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Showing posts with label bi-polar disorder. Show all posts
Showing posts with label bi-polar disorder. Show all posts

Saturday, December 20, 2008

Madoff


Usually if a Jewish person gets into trouble we try not to draw attention to it, we're so embarrassed. We call it a chilul HaShem, an abomination to G-d, and hope the news passes over quickly.

But a guy steals 50 billion dollars, well, it's hard to ignore. Our luck. He had to be Jewish, we say (as opposed to Italian, or Irish, Chinese or Sudanese, a Somalian pirate, a Brit, choose your nationality). People are going to talk about us. Slander us. This time of year, it's especially not so good. It's a real oy vey, something to geshrai (give a sudden shriek) about. Check out this journalist's Jewish Response to the Economic Crisis if you think I'm just a little paranoid about anti-Semitism.

My mother calls me on Friday. She says, "What do you make of this guy Bernard Madoff? Is he sick? I mean, what is he? Is he a sociopath? My friend Beverly says he's a sociopath. What's a sociopath?"

"I don't know if he's sick. I really don't. He might be. Or he might be considered a sociopath."

"Is it genetic?"

"Well, I'm not sure. It may not have anything to do with genetics, although believe me, we'd love to blame something like this on bi-polar or better, uni-polar disorder. Tell Beverly that you think Bernie Madoff had a uni-polar manic episode, a long one. You'll sound smart and it gets us off the hook."

"I can't even pronounce that. But if you're telling me it's probably not genetic, then are you telling me that his parents taught him to be a ganif like that? (Ganif is the Hebrew word for thief.) His parents probably came here on the boat with mine!"

"It's likely people would say that, that this cheating is learned behavior. I don't know. I get pretty tired of hearing parents getting the blame for everything. It's unlikely his parents gave him the green light to steal. It's culturally not what we do. It's frowned upon."

Mom sighs. "I know, I know. We take a kid to a psychiatrist for stealing a candy bar. What is a sociopath, anyway?" She's not into Googling things.

"People don't generally use the word correctly. It's a criminology word, I'm pretty sure. But mental health professionals also talk about sociopathy as related to personality, particularly Antisocial Personality Disorder. Sociopathy refers to having no guilt, to seeing the opportunity to hurt others and taking it. No fear of the consequences. No morality."

"I don't understand. How does a normal, nice looking man like him, turn into someone like that?"

"I don't know, Ma. In our crowd we would say, No Torah. But it's much more than that. Most people have some kind of respect law, for authority, some fear. And they have a super-ego, too, that little voice in the head that says, That's not nice. Don't do that. Seems that Madoff either hasn't got that voice or doesn't listen to it, or has no fear. Your guess is as good as mine, though. Crime isn't my specialty."

We get off the phone. But this bothers me, as it bothers everyone in my community, that this man has scammed so many people out of so much money. Not that their money is necessarily theirs. Some of us believe that if we have it, we have it so that we can redistribute it. But that's philosophy, theology. Some people really do wonder, however, "Is my money mine? Do I really own anything?"

I love the story, and forgive me if I've told it before, about the rabbi out taking a walk. A thief grabs his wallet and runs off. The rabbi runs after him shouting, "Take it, take it! Take the money! It's yours!" The rabbi assumes the guy needs the money more than he does. He's giving it to him so the thief doesn't have to suffer the sin.

So I'm thinking that this man, Mr. Madoff, just isn't thinking right. He doesn't understand his responsibility to the universe to redistribute wealth.

Or he has unipolar mania, a disorder that is rarely diagnosed, because it's generally perceived as hypo-mania, and everyone has one of those in the family, someone who tends to be incredibly gifted, whose gifts or thinking have the potential to get him into real trouble at some point or another, just about the time that his beautiful mind goes too far awry. No fear.

I went to shul this morning and the rabbi talked about Bernie Madoff and how everyone has a war story to tell because this guy took no prisoners.

Then he tells us the following story.

A few weeks ago a couple of young men finished their Friday night dinners and walked to the synagogue to learn together. They studied for many hours into the night, and when they closed the books and got ready to leave, noticed the pouring rain. Since it had been nice when they left their respective homes, neither had brought a coat.

They looked in the coatroom and saw two lone trench coats and various unclaimed items
.

Our synagogue happens to be a repository of men's coats and sweaters. We could open a store. Anyway.

The boys searched the shul to see if anyone was still there. Everyone had gone home.

They had to make a decision.

Should they borrow the coats? Surely if they did, they could return them early in the morning, first thing. Would it matter? Did they have the right to borrow the coats? Is it stealing to borrow something without permission? What is the law?

Rather than err on the side of stealing, the boys left the coats in the coat room and walked home in the rain.
(That will teach them to not listen to their mothers)

The rabbi's point, of course, is that had Mr. Madoff made decisions like these boys made decisions, had he worried, fretted about the consequences of his behavior, the ponzi scheme would never have taken place. He didn't worry, however, not enough. He's not into karma, and scoffs, apparently, at civil, federal, religion and international law, law of any kind. He has Bernie's law.

That or he's manic.

Below are a couple of diagnoses for you to chew on. Don't ask me to pick one because I haven't talked to him, and have no psycho-social-family history on the man. But I'd love to talk to him, I really would. And he does need a check up. He certainly needs some kind of excuse.

therapydoc

Criteria for Manic Episode:

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1.inflated self-esteem or grandiosity

2.decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

3.more talkative than usual or pressure to keep talking

4.flight of ideas, or subjective experience that thoughts are racing

5.distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6.increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

7.excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The symptoms do not meet the criteria for a Mixed Episode.

D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hypothyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Diagnostic Criteria for 301.7 Antisocial Personality Disorder

A. There is a pervasive pattern of disregard fro and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

1.Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;

2.Deceitfulness, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;

3.Impulsivity or failure to plan ahead;

4.Irritability and aggressiveness, as indicated by repeated physical fights or assaults;

5.Reckless disregard for safety of self or others;

6.Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;

7.Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

B. The individual is at least age 18 years.

C. There is evidence of Conduct Disorder with onset before age 15 years.

D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.

Sex differences: According to DSM-IV (in a 1994 publication by the APA), Antisocial Personality disorder is diagnosed in approximately three percent of all males and one percent of all females.


therapydoc

Friday, May 25, 2007

Rocky Balboa

Well rested, well-fed, and well, bored, after a two-day Jewish holiday, I settled back to blogging after the respite. So many things I wanted to write about, but all I could think of was the Rocky story and how it worked for me as a therapy doc last week.

You remember Rocky, right? He’s the fighter who ran through the streets of Philadelphia screaming Adrian! True Rocky cultists refer to more than his love for his woman. They talk about the things that come out of Rocky's mouth. He's an inspiration.

And Sylvester Stallone, a hero of mine since I caught a glimpse of him at the Paramount commissary a thousand years ago at lunch, has a way with words. He wrote the screenplay for the movie.

He's the creator of Rocky-isms.

It ain't over 'til it's over. (In divorce I refer to this as, it's not over until the ink is dry).

The world ain't all sunshine and rainbows. It is a very mean and nasty place It will beat you to your knees and keep you there permanently if you let it. You, me or nobody is going to hit as hard as life. But it ain't about how hard you hit, it is about how hard you can get hit and keep moving forward, how much can you take and keep moving forward. That's how winning is done!

I like that idea, how hard you can get hit and keep moving forward.

If you're willing to go through all the battling you got to go through to get where you want to get, who's got the right to stop you?

Once I lived in Israel. The bureaucracy nearly killed me. Then someone told me the secret, and it's an element, you should know, of assertiveness training-- my version of assertiveness training that is:

NO is the beginning of the negotiations. You begin to negotiate when they say NO and you don't let up. You keep at it and you'll get what you want. It works; it really does.

I mean maybe some of you guys got something you never finished, something you really want to do, something you never said to someone,

Meaning, just because YOU haven't got the courage to backtrack and tie up loose ends, doesn't mean I haven't. That's the essence, by the way, of the 12-step programs, back-tracking, fixing the errors of the past, if possible. I love that.

So Rocky is more than a boxing movie, and true to the Rocky genre, Rocky Balboa is all about perseverance and courage. Don’t Give Up. It was a good call, asking me to review this one (was it you, Mi? I think so!)

But a real review of Rocky Balboa would be remiss if I didn't give the downside, right? You need to know, okay, that the beginning is so, so slow. If you have back problems, maybe don’t even rent it.

I was definitely half-way through the film when I turned to F.D. and said,

"If this doesn’t start very soon, if he doesn’t AT LEAST jump rope VERY SOON, it’s over, it’s over, it’s all over."

Then all of a sudden they were beating the blank out of one another in the ring. Did I mention that it's a boxing movie? FD, who outlasts me with blood and guts any day of the week, said, “This is disgusting. This sport is disgusting.” And he was right.

But I don’t know, it kind of made me feel good. All that sitting and waiting and then finally, finally, a fight. It’s very much like a united front couple before their first fight. Oh, I haven’t told you about united front couples, have I. No, not today. Suffice it to say, the first fight is the last. It’s a knock-down drag-out, take no prisoners argument, and it never happens again. That's it for fighting. That's it for problem resolution. Way too scary to go there again.

So sure, I got through Rocky Balboa relatively unscathed, a patsy for distraction any night of the week. And the very next day I happened to see a really sick patient. It’s not like every day I don’t see really sick patients. I do see really sick patients every single day, which is why it is good to take the Sabbath and these religious holidays seriously. Therapy docs are good for no one when they burn out. I believe there's a Rockyism about that.

Anyway, this particular individual that I'm talking about could be anyone of us with bi-polar disorder. I’ve mentioned in previous posts that bipolar disorder is often misdiagnosed and glamorized in our very caffeinated, manic and neurotically labile culture. The vicissitudes of depression and mania are many.

There is a normal range of sadness for the rest of us, but people with bi-polar disorder feel way beyond that range.

And it's not good. They really suffer. We can marry our depression, those of us who never feel that very dangerous pole, and most of us don't. Depression's actually very sensuous in some ways. But the depression of bi-polar disorder is exceedingly psychologically and physically painful (sheer exhaustion, battle fatigue, nasty side-effects from medication). It's difficult to predict and manage. One out of five people with this disorder do successfully complete a suicide. (Not on my watch. Don't get any big ideas.)

Yet by definition the disorder improves with dogged intervention. Sick today, well tomorrow. I've seen it so many times. The cloud lifts. The light switch goes on. It's magic. (With intervention, don't forget, meaning medicine).

Anyway, let's continue the story. My patient was feeling pretty low, as exhausted/bereft as ever as he's felt in his life with little hope for tomorrow. It can be difficult convincing people that this hopelessness will change, no matter how many times they've been through it. Their brains select out that wellness memory when they are in this particularly horrible place.

But I had just seen Rocky Balboa and I couldn’t help but take a stab at it.

"Have you ever seen the Rocky movies?" I asked.

"Every one of them, I think," he said.

"Then you’ve seen Rocky Balboa?"

"No, I missed that one."

"Rent Rocky Balboa. Maybe it will help."

Between you and me, and between me and him even, and I said that, I hedged my bets, in my heart I know the movie won’t change the way he feels very much, if at all. He may not be able to concentrate. I'm sure, in fact that it will be next to impossible to concentrate, although sitting through it is certainly possible. Sitting is something he can do very well. He hasn't much energy to go anywhere.

But you know something? If he rents it and he does hear the message? If he continues to work with his doctors and take his medication, watching a movie with a message can't hurt.

It's good to know that when you're down, when you're really down, there's a way to move forward, if only by marking time.

THAT can take courage.

Copyright 2007, therapydoc

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   Rabbi Zev o nce  told us that a rabbi, a Jew, has to be ready to go to a funeral and then a wedding  on the same day, maybe within a few ...