Television and Movies Fine Tune Our Empathy Skills

On a walk this afternoon I ran into my youngest son and his wife. They had the baby in the stroller, dressed well as always for such an event, a stroll. She is in a little pink dress with miniscule black kittens and a big pink bow in her hair (via the fashionable baby headband, not shown). She's almost five months old.  I bend over the stroller and we exchange goo goo eyes and coo softly at one another. Then, finally exhausted of that, I bring it up: 

"Do you think you might want to get together tomorrow night for an Oscars party?" 
They consider it and we try to figure out who in the family has the biggest TV.

Baby Fashion Plate (K"H)

Once I treated a patient with high functioning autism who told me that she watches television to learn social cues. Television increases her intellectual empathy. She knows that even though these are actors and have memorized their responses and lines, their inflections and body language are rich in teaching moments.

If you're a person who doesn't understand what vocal inflection and body language imply, then studying it in the media is probably the cheapest, least embarrassing way to learn. The raised eyebrow, for example, could mean surprise, or it could mean disagreement, doubt, skepticism. Really? A pout or a frown indicates displeasure. Think it's simple? It's not.

My patient might not be able to feel the feelings of the people on screen (emotional empathy), but she can learn what is going on inside them (intellectual empathy) by keying in on reaction shots. It is a process, and people with autism are on a spectrum (like we all are), some higher functioning than others. So you can't assume anything, not even the emotional empathy deficit.

Daniel Ross Goodman, a writer and rabbinical student, has an Op Ed column in the Wall Street journal today about The Revenant, a  film nominated for a Best Picture Oscar. Mr. Goodman suggests that movie-lovers enjoy this film because Leonard DiCaprio suffers. We go to feel the feelings of the actors, immerse ourselves in that process. Intense feelings spring from exaggerated events, startling our otherwise dormant empathy. And we want to be empathetic, to feel the feelings of other people. It is why women lunch, and men should. Women shmooze, empathize, then validate. It is a love fest.

Films like The Revenant deliver, manipulate our emotions and most of us do empathize. But don't all good films draws us in, and don't most of us empathize? For some (males) it will be intellectually, because they know they should, and for others it is emotional, because we can't help it. Regardless of type, we flex that empath muscle for a few short (or long) hours, feel what it feels like to be in dire straits. And so many movies are about dire straits that the soon-to-be rabbi's theory makes sense.

Except that none of us, not emotionally empathetic (the luck of the draw, genetics, so quit patting yourself on the back) or the intellectually empathetic (it's still good), have to go to the movies to feel for people.  On a bad day empathetic people empathize with the families of victims of disease, crime, war, abuse, and natural disasters, for starts. On a good day, the best journalists pull it out of us with human interest stories.

Still, I like Goodman's theory because it surely applies in a small way to everyone, everyone goes to movies about people who feel, whereas only some of us watch nature shows about spiders, and I love the example, Hugh Glass, a 19th century frontiersman who suffers twelve life-threatening tests, twelve torturous struggles, on a mission to find the man who killed his son. Mr. Goodman writes:

As we squirm in our seats, Mr. DiCaprio, as Hugh Glass, survives brutal cold, a vicious bear mauling, Indian attacks, and other dreadful depredations...

We feel for Hugh Glass.

In another section of the newspaper, WSJ film critic David Thomson warns us:

Audiences found The Revenant "too much . . .too strenuous, too long, too exhausting, too male, too snowy, to much raw meat, too much violence"

This may seem like a non-sequitur but be patient, but when my friends and I go to the movies, as the previews roll, we play a game. You play it too, the Do We Want to See This One game.

At some point during the preview one of us will say, "Oh, for sure I want to see that."  Or maybe, "You couldn't get me to see this one for all the tea in China." Or, "I'll take the kids." Or, "Don't take the kids." We often disagree. Watching the preview of The Revenant, Leonardo DiCaprio resolutely surviving the freezing cold, shivering inside the carcass of a freshly killed bear, we all agree. No thanks.

Why?

I think because seeing the bloody carcass, the muddy waters, the grunge, our empathy sensors kicked in, but went into over-drive. It is exactly as soon-to-be rabbi Goodman might say. We feel badly for Hugh Glass, stuck inside a bloody carcass. Except that we feel so badly, we can't watch anymore. It is a matter of degree, cringe.

So some of us go to the movies because we want to empathize, but some of us don't go because we don't want to empathize. The second group can't stand too much blood, or too much cold, too much raw meat, or violence. We don't have that need to feel badly, to be put in a bad place, to feel for someone who is in a bad place. Why voluntarily subject ourselves to that?

One hypothesis for the study might be:

People who score high on emotional empathy prefer not to cringe while watching actors feel negative emotions in a film, whereas people who score high on intellectual empathy don't cringe, so they don't mind the experience of watching actors feel negative emotions in a film..  

The theory behind the hypothesis is that emotional empathy can make you feel bad, whereas intellectual empathy is a function of logic, not emotion, and has less of an emotional effect, if any.

Not sure who is bringing the popcorn, or who will make the guac, hopefully somebody picks up some sushi. Watching the Oscars, another excuse for a party, isn't something we do every year because we want to empathize with the winners or the losers, although you could make a case that we watch to live vicariously through them.

It is all about the clothes.

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Disruptive Mood Dysregulation Disorder

Disruptive Mood Dysregulation Disorder (DMDD) is about emotional-behavioral management in children.  Reaching for more user-friendly semantics, FD refers to it as Calming Disorder, a seeming inability on the part of the child (hence the parent, too) to calm down.  DMDD is likely to be the latest flavor of the week, yet another label for children who are oppositional.  Willful.

We suppose that as these children age, as they grow into adults, they will be diagnosed as having Intermittent Explosive Disorder and treated with anger management.  Why we couldn't have used Intermittent Explosive Disorder with qualifiers: refer to children with a 1, adults with a 2, and a 1,2, or 3 to indicate the severity, is a mystery.  Perhaps the reason is that the temperament is chronic, not intermittent.

Here's the abstract.  I'll get to the article this week, but want to offer up a few thoughts regardless.  After all, they did ask me to be on the team to rewrite the DSM IV-TR.  Is it my fault that the page froze after checking "other" when asked for "type of license"?  I have two, and there was no way to communicate that. Calling in I was redirected, sent a new email.  But the link to the application didn't work a second time.

And life gets in the way.

Look for the article in PsychInfo if you have an academic affiliation. It might be on sale somewhere online if you don't.

Emotional dysregulation in disruptive behavior disorders.

Cole, Pamela M.; Zahn-Waxler, Carolyn

Cicchetti, Dante (Ed); Toth, Sheree L. (Ed), (1992). Developmental perspectives on depression.Rochester symposium on developmental psychopathology, Vol. 4., (pp. 173-209). Rochester, NY, US: University of Rochester Press, xix, 396 pp.

(The authors) present a view of disruptive behavior disorders as affective disorders and, from that perspective, discuss the emotional characteristics which are associated with the development of aggressive, antisocial behavior 
provide an overview of the disruptive behavior disorders, the history of the traditional segregation of behavior disorder from affective disorder, and the evidence and arguments for comorbidity of affective and disruptive disorders / consider possible developmental trajectories leading to these disorders / focus particularly on the role of emotion in early childhood and its implications for the development of deviant and aggressive behavior later in childhood and adolescence (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Seems to me we are looking for the prodromal, or warning signs of sociopathy, a disorder that defines what we have referred to as almost psychopathic in previous posts.

Parents are right to worry when their kids have symptoms of DMDD: uncontrollable tantrums, aggressiveness, an inability to manage emotion, an absence of empathy.  When they are cruel.  Dr. Cole has published on empathy in the past, and I think she is on the mark if she is thinking we have to teach children, all children, empathy.

We're talking about it right now because the DSM V is due out in 2013.  Teams of researchers, revisionists, are making all kinds of changes to what we commonly call disorders.  For example, Asperger's, childhood disorder in the current DSM IV-TR, has been known for decades to be characteristic of adults, too.   It is thought to be a spectrum disorder, on the spectrum of autism, and may lose its status as a disorder exclusive to autism.

According to yesterday's Wall Street Journal (Shirley S. Wang), "Aspie's" are up in arms about being subsumed autistic.  Not everyone likes the thought of being autistic, even if it is high functioning.  Yet, most of the "Aspie's" I treat tell me that they are very much in their own world.  They see the point.  More likely however, Adult Asperger's Disorder will make it into the DSM V, at least that is my hope.  Just a guess.

But back to our new flavor.  When we first recognized Bipolar Disorder in children, it amounted to medication, usually too much.  Manic kids were oppositional, hard to control by definition, and they suffered swings, clear signs of childhood depression.  Thus meds saved the day, theoretically, although those of us who work with a family model are generally reluctant to make that referral.

Children with Disruptive Mood Dysregulation Disorder are likely going to be over-medicated, too.  It doesn't take much to over-medicate children.  They are growing and changing all of the time.  And they are mini-emotional time-bombs under normal circumstances.  Having a motor that tends to puff and smoke at the worst possible times, it is understandable that parents are looking for help, lots of help, from that god of psychiatry, Big Pharma.

Thus we can only hope that parents remain patient, able to calm themselves, and bring little Joey to therapy.  If you are such a parent, stay in the room and learn strategies from the doctor/therapist.  The tried and true holding technique, grabbing the little tyke and holding her tightly (without hurting her) until she calms down, works for some kids, but as one reader puts it so well, restraining the child is:

 a tried and true way to exert dominance, lose the child's trust, and create permanent emotional scars.

I think we had both lose the phrase, tried and true, unless we can qualify them well.

Make sure no one is hurt no matter what you do.  Corporal punishment won't work, will work against you.  And although we are capable of holding, able to restrain children, being three times their size, we have to be careful. Not every child responds well to that.  If they are older, best to work on communicating in words, or in art, or play if holding is violently rejected.

There are other ways to treat DMDD.  Engage other siblings, certainly a second parent if one is around, or grandparents, aunts and uncles.  Use friends.  Use your people.  If you have none, find a support group.  Call the National Alliance on Mental Illness, NAMI.

Lose the idea that this is something shameful.  Get more into the idea that it takes a village to raise a child, because it does.

Behavioral modification won't always work, but try it early, start very, very young.  Even a two-year old needs to know the power structure in the family, that he is not the boss of you.  As a parent, you are the boss.

All of this assuming that marital dynamics lend themselves to the therapy, that the child isn't learning aggression in the home, a very big assumption.  And that the dyad at the top, Mom and Dad, or Mom and Mom, or Dad and Dad, have to have something of a working relationship themselves, must communicate, agree on a treatment plan.

It is most likely that children who will be diagnosed with DMDD, unfortunately, are identified patients, that their families are the patient, really, and that only a fraction, a tiny fraction of the children diagnosed in nursery, kindergarten, or elementary school, whichever system has booted them out, have the disorder.  If you hear the news: This child needs a psychiatric evaluation--it may not mean Disruptive Mood Dysregulation Disorder, no matter who slaps on the label.

I'll put myself out there and suggest that as a first line of attack, families need to find a good family therapist, not a psychiatrist, and leave the primary care physician alone about medicating the child.

When it is obvious that a child is dangerous, on the other hand, a team approach is surely necessary, with a primary care doctor, a child psychiatrist (go find one, good luck), and a therapist.  Sometimes  even hospitalization might be necessary.  Or so they're saying in the news today.

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Authenticity and Growing Up

David Schnarch, we learn in Psychology Today (June, 2012), is a psychologist who has spent decades going against the grain, debunking even Masters and Johnson. Debunking M & J, he is up against much of what is considered to be mainstream sex therapy.

Less interested in the mechanics of sex and communicating what we like, Schnarch is more interested in passion, passion between spouses, something he believes is only possible when we own our differences, maintain our individuality, and don’t fret every moment about what the other thinks.*

Sexy means different, separate. Opposites attract.

For what it’s worth, I can’t understand how this is a new concept.

Margaret Mahler (1897-1985), in the 1950’s, discussed separation and individuation, a variation of attachment/detachment (John Bowlby) as the psychological developmental process of human infancy. Mahler said that as newborns we start out symbiotic, with a sense of oneness, total attachment to our primary care-giver, usually Mother. As we gradually become aware that we are not the same person, that Mother has a life of her own, that we are really not one person, we begin the process of detaching from her psychologically, which will continue with others throughout our lives. But detachment in infancy is the beginning of the process of individuation, becoming an individual. By the age of two we're saying No! With attitude.

This process of developmental growth, becoming a being unto ourselves, different, unique from any other, varies for each of us. But we all go through it. Surely some of us start out and end up more dependent than others, and a more dependent, less secure partner might merge in many ways, seek to share values and characteristics of a more dominant partner, just as we do with friends in adolescence. Couples therapists see this as typical of one type of dysfunctional relationship (see the third below), and we see it often in the early stages of connecting, when, it is true, both partners may not be terribly grown up, especially if they partner young.

Some of us like to think we're never completely grown up, that we'll need to work on that until we die.

To Dr. Schnarch, the less grown up, less authentic, more dependent, gooey relationship is not sexy. It might be cute in the beginning, but it gets old. And none of us would disagree.

But really, doctor. Are they all like this, the marriages that need work? And those partners who are less mature, who are less well-individuated, should they just buck up? And if they can't or won't, then what?

If we were to quote Forest Gump on this one he might say, Sexy is as sexy does. And that would be your basic Master’s and Johnson/ standard sensate focus pleasure protocol. It is what any trained AASECT sex therapist (American Association of Sexuality Educators, Counselors, and Therapists) would recommend.

Schnarch wants us to grow up already, to be authentic, because this is sexy. We are more authentic when we hold our ground, when we don’t automatically move closer to the center, when we argue for what we believe in. It is independence that is erotic, not attachment, not if attachment implies that we must agree, lose ourselves in the process.

Certainly he's right, we could learn to do that, and therapy is a great place to start. Most relationship therapists have that part down, indeed, we spend much of that 45-minute hour encouraging authenticity. Honesty is sexy. It is the essence of intimacy.

Thankfully attachment theory, when it comes to infancy, is given a nod (he hasn't thrown the baby out with the bath water). Attachment is needed for healthy infant/childhood development. But for adults, attachment implies enmeshment, at least according to authenticity theory. Attachment, for Schnarch, when we're talking about adult to adult relationships, feels horrible, makes us feel guilty and stuck in our relationships because we feel we have to constantly tend to one another’s needs. Empathy, if I am reading him correctly, feeling another’s pain, actually messes us up.

Oy vey. Surely spoken by a male, one who relates to empathy intellectually.

Schnarch is opposed to marital attachment, or perhaps puts it second to authenticity (detachment) because it leaves no room for partners to speak their own mind, think their own thoughts, or attain their ambitions and dreams. (No room!?)

“We’ve eliminated from marriage those things that fuel our essential drives for autonomy and freedom.”

Whose marriage is he talking about? Every couple is so different! No two alike. And there are many different types of dysfunctional relationships, different types of marital pathology.

Consider four of them:

(1) conflictual marriages;
(2) relationships in which partners complain about missing intimacy,
(3) relationships characterized by one having to be sick in some way for the other to be well, and
(4) couples who pretend to agree, to be on the same page, who present to the world that nothing is wrong, when really, nothing is right.

There are unsatisfying, even pathological marriages, and we could say that a marriage that discourages independence would be one of them.

But there’s no question in my mind that Scharch is missing the central thesis to some off our therapies, one that this therapist has imparted to hundreds of couples over the years, driving them to more intimacy, more closeness, and yes, more attachment and surely, better sex. The mini psycho-educational lecture is addressed to those who complain about the second type of dysfunctional marriage above. But really everyone complains about intimacy in therapy. It is the nature of the beast, and it is rarely, too much intimacy.

A different psychoeducation:

One partner complains about not have enough time with the other. But the other partner thinks they already have enough, even too much time together. One feels suffocated (perhaps because the other isn't well-individuated, in the authenticity model). Another alone.

The novice therapist is able to accommodate, adjust that uncomfortable psychological space. Just grow up! Differentiate, add a new hobby, skill, book club to your life! Distance is good. Learn golf. The partner with the need for more intimacy is thought to be too dependent and is guided to fill in time with other things, develop more self. It feels like a win-win, at least to someone in the room.

But when it happens, in that growing up time, the golf instructor finds a passionate new student and attends to her intimacy needs. Do we not see this every day? She can certainly take this as flattery and rebuff him, run home to her partner exhilarated at the prospect. That’s sexy, for sure.

Is this what Schnarch really means? Possibly. Individuated, she has new ideas, new thoughts. She is more attractive. To everyone. Which is more attractive to him. (Switch genders if it makes you feel better.)

No, it doesn't have to go that way, the growth need not be co-opted by the golf instructor, and perhaps it usually does not.

A seasoned therapist, in any case, does not to go the distancing is sexy path, does not suggest golf right away. Surely golf is good, hobbies are great, individuation is for all ages, not only for infants. But the seasoned therapist tells both partners that intimacy is much harder than distance. Anyone can accomplish distance. It is staying close, being together that is hard.

Ask any retired couple. Accommodating to finally being together after years of individuating can feel like horribly suffocating, drives people who managed well throughout their marriages to therapy.

I agree with Dr. Schnarch, of course, that we have to be ourselves, and only ourselves in marriage (unless fantasy works, and guess what, it does), and that loving one another is easier when we are just that, crazy unique, original creatures that we were made to be. If owning who we are is growing up, then he is right on. But again, no chidish (Yiddish for something new, rhymes with hid-dish).

And to say that empathy is passe, over-rated, misses the point. Caring about the other’s feelings has to be a primary objective in an intimate partnership, should take precedence over golf, even politics, even if it doesn’t feel all that sexy in the moment. Empathy is tuning in to the other's mood, joining, attaching, and it doesn’t feel good is the truth, because our moods aren't always pleasant so no, it isn’t sexy. We don’t like to feel one another’s pain. Far better, really to be on the green, or at work, to avoid the other’s negativity until that other gets over it. Far better.

Not really. Not really far better, not at all.

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*A good sex therapy program, by the way, is never all about the mechanics, always beam the flashlight on emotional marital dysfunction, especially anger. We could say that Schnarch's emphasis on authenticity is really a variation of that.

Progress Not Perfection

This might be a spoiler if you didn’t see last Sunday’s Desperate Housewives.

We’ve been watching Tom and Lynette fight for years, and now that Tom is successful in advertising, he’s leaving her. He has found the perfect woman, someone who doesn't criticize him, who thinks he’s marvelous, and loves him just the way he is.

And she's a doctor, no less.

The couple is separated for several months, and a crisis brings Tom home. He helps Lynette through it and it is clear that the two of them are getting along, even seem happy together. Tom suggests he bring home a pizza and a DVD, that the family does pizza and TV night like they used to do in the past. Lynette jumps on the opportunity to be a family again. The children aren’t thrilled with his educational DVDs, but they go along.

The pizza is ripped open. Lynette makes a face. She doesn’t eat deep dish. She’s been telling him for years that she likes thin crust. He hasn’t been listening to her and she tells him as much. He tells her that this is exactly what he’s talking about, that nothing he does is good enough, he shouldn’t have even tried. She responds by saying that by now, after so many years, it wouldn't kill him to actually listen to her. She needs validation, too. He could care about what she wants. It would be a nice change.

He hands her the point, says he’ll try harder to do that.

An "Ah ha" moment. And she doesn't even have to get to the source, the reason why he ignores things she says, why he doesn't attend to her needs. But this is progress.

That’s television. In reality, people have reasons for not listening and it's nice to bring the unconscious to consciousness. That's called psychological growth, or insight.

The reason I like most is that not listening is associated with narcissism, being unable to see beyond what we want, seeing our needs as primary. For example, in any addiction (and you could say we all have one) the addict is dysfunctional because he disregards the needs and wants of everyone else in order to get his drugs, his drink, sex, whatever. It doesn’t matter, the promises. What matters is satisfying a craving.

Immature? Narcissistic? Sick? The 12-Step programs probably go with sick and selfish. Older 12-Steppers, people who have been sober for years, bop new addicts over the head, tell them, Grow up, be a human being. It works sometime.

The addiction metaphor is only good because addicts are selfish by definition. It can be true in mental illness, too. People don’t have to be, and that’s what recovery is all about. Rising above all that self-absorption and pain.

But take someone like Tom Savo, the guy who doesn't think to keep his wife’s preferences in mind, even when the two seem to be reconciling, a guy who isn’t an addict. I want to say that in his excitement, coming home, bringing home the pizza that makes him happy (and we can assume the children, too) he simply forgets to have her in mind. Oh yes, and a few slices of thin crust for my wife. He missed it, the opportunity.

If that is all it is, being excited, forgetting, it isn't even that dysfunctional. What is dysfunctional is when her needs are never important. When it is systematic, when forgetting his wife is a regular problem. He takes her for granted, doesn't bring home the thin crust because she hasn't made a big enough issue out of it. And even if she does, complaining makes him feel rejected, unloved, and angry, so it is likely to trigger defensiveness and an argument.

The real dysfunction is not when one partner forgets what the other wants, it is when the other's wants are dismissed. Lynette is never really in the picture. Without empathy, without feeling her sense of rejection, he can't address it.

Our relationships go to garbage without empathy.

How does a person get this way? Why are some people more empathetic, more considerate than others? You could say breeding, surely, and you would be half right. Parents can teach children to share, to care about others. It's more important than teaching them to be sure to flush, although that's a two for one. But self-centeredness is functional might help us accomplish things, meet our goals, sometimes. Being goal oriented, keeping our eyes on the prize (or just winning a game) to the exception of all else, others (who distract), we get more done. Or so it seems. There's surely loss, however, when others feel excluded, a social price.

So it could be nature, survival of the fittest. Selfishness could be something Darwin talks about. I haven’t read enough to know, but that makes sense to me.

Take a different example. A guy’s parents are very controlling. He grows up and is determined to run his own life, to finally have it his way. He marries a woman who is giving and selfless, reinforcing his need to put himself first. Except that she does have needs, and when she asserts, he ignores her.

But it depends upon the need, whether or not he ignores her. If it is for something permanent, perhaps a new dress, something she will look at in the future and think, Oh, he gave that to me, what a wonderful husband, it’s a go. He buys it for her. But if it’s something temporary, like a vacation, something intangible, he forgets. He learns that some memories are permanent. It is why we take pictures.

This couple frequently winds up in therapy, and beyond going back to childhood to determine the roots of selfishness, some of us push that 12-Step adage, Progress Not Perfection, because frankly, if we strive for perfection we we're going to be frustrated. We might even give up.

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Please Don't Leave Me

He's Just Not That Into You--It's not a new movie, and a lot of people said they were Just Not Into It.

But the topic had me at hello.

The cast is stunning, for one.  I watch chick flicks for many reasons (they're sedating, primarily), but a pleasant looking cast is at the top of the list. You can't talk about deep subjects all the time and not have a really shallow side somewhere deep down inside.

FD didn't bother with it for 30 seconds. He went to bed. But he was tired, is the truth.

Gigi Haim, (Ginnifer Goodwin, above, bottom right below) desperately seeks a boyfriend. It's the desperate part we don't like.  A woman (or a man, this movie could easily have been about a desperate man) should strive for a little more pride, more independence. Hanging on for dear life when someone is pushing you away, stalking restaurants and bars to catch the prey unannounced, feels like high school.  I know it's hard not to do it, and that for many of us, it's hard to have the kind of self-control necessary to go it alone.  But we've got to try.  That said, we can work on this for years in therapy, and we do.

Gigi anxiously waits for telephone calls, checks voicemail a hundred times a day, even when her first dates don't go well, which is always. What she wants, what she needs, is beyond her social intelligence. The social IQ should tell her that a little mystery, a little challenge, is attractive in relationships. And if the attraction isn't mutual, let it go.  But we're made up of much more than social intelligence.  Our emotional lives tend to rule.

She's rejected often, but nothing ventured, nothing gained. And Gigi's obsessive thinking, her compulsive man-chasing, doesn't hurt anyone. She's obsessed, but she would not be diagnosed with OCD, Obsessive Compulsive Disorder. She doesn't want to be alone, and although we might suggest she feels empty, she doesn't have Borderline Personality Disorder, either.  That's the one we think of when we associate fears of abandonment with mental illness.

She's just not getting it, can't read the signs when it's so obvious that it's never going to happen. Men read the neediness in her face instantly. They politely suggest, “Call me," a nice way of saying, "I’m not interested enough to call you, so I won't be calling you, but knock yourself out."

The film is full of examples of these types of metacommunications, communications about communications. It is worth seeing for that alone. But remember, the epiphanies of a chick flick aren't usually rocket science.

Gigi's social disconnect, her persistence in knocking when the doors are all closed, is a remez (rhymes with them-pez, Hebrew for hint, but hint just doesn't quite say it as well) to the drive that makes some people successful in this world. They know what they want and get it, don't take no for an answer.

When it comes to relationships and love, unfortunately, that kind of persistence and drive doesn't usually pay off. Forcing ourselves upon others only makes us less attractive, less likable. Gigi's manhunt turns out to be the exception to the rule. It's romantic comedy, after all.

Contrast this to Pink, and her violent music video, Please Don't Leave Me. I can't even link to it for you, it's so violent. Pink bloodies her boyfriend, beats him senseless so that he can't get out of the apartment. She's a sociopath, clearly, a violent, antisocial individual. I mean, rock star.  Not that rock stars are violent.

When I first heard the song, the lyrics isolated from the video screamed Borderline Personality Disorder. So I checked out the video at YouTube to see if it would work as a teaching tool for high school kids learning about abandonment anxiety. (They teach kids about that, right, in your high schools?)

Here are the lyrics:

Da da da da, da da da da
Da da da, da da
Da da da, da da

I don't know if I can yell any louder
How many time I've kicked you outta here?
Or said something insulting?
Da da da, da da

I can be so mean when I wanna be
I am capable of really anything
I can cut you into pieces
But my heart is broken
Da da da, da da

Please don't leave me
Please don't leave me
I always say how I don't need you
But it's always gonna come right back to this
Please, don't leave me

How did I become so obnoxious?
What is it with you that makes me act like this?
I've never been this nasty
Da da da, da da

Can't you tell that this is all just a contest?
The one that wins will be the one that hits the hardest
But baby I don't mean it
I mean it, I promise
Da da da, da da

Please don't leave me
Oh please don't leave me
I always say how I don't need you
But it's always gonna come right back to this
Please, don't leave me

I forgot to say out loud how beautiful you really are to me
I cannot be without, you're my perfect little punching bag
And I need you, I'm sorry
Da da da, da da

You say I don't need you
But it's always gonna come right back
It's gonna come right back to this
Please, don't leave me

Please don't leave me, oh no no no.

What's interesting to me is that both women, Gigi and Pink, are desperately in need of a relationship, both concentrate all of their energy to keep a relationship, even go to extreme measures. But they are such different women.

Engaging Gigi in therapy would be a snap. Teaching her rubberband theory, exploring her insecurities about being alone, she'd grow leaps and bounds in a single visit. Well, not a single visit, but a few for sure.  It's hard to let go, and managing neediness in relationships can take a lot of therapy, it's true.  Yet Gigi's not that dysfunctional. She hurts only herself.

Whereas someone like Pink would be self-mutilating in my office and throwing rocks at home.  I'd call in a team to work with her.

The differences in the two women, both so needy, underscores the importance of not diagnosing based upon a single symptom, not even an extreme symptom, although the no sleep thing in Bi-polar Disorder, and the hallucinations or delusions in Schizophrenia are fairly robust indicators of disease.  But even then, there are things to rule out before making a diagnosis. Like speed, acid, other physical disease, brain tumors. Things.

I looked already. Nothing's on tonight.

therapydoc

The Therapist and Confidentiality

This will be a maximalist post.

1. Confidentiality/other professionals:

Some of us like to consult with other doctors. To do this we must first ask the patient to sign

The Release of Information

which consists of pages of legalese and finally, the

Date: _____________________________
Printed Name:______________________
Signature __________________________

You can tell how professional the professional by the uniformity of the lines.  This is harder than it looks, uniformity in lines.

I always assumed that the form protects the patient from a breach of privacy. If someone other than the doctor handles a faxed evaluation,  

             Release of Information
-- PERSONAL AND CONFIDENTIAL-- 

attached, surely that individual wouldn't think of reading the evaluation.

For sure not.

When Blue Cross/Blue Shield of Illinois audited my charts last summer (they said I did high volume so of course they had to audit my charts) I was told that my default releases of information, sometimes an abbreviated form, sometimes handwritten scribble scrabble, didn't cut it. I learned this before the audit, thankfully, so that when BCBSIL really did have a look, my forms were HIPPA compliant.  No chance of breach of privacy there, an audit of mental health records.

And twenty-plus Office Maxed copies of:

I hearby give Dr. ______ permission to speak with _____________ about anything she wants to talk about regarding me, with the exclusion of _____________________, which she should totally not talk about. This release is good for exactly thirty days, starting

Date: _____________________________
Printed Name:______________________
Signature __________________________

went to recycling.

But in the past, within those thirty days I would track down that primary care doctor or psychiatrist and we would pick one another's brains and come up with a logical assessment and a treatment plan. All assuming the patient concurred that such a discussion might be a good idea.

Then the fun would begin.

If you're a family therapist and you work with family physicians or family psychiatrists, the beauty of consultation is that both of you probably know other people in the identified patient's family system. You both have priceless data to share. What’s wrong with the patient isn’t based solely upon the patient's perspective anymore, but that of generations of souls.

At some point as a professional, you gather a small army of professionals who think like you, work well with you.  And if you’re me, you want to know them better. It's not enough just to talk shop.  But this isn't efficient in professional life, yapping about your own health or family matters, even if the interest is there. There's no time, not even for professional geography, a Who Knows Who.  So we rarely finesse professional intimacy, is the truth.

There are pluses and minuses to privileged consultation, besides all the shared data about the patient, which is surely a plus. And each has something remotely related to intimacy in relationships. Relationship therapists see all relationships through the intimacy lens.  It is an occupational blessing and a hazard, too.  

On the plus side, consultation is essentially chatting, which is always fun.  And it's about a mutual patient. This makes it feel like the two of you are just a couple of friends, chatting it up about someone you both know, relieving tension, because your patients are sometimes a danger to themselves or others, and you want to be sure everybody's safe. That is your job. That's what you're paid to do.

But you hardly ever do this with friends, just chat it up about someone else, certainly not someone who isn't a first degree, because you're a professional and you almost feel like you need a release of information to talk about other friends to your friends, unless there really is a danger and you think maybe that your psycho-education might help.  We're not good gossips. 

So this feels good, talking with other professionals about other people.  We finish talking about the patient, then maybe sneak in a few words about our money stress and how we're going to stop taking credit cards.  Some of us find this intimacy (work intimacy) lacking, a little shallow, but it's better than nothing.

On the minus side, it's not like we speak with our consultants every day, probably not even every week.  If we catch up once a month, even every two months, we are doing extremely well.  So if a physician dies or gets sick (and this happens), crazy as that sounds, we might not hear about it until a mutual patient tells us about it in therapy!

When that happens, I can tell you, we're totally taken back, stunned, and the poor patient's visit becomes a discussion of our mutual loss. And then it turns into an exercise in self-restraint for the therapist, keeping it about the patient.

(One day we'll have to talk about that self-restraint, how we do that, keep it all about you, even after hearing that one of the neighborhood kids has died in a tragic accident or our own kid didn't make it home from school that day. It really is an art.)

Another minus is that if you do finesse the intimacy, you end up making people wait because people are always waiting.  Between two professionals, at least one is going to have somebody in the waiting room, perhaps even on an exam table! So you make your call brief and you feel badly, because despite what people think, everyone wants to run on time.  So as soon as it's getting good, one of us has to go.  You could say we're avoiding intimacy, but we're not.  This is being professional, running on time.

The best thing about consultation, the biggest plus, I think, is that when it's good, it is mutually validating (which all relationships should be, of course). Good consultants don't just want to tell over what they know about the patient. They want to learn something new.  So we listen with respect and we validate the other's thoughts and opinions. We do it for one another.  It's a love fest.

2.  Confidentiality/our families:

When your sister-in-law tells you something about someone, she has no Release of Information, and you don't either.  It's implied that neither of you will tell anyone, and you probably won't.  But sometimes you slip, you have held secrets all day long, and have left your professional hat at the door.  Even therapists, who should know better, can be weak at the end of a long day, when it comes to family secrets.

I know, I know, you're going to say, I am a therapist and I can keep a secret!   I'm the best secret keeper in the universe.  And that may be true.  But not everyone can do it, and kol haKavod to those who can. (Hebrew, rhymes with dole-pa-la-toad, means you're awesome, deserve respect, more power to ya').

My in-town kids and I tried to keep a surprise visit from FD. One of our out-of-town kids was coming in for a wedding, unexpected. Even the bride and groom were sworn to secrecy. She wasn't coming in for three weeks. 

Three weeks of secret-keeping.  This proved to be impossible. We blew it four times, which averages to over once a week, and everyone took turns blowing it.  FD is so clueless, he didn't even notice until the fourth blurt, and maybe he wouldn't have noticed then, maybe we could have mystified him about the blurt, but one of us, ahem, simply couldn't handle it anymore. And she gave it all away.

It could be that the whole gestalt, keeping the lives of everyone else so hush, hush, makes some of us a little loose with our own families. Or our boundaries are bad.  I'll try harder, is all I can say. I really will. People change.

As long as we're talking, please don't take that story as permission to blow family secrets, good or bad, it's really not permission, not at all. The best line ever about this came from the mouth of one of my first degrees. When I asked if I could tell someone else in the family a secret she had just told me, she said:

It's my secret to tell!

Good or bad, secrets are proprietary, and there's joy, and pain, in the telling. It is the owner's right to both.

3.  Confidentiality and friends:

Therapist are used to being tailors.  People take off their clothes, we rip them apart, put them back together again, seamlessly, to the consumer's measurements. We like being tailors, like getting to know what people are made of, and in the end, despite the cutting and sewing, everyone feels better.

Most of the time.

And our friends, depending upon our friends, try to do the same thing with us. To us. Because who doesn't want to rip into a therapist?  It's so much fun, and we're such good sports, and we tell you when you're right, and correct you when you have no idea what you're talking about, with a Nice try! But think about it this way.  And we pontificate psycho-babble until everyone is bored out of their tree.

Sometimes friends want us to help them, too, and we gladly oblige.  Friendship is a two-way street, after all.  It's complicated because of the attachment-detachment conundrum. We're used to detaching with patients, while at the same time being empathetic. The empathy chip is working all the time, in all of our relationships, as a default, sometimes better than others. No matter, an empathetic therapist gets better at detaching from patients over time.

But the empathy chip, let's just digress to that for a sec, is always whirring. Empathy, by definition, implies a sense of caring and genuine concern, which is why you see so many therapists nodding until you want to strangle them. It is the active ingredient in therapy and in friendship, as it turns out, tuning in, sensing, sharing the emotional life of another, feeling the pain.  And the joy.

But as professionals, we really don't want calls after hours from patients, so we gracefully detach, keep it all very professional.  And I think we automatically try to do the same with most of our friends, too.  And they do the same with us, maybe because we all have other things going on, or maybe because too much intimacy smothers some of us.  And like attracts like. 

So it's interesting.  Both professionally and in friendship, empathetic humans get their hands dirty.  As professionals we wash every 45 minutes, but with friends we're not so quick to wash it off, or forget.  We'll text a friend quicker than we will a patient, shoot over an email-- You okay?  (I'm pretty sure HIPPA has no room in the rules for texting or email).

People complain about surgeons, say that they are cold. But really, it’s because their engagement and detachment are so brief, so clean, so surgical that there is no time for more. At least that’s the excuse I’m giving them.

Back to friendship. If I am having a long talk with a friend, at the end of 45 minutes I get a little antsy.  Still, after all these years. When I realized that my friendships were lacking because of this, that it really is a problem for me socially, I suggested we take off for parts unknown (at least a half hour from home, Chicago's a big town) and that we stay overnight. I don't know how we ever pulled that off, seriously, looking back, but it was great and we did it for a couple of years in a row.  Now I understand that bridal parties are doing this, getting out of town for weekends, even weeks, with fairly drunken outcomes.

My guess is that the intimacy is just too much, so people get bombed.  And with that?  Everyone's confidentiality, certainly, goes out the window.


therapydoc

What I Did For Love

Wow, it seems my vacay from blogging never was, it's so easy to come back to this. But I needed a break, just some time to attend to things, like shredding twenty-five years of old tax receipts, returns.  That was fun, bringing those boxes out of the attic.  I approached it like I do everything else, with a broom.

While I was away I did an Anniversary Post. Not a blogging anniversary post, but a Marital Union Anniversary Post. What you will get out of it are prime examples of conflict avoidance. Or do you prefer: Synchrony of Emotion. Empathy. All depends upon what color glasses you're wearing.  We prefer something in pastel.

June 22, 2011

FD and I have been married for 36 years.

You should know that the number 36 is considered a lucky number, because it is twice 18, and 18 is a lucky number. If you're Jewish you understand that multiplying things has tremendous psychological power. The number 18 is lucky because it is the numeric equivalent of chai (hard "ch", rhymes with fly), the Hebrew word for life.

How does a word become a number? Each letter of the Hebrew alphabet is associated with a number. Add up the numbers that correspond to the letters of a word, and you get numbers with feeling.  You can imagine the speeches at the Bar Mitzvahs.

What we do to celebrate our life together is regress, stick it to the whole idea that we're getting older and crankier. Meaning, we take off and do what we used to do when it wasn't as hard to do it, with less intensity.  We cancel our appointments, sign out, give over coverage and run away for a day and a half, never too far away.  The Midwest is a lot prettier than people think.  We met in the cornfields of Illinois, two and a half hours southwest of the city of Chicago, in school.

FD does most of the work as I put together a cooler of fish salad and fruit.  He somehow gets our bicycles to stay on the back of the car using an ancient bike carrier. I make a big deal about making the salad while I talk on the phone. It does take forever, right, to make a decent lunch?

We drive away.   This particular anniversary morning follows a night of severe storms all across the western suburbs.  We have reserved a  bed and breakfast in the western suburbs not far from Fermilabs.  FD has discovered that there are extensive bike trails near the nuclear reactor.  Finding the trails is easy, choosing the B & B is hard.  My job.

Do we go to Marcia's Bed and Breakfast in Ottawa?  When I ask Marcia how much, she asks if we're bringing our horses.  I like her right away.

If not Marcia's then perhaps Oscar Swan's in Geneva, where the service is said to be iffy, but we might catch a wedding.

To be honest, Marcia's is a little too far away for a day trip, and frankly, I don't travel well anymore.  So I tell her another day, and we book at the Oscar Swan.  Then FD gets sick, and there is no going anywhere.

But being a doctor, he gets well!  How he does this, I'll never know, but he goes from looking like death warmed over to, "HEY!  Let's go someplace!  I haven't had fever in two hours* and the antibiotics are working, and it's our anniversary!"

I'm saying, "Dude, we should totally stay home, and if we're adventurous, measure the kitchen floor. We take the money we save at Oscar Swan (significant!) and apply it to the new floor."

He goes, "Yeah, but it's our anniversary." He says it with a certain nostalgia.  Or is that a whine.

We settle on a show.  Yes!  Let's go see a show!  We live in a big city, Chicago.  There are many of these.  I suggest Chinglish, a comedy set for Broadway, soon.  He's good with this, but we can't get cheap tickets.  He finds The Outgoing Tide, a play about Alzheimer's with John Mahoney.  John Mahoney is best known as Frazier's father.  He's an older television star.

"Fine, dear. We'll see a play about something depressing.  That's cool.  I'm good.  Truly."

I cancel our reservation at the Oscar Swan.  I have already discussed our issues with Marcia in Ottawa, the proprietor who asked about our horses.  She knows we'll be back one day, probably with grandchildren.  We have a relationship.   We spend more money than we should at the Northlight Theater, thinking that if the weather is good and he still feels good, we can get out during the day and ride somewhere and still make it back to get dressed up for the show.  I love getting dressed up for a show, although this is a passing trend, at least at the Northlight.

The night before, as we've already indicated, the storms are fierce, make religious animals out of Chippy and Dale  and everyone else who doesn't live in our attic.**  We wake up to find that our neighborhood quite possibly has the best weather within a hundred miles.  The sun is shining.  The skies are blue, and the weatherman is telling us otherwise for all of Chicagoland.

But we can't stay here. We have to go someplace we haven't been before, somewhere only we know, as the song goes.  I watch the Weather Channel with great interest.  "If we're going to ride, it seems to me that Antioch might stay clear for awhile."

This is Chain of Lakes in Illinois, where he takes the grandkids fishing sometimes. Before we blink the food is ready to go, and the bikes are hanging low on the Nissan; this is an old drill.  "Drive slowly," he warns.  "The bikes are hanging low." Noticed that, between us, didn't say a word.

And it is, as it always is, just fantastic.  We find the park, get out and air out.  There are three hiking/riding trails within seven miles and check them all out via pedals.  He complains that I ride too slow.  I tell him that I have to stop to take pictures.  It's an addiction, remembering.  We lose that ability all too soon.

It is lovely, we're having a good time.  Neither of us cares much who is trying to reach us when we miss those calls.

It is all good until we hit what feels to me is a highway.  At this point FD tells me that we have to ride on the shoulder of this Route, whichever it is.  The traffic is whizzing by.

No, dear.

He tells me there is no other way to get to where we want to go, and I still insist, Not Me.  Now We.

We look at one another.  Stalemate.  We both want to go.  We want to keep exploring the area.  We rarely ride on the busy streets, but occasionally are forced into it and there is this thing they call a shoulder.  To turn back is white bread, there is no fiber to this trip yet.  We're not white bread people.  Our eyes turn, once again, to the highway.

All of a sudden there is NO traffic.  Of one mind we hightail it across and in moments are comfortably riding west on the shoulder, not a care in the world.  It will be a mile and a half to the next official trail.

The traffic, of course, catches up with us, but we're within three feet of the nearest flying automobile, and we've been here before.  We have faith.  We'll be fine.

Except for the flash flood.  We should have seen it coming.  The sky had changed.

We feel the moisture, we can tell that the water on our skin is rain, we just aren't prepared for a flash flood in the middle of nowhere while riding on the shoulder of a highway as trucks kick what have become rivers onto the shoulder. 

We get off our bikes, rapidly hunt for our parkas, soon a little more protected.  Except that it is pouring and we're in the middle of nowhere and a parka is only good from the waist up.

"What now?" I ask, hoping he knows what he's doing.

"We find a shelter and have a picnic, of course."

Of course.

"We're not riding to this shelter," I inform him.

"No, we can walk there."

And the rain keeps pouring down.

There is no shelter.  But by the time we get to the park, five minutes away, really, the rain is quite finished.  The sun is out, and we're drying off.  It helps to ride standing up, and who can't do that?

I'm wary of another storm, keep my parka on, but FD stops to tell me that this is slowing me down.  He hates that I ride so slowly.  I give in, take it off, hoping that this really is the end of the bad weather.  We have vacationed for thirty-six years in all kinds of weather, weathered all kinds of storms.  A little drop of rain can hardly hurt me now.

At some point we're lost.  My Iphone has a compass that tells me we're heading south and I know we need to go northeast.  FD tells me that my compass is wrong, that we're heading east, which is fine.  "How can a compass be wrong," I ask, suspicious.

"I don't know, but it's wrong."

This inspires confidence, obviously.  I am tired, and a little hungry, and not totally dry, although the sun is doing what it is supposed to do, and there is a lamb on a farm that is basically saying, Come take my picture.  But by the time I get to doing that, he disappears.

Seeing a lamb makes me happy.  We reach the car and FD begins the process of loading the bikes on the car carrier.  It is beginning to rain.  I get in the car, hope he doesn't get too wet, and he doesn't.  We pass the home grown fruit stand, stop to buy some berries, and of course, nothing is home grown, but you have to love that, too.  Home grown bananas.  Right.

     

therapydoc

*Actually, FD came down with this ridiculous illness the day before and started treating it immediately. Loathe to use unnecessary antibiotics, we know he wasn't faking.

** The Is it a raccoon?  Or  Is it a squirrel? story is priceless, but not for today.

There's Advertising, and There's . . .

I shouldn't be doing this. No time for this.

But a public service announcement is important. People need public service announcements.

And therapists have a mandate to warn.

Like if you tell me that you would really like to kill your sister I am mandated, by none other than the State of Illinois, to warn your sister. Yes, to give her a jingle, a poke, and say, "Watch your back. Your sister's intention is to kill you." Or tell the cops to do something of the sort.

Because anyone can get a gun, a sword or some other household weapon. You never know. It is why some of us ride with the principle that it is best not to make anyone angry. Do not ruffle. The less ruffling the better.

THE STORY:

I get up before FD and nudge him, announce that I will make the coffee and get started on lunches, which, if you must know, consist only of bagels with cream cheese, a large slice of tomato, small slices of cucumber, and green onion. You really don't need lox if you have green onion.  Oh, and a couple of chocolate chip cookies.

But while the java's dripping, a concoction of hot water, lemon juice, and honey will feel good.  This is a transgenerational tradition-- although my father often used fruit preserves which he jarred himself, instead of honey. As the water boils I mix a Metamucil aperitif. You get used to the taste.

At some point in this otherwise boring routine, the fatal attraction to email becomes overwhelming. I pop open something from a man representing a group of therapists. It is his second try. He would like to pay me to advertise his website on Everyone Needs Therapy. His website might be legitimate but his spelling is atrocious. And I doubt the veracity of the whole thing, frankly, suspect a scam. Not accusing anyone here, just worried is all.

Here's the pitch:

. . .could you please give us the best price for a small summery to add your . . . site for a period of Monthly . . . We will make payments Via PayPal so if interested, please mention your PayPal id.

Regards, ________

Regards to whom? And my PayPal id. Really? ID in lower case?

FD is getting dressed in the closet complaining that the size he wears in undershirts is always out of stock at Target. He is an average man, he tells me, and this is wrong. They shouldn't run out of the size that most men wear. That's what average means, you know.

Disregarding this, I tell him there's a new Internet scam, one that could hurt bloggers, my people.

FD goes on about the undershirt situation which he will do until he feels the empathy, the love, which I accomplish with further inquiry into the undershirt situation.

"You're an average-sized man, but you wear a Large?"

"Yes."

"Well this makes you a Large man, not an average man, as you say.

He cannot argue with this reasoning nor cares. But the same logic, in reverse, explains why I am a size 4.

"Do you think I need a shower?" I ask him. I'm not in the mood but it is a tradition, showering in the morning, and traditions are important. My hair has grown out of control and needs conditioner. Since I discovered that Suave (translate cheap) is a fantastic conditioner, doors have opened. This is confirmed, that doors will open for you, too, in People Style Watch. The shiny ad for Suave claims to be as good as a salon conditioner!

See. Now that's a product worth advertising on your sidebar. A conditioner for crazy hair. Or Metamucil. Another fine product.

FD does seem happy that I've decided to shower. After all, he fixed the furnace (they usually need thermocouples) and having heat in the house makes the idea much more attractive. I tell him about the blogger scam.

"Just your PayPal id?" he laughs. "Why not a copy of your birth certificate?"

Then one of us comes up with the idea, one that all of you might consider if you're tapped in this possible con.

You write back to Seth, or Paul, or John, or whoever it is who taps you, and you ask for his PayPal ID (capital I, capital D). Ask this person to please fill out the following form:

His
Name:
Birthday:
Address:
Cell:
City and Hospital of Birth:
SS#:
Driver's License #: (and a copy, with pic, natch)

and any other identifying information that you can forward to your cousin, who works for the FBI, not that he need worry.

I'm calling PayPal.

Regards,

therapydoc

James J Lee, Schizophrenia, and the Population Explosion

Old Yiddish Saying:  When things come in threes, it is likely they are blogworthy

 Yes, I made that up

            therapydoc
 

I’m riding my bike to work, pass a woman in her ninth month talking to herself.  Surely she has a Bluetooth in her ear, but from my angle she really looks like she's talking to herself.

And just last week, after shopping, loading groceries into the trunk of my car, a friendly young man parked next to me remarks with a huge smile:

“I swear, I thought you had some kind of mental disorder, talking to yourself like that in the store. I thought, 

Someone should tell her kids! Do they even know!?'

Then I watched you, kind of followed you a bit, and I could see that you were okay, that you had to have been on the phone."

That's reassuring.  Not suffering from schizophrenia, just on the phone.  Thanks for your concern?

When I was a teenager, a mobile phone, or "communicator," was something that Spock used to reach McCoy, the stuff of science fiction,  the technology of Star Trek.  Off television, however, even to an untrained mental health observer, an animated conversation with an invisible other someone, indicated psychosis.  Something very wrong.

And it was a little scary, seeing that psychosis, for every once in awhile a person is going to see a naked person in the middle of the street, or someone walking, gesticulating wildly who is not on the phone. We are afraid of this because intuitively, we tend to be afraid of what we don't understand.

The irony is that the person with a psychotic disorder can be much more afraid, more anxious, fearful of invisible dangers, the voices speaking only to him, shrieking, spewing hate and rage, negativity.  And under the influence of fear, like most of us under stress, that person is capable of lashing out, usually to self-protect.

A couple of summers ago, riding home from work,  I caught the eye of a woman walking toward me.  She was on the sidewalk wearing mismatched brightly colored clothing.  (I'm drawn to bright colors like a moth to a light.)  When she sees me looking at her she flashes a ferocious glare; I feel the fire.  Then she spits as far as she can, misses me by a foot. Violent psychic energy, aggression.  Strike first.

Believe me, as soon as I caught that look in her eye, differential diagnoses were clear in my head.  I didn't need a DSM. 

A person with severe mental illness who is lashing out violently is more often than not doing so in self-defense.  She  might even be hearing threatening voices.  Tell everyone or you will die!  Show the world!  Make a difference!  You scum, prodigy of scum, you filthy human!  Show your worth!  Very rough on the sense of self, having your thoughts interrupted.  Most of us have trouble with our negative thoughts.  Magnify that intensity by fifty or a hundred.  That's how it is with very severe illness.

And we do have to be better at recognizing this, befriending people who are suffering, finding them resources.

James J. Lee, the gentleman who marched into the Discovery Channel building in Silver Spring, Maryland last week,  had explosives on his person.  He listed his demands on a blog.  He demanded that the Discovery Channel  agree to change its programming, that the station become more environmentally sensitive, more green, more inventive, proactive about population control. He thought humans filthy, babies the ultimate source of destructive pollution, the giraffes, the lions, benign.   From his blog: 

Humans are the most destructive, filthy, pollutive creatures around and are wrecking what's left of the planet with their false morals and breeding culture.

. . .  It is the responsiblity of everyone to preserve the planet they live on by not breeding any more children who will continue their filthy practices. Children represent FUTURE catastrophic pollution whereas their parents are current pollution. NO MORE BABIES! Population growth is a real crisis. Even one child born in the US will use 30 to a thousand times more resources than a Third World child. It's like a couple are having 30 babies even though it's just one! If the US goes in this direction maybe other countries will too!

Also, war must be halted. Not because it's morally wrong, but because of the catastrophic environmental damage modern weapons cause to other creatures. FIND SOLUTIONS JUST LIKE THE BOOK SAYS! Humans are supposed to be inventive. INVENT, DAMN YOU!!

In therapy we might say, You sound angry.

Most of us don't need a prophet to know that our world is in trouble. The heat wave across these past two months should tell us something.

Back to our Neo-Yiddish, the threes.  We have:

(1) Many of us seeing schizophrenia everywhere, or so it seems, like new psych students who have just learned about different psychotic disorders,

(2)  Some of us impulsively labeling James J. Lee soon after the Discovery Channel lock-down last week.  It was suggested, in that short post, that students study his blog, Save the Planet Protest, and the news stories that unwittingly review the variables that perhaps contributed to his last selfless act, for he was gunned down before he hurt anyone, i.e., homelessness.

Down came the post before most of you read it, for after all, James J. Lee's disorder did not have to be schizophrenia.  He might have suffered from a different psychosis.  The blogger feared activists and nihilists who might misinterpret remarks, and she had no emotional energy to argue.  The psychic energy that can be characteristic of psychosis, untreated, is remarkable.  The psychic energy that can be devoted to a cause, not all that dissimilar-- without a psychotic disorder.  No need for resistance exercises at the gym.

Mr. Lee will be remembered, at least by me, as the Angry Prophet of Doom.

Then, a few hours after taking down the post, I called a friend for book suggestions, started reading   (3) One Thousand White Women, The Journals of May Dodd.  Libraries are full of good things.

What is this?  One Thousand White Women is a novel by Jim Fergus about life in the United States in 1876 (really 1854).  The Cheyenne, determined to make peace with urban sprawl and the pollution of white men, offered Ulysses S. Grant an option for assimilating the red-faced with the pale-faced. 

Suffice it to say that it is a biological solution and I just can't spoil it for you.  I just started the book, but it is captivating and very funny.  And then there's this quote!

Little Wolf, the Sweet Medicine Chief , is speaking to a specially appointed commission of Congress on behalf of the Cheyenne:

The People are a small tribe, smaller than either the Sioux or the Arapaho; we have never been numerous because we understand that the earth can only carry a certain number of the People, just as it can only carry a certain number of the bears, the wolves, the elks, the pronghorns, and all the rest of the animals. For if there are too many of any animal, this animal starves until there is the right number again. We would rather be few in number and have enough for everyone to eat, than be too many and all starve.

He goes on to say that for this reason his children must become members of the white man's tribe, thus offers his modest proposal.

His ideas about population growth, actually, are not all that different from Mr. Lee's.

So what makes Little Wolf an environmentalist and Mr. Lee a person suffering from schizophrenia, a man who just thought he was an environmentalist?

Little Wolf contains his anger, is very controlled, even when the men on Capital Hill practically throw him and his entourage on a train back west, rejecting his amazing suggestion.  He's tried to be empathetic, to give the white man the benefit of the doubt.  He is educable, this white man.  An empath, Little Wolf is highly evolved.

The Sweet Medicine Chief reaches out to a culture clearly foreign to him, a people who leave a wake of upheaval and destruction, who ravage fields and the habitat; a people out of touch with the balance of nature, uninterested in learning, particularly, capable, the Cheyenne believe, of empathy and change.

Quite a book.

Unfortunately, without that-- lose empathy, lose the ability to intuit the feelings of others, and lose the sensitivity it takes to look within, to see the enemy inside, rather than blame, and we're all clueless, out of touch.  Or more to the point, sick like  James J. Lee,  spewing hatred and negativity on his blog in an insular psychotic rage. 

We don't know if Mr. Lee had been treated for the illness, or even if he heard voices. We don't know and never will, probably, if anyone told him to call attention to the problem of population growth and the destructive nature of human beings, or not. But he probably had it, 295.30, Schizophrenia, Paranoid Type. A tough disorder to live with, or another delusional psychosis.

I know it like in the same way that I know why that woman spat at me when our eyes met.

And what that means, I guess, is that as a society we've got to be doing more to recognize and help people who have mental illness.  No, I don't know how.  But we've got to try to do more.

Lee's website: http://www.savetheplanetprotest.com

And the Discovery Channel, Discovery Communications


therapydoc

Leave Me Alone

That's Greta Garbo.

Every once in awhile I'll see someone who says she's fed up and wants to be left alone. I think it's a Greta Garbo line, I 'vant to be alone, but it's not hers exclusively. Greta doesn't own it.

A person can have a million reasons for wanting to be alone, but one of the more interesting patterns I see in therapy tends to look like the one below. We'll keep it simple, give you a snippet of a typical conversation with a hypothetical new patient.

Patient: I just wish everybody would leave me the ____ alone.

Me: What's the feeling behind that, wanting to be left alone?

Patient (doesn't have to think hard): Anger.

Me: Do you feel angry often?

Patient: Yes. A lot. People think I'm a real b___. They can tell when I don't want to be bothered.

This type of interactional sequence is almost always with a female patient, eldest in her family of origin, sometimes the only girl. She is expected to keep a degree of order and cleanliness in the home, even as a young child and isn't given the freedom to explore the world beyond that home, either.

As an adult, usually an outwardly independent person, she's developed a sometimes testy, irritable nature, and gives overt signs to others that they had best not try to get too close to her. She says No, more often than not, to social events, but she isn't phobic. She's just not interested, she will tell you.

A nice way to describe this personality is off-putting. Another way is to say she's threatening. I like her right away, as soon as she walks through the door. I've seen her many times before.

I give her a cryptic once over after she's used the "b" word, for she describes herself this way. I'll give it a pregnant pause, wait, eventually make empathetic eye contact. Then she sees a smile. We both laugh. It is the laugh of understanding, relating. Empathy.

Me: Well, we all have our days.

Patient: Some people have more than others.

Me: You got that right.

Her story tumbles out, first in the present tense. This is about all the idiots out there who make life miserable; how there's so much stuff to have to take in life, on the job. So much aggravation.

Eventually she'll get to the codependent song* I'm waiting to hear. It goes something like this. . .

Patient (describing her life): And my family in . . .

(Fill in the blank, Poland, Puerto Rico, Mexico, Guatemala, Viet Nam, China . . . )

depends on me for money. And I send it, but the money goes to things like drugs and alcohol. And my uncle just sits around and does nothing. And my sister does nothing. And my brother does nothing except he eats a lot and does nothing and he lives with my mother, who does everything for everyone. And did I tell you that my brother uses drugs, too?

Me (anxious to get treatment under way): You know, there are alternatives. . . You don't have to . . .

Patient (cuts me off): I know, I know.

But tell me, doctor, on another subject, why do I get so upset with people? I have this feelings, all the time, like I'm to blame, like people are blaming me. And I'm the good girl. I'm the one who does everything good. I don't drink. I don't smoke. I don't sleep around. I work. I send money home to my family. I do everything right. So why, when someone says something about me do I always assume they're insulting me, accusing me?

Why does just being with people make me feel guilty?

This confession of personal history signals Psychoeducational Lecture #72 (these are arbitrary numbers, don't Google them) . When innocent people feel guilty it's often because as children they were accused of doing bad things that they didn't do. Or they were accused of wanting to do bad things they never wanted to do. These accusations happen repeatedly throughout childhood until the patient gets out of there, free from family imprisonment.

What follows them, unfortunately, and exacerbates their problems, is that they've been undeservedly punished, usually severely, for these things they didn't do, didn't want to do. The punishment is often violent, accessorized with homemade weapons. We call it child abuse.**

Patient: Oh, man. I got hit. Did I ever get hit. I got hit with belts, paddles, and I was kicked with boots, slashed with electrical cords. I was beat bad.

Me: I know.

Patient: How do you know?

Me: It's my job to know. Sometimes people like you, the victims, survivors, call it what ever it is, hardly recognize harsh punishment like this as child abuse. You don't even own your right to feel angry about it. What good does it do you anyway, you think, to be angry? So you aren't conscious of the connection. You have what is called unresolved anger. And the guilt is unresolved guilt. We have to resolve it.

We therapydocs explains that we have seen it many times before, the eldest female's involuntary role of responsibility, taking care of little siblings as a little child herself, unprepared, the parental child syndrome. This pint-sized, ill-equipped parent is rarely appreciated and is treated badly. She'll try to please, try to keep Daddy or Mommy from getting angry. It's a lot of emotional work.

Meanwhile, her parents don't understand parenting. If anything, they think it's okay that she feels guilty for the behavior of her siblings. They think it's okay to make her feel guilty for talking to a boy, even if she doesn't like him. They are trying to protect her. They think they are doing a good job, instilling in her what I call an overdeveloped sense of responsibility.

And too much responsibility makes us angry.

At some point in therapy she'll want to know that the reason others can afford to under-function is that she over-functions.

If I hadn't heard so many Wild-Person stories I might not have copped the likelihood of abuse in a case like this. The Wild-Person will abuse and blame everyone, all of the children, usually, but there is one child, often the oldest girl, who gets the brunt of the rage. And alcohol is usually the fabric of family life, so well woven that it is hardly mentioned in the history.

Me: They do it for your own good, the beating, the isolation, the insistance that you come right home after school. It's all so you can turn out all right. GOOD. And look. You did.

Patient: Ha! More like a wreck is what turned out. A crazy person.

Me: So you're an emotional wreck, but a good emotional wreck.

Patient: That's the whole thing, all so I should be a good girl. Meanwhile, how many times do you think I got molested as a kid by some drunken relative?

Me: Of course. And you wonder why you want to be left alone.

Who needs people when the ones who say they love you, who should love you, beat the ___ out of you and forget to protect you?

Better to be alone.

therapydoc

*For more on codependency, visit The Second Road. The writing over there is terrific, and every week or so I'll post there, too. You might want to read about what I did yesterday, for example, on The Drinking Holidays. The post is about religious days like St. Pat's, Purim, and Passover.

**There are many reasons to be angry, child abuse is only one of them. A post like today's is supposed to highlights associations between a few different variables. There are many more, of course.