Another Year is Coming!

Another year is coming. not much we can do about it , except stop marking time.  Time, in many ways, is a concept invented by fairly modern men.  I say men because when they started marking time I don't think women had much influence, but I can't be sure. Some wife in ancient Babylonia may have told her husband not to come home late.  He might have answered, "Late?  I don't know what you're talking about.  I'll get home when I get home.  That's what happens."  But they didn't have Apple watches then, which do tell the time somehow, and also show the text message from your wife reminding you, and the  pop-up screen that tells you when to leave and what the traffic is on the way home, as well as the weather, and emails from work that tell you what you have to do when you get home -- so that being home with your wife won't be the same as she hoped it would be.

Others, like some physicists I know, explain that time is not invented, it is the fourth dimension, and it has existed as long as our universe has existed, and it may or may not have existed before that.  In our universe, the physical laws insist that time can only move in one direction, so that if you get home late, then you can't rearrange things and get home early. But that may be possible to do under the laws of a different universe.  There may, or may not be an infinite number of different universes (multiverses). One of the laws of our universe is that we can't get to another universe, not even using Star Wars warp-speed.  But if there is a unipole -- which allows for an opening into another universe, you may be the one to be drawn into it.  However, if that happens no one knows if you will be able, or if you will even want to come back.

Most of us just go along counting time in the usual way: seconds, minutes, hours, days, months, and then years.  A year signifies, roughly, the time it takes for the earth to take a trip around the sun.  We go through all the seasons, those of us who still live in places where there are seasons. So marking the end of the year, after 365 days -- 366 next year, is an occasion for a moment or two of reflection, and to regain the hope that the world will be better and that we each will use this demarcation in time to reprioritize our own lives so that we may live happier, healthier, more creatively and do things that make us pleased to be who we are.

So here is my brief list of New Year's resolution Do and Don't:

1.  lose weight -- if you've already tried to do this, and if you were not too successful, then don't bother.  The odds of any individual losing weight and keeping it off are very against you.  There are so many reasons, from genetic to physical to psychological that make it very difficult.

2. Exercise -- this one is a bit more achievable.  Anyone can get up from where they sit and walk around the block, go up and down a flight or two of stairs, do some push-ups, or strike some ago poses.  Exercise, moderate to vigorous, is good for your body and brain. There is a line, especially at my age, when instead of building up muscles, heart and lung capacity, I find it hurts and I get injured. Pain is a good indication of when what you're doing is wrong.

Have joined gyms in the past, not now.  To me they are boring.  The only good part is I got to listen to music, but it takes so much time to get there, change, shower and go home.  It's easier to walk around the block. I know a lot of people who have always exercised either through some activity they enjoyed or sports.  There are just as many who find that regular exercise is unpleasant and boring. It seems that the ones who like doing it, do it.  The others don't.  Changing from being one of those to the other is very difficult.

3, Mindfulness -- Boy is that the thing, isn't it.  Seems like a good idea, but I'm not sure if it is another health fad, or has real benefits that last.  They say it can clear your brain if you get good.  It's difficult to learn how to do it right if you're pretty anxious to begin with, and those are the people who it's supposed to help the most.  Try it if you wish.  There are many sites that will teach you how.  Be suspicious of the ones that try to sell you stuff.

4.  Blogging.  I'm going to blog on this site twice a week next year.  I now have the time to do it, and I find what I have to say quite fascinating.  I also want to see if I have the discipline and capacity to follow through.    I don't think I'd be a high pick on a fantasy-bloggin site.  We shall see.

But do this for me.  Try to enjoy yourself, in both ways that are important.  Way #1 is to have fun: laugh, be with people you like, do things that are easy and interesting, whatever it is for you -  movies, sports, kids, music, sex, staring out the window, hiding in the closet, tickling a three year-old.
Way #2:  Do something that brings satisfaction, that feeling of doing something for others, doing something that was difficult, figuring something out that was useful, fixing something that was broken, or creating something new that serves a purpose.  If you do #2, you will enjoy doing #1 much more.

2016 -- Wow -- Who Know!

Winter Sing

In constrast to my last post, I will now report that I have just returned from a delightful experience. Of course, being who I am, I felt the mirror image of what I saw, and that troubled me.

This morning I went to the "Winter Sing Concert"of one of my granddaughters at her nursery school. The singers ranged in age from 3 to 5, and were all smiling, giggling, active beautiful children.  They sang songs of  snowflakes melting on their faces, and other songs of the seasons.  Many of the songs were accentuated with hand gestures or body movements.  Most of the kids were paying attention most of the time.  They were smiling and waving at their parents and grandparents who filled the audience.

The concert was given in small but beautiful auditorium, on a small but beautiful campus, set on a hill overlooking the woods and a lake.   After the songs and dances were over we were taken back to my granddaughter's classroom for little snack and a look at their accomplishments.

My immediate reaction to the classroom was that I was jealous.  I wish I could go to a room just like that for three to six hours a day.  They had almost everything conceivable to encourage anyone to explore, play, create, express feelings, attempt new things, find new ideas, relate to others, work with others, work by yourself. or just sit and stare.  They had separate but overlapping areas for painting, coloring, drawing, music, writing,sculpture, piles of natural objects, piles of building objects, rolls of string, and shelves full of books.  There was room to use all of those things, and to combine as many as you wish.  There were very few rules, very few assignments,  nothing rigid, nothing judgmental, no dogma, no right or wrong. It is just a  fantastic place to come and play and see what you wanted to do and be with people to do it with.  And, the place is surrounded by paths through the woods, big and small sculptures, and fields for games and just running around.

Oh, of course, there was nothing electronic.

It was clear that the kids loved the whole thing.  They liked being there, they like each other, the teachers and the activities.  They ran around, they made pictures, stories, skits, games, and all kind of projects.  They worked alone, in small groups and in big groups. They resolved their differences.  They helped each other, the added on to each other's creations.   No, it wasn't perfect, but it was close.

It is in an environment like this that toddlers turn into children and take that with them when they become people.  They learn how to operate in the world and how to operate the world. They get some idea of how to get long, how to lead, how to follow, and how to go off and do their own thing.  Mostly, they learn that world is fun, fascinating, and that they can contribute.  This becomes part of them.

So, what's wrong with that.

Nothing. There is so little wrong that I wish every child could have that. Really,I wish I could be doing that.

The only thing that bothered me was seeing that 95% of the children were white.  100%  came from families who were at least in the top 5% of wealth. Every child had at least one parent or grandparent there, usually two, three or four.

I don't know all of the children and families, but the ones that I do know are really good people.  The kids are not spoiled, too much.  The families seem to have some sense that they are fortunate, and that they can have these kinds of privileges.  I don't fault them at all.

My realistic hope is that my granddaughter will realize how fortunate she is, and use her special opportunities to do good things that benefit more than just the few people around her.  At least she will see that the world is not really like that, and she should appreciate that she landed in the right spot.  It doesn't make her better or more valuable than any other child, but in some ways gives her a greater responsibility to be a good citizen.

My unrealistic hope is that somehow, our society, which at this moment,  is so crazy, competitive, divided and fearful, will realize that it would be worth it to find a way to give every child a opportunity to begin their lives in such an open, caring, accepting, encouraging and explorative atmosphere.

If we really want America to be the greatest, most innovative, creative, caring, prosperous, society, with a sense of unity and pride, then we should be eager to give everyone this kind of equal opportunity to stretch the limits of their talents and abilities.

The kids I saw today are all marvelous children.  Almost all of them will go on to have happy, secure, prosperous and healthy lives.  Many of the children from this area have gone on to do much more than that, and to use their skills and talents in the wider world.

From my work I know that as 3,4 and 5 year-olds, these kids are no greater or more special than any other kid.  If I could put any child into that room for three to six hours a day, and bring their families there too, 95% of those kids would grow up to be just like these kids, and the country and the world would be much better off for it.

We are, each of us, unique. We are each just as valuable.

Call me Crusty

That's Crusty, not Rusty or Grumpy. It's a variation on the theme.  It's an attempt at self-definition, because, as the transition continues, defining my place in the universe becomes elusive.
That's not necessarily a bad thing, but I had been so selfishly well defined for so long that it is an adjustment to be so free-floating.

Two days ago I spent the day being my old self.  I was back in my office being the good therapist. I still am a good therapist, which is still gratifying.  The people who came to see me are really pulling their lives together. Almost all of them will no longer need me, which is my goal. Sure, they would almost all continue to come, because it's always good to see a therapist. But they really can do as well without me, and I want them to realize that, and believe in their own judgement.

Even though I feel I m still good at what I used to do I no longer feel that doing that is good for me. Sitting too much is bad for my neck and my old, expanding prostate.  I also feel that there should be better ways of doing what I was doing, and I want to spend my time figuring out how that might happen.  I have some pretty clear ideas of what needs to be done and why.

But that doesn't mean that the world, or even more than seven of my colleagues will stop and listen, or really have any interest in what I have to say.  My profession, like every profession, has people who are respected and have risen to a place of authority. And, like other professions, those people are much more invested in keeping their ideas going than in exploring new ones.

Now, I have never cared much about respecting those who have become the visible leaders. There certainly are some of them who have done some great work and some very helpful thinking, and I have respect for them.  However, IMHO, most of those who are well known, are those who have the best marketing skills, or have latched on to someone who does it for them.

It is quite clear that marketing has not been my strong suit. Yes, I did what I needed to make my practice work, but after a bit of a push things ran smoothly. But beyond that I did little more than yell from the back bench.

No trumpeting Trump am I. Yet, if that kind of momentary garbage succeeds, do I want to be part of that parade. Makes me sad.  To see people so easily mislead, especially in this time when there are so many real, exciting, uplifting discoveries.

But primitive comes naturally, thought, refection, planning, walking up hill, looking for empirical evidence, takes more energy, and a bit of discipline.

So now, as I try to spread my own gospel, I have to wonder, am I just another old man screaming crazy ideas in the wilderness, or will persistence and fortitude, aided by the truth of my message eventually be persuasive.

It is the ancient therapist
   And he  stoppith one of three.....

An Almost Civil Disagreement

Max and I disagree.

But we are civil enough to at least attempt to discuss our differences.  We both admit that neither of us should expect to sway the other one at all.  We also will try to present our ideas in terms that could possibly be consistent with the other person’s values.  But really, since we certainly don’t share values, we have a tough time understanding why the other person is such a moron, especially when the truth is so obvious.

However, to begin with, we actually both agree.  We agree that our great country, the land of the free and home of the brave; home of the creative, the entrepreneurial; beacon of hope to the world, with a government of the people, by the people and for the people, — is a mess, and headed in the wrong direction.  We also agree that part of the problem is how terribly divided the population is, and that this division has become more hostile and disrespectful. 

We disagree about America’s priorities, more specifically about what to do about taxes, health care, big government, wages, education, race relations, immigration, refugees, war, weapons, guns, banks, the Fed, welfare, climate control, energy policy, Donald Trump, Hillary Clinton, All of the Bushes, Israel, Muslims, Christians, Jews, China, the Middle East, the whole defense budget, cities, suburbs, sex, the electoral college, the right to vote, abortion, transgendered people, soda and salt, and many, many other ways in which people care, govern and relate to each other.

We have some overlap in our ideas about Russia, job training, Ben Carson and gay people.

If you want to know more specifically what his positions are, then watch Fox News and read the Wall Street Journal.  He has those positions down pat, almost word for word. My ideas, which I like to think are the result of hours of thought and refection, after reading many sources, are actually close to what you get from the New York Times and NPR.

Not surprisingly, Max was raised in a rich semi-rural suburb in Virginia.  I was born in Brooklyn, NYC.  Really, that’s all you need to know.

Here are some of my generalizations of where we disagree.  If you want to read what Max  thinks, then you can go find his web page. He believes that people should be self-reliant.

Max believes in good and evil.

I believe in cause and effect.

Max believes that the most basic American freedom is the opportunity to make as much money as you can, and that the government should stop messing around with that.

I believe that America’s greatness comes from how it guarantees freedom of speech and thought. The government is there to protect us all equally from being exploited, intimidated or harmed by anyone. I also believe that the government should do whatever it can to help all of us improve our lives, liberty and pursuit of happiness.

Max says he believes that all people are created equal and are free to do whatever they want with their lives.

I believe that the rich and powerful have always, always, exploited those who are poorer and weaker, and that they very rarely give up their advantages without a struggle, often with violence, but not always.

Although he hides behind euphemisms, Max believes that some people, mostly those like him, are intrinsically worth more than others, due to their native endowments.

I believe that we are all equal in our insignificance.

Max believes that men and women are equal, but also that they are basically different, and they should both keep to what they are best at doing.

I believe that is bullshit, sexist and exploitive.

I believe in science, and in using data to see what is going on and to help make the best decisions.

Max feels that science can be confusing and can be used to prove anything, and that good, common sense is enough to decide what should be done.

I believe that due to rapid advances in science and technology, shifts in population dynamics, and climate change, this country is going through a major transition, and once all of those things are recognized and accepted, and we learn how to integrate all of these new things into how we live and work together, our country will be much better and stronger.

Max agrees with all of that except that last three words.  He would substitute weaker and worse.

I think we both would like to find some common ground, but we don’t know where.

We have tried talking.  We have even tried listening.  But we both have very strong core beliefs that we can’t give up. It makes compromise difficult.

Bang, Bang....Again

Bang, bang.  another white man fires an assault weapon into a crowd of unsuspecting people. He is not a Muslim. He was hardly on anyone’s list of really dangerous people.  It’s just another shooting that will make the headlines for a day, or maybe two, and then, like all the others, just fade away onto the long list of pissed-off, white men shooting people they don’t know. That is, unless the bullet went through your husband, sister or child. There have been about one school shooting a week, just at schools, since the massacre at Sandy Hook.

Already, it is clear that the explanation for this man’s behavior, as with all of them, is that he has”mental health difficulties.” This is a concern of mine since I am a mental health professional.

But this one at Planned Parenthood, in November, 2015, has upset me, perhaps even more than the others. This one appears to be much more of an American Terrorist who has been motivated and encouraged by the current level of political antipathy.  But I doubt that Carly Fiorina, or Fox News feels that they have any blood on their hands.

I followed the messages on Twitter that were responding to the shooting as the man was being surrounded by the police.  So many of them were supportive of his invasion into Planned Parenthood.  I realize that it was Twitter, and that is the place to say as many outrageous and inflammatory things as possible, but so many people, many of whom seemed to base their comments on religion, felt that the shooting was somehow justified.

What frightened me was how these messages were full of the same kind of certainty, and the same kind of blind religious fervor that makes everyone fear ISIS.  But that is a part of the freedom that America offers — the freedom to believe anything you want, and to turn in into a public truth.

None of these thoughts are completely new or wildly insightful.  It just becomes increasingly upsetting for me, as I age, to see that even though so many aspects of our lives have changed, evolved and improved, these improvements are always followed by a strong paranoia about change. At some level there must be a genetic predisposition to fear differences.  Changes in the way we live makes things feel different. People fear change. Fear is a more powerful and protective emotion than curiosity.  We have to feel safe, and somewhat secure within ourselves to be curious. Fear takes that away.

Fear distorts our judgment about how dangerous a threat really is. The fears people have can be mollified by classifying the dangerous person as an outlier.  We always say that the person who frightens us has mental health problems.  He is not one of us, just like the foreigners, the Muslims and, very often, African-Americans.  Politicians know that fear is very powerful, and they often inflate it, to distract everyone from calm, rational, reasoning; from finding a response that may be beneficial, that could lead to a solution beyond just placing blame.  Stoking fear has always been a very successful strategy. 

Any American is much more likely to be harmed by a disturbed white man with a rapid-fire weapon than by a band of ISIL jihadists. But I guess we accept that danger as part of the great American tradition of freedom of expression mixed with the right to bear arms. 

That’s what frightens me.

A Holiday Hint, from me and Rosanne

        I would like to begin by wishing everyone a happy, and healthy holiday season, whatever your holiday may be,  I realize that for many the holidays are full of stress and expectations.  There are already many excellent pieces of advice and guidance posted all over the Internet.  They range from how to deal with your crazy uncle to how to deal with your turkey trauma, and how to come out to your family on the holiday. Read them carefully, and take from them what you can.

I have been a psychotherapist for over forty years. I believe I have seen or heard about almost every aspect of the human condition by now.  I still get surprised from time to time, but I don’t think there is anything that one human could do to another that would shock me.  My view of interpersonal behavior is that it is often distressing and depressing, but just as often it can be uplifting and inspiring. 

Over the years I have gained a great appreciation of how complex human behavior really is.  All of our thoughts, feelings and behaviors are shaped by so many factors, both within us and around us. And all of these influences are interacting with each other all of the time. Nothing stays static, there is never a break, life continues.  It is usually almost impossible for us to really understand why we are acting or reacting the way we are at any certain moment.

I often quote one of my favorite philosophers on that subject, many of you may remember her, the great, and unfortunately late, Rosanne Roseannadanna.  In almost all of her short philosophical statements she would say:

“It goes to show you, it’s always something.  If it isn’t one thing, it’s another.”

To that I would add that it is often more than one thing; it can be many, all at once.   You get demands, ideas, expectations and affection  from your parents, your spouse, and your kids.   This happens at the same time that good and bad things are going on with your job or at school.  The immediate state of your health can make things dramatically better or worse.  Other things, such as your friends, your house, the weather, and your finances also are playing a part.

This is especially true during the holiday season. This is a time full of a constant stream of emotions,both positive and negative, which are more intense than usual. There may be feelings of inclusion and feelings of exclusion.  You may experience feelings of great joy, but they can also be mixed with strong feelings of sadness and loss.

The only advice I would like to give is very general: take good care of yourself.  You can do this by being more aware of what is going on around you, and who is doing what to whom.  Try to anticipate what will come next and prepare a way to deal with it.  And, once you are feeling mostly okay, then take good care of those around you.  That’s really what all these holidays are about.

Good Bye "Rita"

I went to work again today.  I am doing clinical work on an almost weekly basis.  I am trying to help a limited number of patients get where they want to be, and still carrying a few others who will never get there.  Today I said good bye to one of those who fit into the later category.

"Rita", ( all the details have been changed) I will call her, is even older than I am, and she is in much worse shape physically. I first saw her over thirty years ago for a brief period of time.  I saw her five years after that, and ten years after that, and finally, three years ago she really came to see me on a regular basis.  Last year I saw her only four times as she was physically unable to get to my office.  She was brought to this last appointment by her son, and she hobbled in on a cane.

Rita first came to see me on the insistence of her doctor who told her he would commit her if she didn't keep her appointment.  In those days it was much easier to send someone, especially a woman, into the hospital, and they would often stay there for months.  She was one of those women who was well known around the community.  Some thought she was volatile, others just called her nuts.

She always dressed very provocatively, which made it difficult for people to realize how smart she really was. She ran her own insurance agency and she knew her business well, and ran it honestly.  But she was ultra-sensitive to personal slights, and was overly suspicious of people's motives.

Over the years she came to trust me, mostly because I helped her stay out of the hospital.  She finally let me know about many of the thoughts she had about who was plotting against her, and how people took advantage of her.  I came to understand that the lines between what was real and what was distortions were very slight.  She wanted attention; she wanted affection, many people took advantage of that.  Because to that her fears and suspicions became exaggerated over the years. The more distrustful she became the nastier she was to people, which, of course made them pull away from her and avoid her.  She knew they were talking about her, and they were.

Now she lives in the back room of her son's house.  She hides from her son's wife.  Her only consistent contact comes when she talks to her former husband on the phone.  She pushed him away years ago.  He didn't want to leave, but now he is down south and won't come back.

The last few times she came in, including this final one, she retold some of the earlier stories of what had happened to her, how people mistreated her, and how she had responded.  It is fascinating to see how those stories have changed over the years.  In this last retelling she now recalls events as having much less conflict than in her earlier accounts.  She also has a much more positive memory of how she acted in many situations.   She now remembers herself as avoiding trouble when before she had been the victor in epic battles.

This may be because she no longer feels the power of the anger she used to have, or she just as mellowed and wants everyone to remember her as quiet and sweet.

We had a comforting last session.  We reviewed a lot of what we had been through together, but now we can leave it all in a more comfortable context.

Her children, who battled with her for years, and whose lives she certainly made very difficult, will all be with her for the holidays.  For her that it is Shakespearean: All's Well That Ends Well.

Terror, Violence, Instability...Crazy?

Another shocking act of terror, this time, again, in Paris.

The purpose is to be shocking, the purpose is to terrorize. Twenty years ago I remember reading a prediction that this would be what the world would be like.  After the disintegration of the Soviet Union, the idea of a lot of "asymmetrical" battles would occur against fanatics.  They would not represent countries, or anything or anyone that a nation could clearly go to war against, just random acts of terror like this, designed to make everyone feel vulnerable, anywhere, any time.

I gave my little talk last week at the Psychological Convention.  My talk was premised on the idea that emotional and psychological problems are very complex, and that their causes are not just psychological, or biological, or familial, or environmental, but all of those things -- all of those things interacting, all the time.

One of the questions I posed to the group was, " Are all suicide bombers crazy?"  No one answered that question and we moved on to the Big Data part of the discussion.

But clearly now, that is a relevant question.  What does it take for someone to decide that it is a viable option to go and kill as many people who have done nothing to him, with the knowledge that he will almost certainly die himself while doing that?

I guess, at some level, they have to feel their cause is that important.  Do they also think their lives have no future, or do they believe that they will be given a greater future in some kind of after-life?
Or do they feel that the resulting infamy and media coverage is enough to have made their lives worth it?

What kind of group pressure, family pressure, religious fervor, does it take?

This kind of behavior is not new.  Countries, empires, city states, have all been able to convince energetic, healthy young men to go charging into battle for centuries, often at the cost of their lives. All for the greater glory of....what?

Even now the U.S.  has its soldiers all over the world, and now we will certainly have more of them, going into battle against these forces of terror.  Battle, often to the death, has been the way of humans for as long as their have been different groups that can oppose each other.  Religiously, it began right at the beginning with Cain and Able.

But now, the world is much more interconnected.  More and more people are beginning to feel that a person living in China or New Zealand, is very similar and just as worthy a soul, as a person living in Ferguson, MO, London, Moscow or Mogadishu.  We read the same internet news, look at the same pictures of kittens, trade with each other, lend each other vast sums of money, and visit each other's countries in numbers that were unheard of fifty years ago.

But, there are still many, probably a majority of people, who feel that their culture, religion, race, subculture, family, is better, and more important than any other.  They feel that anyone, or any slight difference is a threat to their survival, and therefore needs to be destroyed.

It is the struggle between these two world views that is going on now, internationally, and nationally here in the U.S.  It seems to describe the differences between our two major political parties.

In some ways, both of these views are correct.  The world will not be safe until we all learn to understand each other and resolve our differences peacefully.  We now have the knowledge and technology to be able to do that.

But until that is done, there are people who will fight that goal, and insist on destroying it, and "we" need to be protected from "them."

Presentation 2

My presentation will be this Saturday at one of the big convention hotels half an hour away.  I will give my talk in the middle of the afternoon, when most people will be tired and sick of being there. But they have to stay to the end to get their CEUs.

I'd better be entertaining.

The point of my talk is to try to get Psychologists to realize that it is time they moved into the 21st Century.  A great deal of marvelous and exciting scientific work has been done since the turn of the century.  A lot of it is very relevant to Psychology, but not in Psychology.  It has been done in the fields of genetics, brains science, cognitive science, neurology, and even anthropology and architecture.  In addition there have been great leaps forward in computer technology, the collecting of Big Data and using it to find patterns.

This is already being done by companies such as Ginger io and Lyra, among others.

In preparation for my talk I've been bringing up these developments to many of the therapists I know.  They look at me kind of stunned.

What about confidentiality?
What about the centrality of the patient/therapist relationship? They wonder.

To which I answer :

What about the school shootings?  What about the rising suicide rate?  What about bullying?  What about domestic violence?  What about the rise in opioid use and over-doses?

How are mental health professionals really helping to solve these major problems?

What if a lot of these things could be found and prevented with the use of Big Data and computer discovered algorithms?

What's wrong with that?

Can Big Brother really be like a good Big Brother, and be helpful?
What if it is your doctor's office and not the government?

Trust?

Too late.  It's already here.

Presentation -- 1

I've been busy. It has been much more difficult than I ever thought with this unstructured schedule  for me to know where I am and what I'm supposed to do next.  Time fills up quickly, and often far in advance because many people think that I'n not doing much, and therefore they think I could be available to do stuff for them.

Also, many more of my friends aren't doing much any more so they are now available for us to get together and try to figure out a way to be relevant.

Yes, I still work three days a month.  In fact I am going to work tomorrow and I have a very full day. I will be seeing people who feel that their time with me is valuable and well-spent. For most of them, I can see that their lives are improving. Perhaps I am part of that process.

But also, during this time, I am putting together a presentation to give at the fall convention of our Psychological Association.   I am not a very widely published psychologist.  Most of my work has been seeing patients, but every four or five years I get the urge, and a strong urge it is, to tell my profession that most of them are headed in the wrong direction, and this presentation will be more of the same.

But, I've been right before and I'm right this time.

I have spoken in the past, beginning in 1993, about how the world is changing and we are not keeping up.  The insights and methodologies of the vast majority of mental health professionals is both inefficient and often ineffective.  Psychotherapy can work very well for many people, but the process can, and often does, take years, or even forever. There is not enough time or people available to even take a chip out of the huge block of psychological and emotional difficulties that are created by the kind of world we live in now.

Technological and medical research has done a fantastic job of finding ways to treat, and sometimes cure, many of the worst medical conditions that confront humans, but emotional difficulties are so complex that few people know how to do more than target one or two specific symptoms.  But everyone has about eight to two hundred different difficulties facing them these days.  That's why progress is so difficult.

So, I'm working on the paper.  I hope to have time to explain some of it here.  I'm older now, so I have all the answers.  Stay tuned.

Notes

I write notes.  I write them all the time.  The only time I write in a session is at the first session.  After that I don't want to be distracted, because when I'm writing I'm paying attention to what my patient said and not what he or she is saying.  After the first session I write a note about what happened, and what should happen next.

I also take notes about me.  I write myself notes.  I record things I want to write about, think about, or things that I need go do.  Sometimes I actually read the notes I've written to myself.

Today I found a notebook full of stuff I had written in 2009.  It was almost the same as the stuff I wrote and thought about yesterday.  That is sometimes true of the case notes I write.  The issues of the people I see remain the same.  We struggle to overcome something, and often we find a solution, but the person, the basic parts of the person, the mind-set, the attitude, is usually the same.

Age changes us.  I can feel that.  Experience changes us; hopefully we learn. Situations change us, as we have to react different to different stimuli.

But the "mind" that we have created, which is really the story we carry around in parts of our brain that we bring up to tell us who we are, that remains the same.  If you get your nose broken, or you get married, it's still you.

At least that's what we like to believe.

On World Mental Health Day we....

It Was World Mental Health Day.

I began  blogging on World Mental Health Day, which was Sunday, October 10.  I was too late to add the code to get the sticker, so I won't attract hundreds of new readers who want to learn my views on such an event, but that's Okay, as I'm not clear what my views are.

I'm not sure what we are supposed to do on World Mental Health Day anyway. I guess be mentally healthy.  I didn't finish my bog post that day because I stopped typing and watched football and then went out with some friends.  I'm not sure how mentally healthy it is to watch American football.  I don't really think it's a good idea to watch people literally bash each other's brains out, but this year the Patriots are really good and fun for me to watch.

If Mental Health Day was a fund raiser, I don't know who the money should go to.  There are lots of places doing research, but the findings seem to be all over the place.  Also, the entire body of research done on mental health treatment was called into question in an article in the New York Times last week.  The article stated that most of the studies that get published are the ones that show good results.  the studies that show small, no, or even negative results are not deemed that helpful so they don't get into major journals.  Therefore, the body of evidence is skewed to the positive.

Mental and emotional difficulties have very varied and complex causes.  Most of the studies show small things, such as spending too much time sitting in a cubicle, typing insane blog posts, is not good for your emotional health. Psychology offers a lot of little answers to basic problems: how to control your anger, how to get your child to study, ten ways to relieve stress -- mostly why situation X will lead to behavior Y.  Most of these are interesting and helpful, but they don't put it all together, they don't cover everything that is going on in a person's life. What if your in pain? What if you don't have the money? What if your kid is sick? What your boss is on the phone?  What if you have asthma?  What if all of these things are happening at once?  Why can some people handle this and others fall apart.  Why do some people fall apart when the waves hit their ankles and others can keep swimming when the water is up to their neck?

It's complex.
It is.
Be aware of that.
Be understanding.

It's (was) World Mental Health Day.

Political solutions 1

I am usually loath to post much about politics because there are way too many meaningless, useless, baseless opinions floating around the Internet already. Still, I do have some random thoughts, so why not add to the confusion?

It appears that John Boehner actually listened to what the Pope had to say.  That led to          some kind of epiphany and he resigned. He was not a politician I admired, but I fear I           will miss him.

That’s how it is here in the land
of winners and losers, whiners and supplicants.

That, of course again leads to
the visit of the traveling Pontiff.   Why won’t he be included in the next
Republican debate?  Now that would make for some Reality TV.   He’s got more
money than Trump, and a better costume.

I have read that there is a big

likelihood of a government shutdown over the selling of body parts for medical
research.  I think it is time to not shut down the government, but to shut down
Congress until the next election, if not for the next twenty years.  They
clearly don’t serve any function any more. Perhaps this democracy thing has run
it’s course.  It may be time for Oliver Cromwell, even flawed as he was.  A
good, self-impressed bureaucrat who can execute corrupt government officials,
corporate executives, bankers and hedge-fund managers just because he doesn’t
like their attitudes. A few executions of rich white men could do a lot for this
country.

Why all this?

My girls are stressed. They are worried about wild animals and poison ivy.  But they are four and five years old and they have just been able to realize that the world is full of danger, especially if they're away from Mommy or Daddy. It's a normal reaction.  They have found out that the world is full of difficulties, but that's never going to change.  The difficulties these two little girls face are ripples in the water compared to the waves that most of the children of the world have to deal with, but everything can look ominous when you're four.

What saddens me more is how much fear and stress so many adults seem to be carrying around, and I'm not talking about the folks who are risking their lives to find safety, fleeing from countries where governments and rebels kill everyone in their path.  I'm referring to people who are trying to earn a living, support a family, pay for college, plan for retirement, take care of a sick or old person -- all the things that happen in a life.

I've been reading the book Sapiens by Yuval Noah Harari. In the early part of the book he makes the point that the move from the life of the hunter/gatherer to the agricultural way of life was a big step for civilization, but not a good move for most of the people the vast majority were peasants and had to work the land as long as the sun was up.  A few nobles and royalty lived the life of leisure. Now, I can't say that I agree with this, as I have not interviewed too many hunter/ gatherers. The lives of some of the  adolescent street kids I see actually seem to depend upon many of the same skills that helped the survival of our very early ancestors, and the lives of these kids is certainly quite stressful, so I'm not sure I agree with him.

But the point is this, technological advances, whether it is the ability to harvest wheat, develop GMO crops, find directions with a GPS, or ask Siri how to make onion soup, are all ways that make life easier, but also have the unintended consequence of making life go faster, and thus making people more stressed.

One hundred years ago, when T.R. was president, he would work from 9 Am to noon.  He would send out letters and and wait two weeks to get an answer.  Now everything is instantaneous. The result is that people have to work all the time. If you open an email people expect an answer, immediately.  Now people won't read their emails.

Even fifty years ago most people worked 9 to 5, went home, had a cocktail, watched TV and went to bed.  Now people can work at home, but they also feel the pressure to be working 24 hours a day.

AND, since everything is running constantly, businesses have learned to charge on a subscription basis.  There are fewer things you own; that can be paid for once and that's it.  Every month we pay for cable TV, protective software, phones, cloud storage, data, software,.  Medical companies have caught on.  Drug companies have developed medicines we need to take a pill a week or every day for the rest of our lives.  Nothing is cured; we pay on subscription.  Oxygen tanks are rented, breathing machines are leased.

That means we have to keep on working to make the monthtly payments.  Even a mortgage had a 30 year limit. Iinternet, wireless and medicines go on for ever.

It's supposed to make us healthier, but it creates stress.

So don't worry, the coyotes who roam suburbia won't eat you, but the corporations, who are just there to make a living -- except for places like Volkswagen who knew they were cheating us-- will help keep the stress level high.  And stress corrupts our immune system, which makes us more vulnerable to depression, cancer, diabetes, and just plain irritable pissed-offedness, which stresses relationships.

I don't know if there is a way out, except all of my patients who are over seventy seem to have found the TV station that plays only shows that ran before 1972.  Gun Smoke, Mayberry, and Leave It to Beaver seem very reassuring as the antidote to stress.  Fox News brings on heart attacks.

back at it

After nearly three months I returned to my cozy corner office and sat mostly in the same chair and saw people I had not seen all summer, and one whom I had not seen for ten years.

I spent the whole day there, just one day, but it was certainly enough immerse me over my head in the reality of what goes on this side of the bridge.

I had spent the summer near the beach, watching and swimming as the tides rolled in and out.  Back in my office, by eleven o'clock, after just three hours, I had a much more intense feeling of what it is like to fight against the tide.

None of the people I saw were crazy.  None of them even had bad judgment, even though it could be said they made mistakes, most of their bad behaviors were the consequence of having only bad options available.

By eleven o'clock I had heard what had happened over the interim to realize that not everyone's summer was as blissful as mine.  People suffered with losses of love, money and health. There were  financial losses which were made worse by vindictive family conflicts over the scraps that were left.  These losses were due to illnesses, business decisions made in distant countries, and deceit.

In addition, people talked about the death and dying of close friends and family members. Now there is often a new layer of troubles, which has become more common over the past five years. It is the return of adult children to their parents' home. Often these children, ranging in age from twenty-five to forty, return after a divorce, and bring a child or two with them.  In some cases it is only the grandchild who is now part of the home, as that child's father or mother is lost somewhere out there, due to some addiction, or just total defeat.

Unemployment is down, but the jobs many people have now pay less, have no permanence, and can be very stressful.

Yet, almost all of the people I met with were resilient. With a little support they seem to find a way to carry-on. In the darkness there is a lot o dark humor.  Speaking of her sixteen year-old daughter one woman said:"She broke my heart and went to live with her father.  I was pleased to see how she ripped his heart out and stomped on it, but now she has come back to me."

 My role is to help them sort through options and anticipate consequences, even when the options are few.  My hope is to give them hope that there is some reward for just continuing the process.  That's what we all do anyway.

What adds to the sadness is how little trust there is now in so many of the institutions that we used to rely on to stabilize our world. To a large extent our government is a mess, our religions are being used as often to create conflict as they are to offer comfort, so many businesses seem to be slightly sleazy if not outright corrupt, and the way forward seems very uncertain.

But individually, each person is genuine, sincere, kind and caring, to the best of their abilities, under the circumstances. They attempt to ride over each wave looking for moments of peace and happiness.

The contradictions are everywhere.  The tide comes in, the tide goes out.

Adjusting?

I've been back on this side of the bridge for over a week, but I'm still not good at it. I am reuniting with friends and family who are part of the world, but it's not going that well. Tomorrow will be my first day going back into my office, and I'm wondering what it will be like.
i hope it helps me settle in and get reoriented.

i contacted several people who had told me they wanted to see me in my office.  They all seemed really pleased with the idea.  I was flattered, but I was a bit confused.  What is it that I do?

I spent a good part of today remembering, and I think I've got it down.

I had a great summer.  The time passed quickly and mostly without thought.  I was active, outside, moving around.  Friends came, the kids came, we all moved around together.  We ate, We drank, We hung-out.  As I said, the world on the other side of the bridge was free and light and happy (unreal).

This world is crowded, fast and busy.  It always has been.  But now, after a break like this, it seems crazy and frantic.  Every body's moving fast but things go so slowly. Every one's a little pissed-off because they can't get enough done.  They can't get enough done because few people agree on what the priorities are: Get out of my way! Leave me alone! Listen to me!

Build a road, build a bridge, take the kids to day-care. Go to war, don't go to war.  Vote for this clown, vote for that elitist.  Change the world, but pay the mortgage first.  Give the kids supper.

Sit in traffic, sit in the meeting, but be creative, be innovative. Think of the Next New Thing, watch football, but put the kids to bed first.

It's confusing to me because I don't need to do any of that any more.  I can sit and read fairy tales and watch TV re-runs.  It's more difficult to see the sun set around all these building.

But I do help put the kids to bed -- no fussing!! I do have to pay the bills, and tomorrow I will go to my office and see some folks.  I have been wondering how they are doing.  I hope I can ease them in the right direction.

I still don't have any sessions planned with the three lonely, more than a little crazy, women over sit-five, who really don't trust anyone in the world, except maybe me, sometimes. But they all called, wondering if I'm coming back.  Why did I come back?

I also have another project I am starting that will change the entire delivery of mental health services!!
Because now that I'm on this side of the bridge I feel like I have to do something.  Even if it means sitting in traffic and sitting in meetings.

I'll let you know how it goes after tomorrow.

Staying on this side of the bridge

Again, as it is every year, September creeps in.  The sun rises later and sets sooner.  It’s light comes from a slightly different angle and seems softer, a bit more golden.  The people around me begin to load the kids’ bikes onto the bike racks and head home, as I have done for probably fifteen of the thirty years that we have owned this place by the bay.  More traffic is driving off the Cape than on to it.

To this feeling of an ending, this slight sadness, the melancholy that comes as the last days of a New England summer slip away, Mother Nature usually adds a touch of cool air to let everyone know that it is time to put on another layer and get serious..  It helps make the transition.  But this year the heat and humidity have lingered.  The Labor Day holiday is late, and with it, summer is hanging on.

This afternoon I took the kayak out onto the bay. There was a breeze coming across the water blowing away some of the heat.  It created little swells for me to bounce over.  There were very few boats around.  Almost all of them were working boats, picking up the lobster traps so that the folks who held off their vacations until the last week could have their fresh, local, lobster dinners. I was out on the water alone with the sea gulls and cormorants. I let the breeze do most of the work of taking me home.

This is the second summer that my wife and I have been down here the whole time.  We don’t work during the summer any more. Fortunately, it is by our choice that we hardly have much paid work at all.  In many ways, we are playing our own “September Song.”

It’s our kids who come down for weekends, or for a few of their vacation days.  Now they bring their kids.  We are starting on a third generation coming to this small house, a short walk to the beach.  The grandkids get there in their strollers. The oldest of them are learning to bounce on the waves on boogie boards, and to build sand castles to try and stop the tides.

It’s the unbroken chain of our lives playing out, as it does for so many families who have summer traditions that cement that feeling of family, caring and continuity.  There is a family down the street that all come together for the Fourth of July and again for Labor Day.  They have parents, four sons, their wives, their ex-wives, their  kids and some cousins.  They are a volatile family of arguments and strife, but no one wants to give up the summer, so they come back twice a year and do it all over again.

One of our families traditions is that we never had a TV down here.  It allows us to feel that the whole world is beautiful, prosperous and fun. When we drive over the bridge next week we will again be confronted with the total absurdities and lunacy that have plagued our species since we divided into tribes, or since Cain and Able, which ever you prefer.

We all know that it should be, and could be different, but it never is. So we try to stay on this side of the bridge for as long as we can.

Trying to clean up the mess

I've been back two weeks now and I've been trying, in my own magical way, to clean up the mess I find all around me.  All the crazy thinking I mentioned in my last post.  It seems as if so many parts of our diverse society have become just characatures of themselves.  No one deals with any complexity, few people recognize the overlapping of truths.

But then it gets to be time to step back.  When I see that the same posturing and bullying goes on all over, whether it's about deflated footballs, nuclear war, immigration or the stock market, it all seems like a playground fight between eight year old boys. Certainly, the same level of reasoning.

Look around. Few people  seem to take it at all seriously, and those who do take it so seriously, and seem so obsessed, that they lose all credibility.

I guess it's still summer. Few people want to get all worked up. Most of this stuff will have disappeared before Thanksgiving, and the rest will probably be with us forever, in some form or other  

Today we took our four year old granddaughter on the bumper boats. She had fun sitting in a boat with my wife, trying to squirt me and making the boat go in circles.  She wanted to go on again, but someone pushed the button and the big plaster pirate fired his cannon and water sprayed over everyone.  Suddenly, she remembered she was freighted by the pirates she had seen in some Disney movie and wanted to go home.

On the way home she kept asking questions about pirates, who they were, what they did and how they got that way.  We tried to reassure her that pirates were long ago and far away, and certainly we were watching out, and keeping her safe.

At least the last part is true.

Miss Me?

Hey,

I have returned.
We have been down here by the water almost all summer, but things got too hectic being all relaxed and social so we had to get away.
We headed north to the empty spaces of the Canadian Maritimes.  We saw the big tides come and go at the Bay of Fundy.  They were everything anyone could ask of tides, but I realized that not everyone cares about tides.

While we were away, as I was looking back over my shoulder, we missed a lot of the fireworks that were political in nature.  It became obvious that not everyone cares much about people either. Money, greed, anger and paranoia are still all the rage.  And rage seems to be the right word.

I read a poll that said that most people in Ohio think that the terrorists are winning the war on terror. I don't know what's going on in Ohio, why they feel surrounded by terrorists.  I know here on the Cape I don't feel the necessity to stand guard on the beach.  It may be that the terrorists are behind the ridiculous prices of some lobster rolls, but I can show you a place that sells a lobster roll BLT that will blow your taste buds away. And not too expensive either.

In Florida the state legislature passed a law forbidding doctors from asking people if they owned guns, and if so, are those guns kept where kids can't get to them.   I guess you can never trust a doctor who worries about kids accidentally shooting other kids. Restricting freedom.

Anyway, I'm back now.  I'll take care of all that. Rest easy.

Sanity?wh

It's still summer I've been blissed out down here, chasing the grandkids across the beach   They do funny, startling and often "crazy" things.

What's "crazy"?  That's a good question.  But let's take the opposite approach: what's "sane?"

Here's a brief thought experiment: what would it be like if everyone  the world was sane?

Think about it.

It can't happen can it?

Is there any way we could all agree?  Or, if we disagree to act respectively, be accepting, make reasonable adjustments and accommodations?

If we are all sane, would we have similar standards of what is fair, of what is reasonable?

I guess it goes back to Aristotle, who was looking for "ideals", and the perfect forms and pure ideas to guide us.

We haven quite found them yet.

That leads to disagreement, to tension, to conflict, to stress, to anger or depression, and there you go, You end up with ISIS, mass shootings and 16 Republican crazy people wanting to be President.

Epigenetics - 1

So much information comes pouring in, even when I’ve just been chasing the grandkids across the beach at low tide. I don’t turn on this computer as much any more, because, like most people these days, it seems to be too big and slow compared with all of the mobil devices that I take with me in a plastic bag. Still, so man new, exciting things are happening -- as well as the constant flow of repetitive atrocities and financial manipulations. 

Some of the new information came over the weekend in the very low-tech way, through newspapers.  Because of the glitch in the analogue delivery system we received three papers, one from New York, one from Boston and an extra from Cape Cod.  The Cape Cod gave us local facts and weather, and also a story and picture of a woman who had gone to high school with my son.  She was doing well here on The Cape, except she still had loads of student debt.  Too bad; student loans were another good attempt to put a band-aid on a severed leg. The unintended consequences  soon were mixed with a bit of good old American fraud and deception, and now it’s a crisis.

The NYT Magazine had a lead article by Susan Dominus about two pairs of identical twins who were somehow mix-up 26 years ago and raised as fraternal twins by the two different families.  The four men found each other through a series of connections and are being studied by geneticists and also epigeneticists.

The article focuses mainly on the reactions of the young men, and how they responded differently to the very confusing situation.  It raises the questions of who we are, and what it is that shapes us.  All that nature/nurture stuff.

Although this happened due to a drastic error in a rural medical system, it is relevant  now due to the increasing amount of ways in which families can be formed.  These days, with different kinds of marriages, and so many step-families, and people changing sexes, or just having difficulties having children, the laboratory is an increasingly major factor in the creation of people.

Repeatedly, over my long years of doing psychotherapy I have often  been frustrated by  feeling that I am working with someone whose emotional reactions to certain situations are way beyond what should be expected, even given some difficult situations.  I spent hours working with Lady R, who was very anxious, and saw possible danger in everything.  She did well in therapy, as she was thoughtful and very open to reassurances.  Long after we stopped our visits she would call me after a bad night of fears.  I would spend about fifteen minutes on the phone with her and she would be fine for six months. But i always had the impression that she was being knocked over by the waves of her life, even though they never came up as high as her knees.

By contrast, I have seen people who had awful family histories of physical and emotional abuse, as well as living in poverty, and yet these people were workers and survivors.  It was not as if their lives were without struggles or limitations, but they had developed coping mechanisms that held them steady when the waves of their lives where twelve feet high and threw them against the rocks.

Obviously, we all have genetic differences that shape our personality.  Since the turn of this millennium there has been an amazing amount of work sorting out the kinds of genes that play a part in predisposing each of us toward various emotional sensitivities, or lack of them.  The results of the Human Genome Project, and all the technology that has been developed to explore those areas has opened up vast new ways of adding dimensions to what influences how we all think feel and act.

However it has, somewhat surprisingly,  been discovered that this connection of genes to behavior is much more complex, and much less cause and effect than what was anticipated at first. It has become very clear that even if genes are identical in two people, their behavior has not been determined to be the same.  That is what this articles finally illustrates.  This is what the newer field of Epigenetics is all about. We are learning that Epigenetics is as important as our DNA.

I am now reading Nessa Carey’s book called “Epigenetic Revolution” which begins to explain how changes occur between the time that our DNA, which designs the formation of proteins, and the actual formation of those proteins.  It turns out that, contrary to what was expected ten years ago, a lot happens.  Slight changes occur which affect exactly how and when these proteins are formed. This leads to changes in or bodies, which leads to changes in our thoughts, feeling and behaviors. 

The result of all this is that what happens in your life influences how your genetic script gets played out.  But, it is also still true that what your genetic script is has a major influences on what happens in your life. One cannot overplay the other ( except in extreme cases).

The study of Epigenetics is to determine what affects the expression of our genes. this includes considerations of prenatal development, nutrition, toxins, air quality.  Also, physical and emotional factors play a strong roll, nurturing, family dynamics, structure, safety, stress, and all the other psycho-social elements that psychologists have focused on for years.

The point of this extra long explosion of a post is just to express my enthusiasm about how new science is revealing the complexity of human life.  Our millions of years of evolution have not produced a simple creature that responds to simple solutions.  Our mind, however you define it, comes to us as the result of the flow of many forces all interacting with each other all of the time. 

That is why perfect parents often have problem children.  That is why moral people can be corrupted and great leaders are awful individuals.  That is why happiness comes and goes, and difficulties can be rewarding. As the atmosphere changes, or our food intake changes, or relationships change, or the temperature gets hotter, or we get an infection, we can become different people.

We should, and we will, develop better ways of sorting out what forces help us express our better natures, and what and how to apply them.

Still, as Newton himself found baffling, when there are more than two, or maybe three moving parts interacting at the same time, the possible results increase exponentially and predictions become almost impossible.  With humans, the number of important influences are still being counted.

As I chase the two and four year-old across the beach, I hope that their obvious glee will help them feel that the world is a fun and exciting place to live. One wave may knock them over scare them, and it all could change.  Or they could learn that they can bounce back up and that their family can provide support and safety.  We are all working and hoping for the best.

I said to Them (last time)

Intro:
Below is a bit I recently posted on a list for practicing Psychologists.  In my last post I mentioned that I was worried about the future of my profession and this describes my concern.
As usual I was mostly ignored or else told to shut-up.  At present, most psychologists in private practice are much more concerned about how they really don't fit into the changing health care system, and how their compensation is being reduced.
What I wrote is consistent with what I've been writing about for the last few years: that change is difficult, especially if it means a reduction in pay and learning new skills. Of course it is easier for me to say this all now because I no longer count on the money I make seeing patients.
It is also very possible that I am not just an outlier, or a perceptive critic who makes people uncomfortable, but just a cantankerous old man.
So be it!

Here is what I wrote:

When I was in grad school I drove a cab.  I had to make change quickly, and give people their money in denominations so that they could give some back to me.  Now no one makes change any more. Also, the taxi business is being destroyed by Uber.  Uber drivers don't give change.  Uber riders don't give tips. Yes, there are big problems with Uber, and taxis may, or may not give better service.  Pretty much the market decides. Taxis, just another profession that's disrupted.

I don't think there is, or should be a free market for mental health services.  The people who need it the most often can't afford it, don't know how to get it, don't know they need it, or don't want it. I also think that almost everyone on this list does an excellent job of doing what they can to improve the lives of their patients.  I think that many of will successfully develop a way to support yourselves, using the skills that they have.  If you do that, one of those skills needs to be in marketing.  The APA will give you some help in doing that, but 88% is up to you. (not a scientific %)

I have been in Independent Practice for about 35 years, doing mostly psychotherapy. Due to my age, a bit of financial stability, the changes in health care, and the sudden appearance of four grandchildren I have dramatically limited the number of clinical hours I do, and how I do them.

But, during the last ten years I have become aware of how much I felt the limitations of what my skills were, while also feeling ( of course ) that my skills were equal or better than anyone out there.  I did a lot of reading, exploring, talking and even taking courses in other fields. I now feel even more strongly that the advances in fields such as cognitive psychology, brain science, neurology, epidemiology, genetics, and now, epigenetics, and even criminology, architecture and paleontology offer insights into the determinants of behavior that most psychologists don't pay attention to.  Most of these fields have used new technologies and Big Data to peer into brains and bodies, to find patterns and relationships that were not even conceived of before the turn of the new millennium. 

Also, people's lives are very different.  People work differently, communicate differently, and form different types of relationships. Yes, I still think that having a safe, trusting, confidential therapeutic relationship  can be very comforting, and also produce many positive results. But really, it is not going to meet the needs of our fast-paced, stressful society. Also, several studies show, you don't necessarily need Ph.D. to be good at it.

I feel very strongly that if Clinical Psychology as a health profession is going to be relevant in ten years, we had all learn to combine our knowledge with other fields of study, to find ways of intervening on different levels, such as families, communities and health. We need to lean about mind-brain-body-genetic-environmental interactions.  Human behavior turns out to be very complex.  That's not a big surprise to anyone on this list. But there are tools and knowledge out there that did not exist when I was in grad school, and which hardly get even a passing mention in most of the current psychological literature.

Amazon, Facebook, Walmart and American political parties have become more skilled at influencing and shaping human behavior than both academic and clinical psychologist. That worries me.

Every time someone takes out a gun and kills a bunch of people in a movie theater, an elementary school, a high school, a college, a mall, a parking lot, a military base, a post office,  at his office, at a temple, a beauty parlor, a church, on his friends, on his family, or at a mental health clinic, just to name some of the recent ones, everyone says, "He had mental problem."

Well, what are we going to do about that? Isn't that our job?

I'm sure we can do a lot, and that's a lot of what we should be doing.

*    *     *     *     *     * 

That's what i said to them.The ones who replied mostly defended psychodynamic psychotherapy. Psychodynamic psychotherapy is fascinating for both the clinician and the patient.  It can also be very comforting.  But it often goes on for years and is not effective for people who are being smashed by life.

But I won't bother them again.  I will seek a more persuasive outlet.  Until then, I'll just occasionally spew it out here.

Thanks for enduring this one more time.

It Must Be Me

It's still summer.  Beautiful down here, as I said last time.  Friends, family, people, food, drinks, sun, sea, surf, stars.  Lots of stuff to do.

My wife and I played golf yesterday. We are not good golfers.  I have almost gotten to be mediocre, but I don't play enough.  I began to play because it is one of the few sports my wife will do.  She gets bored after nine holes.

We played on a hot afternoon at one of the local courses.  Since it's summer and busy we were paired up with a couple of guys who are about my age who were golfers.  The were buddies, and they said  they play about three or four times a week. They were were nice people and friendly to us.  They were very good at golf. At least a stroke a hole better than me, more on harder holes. But they didn't seem bothered by us whacking the ball around.  They were mildly competitive with each other. A lot of kidding back and forth.  They seemed to repeat things they had said to each other for years.

Often, when we are paired up with another couple, we get to know a bit about them: where they live down here, where they lived before, what they did, how many kids, grandkids, where they like to eat. just general stuff.  When we get paired up with men, they are polite but no information gets exchanged. These guys talked to each other about fishing, about grilling, and about watching golf on TV.  I don't know if they had wives and families.  They could even have been married to each other, although that seemed unlikely.  Although, really, they were. They seemed like guys who had worked at a job for many years, and now they were happy to be finsihed with it.  They were free now to do what they wanted.  They had earned that.

Today, I went out by myself in my kayak.  Paddled down the river and out into the Sound.  I paddled through the little waves out to the mound of rocks.  Looked at the land, sea and sky, and wondered again who I was and what I was thinking about.  I think about thinking too much.

My wife was busy all day so I stopped for some clams and a beer. I was going to sit at the outdoor bar and chat with the folks who were enjoying themselves, but as I passed I heard they were talking about drinking, and drinks.  The talk was a bit loud and a bit sloppy.  They obviously knew what they were talking about and had been at it for a while.

I just  moved on to a table.

I'm a  fun guy, but not in the ways that most people have fun.  I like to drink, but not that much.  I like to play golf, but the score doesn't matter. The only movies I like are strange and have been seen by about three dozen people.  I get bored by most novels.  I don't believe in happy endings. I love to talk to people, especially now that I don't have to help solve their problems, but I make jokes they don't understand, and references to things they never heard of. I think a lot of things are funny. Many of them are the things other people take seriously.  I think I'm funny.  I'm really good at entertaining myself.  I get all my jokes.

But I can't just relax and enjoy everything day after day.  I can't just take care of myself and let the rest of the world go off and do it's thing.  I know when it does things often turn out badly.  I worry about my kids and my grandkids.  I worry a lot about my profession.  Psychology, and the treatment of mental health issues are not evolving fast enough.  They are not keeping up with the rest of the sciences and with the way the world operates. Not effecient or effective.

But I've been at this for almost fifty years now.  It's time to put it down and let someone else pick it up.  I'm very fortunate to be as healthy and happy as I am.  Let it be.

But I can't.  Things should be better. It bothers me.  Some things have improved, but not enough.  People should care.  Most don't.  They are better than I am at just having a good time.  I'm almost jealous.
But I'd be bored.

I see it with my patients all the time.  Long-term habits are hard to break.

Summa Time, Summa Time

Yes, it's summer.  We have been on The Cape for over a week now. The last few days in June were quiet, warm and lazy.  I rode my bike the mile into town and two cars passed me.  I walked in and ordered a sandwich, chatted with the deli-man, bought a bag of chips and rode home.  We took the grandkids to the beach and I chased them all over the hard sand of low tide. The sun set very late and quietly over the Bay.

I thought I could hear the rumble coming.  Still, I wasn't prepared.

Twenty-four hours later I rode my bike to town to buy sandwiches for everyone.  The road was packed.  I had to wait in order to make the left turn into the parking lot.  It was good I was on my bike as there were no places left to park.  The line to get a sandwich snaked around like the line to ride Thunder Mountain.  The deli-man, his brother, his cousin and the two guys they brought in from the Sandwich Maker's Union didn't have time to look up.  They just read the pieces of paper with orders written down on them and kept chopping and spreading mustard.

The beach parking lots were full. There was hardly any room to put the strollers for the grand-boys.  The tide was rolling in and almost all the soft sand was covered with people. People were chatting, sleeping, digging and flirting. Summer arrived!

It was the Fourth of July Weekend.

America was enjoying it's freedom.  Our family was together.  Other families surrounded us.  My nieces was in a house about a mile away with her husband.  His family was there.  Eighteen people and six dogs in a four bedroom house.  The family next door to us always brings everyone in for this holiday.  They have that house and another one near the beach.  They have lots of people, brothers, and a sister, husbands, wives and kids, ex-wives and step-kids, boyfriends and girlfriends, babies and dogs.  I never remember who is attached to whom. The smile and wave.  They all run a race against each other every years to see if the new wives are faster than the ex-wives.  Whatever.

A few hundred people turn out at night for the fireworks on the beach. Fireworks are not legal in Massachusetts. But for an hour there were almost as many fireworks going off as there were over Boston Harbor.  Lots of little puffs of color in the air, but also many, many big boomers lighting up the sky and filling the night with colors, lights and sounds, falling down on my head from two hundred feet above me. People sitting around bonfires, cheering each booming display. I sat down in the dark and a shadowy form next to me handed me a beer.

Thanks, I said. Enjoy your freedom.

Our kids and their kids all left in the morning to beat the traffic.  Other friends drove in from New York and brought their friends with them. No more changing diapers, just eating and drinking on the porch. They will leave Tuesday morning and other people are due to show up Tuesday night and more on Wednesday.

Somewhere in my mind I am aware of how fortunate I am, and as the real people realize, it is really about Family and Friends.  Yes, I know that somewhere out there some people really take Donald Trump seriously.  But that's their problem  I guess that's what freedom is all about.

I leave you with today's musical tribute:
www.youtube.com/watch?v=xeNAgBFmJpM