Up in the Air

Seriously, it's not that I don't have any original stuff. There's a deeper essay inside me, all about food being the thing we all obsess about most-- weight, to be more specific-- and how money takes the #2 spot.  Or was it the other way around?

But let's just settle for a movie. It's summertime.

Have you seen Up in the Air? If you haven't, think twice before reading this post, there will be spoilers and you're going to see it. Not that it's a must-see, but maybe it should be.  We hear what must be be real stories, told by actors who appear to be real people, stories about the torment of unemployment: the initial impact of losing a job; the mental anguish of facing foreclosure, the loss of status and purpose, bankruptcy and shame; suicide. Required reading? Walter Kirn wrote the book.  There's gossip about him not being invited to the Academy Awards.

Anyway.  If you're me and you travel a lot, the opening sequence is captivating-- aerial photographs like the ones I'm always snapping with my phone. Some of us really, really like flying, despite the hassle, the aggravation in line, the paranoia of security, the wait. The cancellations. I'm taking off for a couple of days this week, that's the plan, and my excitement is palpable. Some of the twitter in my belly has to do with being up in the air again.

Ryan Bingham (George Clooney) loves flying, too, the feeling of living out of a carry-on, paring down his possessions to what he can pack into a light-weight vessel on wheels. He is a motivational speaker, talks ad nauseum about the backpack, how if you filled one of these with all of your possessions, all that you have, all the things you own, packed in all of your friends, your family, your people-- you would find that you are mightily burdened.

All of this, he implies, the weight of living as a social animal, the choice to be grounded, is a burden.

Live like Ryan Bingham and set yourself free.

Has he got OCD, Obsessive Compulsive Disorder? Sure, maybe. Or is he disordered with Schizoid or Avoidant Personality Disorder, fearful of people to the degree of self-imposed isolation? Nah. He speaks to people for a living, empowers them to be good with a solitary independence, tells us to look forward, unafraid. And he has relationships with women, he's George Clooney, for crying out loud, handsome and socially fluid.  He even falls in love. (The female supportive actors, Anna Kendrick and Vera Farmiga made the movie for me, not George, particularly)

Ryan has an agenda with that backpack metaphor, even if he believes in it. What he is really doing, when he tells people that life as a social animal is a burden is a verbal equivalent of slight of hand, a con.

He works for an outsourcing company. You may be familiar with these. They take the pinch out of unemployment, present you with the package, the severance, and point the finger to other sources of employment. But Ryan has the ugly job of having to tell people,

"You're fired."

He doesn't say it like that, he says it nicely. He relabels the experience:

"All great people have been let go."

Or,

"Now you have the opportunity to do what you've always wanted to do."

Or,

"Now you can be great, meet your aspirations."

If you've ever treated anyone who has lost a job, the same words, maybe, have come from your mouth. They can be soothing, they can be true. They are a Bandaid, you both know this, but you're not applying the Bandaid unless the patient has opened with the concept first, alluded to relief and desire to pursue a dream, can see the possibilities inherent in the dream. You both know that being let go means there's a likelihood you may lose everything, certainly much of the life you're accustomed to living, the one you have grown to know, maybe even love.

You don't lose your family, however. You don't lose your soul. You don't lose your goodness, all that is you, or you shouldn't, when you lose your job. We hear this from the actors who have lost their jobs in the denouement, at the conclusion of the film.

They speak into the camera to tell us the rest of the story, as Paul Harvey used to say. This air of documentary makes the film a little grim, is the truth, but it's appeal is that is is so real. Some of us don't mind a little reality in our escapism, find it therapeutic.

In therapy, real people tell real stories, and when the story is about job loss, we talk primarily about how job loss can change one's role in life, identity. But it is changing all the time, identity, anyway. Change can be thrilling, but it can be painful, too, and in this case, the change of role, the challenge is gut-wrenching, a true test of one's mettle. We shrinks subtly suggest:

Don't let the test destroy you. Stay alive, stay well for your family, if not yourself, but do it for you, too. They can't take that away from you, who you really are, your essential goodness

This is a crossroads. Things will change. You will survive. What was that Spock line?

Oh yes. And prosper.

Perhaps.

And yet, to minimize what has been lost? Unfathomable, unconscionable, very bad technique. Platitudes are a condescension on the part of the therapist, or the employer, the hatchetman. Don't give people snake oil, don't hope they will fall for your politics. Now you can be great.

Now you will be broke. How is that great? How at all is that great?

When it comes down to money, everyone obsesses. Thus the job of therapy, when money is the crisis, is to increase denial, distraction, help a person draw upon old resources and find new ones, problem solve. We advise you to stay clear of self-pity, for this eats a person up from the inside out. Spirituality helps here, spiritual resolve to be a better person, not a bitter one, a force for good in the universe. Somehow.*

Attention to anything outside oneself, can be stabilizing. (But be careful here, pick your charities wisely). We don't say it, but we tiptoe around it, but we're hoping you'll get, that even if it is you who has lost the position,

It's still not all about you. Get out of bed. Do something. Anything. You'll be more tolerable to live with if you do.

Job loss is stress, in no uncertain terms, and managing it an art of good problem solving, varied coping strategies, and surely, supportive relationships.

So nurture these especially, the relationships. And while you're nurturing, grab some dinner with friends. Maybe share a salad.

therapydoc


*Spiritual stuff-  I originally put up some of the cognitive therapy that goes into this, but took it down, sorry. 

Cho update

So it's looking as if my assessment in the last post wasn't all that far off.

Cho was a very silent guy during childhood, but went to school and managed to perform well in school. His detachment justifies a Schizoid Personality Disorder diagnosis, premorbid to Schizophrenia, Paranoid Type that presented at Virginia Tech in 2005, perhaps even earlier, in his early 20's. A very common onset for schizophrenia.

His final words, "But you decided to spill my blood. You forced me into a corner and gave me only one option. The decision was yours. Now you have blood on your hands that will never wash off."

To me that sounds as if he thinks he's the one who had been crucified 2 millenium ago (I'm admittedly no expert on this), a sign of schizophrenia, thinking you're the father of Christianity.

We still don't know if he was an abused child. It has been repeated in the news that his parents worked very hard and stressed achievement, which explains why he and his sister tried and did very well in school, despite whatever stressors they suffered. CNN quotes someone as saying that Cho's father said that he had to leave Korea to come to America "where no one knew him."

That sounds suspiciously like foul play somewhere, somehow. In any case, Cho's mental illness surely could have been flagged much younger.

My guess is that therapy docs will be seeing many very quiet children in the next few months, perhaps years, and that's for the best if you ask me.

I like quiet kids. They have a lot to say once you get them talking.

TherapyDoc

Slow Burn- Cho Seung-Hui-Differential Diagnosis

Yesterday I saw the morning news and posted all those questions, knowing full well that much would come to surface in the coming days. It didn't stop me, all day long, from forming an opinion.

I saw kids doing that on television, forming opinions, and I've read blogs with opinions. I mostly heard words like "evil" and "sociopath."

After 2 hours of ABC News (who can resist Diane Sawyer?)and spontaneous tears through the footage of kids hugging and crying, and those pictures of the dead, the young, the beautiful, the talented, I still hadn't heard from the therapy docs.

There was one forensic psychiatrist on t.v., a great looking guy with a really convincing manner, very animated and right-on in some respects, for sure. He said that Cho had contempt, vicious contempt and conceit, and was filled with hatred towards the people who had hurt him.

So knowing that, I feel you need more about Cho's condition. "Contempt" hardly cuts it for me as a diagnosis.

If he was paranoid, he either had a personality disorder, perhaps Paranoid Personality Disorder, or a biological axis I disorder such as Schizophrenia, Paranoid Type.

But that's all too easy, because there are premorbid disorders, conditions people have prior to the onset of say, a psychotic disorder like Schizophrenia Paranoid Type, 295.30. And generally, people with that disorder do not function throughout childhood to the degree that we think he functioned (although at this writing, we really don't have the details about his childhood).

You notice that nowhere am I using words like evil or sociopath. That's because they aren't diagnoses. Sociopathy is a symptom of Antisocial Personality Disorder, but I haven't read anything to indicate that Cho had that. He was considered quiet and detached, not openly defiant through out his life.

Until April 16, 2007, when he defied very openly.

That can happen if a person is hearing voices (delusions) that tell him to do that, to kill people (Schizophrenia, Paranoid Type).

It surely happens when people are psychotically depressed, meaning they are suffering from a mood disorder and they want to die and are at the point of suicide, but their anger (I told you it's bad to be angry) gets the better of them. Add to that the energy (a sequela to anger) to take everyone down with them.

The ticking time bomb thing. They noticed that on campus.

According to his friends, Cho had an imaginary girlfriend. He stalked 2-3 female students, and he told his roommates about a rejection, "I might as well kill myself."
The police say he didn't threaten the women he stalked, meaning he was obsessed with them, a feature of Borderline Personality Disorder and several anxiety disorders. He didn't go home for winter or spring break (detached socially). He slept with the lights on (anxious). He may have had voices speaking to him in the dark.

Here's what I think was going on, and maybe we'll find I'm wrong in a couple of hours (it's still good to go over the different possibilities for your edification).

I think Cho had a Social Phobia and a Schizoid Personality Disorder (DSM IV-TR 301.20) that was premorbid for either Schizophrenia Paranoid Type, or Mood Disorder with Psychotic Features (psychotic = murderous), the primary DX that he had before and during his very violent outburst. Schizoid Personality Disorder looks like this, credit to the DSM:

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following:
(1) neither desires, nor enjoys close relationships, including family
(2) almost always chooses solitary activities
(3) has little, if any, interest in having sexual experiences with another person
(4) takes pleasure in few, if any, activities
(5) lacks close friends or confidants other than first-degree relatives
(6) appears indifferent to the praise or criticism of others.
(7) shows emotional coldness, detachment, or flattened affectivity

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder, or another medical condition.

Schizoid Personality Disorder is found premorbid to schizophrenia.

Anyway. If I think he either he always suffered from schizophrenia but he was highly functional, or

H was an abused person, abused from early childhood, either physically, verbally, emotionally or sexually. Or he lived with someone who beat or abused someone else, perhaps a sibling or a parent.

He developed severe, severe anxiety and a Social Phobia, and more damage, damage to the psyche and to the personality.

The personality is paralyzed in schizoid individuals and Cho didn't talk to people. He did speak through his plays, and he undoubtedly (in my guess-tim-ation) talked to himself about his anger at people who teased him for his inability to spit out words, and his anger at people for being rich, beautiful, whatever. He was his only friend.

One student at VTech said that they used to play games with Cho. "I'll give you ten dollars if you'll say, 'gimme five'."

That makes a shy person angry. It builds up. It's likely it went on throughout his childhood, derision for being socially unskilled, "weird." Socially detached people aren't understood by others, they're teased. But they have feelings and get angry. It can simmer through the years. The anxiety turns to anger. They're both symptoms of arousal.

That kind of psychotic anger is typical in Schizophrenia, Paranoid Type, too. We feel that stress triggers the genetic predisposition to schizophrenia. The stress of needing female companionship, the stress of grades, the stress of comparative poverty--these are triggers. People with schizophrenia are very sensitive. You don't want to upset them, criticize them (expressed emotion, discussed elsewhere in this blog). This is why I keep stressing Be Nice. We do have a societal obligation, among other things, to be nice. His room mates, by the way, are amazingly wonderful people. They were so patient with this boy who was so ill.

The therapy doc he saw didn't recognize the arousal, the potential for harm, because Cho was probably mute. He looked anxious, probably depressed. They'd call it "agitated depression" perhaps.

People did see him seething, however, and one teacher threatened to quit if he wasn't removed from his class, so he was clearly out of control of his emotions. He needed what we would call, Major Meds.

He was psychotic, of that there's not doubt, regardless the cause, and his teachers DID call the police, and students DID treat him with kid gloves. (Go to the CNN website and see that video with his roommates on 360.)

Sure, 20/20 hindsight, he needed to be forcibly hospitalized and treated. I won't hold by evil, or by sociopath, cold-blooded killer ala Sopranos.

The guy was mentally ill.

I have to go watch t.v.

P.S. I'm adding this to the post later. I chose schizoid personality disorder over childhood schizophrenia based upon his high functioning in academics, but indeed, his poor functioning socially, and perhaps inability to relate to anyone, including a therapist, might have indicated childhood schizophrenia. For all we know he was delusional all of his life, and it's possible that he had many incoherent, mind-jumbled days during his childhood.

TherapyDoc