Monday, June 21, 2010

The Power of Confusion

Patient complains that I'm not educating anymore, that all the good stuff is in the archives, 2006. He doesn't say it in a critical way, he says it in a just saying way. He says it so nice, I hear it..

So back to work.  Do I have to remind you that I make up people? The patient below doesn't exist, so if you think it's you, it's not.

The Story:

A woman who has been passive all her life determines to make a change. No more Mrs. Nice Guy. She wants to level the playing field when her husband's family criticizes her.  She wants to err on the side of aggression, and wants me to teach her how to criticize, to insult back.

I'm thinking: No.  Let's not.  It would work, would make her one of them.  But it's not who she is; she's better than that.  Why regress?

The joke is that her spouse has married her because she is really, really nice. She never hurts anyone's feelings. Before she opens her mouth she thinks, "Is this going to hurt someone's feelings? Am I going to be disrespecting this person?"

I know, unbelievable. But there really people like this. If you find some of these, don't let them go. Hang on for dear life.

Anyway, he marries her because she's so nice, and he's very happy. But she discovers that his family is very difficult, very different from hers, very quick to criticize. She has married the white sheep, a nonjudgmental, easy-going person, but they judge people, especially her and how she looks, expect her to be perfect, at least to look perfect, to be like them.  And they carp on her when she's not.

Perfect, in this family, means every hair in place, dressed to the nines, make-up. Some people dress up to go to the grocery store, others wear sweats. Our friend falls somewhere in the middle. She asks me,
Should I have to put on heels to visit a sister-in-law in the middle of the day?  Is this normal?
I'm thinking: No.

But maybe, yes. Maybe she should.   Maybe if she does this, dresses up like them, looks like they want her to look, they'll feel more of a connection to her. The subtext, the unconscious text, is that when we conform, when we follow the herd, the other sheep assume we admire them, that we're not judging them, irony of ironies, so their unconscious anxiety is mollified. That's why like attracts like. So fake it 'til you make it, baby.  Join the club.

Those of you with self-esteem are thinking: NoLet's not and say we did.  (This is a sarcastic remark, passed down to me by my older brother, very useful, although in general I frown when it comes to sarcasm).

And you are correct. No matter how hard we try, we'll come up short with a person who wants us to come up short. Sometimes I think the world is binary. There are only two kinds of people* -- those who communicate in a sensitive fashion, and those who don't.

Many would say we learn more from those who are not esteeming, who are insensitive. We hear a negative message and think, "Wow, I really am a zjihlub!  (Yiddish, two syllables, je, as in the French je, and lub, rhymes with tub  Means slob). I should change!"

Except most of us are just hurt when someone insults us, so we don't change. We get angry and resistant and depressed, immature. We're regressed when it comes to criticism. We feel like we did when we were little and our parents shamed us for things like playing with our food.  It is an art delivering a message that fosters emotional growth, personality change, and still doesn't hurt feelings in the process. It is why parenting is so hard.

But back to our story; better would be to assert:   When the sister-in-law frowns, turn on the baffle, that confused look.  Act as if you seriously don't get it but want to understand.  If you use the following script, first emphasize that you don't want to be interrupted.

The long version, for the short, skip the first paragraph:
I notice you always make a point of making nasty remarks when I'm not wearing nice clothes. In your family, seems to me, people can take it, the nasty remarks, it just bounces off of you, and you seem to enjoy jumping on one another, or on anyone who isn't dressed up.  You'll even laugh about total strangers if they don't meet your approval.

But you need to know that  when you say something negative about how I look, it hurts my feelings. I wasn't raised to be judgmental. So I take it as this huge put-down, a comment about how I look. Could you try not to do this? Just don't comment about how I look and I won't go home feeling badly.

And why do you do it, anyway? Why is it so important for everyone in this family to have to look fabulous all the time?  I don't know how you all pull it off, always gorgeous.   I don't understand why it's so important.  Seriously, what's the deal?  Where's this come from? How do I get to be like you?  How did you all get so fashion conscious?
This should stimulate dialogue that you can steer to the topic of criticism in the family.  It can be a really decent, intimate dialogue. Often about child abuse.  Don't back down if they shrug and say, "Don't know."  Someone knows.  Someone's got some psychological saichel.  (Rhymes with Rachel, but a soft-gutteral ch, means smarts).  After the dialogue you predict the future.
"Okay, so when I come over here in pajamas, you are not going to say anything, right? But I'll try not to come over in pajamas if it's a disrespect to you.  I'll wear sweats."
Then you label the process. When it happens again, the criticism, you say,
"See? You're doing it again. I thought the new deal we have it that it's okay that I be the zjilub, and you be the gorgeous one.
Works every time.


*Binary thinking is shallow, black-white thinking, and virtually nothing is black and white. That's what the bell curve is all about, normality, the normal curve. To be exceptional, extraordinary, abnormal, one's score on a certain trait must be in the tails, must be rare. But you can be anywhere, totally normal, and still not know what's flying when it comes to relationships.

Friday, June 18, 2010


Alone on the sofa, remote's all mine, I hit Power and what do I see? Well, it's Sarah Jessica Parker.

Do I really want to watch Sex in the City? No, but this looks like it's the movie, the first one, 2008.   And I missed it. So yes.

Except it's a No, a serious waste of time. The film is overly soppy, boring, and as much as I love a good chick flick, this doesn't work for me. The only thing I like about Sex in the City I  is Jennifer Hudson--  Louise. The story goes that Carrie Bradshaw, a writer, has hired Louise from St. Louis as her personal assistant.

Jennifer owns the screen, she's the only thing to watch in this movie.  When Louise leaves the job, when she leaves the script,  I'm thinking, I don't need to watch any more of this. But I do watch, just a little more, to see how Carrie will resolve her conflict with girlfriend Miranda. And how in the world will Miranda ever get back with Steve?

Marital therapy, of course.

Anyway, why review this movie with little redeeming social content, unless we want to talk about the soft (not so soft) porn?  Oh, let's not do that.  Not now.

Jennifer Hudson is a woman of color, and watching this eminently watchable, lovely, actor  I find myself asking, How could anyone judge anyone else based upon the color of their skin?

The Story:
I'm training my intern about sexual discrimination and sexual harassment.  She asks me a question about the law.

Which one?

The Civil Rights Act of 1964, specifically, Title VII. The law defines protected classes of people who are protected from unfair discrimination in the workplace, and in schools. The ironic history of Title VII is that in the early sixties, when the law was a nascent bill, hotly debated in Congress, the workforce of the United States was primarily male. Indeed, most working people were blue collar-- this was a time when a person in tool and dye, or the auto industry, could find steady work, support a family.

It became fairly obvious to Congress, a male dominated club, especially to representatives and senators from the South, that if racial discrimination became illegal, their constituents would suffer competition for their livelihoods.

And yet, that's what was on the table, a law that barred discrimination in the workplace. So someone thought up something absolutely brilliant: Throw in sex as a protected class! Make sex discrimination at work illegal, and the bill won't pass!  Nobody wants women in the workforce competing for jobs!   But when it came out that that this was why they included sex as a protected class, the good people in the Congress passed the law anyway.  What a country!  Think of this on the Fourth of July, and sing along.

But back to our story.

All well and good, says my intern.  But why are people so prejudiced? How do they become judgmental? Is it because they learn this in their families of origin?

Sharp kid.

And maybe it's true, some people carry on a fine tradition of racial/ethnic hatred. But it is more likely, unfortunately, that personal experience hard-wires racial stereotyping.  Our brains just love to keep it simple. Don't make me think.  That's the brain.

I had the pleasure of hearing Joanne Trapani, a diversity presenter for Cook County employees, talk about how, for a long time, she associated being Irish with being a drunk. All it took was three dates with three Irishmen who drank her under the table.

We all have one of these examples, experiences with people different from ourselves that drive us to faulty generalizations based upon too little data.  Here's mine:

My mail doesn't come on time, and sometimes there's just no mail delivery to the office at all, none for the entire building.  Worse yet, it isn't picked up from the box on the corner, either, not at the times posted.  My mail carrier is African-American. The last mail carrier was African-American, as was the one before her.  The post office nearby is mostly staffed with African-Americans. I should know better than to blame race or skin color, and I don't.  But that data!  Three out of three!

Not wanting my mail to take a hiatus in a blue metal USPS box, I take my correspondence to another neighborhood. Over there the postal workers are Asian, primarily Korean. Once I mailed a letter at 10:00 a.m. and the letter arrived same day. So you know who's getting my business.

What do we do with this? Fortunately, we have Ms. Trapani as a role model.  We stay rational, accept that our experience is severely limited, recognize there are dozens of other variables at work, that it is not skin color, not race, not national origin, not sex, not age, not disability, responsible for late or non-existent mail delivery.   The bell curve tells us so, the rules of Normal-- that if you consider the entire population, not your limited experience, then you'll see.  Some of us are smart.  Some not so smart.  Some of us are organized. Some, not so organized. Some of us play tennis well.  Others miss the ball every time.  It is the luck of the draw, life.  All random, the cards we have to play.

When social scientists generalize about things being random, we're saying, when it comes my mail carriers, my luck is bad.  That's all it is.  Nothing to do with color or culture.  Just bad luck.

It is scary, however, how we form assumptions about entire races of people, millions of them, based upon a few random experiences with "representatives."  It is so scary that Congress made it illegal to do this in the workplace, to act upon our fears, exclude people we're not so sure about.

And lucky for us, Hollywood is doing everything possible to to publicize the absurdity of our assumptions by sprinkling our feel-good film-going experience of diversity with something that apparently many people really do love and can feel good about.  Gratuitous sex, or soft porn.


Friday, June 11, 2010

I'm Not Depressed

A patient tells me that watching the old guy across the street upsets him because the man looks like his father. Before his father passed away, a little over a year ago, his father, too, was old, skinny, and sick. Seeing this man struggle down the front steps triggers the patient's depression.

Go help him, I say.

Contrary to popular belief . . . I'm not depressed.

If you catch that I am, what you're feeling is my V62.82, Bereavement. I don't even have the newly touted grief disorder, which would be cool in a sick kind of way, to have a brand new disorder, fresh off the press, Complicated Grief Disorder, or Prolonged Grief Disorder, so far as I know.

We diagnose a person who has lost a loved one with Major Affective Disorder only if that person is experiencing sadness, insomnia, poor appetite, and depressed mood beyond two months post loss. If major clinical features like these disappear at the two month mark, it's Bereavement.  My friend who lost his father over a year ago, is suffering from bereavement.

We call it depression if a survivor has
1. excessive guilt about things other than actions taken or not taken at the time of death,

2. thoughts of death other than feeling he or she would be better off dead or should have died with the deceased

3. morbid preoccupation with worthlessness,

4 marked psychomotor retardation,

5. prolonged and marked functional impairment,

6. hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person.

If you have those features (you might add the loss of appetite and problems sleeping) then you're talking Major Depressive Disorder.

So let's talk about me.

Slept great last night, 5.45 solid hours, dreamed of the Black Hawks playing hockey on a black and white TV set over forty years ago.  Had to have been nine or ten, but in the dream, can't tell.  It's cool that when you get older and you talk about things you did as a kid, you might dream about them.

It's Friday and on Fridays I like to have dinner prepared before leaving for work.  The idea is that when I get home I can just do what I want, meaning visit my mom, talk on the phone, clean, maybe even go to the movies with FD. So this morning I wake up and mumble a couple of things under my breath and stumble into the kitchen to see if the coffee's on.


I'm only writing the list below because (a) I like lists and (b)  to illustrate the difference between depression and bereavement. A person suffering from depression would be hard-pressed to get all of the following done (not bragging, just saying) in about an hour, between 6-7 a.m.  My wave must have crested yesterday.

(1) small corn salad, generously seasoned
(2) three loaves of bread, punched down for a second rise,
shaped and proofed
(3) nine raisin muffins.  Not sure why my recipe only makes 9, but it's okay.
(4) fish-- fairly tasty, not my best, but not bad
(5) introduction to this post--jotted on napkin--
Contrary to popular belief . .I am not depressed.
(6) grocery list appended--chocolate chips, zip-locks, decaf beans, rice
(7) added to the "to do" -- "Pay Gary" -- auto mechanic

Forgot the last.  The miracle is nothing burned.

Oh, and I changed the format to this blog.

The last, of course, was a tough call, because if you notice, to the right there's no blog roll, no Blogs I Love! It got lost in the shuffle and I'll have to do it by hand, add my resident buddies, many of you.  Time consuming, for sure.  When you grieve a loss you become painfully aware of how little of this you have, time,  and how important it is to use it wisely.  So email me if you're in a hurry to get me moving on it.


The new blog looks better though, doesn't it?  Eventually I tired of admiring my new look and wrote today's post. Here you go.

Some of you may have noticed that for the past four months (!) therapydoc's moods have been a little low, the tone a little lifeless. You can just feel the sadness, I'm sure, the palpable loss.  But that feeling's gone, virtually arrested.

You don't have a father for over fifty years and not lose a piece of yourself when he dies. I keep finding new questions for him that he refuses to answer.  Things like,
Dad, how to I fix this watch? I replaced the battery and it still won't run!

Or Dad, what DO you do with this gadget. It looks like a watch-maker's kit. Is it?

Or Dad, why did you make barrels of wine if you never intended to drink it or even serve it to anyone?  (He had a glass of wine perhaps once every couple of months, maybe.) 

One of my more fond memories is sitting on the couch and watching a ball-game with him, sipping his beer. (He had a beer maybe once a month, too.)

Or Dad, what do you want on your headstone? How about we go with your name and the date of birth, date of death.  Wait.  Nobody even agrees on your birthday! Your parents made it up at Ellis Island.  A little help here?

Or Dad, where did you put the (too many of these to list).
Things like that.

My mother is upset because she can't tell him about her day. Something amazing might have happened, like a visit to an assisted living place; and he's not around to hear about it. Or she gets herself to physical therapy, she's back in the driver's seat, literally (to our dismay). He would love that, knowing she's still driving.

Or she would tell him that now that he's gone, the neighbor who always harassed him about the landscaper is now harassing her.

My brother would ask him why he never got rid of old sets of golf clubs.  And why are there a hundred decks of cards in a file cabinet, each individually gift wrapped.

Enough. You get the idea.  This kind of dialogue, this kind of thinking, this is grieving, not depression. Sure, there are waves of sadness, tears, fewer at the four month mark than at the one. And sure, the thought of entertaining people or being entertained is loathsome.  So you don't. You just don't.

But there's no hopeless-helpless. There's no worthlessness, although apathy, yes, there's some apathy; and stresses add up faster, fencing these is harder.

In general a person's coping skills are less powerful, don't generally work. The things that made you happy, won't make you happy,   You're compelled to feel bad.  But you get your zip back, just when you think you've lost it, then you lose it again, maybe a few days, even weeks later. That's just the way it is.

Under depression, Major Affective, or an Adjustment Disorder,  you walk through fog, you try to force yourself to do things you know you have to do, and the same holds for bereavement.  Sometimes you accept that you can't force yourself, that you'll have to sit out a dance or two. 

Unresolved grieving, what we used to call it before it became Complicated or Prolonged Grief Disorder, when the grief of loss is seemingly interminable-- can kill some people.  When it's that bad it meets the criteria for Major Depressive Disorder and it should be treated medically, meaning medication and talk therapy.  You have to want to talk about it, however. 

I still tell most people, if it's a loss and it doesn't meet the criteria for Major Depressive Disorder, skip the anti-depressants. Just grieve.  Feel bad so it doesn't bite you later.  Resolve it. And keep it rational.

Before you blink, you'll have worked it through.  And you'll feel like dancing.


Wednesday, June 09, 2010

Snapshots, Ghosts, and Good Reads

What kind of a fan would I be if I didn't say something about the Blackhawks? Last night they won their first Stanley Cup since 1961. Now that was wonderful. It doesn't get better than this for Chicago. Of course, we want to know, why are people still playing hockey mid-June?

A few weeks ago I went to a baseball game, watched as the St. Louis Cardinals clobbered the Chicago Cubs, as usual. It was all too depressing. Real soon I'll get serious, write a therapy post about managing this, depression and sports. Or just depression.

Last Thursday I canceled out and got on an airplane, returned with a carousel of slides, invited all my friends over to see pictures of my trip to France, Germany, and Italy.

No, not really. I went to Atlanta, ninety minutes by air, to visit my kids and their kids and the machetunim (too tired to explain this word). The machs provide me healthy snacks with sugar, like Think Fruit (sold out on Amazon, but I tried). Healthy snacks with sugar-- not an oxymoron in the South.


That's a snapshot, not mine, of a swagman, a Matilda. The joke is that the song, Waltzing Matilda, according to FD, our resident music expert, isn't even a waltz. Waltzing Matilda, however, has its own museum, the Waltzing Matilda Centre in Winton, Queensland. Not too many songs have that, their own museum.

Why Matilda?

The kid is a little cranky and his Mom tells me,
"Just wait until we turn on Waltzing Matilda. You've never seen a kid smile like this one smiles when he hears Waltzing Matilda."
And she's right, of course. It's a smile that lights up the room, and the chant, Tilda, Tilda, delicious. The next Matilda he meets, he'll surely follow home.

Waltzing Matilda is a folk ballad written in 1887 by Australian poet Bajo Paterson. This unofficial national anthem is the story of a swagman or hobo, a drifter who carries his few things in an over-the-shoulder sack hanging from a stick. The swagman in the legend is caught steeling a sheep, a crime punishable by death in Australia, circa 1887. He hastens the execution by ending his own life, then returns as a ghost, apparently to dance.

This isn't going to be good for my kids, is all I can say, when they hear the real story. One can only hope that the song loses its glitter real soon.


I chose Atlanta over Paris because Rak told me her pantry was a mess; she needed me. Although many people, maybe most, resent their mothers-in-law when they begin to clean, move things around, meddle in their lives, Rak does not, knowing I'm a total sucker for a good pantry.


The kids belong to a book club and wouldn't you know, they sent Rak a parenting book, one I'd read about on DaMomma's blog. Rak hasn't read it, she hasn't got time to do most things, but child psychologist Wendy Mogel had me at the title-- The Blessing of a Skinned Knee: Using Jewish Teachings to Raise Self-Reliant Children.

You know how I feel about self-reliance (a.k.a. independence) and taking calculated risks-- both good-- maybe to the degree that a person breaks a little skin on occasion. At least get a paper cut without freaking out.

Skinned Knee is a quick read, one full of good behavioral strategies for parents, and lots of fabulous theology, if you like that sort of thing.*


It's a jungle in Atlanta in the summertime, all green and wet and fertile. You can't predict the weather; it changes hour to hour, minute to minute, but you can count on the humidity. At least that's how it is whenever I visit. But they grow bamboo in the backyard, so it feels very exotic, if wet, and hardly ever snows, which might be a good thing.

Before picking up Skinned, I was in the middle of a war novel about Viet Nam, a random find at the library.

Tim O'Brien, the guy with the baseball cap, author of  The Things They Carried, had to make the decision that many draftees made in the sixties,

Do I run away, dodge the draft, move to Canada?


Do I fight a war I'm pretty sure I don't believe in?

What a choice!

Mr. O'Brien chose war rather than cope with the townies whispering coward behind his back. Shows how far we'll go for our reputations, what we'll do to avoid bullies.

The Things They Carried is literally about what they carried with them, our troops in Viet Nam, and the telling of war stories. He tells us that if you don't tell your stories, if you don't talk, you will be sick.  One story, perhaps the most powerful, is about a soldier who can't talk about his experiences in Viet nam, post-war. The best he can do is drive around the lake alone in his father's old Chevy, again and again and again. He can't talk and he doesn't make it, doesn't survive civilian life.

You read this book until you can't take anymore stories, then you put it down, take a break, read something else. But make no mistake, you come back to finish it. The things they carried, some heavy, some symbolic, all terribly, terribly lush.


I don't have a photo of the tomatoes or flowers, but on one of my walks with my granddaughter (4) we met up with a typical Southerner who offered us starter flower and vegetable plants to take home and plant, which we did. Another neighbor wouldn't let us move on until she packed us up with fruit and crackers. This is not a Yankee town.


We had to go to the Botanical Gardens, of course. FD is a very empathetic guy, you can tell, communes with nature.

They have flowers there at the gardens, and frogs, and the trees hug you, apparently, if you're not careful, with their oxygen.


Trees Hug Back is the headline.

Remember that bumper sticker, Have you hugged your kid today? What happened to that campaign? Probably too much hugging-- all those helicopter parents spoiled it for everyone.


FD found us a new park to break in, complete with nature trails made from recycled tires.

You young people may not even realize that there was a time when a kid had to skin his knees. There was no choice. A playground was a dangerous place, none of this soft landing stuff.


Speaking of landings.

That's an AirTran wing.  I did not sit with FD, and the fellow who had the window seat to my right, James, did his best to get out of my way so I could take a picture.  But it was still hard to focus from the center seat. James had pushed out his hand for me to shake the moment we made eye contact, and it was refreshing, such natural warmth. I think it's a southern thing, but we do feel it, sometimes, when we travel by air, no?

We landed in Chicago, fairly softly, Sunday night around midnight, about as softly as one can on that short runway at Midway.

Good to go, good to come home. The CBT post might be more significant, I guess.

Although there's nothing insignificant, you have to agree, about ghosts.


*Some of us might consider this a kiddish haShem, (rhymes with skittish ha! gem)a positive force in the universe.

Tuesday, June 01, 2010

Spiritual CBT and Flotilla Passengers Shooting at Israeli Soldiers

Two topics to discuss today. Gotta' clear the air a little.

Topic #1

I took out the spiritual cognitive therapy stuff on the last post and a reader wanted to know why.

In that post we were talking about how people cope with crises, and I suggested that when you lose your job, one of the things you might do, if you have a spiritual side, is to use that side to your advantage. I think there were three ways to do this in the long footnote that's now history.

I deleted it because I felt it took away from the post, made it all about religion, which gives the wrong impression. One thing I'm not, I hate to disappoint anyone, is all about religion. Sometimes, however, it creeps into my posts, my beliefs, maybe even, dare we say it, a little spirituality. I've even referred to the "Old Mighty," the moniker my grandfather dubbed his higher power. My grandfather was European, didn't always catch the nuances of the language, or so we think. He also said he was hard of hearing when my grandmother talked to him.

Anyway, what I left out, one of the things I deleted, was a quote from someone I admire.

This young woman attended a funeral and it changed her life. She listened to the many things said about the deceased, a guy who had suffered most of his life.  He suffered with illness and poverty, had difficulty supporting the family he loved, that loved him.  He devoted himself to doing "good" to doing things for anyone who needed him, the family, the community.  He worked selflessly, no money, no job success, no fame outside of his deeds. Mainly he helped others for very little in return-- the type of person who has nothing--  but they rob him anyway, twice. True story.

"Maybe we suffer," my friend said to me, "so that when we die, others will hear stories about us, and they'll learn what it really means to live." Or something like that.

For the life of me I can't remember what the other two spiritual cognitive strategies were. Does anyone else?

That's how spiritual I am.

Anyway, there's nothing good about death, not usually, except perhaps when there's too much suffering, and there's nothing good about war and senseless killing, which is why I'm posting #2.

Topic #2  Flotilla Passengers Shooting at Israeli Soldiers

I can count on one hand the number of times I've discussed Israel on this blog. Actually, one finger.

At the time I was in Israel and scud missiles from Gaza dropped on cities only a few miles away from me.  I thought, "People in America just don't know, they don't get it. The Palestinians are not the defenseless people they're made out to be in the media. They get weapons from other nations who have much to gain in a war against my people."

Anyway, today I hear that Israel is on the defensive once again, this time for intercepting a ship bringing humanitarian aid to Gaza. As a rule these ships are intercepted to ensure that the flotilla do not carry arms to Gaza that will be used against the Israelis.The top paragraph of the Jerusalem Post:

Dozens wounded, including 10 soldiers, in pre-dawn battle at sea; Israel says its commandos were brutally attacked before opening fire.

It didn't happen peaceably, the humanitarian drop. First fire came from the flotilla, not the Israeli Defense Force. But that's not the coverage you're going to hear on television, I can guarantee.

But if you're Jewish, you get all kinds of email about Jewish things, and today the email was all about what happened, complete with links to Youtube.

First, if you're interested, read the story by Yaacov Katz.

Then go to Youtube. Experience war.

Okay, feel free to shoot the messenger.