Monday, December 31, 2007

At the Check-out

Two stories


I did a little shopping for food the other day and had a cartful at check-out. I started to unload.
A young man in a hurry (you can just tell) with only two items takes a place behind me. I turn to him and say, "Go ahead of me."

He does so, grateful.

Then a really famous and successful (we assume, K"H)* restaurateur gets behind me with his cart, not empty, not full, maybe 7 items. But I don't want to let him in, too, or I'll never get out of there. I try to pretend I haven't noticed him and continue to unload. At some point he catches my eye.

"I'm really sorry," I say (always guilty), "I'd let you in, too, but you know how it is. First you let one person in, then another, then another. You're at Hungarian all day long! You know how much the store's take is at the end of the day!"

Kenny laughs and says, "Don't worry about it. I'm in NO hurry."

"Great. So how are ya'?" I ask. May as well make small talk. I'm in a good mood.

"I woke up this morning," he smiles. "So many choices."

"That's my father's line," I shoot back, "I woke, up," he says, "didn't I?"

"No, it's true," Kenny objects, even though I'm agreeing. "I wake up. I look over. I see her. And I'm so grateful to be alive." He continues awhile about all that he's grateful for, a sunny day, that sort of thing, and I nod, agree. We've got time while the cashier is scanning away.

"Everyone could think this way," I say, "when they wake up."

He gives me a skeptical look, one of those raised eyebrow things, as in, YOU should know better.

"I guess not."

So easy to forget. Life is tough. It can be very tough.

This time of year people are grateful, though. For all my talk about how sad people are, and how distressing the holidays can be, and it's true, the season can be brutal, at the very end it seems, on Xmas eve and the days before the new year, people come in all warm and fuzzy. The conflictual couples conflict less. People try this time of year. They even make New Years resolutions.

So I'll say it again, even though in my gut I know it's impossible. Everyone could think this way. I got up today. It's good.

It's a goal, is all.


Rabbi Polstein in Chicago tells this one. He's taught this annecdote to his students.
It's a few hours before a holiday (in this case, Rosh HaShana, the Jewish New Year).
Everyone's cart is full. Everyone's in a hurry. The grocery store is mobbed. The lines are long. At the very front of the line a man, new to the neighborhood, has checked out. His groceries are in the bag. He reaches into his pocket for his wallet. He can't find it.

Everyone's waiting around trying to think of what to do, and a rabbi, clearly not a rich man, hands him his credit card. "Just take it," the rabbi says.

The guy argues, "No, no, how can I do that." (Everyone else is going, take it, take it). Finally he does, and of course, after the holiday, he pays back the rabbi right away.
So Rabbi Polstein gave a class on a snowy morning and told us that once, after telling this story, he happened to be in a grocery store a few hours before Shabbas, and almost the same thing happened. People had lined up at the check-out and the cashier told a woman just ahead of him that her credit card had been rejected.

She has a load of groceries. It's an expensive order.

The rabbi says to himself, Polstein, Polstein, this is your big test! What are you going to do? What are you going to do? He's shifting his weight, scratching his beard, tzittering (basically, worrying)

Finally, he can stand it no longer. He pulls out his credit card and offers it to the woman who is still leafing through her wallet to no avail.

"Here, take mine," he says.

She looks at him like he's crazy. "What? You think I have only one credit card?"

A happy 2008, my friends.


* K"H removes the evil eye.

Saturday, December 29, 2007

Internet Pornography- Part Two

This is a photo from IMDb my favorite website for information on movies.

The last time we visited this subject we talked about spending money at adult book stores, stealing fantasies (pics) of women who serve topless, and acting in blue movies because the pay beats Starbucks.

We touched on the idea that even the straight entertainment industry uses sexuality for mass appeal, too. Some of you didn’t agree that making sexually explicit videos and pictures is exploitation. You felt that if one consents to act or to pose and feels no shame, that it’s basic capitalism, a free market.

What’s it to you anyway, TherapyDoc?

Hey, some people take off their clothes (to make money), so that other people can buy pornography (to feel sexy), so that others (the producers/photographers) can make even more money. It's a free market.

Therapists will get their money somewhere down the line. In our puritanical velt (the religious right won the election for George Bush, remember), nudity raises all kinds of issues, creates intrapsychic and relational conflict. It is the subject in churches and synagogues the world over. So sure, let's take it on. You know I like religious psycho-conflict.

First of all, there certainly is a difference between the two art forms, the blue and the not-so-blue (R-rated) films. It's the difference between pornography and erotica. Both can make a girl blush.

For example, I recently saw Paul Verhoeven's Black Book on video, starring Carise Van Hooten and Sebastian Koch (in the pic at the top) two unbelievably hot actors. Black Book is a sultry, violent film about murder for jewels and money in Holland, 1944.

A lawyer finds Jewish families safe houses and holds their life savings for them for safe-keeping until a time when the war will end. He also arranges their escape over enemy lines into Allied territory when the Gestapo gets too close or if an Allied bomber destroys a hiding place. Relocation is risk at a price. A rescue mission sours, money and jewels get into the wrong hands. Oh, I will NOT tell you the story, it’s too good.

So there I am, on the family room sofa with my feet up, watching Black Book and eating popcorn (made with oil, yes, but no butter) and the movie features much violence and as much or more nudity (along with fantastic direction and performances). I watched for the social and entertainment value (ya’ gotta’ believe me), I wasn't on the tread mill, and I saw a lot of skin. I don’t recommend this to anyone under-age, and certainly not to anyone who is upset seeing naked women or seeing men leering and fondling naked women.

You might ask, how can one lash back on nudity and sexploitation if she watches a movie that features really hot actors with very little on? And let's not forget. I paid to see that film. No free Blockbusters coupons here.

Hypocritical? You bet. (This is along the lines of wasting time, FD, I HAVE to watch this show so I'll know what my patients are talking about). But I'll excuse Black Book as art. It belongs to the genre of erotica, not pornography. And although I'm not personally an erotica fan, at least the film has redeeming social value. Pornography has none.

Wikipedia backs me up with the following distinction:
In general, "erotica" refers to portrayals of sexually arousing material that hold or aspire to artistic, scientific or human merit, whereas "pornography" often connotes the commercial, prurient, morally valueless depiction of sexual acts, with little or no artistic value.
Ours is a society that values art. I took many art history classes downstate for my Bachelors and learned that there is a difference between the words nude and naked.

Nude implies lovely, the human body most beautiful unfettered by clothing. We're works of art, something to be aesthetically admired, in our birthday suits. Naked implies that one should be embarrassed and ashamed, prancing about without clothing. Naked is judgmental, a harsh word.
I would add yet a third category, an umbrella category that says it all, undressed. Meaning, call it what you will, the undressed body turns some people on, sometimes at their own psychological expense, sometimes at the expense of others who didn't necessarily want to click on it or regret clicking on it later.
It is impossible to say that it hurts no one without knowing who has seen it and asking directly. (Patients I've seen who have walked in on parents who were in the buff remember that snapshot memory, not for the better, either, but that's not exactly what we're talking about here).

Let's look at the effect of modeling for erotica specifically, not for pornography even. What if a person models nude for a painting clearly intended to be a work of art. The painting graces the wall of someone else's dining room, the buyer. The model can’t legally take the painting off the wall should (s)he come to regret the job, unless the diner wants to sell it or give it back. It's a Hey, get out of my house! Sounds like a good movie screenplay to me. Someone get on it.

We’re talking about the idea that an act once consensual can become a problem, the same psychological dynamic I wrote about when I posted on being insane at college (Sept 2, 2006). Acting out as a college student can come back to haunt us as adults. Does this mean a kid should never act out?

Yes, but it’s not even a question. Not all kids have the presence of mind to filter, sift through consequesnces or believe in future harm. As adolescents and young adults, we feel omnipotent, deep into developing unique identities, working out the angst of childhood and family issues, trying on new hats.
And kids are going to do what they’re going to do, as one of my friends likes to say.

Bottom line, we learn to live with our mistakes. It’s what makes us older and wiser, and as I’ve said before, owning our mistakes makes us more real to our children.

But owning that photo on the Internet?

Now we’re talking issues. Those photos have lives of their own, they multiply like cells.

Take another, seemingly innocuous situation. A couple makes home videos. They make their own movies, capture themselves undressed. It's easy. Technologically we live in photo-video heaven, own digital cameras, camcorders, cell phones. The film now stars, You.
Couples do this to turn themselves on. The project for their own satisfaction. This pornography or erotica (you decide) is most certainly between consenting adults, right?

But my gut makes me wonder, when I hear about this, is the art truly a product of mutual consent? Really? Or has there been a strong element of coercion on by one partner, the one who has more confidence, more emotional power over the other.

If and when one of them feels guilty and wants to stop the cameras, what happens then?

I've seen this in my practice. A guy films his love-making with his partner/spouse/fiancé. They break up. Somehow the film is all over the Internet. The partner/spouse/fiancé finds out about it. Someone is suing someone, exposing someone, calling bosses, friends; there's considerable blackmail and revenge.

It does sound criminal, doesn't it, such an invasion of privacy? It makes for real psychological damage—regret, shame, suicidal, even homicidal thoughts and gestures. The kind of feelings that never make anyone feel good.

Guilt, shame, embarrassment, panic, anxiety, depression, violent thoughts, post-or acute-traumatic stress disorders, that's the territory we're in.

That's what it is to me, in answer to the question, What is it to you, TherapyDoc?

These are the emotions we work through with patients who regret their decision to say, “Cheese.”

And you're right, you're right, it is often a person's history that drives him or her to posing for the picture, to star in the movie. The desperation comes first, perhaps, the low self-esteem. It is usually not posing that makes one vulnerable, initially. The need and vulnerability can come first.

But posing naked surely couldn't help.
Next time we'll talk about your partner/spouse/fiance's "addiction" to Internet pornography.

copyright 2007, therapydoc

Wednesday, December 26, 2007

Kids at the Movies: ALVIN!

There are so many great psychological stories I'd love to tell about litle kids.

And now that we have a few more of them in the family (grandchildren that I can subvert and hypnotize at will, little people who seem to enjoy the whole procedure, one that involves exhausting me to tears) it's easier to see the light side and to take the time to actually write the whole business down.

We got smarter phones a few months ago, and I get text messages a few times a day (if you have enough kids you can do this, it's a perk), some with pics.

At a wedding the other night I got this text message:

Took munchkin to the movies. A disaster.
Well, what did he expect? She's not even two.

Left the party early, came home to putter around and saw an email from him telling the whole story to the family. We do that, send the first degrees family email. Everyone uses the Reply All option so we can report on menus (it's important to know what people had for supper, all right?), review movies (I'll rarely go unless a film has been cleared by one of them), and talk about whether or not ANYONE saw Desperate. Here's what he wrote:

We just came back from a DGA (i.e. free) screening of Alvin and the Chipmunks. We figured it would be a good test run to see how the munchkin could handle a movie.

The film starts with the titular chipmunks high in a tree. They're singing and gathering nuts. Soon, a chainsaw is heard, the tree begins to shake, and then fall. At that point, a little girl SCREAMS at the top of her lungs, followed by "(my granddaughter's name) no want it!"

We stayed about five more minutes, and finally left when the munchkin told Rac she was scared. Ah well.

Rac added to the replies,

I believe the exact quote was "Chipmunk movie too scaaaaaarey."
I reminded everyone that when FD and I took our two oldest (one of whom is the munchkin's father) to a Sunday matinee as toddlers, a scream rang out in that theater, too, causing literal pandemonium.

I thought he'd never get over it.

Transgenerational, you would think, except it wasn't munchkin's dad who caught it. It was his twin brother, her uncle.

So the moral of the story. These flicks look innocuous, but that doesn't mean they are. Oh, that penguin movie's got some pretty scary scenes, too, btw.


Friday, December 21, 2007

Internet Pornography- Part One

I've wanted to post on this for a long time, but the fear of spammers and cyber-bullies had me intimidated. As a reminder, if you happen to know my name, please never use it in comments or they won't be posted. Let's start.

You don't get a picture on this post.

It's so funny. In 1996 the research chair at the University of Illinois asked each of us in my doctoral cohort what we thought we'd be interested in studying for dissertation. I had been treating a woman who had a "hot chat" addiction, something relatively new at the time.

I'd like to study Internet Addictions, I said.
I published an article on it actually.

He almost laughed me out of the room. Boy, how dumb. I mean, the article was a case study. How in the world would I get enough subjects for a real research project? How could anyone measure Internet addictions? Ridiculous.

That was 1996. Fast forward 11 years. We hear about Internet porn or Internet addictions once or twice a week. Compulsions are part and parcel of my work, and you guessed it, I'll hear about this kind of thing at some party or another, relatively often these days, social animal that I am. I just got an email from a woman who wanted to know what she should do about her husband's addiction to Internet porn. They're in their early twenties. Religious.

A little background here. In the early 1980's, FD and I did a co-therapy rotation to study the treatment of sexual dysfunction with Domeena Renshaw, MD, a world-renowned psychiatrist. She started the Loyola Center for Sexual Dysfunction in Maywood, Illinois.

Loyola is a Jesuit outfit. To be treated at the center at that time, you had to be married. I don't know if those same rules still apply today. But over many, many years, Dr. Renshaw's patients and students must number in the tens of thousands. Her book, Seven Weeks to Better Sex, interestingly, downplays the idea of sexual addictions.

"Sex," I can just hear Domeena say, "is like eating, breathing, and defecating. It's a normal bodily function." Pressed to opine on sexual addictions, she might add, "and if you can get too much breathing, then you can get too much sex, too. It's the natural tranquilizer, by the way."

In the early 1980's Dr. Renshaw's program did not discourage pornography. In fact, therapists and physicians-in-training were to suggest a visit to the adult book store to help patients get comfortable with what turns them on, basically permission to feel sexual. Domeena also strongly suggested that women try vibrators.

It's likely that the novelty and variety of sexual toys these days far surpasses what the stores had to offer then. You can buy such things now on-line, but if you are friends with the right people you might get invited to sex-toy parties that are on the order of Tupperware parties. These sex toys, I imagine, cannot hurt you, and patients do swear by them. But consult your local physician (or clergyperson) if you have any questions. And don't swallow any batteries.

You should know that FD and I took a royal pass on the idea of suggesting visits to adult book stores to patients. I'm glad we did. We simply skipped over that part of the program. Such a recommendation is especially tres politically incorrect these days. Pornography is and always was exploitative.

Sometimes it's hard to see that. Posing for pictures, acting in blue films is a job, after all, a living. Same goes for all kinds of jobs where being a female who is very female, or a being a male who is very male, is a major plus. I think of Hollywood, but the same could be said for positions in virtually any office or service establishment.

Many years ago I had a lovely couple in treatment. Let's just say that she had a nice job as a professional and he supervised a machine shop. Blue collar roots, although it doesn't matter, we've changed the demographic data of the case for this illustration.

She didn't like that he frequented a neighborhood restaurant where the wait staff had to show off a good deal of torso to get a job. She insisted that he stop eating in the restaurant.

"It's exploitative," she said, "making women dress scantily to keep a job."
He, on the other hand, couldn't see anything wrong with it.
"These are women working," he insisted. "It's their choice."
They got nowhere with the argument, and at some point I could stand it no longer. I spoke to him. She was pregnant, by the way.

"Perhaps look at it like this. Maybe you'll have a little girl. She grows up and goes to college. One day she tells you she's got a job waiting tables. The job is at one of those restaurants. (It happens to be a huge chain of restaurants. This is not inconceivable, her getting a job there. The name of the chain would be a good clue for Charades, by the way.)

"No way," he says. "It would never happen."

"And why not?" I gently ask.

"We wouldn't let her."

"How could you stop her?"

"First of all, no daughter of mine will have to work her way through college or anything. I'll make sure of that."

I say, "That's assuming that you stay well, but you never know what can happen, right? G-d forbid. We're talking eighteen years from now. What was your second of all, your other reason for thinking it could never happen?"

"She just wouldn't want to do that. She'd have too much self-respect."

I nod, consider what he says, take a breath.

"But what if you hit bottom financially somehow, and your kid is in school, and she doesn't want to take out thousands of dollars in loans, or she isn't eligible for some reason, and she takes the job, and men are grabbing at her, staring at her, leering, propositioning, all between french fries and a burger. It's not about self-respect, it's about poverty."

I finish the soliloquy, flip my pen in the air, a trademark.

You should know that this is lousy couples counseling, the process is all wrong. A therapist should be instrumental in getting a couple to talk to one another. We're omniscient, there for punctuation.

But she's been trying for a very long time to communicate the importance of this issue and either he isn't believing her or he won't give her the point (more likely). And there I am, a young therapydoc, full of words, taking over, despite my better judgment, knowing deep down that I have joined her and disempowered her at the same time.

He stopped going to the restaurant nevertheless.

They stayed together and seemed happy at the termination of treatment. Who knows where they are now. I know they had a baby girl, got a picture in the mail.

The point?

Men and women who allow themselves to become objects of sexual fantasy, either in restaurants or in titillating videos or pictures, don't usually want the job. Wouldn't you rather practice law? These individuals volunteer, it's true, but many feel they HAVE to volunteer.

Once I saw a beautiful college student who lived with her parents and seven sisters and brothers. She couldn't stand living at home anymore. They used her for child care and housework and it was hard to study. But she couldn't afford to leave. "I think I should make movies," she told me. "I've been offered a good deal. There's really good money in that." I tried to discourage her, discussed a few of the emotional consequences (we'll get to them in another post) and she dropped out of therapy.

It's a living, see?

There she is, your little girl. Earning an honest buck.

Emotion aside, here's how it translates psychologically at the restaurant. The patron is buying the memory. He's stealing her image by burning it in his brain. He takes her home with him, mentally. Or she takes her home with her. We try not to be heterosexist on this blog.

These days anyone can shoot a guy or a girl's picture with a telephone. No imagination necessary, even, no need to burn an image in the brain. Progress there, and your tie-in to pornography.

Enough for today! Any questions? Be patient for the posting of comments and answers. I don't work Friday night to Saturday sun down.

copyright 2007, therapydoc

Monday, December 17, 2007

Think it, Don't say it

I think we left off talking about how you might consider being sensitive to make-up or the lack thereof at the holiday party. It's not about the make-up. Readers made the point that there are a million great reasons not to wear any.

But we try to look for the sad, maybe look through the make-up with some, and ask, sincerely, How goes it? Not that everyone's going to want to out themselves about feelings, but you never know.

It's nice to have permission to do that, to really be honest and be able to tell even casual friends what's going on with us. We need a certain amount of established intimacy in the relationship, I should think. But when does that start? Somebody has to get it rolling, take the risk and the fall. Might as well be you. It's that How are you feeling, REALLY, we're talking about here. You go fishing and sometimes you catch one.

One tries not to do that too often as a therapydoc, FYI. At parties, I mean.

We were looking for ways to approach these family reunions. I wanted to give you a little armor, a Jedi shield, light saber maybe. This year, you can see, we're a little stuck on the party theme. It's just one of those things. You either love 'em or you hate 'em, nobody's neutral. Obviously some people must love them or there wouldn't be so many.

Just an excuse to get together, right? Take it from me. Bring a gift to the hostess. Don't listen to the Your presence is our present thing. A little something.

Oh, I digress. Anyway, on to parties. It's a tool, right, a way of picturing people interacting socially. That movie, Goodbye Columbus comes to mind, but I can't remember-- Did that first scene, the shmorg, take place at a wedding? A Bar Mitzvah? All I remember is that the movie irrevocably stereotyped Jews and it wasn't a nice stereotyping, so I couldn't get past that scene and hated the movie. Don't see it.

For our purposes, just picture everyone at a party eating and drinking.

Could be coming right up at your house. One More Week.

We'll look at an interactional sequence that's pretty common, even though it's terrifically dysfunctional. It's dysfunctional at parties, it's dysfunctional at home, it's dysfunctional in the bedroom or at the breakfast table. It's one of those faux pas that you can't take back once you make it, but boy, you had better try.

What else could I be talking about except:

Don't you DARE say that about my mother.


How DARE you say that about my mother?

Same thing.

It works like this. I'm in some kind of mood, maybe irritated at my mother (Mom, please, this is totally made up, it's not at all about you, we're just illustrating a point at your expense. You're good with that, being part of the fun. It's one of your greatest traits.).

My mom's always been a good sport.

But let's say she were an annoying person, which she is NOT, and that I'm irritated with her. FD is in ear shot and I feel like kvetching and I say, "My MOTHER is SO domineering. She drives me crazy telling me what I should be doing with my life. And have you ever noticed how she always has to have it her way?" (She's not like this, just to reiterate. She's the opposite, if anything, a total push-over.)

But this is a vignette, so FD falls into the unwitting trap and says, "Yeah, I've always thought she's pretty domineering."

Not being a violent person, I take the 5 lb sack of potatoes on the kitchen counter and whip it over his head.

He gets up off the floor and says, "But YOU said she's domineering."

I CAN SAY WHATEVER I WANT ABOUT MY (fill in the blank, mother, father, brother, sister, son, daughter, god-child, any close relationship)_________BUT YOU BETTER THE H. . . NOT!

So clearly, at a holiday party, the same rules apply. It's hard, too, because what are we doing at a holiday party if not talking quietly over drinks and hors deurves about someone else? We're all about pseudo-intimacy.*

Still. Avoid the trap of agreeing with someone who is busy dissing a close relative. You will be sorry.

Let's say your friend, who is nibbling on an olive for example, says to you, sincerely, "My uncle is a total miser." You work with this person's uncle and you know it's true.

Still. You can't agree with him, even if it seems like he wants you to agree. You can't agree because this is your friend's uncle, not Tom Cruise. Your friend knows all about his uncle's great qualities, so he can talk about him. He can say whatever he wants. Not being a close relation, you don't know the half of it, however, even if you do work with him, and if you say something negative this will surely make him defensive. Maybe not immediately, but later on, when he's taking off his tie, thinking about the conversation. And he'll hate you.

This is pretty normal proprietary stuff. We own our relatives, share blood lines basically, and we want to be proud of our possessions, our stuff, our DNA. Insult my mother? My uncle? You're insulting me, stupid.

Doesn't have to be a blood relation, either. It can be anyone towards whom we feel an attachment. If I'm close to someone, that person's a part of me. A friend. A teacher. A doctor. MY friend. MY teacher. MY doctor. Boundaries can blur. We blur them unconsciously.

No, it's not a hard and fast rule. Many of us have abusive relatives about whom we feel we simply have to say something negative. Certainly that's what therapy is about sometimes. It's a fairly good family roast. But even in good therapy, especially in good therapy, we try very hard to look for the reasons people behave in the ways that they do. We really want to get people OFF the hook.

Not that you can't fantasize, when it works, about pulverizing someone who has it coming.

But let's let the victim make that call.

So at the cheese dip, when someone disses his mother, I'd stay on the safe side. Think about it this way.

(a) Whatever you say about someone WILL get back to that person
(b) You insult people? You look bad.

When someone disses someone else, in fact, I'd stick with, "Wow, (she) he's so NICE to everyone else. You have to admire that in a person, you know?"

And mean it.


*Pseudo-intimacy happens, in this case, when we talk about someone else to avoid talking about ourselves.

Wednesday, December 12, 2007


It's funny. We look for symptoms and mix and match with diagnoses, but nowhere is it written that wearing make-up matters. Yet it's pretty obvious that make-up does matter for some, generally the types with the double X chromosomes.

This has happened so many times over so many years. I don't even have to ask, "So how ya' doin' today?" with certain patients. I can look across the waiting room and I know how they're doing. If not painted brightly, then not feeling brightly, back in the black hole.

So interesting, isn't it? And we wonder why artists need that certain something to produce. That certain something is serotonin. The best paintings are produced when the artist is feeling best. Literally painting faces is the same.

Sure, the DSM mentions hygiene. We know that if a person is uncharacteristically dirty for an extended period of time that it is withdrawal. That individual is unaware of the situation, can't remember or care to bathe, can't feel the oil on the skin, can't smell that offensive smell that others notice right away. Such withdrawal is characteristic of psychosis, and the most disabling depression is psychotic. The patient does not know or care beyond the limits of his or her thoughts, feelings.

Does one who is not psychotic, however, not wear make-up to deliberately communicate to everyone else, perhaps especially a doctor, that she's not doing well? Or is it the depression talking, period. What we're looking at here is whether or not the behavior, putting on a little lipstick, is functional and can be controlled.

The answer, I think, is that sometimes it can be controlled, but the will isn't always there. The patient doesn't have much energy and conserves what she has. Putting on make-up is just another job, and getting out of bed is hard enough, frankly.

Why bother preening indeed, when a person thinks: I'd rather no one pay attention to me. I haven't the emotional energy to carry on conversations. I feel ugly and useless. What's the point of drawing positive attention to me, especially since it takes me out of my comfort zone? I'd rather be mindless, thank you.

So different from someone in sales who is on all of the time, even under depression. The personality is all smiles, the hair still in place. This is not always the case, of course, when the depression really gets bad, but when it's middle range, certainly it is.

A person who is hard-wired to perform will perform socially as a default, and look the part, then will crash harder when the performance is over. Performance artists and sales people under that depressed influence are at risk for self-medicating with drugs and alchohol as soon as the down-time permits. Even before the down-time permits.

Not unlike the evening martini, except there are three or more.

You know, of course, that we call one or two drinks a night moderate drinking for a reason. It's not always dysfunctional. Some people do this to regulate their moods and it doesn't ruin their nights or days. I would suggest they're not self-actualizing, however. And the reason I rail against this and am always on you about it is because the drinks get stronger, taller. Pretty soon what you're telling me is a drink is not a drink, it's a vessel that could water a rubber tree plant.

But back to make-up. Younger people don't need it, honestly. So this little diagnostic tip is really more applicable to those of us who are aging, who really notice the lines and lack of color. No? Okay, no. Perhaps we should generalize, however, and say,

If a person is ordinarily concerned about how they look, no matter what the age, and all of a sudden is not concerned, then you should consider ruling out depression.

I forgot! It's that season to be jolly!

Even more pressure, right, to feel good!? Act happy? Dress it up?

We'll talk about it again soon. I'm not finished.

To be continued.

Copyright 2oo7, therapydoc

Sunday, December 09, 2007

Using What You've Got

I think I've told you that a systems therapist, someone who uses family, significant others, employers, teachers, and cats, a systems therapist will use everything and anything to make a point. And sometimes the patient will literally hand over the material.

Here's what happened last week. Remember: I'm changing details for you. I'll say, for example, that the story happened last week, but it didn't. SHE could be a HE. HE could be a truck. No, that wouldn't make much sense, would it. But let's talk.

You may know that it's Chanucha. This is an 8 day festival. There are many interesting lovely things about the holiday, but for me it's about being home, lighting candles, and making sure the house doesn't burn down. Each of us in our family has an oil (olive) burning menorah. We have visitors from out of town this week, making that doubly important, not burning down the house.

It's the evenings that are important in this holiday, and most of us don't like leaving our comfort zone. We stay home at night, but work during the day. I try to get home a little earlier. I try not to schedule new patients who may or may not show, may not call. I try to be especially forgiving when patients cancel last minute. I try to stay in the holiday spirit because I know how stressed everyone else is in general. Merely trying to get it together or keep it together is very hard.

It's no small thing to say that it would be nice if everyone tried to stay in the holiday spirit always. But this is impossible. Even trying is impossible. (Is it?)

Somehow, the week before last, when I scheduled an appointment for last week, but made a mistake. The appointment didn't get saved on Outlook. Obviously it was me who didn't save it, since I make all of my appointments. This probably happens once or twice a year, me completely blowing an appointment. Yes, therapists are people, too, very fallible. It is possible that we can completely screw up, try as we will not to make mistakes. In this case, I'm guessing, I entered the appointment in the calendar and did not push Save and Close.

Save and Close is PRETTY IMPORTANT.

But I didn't know it and was in a pretty fine mood starting work on Thursday only to hear a VERY upset voice on voice mail.

Therapydoc! Where were you! I had an appointment at (such and such a time) and you were nowhere to be seen. Why wasn't I informed? Why didn't you call me if you knew you weren't going to be there? I brought (so and so).

I was looking forward to doing great work today. I'm so upset. I can't begin to tell you how upset I am. This is so unprofessional. What kind of doctor are you?@!

We're in the Being Late territory we've discussed before. **

I don't know about you, but I get a message like that and my chest clutches and I feel simply terrible. I call the patient right away, apologize, offer a next day appointment, meaning, in this case, that someone else will make an airport run, not me. I feel cornered, embarrassed. I say, The rule is in this case that I forgive your co-payment tomorrow.

She sounds quite fine with that.

Then, since I've got a few minutes before my first patient walks in, I look at her chart. I've only seen her once before. I have scrawled across the top of the page, Has assertiveness issues.

Would you agree?

Thus this is a good place to teach you how to use that sort of systems event in therapy. But understand. What a therapist really wants to say when the patient has Let it Fly on voicemail, is, Find someone you like better, someone who will do a better job. Someone who will never ever make a mistake. A better match. Seriously. In our heads we're thinking all kinds of edgy things, basically trying to make ourselves feel better for being slugs and making mistakes. But being a professional is not about doing that, taking our own error and turning it into the patient's fault.

The next day the patient comes in with her S-O and I'm on her team, of course, since I totally do want to tackle that relationship; I really do. To me it's all about everybody getting better, the challenge of it all. I want her needs met and I'm quite sure the direction we're going in is just right for the two of them, for him, also. The therapy flows very naturally and she's pretty happy that I'm getting him to talk about some of the things that bother him, approaching his issues, too, and for sure it's pretty easy to see where each of them is coming from and we're confident about making changes. Then at some magnificent point she really rails into him about something*.

He looks at me, stunned. She looks at me. I smile. I thought you said you had assertiveness issues, I say.

She smiles. I'm getting better already.

Oh, how I love people.

Copyright 2007, therapydoc

*Having assertiveness issues generally means a person doesn't speak up enough. But while working on it, I'll ask them to overshoot, to try for aggression even. Usually, that means they'll fail and the communication will come out just right. A passive overshoot becomes an assertive statement. If it becomes a rant, and it seems a little aggressive, THAT we can tone down relatively easily.

**This would be a good time to read that post on Being Late, if you like this sort of thing.

Wednesday, December 05, 2007

Starting Young: Neuroplasticity

The record is now 3-10, maybe worse. We could use a Michael Jordon.

It's nice to have talent. Every once in awhile I'll treat a couple in which one partner will be working on the other, wishing the other would strive to improve. People in recovery call this working someone else's program, meaning avoiding work on the self. The language is of the "should" variety and has a "you" at the top of the sentence.
You should call that guy about the other job.
You should be taking guitar lessons.
You should be going back to school.
Readers know that a good relationship is supportive, meaning if your spouse wants to learn how to jump out of airplanes for fun, assuming that it's safe, that maybe you shouldn't be holding him or her back.

That's probably not a good example. If FD tells me, I think I want to take up skydiving, and I say, That's GREAT! I'm pretty sure he'll think I'm trying to get rid of him.

In general we support self-actualizing efforts on the part of people we love, even encourage them. But we know it's a mistake to NAG a partner to self-actualize.

One can hint, but not nag.

If one intends to encourage a partner to learn a new skill and that partner is past a certain age, it is a prescription for failure.

One would not suggest to a bored middle-aged human, You really should learn piano, you've always wanted to play!

Why not?

Because neuroplasticity will take a person only so far, is why. Take the man in the picture above, Michael Jordan, perhaps the greatest basketball player ever. He decided to leave the public eye in 1992 and retire from the game. Soon after retiring from basketball, he took up baseball.

He had always liked baseball but wasn't very good, so he played for a minor league team, hoping to get better. With a .200 batting average (that's really low, if you don't know baseball stats) he ultimately quit the farm team and returned to basketball.

The Nike ads, of course, followed him. Here's a quick story from David Halvestam's book, Playing for Keeps.

Mr. Jordan returned to basketball and played for the Indiana Pacers. He let the talented advertizer, Jim Riswold, film television ads that essentially made fun of his lack of baseball prowess. In one he's at a truck-stop diner, living out the grim blue-collar life of a minor league baseball player. He sits at the counter of the greasy spoon, lonely and sad.

A friendly, middle-aged black waitress tries to cheer him up and gives him advice saying, “Honey, there ain’t no curve balls back in the NBA”

Riswold loved it, Jordan approved it, but the Nike people didn’t go with it.

The point is,

Michael Jordan, perhaps the greatest basketball player in history, a record-breaking athlete, decided to pick up baseball relatively late in life. It didn't work out.

Harold Klawans, a versatile contemporary neurologist, author of several articles and books, explains why Michael couldn't hack it in his book, Why Michael Couldn't Hit. It's all about age.

Maybe you've noticed that as a kid you picked up new languages quickly.

FD, for example, taught our youngest son Rashi script when Little One was five years old. Rashi commentary is in very small print, found in margins of Talmudic texts. The script looks like Hebrew but it's not; the letters are mysterious even to many Israelis; it's hard language to learn at any age. Rashi wrote Hebrew in a different script on purpose so that those who wanted to harass, rape, or kill Jews on the basis of texts wouldn't read what he had to say, misquote or misunderstand, threaten lives and livelihood, and burn holy books. That happened all the time in his day.

It's best to learn Rashi script young for the same reason that it's best to learn all languages young. Some of us learned French. Others Spanish, Latin, or Greek. FD learned music. And Spanish. As a physician, both serve him well.

These days we encourage children to learn everything, and many seem up to task. It's easier to learn as children because childhood is the time that the brain has the greatest plasticity, meaning it's able to adjust, add new information, incorporate new concepts.

Don't take it from me. Here's a direct quote from Washington University's website on neuroscience for kids. For more information, click, here)

Neuroplasticity is the lifelong ability of the brain to reorganize neural pathways
based upon new experiences. As we learn, we acquire new knowledge and skills
through instruction or experience. In order to learn or memorize a fact or
skill, there must be persistent functional changes in the brain that represent
the new knowledge. The ability of the brain to change with learning is what is
known as

As we age, we think that plasticity hardens up a bit. It gets harder to learn.

But neuroplasticity doesn't disppear entirely, which explains why someone like my father (87) can pick up computer skills. We can still learn at any age, just not as well when we're older.

So encouraging our kids to learn as much as possible is functional unless the stress gives them headaches and ulcers, in which case we might consider chilling out a bit. We want them to establish neurological pathways, templates of information in the brain, although these pathways may atrophy over time with disuse.

As adults, should we wish to call upon old skills, we might need to refresh the old pathways, to review what we initially incorporated as younger beings. But it's easier to refresh than to start from scratch.

Once you've learned a piano piece as a child, for example, you can pick it up mid-life, even late in life. You can then practice it, tweak it, and add your personality to the performance. And you appreciate the piece much, much, much more than you did as a child of seven when it was all so much drudgery.

But learning every good boy does fine, or do re me at fifty might get tricky.

You don't want to stress the kids? Fine. But take a look at little Tammy and tell me she's not unbelievably wonderful. And why do I feel this kid isn't going to be bored after school and that her mother won't have to worry that she's getting into mischief? Okay, okay, we need not generalize that far, perhaps she will. I just don't think so.

That's the J S Bach Italian Concerto. I hear it a couple of times a day because FD is getting ready for his recital. And you know? It sounds just a little different each time.


Sunday, December 02, 2007

Guys & Dolls and Couples Therapy

When you see a guy reach for stars in the sky
You can bet that he's doing it for some doll.
When you spot a John waiting out in the rain
Chances are he's insane
as only a John can be for a Jane.

When you meet a gent paying all kinds of rent
For a flat that could flatten the Taj Mahal.
Call it sad, call it funny.
But it's better than even money
That the guy's only doing it for some doll.

Sure, it's hetero-centric-sexist, and yes, it's counter-gender liberation, too. But give that a pass for today, okay?

It’s not as if I go to Los Angeles every day, but the Un-city* has been my domestic destination of choice for the past few years. I don't go only to see family. The Un-city offers social services that are perhaps the very best in the nation for the treatment of sexual assault survivors. I study those.

Besides treating victims and survivors, the LACAAW (Los Angeles Commission on Assaults Against Women), for one, provides enlightened prevention programming for youths of all ages.
It’s no accident that celebrities hold galas for the cause. David Schwimmer comes to mind as a huge donor to sexual assault services, but there are many others.

A different fund raiser dragged me away from the office and the 32 degree, overcast and grey Chicago landscape to a sunny west coast winter blast (Yeah, I got the cold weather. Tomorrow will be 70 in the shade, but I'll be back in Chicago.)

I came here for GUYS & DOLLS! And this is no ordinary production. The cast and crew are all female. If you’re familiar with the musical, then you know that the show is set on Broadway, circa 1940’s. A dozen gamblers, all men, are the object of a female-centric Salvation Army mission of reform.

The musical-comedy is romantic from the top. Miss Adelaide, who is a burlesque star/stripper, you'd never know which in this sanitized show, and it doesn't matter, adores Nathan Detroit who organizes a floating crap game in New York. They’re engaged for 14 years and she’s nagging him to marry her. They still adore one another, which makes a case for a very long engagement, I suppose.

Nathan has promised he’ll stop gambling, but that’s not going to happen. He’s very worried that Big Jule from Chicago is coming to town with wads of dough, and no place to lose it. The heat is on; Lieutenant Brannigan is on Nathan's heels, the game is on the run. Nathan needs money to pay for a new location. He needs money for that and bets Sky Masterson, the debonnaire sophisticate of the international gambling world, a thousand dollars that Sky can’t get Sarah Brown of the mission band to go to Havana with him for dinner.

Sky tries hard, and Sarah does her best to resist, but the mission will fold unless she finds a room full of sinners. A General of the Salvation Army is sorry but Sarah has to justify the cost of keeping the mission open (not unlike most rape advocacy programs in the U.S.) Sky says, Join me in Havana and I’ll fill the room with sinners, and he makes good on his promise. Of course the two fall in love, and it’s surely one of the most romantic stories in Broadway history.

Or in our case, on 241 S. Moreno Drive off Wilshire.

This women's production is a benefit for Aleinu Family Resource Center, a program of Jewish Family Services of Los Angeles that provides counseling, social skills groups, child safety education, crisis support, and parenting workshops.

If you get tired of me you can go there.

But back to the show.

Women playing men.

It’s the third year, the third show for the Jewish Women’s Repertory Company, a troupe of women who break away from day jobs and children for the chance to let loose on stage for charity. Because JWRC respects the Jewish laws of modesty, men aren’t in the show, don’t direct the show, and aren’t allowed to watch the show. It wouldn’t matter if any of the players had five first degree male relatives who had been listening to her practice since June. No dice. Even male (meaning Y chromosome) family members can’t walk in the door, can’t even listen from the lobby. I don't think.

Spouses, more than a little tired after more than three straight months of childcare during rehearsal, greet the actors with flowers AFTER the show.

So as I’m watching this amazing production (2 more to go, Dec 2 at 3:00 & 7:00, for more info go to http://www.jewish/Womens and am kicking myself for not contributing an ad to the playbook. I’m thinking, THESE WOMEN ARE GREAT, and the DIRECTORS, Rachelle Freedman and Margy Horowitz are stupendous, as is the music, and the PRODUCERS, Margy Horowitz and Shani Rotkovitz, put together a perfectly wonderful show. The work is evident. I think to myself, I'm in New York.

The choreography, the sets, the way each player tipped his (her?) hat, every detail inspired me. Empath Daught had to tie me to my chair. I’m one of those people who jumpstart the clapping after solos at jazz clubs, too. You should pay me to be in an audience, seriously.

The production is presented through special arrangement with Music Theatre International (MTI) in New York. And let’s not forget credit to Frank Loesser for the music and lyrics, and Jo Swerling and Abe Burrows for the book.

Of course I could post about gambling, here.

Or about how love changes people. Indeed, my sister-in-law who is a performing artist, you’ve seen her on shows like Desperate Housewives and Murphy Brown, and in a few movies, a tremendous comedic actress, and brilliant (that goes with the territory) corrected me when I said, There is no way that Sky and Nathan truly changed just because they ultimately succumbed to marriage. They're GAMBLERS.

S-I-L and other kibitzers listening in argued, "Doc, you’ve missed the point of the show. Of course they changed."

Sure they’ve changed, sure, which is why we love the American musical. We’ll watch GUYS & DOLLS for another forty years, whereas shows with violent themes become footnotes in the annals of entertainment history. (Just a footnote, there).

I think I told you that once FD and I wrote a musical about child abuse-- it was cute, actually, but another sister-in-law told me it would never fly. People like it happy, she said, and she’s probably right.

And we like it romantic if at all possible. It's romantic to think gamblers can change, and some of them do, I suppose. But romantic can be code for heart-break.

But let's get to the couples therapy stuff.

Therapists hear all kinds of stories, and couples therapists hear them, too, mostly about the hardship and pressures of life, the systemic effects of mental illness, the miscommunication, hatred, back-stabbing, plate-throwing, knife pitching, word-slamming, gut-wrenching issues of every day relating. But still. Some of us continue to be more than a little Polly Annish about love, and despite what I say about romance, and you shouldn't assume it WON'T carry the relationship.

If they’re coming in for therapy, I assume people still want to fix it. They want their significant others not only to love them, but to adore them. And who are we to argue? Why shouldn't that be?

Once someone asked me to look at my work critically (not necessarily scientifically), to choose the one variable, the one element of intervention that works best (for me) overall.

Please don’t think for a minute that relationship therapists with post-graduate training don’t juggle three dozen variables at all times (there’s you, your S-O, and your marriage/relationship, three patients, minimum, all with issues that could take a week or three years to resolve).

The variable, however, that probably gets people to reconsider keeping their relationship more often than any other is romance.

It isn’t easy, finding the romantic funny-bone in a couple that has lost its sense of humor. In most cases it’s best to not even try early until one of the partners can lovingly joke at the expense of another. ANY sense of that and you’re golden, by the way. If you see a single glimmer of affection, and they want to stay together (meaning it’s not a divorce therapy), then you can make it happen.

Even it you can’t see a reason they should stay together, if they want to stay together and you don’t think you can make it happen, well, you’d better darn well punt early to someone who can. You should be able to revive them from the straits of hopelessness if you're in this business.

I say that because in my practice most couples start therapy at about the time that both have come to a realization that not only is the thrill gone, but so much emotional history has floated under the bridge, so much resentfulness and ill-will has piled up between them, it’s like a huge wall, too thick, too high to break down or climb over. (NO! I won't block the metaphor. Sue me.)

The two are pretty sure they’ll be happier apart (at least one of them is). And yet, for whatever reason, they’re willing to take a stab at the depression and the despair, the hopelessness that has settled. They’re too tired to get a dust cloth. The therapist is basically maid service.

So we've got two people and they can’t laugh anymore. Their communication is either avoidance or argument (there's no such thing as no communication), and relationship therapy is all about communicating and arguing, or not, sometimes, problem-solving and fixing three broken vessels.

It’s not a romantic comedy. It’s not a broadway musical. And yet.

Many a couple has had to sit through The Unsinkable Molly Brown, has had to learn the lyrics to “I’ll Never Say No to You.” That's just the way it is in certain therapies.

And sure, I’ll recommend it whole heartedly: Guys & Dolls

Try these songs for starters:

"I’ll Know" (when my love comes along)

"A Bushel & a Peck"

"Guys & Dolls" (the one that starts out this post. . .You can bet that he’s doing it for some doll, some doll, some doll, some DOLLLLLLL!!!!!!

"I’ve Never Been in Love Before"

"Marry the Man Today" (and change his ways and change his ways and change

You can get tickets at the door. If you're female.


*I'm pretty sure it's The Atlantic that made that interesting stab, all the way from sea to shining sea.

November 07 Back a' cha'

Yes, it's December and we're still on November, catching up with friends. I can't help it if I got way-laid for the weekend in Los Angeles. Things happen. But I'm back to thanking those of you who linked over here, only hope you didn't feel any pressure. We're about to start a series on enmeshment very soon. So many misconceptions about it.

We start with Molly in Germany, sexy and smart and litigious. Except for the last part, why wouldn't you read her blog? (Can she sue me for reading, for humming along while I read?)

And once a person starts to talk about humming and music, before you turn around he's hanging out with people who swing electric guitars. Take a look at The Soul of Rock and Roll and see why I really don't fit in, but as usual, keep ke trying.

And again, The Squib, makes me laugh. You might like this comic, too, AllVishal. Some bloggers write their own jokes, and the ethnic on ethnic can really make me smile. On the same blog, The Banterist sues Sesame Street (I think for the prices). By the way, I have no idea why there are yellow highlights all over this post, and have no energy to figure it out, either. Who knows what I was thinking?

New-Movies recommends Bella, supposedly the Life Is Beautiful of the year. The trailer looks scrumptious.

For real art, as in fine art, see what Susan Borgas does for a living, and check out Thailand Gal, too.

And for a good cause, check out ProBlogger. Movember (mustaches in November) started in Australia and New Zealand but is now international. This month the men down under are growing mustaches to raise money for prostate cancer and depression. Dig into your pockets if you're sure it's not a scam. This blogger trusts no one, which is why she's a therapist, probably. It being December, perhaps you're too late altogether.

My post on Borderline Personality Disorder, surprisingly, drew no fire from the internet blogger community. Phew. There's more to say about why diagnosing people is a bad idea, and I'll get to that, but check out Mental Health Tips and the Florida Bipolar Personality Disorder Association for more on the subject of borderline disorders.

Trauma Center is there to sew you back up if need be.

Let's talk business psychology (I think that's what this is about) Your High Payoff provides a few tips about focus and reward. I would so stretch that metaphor.

Now this is not to criticize, it's just a fact that most bloggers ARE named Dave! The coolest Dave (who is out) can be found collecting scientific posts at How to Save the World.

Some of the best blogs are funny, let's face it, but I need them clean or I won't link to them, not consciously. New Critics is totally worth a peak, and hopefully there's nothing up there that's objectionable. If so, just leave.

There are several religions, you know, and a blog that's mostly about Where Faith and Inquiry Meet. I'm glad people think about these things, honestly.

Lest you should think that I discriminate against atheists or agnostics, there's a Swedish archaeologist who insists there really is no apple pie in the after life. That could be a problem for some of us. I fear behavioral change looming if I personally dwell upon it.

I can only wonder what my friend the Rabbi Without a Cause might say. The good rabbi plugged this blog, making it, I suppose, a kosher blog. (Sorry, btw, for spelling that word compliment wrong in a previous post. I know that many of you hate it when I do that).

Shirat Devorah explores the bee situation. Not good.

And Yid with a Lid never lets me down when it comes to my daily political news in Israel fix. Also not good. If you worry about people shooting at other people praying at the Western Wall FROM the top of the Western Wall, you should be worried about what's happening in Israel this week. The point of the Annapolis Conference is to divide Jerusalem.

Those of you who are squeamish about words will want to avoid Curiosity Killer's posted video about the F-word. I'm only linking here because maybe we should desensitize, I don't know. I watched it and wondered if my cringe problem is an age thing.

For a politically conscientious blog, see Eric on racism, feminism and other important topics. For sexual assault and survivor support visit Thriver, always a wealth of information. And Martial Development will provide you links about bullying and harrassment problems.

Fact is, I can retire my blogging hat. There are so many good psych bloggers out there. Dr. Shock linked to ENT's post about the myth of the double bind causing schizophrenia. It's old news, but it's nice to see that Myth Busters are doing their jobs. Shock finds all kinds of interesting, often conflicting reports to read on the web about all kinds of things.

Mother-wise Cracks is at a concert (way up in the balcony) with an acrophobic, for a laugh. A laugh?

I have to start the work week, seriously. Have a good one,