Again,'Tiz the Season

We have passed the moment of most darkness, but it is still crappy out there.  It is dark, damp, piercingly cold and windy.  "Tiz the Season once again.  Perhaps I'll drive around and look for over-lighted houses to perk me up.  I took the girls out to do that the other night.  They are 2 and 3 years-old cousins.  They were delighted, but confused about the whole thing.

Me too.

I am not going to work for these two weeks.  I left the office with very mixed feelings.  The last day was too extreme. Two of the people  I saw are doing very well and were headed out to happy holidays. But two others falling apart physically.  One is very old and things are starting to not work.  The other is quite young and his diagnosis is very scary.

But Alice  (see 12/9 post) came back in and a doctor had given her something for her pain which she was enjoying very much.  As her pain subsided Alice was once again very much alive and hoping to stay that way.  She was again filled with rage and thoughts of vengeance; back to her sweet old self.

So, to all of you who do not wish to impale your brother or throw your mother off the train this Holiday Season.  I wish you all the best.

Be warm, kind and respectful to all around you, no matter their views, or foolishness. We are all really just the products of our physical being and the experiences we have been through. We are all searching for a few rays of happiness.  We each have the power to give some of that to one another.

Enjoy.

Why I am not always the best Therapist

In some ways I'm not the best therapist for today's conditions.  That's not why I am slowing down, I have another seventeen reasons for that, but it seems to be true.

Sure, sure I can see a lot of progress in the people I see in therapy.  About 45% do well and I push them out after a year or so and their lives are easier, happier and they function better.  Another 35% do REALLY well, and they come up from the depths of torture and despair and put something together like a relationship or just happiness and that makes me feel better.  Another 20% don't.

But, as I said in my last post  (you can click back and read it, if you haven't already), the world, especially work, is much more fast-paced and stressful than it was when I opened this practice of psychotherapy.  For many of my patients I find that part of what we do is strategize how to deal with that stress -- not just breathe deeply, but how to prioritize, how to deal with a bad boss, how to deal with the huge, constant demands that a corporation. large or small, places on an employee.

Years ago, in the 90s, when managed care was clearly going to continue to be an intrusive pain in the ass, even before they began reducing fees, I decided to expand my revenue base and do some direct consulting to some local businesses. One was to a company that made stuff, and another was to a local financial services company.  My job was to help higher, but not top, management make their employees more productive.

Well, the company that made stuff, made some real crappy stuff and treated their employees terribly.  The financial services company had a business model that was either just this side or just over the line of being sleazy.

In my head, although I didn't actually say it, my best advice would have been to get the hell out of that business.  I didn't do much consulting after that.

I often still feel that way when I deal with my stressed-out patients now.

But I also realize that they don't have too many choices, and having and holding a job is very important these days.

But since I left working at a community mental health center in 1981, I have not had a boss. I set my own hours.  No one really tells me how to work, although I do consult and collaborate. Insurance companies set most of the payments I get, but at least I don't have to deal with the worst of them.  Many of my colleagues don't take insurance payments at all.  I didn't want to go that way, but it was my choice.

Whenever I see an opportunity I try to encourage people, especially younger ones, to try to do their own thing, build their own business, do something they want to get up and go and do.

But that isn't easily done, especially if you are part of a family that needs to be supported and given some stability.

But it's tough to see so many people feeling so much stress, and having so little control of it.
A lot of them are much better at it than I ever was or will be.

Big Data 2

Yesterday:  A couple of my patients were talking about how stressful and how constant their jobs were.  Later I met with a few of my colleagues for our annual gathering and we joked about how much money we weren't making.  Most of us can track at least a 20% fee reduction from insurance companies over the last eight years -- beginning long before Obamacare.

Part of the reason work is stressful is the result of how we live in a global economy and many jobs, from running a chain store to developing software to track weather satellites, is often done by teams from all over the world who work together virtually.  That means that someone is always working on it, and everyone is always part of the process, so everyone is "on" almost all the time.  Another reason, and here we begin to get into Big Data, is that costs are tracked all the time too.  Data comes from everyone's computer about who is doing how much of what.  It becomes clear from the data when someone's job is no longer needed, then they can be cut, just like turning off a machine.  It makes it easier because the person who cuts someone else out of the job has no real idea who that person is because they may be working a thousand miles away and not across the hall.

Then because people get cut so easily everyone knows that jobs are not only hard to find, they are hard to keep, so just having a job is a good thing.  That means the employer won't have to pay as much because people want to work, and people know they can be replaced easily, either by someone else looking for work, or else by a machine that won't complain.

Because so many people work in ways that are connected to some kind of electronics, whether it is a big office workstation, a hand-held box scanner or a GPS, all kinds of data about how fast people work, who follows rules, who creates better methods and who creates trouble is monitored and algorithms are developed to pick out the "good" workers and weed out the "bad" ones.

The pressure to get something done seems much more intense than it was ten years ago, and certainly much more than it was twenty-five years ago, pre-email, when you could go home from work and not have constant up-dates.

The pressure is great, but to what end?  Most jobs seem to be help business get get better organized so that they can sell me stuff I don't need and probably didn't ever think I wanted.  Most airplane travelers are business travelers who travel to help businesses run other business to make something, somewhere that someone else will sell to me.  While they are traveling they go to hotels and restaurants and use cars and use business machines to keep in touch and to track how they doing, and how much gets made and sold.

It all seems to go around and round.  It creates a lot of stress, but it gives people jobs so that they can have families and buy stuff for their families, which keeps the businesses going

Now everything everyone buys is tracked and priced and that allows someone to advertise to whoever bought what they did to buy more of it, quicker and maybe cheaper.  Which is good because I just got a $900 sweater for $9.99, and if I buy another I get another one free, but I don't need three sweaters, but I  may some day.

Should we sorry about this?  Should we get off the grid?  Keep all our data private, away from the NSA, and Google and Amazon and Macy's and Walmart and Target, or should we just buy another sweater and keep it all chrunning along?

And it's been three years and the US hasnt started a new war.

Holiday Season is Mixed

'Tis the Holiday Season again, as we all know.

We are less than two weeks away from the Solstice, at which time we will begin to get our light returned to us on this side of the globe.  It is spending its allotted time down on the Southern Hemisphere right now.

Last week, to kick off the holiday season, David Brooks, the esteemed columnist of the NY Times wrote a piece explaining why it is not good for anyone to commit suicide.  A cheery topic, and I'm not quite sure why he picked it, except that some statistics came out showing that suicide rate around the world seem to be increasing.

Mr. Brooks said it's a bad idea because most people who attempt suicide and somehow fail, later to report that they are able to reach a point at which they are happy to be alive.  Also, he said, suicide is selfish, and it hurts the people who are still alive.  This is often, although not always, true also.

Now, I'm not for suicide, except perhaps if you (perhaps me) get old, are in great pain, can hardly remember who you are, and have no chance of improvement except to take huge amounts of drugs which will made your pain less but your awarenes of self negligible.

I have spent lots of time convincing people to stay alive another day or two, just to see if they feel better, or see some other option.  I generally feel that we all will be dead for a really long time, and that we are only alive for a short time, so we should see what happens with the time we have.

But I appreciate that some people spend the time they have in misery and desperation, and despite the wisdom of others, it often feels like the stress, the pain, the losses, the agony, just isn't worth hanging around for.

I spent an hour with Alice (not her real name, and not the exact details) last week.

She is now almost sixty, and looks about eighty.  Her pain began as soon as her mother decided that Alice looked too much like her father.  Soon after Alice's birth her mother stopped liking the father, and Alice along with him.  Because of this resemblance, the mother rejected Alice.  She would beat her, demean her, scream at her and lock her in a room.  The mother did this to half of her six children. The other half she favored.

Alice survived because of an aunt and her older sister who both tried to protect her.  But her life was never smooth.  When she was fourteen her brother brought some of his friends home so they could rape her.  She broke three of her brother's ribs with a candle stick, and sent one of his friends' to the hospital with a concussion.  That got her into a "girls' school.'

Her one real love relationship died of an overdose.  Her other attempts to be with a man were much less than successful.  These relationships were often violent.  Alice was in many fights, had many rages when she almost killed someone, and was often badly beaten herself.

From the ages of 17 to 53 she drank very heavily.  Then she stopped.

Now she is calmer, sober, but alone and in great pain.  Her father has been dead a long time but her mother, almost ninety live on, with a sister, and still swears at Alice.  Alice and that sister are the only two of the six who are still alive. Two died of cancer, one in a motorcycle accident and one was murdered.

Now Alice needs a new hip. She walks with great difficulty. Her wrists are so bad that she can't open her car door without a great deal of pain.  She is probably brain damaged a bit from all the fights and alcohol.  Every joint hurts.  She trusts no one.

She said that she often wishes she was dead.  She won't kill herself because,... because that's not what she does.  She is a survivor.

So we talk about what we can try to do to make her life a bit better.  She isn't religious.  She didn't think God was on her side.  She doesn't believe in love.  She hardly believes in "like."
But when she takes a couple of Percocets, she can get comfortable enough to be curious about what will happen next.

I hope your holidays bring you closer to someone who you can like and trust.

He Passed!

I am still working, and more and more my work frightens me a bit.  There are so many things that can happen that we can't control.

One of the things that makes me scared is the unexplained increase in Autism Spectrum Disorders.  About ten years ago I was a bit skeptical.  Was this being over-diagnoses?  Were kids who were a little odd or a bit removed getting labels that would hurt their lives?  Or were they getting labels so that they could qualify for more educational services?

I didn't know.

But as the years went by and I saw more families with these boys, mostly boys, I was convinced by the evidence that something was happening.

Now, this is a Spectrum disorder, and some of these kids are different, but fine.  They miss some social cues, and they over-focus, but they can be well-adjusted and productive.  But others are further down the Spectrum.  Some need help, some need a lot of help, and some are just overwhelmingly non-functional.

And the numbers seem to be increasing. According to recent data 1 in 52 boys are on the Spectrum.  That's almost 2%.  There seem to be some contributing factors, such as older parents, especially older fathers, but the real cause is not clear.

At the end of August my third grandchild, and first grandson was born.  I had no reason to suspect that anything was wrong, but I have seen how much time and attention and effort a special needs child can absorb from a whole family, and I would do it if that was necessary, because what else do you do, but I would prefer not to.

But now he boy is over two months old.  He looks at my face, old and puffy as it is.  He looks in my eyes as I hold him.  He reaches out to be held.  He now smiles when I play with him and move his hands and he coos back at me when I coo at him.

He's fine.  He passed.  I'm don't have to worry.

In six months I'll buy him a truck and a basketball.

I did that for his older sister too, but now all she wants is her tu-tu and to dance!  How does this happen?

Anyway, Lets all Dance!!

Happy Holiday if you Can.

Big Data

I'm reading the MIT Magazine.  They highlight 35 innovators under 35, about half my age.  Many of them use Big Data to see trends, make predictions, help the world.  Amazing stuff.

One person has constructed software that predict outbreaks of cholera, another has learned to show traffic patterns that can help reduce fuel consumption and help people shop locally.  Another does genetic screening for recessive diseases.  A pharmacist in Ghana has an app that will tell people if the medicine they are taking is real or fake -- a lot of it is fake in third world countries.  On and on, great stuff.

It was Big Data that led to the new statin drug recommendations -- that half the wold should take more pills.  Now there is a reaction to that.  People don't feel that Big Data captures them, and their individuality.

Psychotherapy does not led itself to Big Data.  That is it's strength.  IT assumes that everyone is an individual; everyone is unique.  And we are.  People respond so much better when they are treated as a special. unique individual.

But Big Data sees things that no individual can.  We are all a contributor and a victim of our times.  We breathe the air and drink the water and eat the processed food.  We think the thoughts that come all the media of the day, and those around us.  Things happen because other things happen.  If you can see what is happening you can help, or prevent other things from happening.

But I'm ME, we all cry out.  None of us exactly fit the profile of who WE all are. We can't forget that.

Very difficult to find the balance. Who to trust.  How to decide what to do.

Not That Good

It's pretty clear to me now that I am in the process of winding down my practice.  I've been in a "private" practice in this city since 1981.  The reasons for my starting to close down and move along have been discussed here in several ways, and will be again.  But not today.

But, I have been looking back as well as forward and I can see that having a practice like this as mostly what I wanted to do.  My first choice would have been to be part of a real community mental health program, such as the one I was sent to school for, and where I had my first job.  These were places where people could go for evaluations and treatment of social, emotional and learning problems, and also for neighborhood problems and community issues.  We were just learning how to do preventive work, educational work and consult with other agencies when President Reagan decided that this sounded like Socialism and his government wouldn't pay for those things.

So, we got licensed and went into private practices and then we got paid by insurance companies.  That model was good for treating the kind of problems people brought to us, but  treating them one by one, which was often kind of frustrating, since many of them really were caused by what was happening in the community, or society at the time -- still true.

Also, looking back I can see how successful I was at treating people with relationship difficulties, with anxiety and panic problems, with many forms of depression, with loss, loneliness, addictions, and many of the other things that disrupt and deplete people's lives. Often that was very gratifying.

But we, mental health professionals: Psychologists, Psychiatrists and all the others, still have very little  success treating the real destructive kind of "mental illness," the kind that rips families and communities apart.  That is we offer very little help to the person who is angry, obnoxious, aggressive, upsetting and destructive.  These are people who get about six diagnoses during their lifetime, including Borderline Personality, Major Depression, Bipolar Disorder, Antisocial personality, Oppositional Disorder, and other such names that don't identify an underlying cause as much as they are just descriptive.

We offer these people many medications, dialectical behavior therapy, cognitive behavior therapy, and many other kinds of treatment that don't work, mostly because the people don't attend, don't follow, get angry and frustrated easily and leave.

There are many people who are afflicted, if that is what it is.  They bring heart-break and havoc to their families, they take too many drugs, make bad decisions, and cause problems in the community. I feel, that because so many of the tasks required in today's society are complex, and demand much more interpersonal interactions, and at a quicker pace than previously, that more people break-down and reach their breaking point.  Then they get angry, stop functioning, don't pay their bills, get in arguments and fights, and end up either in legal trouble or in bed for weeks. When they get out of bed they are further behind, angrier, and cause more problems.

I have seen many for therapy, and then they don't return.  I hear about so many more because their families suffer come to me for help.  They don't know whether to try to help or cut ties, and neither strategy is successful.

It's very sad.  We have all kinds of labels, but no real treatment.  The cause is probably a combination of genetics, family, community, timing, diet, toxins and luck.  But then what?

That is the real problesm in mental illness, and we don't have a clue.

Boston Strong ! ? !

I live close to Boston.  I went to college near Boston, where I met my wife.  We left for graduate school, but came back to be near our friends, and be part of the culture that is in Boston, Cambridge and around here.  We raised our kids close to Boston and they are raising their kids here.

There was a parade in Boston yesterday so that people could line the streets and cheer for the Red Sox, who had just won the World Series.  I didn't go to the parade, although I did watch six minutes of it on TV.  I don't go to any of the games, although I did watch many hours of the playoffs on TV.  I went to two Red Sox games this year.  I enjoy baseball.  I played a lot as a kid, and for several more years of softball in my fifties and sixties.

Many writers, analysts, bloggers, pundits, sports people and politicians are talking about how this baseball team was very helpful to the city after the bombings that occurred during the Boston Marathon,  a signature event of the city.  I agree.  This was one of the greatest bonding moments any city could have. Better than anything that could be planned or staged.

First, you have to realize how much sports means to Boston, especially pro sports, especially the Red Sox.  The Sox are like football in Ohio or Alabama. They are more important than surfing is in California or skiing is in Colorado.  We are not that outgoing here in New England, but everyone will comment on the Sox, even if you don't care about baseball.  A strong woman candidate lost an election for Senate because she didn't know who pitched for the Sox.  Even my wife watched the World Series, and dropped her knitting when Jonny Gomes hit that three-run dinger.

Ten years ago, in 2003, when Pedro couldn't finish against the Yankees, so many of my patients were just bummed out for two weeks it was hard to talk about anything else.

So this year, after the bombing, it was clear that the city began to pull together for the Sox,  The Sox who came in last, last year.  It clear that the Sox would show that the city, the region, was not to be denied.  That it could be knocked down, but we get up again, and that we get along, as a team, with each other.

I came to Boston as a student. So many people do.  So did the bombers.  We need students, we value intellect, study, research, innovation, technology, and everyone who does that.  We value everyone from everywhere.  If you walk around MIT, Harvard, BU, BC, Tufts, Northeastern, and the rest of the fifty or sixty colleges and universities that are in and around Boston, you see people from all over the world: China, Africa, Europe, the Middle East, Latin America, Mississippi. They are what makes this an exciting, stimulating, fascinating place to be.  Two angry, discouraged brothers, whose sense of decency went off the rails, are not going to change that.

We, all of us in and around the city wanted a way to show that.  We still cared, we still like and respect each other, we still get along -- differently from the way we did in the 50s, 60s, and 70s, when we didn't get along that well -- and when the Sox kept losing.

The Red Sox helped us to do that.  The players were from about fifteen different US states, as well as  the Dominican Republic, Aruba, Venezuela and Japan. I think two are from New England. We cheered for them, they played for us. Everyone had a good time. There was a big parade.  No one got hurt.

Boston will continue to be vibrant, stimulating and welcoming. Bring you willingness to learn, to collaborate, to build and create.  That includes all ideas from all cultures and backgrounds. Skills of pitching and hitting are also welcome.

She asked......

Ok, so that craziness and symbolic dance to please the powers that pay for it is over.  The National Parks are open, so that helps me, and others will get their food stamps, Head Start visits, cancer treatments, cosmic research, NSA surveillance, EPA protection, meat inspection, and paid for developing a big stealth jet that will never be finished.

I will be off to Yosemite soon, to visit a place I have always wanted to see.  I did not expect that it would be part of a political statement.  But, as I said in my Listserve post:  Nothing surprises me.  Nothing is too absurd, especially when it is exploitative, when those who have tell those who don't that they should suck it up.

Meanwhile I have been slowly responding to the hundred of questions I received last month.  people seem to care.  When I finally respond, most of them respond to my response, which is nice.  I now have a couple of hundred new email pals from all over the world.

Here is one example, here is only a part of what she wrote:

I am dating a man, actually engaged to him, who has "cheated" on me several times...cheated by engaging with women/old flames via social media twice in two years (suggestive texting)...and once he snuck off to go dancing, where he met a woman, and kept the flirtation going (no sex/only kissing) for a few weeks before he ended it.

All smoke and no flame, I guess you could say.  But I don't like it.  Not one bit.  

I responded:

Good question; sorry for the delay in responding.

My thoughts: (and read every disclaimer possible into these)
If he really, really is only doing these flirtations on-line, or by text, and he really wouldn't act on them if given the chance  (can anyone believe that? even him?)  But if that is true, then you have to remember that he is fifty, and I remember that as a dangerous age for men. It is really a time when we don't want to feel as if we are slipping into irrelevancy.  We are too slow for basketball and have to play "Senior" sports.  It's all about still being attractive.

But, if it really makes you uncomfortable, and you are worth it to him, he should be able to control it.  You can confront him gently.  Tell him how much he means to you and how much this makes you feel queasy and how you think less of him and his insecurities.  And also tell him that if it continues, you will not only leave him, but that your parting shot could make him unable to operate for a couple of months.

Give him that whole " hell hath no fury..." routine.

Forgive me for taking so long to reply, but I received hundreds of questions, and I still have my day job so it is taking me a while to get to them all.

All the Best!

Political, Slipping away

I have been very busy, and when I'm not busy being busy I have been busy answering the literally hundreds of questions I have received from around the world.  They mostly have been about how to get along with a significant other or how to find meaning in life.

I mean, good luck with those.  I will post my answers more often than I have been, I hope, if I'm not busy.

But right now I have to make a brief comment about the obvious: The U.S. government is fucked-up.  But I don't want to spread the blame equally, I think that 94% of it goes to the right-wing wing nuts who feel that spending money to keep middle class and poor people healthy and financially solvent is the worst thing that a government can do. But now they seem to have changed their mind about what they are upset about, and it seems to be that now they are upset because everyone can see they are a bunch of sore-loser blowhards who backed themselves in a corner and the President is pointing this out.

They thought they would be clever and hold the world up for ransom, and they still might.  But hopefully, this is another step in the beginning of the end of those who feel that the purpose of the United States is for white men to make as much money as they can, any way they can.  I know that five members of the  Supreme Court still believe that, so that will cause more trouble, but most of the country is turning away from that.

Obamacare is a huge social program, and it is the beginning of a slide toward government health care. That will prove to be widely accepted and greatly appreciated.  I do believe that everyone should be on Medicare, and then be allowed by buy their own supplemental plan, and that something like that is thirty years away, but maybe sooner.  For in twenty years most of the Tea Party will be in nursing homes trying to vote for Ronald Reagan again. By then the video game generation, who seem to be the kind of folks who care about each other collectively, if they are not blowing each other away and stealing each other's cars, will take for grantedthe benefits of universal health care, and not mind paying more taxes for it.

A clinical observation

Over the years of dealing with many people and hearing about thousands of relationships I have concluded, from the anecdotal evidence of my observations, that it becomes much more difficult to end a relationship, no matter how difficult, unrewarding, and troublesome it has become, after you have had sex with that person three or more times.

Seems to be the case...

The short answer

"A Mister Richard Fader from Fort Lee New Jersey writes:".......(most of you probably get that, right?)

Anyway, more than one of the questions I received was from far away and it asked, simply, if I thought that there would ever be a time when the people of the world would get along better, and that greedy, power-hungry people would no longer have such a strong influence.

I replied:

I do think that, overall, the world has become more civilized and there is really less torture, fewer huge wars,     and more are  people getting along better. I don't know if you have a chance to read Steven Pinker's 

"Angles of Our Better Nature" but he makes a good case for that.

Yet, it is obvious we are not close to the great wave of human harmony.  I think the global climate change has 

put pressures on countries to fight for basic resources that are becoming more scarce.  
That is a lot of what underlies the problems in the Middle East and northern Africa today. 

I also think that technology has made life so much more efficient that it is becoming more difficult 
for people to find meaningful work, if they can find work at all.

Until those problems are solved in a manner that gives everyone a chance to survive and have a 

decent, but not decadent lifestyle, there will be fighting and trouble.

Take good care of yourself.

social anxiety

I am slowly reading through the comments and questions I have received from my Listserve post ten days ago.  I am going through them when I can, but I also have have my day-job, the three grand-kids, a wedding I attended, a bit of time with the wife and friends, and then the Sox clinched the pennant and the patriots caught the ball and won another game.

But a few of the questions were about how to deal with social anxiety.  As one woman put it:

I'm in a field that requires a lot of 
networking, but I have a lot of social anxiety when I spend time with these 
people outside a professional setting. I don't feel like I belong, that I have 
any right to be there. I get seized by dread. Any advice?

These feeling on not belonging, not being worthy, feeling conspicuous, and constantly

lacking, are very common, much more than anyone who has them realizes, mostly because 

no one talks about them.  But they can be very powerful, and they put a great strain on a

person's life, and a strain on the lives of others who depend upon them.

I have treated many, many people who have many different shades of anxiety disorders, and most of them make a great deal of progress and function much better.  Only a few are ever  completely free of  those feelings and are never bothered again.

It is because of this I am fairly certain there is some genetic component to this.  Some          people are designed to be more sensitive and more reactive.  There are good parts to that, 

to being more aware of how other people feel, and what is going on around you, but it can 

get way overdone and make a person so uncomfortable and be such a strain that it greatly   limits their lives.

That isn't to say that the cause is totally genetic; that is never the case.  But when someone who is prone to anxiety is put through circumstances of great stress, ambiguity, or is with  people or in circumstances that they cannot control, they are vulnerable to panic attacks     and strong feelings of anxiety, doom and dread.  

Given all that, this was my reply to the people who asked about social anxiety:

Social anxiety really sucks.

 some tips:

 1.  When you go into an social setting don't expect to be fine; that will only disappoint you and make it seem worse.  Expect the anxiety and sit with it. See if you can let it pas through you.







 2.  Of course you belong -- we are all united by our real insignificance -- even if you don't feel it.  if you are surrounded by people and feel tense, just sit and observe.  Don't pressure yourself to talk until you want to.  Try to pay attention to the conversation more than your internal feelings.  If you can show people you are actually listening to them they will be very flattered and they will think you're a great person.







So, that was my "Internet Advice," It's worth about as much as she paid for it.  I hope it was helpful.  Anxiety increases when people try to control things that are not within their power to control.  Your mind churns and churns trying to find a solution.  Then you feel that your mind is out of control and you must be crazy.  That's when things get worse.




Anyway, I hope that none of you feel like that today.  



Enjoy the beautiful Autumn weather. ( and forgive me for the disjointed formatting, I'm not sure where it came from.)

the task ahead

I am almost finished telling everyone who sent a request that I will get to their question some time in the next -- who knows when --- but I will.

In my message to the Listserve I said I would answer questions and of the 260 responses, a bit more than half seem to be legitimate questions.  In the piece I wrote I stated that nothing that people do surprises me anymore. After reading the comments, I find I am not surprised, I am a bit saddened that there are so many people out there who are not only struggling with so much, but are also searching for a way to find help.

As I have said in the past, I am not a fan of psychiatric diagnoses.  I feel that these labels only mark people as "sick" when they are really just dealing with the shit the world has handed them, often from the moment they meet their parents.

The causes of upset and strife are similar all over the world: stress, loss, loneliness, illness, trauma, and inadequate resources.  These are the factors I usually look at when I try to define a problem and then set about looking for a solution; something that is always a joint process with the patient.

The sad part to me is that there are so many terrible situations that people are reporting, and I hope to be answering them really soon.  The other side of the picture is that only one percent of the readers of the List felt the need to respond, so the other 99% either thought what I said was OK or useless, but they are moving on well enough without me.

In some ways that's comforting.

A comment about the comments

The comments in question are not the comments on this blog, which are mostly Forsythia's welcome and supportive comments.  But I have been reading the emails that I have been receiving from the post on the Listserve on Friday.  There are over 200 of them, and most took me up on the offer to ask me any kind of question about relationships.

The questions have come from all over the world,literally: China, Portugal, Brazil, UK, Australia, Italy, South Africa, India, and at least twenty U.S. states.  I believe I have heard from every continent that is not covered in ice.  Some of the questions are very specific and about the relationship the questioner is in.  Some are very general and ask for the kind of general guidance that I am reluctant to give. And others are from people who are dealing with emotional difficulties, the kind that I deal with in my office.  In fact, I hope to make a few referrals if i get more specific information of where the questioner is located.

Many people state in their email that they have not  sought help, and have not asked their question before.  Several have said that they feel more comfortable asking someone who they don't really know, who is hundreds of miles away.

Again, it shows how much confidentiality, and the fear of being judged plays such an important role in establishing a therapeutic relationship; any relationship really.

I hope that over the next few weeks I will have time and permission to post some of the questions, and my marvelously wise answers here.  But now I have to go and change my grandson's diaper.

Be patient kid, you're acting like you're two weeks old.  Oh, right.......

The Listserve

A year or two ago, someone in NYC began an Internet project called The Listserve.  He or she got about 24,000 people to sign up to get an email a day from a randomly selected person who had subscribed.  I have been reading these emails fro about a year.

A two days ago I was randomly selected.  What I posted is written below.  But before you read that I want you to notice that at the end of the post I invited people to ask me any question they wanted, since you already know how impressed I am with my own knowledge.

Well, so far, less than two days later, I have received over 200 comments and questions.  In the coming days I will post some of the question I received, and my very clever answers.  That will be easier than thinking up things on my own.

Here is what I posted:

Hello Listserve:

            I am considerably older than most of those who have already posted 
their messages on this site, and thus I have lost most of my armor of idealism .  
Much of this is due to the experiences I have had working as a Psychologist in 
Massachusetts mill cities for almost forty years.  I feel I have seen almost 
everything humanity can offer.  I no longer question whether something is good 
or bad; I just see it as fascinating.

            There is nothing anyone can do that would surprise me any more.  
Anything my wildest imagination can produce someone out there is doing it, and 
they are doing it thinking it will bring them happiness or satisfaction.  Most 
of the time it doesn’t.

            I would give you all advice, because I know, better than Dr. Phil, 
what you should do with your life, but more than that I know that you wouldn’t 
listen. That's not how people change.  Change has to come through emotional 
experience.  Perhaps in three years you might think back and say, “maybe that 
guy was on to something.”

            I am a big believer in the saying “When the student is ready, the 
teacher appears.”

            Humans are a work in progress, an intriguing but flawed species.  If 
you haven’t realized by now, please take notice: the world is almost always run 
by character-disordered people.  Kings, Queens, generals, presidents, tyrants, 
business leaders, billionaires, market movers, and celebrates are usually 
greedy, power-hungry narcissists, or else they have that missionary zeal and are 
self-righteous.  That’s not always true, only about 90% of the time.

            Most people are basically kind and caring. They want to get along, 
have a few satisfying relationships – which is difficult enough-- contribute 
something to the good of the world and then relax and enjoy their family and 
friends.  But then someone comes along who wants to grab power and take control  
of everyone and everything.  He (it almost always is a he) identifies some small 
difference as a huge threat, then gathers a group of devoted followers to save 
his people from it, and everything goes downhill from there.   Just look at 
history, and look at what’s going on now.

            As I said, I am old, I am wise, and I know everything about human 
relationships.  If you want an answer just send me the question.  I won’t expect 
you to take my advice.

Diagnostic discussion

Given all of the talk about how helpful, accurate or scientific psychiatric diagnoses are, and how embarrassing DSM V is, there is an attempt o bring some hope to psychiatry in an article in the Sunday NYT Review section.  In that piece, Dr. Eric Kandel, a Noble Prize winner in physiology, tries to make the case that we are well on the way to having better diagnostics through brain research.

In his explanation he gives a very positive nod to the use of psychotherapy as an effective treatment for mental disorders.  Along the way he re-labels psychotherapy as a brain-treatment, and takes a slap at therapists lack of scientific rigor, but his view of therapy is general very positive.

He makes a case, that is much more hopeful than real, that further study of neuroscience, genetics, and bio-chemistry will eventually, in years to come, reveal the underlying causes of mental disorders, and greatly improve diagnosis and treatment.

I certainly agree with Dr. Kandel that these sciences are of great importance to the understanding of some of the contributing causes of emotional and behavioral irregularities but, given who he is and where he comes from, he is trapped in a very reductionist, medical model.  If psychotherapy is a “biological brain-treatment” as he states, so is a family, a sub-culture, and a romantic relationship.  These things also have a major impact on how a person feels and behaves, and they cause many major changes in the brain.  Until we learn how to integrate all of these factors into our attempts at understanding what causes what,  we will be still fumbling around with inaccurate half-truths.

At present, diagnoses are often as much a political act as they are a science.  They are descriptions of what is considered, at the time, unacceptable behaviors.  What is unacceptable changes with the culture, and the soical values of the times.  There are many, many examples, from hysteria to homosexuality, that were illnesses then, but are seen as acceptable now.  I am sure what is now called bi-polar disorder in ten years will have four different names.

Yes, our mind is a product of our brain, but our brain reacts to what is happening in the world around it as much as what is happening inside our skulls.

That’s my view, even without a Nobel prize.

August -- gone

There is just over an hour left in August of 2013.

Quite a month.  It is so precious here in new England, and it goes by like a breath of salt air off the ocean.  Gone.

What happened this month, beside the world almost having everyone go to war again because a few crazy people can't share power?

I didn't work almost all of August.  More than ever I really enjoyed not going to the office.  The patients are all important and worth the effort, but the system has become even more complex and burdensome, and the big insurance companies continue to find ways to pay us less, and then blame it on Obama.

I did spend a lot of time with some crazy people, but they were not my patients, so I could just let them be interesting and let them prattle on about their views of the world, themselves and whatever it was they found so meaningful. Noy my problem.

Today was my daughter's birthday and, as it happens, my daughter-in-law's birthday, which makes things a bit hectic.  But now, to add to the confusion, my newest grandchild, and first grandson, was born yesterday.  He is a big, healthy boy, with two tired, proud parents and an almost two year-old sister who is still trying to figure out why her life is suddenly so different.

So the world reamins it's complex, unfiar, unaring, often cruel place, but my immediate, tightly knit, cloesely guarded spot in it remains remarkably, happy, prosperous, and almost all very healthy.

But now August is gone.  It is  that sweet, melancholy time when the light becomes sharper and golden, when things start up again and become more serious.  We put away the hammock and the kayak, and wonder where the time went.  We didn't get to take that five mile walk to the end of land to the lighthouse for the fifth year of planning to do so. I did paddle across Pleasant Bay.  I did take the girls to the beach and run in and out of the water, and in and out of the water, and in and out of the water.

Hopefully we will do it all again next year, with the boy sitting in the sand, and we try to stop him from eating it.

Quick Fix

I am away from my office for a few weeks, wandering around near the water, doing a pretty good job of not thinking about those I left behind.

Down here I get to talk to friends, and friends of friends, and just see what they do and hear about what they think.  I don't have to do anything about it, which makes life much easier.

But what I hear can be pretty distressing, and that is, even more than before, people are going for the quick fix.  Psychotherapy seems to have lost some of its panache; it takes too long, it costs too much,  and it can be painful to think about the bad things, or to confront difficult problems.  These days it is much easier to find a life coach, a motivational speaker, a spiritual healing, an body-mind energy consultant, a brain-ionizer, a vitiman dispenser, or just a guru to show you the path.

Now, the quick fix has always had allure, for centuries.  But many years ago the fix seemed to be more through suffering, sacrifice and prayer.  Today it seems to be through self-indulgence, self-appreciation, fulfillment and money.  And who can say no to that.

The trouble is, of course, that the quick fix rarely works.  What these kinds of fixers seem to miss is that they are fighting against all of a person's biological history, genetics, family history, interpersonal history, cultural and sub-cultural patterns, and financial resources.

Usually the effects of a weekend pep-talk and a few exercises feels really good, and lasts for anywhere from three hours to three weeks, sometimes a couple of months.  But almost always, those entrenched thought and behavioral patterns creep back in and take over.

However, the bigger problem is, that psychotherapy also, often takes a great deal of time, and still isn't that effective.  That process too has to fight against all of a person's biological history, genetics, family history, interpersonal history, cultural and sub-cultural patterns, and financial resources. Some of these we can confront and work through, others, such as genetics, social class, finances and sub-culture, are often cannot be influenced by verbal interactions that happen in an office for an hour 9 now 45 minutes according to most insurance companies), a week.

There are things that I would strongly recommend that a coach can be necessary;

-- Sports

-- Financial planning

But, with both of those, be careful, find someone with a successful history, the longer the better, and make sure that what they said they did really happpened.

The $ factor.

I thought I had posted it here, but I only sent it out as a tweet:
"40% of my patients problems could be greatly improved, if not completely cured, by $35,000."

(I tweet @therapistmumble, but it's hardly worth following because I tweet about once a month).

On the front page of today's NYT "Review: section is an article by Moises Velasquez Manoff (that's a name for the new world) which gives a lot of research support to the concept that the poor suffer in many ways -- health, longevity, depression, etc, much more than people who are financially comfortable.

http://opinionator.blogs.nytimes.com/2013/07/27/status-and-stress/?_r=0

Now, to most of you this probably comes as a "Duh!"

But, unfortunately, too many people in this gold ol' U.S. of A. seem not only aware of that fact, but happy about it. We are getting back to where we were in 1964, of blaming the victim, and using the poor to make the rich feel better.

This is not a prescription for the long-term success of any society.

Not enough

         In between session of running in and out of the water and jumping over tiny waves with my almost two year-old granddaughter, I was able to read parts of the NY Times on Sunday. As usually, there were many descriptions to some awful things that are going on around the world, which show the varied ways in which people can be horrible to each other.

         I read a few more positive things also, but one piece that I felt was the most relevant to me as a Psychologist was on the back page of the Review section, written by Nickolas A. Christakis, a sociologist and professor at Yale.

http://www.nytimes.com/2013/07/21/opinion/sunday/lets-shake-up-the-social-sciences.html?hpw&_r=0

         I thought it was important because what he presents is very much like I have been saying for at least the last three years to the seven people who listen to me, and that is that our discipline, the science of Psychology and with it the practice of psychotherapy, have become too narrowly focused on the same specific areas we have already studied, and on variations of the same ways in which we have been practicing for seventy years.

         Clearly the practice of Psychology has resulted in many improvements in treatment, especially in how we deal with specific problems, such as PTSD, panic attacks, and even borderline personality.  But we have not taken any dramatic leap forward in conceptualization, and especially in the combining and utilization of knowledge from other branches of science.

         There are so many exciting things going on the fields of genetics, microbiology, and biochemistry that seem to be relevant to how we think and what we do.  It has also become clear to me, after over thirty years in practice, that the core of what we do is based upon a model devised by overly intellectual white Europeans early in the last century.  We can now see that there are so many other factors to consider, such as health, wealth, culture, sub-culture, information availability, and use of technology.

         All of these genetic, biochemical, sociological, and certainly political factors are constantly interacting  with each other in very complex ways and I feel strongly that if we are going to improve our understanding of the causes and influences of what makes people think, feel and act the way that they do, and therefore improve our treatment of those who suffer from it, we have to greatly expand our foundation of study. We have to be much more aggressive in our efforts to learn from, to interact with, and collaborate with others in other disciplines.

         As the market has been showing, unless we change, we will become more out of date and irrelevant.

         

Fishing

I ended my last post by saying that in today's climate it may not always be good to teach a man to fish.

But, really, I didn't get the analogy exactly right.

If you give a man a fish, you can feed him for a day, even if he doesn't know how, or doesn't have the resources to cook it, if the fish is fresh enough.

But if you teach him to fish:

You can teach a man to fish, but are you going to buy him a boat, pay for the fuel, and then pay for the liability insurance?

He may get arrested for not having a license.

To get a license he may have to bribe people, or all the licenses may already be taken by corporate entities.

You may be introducing him to fierce territorial competition, for which he is unprepared.

There may not be enough fish due to over-fishing and lax regulation.

The fish that are left may be a health risk due to the polluted water they live in.

Did you also teach him to swim, or are you putting his life in danger?

And don't think farming is any better.

Nothing is that simple any more.

Summer

Summer is certainly here.  The Big 4th of July Weekend has passed and everyone is in full summer mode.  Some are sitting on stoops, going to bar-b-ques, headed to the beach or the lake.  The city is full of events to keep the residents home to spend their money locally, or to entertain the tourists.  All the cities, large and small on the New England coast, from Newport, RI, to Bar Harbor ME are full and festive.  The visitors from Topeka probably think it's like that all year long.

For me, still working, still doing at least three full days a week, the divide between work and play is huge.  I feel so fortunate that my family, all three generations now, is happy, healthy, enthusiastic and even prosperous.  It becomes even more difficult to turn the pages of the Sunday paper and read about what goes on in Egypt, Mali, Syria, China, Spain, and even Florida and Texas.  It is even more painful to see what happens with our very own government, grinding to a halt in Washington, D.C, helping no one, solving nothing.

That is also what upsets me in my practice.  So many of the patients i have to deal with have problems that are due as much to politics as they are emotions, neurological, genetic or family dynamics.  I see a 58 year-old man who knows he will never be able to get a job that pays close to what he has had before. His unemployment support has ended.  His wife is exhausted from dealing with his feelings of hopelessness.

I see a 25 year-old woman who is working as a waitress and wants to go back to nursing school but she already has $32K in student loans.  Her father is dead and her mother makes $14 an hour.  She would have to take all of her courses, do her clinical rotations, and also be working full-time to support herself,. A friend of hers from high school, whose grades were never as good as hers, has father who is buying her a condo near school and paying all of her expenses.

I have about a dozen more examples for this: cases in which $25K would be much more help than two years of therapy.

Give a man a fish and you feed him for a day.  Teach him to fish and he will starve to death if there are no fish to catch.

Gettysburg to 2013 to 2163

We are rapidly approaching the 150th anniversary of the Battle of Gettysburg, one of the bloodiest few days in U.S, history.  This will be a time of reenactments, strategic studies, and speeches about valour, honor, freedom defended and freedom lost.

There were fifty thousand casualties at Gettysburg.  Most of them were young men who had holes shot through them from fairly close range.  Most of them probably had little idea of exactly what the reason was for them to put their lives in danger.  They were defending their land and their culture.  They were brave, irrational and sucked in by peer pressure or fear of punishment for treason.

The underlying cause of that battle, and of the entire U.S. Civil War, had to do with the existence of slavery. Looking back on that, from a perspective of 150 years, there are few few people left, not even Paula Dean, who will defend the enslavement of other humans.  It seems very generally accepted that it is inhumane, unjust, and that it should not be done.

But that does not mean that soldiers from the South, the slave owners, and all of the others who went to war, were callous, mean or inhuman.  In truth that war, like many that have followed it, was due to changes in economic and energy policies.  The Southern states depended upon slavery to keep it's economy profitable. If they had to pay people to built those beautiful houses in Charleston most of them would not have been built.  If they had to pay a decent wage to plant and harvest cotton, the price would have been too high for the North, as well as the English and French to want to pay for it.

When almost any society is threatened with a complete loss of their comfortable lifestyle the most common reaction has been to go to war to save it.  That's a good part of what caused the American Civil War.

Now, 150 years latter, there is another debate occurring about the U.S. energy policy.  There is no threat of war because, at this time, there is no threat that anything is going to change that policy.  There is a major threat ( it is already occurring) that if that policy does not change that we are radically altering the living conditions of the planet we live on.  There is a large possibility that the number of casualties will be greater than the 800,000 of the Civil War.  Due to the violent weather we have had just in the last five years, millions of people have been affected.  Many have lost their homes, most of their possessions and their livelihood.  Many across America have been injured and many have died in floods, tornadoes, hurricanes and fires or have been affected by some of the worst droughts in history.

Many across the world have been affected by floods and droughts that have ruined economies and resulted in starvation, refugees and wars.

In 150 years, in 2163, when people look back at what is happening today, I think that the lack of action on the energy policy that affects climate change will seem as unacceptable as slavery seems today. But people are defending it now for the same reasons they did then -- there are many people making a good living the way things are.  Oil companies, car companies, electric companies, any company that uses a lot of power to do business does not want to pay for the changes that would be necessary if we began to eliminate fossil fuel.  Most of us wouldn' t even be able to get to work.

It's very possible that some kind of new technology will save us from these catastrophes, but if that happens it won't be cheap.

But in 150 years, if many cities are under water, or billions of dollars are spend to prevent that from happening, if the weather patterns are consistently more violent than today and huge rains, long droughts and tornadoes become common, people then may be wondering that we were thinking.

We were thinking the same thing that the soldiers in Pickett's Charge were thinking: we are defending our way of life.

A brief criticism of everything

Today, one of my colleagues posted the following link to an article

http://www.medicalnewstoday.com/articles/259854.php

Nose jokes aside, and moving further and further away from Freud, I find this study to be very exciting and I hope it is an indication of the direction that mental health will be taking.

Many of us feel that the new DSM V is a bit of an embarrassment to the field.  It is not scientific, it is based on symptoms and not causes, and in many ways is much more of a political document than a medical one. 

Real research that tries to find the causes of problems will eventually lead to better treatment. Catch-all terms that change over time and are merely descritive of behaviors that are currently out of favor are not very helpful.

This article is a very small first step.  The authors state that: The results showed that nose neurons from the schizophrenia patients had much higher levels of one particular microRNA (called miR-382) than those taken from the unaffected controls, as Shomron explains: .......After some more research, the team found that this particular microRNA molecule regulates the expression of genes that are involved in the creation of neurons.

This is just a marker, it is not a cause.  But it takes us way beyond the early theories of only environmental causes. It shows that true schizophrenics have a different brain chemistry, as the result of a mutation in the expression of a gene.

BUT, i also want to make it clear that I believe that biological explanations will only rarely be sufficient.  That's why DSM VI will also be a failure, as they are basing their future on finding more bio-markers.

However, if Psychology is going to remain relevant to anything but advertising, we will have to interact and collaborate with other sciences to develop a better understanding of what shapes human behavior, both adaptive and maladaptive.  I think these sciences need to include both the more basic ones --biology, chemistry, genetics, as well as the more general ones, such as sociology, anthropology, and even climatology.  

We can't be stuck doing the things we did forty years ago and calling them different names.

So, up your nose to your brain!

DJB

interconnecting parts

The world we live in now has become increasingly complex.  We are all so much more interconnected that the things we do and the things we use have effects on other people's lives, usually without any intention, or even awareness on our part.

There are large things we do that effect other peoples physical and psychological health. We make choices about how we behave politically that make a difference.  The things we choose to buy, the places we go, the people we choose to interact with all effect those people.  Many of these are intentional choices we make about how to use our time, resources and energy.

How we treat the people we interact with makes  big difference in the kind of world we live in.  If we are friendly, positive and up-beat, most of the people around us will respond to us that way.  This is not universally true, but it does make a difference.

The reverse is also more true than not: if we treat others with anger, scorn, disdain or indifference, we will find that the world we live in is not pleasant.

The world was not designed to give us up-lifting, meaningful or fun and rewarding times.  Quite the contrary, our species has survived because it has (mostly ) learned to adapt the the local conditions. Our species has survived and become dominant because we have learned to be social and to work together.  However, we have also learned to divide into small groups and fight for resources.  This behavior may no longer be adaptive, but it has not yet been extinguished.

The problems most of my patients bring into my office are usually the result of some behavior that is basically necessary for survival but is now being misapplied.  Anxiety is an example of being too fearful, and of trying to control things that cannot be controlled.  Paranoia is from a loss of trust. Addictions are usually a perversion of what was pleasurable. Depression is often, to a large degree, from feelings of incompetence and worthlessness.

So be aware of how you feel, and how you express yourself to those around you.  How you act does change the world you live in, and that world, in turn, will change you.  It is a constant, interactive process.

Old White Man

For various reasons I had a sessions this week with two brothers and a sister.  They were in their late forties and they compared their impressions about what it was like growing up in their family.

But now their father, who was a distant father but a very successful businessman, is eighty-eight. He has been a widower for a long time, and now he is home, by himself, and moves with great difficulty.  His children, mostly his daughter, come to see him four or five times a week to bring him food and cook for him.

He is not very sociable, because is usually tired, and they often find him asleep in his chair.

His daughter explained that this is true because every night he sits up in the chair, facing the door, trying to stay awake.  He holds a 35 caliber pistol on his lap and waits for "them" to come and try to take away his.........well, that's not quite clear.

One of his son's says that the gun doesn't have a bullet in the chamber and the old man doesn't have the strength in his hands to pull the lever and get his weapon ready.  But it's the thought that counts.

Crazy, Scary, Sad

That was quite a week for those of us here around Boston.

Terrorism? Angry? Psychotic? Sad? Misguided?

I saw a patient on Tuesday who said he and his two kids had watched the end of the marathon and he was about fifty yards away from one bomb and forty yards from the other.  He said he knew immediately what was going on and he just picked up his kids and ran out of the way.

We have a fried who lives in Watertown, about four blocks from where the first brother was killed.  The police came to her home, in full riot gear, with automatic weapons drawn and walked through the house making sure she was safe and no one was hiding.

Two kids, two brothers, shut down the whole Boston area, about five million people shut in their homes.

Perhaps the one brother captured will be able to give some kind of an explanation for his actions, but it will never make sense.  What allows someone to feel that they need to blow-up random people to make a point is never quite clear.  Yes, there are political grievances, where one group feels unfairly dominated and exploited by another group, and they feel the only way they can he heard or to get their plight noticed is to kill a few children, but even in those cases, if people really want to find a solution, it could be done.  But there are enough powerful people who don't want the problem solved.

History shows that there are always many people, especially those who take leadership roles, are either have a fanatical devotion to the cause, or a fanatical devotion to their own importance, to allow for any compromise.

That is happening now in our government, in several places in the Middle East, and in many other countries around the world.

The main concern of most people is first for their own safety, then for their own well-being, and then for the well-being of their family and core group.  Yes, there are many people who truly care about the welfare of people they don't know, and who may be far away.  Many of them, including myself, will do things to be helpful......to a point.... to the point where it sacrifices my own safety or well-being.  Sure, for a moment I have helped someone having a seizure, or I would pull a kid out of a lake, but probably not let them come live with me, or pay for them to go to college.

All of this still cannot explain what these boys did.  It must be more than just a psychological problem. On the reductionist end it is biological, down to the unfolding of proteins in the brain.  On the global scale it is related to the clash of cultures, ubiquitous saturation of violent images, and the well publicized examples of others who lose control.

The city, state and country must have spent millions of dollars and used thousands of people to track down and stop two young men. The forces of law and order did an excellent job -- perhaps using too many bullets.

All I can conclude from this that something like this will probably happen again within a few years. Again we will wonder why -- for the individual involved.  But the bigger causes, of people believing to strongly in things that really don't matter, will still be there.

Coping and Traveling

First, I want to thank the people, those whom I know and those whom I don't, who expressed support and concern for my wife.  Although she is still a bit stunned and a bit pissed off that she is afflicted with this, she is paying very close attention to doing what she should be doing, as she usually does, and there have been good results from doing this.  She does seem healthier and more stable.  There is more to do, but progress is being made.

A while before the diagnosis was made we had planned to take the trip we are on now.  We know that Spring comes late in New England so we came South, in part to visit friends who are down here, and then relax for a few days  here where it is warm, friendly and beautiful, even if the food  is too rich.

But what becomes clearer every day, from seeing my friends and hearing their stories as they relate to my wife, is that getting old kinda sucks. Right now I feel pretty good, and think of myself as fit and flexible. In my head I am the same as I was thirty years ago when I was playing basketball once or twice a week.  However, if I make the mistake of looking in a mirror, or trying to run and jump, it becomes very clear how different I am from how I was then. Also, one of my good friends can barely move his legs, another just had a second heart attack, a third cannot eat anything with fat. A fourth is having both knees replaced this summer.  We even have a couple of friends who clearly are not as mentally sharp as they were ten years ago.  On and on and on.

Psychologically, it isn't easy, and in some ways denial is the best strategy, except when there are measures that can, and need to be taken.  But within the pretty near future most of my friends and I will all be seventy years-old and then it will be tougher to still think of ourselves as just " middle age."

struggles

I've written here before about how it is much more difficult for me, as a psychotherapist, to deal with the folks I see who are physically crumbling, hurting and in pain. I can deal with anxieties, depressions, wild ideas, bad judgment, bad behavior, as well as the lost and lonely, but the the suffering from illness, pain, especially when it is chronic and in a few cases, fatal, is the most draining for me.

Now, in my own home, my wife is dealing with a disease that is probably going to be chronic, is a long way from fatal, but is certainly life changing.  Although she has always been strong, healthy, active, alert, and for the most part living a much more correct and risk free life than I have, she has somehow contracted diabetes, in a form that seems to be a mixture of both Type 1 and Type 2.  Suddenly, from a life that was open and free flowing she has to take measurements, count carbs, and take a regimen of shots and pills that is still being calibrated.

I have no doubt that she will do all that she needs to do, and find a way to balance her life. Yet being hit with this, with really no warning or any way to anticipate that it would come, except for a sudden thirst and weight loss over a period of only a few weeks, is such a shocking smack of mortality that it has just washed me over with the sense of melancholy that comes with the realization that we are all so fragile and ephemeral.

As a husband, it is frustrating because I cannot reach in and turn her pancreas back on and drive away the virus, or toxin or whatever it is that has shut down that organ. I can only be here as best I can.

As a therapist, who works with so many other people who are suffering, and who has done so for so long a period, it seems to highlight how slow, inexact, and inefficient the process of psychotherapy is.

Since this has begun I have been more tired, and I have had to make an extra effort to be focused and attentive in my sessions.  What I see is that so many of the patients, who I have come to care so much for, really are more deeply troubled than I had wanted to see before.  Part of the way I work, which has been successful, is to regard all the people as basically able to function, and even if they are messed up I try to draw out their strengths and show them the expectation that they can improve their lives.  I am sure that this helps them reach for that too.

But when I really dig into their lives and minds I often see how difficult what they have to deal with is, and how their thinking  has been crushed by either/and emotions, family, illness, society or just bad luck.

And, as it is with my wife, all I can rally do is be there, reflect upon it, and talk to them about it.
These are not very powerful tools.

Turning the Corner.

       In the month since I have last posted something here many things have changed.  But what I feel most is that if I have not yet turned the corner, I can certainly see around it. The future may be full of fears and fantasies, but there is now a pathway through the fog, and for the most part, at least right now, it is exciting.

       The downside is that there is a large negative influence that has exploded upon the scene.  This is not just the constant addition of obstacles and impediments to the practice of my profession.  No, this is very personal and it is the diagnosis of a chronic illness of my wife.  It is something that can be managed, and it may not turn out to be as destructive as it possibly could, but it does change the way she views herself and how she will need to operate in the world.  The extent of the necessary vigilance is not yet known, but the impact of mortality, and of the randomness of fate, is now always present.

       This will mean more pressure from my wife, and from inside of me, to live our lives a bit more deliberately and bit more meaningfully – as if I haven’t been doing that.  She doesn’t like feeling that things are beyond her control. She is hurt and angry, so I get to be the victim of mini-slights and corrections, as if it is me who is out of control. But I realize that those slights are temporary.

       But before the diagnosis hit, and about a week after my last note here, I turned on this computer and sat in for the opening week of my on-line course on biology and genetics.  It is being given free ot any and all who are interested.  But it is not a consumer friendly version of anything.  It is the course given by Eric Lander, the leader of the Human Genome Project, last semester at MIT.  

       The only difficulty is that the course, to do it well, requires lots of time.  Because like any real college course about the Community College level, the tests require much more than answering questions about what was taught.  They require taking what was taught and using it to solve a problem.  The problem involves terms and concepts that may have been briefly mentioned in a lecture, but which take time to review, organize and understand.  For example, the course gives the list of amino acids, but never really clarified the differences, or how they bond, or how they interact with other proteins – or for that matter what proteins are and how they are formed.  But the questions make you go and find these things out, which is possible, interesting, but very time consuming.

       But the main thing for me is that the course is about what is being learned now.  It is about things that were discovered ten or five or two years ago, and how they are being put to use, may possibly be in the future,  Also, it is about a basic feature of who we are as people and how we got that way and how things inside of us work, or don’t work.

       I find this such a refreshing change from the vagaries and speculation of psychology and psychotherapy.  The genetic/biochemistry interactions that create many features, traits, and illnesses that we have are extremely complex, and most are not at all clear yet, but they are emerging, and ways to explore them are also emerging.  It is such a long way from the personal speculation about hypothetical constructs and pompous “interpretations” of slight bits of behavior that have been true in psychotherapy for decades.  These “interpretations” often reflect much more about what goes on in the therapist’s mind than in the patient’s.

       For me, now, this is exciting. It is new, it is evolving, it is fascinating and it could and should be useful.  Will I ever be able to use the knowledge I gain if I continue to pursue things of the same of similar nature.  That is my goal.  I don’t expect to ge a Ph.D. in genetics or microbiology.  I don’t expect it will be me who make any startling discovery, or theoretical break-though.  But I would like to find a way to show how so many things are tightly integrated, and highly interactive, both inside and outside of people.  How a change in diet, fatigue, air pollution, architecture, sunlight, muscle tone, or repetitive noises can influence someone.  This can interact with family relationships, work performance, a personal slight, a sexual flirtation, a political point of view.  These things can affect family, friends, neighbors or a whole subculture. Those things have political ramifications that can affect diet and air-pollution that can affect how glucose can form the proper bonds with other amino acids, which can help or hinder a gene from performing its function properly.

       It is vastly complex, and I understand that no one can really have a real grasp on the details.  But it is exciting, fascinating.  And mostly, it is real.

       And anyway, I’m not that good at details.