The Paper and the U.S. Postal Service

THIS is not to be believed.

I intimated yesterday that I only sort of attended the conference. Let's just say I was in and out, so to speak.

Here's the deal. I got lost in downtown L.A. driving around aimlessly, looking for the Sheraton. The Sheratons that I remember have big S's on top of them. Now they're tucked into shopping malls. This one's in a Macy's.

So who knew?

When I MapQuested it, frankly, I was a little wiped out from traveling and more than a little hungry. So my photographic memory, which usually serves me quite well when it comes to maps, was completely on the fritz.

And to make matters worse, I couldn't get Margo's printer to print.

I finally found the hotel by nose after a good 45 minutes of hunting around and listening to other drivers swear at the way I made very swift 180 degree turns on 3rd Street, or was that 4th Street or Flowers or Hope, can't remember.

When I pulled into a parking garage it turned out to be a tight a double helix that it made me want to vomit all the way up to LEVEL 4. It's good thing I'm not a breakfast person.

Hit the elevator down to the lobby (they have a happy lobby over there at Macy's). I was all set to blow off the conference right then and there and SHOP but it was only 9:00. So I ducked into the hotel (elegant but no computing stations, come on), and descended to the conference rooms to register.

So dreary. The atmosphere was so dreary. And outside, I remembered, the sun was shining. Real sunshine.

I signed in and hunted for an interesting paper presentation. The plenary speeches were scheduled for the afternoon, an outrage, in my opinion. They're supposed to be the main attractions of any conference, and they're supposed to kick them off. If there's one thing I go to these things for it's the plenary speeches.

The so-called interesting paper presentation eluded me. I'd tip-toe to the back of a room, listen as long as it took to KNOW that the speaker wasn't going to hold my interest, then pretend that I had an important call that I had to take. I'd put the phone up to my ear, and book.

At worst I could get a cup of coffee. At best I could find a Kinko's and copy the paper to send it out to that editor in Milwaukee.

I chose to go to my old home away from home, Kinko's.

Turns out that Fed-Ex Kinko's is only two blocks away from the Sheraton! And they were so cheerful, so pleasant! Free paperclips, as always. I took this opportunity to take out my contacs so that I could read the map that I had shlepped along, heretofore useless since I can't read anything with small print wearing my contacs.

And I called G.D.

Me: So, Dear, whacha' doin'?

G.D.: I've got the boys. We're heading for the Kid Space Museum in Pasadena.

Me: Oh, I'm going. Pick me up. But I have to mail my paper. I saw a post office in the Macy's mall.

G.D.: Great. I'll be there in 15 minutes.

Me: (thinking, How much shopping can I do in 15 minutes). Okay, call me when you're outside. I'll hustle.

And I did. I mailed the paper at the post office in the Macy's Mall. Actually, I had already put about $2.90 on it in stamps. I asked the clerk to make sure it was enough. She weighed it and smiled. I'd overpaid twenty cents. Not bad.

This terrific person stamped the manilla envelope with a cool red circle stamp and tossed it to a cart. I said a quick goodbye, kind of proud that I'd finished the task, thinking the paper still wouldn't make it to Milwaukee until after the Veterans Day weekend.

Who actually knows when the U. S. postal service mails stuff on Federal holidays?

Got to Macy's, managed to score something rather personal in record time. G.D. was calling from outside, saying HURRY UP, the kids are getting antsy. He was getting antsy.

I rushed out and we had a GREAT DAY, which you read about yesterday.

But here's the upshot. Before I left town I complained to you about Mr. Smith, not his real name, the guy who delivers my mail to my office in Chicago.

Complaining about a postman is probably dangerous business if you think about it. What if they go postal? What if your mail gets stuffed in the trunk of the guy's car and you never see it again, all because you complained?

Since it's unlikely that Mr. Smith reads blogs so I ranted here about what I considered his lackadaisical attitude towards delivering the U. S. mail.

But the postal service at Macy's? Unbelievable. Listen to this!

We had had a long day, packed it in with those kids, did the museum thing, trudged through a rather wet Rancho Park, took the family out to dinner, met Cousin Roz and b-i-l Scott at Nagila, too, and finally landed back in the Valley, said good night and had a chance to log on.

There was email from the editor of the paper. And I quote:

Dear Professor Freedman,

We are in receipt of your revised manuscript, "Accepting the Unacceptable. . ." Both the mailed hard copies and electronic copies have reached our office, and have been forwarded to our editor for further review.

Same day.

The paper got there that day, the same day I mailed it. The paper flew from Los Angeles to Milwaukee, hopped on a U.S.Postal truck and made it to the editor's desk in less than 8 hours for $2.90.

It was not marked Express Mail. It was not even 2-Day Priority Mail. It was simple first class mail. United States Postal Service. Same day service. Under three bucks.

Now that's unbelievable, isn't it? I sure think so.

And another cool thing? I surfed my favorite blogs (I think it was that same day, can't remember, but it was that week) and Citizen of the Month had favorited this blog with a crush. Now if that isn't Los Angeles hospitality, I don't know what is.

Thanks, N.K.


Copyright 2006, TherapyDoc

What do Borat, Sexual Assault, and Informed Consent Have in Common?

I was in L.A. and I looked for Sacha Baron Cohen, A.K.A. Borat, who apparently dined at Pat's a really good kosher restaurant.

Not that I was at Pat's, but I couldn’t have been all that far away.

Who is Sacha Baron Cohen ? He's a comedian and has a hit television show in London and now stars in one of the biggest movies in America, Borat: Cultural Learnings of America for Make Benefit Glorious Nation of Kazakhstan, supposedly hilarious.

The film is a "documentary" about American culture, which is not a documentary. Rather he duped people into thinking he was interviewing them for a documentary, playing Borat from Kazakhstan, a film-maker with an interest in American life.

Borat Cohen did not let on that he is really a comedian intent upon embarrassing anti-Semites, racists, and misogynists.

In the process, people made complete fools out of themselves and signed away their right to refuse to be in the movie. According to one film review, unsuspecting interviewees were promised that the release of the movie would not be in the U.S. and that they would not be identified.

Promises, promises. Interviewees were made out to be the biggest morons in the movie according to one reviewer, James Berardinelli.

People don’t like being made out to be misogynists and racists in movies. Especially when they've been promised the movies would not be released in the United States. At least two Americans, fraternity boys from North Carolina University, who participated in the “documentary” signed releases while under the influence of alcohol.

Borat (Sacha Baron Cohen) picked them up, got them drunk, showed them a lude film starring Pamela Anderson. He filmed their racist and misogynist jokes. The interviews will be seen by millions of people all over the world. The children and grandchildren of these kids (not to mention their mothers and fathers) will not be pleased.

So they sued for lots and lots of money. Why not?

It is the issue of INFORMED CONSENT that grabs this doc.

Jason Fortuny may have been guilty of the same thing, duping shady people. But Jason says that he wasn't out to deliberately humiliate anyone. He told me that he did his Craig’s List experiment because he was curious to see what would happen. That’s what he said. He was curious.

Sacha Baron Cohen is accused of deliberately humiliating people and contextualizing a situation in which they would make racist and anti-Semitic remarks. He was out to make racists and anti-Semites look bad, and he succeeded.

Theoretically, we should give him a prize.

But this is America, and in America consent must be INFORMED CONSENT.

INFORMED CONSENT IS ONE OF THERAPY DOC’S BIG DEALS.

See, I don’t like sexual assault or rape. These are acts of violence that more often than not occur to women when they are under the influence of alcohol. Under the influence they can not give a perpetrator informed consent. In 90% of all rapes, the perpetrator is an acquaintance of the victim.

So it IS possible to obtain informed consent for sex if you know the woman you want to have sex with. You just ask. By law, if one or both of you are under the influence, you risk the whistle blowing bit with rape.

Informed consent vis a vis sexual relationships means that the woman is able to tell a man that it is okay to have sexual relations. If a woman is under the influence, she’s impaired. It’s almost always a woman who is raped, by the way. Seven out of ten victims are women.

Similarly, Sacha Baron Cohen got these idiot frat boys (their names haven't been released) drunk. They made morons out of themselves then signed releases (informed consent) so that Mr.Baron Cohen could use them in his film. Since they were impaired, they have a case.

Seems to me, but I'm not a lawyer.

Seems to me that Mr. Baron Cohen will end up settling. The precedent for informed consent is established as I’ve described above in most United States regarding sexual relations.

So as much as I would love to support you on this, Sacha, and would have given anything to have been at Pat’s to have interviewed YOU while you wined and dined on the town, I can’t do it. I can't support 'cha. (Unless you give a lot of money to Israel, then maybe).

Seriously, you could have got the same footage with informed consent. There are plenty of racists and anti-Semites in this country. I guess that was your point.

Copyright 2006, TherapyDoc

About affection- Part One Engaged vs Disengaged Families

Wednesday, November 8, 2006

We’re on an airplane, flying into Burbank. I hadn’t wanted to shlep the Thinkpad, if you have one you know why, it's so heavy, but FD said Bring it.

I hate it that he’s right about so many things. So much.

And yet, it’s good that he is because two brains really are better than one.
P.S. If you think like this in marital therapy, you'll do okay.

So here we are the two of us. He’s charting out some music. Composing I think is the word for it. Being in a band, one has responsibilities. I take his hand in mine every once in awhile, am kind of happy.

But boy do I have a headache, one of those I forgot to eat today headaches. With all the tumult, the packing, the last minute errands and calls, then there was The Paper.

Which is finished, by the way.

Submitted it electronically in a flurry, and printed it out, just one copy. But I need two hard copies to mail to the editors at the journal. These academic things get long with all those stodgy sources, four pages of references on this one. So instead of wasting ink at home, the precious thing’s with me in a carry on, ready to copy and mail from L.A., not because I needed this extra hassle, believe me, but because there wasn’t time to get over to Kinko’s.

There was a time, not that many years ago, when they knew me by name over there at Kinko’s. If you ever go to graduate school, it could happen to you.

So I’m pretty relaxed right now, looking forward to feasting my eyes on my family. I closed them a couple of times, too, my eyes and one of those times I started writing in my head the story you're about to read.

This is the story about affection in my family, my family of origin. For the record, the family of origin refers to a person’s parents and siblings. I don’t think my family of origin will mind my telling the story.

We’re a relatively small one, just the parents and three kids, me sandwiched between two brothers. As the girl I was afforded plenty of privacy, had my own room. The two boys shared theirs, a boy room in soft greens and blues. I liked oranges, pinks, and hot pinks. Crazy, right?

Basically we kids were raised in one of those traditional families where you listened to your parents. Your mom was nice and you could wriggle out of things with her, but if your father told you to do something, well, you just did it.

My dad had an amazingly effective way of scaring the living . .. out of us (love you, Dad). When we three kids were little we bonded properly, according to him, US AGAINST THEM, kids against the parents. Dad always took credit for this alliance against him. He felt it was the right way to build a strong sib-ship (my word, his idea).

If you've read anything by Sal Minuchin (students, paying attention?), one of the real fathers of family therapy, you know that having the generations in alliance is really a fantastic thing in a family.

After all, goes the rationale, parents will be gone one day, we think, hopefully we will outlive them, and it would be nice if the kids all got along. As you well know, this is not a given in many families.

But I would like to suggest that what we had as children in my family, our US AGAINST THEM alliance was really pseudo-intimacy, feeling you’re being intimate in the process of talking about others, now ourselves.

It doesn’t have to be that way exclusively. We could have talked about our parents AND talked about ourselves, but I don’t remember that happening. There weren’t many discussions about personal feelings or thoughts, I don’t think (correct me if I’m wrong, Mom or Dave, maybe I am). We were studious kids and when we could, we played sports.

Like most families we had good times and bad. Somehow, I don’t know exactly why, but I have my theories, maybe the spacing of the kids, maybe it was just our personalities or genetics, maybe it was a million things, maybe I’m too hung up on sharing lately, in general, but there wasn’t much intimacy.

On the enmeshment versus disengagement continuum that I haven’t yet talked about, we were probably on the disengaged side, although mom pushed pretty hard to engage us. That's why I sometimes wonder (am actually sure there is some correlation) to genetics and social interaction But let's not go there now.


Disengaged ____My family______________________enmeshed

A disengaged family doesn’t communicate at all about feelings, thoughts, what they want to do, particularly, either. If a kid wants to do something, he has permission, he's pretty sure, to just do it. There’s a sense that it’s okay to do your own thing, that no one cares, and that can truly be the case, but usually not.

Disengagement can be about benign neglect, but it can also be about being afraid of intimacy. Parents themselves are afraid to talk about their histories and feelings can also be afraid to express opinions, or G-d forbid, to interfere.

Their fear of intimacy is rooted in fears of rejection, their own antipathy and discomfort with closeness/suffocation, fear of exposure or ridicule, and finally, fear of fusion, losing one’s sense of self in a relationship, melting into the other’s personality.

Easy stuff, I’m sure you’re getting it.

The other reason for disengagement is pure and simple child neglect.

Enmeshed is the exact opposite. A kid gets no psychological space, isn’t allowed his or her own thoughts. Parents have to know not only what kids are thinking, but where they’re going all of the time, and with whom, not really to protect the child, but out of psychotic fear that the child will be swept away, seduced into being different by others who are different, and then will reject his parents.

True enmeshment makes it virtually impossible to develop any kind of confidence or cogent sense of self. True enmeshment means there’s no YOU, rather you’re an extension of THEM. The family is a collective psyche. I write a bit about this in SEPARATION AND SELF: THE ANTI-ENMESHMENT VARIABLE
Big words, but I think you get it.

Oh, and no matter the pathological pole, whether a family is disengaged or enmeshed, LOVE may have nothing to do with it.

Love, a certain kind of love, insecure, needy love, courses through the veins of the families at the ends of the continuum. Those of us in the middle probably turn out okay with a little therapy and luck. As you probably know, I feel everyone needs both.

But it's late and G.D. is looking at me like he wants to tell me something about how the cross-winds won't help us or there's a fault somewhere down there or did I know that the speed of an airplane. . . And he thinks I don't listen.

I had wanted to tell you a story about affection, a personal story. It’s my favorite thing, affection. But my battery power's running low, too. Plus I knew from the start that this story is going to have to be in 2 parts. That would make 3 parts if we include this one.

And face it, I'm on vacation.

It can wait, right? At least you learned about disengagement versus enmeshment. Gotta' go.

Copyright 2006, Therapydoc

Falling Asleep in Shul

What happens to me is probably very common, but I haven’t read about it anywhere. I know it happens to a lot of people. Maybe it happens to you, too.

I can’t explain it, but it happens when I’m in the synagogue. (Shul is Yiddish for synagogue). When the room is warm and a hush falls over the crowd, and the rabbi gets up to speak, pretty soon he has this nice, lilting drone going. Well, when that happens. . .

I fall asleep.

So today we had a scholar in residence. A very nice rabbi, Rabbi K. He wrote a great book which I was supposed to read but stubbornly neglected to read, but will get to, eventually, with no promises. So Rabbi K. was in our shul to be our scholar in residence for this Shabbas, our day of rest.

He had already spoken to a packed crowd on Friday night, and he spoke when I was there this morning when all this happened. He spoke again this afternoon, and he’ll be speaking again tonight. It’s not easy being a scholar in residence. You need several different speeches.

Anyway, when our regular rabbi speaks I might catch a few zzzz’s, I’m not going to lie. But I love him and there are no hard feelings. He can't see way up into the balcony, anyway. I’m sure he’d fall asleep listening to me, too, and it’s not like I ALWAYS fall asleep when he speaks. I try to listen. It’s probably a statistically significant bet that I do, however, for the reasons I stated above.

But today Rabbi C. (mine) introduced Rabbi K. (our scholar), who started off quietly, which put me in that space, you know, within perhaps 50 seconds. Last I heard he was saying that he was going to talk about a Get Rich quick Scheme, the best way to become rich which wasn’t going to have anything remotely to do with money. Soon he was off to the races talking about Marital Relationships and I was down for the count.

Suddenly, a tremendous racket outside awoke me, jolted me in a very big way. I jumped up and it seemed that everyone was talking, but no one was really talking, some were simply explaining what the commotion was and others were asking, What’s the commotion?

I asked my friend Amy, sitting on my left, who does catch every word (yo, Aim) What’s the commotion?

Apparently there were about a hundred people standing outside the sanctuary in the hallway, and when one of them opened the door the noise of one hundred people whooshed in, rudely waking me and probably others.

Things quickly settled down, but these are moments when one has to make a major decision:

(1) Do I go back to sleep? Or

(2) Do I try to hear the rest of what the scholar has to say?

I opted for staying awake, as I usually try to do when I wake up somewhere during anyone’s speech. It’s not like I’m avoiding what the rabbi has to say, it’s just that strange confluence of variables that have the soporific effect. Those soothing intellectual words from the pulpit.

This is why, by the way, many clergy people scream at their congregants, I’m convinced.

When I woke up Rabbi K. was speaking to the men. I could tell because he never looked up to where the women sat in the balcony (for reasons of modesty). He looked directly at the men who were in front of him on the main floor of the sanctuary and said things, like, “When you come home from work, you should compliment your wives.”

So he was talking to the men, who, face it, need to know these things.

He told the men that the secret to being rich had to do with respecting their wives, listening to them, praising them, appreciating them, complimenting them, letting them speak first, always.

I agreed with him a hundred percent, except for the last five words. LET THEM SPEAK FIRST ALWAYS. Always? Clearly he did not read my posts on listening.

In Listen One and probably in Listen Two, I divulge the secrets of shutting up.

Shutting one’s mouth is the essence of communicating well, clearly, because it is in that void that one hears what others are trying to say and learns something. That is unless one is thinking of the next thing to say, which is not what one is supposed to do in active listening.

But forget about active listening for a second. We were talking about Who Gets to Speak First at the End of the Day, one of my favorite topics. The rabbi had suggested that if a man lets his wife speak first it would be good for the marriage.

But I disagree. The ikur (meaning, main thing, Hebrish, a mix of Yiddish and Hebrew) is that one need not automatically shut up and listen. That would be stuffing feelings and emotions that really, perhaps might need to be uncorked in order to proceed in the listening process. (this talking thing beats uncorking a bottle and is cheaper).

What works emotionally for the couple is when BOTH partners are sensitive to one another, each gauging the other's need to talk.

SHE or HE should be checking HIM or HER out at the end of the day (change these pronouns as you wish), sensing whether or not the world has trashed the other like a sack of garbage. Some days are like that, okay?

If I were the rabbi, and believe me, this is with all due respect because I like his message, for the most part, but I would have told you:

You should be checking out Your partner and vice versa.

This is not necessarily a verbal examination. It is not a, “So how was your day?” thing.

At the end of the day BOTH of you should LOOK at each other to see if there are any new gray hairs, any new wrinkles. You have to look for the sadness, the worry, or the gladness (preferably) in the other’s eyes. This is not a passive process.

Then. . . the one with the better looking face, the one who has not got a furrow of brow, a turned down mouth, that tenseness of the body, the shoulders, the one who’s in a better place needs to invite the one who is not in the best place to speak, saying, “Tell me about it. Talk to me.”

I know, I know, sometimes, perhaps usually, it’s not an easy call, determining which of you is in a better place. But you have to make it.

That’s love, friends. It’s not a gender thing at all.

Thanks Rabbi, for reminding me to say that again, to reinforce one of those definitions of love. If you said it while I was asleep, forgive me.

Copyright 2006, TherapyDoc

Blogger Burn-Out

You know, therapists burn out. This is a well-known phenomenon. They work for years to get this fabulous education, and about six years into it can't stand the work anymore.

Sometimes it's too much of one diagnosis or another, like seeing too many depressed people in a day can (HAS TO) make a doc a little depressed.

Or maybe there are simply too many borderlines out there, or too many traumatizing stories. Borderlines can have therapists all up in arms, worried about themselves, their families and personal harm, worried about others who have to deal with them, still more worries about suicide gestures and occasional success.

So real estate has tremendous appeal, okay? Not for me, frankly, but it does seem to be the choice for lots of other therapy docs. I kind of love my job, you know that, and I balance the types of folks I see every day, lay lots of responsibility for their welfare back on them.

But what about BLOGGERS? Do BLOGGERS burn out? They write day after day, week after week. They go nuts when they go on vacation, terrified their ratings will drop in Technorati, have others blog for them in their place!

So do they? Do they burn out, writing, writing, writing, day and night, organizing, editing, re-editing, reading other blogs, redesigning their websites, losing precious template symbols that trash the site (temporarily), commenting to others and to those who write to them, deep into the early hours of the morning, bleary-eyed, half awake the next day, manic, full of words, crazy.

Do they burn out? Do they?

Nah.

Copyright, 2006 TherapyDoc

Seasonal Affective Disorder--I'm Sharing about SADS

Yes, it’s that time of year. The days are shorter, they’re getting colder. The holidays are coming and the memories. . .

Oh man, the memories. . .

So a lot of people get depressed. It’s called the Holiday Season Blues, but professionals call it Seasonal Affective Disorder.

It’s a real thing. Some people literally only get episodic, meaning they suffer an episode of a major affective disorder, depression. Sometimes it’s mild, sometimes moderate, sometimes severe.

Sure, get therapy, right?

But also, get light. The studies on light indicate that if you light up your house, you’ll feel better.

Time for Therapy Doc to share.

About eight or nine years ago I got really down in late October. It was a truly irrational thing, and like usual I blamed it on anything I could think of (hormones rule, in my case), and tried to patch things up wherever I could, followed all of my own rules. Still felt like a ton of bricks hit me and walked around in a daze.

In mid-November Science Fair began. For those of you who know what that means, it’s pretty intense for the little buggers who have to come up with a project. Occasionally my kids would do projects that were psychological and I’d get involved, which was fun. G.D. helped when things got more scientific and I’d lay back and chill. I rarely got into the homework thing with the kids on the best of days.

One of the kids was doing a botany project for Science Fair. He’d lit up the family room, basically, with fluorescent lights 24 hours a day. I hadn’t even noticed it, pretty much was wrapped up in work and survival, making dinner and getting laundry into drawers. Opening mail.

But when I’d come home at the end of the day, no matter how late, there was light. And I didn’t really notice. But there WAS light screaming from the family room, streaming into the kitchen. The whole place was lighter. And without even noticing, I felt better.

NOW. Is this hocus pocus?

I’ll let you decide (sure, it’s anecdotal and it is not a representative study or empirically valid or whatever, but pay attention anyway).

Science Fair ended. I hardly noticed except the child we’re talking about PLACED. He did really well, so well in fact that the school awarded him a savings bond that we found stuck in a file many years later.

But when it ended, he turned off the lights. Once again, I didn’t notice that he’d turned off the lights. I could have been a better mom, I’m sure.

But when I got home at night, after he’d turned off the lights, I would walk into the family room searching for something. I’d stop and wonder what I was looking for, seriously. I thought it odd that I was doing this, but at some point I started getting depressed.

I’d be depressed and standing in the family room with it’s regular lame soft bulb fixtures, looking around, feeling SOMETHING was missing.

When it hit me that it was the fluorescent lights, I dug them out of the closet and turned them on again, and oh, oh, oh. What a difference a Watt makes!

This is a totally true story. My recommendation for SADS? Why suffer in the darkness, seriously? Fluorescent bulbs are cheaper and last longer. Talk to your hardware person and lighten up.

Copyright 2006, TherapyDoc

Anti-depressants, suicide, and teen-agers

I first posted about a teen and suicide a few months ago.

The subject never really disappears for therapy docs, but it’s back in the news again. So I’ll be hearing about it at the office today. People will be asking me questions.

Not to digress too far, but it is the elderly, not ironically, that is the population most at risk for suicide. One becomes less newsworthy after 65.

But back to teens. The research flips back and forth, but my understanding of the problem is as follows:

Teenagers are at risk for suicide in general, primarily due to pressure about academics. Pressure about school and grades underlies most teenage suicide. This is the reason that I emphasize that parents NOT pressure their children about grades.

Pressure them about curfew, pressure them about relationships, pressure them about morals. When I say pressure I mean talk. Talking to teens is often interpreted as pressure. They already know where we stand on most things, so they put us in the category of white noise.

BUT DON’T PRESSURE THEM ABOUT THEIR GRADES.

You don't have to pressure if you make your child’s academic progress one of his or her first big decisions. You can offer to pay for tutoring. You can intervene if a teacher is too hard on your kid. You can help with the homework if you're really, really helping.

But make the child do the work himself and make it okay not to do SO well. You had your chance to go to school.

BACK TO DRUGS.

Teenagers do express suicidal ideation, some for attention, others to be cool, some because they are really depressed and do think they would be better off dead. Caring parents bring these young people to therapy and participate in it themselves. They’ll do anything to be sure their child is safe.

A busy adolescent-centered practice draws a few dozen cases like this a year. Many therapy docs won’t see adolescents because teens are tempted to try on different behaviors in their search for identity, some of them really dangerous. They’ll explore risky deviant sexual behaviors like pillow sex (suffocation). They’ll experiment with drugs, cut themselves, etc. Docs are afraid of being sued if anything happens.

So those of us who do see wily teenagers watch them carefully. And if we refer for medication, we make sure that the prescribing physician doesn't just put a child on anti-depressants and say, Have a nice day.

That's what they found in the original studies of teenagers on anti-depressants. They were usually prescribed "harmless" SSRI’s, a class of anti-depressant medication. But once they felt better, they were set free and some did kill themselves (between visits). Their doctors had let up, stopped seeing them weekly after the symptoms of depression abated. The decision may have been based upon the economics of medicine and managed care that managed too tightly.

We have known for a long time that some of the SSRI’s (Prozac was the devil) could trigger a psychotic episode in people with bi-polar disorder. The mania and Prozac didn't jive. But now Paxil is commonly used, often as a "life-saver" in the treatment of bi-polar disorder. Patients are watched closely, of course.

I am not a medical doctor and cannot prescribe medication for my patients. But I will tell you that I feel that I have to recommend medication evaluations for very depressed patients at all ages. It's simply the rule. Not doing a med eval is like washing the floor without sweeping.

If a medical doctor says that no, the patient does not need medication, then fine.

We insist upon a med eval because empirical study by the National Institute of Mental Health has consistently indicated that anti-depressants relieve the symptoms of depression. Once the physiological symptoms are gone (see more on this on another post), it’s much easier to change the dynamics that are contributing to the disorder.

The very best treatment, proven time and time again, is a cocktail of cognitive therapy AND medication.

Depression is a physiological condition.

And everything psychological is also biological. Thus medical intervention will effect negative symptoms, i.e., lethargy, lack of focus, confusion, etc. (see other posts on depression on this blog).

When a patient is really depressed, just participating in talk therapy, or working on reversing negative thoughts, changing behavioral patterns, can be futile, more painful because it may not work.

The quick and dirty? Don’t be afraid to see a physician about medication. But don’t walk away with a prescription and avoid real treatment. Treatment implies therapy, at least weekly in the beginning, sometimes more often. Sometimes I'll know that a patient needs to be in the hospital right away.

Unless your family physician is going to follow your child closely (or has someone like me doing that), get a psychiatrist to do the medication evaluation. The primary care doctors need to be informed, obviously.

And by the way. If your therapist is like me, he or she may see a tremendous amount of latitude here, may see cognitive, behavioral, family treatments, etc. as better options than medication in many, many cases. But if we say you need a medication evaluation? You do.

Copyright 2006, TherapyDoc