Hawaii

Would you believe it? A shoe store capitalizing on the false nuclear alarm in Hawaii. Sorry, Famous. Bad taste.

You may know that I have a little annihilation anxiety, most of us do. But I’m still conscious of it, having had it most of my life. For years, as a little kid, then well into my adulthood, I had a recurring dream about home invaders, two big men climbing through my bedroom window or banging down the front door of our home. I could see them through the little triangular windows of the front door, used all my might to keep them from getting in. I'd wake up in a sweat. 

The dreams persisted once every month or so, until, as a middle-aged woman, as a responsible mother, they just faded away. There were too many other things to worry about, like the safety of the family, my children.

That, or the dreams stopped with the empowerment of Master Han, a Tai Quan Do instructor. I was too uncoordinated to do Tai Quan Do so he just gave me a couple of private lessons. Master Han taught me to bang an attacker's nose with my head, smack a groin with my knees, and box ears, if at all possible. Use your whole body, he told me.

That helped, and when I walk alone I flex my muscles, open and close my fists. Smack them, ready. But I still worried, even after Master Han, when I got on an airplane, that it would go down, worried to the degree that at one point I wrote last requests of my children, deep thoughts, a kind of a will. I found it recently and boy, am I glad I didn't die. They would have thought me beyond help. Dead, but beyond help.

Do not open unless I'm not here any more. 

I tore it up, irrelevant so many years later. Sometimes I think about this blog and think: I should take that down, too. 

Once, before getting on a plane to Israel, I glimpsed someone I recognized, also boarding, a teacher, a woman who contributed to the community's intellectual and spiritual growth, every single day. I was in awe of this person and thought, We’re good. This plane isn't going down. It was a great trip. I never relaxed as well.

And flying hasn't been a problem since.

Have I told you, that despite the nuclear scare in Hawaii, we went anyway? I started this post before we left but decided to wait to post it because the pictures would surely be worth the wait. They're going up in the waiting room. 11 x 9's.

The thing about Hawaii, what makes it a big deal, is that it is the kind of place we've wanted to visit for decades. I do mean decades. You get older and say, decades. We'd joke around and say, One day, before we die, we should go to Hawaii. But it is so expensive, and being committed to spending our tourism dollars in Israel (and seeing family there) we usually head the other direction, assuming there's time and money, a big assumption. So Hawaii was really kind of a dream.

But the miles build up, flying to Israel, taking domestic business trips. Then one day last October FD proclaimed:

"There's a conference in Maui. Why don't we go?"

Maui, as in Maui Hawaii?

Yes.

Book it, now! 

So no to Costa Rica, no to Barbados and St. John. No to Viet Nan or Thailand. Although I have been to China without him for a wedding, and we have been to Paris for a day and London to see relatives, also on the way to Israel, but that was years ago, decades even, so. .  .

YES to Hawaii, even with the stupid nuclear alert, and that it is so close to Korea, such a sweet, happy target. And YES to the new world view—It is the regrets, at the end of your life, you regret the most.

Between October and early February, however, the universe still conspired, fanned my latent annihilation anxiety, the nuclear alert in Hawaii a big part of it. But there was also The Crown.

BIG SPOILER ALERT!! If you haven't seen this docu-drama about the Queen of England, try to find it one day. We're about to ruin an episode is in the second season, the one where Charles goes to a physically taxing boarding school--Phillip's insistence, Elizabeth's objection. It was HIS school, Phillip's alma mater, thus the son must go. If you haven't seen this and think you might, then SKIP THE NEXT PARAGRAPH. You have been warned.

We flash back to Phillip as a child, away to this school. He hates it and is moody, oppositional and punished for that, not allowed to go home at semester break to see his beloved sister and her family. We're in Nazi Germany, pre-war. Since he isn't free to go home, his sister goes on holiday elsewhere, and we see her and her family on a small commuter or military airplane, not sure which, but there's terrible turbulence, and screaming, and it doesn't look good at all, and FD turns to me and says: Not the sort of thing we should see before a long trip, I suppose. And I think, Well, no, probably not. It ends badly for Phillip's sister, one of the only sympathetic people in his life.

So for about half a second I reconsider Hawaii, then recover my sanity. 

Young mothers and fathers feel this paralysis when they entertain the notion that something could happen to them, leaving their children orphans. They hold that baby, that child, and think: What will this helpless creature do without me? Good G-d, I have to stay alive!!

And it is true. We know, quite well, that it is horrible to lose a parent young, a nightmare. We need our parents, especially the really good ones who love and love and then love us some more. It is a universal nightmare, the idea that we will die, will leave our dependents because face it, nobody could possibly nurture them the way we do. The thought of abandoning children keeps parents on their toes. They say no to the third or fourth drink, and when the joint is passed and they're driving, decline that, too. Young parents, even older parents, are wary of danger, and when they travel, say extra prayers, some take out extra insurance. (Is there still flight insurance? I don't think so, but my mother did that).

Knowing that anxiety is a family thing, and that we are little sponges as children, that we absorb our parents' feelings, I think I always knew, at some level, that this would be a personal lifelong curse. It seemed likely that my annihilation fears, which have generalized to worrying about everyone close to me, FD, my brother and his family, extended family, certainly my children, would linger despite the irrationality. We're all going to die, are we not? It is an uncomfortable feeling, anxiety, so I've learned to talk myself down, naturally, and mastered a thousand other ways to reduce anxiety behaviorally, never took a Xanax in my life. Without all that work, my thinking, I would be that apple that falls close to the tree, my mother's daughter. For her anxiety, especially about us, my brother and I, never faltered until the day she died.

What are the statistics of dying in an airplane crash? I only looked this up on Google, not the psych databases, because I had to pack for a trip and didn't have time. And now that I'm home, sorry, I'm too busy studying other things. But once I really did look it up for a patient. I can't find the results of the literature review right now, sorry, but learned that the best treatment for a fear of flying is virtual reality therapy, or desensitization, VRT. Get one of those head sets and a professional to hold your hand, or use your other tried and true interventions, breathing, muscle contraction, Headspace. The odds of dying on a commercial flight are 1 in 11 million, by the way. So bet on the pilot.

You get older and it isn't so scary anymore, the idea of dying, not that you want to abandon your kids. Even if it isn't scary, however, it isn't what most of us want, not having finished what we've started, fulfilled our dreams. We have more work to do, even if we're almost at retirement age. Some of us can't even conceive of retirement. Some of us. (And can't afford it, probably).

So did I worry about dying on that airplane?

I don't think I did. The anticipatory anxiety was all I needed, which is why the paradox intervention, even if you see it coming, still works. If you fear flying, be sure to do your preventive worrying regularly. If you're already doing that, kick it up a notch. Worry harder.

We started this post with that clip from an email advertisement from Famous Shoes, This is not a drill. . . It is likely that the CEO of Famous knew of Tom Leher. Mr. Lehrer, a satirist, wrote some great lyrics about nuclear war (see the video below to the end).

One more thing. Mr. Trump? If you're listening? Or Kim Jung Un? What about a little detente, some good relationship therapy. I'll take your insurance. Donald, you might have to apologize for what happened in the Korean War, just a head's up.

Oh, and both of you need a visit to Hawaii. It is a must before you die.

therapydoc

The Art of Fear

A friend of mine was telling me over a piece of Torah (This could be anything learned from the Jewish holy books, from the most complex argument, to a simple story.) He added that on the day he learned it, he also came across the same lesson from a different source. And then it happened again, the very next day, same lesson, while reading something secular. 

Cool, right? We both said it at the same time. But a part of me thought, Or random. What my friend is referring to is Torat Emet, a sign, repeated pointers, to the truth of the lesson. The emet. It is a spiritual thing that manifests in the real world.

Knowing this, while reading Kristen Ulmer's book, The Art of Fear I had a similar experience.

Otherwise it would be easy to dismiss this bio-self-help book, like my professional self insisted. Because Ms Ulmer isn't a mental health professional, and she cites no research or empirical validation of her methods. The Art of Fear is about the lessons she has learned from life as an extreme skier, as the first woman to break into extreme ski jumping, or simply, flying off mountains. On skis. She's learned much from her Zen master, and we could say that this teaching, her book, is her Torah.

So two things happened in that odd, spiritual way, that pointed to taking Kristen's work seriously, one anecdotal, the other clinical. We'll get to them. But something is bothering me. There's a huge problem, and it is laced within the pages of The Art of Fear. It isn't content, not the lack of empirical evidence back up her own claims of treatment efficacy, but an opinion, a slap in the face, a narcissistic injury. Our author dismisses the whole of psychotherapy, all of it, behavioral treatment, dialectical, cognitive therapy, everything, you name it, based upon a handful of visits to a psychiatrist and a therapist. She thinks that time spent with people like me, or maybe you, too, the clock ticking dollars and cents away, is time and money wasted.

What, Kristen, you didn't think we'd notice?

A short rant to the author is in order:

My life, and the lives of every other therapist in the world, the millions of patient hours that we spend with the people we see, matter. Our time with people helps. And although some might benefit from The Art of Fear, I'm sorry, many will not. 

 The online courses offered on your website may be fabulous, Kristen, but the bias, your accusation about the mental health professions are simply outrageous, and not nice. And those online courses that promise, well, everything? Smack of snake oil.

That just came out, the part about the snake oil, because meditation isn't snake oil, not at all, far from it, or quackery. We see good results with patients who have studied with zen masters, and many of us recommend meditation almost always for emotional management. Yes, management. It is like sending an alcoholic to an AA meeting, very helpful. When it works. If he works it, it is therapeutic to manage emotion, when we can pull it off, and more so, to make behavioral changes. Life should be about change, growth. Not navel gazing.

Still, this method does help. And Kristen's way of seeing, a nice way to conceptualize emotion, so we won't dismiss it. To sum up her therapy in two words, they would be body meditation. In this practice one learns to switch from nagging thoughts to the body, to feelings and where they are located. Body meditation practice can be very very helpful, especially for anxiety, thus no disrespect. But my patients come back to me a month or two later as if they have forgotten all of it. They lose the entire Torah.

"Are you still meditating?" I ask.

"Well of course, and it is very helpful. I'd be a mess without it."

"Keep that up," is my stock response. Then we proceed to discuss the entire gestalt, feelings, thoughts, behavior, the past, the future, all of it, everything that is bubbling over in that moment. And yes, we are speaking, feeling, in the here and now, yet talking about the past and the future. Because being here now, the patient is still a mess. And needs to talk about it now.

So here's the story.

The Good Reads book tour sends me intriguing paperbacks for review, and The Art of Fear landed in my mail box a few days before my vacation in early June.

Having buzzed through half the book before leaving, I get a call from a patient having a huge panic attack. His anticipatory anxiety is about an upcoming event, and his state of panic is his worst ever.

We had worked on the likelihood of ensuing panic before and during the event, and he had a few tools to work with. These usually worked: the breathing, the muscle contraction, finding rational reasons for and counters to his fear. He wanted to try a treatment strategy, virtual reality therapy, or VRT, that based upon my review of the research, might help, too. But the treatment center that advertised it still hadn't set up a program. So glad you called. Try us in December.

Kristen's words still fresh in my head, it was a no-brainer to try her intervention.

Listen, I said. You and your fear are one person. And you are a good person, Fear is a part of your self. It is you (one of you). You have fear for a very good reason, and you are showing respect by letting Fear out of the basement, not repressing her. She won't kill you, she loves you. All she's saying is, Pay attention to me, would you PLEASE? Because if you don't, I'm going to mess up this event, it will be a rocky affair and there is nothing you can do about it.

Fear can be a relentless, mean part of our psychology, And it is true, our emotions, ourselves, one in the same. Every therapist knows this. We don't suggest running from it, avoidance, or repression. Those are primitive defenses. We talk, and experience, feel and dialogue. It is what therapy is. We do a million other things, too, because there's no one size fits all in this business.

Fear, Kristen rightly tells us, is on our team, working for the good, just one voice, one of ten thousand employees at work in our community of selves. All for one, one for all, our feelings are hard at work, teaching us about ourselves, and they are starved for attention.

Her advice in The Art of Fear? Just listen, give Fear all of your attention, bow to her. Fear deserves respect. And pay no mind to all of that negativity in your head, those scary interpretations about fear, and her representative, anxiety. Negative thoughts build on one another (as if you didn't know) and grow more powerful as we obsess, even when there's no reason to believe any of it to be truly likely to happen. There's always a chance, however, so the thinking brain will go crazy, lawyering around, defending reasons to feel afraid.

I like to tell patients,

When you hear a rustle in the park, it could be a bear, but it could be a bird. 

Giving negative thoughts all that power is irrational, so goes traditional cognitive behavioral therapy. Kristen would say, and she's not wrong, that the thoughts are our off-course way of controlling Fear, and Fear doesn't need to be controlled. She just wants some respect, time. We try to come up with a plan to keep her in the basement, but she will not be denied! Give her a few crumbs, heck, the whole loaf, junk the thoughts driving her.

(Because that's easy).

The treatment: To stop the madness (the thinking), shift to the body, become aware of how it feels, find the emotions, especially fear. Give her equal time, no, much more time than you spend justifying why you have cause to worry. need to be afraid.

Brilliant! It is. And if you like metaphors and little stories, the book is full of them.

The therapy is called Shift Therapy, and I like it very much, because it is so familiar, a warmed over version of Psychotherapy 101, first year graduate school education. Social workers (most therapists, believe it or not, are social workers) since the early 1900's, are trained to tell patients to give emotions their due, to validate them. The patient should get in touch with her feelings. Just feel. Stop working on not feeling, because feelings might escape in one way or another, disguised as anger or resentment, jealousy, blame, shame. Let the tears come, we say, and it is okay for the heart to quicken. It is telling us we're alive.

Old school, still delicious.

And what goes up, you know by now, must come down.

The art of feeling is nothing new, still remains the essence of a good psychotherapy, despite the dozens of manuals prescribing treatment protocols. Kristen's is now one of them, or could be, if she didn't have to diss the mental health professions to go it alone. That, darling, should say something, not to play therapist here.

My patient, the one with the panic attacks, reported that the event went spectacularly, by the way. He had a great day. It could not have gone better. I took that as evidence, validation of some of the truth of Kristen's book, grateful to have found it by chance. Or was it chance?

Then, last night, a few of my friends and I had movie night. We don't go out. One of us goes to the library and takes out five or six DVDs. We bring our own dinner, chow down and talk, then go through the selections to find one we haven't seen. We chose Eddie the Eagle.

Sounds like a dumb kids movie, but this is about a little boy who becomes a big boy, then a young man, who remains a little boy, forever. Eddie has always had just one ambition, to be an Olympic contender. He wants medals. He has a cute metal box awaiting them.

He fails miserably at all sports, is told that he is not an athlete, that he never, ever, will be in the Olympics, but he doesn't care. He keeps looking for yet another sport. He will practice, hard, because he is determined to be an Olympian, to compete with the gods of athletics. He is positive, he is sure, and he is, in a word, almost fearless.

I don't want to ruin this one for you, so we stop right there. This is a feel good movie, and a true story.

A seemingly random choice of a film, still, a sign pointing in the direction of Kristen Ulmer's book. Why? And why was I a day late blogging for the book tour? Because apparently, it had to wait until three women poured over some DVDs, only to decide to watch one about an Olympic ski jumper.

Kristen Ulmer's new book

Kristen Ulmer is a ski jumper, the first female extreme sport hero with accolades to prove it. Most of her life, she tells us, she kept Fear in the basement and fearlessly pursued all things dangerous, like flying on skis off cliffs.

Simply mind-boggling to anyone with a Jewish mother.

So that's it, the story, the whole truth.
A final word to our author:

I love the technique. It will work for some, not all, and I will continue to refer out to zen masters. My advice to you, however: Refer out, as well. Punt when you're in over your head, tackling the hundreds of other diagnoses in the DSM 5. Stick with athletes. You get them. For this work is not all about fear, believe it or not, and there's no one size fits all to calm that monkey brain.

Avoid all shades of autism and be very, very careful with patients with severe personality disorders and psychoses, even OCD, and certainly suicidal patients.

This is painful work, you will absorb more of it than you care to admit, and you'll cry, too, and laugh often if you love it.

But obviously you won't be keeping your emotions, and hopefully not your laughter, in the basement.

therapydoc