute worst thing to have. At least there is something to complain about when we have family.

I tell people to think of children who survived the Holocaust who have no memories of their parents, or very few left, and grandchildren who never met their grandparents. Nothing to complain about there. And millions, face it, lose family in one way or another. No reunion. No stress. Would you trade? Perhaps, and nobody would blame you, certainly not me. But sometimes this shoe fits.

(2) Assuming this is a non-negotiable, you are going to see family in the next few weeks and you do hold significant grudges, see if it is at all possible to forgive and forget. You may need to air those grudges out loud to many people before you go, or in therapy, or even make a list. It is good to let go of the baggage, at least try, and talking is one way of letting go.

(3) Think of it, that inventory, that list of grievances based upon real life events, as a bad dream, many bad dreams, and file the memories.  File the angry memories full of hurts into mental envelopes that represent a stuck part of childhood, when the ego was too immature to handle the stress. You're older now.

(4) If you a sibling or a parent has spurned you, reconnect with others, or maybe an old friend in the neighborhood. It would be a shame to let the past wreck the precious few days off ruin a chance to see people you like. Latch onto your allies and make believe it never happened (see above about bad dream), whatever it is you're angry about, if only for a week or so. Give yourself a break. (Talk to your therapist about ways to cope with obsessive thoughts. Or Google it.)

(5) Think. It isn't good to judge people. Human error is a part of life. We don't know the whole story, can't understand, not what happened then, maybe not even now. The motivations of others are a mystery unless we ask, and even then sometimes. The family reunion is the best opportunity to ask about those motives, to get new information, to understand people who share our DNA.

It is a small handful, that group we consider family, and they tend to be the subject of therapy. So get more information. We'll  use it. Think of it as an informational interview.

(6) The informational interview may not be possible, obviously. Being in the same room does not mean that everyone is going to just open up and talk to one another. Best to script a few conversations ahead of time. The time together will surely be more fun, if we make the effort to ignore the past and pretend everything is okay.  Make small talk. Prepare a list of things to talk about ahead of time.
"Have you tried the sushi?  It is amazing."  "How about those Bears!"
 (7) If it is possible, if time together with family does miraculously become something of an extended family encounter group, then listen more, talk less. It is likely there is a vast amount of knowledge that you do not know about the person you wish wasn't coming to Grandma's this year. For all you know, this person has been through chemo three times. Still feel the rage? If yes, get therapy.

(8) To engage someone in a conversation of the past, difficult moments in childhood, it is best to keep it general. Rather than say,
"What were you thinking when you threw me down the stairs and when you hung me out the window?"
Best to ask, 
"How was it for you in that house thirty years (whatever the number) ago?  I was so miserable. I thought you hated me."
 Even that could be too specific. Start with the first sentence, see where it goes.

(9) To avoid any conversation about the past, if that suits you better, stay busy, help out, and bring a book or a tablet. It is likely that all of the above will be mute because everyone will be glued to an electronic gizmo anyway. We live in a wonderful age.

(10) Cater to those who have personality disorders. Resistance is futile. If someone is narcissistic, you won't be fixing this. Let this person have control, flatter to the degree that is necessary, and you might be able to hear some fabulous stories, a spin on what happened that year(s) Mom forgot her birthday.

That can be difficult when the negativity, the jealousy, the anger, is palpable. Refer to all above and bring out a deck of cards, or play checkers with someone. Or if necessary, Solitaire.

Better yet, join us for poker and Chinese.

therapydoc


Tuesday, November 26, 2013

Grateful for . . .


You may know that when it's cold outside I love taking the bus. Yesterday I insisted on it because FD needed the car. He could get me to work, but not home. The bus works just fine for me.

We share one car, multiple reasons. When the weather is good FD always rides his bike. But when it is bad, schlepping one another around to stay warm, which for others would feel like a hassle, feels intimate. Let's call that auto-intimacy.

This year Chicagoans have to use the new RTA card--the Ventra. It came in the mail. A friendly city employee even called the house to encourage us to use our new cards, charge them up, fill the city coffers, put those pieces of plastic to work. This is Chicago, calling every home-owner is quite a lot of calls! We can only hope it is stimulus money paying for it.

But I never got around to activating my Ventra card, still packing twenty dollars worth of rides on the old one.
Not Ventra but not bad

And last night I board the bus, and fumble for the one I bought from Walgreens (left). As the driver pulls away from the curb I ask, “Do these still work?” Then I notice that the old card-insertion hardware is still right there and swipe my old card through the slot. 

Because Chicagoans have been known to occasionally go postal on bus drivers ( wish I was making this up), drivers are now shielded from passengers by a thick plastic divider. My driver is mouthing words on his side of the divide.

“What?” I shout, like the hearing-impaired elderly I am becoming.

“You did that like an old pro,” he repeats.  “Like an old pro.” All I hear is old.

I look up and it feels as if the eyes of the entire bus are on me, a bus chock-full of seated passengers. The only seats left are for differently-abled passengers. After sitting and listening to people’s problems all day, I don't mind standing, like it. 

At the next stop a stocky ruddy-faced older guy in a tattered blue ski jacket, knit cap, slowly boards the bus. “It’s slippery on the sidewalks!” he exclaims to the driver. He takes a seat in the differently-abled section that faces the aisle, his back to the window, facing me.

His eyes meet mine often, then dart away, as do mine. Finally, he can take it no longer. 
“I can’t help but notice your bag. . . Hines V.A., huh?"   


  The nylon Veteran Administration sack is something that neither my mother, nor I, apparently, could give away. She never used it, but I did-- large, strong, light-weight. Good zippers. My father loved going to the V.A. for his medicine, his hearing, and his eyes, the little things, even though it was about an hour away. He shouldn’t have been driving, either, in his late eighties.
 "Were you in the second World War?" I ask.

"No, Korea. Then Viet Nam. Then I joined the Foreign Service. They pay you for that."

"Wow, thank you for your service. I'd take my hat off to you but it's too cold. What do you think of the new deal with Iran?"

"If it saves lives, I'm all for it," he says, serious. "I'm for anything but war. You know they just put on a new wing a the Hines V.A. and it is full of young people missing arms, legs, all kinds of dismemberment. Wars. Bombs. Lots of young men. Women. It's a beautiful wing of the hospital. For them."

We ramble on a little more about politics, and a woman sits down next to him, captures his imagination. She looks homeless to me, has a worn carry-on bag with all kinds of bold letters warning others not to tamper with it. She reaches into another bag and finds something to munch on and I turn away, look out the window.

I hear my friend asking her, "Are you diabetic? Cuz if you're diabetic you shouldn't be eating that."

I look and see she has an  Entenmann's chocolate crumble doughnut and is feeling no pain. "I ain't diabetic," she replies. She smiles broadly at me and I smile back.

A new passenger, a diminutive woman of color, has a seat. Our war veteran immediately turns his discussion to her. He knows her. "Of course I have it!" He reaches into his pocket to grab his wallet and thumbs through the cards, finds what must be a discount card to something. In the process an ID falls to the floor and I reach for it, return it to him. The woman is thanking him profusely for the discount card and he smiles at me, thanks me.

At his stop, as he rises to go, I introduce myself, tell him I hope to see him again. He offers a warm, beefy hand and tells me his name. "Thank you again, thank you so much for picking up that card," he says sincerely. "At my age, you have no idea, it is so hard to do things like that. I'm eighty, you know."

"No problem, you're welcome. Live long and prosper, sir"

"I hope so," he says. "I'm going to the casino."

therapydoc

P.S.  Happy Thanksgiving, friends.

Tuesday, November 05, 2013

I See You, I Hear You

This post is dedicated to Bev, who always saw and always heard my mom.


Zeek and Camille 
 I've been watching way too much TV, and feel guilty because I remember telling my kids how it is so numbing, how it can get away from you, the hours. And it's the truth, more than likely, why we love it. That and looking at people who are good-looking and talented enough to make it onto television.  Our own people zoo.

Does the job. And yet, it has to stop. An hour a night is all I get, then it's back to books.
Who needs friends? One big happy family

You do learn things from TV.

After hearing about it from a critical mass, I found • Parenthood on Amazon Video, all of those old episodes about aging and not so aging hippies and hipsters, one big happy family in Berkeley, circling the hub, the deteriorating old family homestead, complete with a barn. The teenager, even the young children, are the ones who think outside the box. There's an especially adorable child with Asperger's constantly screaming the truth. "Dad just said. . ."

The basic idea is that this is a close extended family, if not a little too close. Family members are honest with each other, or they are into the second season. Sarah, who has left her addicted ex to bring her two teens back here, is less mature than her 17-year old daughter Amber (Mae Whitman, so watchable), who loves her anyway, for all of her painful parenting mistakes, perhaps for them.  Lauren Graham (Gilmore Girls) always gets these parts, the emotionally vulnerable, single mom doing the best she can , who acted out as a teenager and still behaves more like a teenager than her teenagers when she can't determine what to do. And they let her know it.

Perhaps because the boundaries in the family are so thin (everyone knows everything about anything that goes on), the ensemble as a whole fails to set the boundaries on relationships outside the family, too. Sarah lets her daughter's teacher make a play for her. Her daughter sleeps with her cousin's boyfriend.  These boundary conflicts resolve, people forgive. Somehow the power of the family works magic, even when you do really bad, inconsiderate things. When you love one another, you can do no wrong. Or if you do, nobody will stay angry for very long.

I love that. Another reason to watch television.

Not everyone is a screw up, of course, as parentified children are a big theme. At least one or two of the five adult kids have to be mature because they grew up in the shadow of the patriarch of the family, Zeek, a sixty-something Vietnam vet with a history of intermittent explosive disorder, drinking, acting out, and general cluelessness as a father and a spouse. Adam, the oldest son, had no room as a child to get into trouble; it didn't appeal.

Having no male role model worth following, the most functional of the children, Adam fit the role of real father to the whole family. Everyone looks to him for advice, and because they have no boundaries, literally plop in on him at his office to talk during his work day, not a care in the world that this could jeopardize his job.

In the first episode of the second season, Zeek and his wife, the beautiful, long-suffering, quiet, artistic, Camille, are in marriage therapy. She has finally made it clear that not only does he not listen to her, but he really doesn't see her, either. He doesn't focus well enough on her to put her in the room, to put her desires, her needs on the list of things to do.  It isn't about love. He adores her. Just can't get outside of himself enough to take her needs seriously.  His are what matter.

He either changes or she's through. In either case she wants to sell the house, travel, get away from the children on occasion, buy a condo, really live that last chapter of life before they are too old to live it. Zeek won't even talk about it.

After awhile, because of the therapy that he hates so much, he realizes that he should pay more attention, should look at Camille, and he does. He can even say it, undoubtedly the therapeutic homework, the intervention. I see you. I hear you.  And it is a beautiful thing.

I liked it as a marital therapy technique.  When a partner isn't hearing, isn't seeing, the other partner should offer a blank stare, or a raised eyebrow that somehow communicates the problem, You're not seeing me, and the errant partner does a My bad.
 I hear you. I see you.
Beautiful, but not so beautiful that it should make me cry, particularly.  Then on Friday night, we're dressing to go to a friend's for dinner, a couple we haven't seen in quite awhile. I put on a pair of my mom's vintage earrings and a jacket she used to wear, not that I could remember her wearing either. But she took them with her to the retirement center after my father died, after we sold the house, our homestead, and she certainly couldn't take everything. So these things, these earrings, this jacket, made the cut. She valued them.  She wanted them to be with her even though she wasn't dressing much to go out anymore.

She must have worn them in her sixties or seventies, but honestly, for the life of me, as I put them on that Friday night, as I marveled and struggled with the backs of the earrings, had no recollection ever seeing her wear them.

I heard her, for sure.  You couldn't not hear my mother. Not because she was loud, but because she didn't say everything on her mind, so what she did say you heard.  When she talked it was deliberate, focused on a goal, something important, something that bothered her, or she was asking you about you.  She was never gossipy, unless a person bothered her, and that happened on occasion, and she had to work that out, even in that last year of her life. Abandonment issues. Who doesn't have some of those?

Intelligent, insightful, I wanted to hear her as an adult, not so much as a teenager, a common thing, we now all know.  But if you don't listen during one chapter of a person's life, they assume you aren't listening even when you are.  Unresolved issues. (Who doesn't have some of those?) She probably had no idea how much I valued what she said. When I told her I valued her opinions, when I told her how smart she was, she didn't believe me (although I could tell she considered it).  This is true humility, a character trait that breaks my heart.

Anyway, in that hypmanic episode, the kind that happens to so many of us when we are experiencing a life-changing event, in our case the trauma of parent-death, which is life-changing in so many ways, I hauled off from her apartment* with about a quarter of her clothes and much of her jewelry, brought it all to my own closet, and am now in the process of going through things.

Why can't I remember what she looked like in her beautiful clothes?  I didn't see her.

It kills me.

therapydoc

*We did the move a month and a half following her passing and I hardly worked, which was good for all of us, frankly. I put up a blog with her art and her furniture, her vases and creamers, and the kids chose what they wanted. The movers made four stops, five if we include the move from storage to Atlanta last week. (Yes, it IS possible to get things out of storage in a month, but it isn't easy.)

It could have been an episode out of Parenthood, the move. Maybe it will be. When I wasn't boxing up her things, I was boxing up files from my office. To complicate things, during her illness I had added a second office location, rented it to be nearer to her if she needed me. Turns out she would not.

Another disorder that never made it to the DSM V: Multiple Moving Disorder.

vintage jacket

vintage earrings 



Tuesday, October 29, 2013

Why We Have Sex

We're always saying it around here, sex is marital glue. But it isn't always.

New study, University of Toronto, published in the Personality and Social Psychology Bulletin, summed up in last week's WSJ. Worth a look.  What you learn:

We have two ways of dealing with this particular bodily function, sex.  We participate because either:
(1) we want to feel good, make our partner feel good, or
(2) we want to avoid a bad feeling about ourselves or about our partner or relationship-- the negative consequences of not participating.

Whereas it might seem that our motivations to approach or avoid are relatively circumscribed and few, a previous study at the University of Texas (2007) found 237!!! motives to have sex, everything from spiritual closeness to the Old Mighty to retaliation for a partner's affair. That retaliation could be sex with the partner, or with someone else. These are mind-boggling motives no matter how they shake out, and great fodder in therapy, they reveal so much about us.

There probably really are precisely 237 reasons to have sex because the Texas inquiry had to be qualitative, meaning social scientists interviewed enough people for a long enough period of time to literally saturate the category, reasons to have sex.

And we're not even talking about the reasons for not even bothering with sex, another study altogether which surely would include the intimacy fears-- those fears of exposure, annihilation, suffocation, rejection, etc.,-- as well as our personal mental status problems, i.e., depression, and let's not forget our physical laments, marvelous, valid, at least for awhile, excuses-- as in menopause, peri-menopause, pain, fatigue, hunger, etc. Such are among the reasons we literally, physically, but mentally, too, avoid having sex.

But avoidance in the University of Toronto and Texas studies is about avoiding psychological thoughts and feelings by having sex, not physically avoiding it.
See how confusing it is to be an academic?
The University of Toronto team divided responses into two categories. Self-motivated or partner motivated reasons for having sex. (Interesting that sex becomes the object of a preposition, not a verb here, and we're always saying that love is a verb.  Self-motivated and partner motivated reasons look like this. Try to figure out which are which:
If I do it, I'll start my day out right.
If I don't do it, he might find someone else and I'll be alone.
If I do it, he'll start his day right, and I want him to feel good.    
If I don't do it, he might think I don't really love him, might even look for someone else.
It isn't easy, sorting all of this out.

And yet, two basic, important findings:

(a) Partner motivated approaches are the most telling predictors of couple satisfaction. So it's okay, you see, to be selfless to a point.
(b) Whether or not it is for me or for my partner, if the reason is positive, there is higher relationship satisfaction overall. You feel like a better team.

That's the marital glue we're talking about.

It also means we shouldn't be having sex for negative reasons. (Obviously, the reasons are always wrong in any type of sexual abuse that isn't consensual or in which consent is coerced). But to make a seemingly good relationship (we have sex!) truly good, much better, the job would be to work out the negative reasons. Work them out and the relationship is more emotionally intimate.

And when that's how it is defined, truly emotionally intimate, it likely that sex will be marital glue. I would go so far as to say, only then.

I'm truly grateful for that study, because it makes it much easier to explain to my patients.  I mean it.

therapydoc


Sunday, October 20, 2013

Bullying and Suicide


Rebecca Sedwick, suicide victim of bullying

People are pretty disgusted by the news of twelve year-old Rebecca Ann Sedwick's suicide jump from a tower at an abandoned concrete plant in Florida last month.

On Monday, the county sheriff, Grady Judd took a hard stand and charged two Lakeland teenage girls, 12 and 14 (12 and 14!) with felony aggravated stalking. Bullying, technically, isn't a crime; it is something kids do. But aggravated stalking is an adult crime across the nation, and juveniles can be just as guilty as adults.

Who stalks? There are many reasons, and we'll discuss them below, but the behavior seems to be generated by either insecurity or sociopathy.  Those fearful of abandonment take matters into their own hands and punish the ones who try to leave. The sociopaths or almost sociopaths, are criminal-- they have no remorse, no guilt for the harm they cause. Sociopaths (legal determinations) are often diagnosed with personality disorders, antisocial personality disorder at the top of the list. Some are children.

Even after the suicide, the older of the two young adolescents continued to write cruel things about Rebecca on Facebook.

"Yes ik [I know] I bullied REBECCA nd she killed her self but IDGAF [I don't give a f***]"

That threw the sheriff over the top, determined the felony charges.

Heartless. How does a kid write such a thing!? Does this kid need therapy? Undoubtedly.

And to think I just told a mother of a bullied child last week, "I like working with kids like yours, with the victims. The kids seem to like therapy."

What I don't mention is that victims are easier than the perpetrators because they don't have the attitude, the resistance, the disdain for authority. So they are easier clients. Merely depressed as hell.

Now I feel bad for implying I don't even want to work with the bullies and cyber stalkers. It isn't all their fault. Aggression doesn't happen in a vacuum.  Bullies are usually victims, displacing their own anger, no matter the cause, often unconsciously, onto someone else.  Displacement is a psychological defense, protects our fragile egos. Being young, these kids have time to work on their identities.* It's what we do in therapy.

Most of the time, too, aggressive behavior is easy to reverse -- a little anger management and family therapy and the kids are giving workshops to their friends. That has to be woven into the new bullying laws, the family therapy part.

When it isn't displacement, aggression is likely to be transgenerational, passed down generation to generation under the guise of domestic violence or child abuse. It is usually learned, and in some families considered normal.  They all have tempers in our family.  Every therapist has heard that one.

There's research that tells us a predilection toward violence might be caused by a birth accident or the lack of the empathy gene.  Wonderful people have difficult kids, and their parenting doesn't necessarily pay off.  We need more specialists, more research to help them.

This new sociological darling, bullying, or cyber bullying, cyber stalking, concerns us because now, more than ever before, suicides are mounting. We don't know which causes are the most likely, but in Rebecca's case the lead tormentor apparently learned the behavior.

Caught on camera, Vivian Vosberg, the step-mother of the "bully ringleader," is pummeling a boy in her home. A group of children laugh, push. Chaos ensues, noise, a scuffle, and all the while, someone is manning the cell, the video cam.

She's been arrested on child abuse charges, sent to jail, and her daughter, the cyber stalker quoted above, is supposedly in state custody. Ms. Vosberg claims she was merely breaking up a fight.

She is only thirty years old, looks like a teenager herself, and her neighbors are talking about her as a bad role model, blaming her for her step-daughter's behavior, no matter what really happened or what triggered her behavior on tape. It would be nice if Ms. Vosberg would tell the press more about her stress, more about why she hit that kid, and more about her trouble with her step-daughter. As it is, she denies the child's role as a cyber stalker. She needs to become a part of the solution. We need one.

If she won't own her part, the lesson for her step-daughter is that old adage, See one, do one, teach one. Many children joined in the stalking but they didn't have the audacity to continue the abuse after Rebecca's death. This kid, Vosberg's step-daughter, needs more attention, more of an intervention than the rest.

Meanwhile, Rebecca's mother, Tricia Norman, knew there was a problem, tried to help, but laments that she couldn't do enough. She pulled her daughter out of school, home-school her, then arranged a transfer. Still she couldn't protect Rebecca.

Probably because cyber stalking is a crime without walls, and continues even after the stalker stops talking. What is written on the Internet is permanent. The tragedy is that Rebecca believed herself worthless. She believed what those young girls wrote on her wall.

Her mother told reporters:

"She would come home every day saying she's not worth anything, she was ugly and stupid," 

Rebecca heard it from ten or more children, was verbally taunted, physically abused, beat up. Repetition makes its mark. It's hypnotizing.

Her mother made her delete her Facebook account but after Rebecca's death found messages on the child's phone: "Nobody cares about you," "I hate u," "You seriously deserve to die."

Mother tells reporters:
The effect of such abuse?  She started cutting, left pics of cuts on her thighs, cuts her mother had never seen, and pictures of herself lying on the railroad tracks, waiting for the train. 
Tricia Norman blames herself for not doing more to help her daughter. I want to tell her not to, that the problem is epidemic. The violence in our culture defines our culture (see Saturday's WSJ, Are the Streets Really Paved with Gore). When kids witness violence in the home it reinforces what is seen in the movies and on television, YouTube, everywhere.

Therapy might have helped, for sure, but a socially isolated child is at risk, even while in therapy, when systematic, repeated, mental, verbal, and physical abuse has torn down, whittled away at the will to live. Without friends, at any age, we're miserable, feel we're better off dead.

Just one more jab will do the job.  And we can't control all of the jabbers.  Children, the old saying goes, are mean. They have their reasons.

What to do?  Identify them early. Intervene early. Call the parents of your kids' friends, the ones who hurt them. Programs in schools have work to do, and should include discussions of the media, the lessons learned watching.

We need to establish interventions for bullies-- suspensions, amends to the victim, group therapy in the school, family therapy at a local agency, and legal proceedings to add some teeth to the solution. Keep that therapy alive for at least a year, make that two.
Then maybe we'll find out what young people like Rebecca Sedwick have to contribute to our society. My guess is, something special, given the chance.

therapydoc

*We're starting to see that intractable, violent personalities, kids without empathy, are recognized in early childhood. They are a minority. Most of us take quite awhile to decide who we are, who we want to be, and may be well into our twenties before we begin to really become the people we hope to be.

Monday, October 07, 2013

Celestial and Cerebral Reunions

When patients come to me distressed about a recent loss, we go through the process of differential diagnosis because there are many types of depression associated with grief.  At some point we get right down to facts:

How we grieve, or bereavement, is beyond our control. We're powerless for the most part.  Crying, tearing up, feeling adrift, lost, disengaged from the rest of humanity-- is a natural response to having lost something of tremendous value, something, someone, that we cannot see anymore, can't feel, touch, hug, cherish, even care for anytime soon, maybe ever.  It is especially natural when the object of grief was complicated, difficult to grasp, or the relationship suffered strain and miscommunication.

I received email yesterday from Mario Trucillo, a doctor under the assumption that I'm a caregiver by trade. He asked for a link to his blog, The American Recall Center It's about FDA recalls

I'm put in the context of caregiver (maybe he didn't read very carefully) because for the past few years, before my parents passed away, I lived closer to them than my brother and could drive here-there-and everywhere, take care of a few daily needs. But technically, I'm not a caregiver.  Even while performing some of the tasks of that job, I always considered myself a daughter, my brother, a son. Caregivers are people on a much higher level.
Proof of Heaven? Maybe

But let's get back to bereavement and tears. It may be American Health Literacy month (according to Dr. Trucillo) but we don't have to stick to what has been found empirically evident.  We can hypothesize, too.

Some people cope with loss by assuming there is an afterlife complete with heavenly reunions.  Sci fi, to me, but my cousin in Israel, hearing about the loss of my mom, wrote:
"Now all of the cousins are together." 
I have to write to her, now that I'm finally getting to thank you notes. It is comforting to her, the thought that our mothers are together now. Just hearing from her is a comfort to me.

Lesson learned: always reach out to your friends, even to random people you know who have suffered a loss.

But something may have been lost in the translation. The thought of heavenly reunions unfortunately, doesn't work yet. A close friend advised a book,  Proof of Heaven: a Neurosurgeon's Journey into the Afterlife by Eben Alexander. I started it yesterday. So I'll let you know.

Moving right along. The DSM V, that new edition, is a wiser 941 page tome of diagnosis than the last.  It required much more concentration than I've had, lately, but it seems, that like its predecessor, bereavement is still a differential diagnosis.  Clinicians are encouraged to especially whether or not a diagnosis of major depressive episode ought not be considered, depending upon the circumstances. We're to take weight loss, insomnia, intense sadness and rumination over a loss very seriously.  Not necessarily just bereavement, in other words.

I don't know if I've said this or not, but I never expected to be grieving my mother, not this much. Denial, obviously.  But I felt that my mother and I had such a good relationship, that there was nothing unresolved, nothing to make a simple matter like loss so difficult.

What happens is that the brain has so much of our lives packed into our central processor,, amygdala and hippocampus, not to mention the cerebellum, basil ganglia and motor cortex, that we can't begin to predict such luck.  What we can predict is that when we have been ultra-involved with our parents, their go-to people as they age, memories will be vivid.   The flashbacks accessible, palpable, real, we become aware of all of the things we could have done to make them more comfortable. And the guilt-- what we should have done for them, as opposed to the little we did by comparison, is unrelenting, as are the thoughts.

Air them, naturally, and they do relent, recede. This is what friends are for.

We can always be a better . . . A nice little PhD thesis for one of you:
The degree of our involvement with a loved one before death will predict the intensity of memories and magnitude and frequency of flashbacks in the first months after death. 
You could use a hired caregiver group as a control, make up your own hypotheses. Other variables matter, too, type of relationship, cultural expectations, external support, income. It is likely, no matter, that if we're a go-to person, almost anything will remind us of the person we lost.

Major Affective Disorder with Depression, sure.  But repeated exposure and the trauma at the end of life, depending upon those other variables, is likely to be associated with Acute Stress Disorder (308.3), too. We consider it anytime there is exposure to actual or threatened death, serious injury, or sexual violation, when a patient has witnessed a disturbing or violent image, say a serious car accident (blood, dismemberment, etc.).

Memories of coma, a parent's eyes pleading for help, those last moments of life, even if they are good, are snapshots that are recorded, indelible. The DSM 5 calls this an acute grief reaction and suggests the adjustment disorders be ruled out, too. We're seeing that no matter the diagnosis, it takes work to put such memories into safe files in our brains, lick those envelopes and put them away.

I had heard about something else, this from an enmeshed patient (she described herself this way) but didn't expect it would happen to me.  Sometimes everything is vetted through thoughts of the deceased.  Nothing is interpreted without an unconscious, non-intentional, surprising, mother-coated lens . She is everywhere.

Examples:

I get my nails done, first time in three months. The manicurist is a little rough and I think, Good thing I didn't bring Mom here. She might have hurt her.

My 8-month old grandson tends to draw out one note and sing, not say words. He is a little young, we'll cut him some slack, and this is probably how we should all communicate. But he latches onto one note and holds onto it for as long as he can.  The note is loud and clear and beautiful, and I remember that his father did the same thing as a baby and that in the car I would play him tapes of Luciano Paveratti and Placido Domingo. (Today he is a part-time cantor). This thought immediately blends to the anniversary card with the crisp one-hundred dollar bill that my mom would give to me and FD each year for the opera.

I am sitting with a friend and notice her slim hands for the first time. My mind's eye jumps to watching my mother's hands and how they alternatively swelled to purple and blue, sometimes responding to cold or heat, sometimes merely her crazy electrons, completely out of whack.

On those Jewish holidays, just last month, on the holiest day of the year, when the liturgy is especially beautiful, I hear her voice in my head as if she is on my right side, singing in my ear as she did when I was seven!

Last week FD and I visited our kids and grandkids in Atlanta, and waiting on the curb for our ride to the house I think, I have to call my Mom, tell her we're here, arrived safely.  What used to be an obligation, and I think this is the real kicker, is something I wish I could do but no longer can.  My solution is to talk to her anyway, the mock call, an intervention suggested to others.
Hey Mom, we arrived, how ya' doin'?   No, waiting for them to come and get us.  Sure, will call you tomorrow.
Not to mention that one of her great-grandchildren looks like she did as a child.

I find it hard, a one-way call.

Then, on the return to Ohare, in the terminal waiting for FD to deplane I think, Well, that was a nice trip.  Haven't flown since (my son)'s wedding in May.  And this immediately signals the thought that she wanted so badly to go to the wedding and couldn't. And although we set up FaceTime for the ceremony, and she spoke (via an Iphone recording) to the 200 plus guests at dinner, it wasn't enough. She was angry, upset about missing it.

But if you were to ask me how I'm doing I would have to say, Fine.  This isn't a bad thing. The real diagnostic data that matters is functioning, and fortunately, robot that I am, that many of us are when it comes to work, that's still there. Focusing upon others is a natural distraction.  As is Modern Family.

However, if you're taking out a friend who is going through this sort of thing, stages of grieving, just saying, maybe you are going to lunch or to the cemetery, wherever, you might want to be the one behind the wheel of the car.

therapydoc


Sunday, September 22, 2013

Mothers Who Can't Love

Only weeks ago, maybe between my mom's lapse into coma and her last breath, not sure, I found a book in my mailbox:  
Mothers Who Can't Love: A Healing Guide for Daughters, by Susan Forward, PhD
I tossed it into the Get To This One Day pile. Found it yesterday, buzzed right through. Thank you Harper Collins.   
I'm talking to FD about someone we both know, and he asks, "Why is he this way." I suggest a particular parent-child dynamic, only confuse him more.

"How do you know this?"

"Because this is what we do in my profession, look backward to parents, how they treated now grown/adult children as children. We look for clues. In your profession history helps, but the lab results and the vitals tell more. For us, history is everything.

It didn't hurt, I confessed, that the subject of scrutiny, at someone else's visitation, talked about his father. From this it isn't hard to extrapolate, suggest broad strokes about personality and behavior.

"Oh," he says.

Keep in mind that there are all kinds of genetics that play into personality and behavior. Yet, it is this relationship cause-effect, or psycho-dynamic diagnostic that explained why it took so long for me to write a eulogy for my mother.  Her attributes meant nothing unless I could tell over the why. To me it was the what made her this way that mattered.  In the months of her illness I obsessed about her childhood and how what she experienced in those formative years affected her as a woman, as a mother.

It didn't help that she demanded to hear the eulogy before she died.  She really wanted to edit it.  She edited a few drafts, but it was the sixth that came to stage. We assume she loved the whole show.

One day you'll hear those stories, how my mother loved to love people, to show a smile, how everyone loved her, couldn't help it. Oh, just one. One of my sons went fishing with my father and his friends and one took him aside.  "Let me tell you something young man. Your grandfather is one in ten-thousand. But your grandmother?  One in a million."

But this is a therapy blog so let's move on, talk about the antitheses.

Dr. Forward does a magnificent job describing mothers who can't love, certainly can't show love, those who make adult children cringe even when they know, perfectly well, that they are no longer children, should not be stressing, reaching to cope, spending so much psychological energy and time on a mother.  She suggests ways to set boundaries on moms who enmesh, control, criticize, and otherwise weasel their way into our brains.

Face it.  It is all about the boundaries.  It is all about, "You, mama, have more to lose than I have. You have already made my life ridiculously unbearable. The party is over."

Dr. Forward suggests letter writing and non-defensive communication, above all else. And sometimes, time off from the relationship altogether.  I don't think I ever labeled retorts to critical mothers as non-defensive communication, but surely, this what it is, it is the way to go. Never give mothers like this more fuel, more of an edge.  When we defend it is as if there is something to defend, and with mothers who can't love, guess what, no one needs to defend against their negativity. Their bad.

A short list of simple non-defensive responses to criticism, accusations, complaints demeaning comments, and negative untruths. Parentheses mine:
Really? (add a raised eyebrow)
I see. (sage nod, try not to smile)
I understand.
I'm sure you see it that way.
Practice these in the mirror or with others. If you want to go on the offense, restrain yourself, although I've suggested staging grand behavioral hysteria, falling on the floor, holding your belly and laughing until tears come out of your eyes.  Some of us have to emphasize the absurd, and it works. Dr. Forward would surely concur.

She uses lists-- You make lists.  (a) The lies the mom tells, (b) The truth that really is.
(a) "You are selfish."
(b) "Actually, I'm not."
There is also an adult daughter's Bill of Rights. An abridged version:
You have the right to not take responsibility for anyone else's problems or bad behavior.
You have the right to get angry. (Susan Forward is particularly good with anger)
You have the right to say NO.
You have the right to protest unfair treatment or criticism
And Dr. F suggests Position Statements.  I love this.  When a parent crosses a line, makes you feel uncomfortable, reinforce the boundary with a clear, direct, redefinition of her power and what will no longer describe your response.
I am no longer willing to...
I am willing to...
It is no longer acceptable for you to. . .
I issued a position statement to my father, professionally bullied him many years ago.  I was in my thirties, he must have been mid-sixties. Now I have mixed feelings about it, years later, although I still tell the story. When his grandsons, my twins were about four or five, one of them, when frustrated, would shoot out tears. Annoyed by this my father mocked him at the kitchen table. "Cry," he teased.  "Babies cry."

I looked at him, glared, and asked, "Are tears BAD, Dad?  Because in my profession, we don't think so.  If you make him feel badly for crying, if you continue doing this, then we won't be visiting. So please don't."

That was a Position Statement.  He apologized and never did it again.

I miss my father, and wish, instead of bullying him, I would have simply, sincerely asked, "Did your father mock you when you cried?  When?  How did you feel?"  We do remember things like that, you know, those snap shot memories of trauma.

That would have been productive, too.

therapydoc


Monday, September 09, 2013

It's Going to Get Worse Before It Gets Better

In my defense, I was tired. I had been up since four on Labor Day, although I napped, and to prepare for an upcoming Jewish holiday threw together a few chalahs (those breads Jews make for the Sabbath and holy days, shiny and twisted), one carrot cake, two blueberry, and four sheets of chocolate chip cookies.  For a change, it all turned out well, not a burnt morsel, nobody fell.
West Wing on Mourning

FD and I colluded to tackle a closet and made considerable progress. You know what that means. You label what should go back in, and most importantly, throw a great deal away.

At 8 pm, paralyzed, the TV beckoned, I succumbed, chose vegging and watching to reading the new DSM 5. Nothing appealed on the tube so I turned to The West Wing on Netflix.

To me, it is new, although a well-respected patient had recommended it years ago when there was no time, no inclination, for television.  My luck, I pick a Christmas episode (In Excelsis Deo) in which Leo McGarry, White House Chief of Staff, is about to be outed for having had a Valium addiction when he was Secretary of Labor.

"It is going to get worse before it gets better," Josh Lyman, his young deputy tells him.

And maybe it will. I'm still in the first season reruns.

Meanwhile, Mrs. Landingham, the President's secretary, tells Toby Ziegler, Communications Director, that she's sad because on Christmas she thinks of her two sons, killed in combat in Viet Nam in 1970. A minute later Toby takes a call from the police. A homeless man found dead in the park has Toby's business card in a jacket pocket.

"Is he a friend of yours?" the detective asks Toby.

"No, but he's wearing a jacket I donated to the Vets.  My card must have been in a pocket. Sorry I can't help you."

Cleaning out that closet, one of the things I found was a bag of clothes put aside to give to the Vets. Irene from Purple Heart calls me at least six times a year to see if there's anything to give away. There is always something to give away.

Toby doesn't recognize the body but feels he must do something for the dead man wearing his jacket. There is a bond. He searches out the man's relatives, finds a brother-- "a little slow" -- and determines to see that the deceased has a military funeral. He oversteps his authority and uses President Bartlet's name to make it happen, but when the president hears about it, he is unhappy.

"Do you realize," President Bartlet chides Toby, "that when this gets out, every homeless Vet is going to want a military funeral?"

"I hope so," Toby replies.

The President thinks about it, nods, and lays a grateful hand on the aide's shoulder. He gets it.

The music on the West Wing is sinfully good, and between the children's choir and the Xmas pa-rum-pa-pum-pum continuing throughout the snowy funeral, and Mrs. Landingham (Kathryn Joosten, Mrs. McCluskey of Desperate Housewives) telling Toby to wait up, she wants to go to the funeral, too, I'm in a million tears and hunt down FD to tell him that I have stupidly booked my whole day tomorrow, between babysitting and really working, and Wednesday, too, because distraction helps, but now I want to go to the cemetery to see how my mom in doing instead. She's been there a little over a week, after all. She is surely upset with me.

Although she knows the trip out there is going to kill my back.

I'm worried, that this could get worse before it gets better.  Best to watch less TV, maybe. No, watch more! When television is best, it inspires us to be better people. That episode of West Wing, several that I've seen so far, moralized without ever using the word. A bit like my mother.

So the next night I watched a Sopranos episode from the third season, wouldn't you know, the one where Tony's mother dies. "Why is this happening???" I shout to FD, but make it through the show anyway. No idea what happened there except Tony's sister insists people say things about their mother at their family/friend get-together after the funeral and no one can think of anything nice to say.

In the comments to the last post, one of you mentioned that as I work my own program, that grief therapy I've been shoving down your throats for years,that I should talk about it here (or did I dream this).  At first I balked, thinking, the new DSM will prove far more interesting, and I just read The Thirteenth Tale by Diane Setterfield (amazing), and The Good Wife is starting on television at the end of the month.

They're saying, you know, that blogging is dead. But someone told me the other day, "It will make a comeback, for sure.  You'll see."

We're in the seventh year of Everyone Needs Therapy. Seven years!  Maybe it is time that I write more about myself, my life, my mom and dad, my brothers, handsome and strong, one here, one there. Something tells me that you won't mind.

therapydoc

Friday, August 30, 2013

No Bother

In my family, real life consist of communication about What We’re Going to Do.
I’m going to drop this off at M.’s, then run over to the Jewel and pick up coffee, come home, take a shower, get ready for dinner.
I’m going to pick up Safta (grandmother) at the beauty parlor, drop her off, then run to the cleaners. When I get home I’ll baby sit so that you can go to your appointment.
Stuff like that.  


During the past three years, as my mother's health declined, she lived independently at a retirement center. She rarely asked for help, although she needed it. We could anticipate her needs, but she hated that we had to meet them, so independent for so long. "Go home," she would say, when I checked on her. "Go take care of your family."

If my brother or I wanted to go to a conference (our vacations are always conferences), we communicated well in advance. Someone had to be around in case our mother needed something, in case something happened to her. We always accommodated one another, only too happy to do it.

About a month ago we had a problem. We had a schedule conflict. 

The history:

FD and I rarely leave the country, hardly ever, unless someone in the immediate family is getting married.

But in February he tossed me a pamphlet for a tropical vacation, and a conference we could both attend in the fall. We talked about it as if it was a dream, probably something we couldn’t pull off, but surely an idea worthy of serious consideration, planning.  I offered to present a workshop there, too. Never did reach the right person for that.

As my mother became unsteady it seemed unlikely, this dream. And yet. . . anything’s possible. 

Flash forward: 
  
Only a few weeks ago, visiting my mother, she seemed tired, too tired. I called my brother and told him that I had to go to work, but that she didn’t look good to me, and if he could stop in to see her after hours, it would be good.  He did and popped her into his car and drove her to the hospital. I was minutes behind. 


In the ER I happened to mention the tropical vacation and my sister-in-law jumped in to say that they, too, had a trip scheduled for the fall, same week-- overseas-- and it couldn’t be changed, the tickets, already purchased.

Oh no. 

Admitted at Evanston Hospital, the hospitalists pumped my mother full of fluid IV and got her sodium up, discharged her in 18 hours, much to my dismay and outrage. Thanks, is what I told the doctor who insisted Mom couldn’t possibly stay longer for observation. Thanks, I repeated as the young professional left the room, finished with this case.  For nothing. .

Not something my mother would have said. 

We went through a nursing home stay, then an admission in another hospital, then a discharge, knowing recovery to be unlikely.  

My mother, always the people-pleaser, passed away last week, four weeks later.  

She probably didn’t want to be a burden.


therapydoc

Thursday, August 22, 2013

Stumbling in the Man Box

I'm watching TV with my mother, who can't hear and has long stopped caring.
"Just put on Channel 7," she says.
I've learned to just put on Channel 7.  Nobody ever died of too much Wheel of Fortune.

What I find interesting is the way that disabled in so many physical capacities, she makes the best of each bad situation, even hopeless situations. So she can't hear, but she can watch.

Later on, in my home, I'm watching HBO's The NewsroomDon Keefer (Thomas Sadoski), a news producer, is struggling with his office chair. He is on the floor in his office, has dissembled the legs, the wheels, and is changing them so that the chair will glide easier. He tells whoever it is that catches him at this that he is mechanically inclined. Later in the show we see him at his desk, seated very low. He looks like a child, too small for the man-size furniture. He leans back and the entire chair falls apart. He makes the best of a bad situation, but then, he could also have asked for help.

Different scenes, of course. My mom would ask for help, although she never liked it particularly, asking. But she always did when she needed it, and helping her, as children, developed character. (After all, we did nag for the dog, even if she was the one who asked for help walking him.)

If there was something anyone could do for my mother's hearing loss the other day, she would have asked for it, but at her stage of the game, it is the least of her problems.  Don, in The Newsroom, won't ask. It is a matter of pride. He'll stumble along and make the best of a bad situation, like my mother. His situation.

As a man, Don is stuck with certain, shall we say, man-isms.  A guy can fix his own anything.  A guy is capable, doesn't need to read the instructions, either.

One particle board kit and this myth about the necessity of instructions, bites the dust.  FD, who once stumbled in the man box, refusing to read instructions, put together a cupboard for me, a great deal, too, if a person doesn't mind hauling hundreds of pounds of particle board. Even with a good dolly, there is much muscle work here.

Before this new stage of life, the one in which instructions become valuable, deep middle age, he wouldn't do that, referred to the paper and print. The challenge is in figuring out the kit without instruction, without help. But now FD reads first, during, and last. That said, he won't be buying another this large and this heavy again. We humans of both sexes  are educable.
For Whom Would You Like to Make the World A Safer Place

We learn all kinds of things, and unlearn them, sometimes.

For example, we could say that not reading instructions, not asking for help, is learned behavior. The role models of boys in their Wonder Years, the heroes, the mentors, inadvertently or sometimes consciously buy into machismo (a word on Wheel of Fortune yesterday). They learned machismo when they identified with role models, other men, usually fathers but sometimes uncles, grandfathers, or foster parents.

Therapists often hear explanations about why people parent the way they do.
"I do what my parents did.  We didn't have books.  I parent like my father parented me, and I turned out okay."
Like ducks who follow the first thing they see after they hatch from an egg, we follow our parents and early guardians, at least until adolescence, and even after that, much is cemented into those neuro-pathways. What we do, what we believe, doesn't just die with childhood.

Assume, then, that children with role-models who freely display rage, who vent to children, break walls, for example, slap, crack the chandelier with their decibels all for a bad report card, model violence.  The role model might say that it is all for the cause, the edification of the child-- grades are important--they mean so much--but it is what it is.

So I went to a conference about stopping violence, always relevant.  I go to as many workshops like this as I can because some of the presenters are so incredibly talented and I always learn something. This one was presented by Up2USQSI.  You can find them on Facebook. Strangely enough, while visiting my mother in the hospital a few weeks ago, a rabbi stepped into her room. I thought  saw her there.

Rabbi Eileen introduced herself and began to discuss my mom, kind enough to include mom in the conversation, not talking around her. I recognized Eileen immediately as the woman who spoke up the most at the Up2Us workshop. She answered those thoughtful questions at circle time. She owned it, that she was there, in this other role, social worker, and effusively Liked the workshop, asked me if I learned anything that Thursday morning.  I said, "Why yes, of course.  The Man Box."

At the workshop, as a group, participants threw out adjectives about what it means to be a man.  Below is our Man Box. Woe to be in a box like this.  Not so good, being a guy.  I've always been thankful to be a woman, except when lifting something heavy.


The presenters, school teachers interested in changing the world, one workshop at a time, do it by teaching kids to shout out when others demean women, usually with verbal violence. They also teach professionals like me, people like us. Men don't have to identify with all the wrong things. They need not be joking at the expense of women, at the expense of anyone, and when someone else does, it can be labeled for what it is, not cool.
Not my job

I had to think, what does NMJ mean? (from the funnel), because I didn't pay enough attention at the workshop.  Not My Job, right?

But it is.

therapydoc



Making It Our Job