Tuesday, November 24, 2015

Pre-Thanksgiving Snapshots

(1) LOSING PETS, BEING LIKE PETS

Once in a while you'll see a sign on a tree, Have you seen Fluffy

Somebody in my neighborhood keeps losing his iguana and posts pictures in the summer. I always wonder, if I found him, what would I do?

But this isn't about that.

Therapists hear many pet stories. People are crazy about their animals, marvel at their better qualities, worry when they are ill, and grieve their loss. When a favorite pet moves onto the next world, it is as if a person in the family has died.

Because pets are family. They live with us, we feed them; they reciprocate with unconditional love. It is a fair deal.

My brother and I have the same memory. You tell me how this happens. He tells the story exactly the same way:
One chilly autumn morning, the dog scratched at the back door to go out to the yard. About to leave for school, I saw an accident on the kitchen floor, wiped it up quickly, then let him out. He'd been sick for months, but he was a very old dog.
My father walked in, saw me watching the dog from the window.
He looked at me, I looked at him. "We should. . ." 
We both said it at the same time. . . put an end to this. Then we carried the dog into the car and took him downtown to the Anti-cruelty Society.
Maybe both of us were there, my brother and I. Or maybe one of us told the story and the other snagged it. But that we each own it tells me we both wanted to be there.

You want to have every last minute with your pet, especially if it is a dog. Because no one else will wag a their tail at you, not like a dog, and you can't buy that loving gaze, the nonjudgemental innocence. (Well you can if you buy a dog).  We count on our dogs, we count on all of our pets, for venting, to comfort and hear our woes, listen, without interrupting.
Still a puppy, thankfully
We could learn from them.

(2) FRIENDSGIVING

Like a good pet, there are people who are always there, assuming we have cultivated friendship, not an easy thing. When the family is far away, or the thought of being with family has lost its glitter, the alternative is Friendsgiving.

If you get an invitation for one of these dinner parties, just go. The food will be amazing, everyone can cook these days, and there will likely be a break in the conversation for guests to toast the hosts and one another. Maybe you'll go around the table. The praise and thanks will be about the importance of being there for one another, providing consistency, support, help when it is most needed. Some will be singled out as endless givers in relationships.

On other days our egos are in the way. We are too busy wondering why nobody has done anything for us lately. So it is good to get outside of that, thank our friends for what they do.

The whole business, however, can get stressful, especially for the hosts. The problem is the association between hosting and physiological arousal, and two little discussed DSM 5 disorders, specifiers of generalized anxiety disorder, related to performance and anticipatory anxiety.

(1) There Will Not Be Enough Food Disorder,  and
(2) The Food Will Either Burn or Be Undercooked Disorder.

Luckily, other bloggers have addressed this problem and many other problems, so I defer to Emily Fleischaker, the food editor on BuzzFeed (the post is clean, nary a 4-letter word):
17 Rules of Friendsgiving
The best, for sure, is number 17, Don't Tell Mom if You Like It Better than Regular Thanksgiving.

(3) SUPERGIRL
CBS new SUPERGIRL


Spoiler: She zaps the turkey because her mother worries it might be undercooked.

Everyone is afraid to tell everyone else that they watch SUPERGIRL. But they do. Test this theory this Thanksgiving, or Friendsgiving, whatever. Nobody will mention SUPERGIRL outright when the conversation turns to TV talk. But when you bring it up, just wait and see. You are not alone.

Maybe we don't want to appear too geeky. Liking a show that is campy, soppy relationship-wise, female-centric, has special effects and a drag down, knock 'em dead, but don't necessarily kill the bad guy scene in every show, plus throw-back costumes out of a comic book, maybe isn't cool. Who reads comic books?

Um.

Geeks know that fantasizing, and watching or playing fantasy games, can be a healthy coping strategy. (Until it isn't).

But assuming you're not the addictive type, if you can't wait for the new  Star Wars movie, catch an episode of SUPERGIRL on CBS. The first minute of each show will fill you in on the backstory.
DC comics Supergirl
As if you didn't already know it.

(4) WHEN THE NEWS IS SAD AND BAD

The news, unfortunately, is hardly ever good and it is often sad. Therapists warn against too much of it, too many headlines.

We didn't need Paris to know that terrorism is bad news, and that it is closer than we think, a real international threat.

Years ago, after one of the college massacres here in the US, some of us blogged about the way that Israelis handle security. They have had more than their share of suicide bombings on busses, in malls, pizza shops downtown. For years no one has walked into a school, an auditorium, stadium, shopping center, even coffee shop in Israel without first having their bags checked and bodies scanned with a wand.  If you live there you don't complain about these measures, not at the airport, not anywhere else. Soldiers are usually posted everywhere, and they are awake and armed with rifles, anywhere people might congregate.

Do we need that? Yes, we do.

I think that it will be hard to be happy this Thanksgiving.  I think we will all be wondering when and where the next ISIL attack will be, how many will be killed. Will we know a victim? The moment will pass, of course, the discussion will be over, and we'll get back to dinner and talking about shopping, movies, and of course, TV.

In Israel the war on terror is becoming more personal, more challenging. The Palestinians, despite grabbing attention for not having a country, live there, in Israel proper, not just in Gaza. And now anyone can be a terrorist, no professional training or expensive equipment is necessary. All you need is a car and a knife. Not even a car. Just a knife. Everyone has knives, our most primitive tools.

Ezra Schwartz, stabbed by a terrorist in Israel
Ezra Schwartz, a United States citizen from Boston studying in a yeshiva, was stabbed to death last Thursday. He was  delivering food to Israeli soldiers. Young Ezra is describe with
boundless energy,” capable of “making friends with anyone.” From mentoring his siblings to spending quality time with his grandparents,Schwartz was remembered for earning the respect and love of all kinds of people — “kids with little quirks and idiosyncrasies were his specialty,” according to Schwartz’s grandfather.
He was eighteen.

Hadar Buchris, stabbed by a terrorist in Israel

Yesterday Hadar Buchris, a female Israeli seminary student, also a child, 21, suffered multiple stab wounds to her head and chest while at a junction in the West Bank. She died in Shaare Tzedek hospital, a victim of this new knife intifada.
"She was a very talented theater student and a successful comic who always created positive vibes around her friends, . .. She was also a kind of 'psychologist' who would lend a sympathetic ear to whoever needed it.
This has been going on for a few months. It started with Palestinian drivers ramming cars into crowds of people at bus stops, or in train stations, hoping to kill pedestrians. They are succeeding. The drill works like this. After the car hits the targeted group of innocent civilians, the driver gets out, grabs his knife from the front seat and runs off, stabbing and slashing as many people as he can on his way to escape. Attackers are usually shot by soldiers or police, so it is really a variation of a suicide-homicide attack on Jewish citizens.

There used to be rules about war. You didn't go after civilians, the elderly. Children.

The Israel Defense Force posted on November 18:
A year ago today, terrorists entered a Jerusalem synagogue during morning prayers. Armed with axes, meat cleavers and a gun, the terrorists murdered 5 worshippers and a policeman.
That happened again, as men left afternoon prayers in Tel Aviv last week, praying for an end to sickness and war. 

Lital Shemesh (below, or watch her video on FaceBook) tells us:
In just two months: 7 shootings attacks in Israel, 51 stabbing attacks, 13 car ramming attacks, 51 rock throwing attacks. It's time to speak up against terror.
Nobody knows what to do with this kind of terrorist, the one that appears out of nowhere, sometimes a he, sometimes a she. The hatred is the same hatred that drives young men in Brussels to step out of taxis in Paris with loaded guns wearing suicide vests. It is the same kind of hate.

Meanwhile, the FBI reports that the majority of the hate crimes in the United States are against Jews.

How can we stay happy? Should anyone be happy when there is so much anger and hatred in the world?

Of course we should! We have to try. I went to a funeral today for a Holocaust survivor. People in the camps tried to stay happy and they were literally starving. We are most alive, you know, when we are happy.

Happy Thanksgiving friends. Try not to let it get you down. Don't let the news ruin your holidays. Don't cancel your plans to visit Israel, if you have them, for there is much to learn there. Don't let them terrorize you, not here, not there, not in the USA or England, France, Turkey, Argentina, Canada, Japan, Malaysia, or wherever you are. It really is what they want.

Escape it with the likes of SUPERGIRL. Or quality time with the people you love. Take the dog for a long walk, good for you, good for him. Or sit down and write to your congress-person about more security. We're going to need funding for guards in public places.

therapydoc




Friday, November 13, 2015

Hoarding, Mess, and Barry Yourgrau

I want to think that everyone has a closetful of plastic bags.
Barry Yourgrau's MESS, required hoarder reading


The city of Evanston banned plastic grocery bags, the ones we see caught in the branches of trees, if we look up. The good news is that we can now choose between a bag made out of tougher paper (they still break) or new sturdy, shiny plastic bags that talk.
Recycle!

We're supposed to bring them back to the store to use them next time.

This never happens. They remain in the trunks of our cars because who can remember to shlep something out of the trunk of the car to shop? But the thought of reusing things is nice.

Chinese gift bags

The cynic in me thinks of an Iranian relative somewhere on the family tree who made his fortune many years ago in the shopping bag business. Smart guy.

On a recent vacation, I found the shopping bags in China so crisp, new, and easy on the eye that throwing them away proved challenging. I paused before giving gifts to relatives. A voice inside whispering,  
Keep the bag.
It shouldn't hurt to throw things away, but the illustrated panda and the fortune-cookie script in Chinese-- priceless. Such things keep memories fresh, like photographs, but not being much of a pack rat, seeing the bag is wrinkled, it is history.

Similarly, had there been two panda bags, only one would have made it to  the closet with the good bags in the first place. (closet not shown).

Let's get serious and take a look at the features of Hoarding Disorder to determine what is pathological, what is not. Because lately, a lot of people are nagging other people to get rid of perfectly good stuff. 

Hoarding Disorder (F42) DSM 5 (not word for word but close, page 247)

A) Persistent difficulty discarding or parting with possessions, regardless of their actual value.
B) The difficulty is due  to a perceived need to save the items and to distress associated with discarding them. 
C) The difficulty discarding possessions results in an accumulation that congests and clutters living areas and substantially compromises their intended use. 
D) The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment).
E) The hoarding is not caused by another medical condition, such as a brain injury, or cerebrovascular disease)
F) The hoarding is not better explained by the symptoms of another mental disorder.
We're to specify if there is excessive acquisition, and if insight into the condition is either good, fair, poor, or delusional. 80-90 percent of this clinical population fit excessive, most with hoarding spending habits. But many of us hoard freebies, like gift bags. Few steal. 

The word persistent refers to a life long condition, not having acquired an inheritance (a garage full of incredible stuff). Most hoarders believe in the value of their possessions. Many are simply sentimental fools. There are combinations.

Also a feature of Obsessive Compulsive Disorder, holding onto possessions is a way to defend against intense contagion fear. Keeping something serves to protect others from the perceived biological contagious quality of the item. Hence there might be rancid, putrid, moldy things among the possessions of those worst afflicted.

Animal hoarders probably fit in there with obsessive compulsive personalities.

Someone with this disorder might feel defective, incomplete. Surrounded by things fills us up.

It is also a familial disorder, fifty percent see it in other family members. That said, a traumatic event might precipitate safety in hoarding.

It is not an easy problem, not for the person who has it, not for family members.

We think that because the thought of discarding acquisitions causes distress, that hoarding behavior is intentional, even when it is dysfunctional to the degree that there is no room to move, a narrow snake path left, maybe, for a visitor to find the bathroom (although visitors tend not to be welcome). Piles of newspapers or National Geographics decorate beds, take the place of mattresses. This would be where back issues of Psychology Today, the ones we'll never get around to reading, might go. A hoarder will frequently sleep in a chair rather than chuck items on the bed.

It could be because as humans we're members of the animal kingdom. Take hamsters. Once while house-sitting the dog and a family hamster, the hamster escaped! He had been planning it for weeks, for sure, but when we found him, had an excellent stash of candy and dog hair that he couldn't possibly have acquired on such a short vacation. He had priors.

This nest could have meaning, could be what hoarders are up to.

Barry Yourgrau, in his beautiful memoir, MESS, describes his struggle to get rid of his clutter. The fear of losing the love of his life, who insists he make her dinner in his apartment, motivates him to change.

Forget that the writing is so strong, which it is, and that you will learn new words, like flaneur. In an effort to clean up his act, Mr. Yourgrau tries different methodologies,a multivariate approach. Family therapists don't believe in any one size fits all cures to life's obstacles, and because people with hoarding disorder in particular tend to be indecisive, trying everything is the way to go.

Barry's scientific approach:

(1) He studies up on famous hoarders and visits them to learn more about himself, You don't have to be a journalist or hunt any of these people down, it is all in his book, makes for an interesting who-done-it. People with this diagnosis can be exceedingly private.

(2) He attends Clutterers Anonymous meetings, reinforcing the therapy adage that we are only as sick as our secrets. Hearing what other people are doing, feeling, hating about themselves is the great normalizer. Plus the stories are compelling and true.

(3) He hires professional declutterers to help him get rid of things, a very brave and painful process. But love is a great motivator, and losing the love of your life, a person who will take you to far away places to buy shiny new things and an endless buffet of bags, is not something you want to do. Lose your clutter, find yourself.

(4) Which is the process of therapy, too. Barry goes through a few therapists before finding the right one. Finding a therapist is like finding a 12-Step meeting you like; try six before you give up. He shares the experience, the ah ha moments, only briefly touching upon being a twin. Being a twin, imho, can account for much of the psychodynamics of the disorder.
Maybe Barry Yourgrau was blue. MESS




Twins tell me that they are particularly cautious, even zealous about their belongings. They are forced, even in utero, to share! The competition for resources never really stops, either. Whatever the other has, even as an adult, can seem better than what you have. And nobody talks about it because it is like talking trash (no hoarding pun intended) about yourself. Even arguing with one's twin can be like arguing with oneself. What you do get is a color, and you are glad for that. You are the one in the orange.

So the author has that going for him, along with the fact that he moved so much during childhood, and moving is associated with hoarding, so much interruption, so much down-sizing. A person wants to hang onto their things, especially if they seem ephemeral, which goes along with never throwing anything away, even when you can replace them at will, as an adult.

The excuse, one of the many, is that everything might be useful one day. We have our comfort stashes, old medications,paint cans with an inch of paint or less. Add your example here.

Well maybe not all of us. The spouse of a Marine, a career service guy, once told me that she couldn't bring home a new blouse unless she gave away an old one. A Marine might have a watch collection, however.

What is the difference then, between a hoarder and a collector? If Mr. Yourgrau acquired only specific things and organized them systematically, even if there were a lot of them, he would be a collector. So there is that out.

But if your basement is really one big train set, you might reconsider the whole idea, make room for a ping pong table, just to stretch your identity.

And if the plastic bags are everywhere, just toss them.

therapydoc.




Thursday, November 05, 2015

A little more about that dirtyword: Blame

Should I sue the hotel?
Not saying there's anything new, here. But is is a practical application, something to keep in mind when someone is busy blaming you for God knows what. 
When we think back later, we say, What a silly argument!
This morning FD left without his keys. He returned right away and knocked on the door. It took me awhile to open up and he was angry--at me-- for taking so long, making him late. The best possible spin on this is to assume that sharing emotions is a good thing, better out than in. Permission to let off steam is what healthy couples do.

So why does it feel so bad?

A few months ago, after stubbing my toe on the metal frame of a hotel bed, I cried out. Maybe I even cursed the hotel. It hurt a lot, warranted expletives, facial grimaces. The object of the anger, unclear. A person can't exactly rant at a bed frame, it is inanimate, doesn't care. Hotel management might care, but it is inconvenient to go to the front desk, ask for the manager, complain about a bed frame. So I let it go. Somehow we survive such things.

The mystery is when something happens and someone could be blameworthy, just a little, but still. Perhaps a child leaves a tricycle on the walk and someone trips. Or, looking around to answer a Where Question, we bang our shin on a coffee table. Or a document is missing, a bill, a check. If a housekeeper has been around in recent history, she's the first scapegoat. If not, anyone will do.

What could have been bad luck, clumsiness, or simple short-sightedness, becomes a gotcha' moment when someone's around. We assign blame. The front desk is in the room.

I've thought of a few reasons that people lose it, act either as little children or very scary adults when something goes wrong. We've all got at least of few of these working for and against us.

(1) Social Needs

We're born social  animals, and as infants can't get very far in life unless somebody takes us there, cleans us up, too, feeds us, etc. That first social experience, a mixture of biological and learned dependency, is never erased entirely. Our memories packs primitive, but powerful social expectations, Someone else should protect us, anticipate our needs, prevent us from harm, The best parenting, the most charmed childhood, won't erase the imprint. But it might make us less reactive to the thought of abandonment, more independent.

That primitive memory, our infant ego, unfortunately, is fed with wedding vows. (Not that you shouldn't get married, but it is a good thing to discuss).

(2) Generalization

Spouses or intimate partners become our mothers, fathers, sisters, brothers, aunts and uncles, friends and lovers, all in one. They represent any and all of our people in the here and now and the past, too. Those who have systematically disappointed or hurt us get top billing. We might not have been able to punch back as kids, but maybe we acted out. As adults, the force is with us--displacing anger on a loved ones just feels right.

(3) Stress

Stress, perhaps from hunger or lack of sleep (new parents are particularly susceptible), often makes us testy. Add to that testiness a sense of hopeless over life's inevitable dilemmas and one more potch (rhymes with watch, means slap in Yiddish) becomes the proverbial straw that breaks the camel's back. A decent crisis, post-potch, even over something that will seem silly later, evokes a  rise in adrenaline. Then the fight or flight relief response kicks in.

Except there's no place to go, because the problem, the crisis, has to be solved, the key found, the broken glass swept up. So flight isn't an option.

But fight is.
You're going to say, but not everyone does this, displaces anger, goes on the offensive when things go wrong. Some of us prefer to mutter to ourselves, shake our heads back and forth, occasionally pound a pillow, even when someone is home to take the blame.
So maybe something else is at work, perhaps annihilation anxiety is the answer. That might explain both the aggression for some people, and self-control for others.
(4) Annihilation anxiety.

If you have ever held an infant, you might be familiar with what is called the startle response, a noticeable shiver that disappears as an infant develops. But some of us know it is still there. We feel it when we're afraid. When we are small we are afraid quite often, everything feels dangerous, a bee buzzing around us, a parent with a frown. This feeling has been described as fear of annihilation, which might sound extreme, but if you're little you just don't know, especially if you've been subjected to child abuse,

Abused kids get negative messages about who they are. They are told that they are deficient, blameworthy, to explain frequent punishments, displacement of a parent's negative emotions about God knows what.

So when things go wrong, an abused person, to avoid more abuse, might jump to apologizing even if they have nothing to do with anything. This averts a crisis, owning responsibility,and functions to avoid annihilation. If they don't apologize, they keep it quiet, have learned that passivity is better than saying more, getting into more trouble.

Alternatively, abused kids identify with the aggressor, learn that the best defense is a good offense.

But not only abused kids learn that. It is a social response to stress that just works. Anger puts everyone off. So use it to your advantage, is the thinking.

The rest of us learn variations of the above, probably much less extreme.

So in the end there are no easy answers, no one size fits all.
But at least I know, when I stub my toe, that I have only myself to blame. And FD? Just a guy with too little sleep, maybe not enough food, and too much stress. That's all.

therapydoc