That Circle of Life

For transliterations and definitions of phrases in this post, skip down to the end.

My Uncle Max passed away just the other day at 88.

He was a stalwart of this Chicago family, a proud American with a good name, a name known here and across the ocean for good deeds and charity, a legacy we could all emulate. Proud spouse, proud father, proud grand-father, even prouder great-grand-father, I saw him flirting with the very youngest in the family, a very little one, only a few weeks ago.

Carl Whittaker, a father of family-therapy, when training young clinicians would always say:

This work can get emotionally trying; flirt with every infant you see.

It's safe to generalize from treatment to life most of the time.

Original Chicago frum, my uncle seemed secure in his place in the secular world and secure within our little ghetto without walls. Most of us in the family are like this, and most of us have stayed in Chicago and have lived here a long time, unless we've wandered in post-matrimonially from another town, in which case the family does its best to make a person feel as if he's never lived anywhere else. Not the most numerous, surely not few, we're just your run of the mill people-people. We cover home-makers, social workers, lawyers, doctors, psychologists, teachers, administrators, principals, writers, directors, stock-brokers, book-keepers, artists, scientists, insurance brokers, recruiters, and kashrut-mashgichim. No baseball players or soccer moms, as far as I know. I'll probably get into trouble for leaving someone off the list.

An organic system, we do our best to be there for one another for happy occasions and sad ones, too, and when we neglect to do that, try to give one another the benefit of the doubt. For none of us are perfect and family is a good place to practice this sort of thing, giving the benefit of the doubt, which, I'll say it right now, happens to be apropos of nothing in this post, but is a Jewish world view that applies largely to marital therapy and relationships. So I tend to throw it in when it works, the benefit of the doubt, even if the directionality of that relationship within the family or the tribe, for that matter, has yet to be empirically established.

Anyway, I remember when my parents reached my stage of life, how they started going to a lot of funerals. They had a funeral to attend a week, it seemed. The parents of their friends were passing on, and they had to deal with the funerals of their own parents, my grandparents, too.

As they aged, their health and the health of their peers declined. My mother would say, "Do you remember So and So? He's in the hospital again, and when Dad and I visited him, his wife_____ was there, and she's not doing so well, either."

Your parents slowly, systematically run out of friends their own age, and before you can blink, you're going to more funerals, too, more often than you once did. You're in the same boat, and not immune, and you start to think, Pretty soon my kids will be here, too, and it'll be my generation they're talking about. Death happens, strikes a family, and there you are in the shoes of your once middle-aged parents.

First one of your mother's siblings might pass away, then another. Then another. In my family, when the third maternal sibling passed on, I heard my mother say to my father, "We're really starting to lose numbers, Sid."

And a baby would be born.

I got the news about my uncle while sitting in a snack shop on Burbank, eating lunch (grilled fish sandwiches) with my daughter, my son-in-law, my son-in-law's sister and his mother, my machetainistah. We're in this shop, sitting at a table by the window because all we have is ambient light, daylight streaming from the window. You never know when the electricity is going to go out in Los Angeles.

It's uncanny that when I'm out of town. I won't get any calls unless I'm sitting down to eat with a bunch of people that I haven't seen in six months. But I take the call today anyway, because I've left more than a few rather distressed folks back in Chicago with these words: They have phones, I have a phone, where I'm going.

Patients know I want them to call me when certain stars are in alignment. So I answer the phone and it's my mom.

Lemme call you back in an hour? I ask.

She says no and tells me that Uncle Max has passed away. Max is her sister's husband. This is a shock, although he's 88 and sure, he's been sick. With the news my face drops, the way faces always do when they get the news that someone has passed away. My mother is telling me to please inform the family, to tell everyone by way of a family email shout-out. Give the cousins the details of the funeral.

I assure my mother I'll take care of it. Everyone at the table in the snack shop understands; they have heard the, Oh, no! caught the whisper, Uncle Max! and they want details.

I have no trouble telling over a few things about my uncle at the table, describing his way with the family, his passion for Israel, his professionalism. My appetite is gone and I don't really want to finish lunch, but it feels wrong not to eat, not to pick up, change topic, for we had been talking about choices in life before this interruption, something happy, something important to my son-in-law's sister. So we jump back to that and in minutes the mood is light and good.

I have a rabbi who says that a Jew has to be ready to jump from a wedding to a funeral, from a funeral to a wedding, to switch from happy to sad, from sad to happy, on a dime. True enough, all well and good, and he knows that that works-- as long as you're not suffering from some disorder or another.

We bury our dead quickly, so the next day, while my daughter is driving the kids to school, I'm in the front seat making plans with FD to broadcast the eulogies from his cell phone. The idea is to get to Coffee Bean after we drop off the kids, wait for the call. My daughter notices me get upset and asks about it. I hate not being at the funeral, I tell her. Predictably, the broadcast doesn't work out. Reception makes it sound like FD is on the subway, not in a synagogue.

After I give it up, my daughter wonders about my relationship with my uncle. We weren't close, especially, it seemed to her, didn't run to visit him and my aunt every week or anything like that when she was little.

And she's right, of course. It's all natural and good, his passing, the way things should be. I remind her that she hasn't known her aunts and uncles for as long as I've known mine. Just as they've watched me grow up, I've watched them grow older, too.

We're all in this, none of us avoids this rich, if depressing process, the many colors of aging. What is important to us as young people is less important in our later years when we inevitably obsess over the physical gifts we've taken for granted, lost. And yet we find that some of the things we always treasured still reign supreme, indeed are the only things that become important in the end.

When I last saw him he was sitting in a chair in his room in the rehabilitation center praying a very long afternoon service. One of his granddaughters had come to visit from New York to see him and to attend a different family funeral. He flashed that huge smile of his when I walked through the door, the smile I think of when I imagine him walking through the door of my childhood home, when he and my aunt would come to visit.

I had to leave to get the work before he finished his prayers.

therapydoc

Chicago frum rhymes with Chicago BOOM, and refers to the orthodox Jewish community.

kashrut mashgichim- This is Hebrew, rhymes with GOSH-ROOT SLOSH-WICK-HIM, plural for the food specialists who certify that an eating establishment is really kosher. I'm not going into what kosher means or how to pronounce it.

machetainistah I think it's Yiddish, rhymes with GOTH-EH-RAIN-HISS-DUH, and refers to the mother of your son or daughter-in-law.

How to Save a Life

Caveat: This may make you feel bad. If you know someone who killed himself, or herself, and you feel badly about your part in it somehow, get therapy. Or talk to someone about it. You matter, too, and despite what you might think after reading what I write below, you probably couldn't have helped that person, probably could not have saved a life. It's one of those things, best to take yourself off the hook.

One night last week FD said to me, "We should make a shiva call tonight."

Someone who sits shiva has lost a parent, sibling, or child, a member of the  family of origin. From burial to "getting up" from shiva, friends have a week to stop by and sit together with the mourners, console. Or they can call on the phone, if the mourners are out of town. My parents call it a condolence call.

I felt badly for not being on board, but it had been a long day. I just didn't want to sit anymore, not with anyone. I wanted to eat some dinner, make a few calls, work on taxes, try walking a little on the treadmill, see if I could ride a bit on the stationary bike. I told FD I had a break the next day and intended to visit our friend then, maybe do some shopping afterward. Did he want to come along then, skip tonight?

Call me before you leave, he said.

So I did, and he went along. We visited someone who had lost his father, a dear man in his eighties. Our friend talked about his mother, alone now and missing her spouse, what that must be like, missing him for what will be the rest of her life. To her, this man in his eighties died prematurely.

Sad but a relatively easy shiva call, as shiva calls go. No one lives forever, children should outlive their parents. There's a certain order that makes life just a little easier to take, sometimes.

After the visit we grocery-shopped and had some lunch. I dropped FD off at his office and started back towards mine.

Then I heard the song. I'd heard this song maybe three or four times before, and each time would think, Catchy, but what's he's saying? Is the refrain really, how to save a life? Is this song about suicide? It sounds like the lead singer is blaming himself, this mournful, plaintive voice in the band, the one full of regret.

But honestly, all due respect, words run together for me and I don't want to think this. I'm on my way to work thinking, how to save a God knows what, flashing on that first patient and  wondering where am I going with this woman. Is my treatment plan on target? One false move. . . No room for mistakes.

I’m an aquarist and have had a bad fish week, lost three, one to an attempted homicide. The bat fish didn't make it through the mauling. A trigger mistook him for a leaf, perhaps. The clowns died of broken hearts, in sympathy, no idea. They just couldn't smile anymore.

But these are people.

I get to the office early and log onto YouTube, because there's really nothing to worry about with that first patient and I know this, truly the job is in hand, the work's been done. We're in middle phase, putting together a few pieces, not resuscitating anything, anyone.

And there it is, the music video, obviously a hit, a clear winner, it pops right up. Many others boast videos "with lyrics." So apparently I am not the only one who didn't get them on the radio. Once you know the words, like everything else, meanings are clear as rain.

Where have I been? Why haven't my kids told me about this? Don't they know I need this stuff? It's like oxygen for me, a song like this. I print out the lyrics, then watch the video maybe five times, mesmerized.

Fray, the band, won't let me embed it on my blog, so readers must find it themselves or follow a link.  With their permission, here are the lyrics.

How To Save A Life:
Step one you say we need to talk
He walks you say sit down it's just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
You begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you've told him all along
And pray to God he hears you
And pray to God he hears you

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

As he begins to raise his voice
You lower yours and grant him one last choice
Drive until you lose the road
Or break with the ones you've followed
He will do one of two things
He will admit to everything
Or he'll say he's just not the same
And you'll begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life
How to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to
Save a life

A critical thinker would watch the video and say, so emotionally manipulative. These are actors, hired to look sad, to draw attention to a problem affecting youth today, but there is no way that any of them would really want to die, would voluntarily take their lives.

But the truth could be otherwise. Although these are actors, they are representative. There is an ennui that affects young people, like old people, a psychic pain that affects the leaders of tomorrow, and I see them in my office and we talk and talk and talk, and there was a time, when I was young, that I would be on the phone all night with them. I knew so little back then.

More aggressive, I haven't done that in a long time. Not only are youth at risk, of course. Anyone who has lost everything, which is easy to do, is at risk—middle-aged men and women who have no savings, no jobs, fathers, mothers, grandfathers, grandmothers, the old and the young have angst, suicidal wishes. We know them.

Along comes one, distressed, withdrawn, glassy-eyed, a friend of any age, who has changed. And let's say you have this chance, somehow, to stay, to help this friend through one night in particular, one awful night. It is a horrible position, to have to do that, to make that choice. And with grown men, it's not as if anyone is asking you to stay and hold hands, not usually.

Maybe you know. He’s not going home to anyone. He’s isolated. In a book you are reading you learn that isolated people are at higher risk. It is sometimes easier if there are friends, family around. Living with someone is better than living alone; the support is built in, not that this always helps. People can be in the next room and not be there, not be very much help at all. They may even be a part of the problem.

Thus as a real friend, you have to stay to save a life, as Fray tells us. You may have to call someone else, explain why you'll be late, maybe why you'll be out all night. Mention that you might need some assistance, too.

But you have to stay, and you might have to stay up all night.

You never want to be in charge of someone's life, it's not a great position, it's not usually what we sign up for when we say, I'll be your friend. But sometimes, by staying, we make it a little easier for a friend in trouble to hold on. Stay just a little longer, until you have a chance to bring in bigger shoulders.

It can be hard hanging in there with someone who is seemingly smiling politely back at you. (Lyrics like these strike a familiar chord. We've seen this smile). You can't politely look right on through, go your own way. To be trite, you may not pass this way again.

Between the lines of fear and blame. You begin to wonder why you came.

Except you shouldn’t wonder, because your fear is nothing compared to his, and no one, really, is to blame. Depression happens and is obviously the domain of the therapists, the professionals—doctors. We have the tools. Sometimes all we need, however, is some unknown actor to play a quiet understudy role, to be a stand in for a few hours, keep our patient alive, watch him and don’t let him let that impulsive, senseless act happen. Get through the night and then find help, the bigger guns, to fight your friend's depression. Tell someone, a parent, a primary care doctor. A cop.

Anyone can sense a death wish, you know, feel that Spidey sense tingling. It is a scary feeling, sensing a death wish, because we have no control, none over the actions of others. Intimate information, insider knowledge direct from the mouths of our suicidal friends will haunt us if the act is consummated.

Like isolation, seeing self-destructive behavior is insider information. If a friend has been hurting himself, or has been hurting for a long time, drinking and drugging without any thoughts about tomorrow, then the direction of his mood won't spontaneously lift, the negativity won't fly away, not without medical intervention. That is when we have to seek help, can’t wait around for tomorrow. It is too dangerous a cocktail, negative thoughts mixed with accessibility, the accessibility of drugs, alcohol, bullets, ropes, blades. We can't walk away the truth of our violent world. We have what to fear, old Yiddish expression.

So scary, and we’re so powerless, You wonder why you came. So you go.

When we don’t, when we reach out, they punish us. This is how they make us feel, depressed people, like we're useless and powerless, like we can't help them. Why bother? This is how they feel, useless and powerless, failures, better off dead, not worth bothering about. It is called projection, and a sensitive friend feels what is in the heart of another, this feeling that there may be, truly, nothing that can be done.

Such a trap, and so wrong! Over-rated, powerlessness, hopelessness. Push help, find those friendly cost-effective social service people at the local mental health agency, the professionals. They’ll think of something. That is the rational way of seeing despair. The social scientists can't treat everything, not every time, but God knows, they can treat depression, and more often than not, win the battle.

Someone has to stay rational, unafraid, and above all, hopeful. You, the friend, perhaps the lover, sister, brother, parent, spouse, are elected. Maybe it won't work, maybe you will lose this person in the end, but you don't really know that, do you? So you can't run away, that's for sure, hoping that in the morning your friend will be okay.

You can't stay right if he turns left. This is the projected abandonment he is hoping for, you validating his worthlessness with your leave-taking. Don't fall for these words, I'm okay, go home. Be sure someone else is on call. Or stay.

This is not to say a person should be manipulated to stay by suicide threats designed to control the relationship. This is entirely different, a typically borderline personality modus operandi, and it is not an easy call to make. One in five with this disorder do kill themselves. But threats are threats, and as such need to be taken to a higher court. There is a fine line between dependency and despondency, but sensing you are walking that line, it is best to get out of the helper/rescue role.

It is too big for you. It is too big for most of us. That is why such people are so lonely.

Oh, so much to say. Why did I start?

Because so many people, after a suicide, say, I knew.

I tell people to talk openly about it, about this idea that most of us have had, at least once in our lives, that life is too tough, that we wouldn't mind finishing it. And they should discuss meaning, why choosing life is the better alternative, because there is meaning. It is our job to find it.

Having the discussion doesn’t make it your job to find meaning for your friend, the one who wants to die. It is the job of professionals. But you can play with it. It is a wonderful, rich, very intimate conversation we're talking about, and as such can be therapeutic. Therapists have no corner on these conversations. We do tell people that a suicide is permission to the generations to come that it is okay to throw their lives away. And if you do happen to help a friend find meaning, if together you find that elusive raison d’etre, within the throes of discussing depression, you are amazing, both of you are, and should consider this profession.

Oh, but we aren’t finished. In the process of this philosophical discussion, should your friend mention a suicide plan, then this is a heads up, don't take it lightly. There is real risk. Your friend is capable, armed, can exact a suicide. Now is the time to phone for help. More drama now, less later.

You can and should call parents, if there are any, and they are around. Real friends know how to find them, aren't afraid of these people, the ones who birthed a suicidal buddy, who brought a suicidal friend into the world. It is possible that these people hold the key to something very elemental to your friend's survival.

If there are no relatives nearby, then you may be the closest relative right now. You don’t want to lose him, but he can be such a burden, sometimes we give up. If it were our child with a fever, we wouldn’t give up. This is a child with a fever.

Where did I go wrong, I lost a friend. Somewhere along in the bitterness.

Whose bitterness? Suicide is an angry act, a vitriolic act. At some point there's energy, enough to make it so, that decision, the one that spells relief. It takes a lot of psychic energy. The decision to do it can be invigorating. So we watch people when they say they're feeling better, watch them more closely. We're thinking, the energy is available, the time is now. He's going to go left. There's so much energy in the bitterness and anger. Toxic stuff.

Let him know that you know best. Cause after all you do know best

All you know is there’s something really wrong here. Even we, the professionals, the ones who know, don't give advice. We listen. We teach from experience and we do it gently, if we do it at all. All we know is we find death repulsive. Our friend does not.

When your Spidey sense says, You're not getting through, this person is going to try it again, it is time to call for reinforcements. I've had kids never see me again because I forced a hospitalization.

Enough. It is a blogger’s prerogative to ramble on, but you get the idea. You know the symptoms to look out for, the loss of interest in the usual pleasurable activities, not caring about school or work, not caring about hygiene, expressing hopelessness and helplessness, giving away possessions, revealing a suicide plan.

You don't want to be an armchair therapist, here, not a self-appointed therapist, certainly don’t want to beat on someone's short-comings, not ever. Like Fray warns us in the song, we don't tell a person what he doesn't want to hear.

Our unconditional love and support? It might feel good, but it might not, won’t necessarily save anyone’s life and doesn't take the place of professional help. It is all we have to offer, however, when someone won’t get help. The real kicker is that people can fool the healthcare professionals. As soon as they’re released, they overdose or shoot a bullet through their heads.

When they have had help and given up, it is the worst. We have to reinforce that therapists are a dime a dozen. Try another.

Meanwhile, scheduling is impossible, and there are no appointments and your friend is taking his feelings into his own hands, dosing out his own medicine, not caring if it helps or not. And you're there and you can tell, he's too drugged up, or he's drinking too much, that this isn't good.

So you call 911.

And there, you've saved a life.

You don't have to wonder about any of it, you don't have to wonder why you came, why you stayed. The un-timeliness is what we're talking about, the premature death, the one we want to avoid, no different in its importance than the one we talked about earlier, the octogenarian who still died prematurely, at least according to his wife.

We want to save a life at any age. That's why we stay. We—you—are a part of it.

therapydoc

With Feeling

See the yellow fish? He doesn't look too good.

We were talking about truth in blogging, and I felt conflicted that I have to be in this position of reminding you that when I make up an anecdote, that I'm making up an anecdote.

Ordinarily bloggers are honest. But a therapist never wants to reveal case material publicly, for fear of breaching the privilege of patient-doctor confidentiality. To avoid that, I patch together random interactions, invent stories, create personalities.

But when it's about fish, I can tell you, the stories are true.

Sometimes I wonder if fish can be empathetic. I know that dogs are, and cats, maybe. Probably those elephants we talked about have some empathy. I'm not a pet psychologist, so I'm clueless here. Feel free to help me out.

Therapists are empathetic, or they're supposed to be. But even an empathetic therapist can and should be able to detach. If a therapist doesn't intellectualize, doesn't lead with the head and not the heart, then everyone in the room is going to be an emotional wreck. People don't go to therapy for that, to increase their perception that life is basically chaos.

So I can detach when I work, detach with my friends, detach even, from my family.

But as a hopeful therapist, a person who sees improvement in just about every thing, every one (although it can take some time), and every type of situation, the thing that still throws me is death. Not leading with the heart here isn't an option.*

The Story:

FD tells me that my fish jump to attention when I walk by the tank. They swim a little faster, breathe a little harder. Of course they have eyes, you know, so it is not out of the realm of possibility that they recognize me, associate me with frozen krill and brine shrimp, Formula One and Formula Two. Who wouldn't jump, just thinking about yummy stuff like that. Mmmmmmm.

So I can relate, I guess, to fish developing relationships, in their way, with people. We just talked about elephants a few days ago, and I imagine that elephant keepers (keepers?) commune with their pachyderms, whereas if someone like me spent a week with an elephant, it's unlikely we'd have much of a relationship. The beast would sense my fear, my disrespect when it came to his bodily functions.

But pretty tropical fish that swim around in water, well, we attach emotionally to them, and it would be nice to think that they care, somehow, too. When I come home from work I go straight to the tank to say hello, to see how they're doing. When I get up in the morning I'm quiet, so as not to wake them. In exchange for this, they swim around and look pretty, try not to die.

I had Blue, just Blue (don't panic, he's fine), for over a year because having one healthy fish was fine to my liking. But as you might remember, he got a little too big for the tank, so I asked FD and Number 3 Son to move him into larger quarters. A little construction, no small task, actually, and Blue had the ocean to himself.

Such a large tank all to himself did seem silly, or so they all told me. So with the help of my son-in-law (a real fish nut, you should see his tanks), we created a community for Blue. He did pretty well, too, once he established his territory (the conch) and seemed to enjoy the company. I was really worried since Blue is a fish with really sharp teeth, and fish like that, should their appetites kick up. . . well, you just never know. But he never gnashed at the new fish.

One night about a week ago, I got home, hung up my coat, and took a hard look at the tank. The yellow tang, a little guy (you usually see humongous ones in the stores) looked sick. He had a brown spot where one would guess his heart should be, and he was leaning against a rock on the floor of the sea.

I tried to hand feed him, but he didn't look interested. He didn't even sniff at the food. I called my son and reported the symptoms. "Brown spot?" he replied with a sigh. "You may as well fish him out and put him in a plastic bag and freeze him, Mom."

Why the freezer, I don't know. But I couldn't do it. I had just watched a Boston Legal episode on euthanasia* and it made me consider the whole business of assisted suicide, even when it comes to fish. So writing this I let Little Tang gasp for life, holding onto a thread, and felt more than a little sick, myself.

When he passed on, he would go the way fish are supposed to go, downstream, I thought. And it would take me awhile to get over him.

Soon Little Tang gasped his last breath. When I discovered him he had wedged himself under the rock, making it difficult for me to fish him out with a net. I stuck an algae scraper into the water, a long stick. Usually Blue runs from it, hides. But this time, when I tried to poke the tang out from under the rock with the stick, his protexia went nuts. Blue bit at the stick, swimming around frenetically, as if to say:

Haven't you done enough damage for one day?

I felt blamed. Yet it did seem that Blue cared about his little buddy. And he wasn't going to let me show any disrespect for the dead, or as someone insensitively suggested, steal his midnight snack.

I gave it a rest, came back and fished out the dead fish. Again Blue objected. But he was powerless.

I knew it would be hard for me to sleep. FD came home and I told him the story and shared that the other fish might be at risk. When one fish goes. . .He said, "Maybe you need to syphon some of the water. Aren't you supposed to change some of the water every couple of weeks?"

When the kids lived at home, it did seem that they made a huge mess syphoning water relatively frequently. But since it's been just me and Blue for so long, we had it so that once a month was just fine. And miraculously, it never got messy.

So I got a little defensive, but FD put the bug in me. Although it was late, after midnight, I started a water change, just 10 gallons, but enough to keep everybody safe. And the next morning, no question, the three remaining fish seemed healthier.

So.

(a) I was right to feel guilty,
(b) taking responsibility made everyone feel better,
and
(c) whether or not fish have feelings is still anyone's guess.

therapydoc

**You can argue that every type of loss feel a like a death, and you would be right.

**The Boston Legal episode I'm talking about has the best treatment of parents cutting off an addicted child I've ever seen. Episode listed on the ION station as WCPX 13, it's about Shirley Schmidt being best man at her ex-husband's sixth wedding, assisted suicide, and an amazing treatment of addiction in family relationships.

I think it's the episode responsible for hooking me on this show, which, by the way, is awfully preachy this year. And for Republicans, insulting. I posted on the cut-off in families with addictions, if you're interested in this at The Second Road.