Tuesday, April 26, 2016

Trainwreck

I'm just a kid, maybe 18, working a clerical summer job at a bank, in a department that, unless you are a finance major, feels opaque, like one big secret. But my job is easy, attaching labels for certified mail, filing documents. This is the pre-computer age, everything is on paper. 

The entire department is female, except for the vice president, an older, sagging man in a pin-striped suit, long, white mustache. A skirt-chaser. He has a separate office, Mad Men style. The women are in desks lined close together, forming a grid, front of the room to the back. No cubicles. The lights are fluorescent, pens click, papers shuffle. 

The woman to my left is in her mid-forties, Greek. She takes a motherly role, shows me what to do, asks about my college plans, my boyfriend. 

"Oh, I don't have one, but yes, I'll go to college in September." 

She's surprised about the boyfriend part, and from here on in talks about the boyfriend I will have, and eventually marry, not too soon, not too late, and the children, and the house, and the job. She is, in retrospect, dead on.

The supervisor on the floor, our supervisor, is a stern woman, tall and sallow, pock-marked, but neatly put together and I can see that she is beautiful, in her way, as we all are, beneath her frown. On Monday mornings, before she comes in, always a half hour late, the entire room is buzzing, wondering what mood to expect, bracing for the worst. She will, undoubtedly, be hung over. 

It isn't something that I can see, as she makes her royal entrance, red scarf loose across her neck; short-handled, oblong ecru purse at her side. Her desk is in the corner of the back row, the rest of us face front. It is my first experience with an entire system openly managing the effects of alcohol, and I am fascinated.

To this day, with all I know. Anyway, I wrote that, for what it's worth.

Sometimes a patient walks into the office and I scent the lingering scent, see it in the eyes, in the face, in the color, a toxic look, and I nod, smile softly. "Talk to me." It is rarely about the alcohol, or the over-use, more likely about the social problems that this is inevitably causing, either with a child or a spouse, a co-worker. And we talk, once more, about the early years, before drinking became a  rote thing, and how these early, cliche experiences entered into the equation, and whether or not all of life, from there on in, must be determined from that, or do we have free will. Are we in charge of our destinies, in charge of anything, for that matter?

Some days it feels like yes, some no.

Sunday night ended two days of eating and attempts at drinking (on Passover we're supposed to drink four cups of wine over a five hour ceremonial meal; most of us dilute them by the second, massively.) The first days behind me, I check to see if the Cubs have won, and if there might be anything decent on TV. Amy Schumer's Trainwreck pops up on the menu guide as I check my phone.
Bill Hader- unlikely romeo

Cubs 9, Reds 0.. And yes, that is irrelevant, but when your baseball team is scoring touchdowns, you brag.

And of course, Trainwreck has me in the first scene, a parent sits his two daughters down on the hood of their car, one about seven, the other four, to tell them that he is getting a divorce, that marriage is obsolete. Why be stuck with only one doll, forever and ever, when there are so many, many, many other dolls to play with? He goes on and on until Amy and her sister Kim (Brie Larson) get the idea, but only one of the two thinks he's onto something.

Despite the nudity and the raunch (fast forward if that feels like the right thing to do) all else is charming. With a subplot lifted from The Devil Wears Prada, we're drawn in against our will to the versatile Bill Hader as Aaron, the saintly altruist, a Doctors without Borders hero and pro team physician.

Marissa Tomei makes a cameo appearance in a movie within the movie, reminding me, off topic here, of her argument with Joe Pesci in My Cousin Vinnie, a teaching moment if ever there was one, on productive couple conflict resolution, the argument about the faucet dripping in bathroom, if memory serves.

But back to Trainwreck.  Affable professional basketball players are the voices in the ears of relationship-hapless Aaron, and they play themselves, LeBron James and Amar'e Stoudemire. A lovable homeless guy supports Amy, knows she's alcoholic, like he is, and that she's a woman without borders, in her way.
Amy with the homeless guy
Here come the big spoilers, so stop reading if you haven't seen Trainwreck.
Amy Schumer with her father in Trainwrec

Gordon, Amy's father (Colin Quinn), is suffering in a nursing home from MS. Amy is warned, by a nurse, that he's hoarding his medication. He may be older, and male, but the father-daughter team share the same irascible world views. She's so like him, promiscuous, alcoholic, a person who fails others, as alcoholics do, when needed.

She doesn't act on the information that he's hoarding, and he completes the job. She's done nothing with the  tip-off, has not got it together to save her father. Life gets busy. Phones go off. Whatever.

We see, from this story, that behavior is reinforced, be it genetic or learned, when parents teach by example, that we have permission to be an alcoholic, permission to be the person who fails to come through, fails to help when needed, if our parents behaved in the same ways.

And certainly, alcohol enters into that equation, the choice to drink at the most inopportune moments, will bring us down.

No surprise to formula, Amy hits bottom, makes new choices.

Throughout, in every moment, Ms. Schumer is hilarious, her timing perfect, her deadpan delivery, so smart, that maybe it is worth the fast-forward, at least to some of us with more conservative, older sensibilities about what should be shown on screen. What Trainwreck illustrates is exactly how a good crash, a therapeutic, critical moment, comes about. "Bottom" is about loss, losing people you love, losing your livelihood, and most poignantly, losing your dignity and self-respect, to alcoholism.

My god how we try want to stop the ones we love from losing all of those things.

It is the kind of thing, we suggest to that patient, the one who is drinking with no intention of ever giving it up, who thinks he or she is in charge, that is likely to happen, the bad result. There's no such thing as a functioning alcoholic. Functioning is only functioning until it isn't. And it likely won't end, the recovery from loss, like it does in the movies.

therapydoc



Tuesday, April 12, 2016

Snapshots: Spring Forward

(1) The Chinese Laundry 
It's Curtains


I kept looking at my draperies and thinking, just cut them. As in, I should cut them. They are ceiling to floor, and the window is only 56 inches high, so maybe a fresh look will do me good.

But not having a sewing machine, and suffering from poor hand-eye coordination, I ask FD to bring them down to our local laundress. She's generally good with repairs, so this should be something she'll manage fairly easily.

She calls me with an estimate, then assigns the job to someone else.

Within a few days, FD fetches the drapes. He brings home four hangers, two with draperies, two with the left over material.

"You're not going to like it," he says. "The guy who did the job ironed one curtain, then one of the scraps."

"Not gonna' fly," says I. "I'll bring it back tomorrow."

"Don't bother them," he advises. "They seem busy. I'll iron it."

Not wanting to put him out, I tell him I'll just hang the drapes and see.

So that's what happens, and frankly, one drape doesn't look much better than the other, and life gets in the way, so the draperies stay put, cover the window for about a week. Whenever I look at them, they annoy me.

Then yesterday, I notice a skirt in the trunk of the car. It was supposed to have been dropped off at the cleaners weeks ago. On my way home from work I make the stop, mention the drapes.

My laundress laughs and says, "I told him I would do it, iron the other one, but he says, no, you want them, like yesterday, not to worry about it. Just bring them in tomorrow, and of course I'll do it!"

"But both drapes need an iron, not just one."

She reassures me, "Just bring them to me."

And I'm quite sure that is the end of the story.

The lesson, in case you're wondering, is not If you want something done right, you should do it yourself.  Far from it.  The lesson is that when you're paying decent money for someone to do a job, and you don't like it, open your mouth. Maybe you'll get results, maybe not, but this one falls under. . .

Assertiveness training 101.

(2) Labeling Ourselves

The man is facing me for the first time, describing himself using DSM 5 language. The DSM is the American Psychiatric Association's diagnostic bible. Anyone can buy one, but the book is pricey. The DSM is a sliver, a subset of the ICD 10, the International Classification of Diseases, a much bigger volume that describes the global medical community's accepted medical disorders.

Everything psychological is also physical.

I ask the patient, "Did a doctor or a mental health professional tell you that you have . . .?"

"No, I looked it up."

This is common. The patient comes in with a diagnosis, and the diagnosis is the excuse, the reason for getting help. It is as if without one there is no real need for therapy. But with one, well, now we can get working on this thing that defines me.

But therapists know better, for so many people we see come for help because it is someone else who is making them sick, or made them sick. Maybe a parent or a spouse, a child, a colleague, employer, lover or peer.

Just yesterday, after dedicating a stone at the cemetery, a cousin and I sat at a table discussing our families of origin, and how they had contributed, massively, to our angst during adolescence. As we got closer to how our personalities had been affected, others at the gathering interrupted us to say goodbye. We shook our heads, smiled, and shrugged, knowing it would be impossible in this crowd to continue such an intimate discussion. We'll talk, our parting words.

It is therapeutic, at any age, to talk about these things. But diagnosing everyone? Is that necessary?

Well, diagnoses provide structure and a vague sense of stability, like a pole or a strap to hang onto when you're standing on a moving train. And now, in the information age, thanks to the pervasiveness of diagnostic criterion on the Internet, and the marketability of these topics on websites, television, and the news, people are coming to therapy, handing their therapists their diagnoses.

It is uncanny how often they are right!  They've diagnosed their parents, siblings, grandparents, everyone. They've caught onto genetic predispositions and heritability, even understand system dynamics, albeit roughly, and many are quite young.

And as much as I can go on and on (and will one day) about how thinking of ourselves and others as this one big thing, this diagnosis, boxing people in, as much as I rant that labeling, especially labeling for life, diminishes, limits, has the potential to stifle growth, it is an obsession, so we have to talk about it. And for good reason, the implications for the long-term, among them, and the treatment ramifications.

So it is good that we can talk about them, these buckets we're in. Good therapists applaud the help-seeking effort, especially young people for their  bravery. We lavish praise with the certainty that because they have caught the virus (young is even better), managing it will become easier. Change might become so habit forming over time, so much so that the once disabled, panic stricken, disorder-labeled self will stop to wonder: Did I even have it, this thing I took on as my identity?

It happens.

therapydoc


Thursday, March 24, 2016

High Functioning Autism, Ethnic Jokes, and Purim

Ordinarily I wouldn't get started on this, knowing that it is likely to upset at least one reader. But because some of you will propose theses for doctorates and masters degrees, it feels like the right thing to do, open up a topic for further study. Also, this is Purim Torah. And despite what's going on in the world, I'm in a better mood.

Purim isn't the topic for further study, not unless you're Jewish and like studying up on stories from days of old. But the story is about genocide, which is related to racism, and racism affects our mental health because (a) it hurts and provides people with excuses (bad ones) to kill, and (b) racists sometimes tell bad jokes.

Purim is one of those, the joke's on you, holidays. The story is a tale of monumental reversal, salvation, victory, fasting, love, sexual exploitation, and plots inside the kingdom. We're talking Persia, 369 BCE.

Briefly: The Persians beat the Babylonians, and Jews exiled from Jerusalem by the Babylonians wound up there. The king, Achashverosh, has done away with his wife Vashti because she wouldn't dance naked for his friends at a feast. These feasts go on for days and days, and people get wildly drunk They expect to be entertained.

Having banished Vashti from the kingdom, Achashverosh orders that all the beautiful virgins in the country come to the palace to interview for the job, queen.

Esther, a Jewish orphan, adopted and raised by her older cousin Mordechai, becomes the king's top pick. The king loves Esther dearly. He has no idea she is Jewish.

An officer of his court, Haman, is a huge anti-Semite. Haman is narcissistically injured (angry) at Mordechai who refuses to bow down to him at the palace gate. (Jews only bow to God, or sometimes to marshal arts teachers to be polite). Haman has made it in politics, has influence with the king. He requests the annihilation of the Jews, ostensibly because they follow a different set of rules. Achashverosh, a simple guy who just wants to feast, can't see why not. Differences between people are threatening. He signs off to the execution of the Jewish people.

Mordechai gets word to Esther that she has to stop the edict, must intervene somehow. She's not so quick to accept the mission. The king will put to death anyone who visits him without an invitation, and she has not been invited in 30 days. Mordechai tells Esther that if she does not take the initiative, then salvation for the Jewish people will come from somewhere else. She steps up.

An aside to therapists: When working with patients who feel hopeless about their lives, who cannot see a way out, not a single possibility, yet have some faith in God, you can use the following line from the story, even tell an abridged version of the story. Try to say it in Hebrew, because it makes an impression, lends authenticity. The transliteration is in the picture to the right:

The (salvation) solution will come from someplace else, is beyond what you might expect or are looking for.

Solutions come in two dresses, either creative thinking, or seemingly random events.
it isn't our call

But back to the story: The Jews pray and fast for three days, hoping to curry God's favor. Esther gets her audience with the king, liquors him up and outs Haman as a bad man with murderous intentions. The king is outraged and reverses the decree. He hangs Haman and his sons, and permits the Jews to kill their enemies within his kingdom (it is a huge kingdom). They take no spoils, but declare another holiday, a good reason to knock off work early.

It is an eating and drinking holiday, but before any feasting, there is running around town with gifts of food and charity. Kids dress up as kings and queens, and the story is read from a scroll. A younger adult generation entertains with a video, kids who should have gone into film making, not medicine or law, roasting the rabbi and almost everyone else.

Why bring up Purim? It is a lesson that with the stroke of a pen, kings and potentates can order the end of life. It starts with advisers, meetings, influence, maybe someone whose ego couldn't take a hit. Such attitudes are passed down in families and communities, but mostly, families. We trust our parents.

There is a connection to high functioning autism.

Once I saw a man with high functioning autism (or I made him up for this post). We called it Apsergers Disorder until the DSM did away with Aspergers in 2013. The man, like his father, put people into racial and ethnic categories. The Blacks. The Mexicans. The Polacks, The Asians, The Obese. Everyone had a box, and the man, like his father, couldn't describe anything that a person might do or say without first putting the person into the box.

He's a nice doctor for a Jewish guy.

Why does he have to take seconds. Look at him!

At first I thought it a racist thing, then realized he had indeed learned it from his father. But more than that, he honestly didn't see anything wrong with it. He thought it was great that he could do this, organize people, understand them by labeling them. He didn't see the labels as gross generalizations, ridiculous simplifications, or that 99% of our DNA is the same.

(Once I went to China and said something about the Chinese, thinking my experience mattered. FD said, "You really can't generalize about 1.5 billion people.")

When I got to know the patient better, I realized that for him, everything had to go into a box. He had to organize somehow. Having high functioning autism, unable to empathize, he also didn't know he had the disorder. As often happens with such patients, he came to therapy for his wife, who had issues with him and his social/marital insensitivity.

He and his father had made an ethnic or physical trait category into a social cue. Labeling people appealed to his obsessive compulsiveness, helped him gain some control in a world of humans who otherwise mystified him.

Moral of the story: When you have a patient who sees nothing wrong with telling ethnic or racist or very insensitive joke, it is a sign that he might have a disorder, such as high functioning autism. He may not mean any harm. You'll know if he is completely confused by your efforts at correction.

Now, Haman? A total racist, calling for the annihilation of a people he didn't respect, hated for their differences, their values. Today he might be put in jail for conspiracy to commit a genocidal (terrorist) act, duping an innocent king on the sauce. And he would see a therapist, undoubtedly, to work on his narcissism  and sociopathy.

therapydoc




Wednesday, March 23, 2016

Brussels

I'm talking to an older man today, working through some of his grief issues, and he looks up and says, "And this thing in Belgium doesn't help."
Solidarity with Brussels

What thing in Belgium?

It was one of those mornings-- on the phone when I would normally hear the news driving to work. Missed it.

The grief patient tells me about the terrorist attack, that it hit the airport, the train. Public trans, soft targets.

I don't tell him that I have been in Brussels Airport, that I've slept there, prayed there. A long stop-over, going home from someplace else. It is an odd feeling, knowing that this is a hotbed of anti-Jewish feeling, and that Belgium opened its doors wide to its enemies, welcomed them.

They have cots at the airport, and quiet places to think.

Memories of a different chapel for each faith, too, along with your typical book and magazine vendors. We buy small toys, candy. There's a crowd at the terminal, attendants in red, things are clean.

At the time we worried about Ebola. Many Africans travel to Texas via Chicago via Belgium. There had been a case. The man sitting next to FD doesn't look well, covers his face the entire flight.
Brussels Airport synagogue, mosque, and graphic novels

We didn't worry about ISIS in 2014.

I didn't have to share about this, the Brussels airport. Why write about an airport? A perfectly good post awaits publication for this week, one about humor, racism, high functioning autism, and the Jewish holiday, Purim. The desire to share, however, is associated, maybe, with our need to connect emotionally, in this case to show solidarity with people who have been attacked, bullied in a very big way. There aren't that many ways to show outrage, short of filtering our Facebook profile ppic with the Belgian flag. We saw this after Paris, French flags.

And there's something else. People want to connect with people who have a connection, even a weak connection, to big events. When Paris reeled from terrorism, one of my French patients told me that people she hadn't talked to for years, people she didn't especially want to talk to, called to show solidarity, to wish her and her family well.

We just want to huddle together when we feel powerless, be in one space, share our concern. And the overwhelming feeling, at this point in time, is powerlessness, and the Internet that shared place. Can we stop the meshuganah kups (sounds like meh-shuhg-in-uh cups, means not quite right in the head), a Yiddish expression my father would have used to describe ISIS warriors?

Of course, but how soon?

I asked FD a question. How does a late night TV host go on tonight, someone like Stephen Colbert, paid to be funny, how does he do it?  I can't even watch to find out. FD agrees, you don't watch, don't care to find out. He is solemn.

Tomorrow is a fast day for Jews. It precedes the holiday of Purim, a very festive, happy holiday, and hopefully I will post about it, and how it ties into humor, racism, and high functioning autism. But it might not be very funny, is the truth.

therapydoc


Saturday, February 27, 2016

Television and Movies Fine Tune Our Empathy Skills

On a walk this afternoon I ran into my youngest son and his wife. They had the baby in the stroller, dressed well as always for such an event, a stroll. She is in a little pink dress with miniscule black kittens and a big pink bow in her hair (via the fashionable baby headband, not shown). She's almost five months old.  I bend over the stroller and we exchange goo goo eyes and coo softly at one another. Then, finally exhausted of that, I bring it up: 

"Do you think you might want to get together tomorrow night for an Oscars party?" 
They consider it and we try to figure out who in the family has the biggest TV.
Baby Fashion Plate (K"H)


Once I treated a patient with high functioning autism who told me that she watches television to learn social cues. Television increases her intellectual empathy. She knows that even though these are actors and have memorized their responses and lines, their inflections and body language are rich in teaching moments.

If you're a person who doesn't understand what vocal inflection and body language imply, then studying it in the media is probably the cheapest, least embarrassing way to learn. The raised eyebrow, for example, could mean surprise, or it could mean disagreement, doubt, skepticism. Really? A pout or a frown indicates displeasure. Think it's simple? It's not.

My patient might not be able to feel the feelings of the people on screen (emotional empathy), but she can learn what is going on inside them (intellectual empathy) by keying in on reaction shots. It is a process, and people with autism are on a spectrum (like we all are), some higher functioning than others. So you can't assume anything, not even the emotional empathy deficit.

Daniel Ross Goodman, a writer and rabbinical student, has an Op Ed column in the Wall Street journal today about The Revenant, a  film nominated for a Best Picture Oscar. Mr. Goodman suggests that movie-lovers enjoy this film because Leonard DiCaprio suffers. We go to feel the feelings of the actors, immerse ourselves in that process. Intense feelings spring from exaggerated events, startling our otherwise dormant empathy. And we want to be empathetic, to feel the feelings of other people. It is why women lunch, and men should. Women shmooze, empathize, then validate. It is a love fest.

Films like The Revenant deliver, manipulate our emotions and most of us do empathize. But don't all good films draws us in, and don't most of us empathize? For some (males) it will be intellectually, because they know they should, and for others it is emotional, because we can't help it. Regardless of type, we flex that empath muscle for a few short (or long) hours, feel what it feels like to be in dire straits. And so many movies are about dire straits that the soon-to-be rabbi's theory makes sense.

Except that none of us, not emotionally empathetic (the luck of the draw, genetics, so quit patting yourself on the back) or the intellectually empathetic (it's still good), have to go to the movies to feel for people.  On a bad day empathetic people empathize with the families of victims of disease, crime, war, abuse, and natural disasters, for starts. On a good day, the best journalists pull it out of us with human interest stories.

Still, I like Goodman's theory because it surely applies in a small way to everyone, everyone goes to movies about people who feel, whereas only some of us watch nature shows about spiders, and I love the example, Hugh Glass, a 19th century frontiersman who suffers twelve life-threatening tests, twelve torturous struggles, on a mission to find the man who killed his son. Mr. Goodman writes:
As we squirm in our seats, Mr. DiCaprio, as Hugh Glass, survives brutal cold, a vicious bear mauling, Indian attacks, and other dreadful depredations...
We feel for Hugh Glass.

In another section of the newspaper, WSJ film critic David Thomson warns us:
Audiences found The Revenant "too much . . .too strenuous, too long, too exhausting, too male, too snowy, to much raw meat, too much violence"
This may seem like a non-sequitur but be patient, but when my friends and I go to the movies, as the previews roll, we play a game. You play it too, the Do We Want to See This One game.

At some point during the preview one of us will say, "Oh, for sure I want to see that."  Or maybe, "You couldn't get me to see this one for all the tea in China." Or, "I'll take the kids." Or, "Don't take the kids." We often disagree. Watching the preview of The Revenant, Leonardo DiCaprio resolutely surviving the freezing cold, shivering inside the carcass of a freshly killed bear, we all agree. No thanks.

Why?

I think because seeing the bloody carcass, the muddy waters, the grunge, our empathy sensors kicked in, but went into over-drive. It is exactly as soon-to-be rabbi Goodman might say. We feel badly for Hugh Glass, stuck inside a bloody carcass. Except that we feel so badly, we can't watch anymore. It is a matter of degree, cringe.

So some of us go to the movies because we want to empathize, but some of us don't go because we don't want to empathize. The second group can't stand too much blood, or too much cold, too much raw meat, or violence. We don't have that need to feel badly, to be put in a bad place, to feel for someone who is in a bad place. Why voluntarily subject ourselves to that?

One hypothesis for the study might be:
People who score high on emotional empathy prefer not to cringe while watching actors feel negative emotions in a film, whereas people who score high on intellectual empathy don't cringe, so they don't mind the experience of watching actors feel negative emotions in a film..  
The theory behind the hypothesis is that emotional empathy can make you feel bad, whereas intellectual empathy is a function of logic, not emotion, and has less of an emotional effect, if any.

Not sure who is bringing the popcorn, or who will make the guac, hopefully somebody picks up some sushi. Watching the Oscars, another excuse for a party, isn't something we do every year because we want to empathize with the winners or the losers, although you could make a case that we watch to live vicariously through them.

It is all about the clothes.

therapydoc



Friday, February 19, 2016

Snapshots, Books, and the Countdown: Five, Four, Three

I feel like there's so much to say; like we haven't talked in ages. 

(1) Parenting

My six-year-old granddaughter draws a stick figure picture of herself running away from my son. In the picture he's counting down: Five, four, three, two, one. Bedtime. He posts that he has no recollection of doing this, counting down.

I remember it. He and his brother are six, their sister, four.
Me: Better be in bed at the count of one.
There's a thrill to this intervention, despite the total lack of consequences.

The magic of counting down to bedtime is that it is a competition. Can I beat the parent? Can I make it to bed before he says, One?

And a kid needs a good reason to run, not walk to bed, because running is fun and walking is not, and it is much more fun jumping into a bed, feeling the fluffy pillows and covers receive you.

Probably the best reason for the countdown, however, at least from the kid's perspective, and maybe my son knows it, maybe he doesn't, is that the parent is going to slowly follow you to the bedroom, making this feel dangerous if you lose, and as soon as he catches up, as you dive into bed one step ahead, he'll snuggle his much larger face into your hair, and then your neck, and say,

"I love you. Now go to sleep."

(2) The Stinking Flu  


The primary care docs are compelled to prescribe the flu vaccine, and why not, it is cheap and sometimes effective. When it isn't effective, that's when everyone is up in arms, or shall we say, dead to the world, useless in bed.

My brain on the flu:


video
reading flu test


The season is almost over, but still worth advising that if you have a fever and flu-like symptoms, go to the doctor, not that he'll be paid, a topic for another day, but he can't charge you more than your co-pay.

Certainly don't go to work to spread the joy. Or to therapy.

(3) SADS

It is February so all my SADS (Seasonal Affective Disorders) patients have been coming in. We're all good sports in the beginning of the winter, those of us who live in the midwest. In the beginning, in December, our skies are blue.

But by now everyone's saying, enough already. The days are still too short, the nights, too cold.

Brain feels frozen, landscape dirty, dull, like a futuristic movie. People are saying, "It doesn't know if it should rain or snow" and our cars beg washing, not that it will last more than a day.

Oh! As Alan Sherman used to sing in Hello Mudda, Hello Fadda, about the kid complaining about malaria, the poison ivy and the weather at summer camp.

Wait a minute, it's stopped raining. Guys are swimming, guys are sailing, playing baseball, gee dat's better. Mudda-Fadda kindly disregard this letter.

It IS sunny out there, and a toasty 50 degrees!

But since we've started, let's finish up.

SADS sufferers have to fool the brain. All that light therapy, do it, spend the money on electricity in the winter, turn on everything that holds a lightbulb, anytime you're home. Raise the shades, open the blinds.

And take up one of those health club offers to try the machines on the cheap for a month, even a week, if that's all they give you, but pay in cash so they can't keep your credit card. The fine print is blinding. Then quit when the weather gets warm, get outside and see what's green.
Sledding in February

Or take someone mud-sledding, now, before the snow is completely gone.

One more month to go.

(4) Annihilation Anxiety  
Not phallic symbols. Weapons 

Most people don't know this about me, but before I get out of my car, before I leave the office to head home, I peek outside and look around. Basically I'm worried that someone will want to kill me for no reason.

Not that the neighborhood is bad, it isn't. But if you hear enough neighborhood lore, or read the local news police blotter, you can become hyper-vigilant. Secondary trauma.

Last night, seeing the sidewalk clear of dangerous-looking citizens, my car dusted with new, wet snow, I reached into the back seat and grabbed a new retractible snow brush. When I flipped it across the windshield, the brush extended easily to the width of the car.

Snow drifting in my face, I felt I'd emerged from work victorious, waving the snow brush high into the air, daring the traffic or anyone on the street passing by.

Ditto, the selfie stick. On a vacation we rented bikes, stopped at the beach to take a picture. The stick whips out to three feet, maybe more. Light-weight, FD declares that a slap from one of these will hurt. He's reading my mind.

Paranoia?

For sure. But still.

One more. This time it is a Soda Stream canister. The slim canister that makes the fizz has lost its CO2. I take it into my hand, really feel it before exchanging it for another at Target, my grip naturally testing the weight. The shape, the feel, it is powerful, wieldy.

In the spring, when we ride bikes to work, it will be the titanium lock that magically saves us. Something a coyote won't forget, is what I tell FD, who nods empathetically.

(5) Being Alive
A new one from Colin Beavan
Feeling quite dead from the first few snapshots, this book appealed to me.

Colin Beavan (he's been on Stephen Colbert, enough street cred for me), thinks that most of us merely go through the motions, don't live the life we want to live.

You could say that therapy is all about that, finding ways to live life, in a way that we feel it, feel alive. Nobody's happy all of the time, after all. We get a few minutes a day if we're lucky, and have to work at those (says your therapist). We know some of what works, what is tried and true.

You feel alive when. . .you finish a brisk workout. When a baby smiles at you. When the IRS refund is in hand. When you ask your adult kids on a random afternoon:

Hey, anyone want to come for potluck dinner?
 and they say, Sure.

That's happiness.

Colin will tell you these thing effect the world, your smile, the one inspired by the baby's smile, spreads a wave of goodness into the ecosphere. The potluck dinner, because there are multiple good vibes buzzing into the cosmos.

His new book is an attempt at debunking the myths most of us buy into, the ones that keep us (his opinion) from doing what we would really want to do. Whether it works for you will be a personal thing, because How to Be Alive recycles (appropriate for a book designed to help the world) what self and cognitive psychologists have said before. Yet he offers so many different stories, metaphors, and examples, that you have to learn something new. And he squashes irrational thoughts like gnats.

So this is a non-sequitur, but speaking of gnats, a year ago January I started my first herb garden ever, little pots on a window sill; the yield amazingly, shockingly successful, a jungle in the kitchen. But by summer the house was inundated with midges, little bugs that land on white shirts. They look and act like gnats. But we still had a lot of basil and dill, so could only complain so much, and handed out plants first come, first serve. That's being alive.

Getting back to that book, it could have titled Green Therapy. But How to Be Alive: a Guide to the Kind of Happiness that Helps the World  has so many more key word.

You might remember a story somewhere on this blog, about the people in the park, and dogs off their leashes, me, and maybe you, too, on bikes, becoming a part of that ecology. It is one way to connect with the world.

Colin, on connecting:
Your life is equal to all of your relationships added together.
All of your relationships together are equivalent to your relationship to the world.
Therefore, your life is equivalent to your relationship to the world.  
 And, what you do in your life, affects the world
 And what happens in the world, affects you.
 Therefore, you are important to the world and the world is important to you.
So make a dent, he's saying. Or grow something other than roots and give them away, maybe develop a community garden. Or a community compost.  Or both. There's a story on that.

(6)  Sheer Numbers
NAMI APP for HELP
Recently a reader wrote to thank me for universalizing her problems, for reminding her that she's not alone, not the only one who finds life difficult, who has bizarre thoughts or brain twists that no one else seems to understand.

We all have bizarre, irrational thoughts. See above.


The letter got me thinking, however, looking up statistics.

NAMI, the National Alliance on Mental Illness has always been a wonderful resource:

1 in 5 adults in America experience a mental illness.

Nearly 1 in 25 (10 million) adults in America live with a serious mental illness.
One-half of all chronic mental illness begins by the age of 14; three-quarters by the age of 24

1 in 100 (2.4 million) American adults live with schizophrenia.

6.9% (16 million) of American adults live with major depression and 18%, or 42 million have anxiety disorders

There are many more statistics like this. My friend, you are not alone. 

The one that blows my mind is that nearly 60% of adults with mental illness had no services in the previous year. Did we notice? I think we did. 

Visit to the NAMI website for resources and more stories. And write to your governor if you don't like how he's balancing his budget. 

(7) Prison Isn't Good for Us

The Mental Health and Safe Communities Act , S.2002,or Cornyn Law is waking us up to what goes on in jails and prisons.
Mary E Buser is a social worker


We know about homelessness, that the chances that the woman in the park, the one in the sleeping bag, might be suffering a mental illness or addiction are high.

Most of us don't know, however, that a quarter of our prison population has a recent history of mental illness. It isn't all about sociopathy, which is what you would expect. They have garden variety depression, anxiety, and psychoses.

And being in jail aggravates it. 

And naturally, we pay to take care of the treatment, which every prisoner wants, because it gets them away from other prisoners. So while the healthy but sociopathic fake it, resources are squeezed for the truly ill.   

The Cornyn Law is a snapshot of the remedy, proposes training for police and first responders by way of the

 National Criminal Justice and Mental Health Training and Technical Assistance Center. 

Here recruits learn to recognize mental illness, steer future "convicts" away from federal custody, and divert them o community social services. In a perfect world.

Mary E. Buser's book, Lockdown on Rikers reads like a diary, what it's like to be a social worker at the famed Rikers Island, New York City's jail. Buser exposes the tragedies of the system, the pain of inmates who might be innocent but can't afford bail, who wait for months on end, sometimes years, for a day in court. A plea bargain gets them out, but with a record.

At the jail, waiting for the hearing, innocent men and women miss visits to sick relatives in the hospital, funerals. They can't help their families financially, too many cases for the system to process. You'e seen The Good Wife, Law and Order. You read about them and wish that the varied stories about Rikers are exaggerations.

But they're not.

Solitary, by the way, is hell.

As is the flu, but hey, wait a minute, it's stopped raining.

therapydoc   

That was a lot, but March will be busy for me, and I forgot to mention Vessels, a love story I promised to review. You think it is a love between a couple, but the story is much more mysterious, more cryptic than that. Written like poetry (the kind you actually get), rich in paradox and metaphor, VESSELS is a story about art, an artist, and bad breaks, and keeping a marriage together under the most trying of circumstances. 

I've already given too much away. 

Daniel Raeburn teaches non-fiction writing at the University of Chicago. 

Just one more thing, bear with me. For links to therapy experts, check out Social Work Careers
Experts

Friday, February 05, 2016

Do Therapists Age Out?

I admit to sometimes Googling people, if not after they make an appointment, then before. It helps knowing the public profile, what people are trying to present to the world, as themselves.
Nancy Slagg's profile on Yelp


Working downtown, some prefer to go to therapy on their lunch hour, then go directly home. Because seriously: Can you simply change the channel, switch from sharing things so personal, to attending to what matters most to your boss?

It is an art, switching channels, one honed with time and experience. Rabbis and other men and women of the cloth do it when they run from a funeral to a wedding. Therapists do it when they're seeing eight patients in a row to make some money. We get good at disengaging from the last patient to focus on the next. In a matter of minutes, maybe seconds.

The story:

A friend asked me for a recommendation, a therapist he could see downtown, maybe on his lunch hour. I remembered a short list buried in my email and forwarded him the names.

But we were together at a kids' basketball game, watching the home team get clobbered. So I Googled a few of the referrals. One therapist seemed to be about my age, and I marveled at her accomplishments. She is on the faculty of a prestigious university, does research with the homeless, and has a private practice. She's also a bit expensive. When I showed my friend the bio with photo, he balked.

He says it is possibly ageism, but he wants someone younger, more likely to relate to the issues of his generation.

This gives me pause. Do we really age out? I'm quiet.

The incident gives me a reason to Google myself, something we're told we should do every few weeks, but only true narcissists do. But who knows what kind of negative stuff is on Yelp? My search finds an interview foreign to me. The printed words are definitely mine. It is an online issue of a major newspaper. The final cut has never come to my attention. Or have I just forgotten?

Random people call you up, ask if you will take 15 minutes to chat about a particular subject, and you say, Sure, sure, why not, and before you blink it is over and that's the last you hear from them, no matter how intricate the questions, or how thoughtful the answers.

It graduates to an out of sight, out of mind, thing. You just forget. In this case we had discussed romance and intimacy, getting the most out of a loving relationship, this being that time of year, February, Valentine's Day.

It is worrisome, the thought that I might have seen the interview, read it online, and yet it is totally gone from my long-term memory. Maybe my basketball loving friend is right about aging. Or maybe it isn't aging so much as very full days. When I go on vacation it is all about not returning calls.

The whole interview business reminds me that putting one's self in the public eye, whether on a blog or talking to a reporter between patients, makes you ripe for abuse, thought snatching and misinterpretation. Students plagiarize. They're karma, you used to say. Why care?

And there are apps that help you find where your words have gone. I discovered Dupli-Checker. You don't have to download anything. But now it bothers me, the paranoia. Old people get that, not me.

So people my age not only aren't in touch with young people, but we're likely to get paranoid, too.

Wait a sec. Do therapists get too old to relate to younger people? We have to address this, argue the assumption.

And it is easy, too, because in the big picture, therapy is like this:
Each of us lives in a dense forest. And in this forest are multiple, mostly hidden reasons for our pain and suffering. The answers are there, too, the better responses to situations, challenges, solutions we have yet to consider, wouldn't even think to consider. The forest contains every variable necessary for a good, no, a great therapy. Yet almost all of them are camouflaged, like the spiders, rabbits and other small animals in the forest, the birds in the trees. The older we get, as therapists, the quicker we see the spiders, the webs, the rest of what is hidden. The older we get, as therapists, the better we see what other people, even younger therapists, can't see. 
We'll take notes, naturally, to remember.

therapydoc