New Years Greetings, Jewish Style

Just a quick post before the holiday. I left another over at the The Second Road , if you're interested, where I'll be guest posting once a week.

Here's how I ended my first entry (Commitment)

Hey, I could have gone anywhere with this post, and probably did. I wrote it on a plane, going over it in my head in hypnogogic sleep, eyes closed.

Thanks for having me, Second Road.

May your site become the GPS of recovery programs.

Sounded right at the time. But here's what I really wanted to tell you before I forgot, before taking off for the holiday.

Jewish or not, in the next couple of days, you might be hearing people around you saying,

Have a happy, healthy New Year.

Or,

Have a happy, healthy, sweet New Year.

This is because Jews like sugar. We really do. We'll dip an apple in honey on the holiday this week just to make the coming year sweet. If we eat sweet things, the year will be sweet. Like on Star Trek, Captain Kirk says, "Make it so, Suloo." We try to make it so.

It's a belief that by saying it, doing it, putting ourselves through the motions, we can make things happen. Change things. This is one of the secrets of behavioristic religions like mine (we're all about doing). And social scientists generally also subscribe to cognitive-behavioral interventions, and surely, hypnotism. Making it so is a little of both.

So...

Have a happy, healthy, sweet new year. May there be no more suffering in this world, and if there is, we should have enough honey to go around.

therapydoc

P.S. For those of you who want to know what the Jewish people are praying for in the next couple of days, the reason your Jewish friends won't be at work, won't be taking calls, won't be publishing comments, etc., take a look at this.

Water, water everywhere: David Foster Wallace

This is where the waters meet the sky.

If you look really hard you can see buildings and seashore below, the Atlantic Ocean meeting Fort Lauderdale. But from above, it's the horizon that's truly sensational.

I have the window seat and the African American mother to my left is teaching her three year old to recognize words in a picture book. The three seats behind us are all empty, so Mom packs up the crayons, books, and child, and moves. I can put up my feet if I like.

After learning a little and saying a couple of prayers, I'll get comfortable and do that, put up my feet.

The son of a close friend is now married to a lovely Miami girl, the reason for this short trip. I actually asked his mother, "How would you feel if I missed it? It's going to be hard to get away."

She looked at me as if to say: Fine, so I'll hate you forever. Miss it.

Gotcha'.

The day before that Sunday wedding, I took a walk over to see #3 son's latest additions to the family, the new Grandfish. He bought me a couple of new fish, too, baby clowns.



It's a new tank and not yet furnished. We take time buying furniture around here.

My son is now best friends with every salt water aficionado on Craig's list in Chicago, and gets us fish at rock bottom prices. When he was in high school he started a micro-business as an aquarist, set up tanks for people, helped maintain them. He called it Rock Bottom and we had fun making the business cards. Rock Bottom didn't exactly take off, but we've always found a certain reliable joy in this family hobby. Keeping fish alive ratchets down the anxiety for those of us who lean toward Type A.

So when he called to ask if I wanted the two clowns, of course I jumped at them. They huddle together and dance in the corner of the tank in the family room. They seem very happy, and yes, are eating well, for those of you worried about such things. (They looked like babies when I left. FD has done a nice job feeding them out of their infancy in my absence).

This is the late David Foster Wallace, a picture from the Wall Street Journal. He knew about fish, too. You can read DFW's commencement address to the 2005 graduating class at Kenyon College online. It begins like this:

There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, "Morning, boys, how's the water?" And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, "What the hell is water?"

Born February 21, 1962 in Ithaca, New York, Mr. Foster died September 12, 2008, a suicide. For more biography, read Richard B. Woodward or Whitney Pastorek's features online. Books about him must be in the making, perhaps they're already in the stores. This gentleman who took his own life (not unexpected, we hear) authored 8 books, including novels and critiques of American life, and one on infinity, as in math. Wildly popular, literary magazines cleared space for David Foster Wallace, as much as he wanted.

Writers worship him.

Mr. Wallace tells over the fish metaphor about consciousness to the graduates at Kenyon College and continues, unless I'm interpreting the speech incorrectly, to say that water represents everything outside our immediate consciousness, that our awareness is hopelessly bound by our self-centered (through no fault of our own) perspective, and that none of us can be anything but wrapped up in ourselves, as much as we try to get out of our heads, thus we don't notice the water until we are older, and even then it is on the cusp of consciousness, and noxious.

Rather than the usual commencement pep talk:

Seize the world, you're all young, good-looking, and above-average,

Mr. Wallace tells the class, basically,

Good luck, suckers. Life is a bear and then you die.

I finished reading the speech, put down the newspaper and thought to myself,

"This is what it is to be someone like DFW, impossibly stuck in the world inside his head, stuck in words."

And I related just a little, as perhaps you do, too, as a writer. But what a terrible waste of a beautiful mind, one that surely couldn't take the madness of it all, so many, many words. Then perhaps, all of a sudden, none. Or none of them good, none of them gratifying.

When I was in my late twenties, a friend of mine called me with a post-partum depression. She said that everything she saw, everything she read, became exaggerated somehow. Things that should be upsetting, but only marginally, now distressed her, terrified her. She couldn't watch the news or pick up a newspaper without dissolving into tears. She didn't want to hold her baby for fear that she would drop him.

These can be symptoms of a pending catatonia, the worst of the depressions imaginable, a psychotic withdrawal into the recesses of the mind. Medical intervention is critical, will save such lives, preserve the parents of the next generation.

David Foster Wallace will be the subject of many a thesis, but to me his decision to suicide, the ultimate withdrawal from life, withdrawal from the water, makes him a casualty, another person I would have wanted to shake, to scream at, insisting, "Just try another medication! There's an agent for everyone!"
Or even a little electricity, just a little.

If I didn't believe in the impervious power of mental illness,* I would say that he needed meaning in his life, too. When he saw the water, and he did, he knew he existed in there, but saw no purpose, not enough. You could say that to him, his pond was more than half empty.

As prolific and productive as he was, Mr. Wallace either didn't want to connect to life, or couldn't, hadn't the energy to make the effort necessary to swim, until finally he found it, the energy, and used it to take his own life. At the age of 46.

With the best years, for a writer some say, yet to come.

Although I haven't read his books, I'm guessing, from his speech, that he failed to see meaning, characteristic of depression, and that hurried his decision along.

To some of us, it is so simple, meaning. Go out there. Do your best. Say Yes when you can, say No when you really know that Yes will come at too great a price.

Give, give, but not too much, and the self will feel worthy, satisfied on more than one level, will know where and how to rest comfortably. The self is that which we can never escape, you see, even if it is not always obvious to us and operates subconsciously; changes imperceptibly, with every sensory impact. The brain, interpreting sensory data, is our first reference point of awareness and self. It is the brain that subsists in the water, or swims, if you prefer, in the sea, the self tucked inside.

We do things as people, and our self-images, what we think of when we say our selves are interwoven into consciousness with our actions, our roles. We call this stunningly complicated weave our identity. Self is separate from the water, but inevitably connected, more or less, depending upon how busy we are. We're going to get wet, regardless, when the waters get rough.

Consciousness, whether it is involved and interacting in life or not, is the water, and it can be unbearable. Our awareness is ours, no one else's. It is private. Our realities are all different, some more negative and disengaged than others. Dr. Wallace understood this, probably, but could not change that experience, couldn't find a more comfortable pond, because of his illness, through no fault of the Pond-keeper. If he were alive he would say, I don't like living in the sea of humanity. It is too hard.

The plane is heading northwest now. I no longer see the ocean, but the memory trace of that place where the ocean meets the sky will basically keep a person like me happy for a long time. Just that sensory data is enough.

And I'm going home, did I tell you? Because Nemo 1 and Nemo 2 are probably looking for me. The impact of little fish, oceans and sky, people in our personal worlds, things we must read and do, the mentoring of our children, sharing life's bookmarks, our missions, meaning, make all the difference. Our commitments shape this thing we call meaning; they guide us, help us move the furniture, improve the clarity of the water in the tank. It can be about as simple as that.

Unless we're really sick. Then there is absolutely nothing simple about the water.

For a real look at DFW and what we've lost, read Carol. She embedded video.

And a writer writes about the writer, Mark Caro, Chicago Tribune.

therapydoc

*In his case, Bi-Polar Disorder, read the comments.

Those Appetites

"I hate it when you're depressed," says FD.

"Me, too. But I hate it more when you're depressed."

He smiles. See, everyone gets this way.

Some of us still assess depression times three. "X 3 or times three" means no appetite for food, sex, or sleep. If a person can't eat, has no interest in sex, and can't sleep, we can safely say, Depressed X 3, unless there's another organic reason for those symptoms, maybe a medication that's responsible.

I know, I know, you're going to say that it's also common to do the opposite, have an increase in an appetite for food and/or sleep. And you're right.

Anyway. I had an exhausting day, including a meeting with a new advisory council in the community. It's an advisory council for an agency that educates educators and administrators in the community about a topic that tends to be depressing in general, childhood sexual abuse.

I'm new here (thanks so much, RZ) although not altogether new. When the community zeroed in on a childhood sexual predator several years ago, I helped break down the collective community denial. But I had to quit. When the going got tough, the tired got out.

But RZ got me back in as of a few weeks ago, and I went to my first meeting of dynamic, incredible people who are teaching safety to school and camp administrators, a first step. Teaching the kids, obviously, is the second.

I learned something new, too, about a website for mandated reporters in Chicagoland. It's online training for mandated reporters Virtually everyone working with kids is required to know this stuff in Illinois.

The meeting in the afternoon sort of drains me, as it might drain anyone, but I zip back to work afterwards (I have the car, these things do come in handy now and then) and see a bunch of people.

Home late, feel fine until the phone rings. The call is about an old issue I still haven't resolved, preferring conflict avoidance (who doesn't!). But now someone wants it resolved. It has to be resolved, and it has to be resolved soon. By me. The story, the players, the whole thing is full of spleen and basically knocks me out of the ring for the night. And unfortunately, I can't tell it.

I hang up feeling the worst I've felt in months psychologically, go to bed by nine, something out of the ordinary, with a Robert B. Parker book, Hundred Dollar Baby.

If you know Robert B. Parker, he writes page after page with dialog on the order of this:

"How can you eat tongue," Corsetti said.
"You know how intrepid I am."
"Oh, yeah, I forgot that for a minute."
"You make first yet?" I said.
"Detective First Grade?" Corsetti said. "You got a better chance of making it than I have."
"And I'm not even a cop anymore," I said.
"Exactly," Corsetti said.
The coffee came. Corsetti put about six spoonfuls of sugar in his and stirred noisily.
"Is it because you annoy a lot of people?" I said.

How hard is it to concentrate on this? (One Hundred Dollar Baby is about prostitution, by the way, or is it better to say Escort Services or even Sex Workers).

FD comes home late and I tell him about the new old issue and he tries to help me work it out, but he can't. Not really. None of his thoughts on the problem work for me, and my thoughts don't work, either. But it's comforting knowing he's got my back.

Sometimes when you're problem solving you have to accept that there may not be a good imminent solution. Sometimes the answer has to be to accept the problem for what it is, something annoying and stuck.

Except that I never really accept things as unresolvable. I'm in the profession of resolving.

Death I get. That I can accept. Illness, too, but not always. Other stuff? There has to be a way.

But, no matter how many heads you put together, just because you want to solve something doesn't mean it's going to happen. Like the problem of sexual abuse in a community. There we are, twenty-some smart people, no where near solving the problem. But we're closer to something of an answer now than we were ten years ago.

So I sleep on it, wait awhile, brainstorm again, mostly in my own head. Until something's right you're in no man's land, just feeling badly. But you rock on anyway.

Morning comes and FD's pushing breakfast on me and I'm gently saying No since it's only been a few hours since that feeling of probably never eating again. That's when he says, "I hate when you're depressed."

Technically the crisis is only 10 hours old. And it's not like I'm grousing or complaining or anything, either.

He lets it go, warms up a muffin, splits it, takes half, leaves the other for me. I snub it, go upstairs, do a little paper work, take a nap. I didn't sleep well the night before.

Before I blink it's 11:00 and I've got to go to work. I'm staring in the mirror wondering how to improve what I see when I hit upon a solution to the crisis. A quick and dirty, perfect solution, if only temporary. I feel a little better, jump into my biking clothes and pack up to leave.

But first I stop in the kitchen, wrap up the muffin. FD sees me. He's scavenging in the cupboard.

"I'm thinking PBJ, on rye. Not toasted. Marmalade." I say, "To Go."

"A fine choice," he agrees.

therapydoc

P.S. Now if we could only think up something for those guys on Wall Street, right?

Mandated Reporting

Well, I guess I passed the test because the website
gave me a certificate. Mine didn't print out very well because the printer's almost out of ink or I'd show it to you.

The test is on mandated reporting of child abuse, who should do it, why, and how. Child abuse, for the record is something that is going on in a kid's home, or maybe in a close relative or guardian's home. If the person allegedly abusing the child isn't family, it's not abuse. It's a crime.

This comes up because school's in session, so teachers in Illinois, who are mandated reporters, are being asked to go to the DCFS* website for training on mandated reporting.

But teachers aren't the only ones who are mandated reporters for child abuse and neglect.

Maybe you are, too.

Here's a quick list of professionals required by law to inform authorities about suspected child abuse or neglect. Anyone, even non-mandated reporters, can make a report however (anonymously if you like) by calling 1-800-25-ABUSE.

Go to the the DCFS** website to find out more about the signs of child abuse, things that should make a person suspicious about maltreatment.

But quickly, mandated reporters include people who work with children, and they are required by Illinois law to report suspected child abuse. The list includes, but is not limited to teachers, school personnel, doctors, nurses, clerical people in schools and community agencies, child care workers, law enforcement officers, social workers, social service administrators, firemen, and clergy. There's an extensive list on the site and a cute interactive puzzle. Take the time to visit. Have some fun.

The training and testing took me a half an hour, and I learned things. You can get 2 hours of continuing education credit, too.

You also get nifty downloads if you want them. The decision tree is interesting, tells you what happens after you've made a report, and for those who feel uncomfortable with the whole business, there's a great one from the child's perspective, should you have the privilege to gain a child's trust:

DEALING WITH CHILD ABUSE OR NEGLECT DISCLOSURE TIP SHEET
• Use words I will understand
Always use age-appropriate words.
• Never say you'll keep this a secret
Never promise the child that you will keep what they tell you a secret. Explain to the child your role is to ensure she is safe.
• Don't tell everyone
Although you cannot promise to keep the information a secret, you should assure the child that you will not share this information with her peers or anyone who really does not need to know about it to keep her safe.

• Explain you still care about me
Reassure the child that what she told you will not change the way you feel about her. Children are often afraid that you will think they are bad, or that what happened to them was their fault.

• Disclosure may be difficult for me
Always keep in mind how difficult it has been for the child to tell you this.

Remember:

They may have been threatened not to tell.

They may feel embarrassed or ashamed.

They may have tested others and decided it was not safe to disclose.

They will be watching your reaction very carefully. As often as possible, try to keep the child informed about what will happen next. She will likely be very anxious. If appropriate, let the child know you will be calling DCFS and explain that it is the job of DCFS to keep children safe.

• Find out answers for me
The child will probably have lots of questions about what will happen that you cannot answer. Don't make up an answer. It's OK to tell the child that you don't know what will happen. It may help to tell the child that you know this is hard for her.

So getting comfortable with approaching and listening to children is the objective, here. And following the law to the very letter. It's the least we can do.

therapydoc


*DCFS is the Department of Child and Family Services, a state of Illinois agency.

No Hitter

Here I am on a Sunday night doing something really important (beating a game of Spider Solitaire, it's my third start, same game, but I beat it), when I get a call from Number Three Son.

"I just thought I'd let you know, since you and my little brother are the only Cubs fans in the family, that Carlos Zambrano is three outs away from a no-hitter. You might want to turn it on."

Well, sure.

And I do, except I worry, What if I jinx Zambrano? What if it's me watching the game that somehow ruins it?

But it doesn't! Indeed, in the ninth inning Carlos Zambrano finishes off Houston like a hurricane (that was mean I know, forgive me) with two bounces in the infield and the last batter down swinging.

Z one and only falls to his knees first thing, thanks the Old Mighty.* Gotta' love that.

I listen to the television interview and how awesome is this?
I hear there hasn't been a Cub no-hitter since 1972. 1972!

And I got to see it. Such cheap thrills. Thanks Three!

FD walks in, a little surprised to see me taking it in and says, "I told you that rest from all that time off for bad weather would help Zambrano!" (Everyone takes credit or blame for these things.) Then he flips to the weather channel for information about our collective futures and we're looking at people wading through the the streets of Houston and Chicago.

"My patients walked into the building today and literally shook the water off," I say.

Mr. Answer Man reports, "We had 10 inches yesterday, 8 inches today, a record. What we saw today, believe it or not, was the actual hurricane, just the rain, not the wind. The storm made it to Chicago from Houston in about 24 hours. Can you believe that?"

Little One does the math, figures the weather system traveled 33 miles an hour. That's fast for a storm.

The light to Blue's tank pops on and the fish gives me the eye. "Ya' gonna' feed me, or what?" He's so snide.

"Blue's telling me he wants to eat," I inform FD. "He's such a smart fish."

"Are you kidding?" FD laughs. "Blue is looking at the TV and saying, 'Wow, take a look at all that water!'"

therapydoc

*The Old Mighty, for those of you new to this blog, is how my grandfather, Z"L (of blessed memory), an immigrant to this country who slept on park benches for a couple of weeks before finding a relative in Chicago at the age of 16, referred to the All Mighty. We sort of think it makes sense, covers both bases.

Generalized Anxiety Disorder

FD is about to leave the house and I look at him and say, "Maybe we should have my brother take off that skin tag on ___(one of the kids)."

He looks at me, furrows his brow. "Have him look at it." He's looking into my eyes. It's early in the morning.

I explain, "I have to have something to worry about. It's what I am."

He says, "It's the GAD."

"Huh?" (I know what it is, but don't want to believe he's even be saying this, even though I'm pretty sure he's joking).

"Generalized Anxiety Disorder."

"Uh, duh. Like I don't know what GAD is? I invented GAD."

On that exaggerated note, how about taking a look at the symptoms of GAD? What's the worst thing that can happen? You'll worry you have it?

Diagnostic criteria 300.02 Generalized Anxiety Disorder *

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)

B. The person finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.

(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep difficulty (difficulty falling or staying asleep, or restless unsatisfying sleep

D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.

E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g. hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

See, to diagnose stuff, you really have to know the entire DSM-IV like the back of your hand. Wait a minute. What do I see there?

therapydoc

* The diagnostic criteria listed about come straight out of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994 (DSM-IV). We're all anxiously awaiting the DSM V.

It's September 10th

It's September 10th. This is what Microsoft Outlook tells me. It's what my phone tells me, and my computer. September 10.
Why am I scared?

It's beautiful in Chicago. Low 54, High 73. The sun is coming down and I'm riding through the park on the bike trail, on my way home. Nothing could be nicer. I'm not even turning on the radio. The birds are chirping, the traffic is light on the streets, only a few soccer players dot the park and middle aged walkers are owning my path.

A man is walking my way, but he's looking up at the sky. It's just the two of us, really. I follow his gaze. He's looking at a big white airplane with red markings on the wing.

The airplane is flying low. It's gone in a moment.

It's September 10th. Why am I scared?

I'm a person of faith so I'm not. I'm not scared. Although traditionally, it is a season of awe and fear for the Jewish People. So I should be scared. We believe that everyone's life, and you don't have to be Jewish here, is in balance during the High Holidays. He/She determines the future for the whole world, sorts through our thoughts and actions in the coming month, sort of like we pick through vegetables and decide on a menu.

But right now, whatever He/She has in mind is going to have to be all right. September 10 is slipping away, anyway, like any other day, and tomorrow, September 11, will, too.

I get an email from Smooth Stone who requests a link. This is well worth the read. It's a tribute to Welles Remy Crowther, a hero on September 11. His greatest ambition in life? Help others.

He's gone.

On a happier note, I just watched Randy Pausch deliver The Last Lecture on the Public Broadcasting Service, WTTW in Chicago. That's something we should all support, PBS.

You're supposed to ask, "Isn't that the guy who died of pancreatic cancer? How could there be a happy note here?"

Indeed, this vibrant, brilliant, fun-loving engineering professor isn't with us anymore. But you can watch his last lecture on YouTube. What a wonderful human being, a person who really understood what it meant to enjoy life and to live it well. And he knew it before he got sick. You have to see him to believe him.

Here's what the sidebar on YouTube tells us:

Carnegie Mellon Professor Randy Pausch (Oct. 23, 1960 - July 25, 2008) gave his last lecture at the university Sept. 18, 2007, before a packed McConomy Auditorium. In his moving presentation, "Really Achieving Your Childhood Dreams," Pausch talks about his lessons learned and gives advice to students on how to achieve their own career and personal goals. For more, visit www.cmu.edu/randyslecture.

He says he did it for his children. Something about head fakes and football.

therapydoc