The Therapist Mumbles

Back Again

2012-01-30T16:44:00.000-08:00

So, i went away. I had a very busy week from January 16 to 20,including having to go to a funeral. Fortunately, this was the funeral of a friend's parent, and not of a friend. Those are getting closer, I know, but at least not yet.

Then I went away. Took off to the South to find some sea and sun. Being of this transitional age, we now have friends who are there when we get there. More and more of them are taking time, many are taking much more time than we are. They are either older, richer, or laid-off and letting it all go. So this trip was different. I usually go away with just my wife and maybe we will meet someone as we travel, as we have gotten good at stranger-travel conversation. I find that interesting to talk to people from other cultures, like Mississippi, which we did last year. Now we are meeting our own friends, and this time we meet with their friends, each of whom had brought along a friend.

So there we were, at one time there were more than a dozen of us; old wrinkled people, charming, well read, well intentioned, but certainly not as attractive as any of us once were. It's a shame. I realized how much I like to be with attractive people. It tinges things with a bit of excitement.

Now we talk about art and food and wine. (I don't like wine, I'm a beer or whiskey {not whisky} guy). These folks were very interesting, well read, well traveled, successful. We were way down at the Southern end of the country, but we all had lived most of our lives up here within a twenty mile radius of each other. Small world? His kid had played basketball for the same high school my kid played for, only four years earlier, but we had never met. They were business people, an artist, a writer,an editor, a couple of teachers.

But everyone was kind of a bit confused about what comes next. Do we just amuse ourselves, or can we find a way to help the world do a little better. We all agreed that it certainly needed the help. No one was particularly asking for out help, except to send checks. But all of us were amazed and disturbed to see that how the people who want to be leaders are so full of fury, venom and destruction. Any talk of compromise or conciliation at any level, from the neighborhood to between two nations, was only seen as a sign of weakness.

I am back now, dealing with 18 messages, six new people in the middle of crises, with fewer people offering any way out. I won't be taking time off again for a while.

30 1/2

2012-01-13T19:16:00.000-08:00

With the readjustment of my schedule, plus the introduction of two beautiful granddaughters into my world, there has been a big shift in my life. I have three and a half work days followed by three and a half days with little or no work.

The two worlds are radically different. Often, on a day that I am not working, even the idea of having to make a phone call seems like such an intrusion. I have to gear up, rearrange my mind and actively remember how to do it. On the days that I do work I am up two hours earlier. I stretch faithfully, I join the flow of heavy traffic and I am deeply immersed in the world.

Wednesday of this week was one of those work days that were the original inspiration for me to begin this blog. It seemed as if the whole world, in its many variations was parading into my office. I had ten consecutive hours of appointments, each unique and totally different that the previous. It was well after 7 PM, when I cleaned off my desk, and realized that my impression of the day was totally Fellini-esque. 8 1/2 all over.

Most of you are too young to have experienced 8 1/2 at it's original time. The movie is perfect and marvelously done, yet has not real plot, makes little sense, and it may or may not mean what you think. The images are still so memorable and grab that sense of how life is, at those times when life overwhelming and incomprehensible. From the first scene of being trapped in a traffic jam and having a panic attack alone in car, to the end, the parade of the characters, it was an exact description of the feeling of last Wednesday.

The clowns, the acrobats, the jugglers, the beautiful women, the painted women, the fretting businessmen, the sad wives, the lost unfaithful husbands, and the director who is searching, searching for an underlying theme.

That is what I do after a day like that. I still do it after thirty years of doing therapy.
Who are these people? How did they get like this? What can I do for them?
and then, a the meta-level--

Why is the world like this? Why do people do these things to each other? If, as many of my patients say, "everything happens for a reason" why is it that I don't see the reason---
except to continue on, searching for the reason. Or ,as the Guido character in the movie says: "I have nothing to say, but I want to say it."

I stopped on the way home that night and bought a pizza. The next morning I was back in the office. A woman came in and told me how she was proud that she has been making progress. She has recycled six (out of 12 -- probably really 30) clean, empty plastic orange juice bottles that could have had be re-used many times for many purposes.

She did it, but then she cried.

Change is difficult.

Reality is hard to define.

Books 2

2012-01-07T07:32:00.000-08:00

After sitting in a small comfortable room talking to people for roughly an hour at a time for thirty years, certain phrases become part of my repertoire. One thing that I often say to people who are in the middle of making some changes in their lives is this:

"You have to use the small part of you mind that is conscious to make sure you do what you want to be doing."

I am not a Freudian, so I am not saying that you have to overrule your Id, and repress you unconscious impulses. Although, in a different way I am.

What I really mean by the sentence I quoted above is described very well in the book Thinking, Fast and Slow, by Dr, Daniel Kahneman. He describes to types of thinking, one is fast, emotional, responsive and not subject to reflection. He calls this, cleverly, System 1. System 2, is what I deal with in therapy. Slow, contemplative, thinking about thinking, reasoning, more rational, planning.

System 1 is much more primitive and emotional. It is there to help us survive in a tough world. If we are going to catch food instead of be food we have to learn how to react quickly, using very little information to make decisions.

However, in the world we live in now, things are much more complex, and thankfully, more civilized. The people who do best are those who can see the longer-term consequences of their actions:

Getting angry and smacking someone is System 1. Getting angry and realizing that smacking someone will lead to bad things for them and for you, and thus learning to rephrase your argument so that you can negotiate with your adversary, is System 2.

As I said, learning to use System 2 is what therapy is all about.

In some ways I have been saying that in this blog. To publish a book these days it helps to have a "platform" to give you credibility. Dr. Kahneman won a Noble prize for this work. He has a bigger platform than I do. HIs book is easy to rad and helpful.

I think it's always helpful to think about what your thinking about, although it can get tiresome. Then you need to take a break and watch football.

Books, (1)

2012-01-01T18:23:00.000-08:00

Hey, Happy New Year.

I hope you're all well and had a good holiday week and now you're rested and ready to make this year, 2012, the best ever. Of course, we have one more day off tomorrow before we have to put in all that effort.

But this is it. This can be the best year ever. We know how to do it; we just don't agree.

Anyway, over the holiday I have not worked too much. Part of what I have been doing is reading, and two of the books are long, heavy, academic kind of things that interest me. I started one mystery and it was really well written, with good characters and a clever plot, but by the middle of it the events became either predictable or ridiculous. I'm not good at letting those things slide, so I went back to these somewhat ponderous academic books.

The first, which I will deal with briefly here, is Steven Pinker's "The Better Angels of Our Nature." He takes about 700 pages to make the point that we, humans, have become more caring and less violent over the last few centuries. In order to make his point he fills hundreds of pages of descriptions of the kinds of torture and gore, rape and slavery that were common for centuries. Most of that, he maintains, is either being eliminated or is at least frowned upon, when forever it was just part of human life.

The point he makes, which is a different stance for him, is that we are not genetically programmed to be violent and murderous. He shows how the growth of civilizations around the world have really served to civilize people. We now care about things that were never even considered as possible, such as equal right s for women, a punishment being too cruel and inhuman, not hanging people for robbery, racial equality, the right to a fair trial, democracy, and the big one, which really has just begun to take hold in the last fifty years, that wars are not worth the trouble, and that they can be avoided.

This is a major new idea, and for most people it just became even a discussion in the 1960s when a lot of soft, educated, rich Americans, like me, were willing to put reason ahead of patriotism to not get hurt. This had always been unheard of, and often resulted in executions.

Certainly, there are still many people who feel that anyone who is of a different race, and women and anyone who is different in any way: gay, foreign, Muslim, etc, is still basically inferior, and because of that they can be easily slaughtered. But that way of thinking, which was once so unquestioned, is now questioned almost all the time.

The biggest example I think, of Pinker's point, is that right now most of the developed world is in a big economic slump, and jobs and money are scarce all over the world. But no one is threatening to go to war over it. In the history of the world, that is something really new.

So, enjoy that idea, and Happy New Year. Let's work together to make it the best yet.

Christmas Again

2011-12-25T18:09:00.001-08:00

Christmas is rapidly fading into the darkness. We drove around looking for lights here in colonial New England. For the most part people are traditional, a candle (electric) in the window, with some lights, mostly white, around a tree in front. This year Home Depot, in addition to selling those wire reindeer must have put out strings of blue, green and purple lights, they seem to have caught on around here.

We came around a curve on one of the more traditional colonial neighborhoods and were suddenly rewarded by a four story house with what must be at least 30,000 lights. Not just lights, characters, ornaments, shapes and trees, and the best part was that each segment blinked on and off in some kind of random, blinding pattern that added to the celebratory chaos.

A quarter of my clients spend Christmas by themselves. Another 40% have to deal with difficult family situations, either choosing to see father or mother, or just plain old fashioned tension, due to constant criticism, rejection or something worse. But that leaves 35% who want to go home for the holiday. They see their parents and siblings and they feel refreshed, sustained, welcome and happy.

As you may have figured out by now, I am not the biggest fan of the religious aspects of anything. But I don't want to get into that now; just ask Michelle Bachmann and think the opposite. But I do believe that any occasion that makes people think for at least a minute about Peace, Love and Understanding is worth celebrating.

I hope everyone celebrated happily, and in their own way. I hope everyone got what they wanted from Sanity Clause.

pushing buttons

2011-12-19T18:31:00.000-08:00

I got to spend a bit of time with the one year-old. She is good natured, mobile, curious, adventurous, friendly and very quick to laugh. I guess you can tell that I like her. It's fun to be around someone with such enthusiasm.

We got her some blocks in a bucket. She picks the blocks off the floor and throws them into the bucket (mostly). The she crawls over, grabs the bucket and dumps it over. She laughs heartily.

But whenever she spots any electronic gadget she immediately heads for it. An iPhone, and iPad, the TV remote. She already knows those things have magic power. She has apps on the iPad. She pushes the screen and animals appear. She pushes it again they made noise. She laughs.

She does Facetime on the iPhone. She smiles into the screen and says "Hiiiii. " Then she grabs the phone, turns it over and turns it off. She laughs.

First I thought, this may not be good for a child. She will think that all she has to do is push a button and the world changes. Then I realized, it is good for her. That is the way the world works.

sloppy

2011-12-08T16:18:00.001-08:00

We went away, the wife and I. She said winter is coming, build your strength. She asked my daughter where to go, the one who has been everywhere, really, everywhere. She said, go here, it is the most beautiful, most far away, the most the way it should be place there is ( and pretty pricey ). So after a long week at work in which I tried to cram everyone in. I made nine phone calls in the last hour to arrange for everyone else. I rushed home and packed.

We went, and it was. The turquoise bays, the warm water, the sloops bobbing up and down. This place was quiet, isolated, with nothing but water. No TV, no music, no radio, no telephones, no golf; nothing but a perfect setting and fine food with people popping up, bringing everything, and then disappearing.

I talked to two men who live on the boats. One brought his wife, one left his behind. They go from island to island. They take pictures of the sunset. They ferry around the people who want to snorkel, or see other islands. They have escaped from the world.

Attractive? I didn't think I could do it, to just drift along, and let the rest of the world make idiots of themselves over taxes, entitlements and financial derivitives.

The trip home was exhausting. I got home and received twelve messages. Three people were yelling, two were crying. One of the yellers was from one of my patients who I had called just before I left. She was the eighth of ten calls. She called back screaming and swearing at me. Apparently in my haste and exhaustion, by the time I reached my eighth phone call I was too rushed, too flip and not all that professional. I thought I was rearranging her appointment as she had hoped, she thought I had insulted her.

She is a delicate, accomplished woman. We had done a lot together to deal with her anxieties that came with the constant quest for achievement against belittling men in a difficult field. Now it seems that one slightly misguided remark had huge unintended consequences. She screamed and swore; she vowed never to talk to me again and that I shouldn't try to contact her.

Now, she did have a right to be upset; I was a bit too flip, but really, what bothered me was that after all the work we did, she was just going to scream and retreat. If she was going to quit and leave me because I treated her badly, (which I really didn't, and certainly didn't mean to) she should have learned how to confront me, deal with it, let me acknowledge my mistake, and then either get over it and accept an apology, or walk away knowing she made a point.

But she didn't do that, so now I have to deal with it as I can, as it isn't ethical to just let her vanish without some kind of follow-up. It will be frustrating. She was a really fascinating person to work with too, so I will miss her.

So, I went home and told my wife that if we sell the house, we could get a really nice boat, and still have enough money to wander through the islands, rum in hand, for a long time.

Except I don't know how to sale, and she doesn't do well if the water gets choppy.

Sucked inot the Internet 2

2011-11-28T17:04:00.001-08:00

Hey, I was home today. It was a gift of a warm day and we went for a nice walk around the lake two towns away. I also got new tires for when it gets cold and snows. The rest of the time I spent "working" from home.

So many of my patients, especially the men, but not only men, many of whom are unemployed, underemployed or have never worked a full month in their lives spent time like this, sucked into the Internet. The day can pass quickly, seamlessly. I learn about things I never thought about. I looked at things that I always think about. I read book reviews, movie reviews, stock reviews, politcal garbage and sports reports. I read your blogs and now I'm writing on my blog.

We are all part of a world that was unknown ten years ago and is overwhelming now. The input is constant and addicting. If you stay away fro three hours then you begin to feel the world has changed and you're missing it.

I can't tell if the world is changing or if it is all a lot of sound and fury signifying nothing. (catchy phrase that one).

But it certainly takes up time, and a lot of emotional space.

Tomorrow I will return to my office and sit with people, facing em, listening to them, watching them cry and laugh and breathe, and for almost an hour they will have my entire attention I will have theirs. That's something special in the world we have today.

No wonder there is such a demand.

No wonder insurance companies don't want to pay for it. So low-tch, so unmeasurable, so unaccountable, unreliable, unstructured and open-ended.

Yet, for so many conditions, it is the best treatment.

That's why I write about it on the Internet.

Thankful

2011-11-23T17:42:00.001-08:00

Tonight he is sitting by himself watching TV. The big picture window now looks out into absolute darkness. Perhaps there are a few lights twinkling on the hillside across the late, but they are far away and difficult to see. Tomorrow morning when the sun comes up he will be able to look across the water at the green hills and the taller mountains behind them. He will make some coffee and sit alone, waiting for his son and daughter to come and join him. He has not been able to have them over for a Thanksgiving meal for ten years.

He is divorced from their mother for about fifteen years. He ran through about thirty women since then. Mostly he ran through about 1000 bottles of Jack Daniels and a couple of pounds of cocaine. That all ended him up in jail as the result of several incidents that he has no memory of being a part of, but that doesn't mean they didn't happen. He realizes that being in prison saved his life. Three years, four months, twelve days.

He's been clean and sober ever since. He has a job now, doing what he knows how to do. At first he went back to the woman who waited for him; the woman he loved in high school, the woman he was with on and off when he was married. But somehow she wasn't that interested in him when he was sober, working, and trying to be stable.

Thankfully, he chose being sober, working and stable instead of great sex and good times. He has run away from six other women during the three years since he was set free.

He found this place. He pays the rent. He breathes deeply and looks at the mist rising from the lake. Tomorrow morning he will put a turkey in the oven and know what thankful means.

I hope everyone else can enjoy the holiday too.

It's a blur

2011-11-16T18:40:00.001-08:00

I can no longer tell the difference between sports, at all levels, The Republican Presidential debates, and Dancing with the Stars. It seems like it is all the same people doing the same things.

Is that Hamid Karzai dancing with Khloe Kardashian?

Is that Michelle Bachmann pitching to Chad Ochocinco?

Who can tell?

something to worry about

2011-11-13T18:09:00.001-08:00

Shelia was referred to me after she spent a night in an ER, with a bad panic attack. She is twenty-seven ears old, and her mother came with her to explain two things that she wasn't sure her daughter would tell me. The first was that when Shelia was nine they thought she was going to die from meningitis. Then, ten years later she was in a car that crashed into a pole, but she had a seat-belt on, and except of slight burns and scrapes she was not hurt. The driver broke about seventeen bones and was in the hospital for months. Her mother said that Shelia had spoken about each of these things once.

It took less than thirty seconds for Shelia to begin to tell me about these two incidents, and then several others that her mother didn't know about. She had gotten drunk and fallen off a roof. She had skied off cliffs, and had done several other dangerous things, clearly not caring about the chances of survival. She knows she had the panic attack when she learned that her friend's mother was diagnosed with cancer. She feels that another person is going to die. Everyone will die.

Shelia told me that although no one said anything to her, she knew when she was in the hospital when she was nine that everyone expected her to die. She has expected to die ever since then. Every night when she tries to go to sleep she is afraid to close her eyes because she is afraid she won't wake up. She told me that they love her at work because work distracts her and if she stops to think about anything else she wonders when she is going to die, so she works hard every minute.

Why bother to live when you're just going to die? For Shelia, that question always hangs there.

She is quite an attractive young woman but she has never dated anyone seriously because she feels like she will die and leave them soon. "Life is kind of useless isn't it? You live for a while, and then you die, so why put all that effort into doing all this stuff?

She told me that she knows she should have developed an appreciation for life. She knows she is lucky to have so many chances. But she doesn't feel that way. She feels as if she has only delayed the inevitable.

I told her that I know how scared she is, but next I said that I know what's even worse is how lonely she is. Then she just cried.

We have a lot of work to do, because I really can't answer a lot of those questions, but at least we have made a start.

11-11-11

2011-11-11T13:46:00.001-08:00

Today is 11-11-11. I have several clients going to weddings that will happen on this mystical day.

The original 11-11-11 was in 1918. It was the day and time to mark the end of hostilities on the Western Front between France and Germany.
It was the end of the War to End All Wars.

It certainly isn't fashionable, but the best I can say is "Sure, Thanks, Whatever."

It didn't end all wars. We aren't saved, things got worse. Perhaps in the last thirty years things have gotten a little better, but not that much.

I am not really grateful for the men and women who died, and the millions more whose lives were ruined and disrupted. I am very sad and sympathetic.

War is a waste. It always was, always will be. The poor and the foolish die to keep the rich and powerful rich and powerful.

Yes, there are crazies out there now who want to randomly disrupt and even kill innocent people in this country. There are also rich and powerful people in other countries who want to get an advantage on the rich and powerful people in our country. It is now, and always has been a blunt and heavy-handed way to gain an advantage for resources, money, energy, and sometimes sex. Often religion has been thrown in to raise the passions and confuse the situations even more.

All I can say is that if I had lost any of my kids, or even myself, fighting in some stupid war, especially something like Vietnam, Iraq or Afghanistan, or really any of them,

I would really be pissed.

So, if you really want to help all the folks in our armed forces: End the Wars.

From the Left and the Right

2011-11-05T11:54:00.000-07:00

This is what I have learned from working in a working class mill city: Everyone is right, everyone is wrong. Or, once again, things are complex; too complex for our political system to handle.

Recently I've begun to see a new patient, Ray (not his real name). He's 23 years old (no he isn't, but let's say he is). He is from one of the local minorities; we have many different minority groups in this city. He came to me because he almost lost his temper and beat-up his cousin. His cousin, who was strung out on various drugs, was pushing his girlfriend around and calling her a whore. The cousin and his girlfriend already have a baby. They live off the money she gets from the state to pay for the child. They don't do much else. They don't seem to want to.

Ray lies with his mother, who works at the big chain store. His father is in NYC somewhere. His father comes home about three times a year. Ray dropped out of H.S. One day when he was bored he signed up to take his GED. He passed it all that day. Ray works, making $8.50 an hour cleaning up a pizza restaurant. He wants to go to college but he doesn't have the money. Two of his sisters already went to college. One is an LPN and works in a nursing home. The other got pregnant, dropped out, and owes about $15,000 in student loans that she will never pay. Ray isn't sure that going to college will help get him a job that will allow him to pay back the money he needs to go.

The politicians on the right say that giving money to poor folk to pay for college is a huge waste of money. Many of them drop out, or get ripped-off by these on-line private schools, or private trade schools. They say government programs waste enough money. They have a point.

The politicians on the left say that the only real way out of poverty, and to get Americans working again, is through education. $8.50 an hour won't pay for a car, not to mention a wife, a kid, a house. People need an education, a good education, life skills, job skills, thinking and problem solving skills.

I say, don't give or lend people money, make college free. Sate colleges should be totally free. They should also raise their standards so that when people graduate they not only know something, they know a lot. There should be free remedial programs for those who do not have the skills for college.

The money for those colleges should come from taxes. Everyone should pay taxes. It's like investing in our country. If you have, you should give. If you take, you should pay back.

But what if you're lazy? But what if you're crazy?

Nature's tricks

2011-10-31T14:12:00.000-07:00

Tis All Hallows Night, the evening to celebrate the dead and dying. Most of the snow is gone from around here, and my neighbors all have their power on, although that can't be said for many of those fifteen miles away. That's just one of Nature's tricks.

As the sun began to slip away I pulled on my black sweats, pulled my too-big black hoodie over up head, pulling the strings on the hood so it comes down over my eyes, then I set out to walk the neighborhood as the Emperor from Star Wars, one of the best known movie villains. I didn't bother to get one of those white plastic scream masks, the craggy lines and furrows in my face from more than thirty years of listening to misery are enough to frighten any six year-old.

Now I have returned and I wait for them to come to me, the princesses, witches, many various animals and super heroes. I don't know if it will be a busy year. There were lots of parties scheduled for Saturday but the storm blew them all away.

I appreciated being able to take a brisk walk, emperor or not. The most difficult patients for me to deal with are the ones who are sent to me to help find a away to keep them going and hopeful, even when movement is very difficult and hope is draining away fast. I am seeing several people who are in tough physical shape. Cancers, which may or may not be treatable, degenerative bone diseases, MS, Parkinson's, crushed vertebrae, or missing limbs. I also have a couple of parents of children who have complex medical problems.

I talk to them; I listen to them. We try to find other things to think about, ways to lessen some of the tension, to avoid some of the pain.

What makes the task more complex is that so often the treatments for many of these problems are often the causes of other problems, and the treatments for the secondary problems can also create new problems.

I don't want to blame doctors or medicine because many of the new treatments are truly amazing, and many people are alive today, and healthy, who would have suffered and died ten years ago.

But the medicines are often so strong, and almost everyone reacts differently. People get dizzy and fall down, and break things. People become terribly allergic and break out in painful rashes, or hives. People can't digest food while taking certain medications and they lose weight or throw-up and then they find that they can never eat certain foods again. People get scars from radiation. People gain weight from many pills, others develop neuropathy, or other auto-immune diseases. What is worse is that it seems that once people develop sensitivities they become increasingly sensitive to almost anything and everything.

Seems like one of those tricks of Nature.

So I just keep walking. Walking and whistling in the dark.

N.B. +

2011-10-24T13:24:00.000-07:00

Nota bene: I have been blogging here, not too feverishly, for about three years. After about six months I got a flurry of questions about the ethics and confidentiality of what I was doing. I think many of them came from pastoral counseling students. I think I reassured them, as I will try to do again, that I am very aware of the importance of confidentiality as a part of therapy. I believe that any patient must feel that anything they say to me will not be revealed to anyone. I inform them of the very few exceptions, such as imminent danger to themselves or others.

I don't think any of my clients could point to anything I write and say "that's me." Although I hope they could say, "that could be about me." I write her to attempt to sort out themes. The theme for me in the last post was partly about how sad it is when someone feels so battered that they choose to retreat from the world. But the other part was about the limits of my influence as a psychotherapist. I can only influence anyone so much. I have come to believe that people cannot, and should not try to do what they are not ready to do. And, they may never get ready, because what I may see as possibilities for them may be something that they will never be interested in doing.

I know that one of my faults as a therapist is to set goals for people that are often different from anything they ever envisioned themselves doing. For many of my clients I have some idea that, if they have not already done so, they should go to college, open their own business, and be in enriching, mutually beneficial relationships. Now realize, I never verbalize that, and I often can see that those are not things that many people expect, or want to do.

The point is that I feel no one should be limited by anxiety, worry. loss, depression, self-doubt, rotten parenting, or any other emotional difficulty. --- There was even that story on the front page of Sunday's NYT that told of a schizophrenic woman who built her own business to keep her psychic demons in check.

Not everyone feels that they can, or want to pull themselves together to the degree that I would like to see. I have to honor that.

And I won't name any names.

not my choice

2011-10-21T19:06:00.000-07:00

I have written about GR here a while ago. She had lost her long-time boyfriend, who was married to another woman, when he died under suspicious circumstances. That was over a year ago.

GR is a very intelligent woman who has had emotional difficulties since childhood. It was not that she was born with deficits or neurological problems, she was just born into the wrong family. Her mother was a religious fanatic, a hoarder, and used her kids to clean and cook. Her father drank too much, and tried to put his hands in the wrong places. GR and her sister went off in opposite directions at adolescence. Her older sister was out-going, thrill seeking and friendly. By the time she was seventeen she had been having sex with two different men a week. Now, fifteen years later, she probably still does.

GR, in contrast, has had two lovers in her life. One got her pregnant. When her son was about five, and GR was home alone and drinking, her mother called protective services and had the boy taken away. The mother took custody mostly so she could collect a check from the state. It took GR about seven years, and all kinds of treatment letters and programs to prove to enough people that she was competent, and she was able to get the boy back.

At one time, in high school, just to see if she could, GR decided to study. She got all"A"s that year and was ranked fourth in her class. No one at home noticed or cared, so she gave it up, as not worth the effort. Twelve years later, while she was seeing me, as part of the process of regaining custody of her son, she went back to college. Again, she did very well for one semester. But then her boyfriend died, and she gave it up.

Now she has given almost everything up. Her son is with her and he is doing OK, not great, in high school. She is on disability because of her chronic depression and OCD. She gets some support for her housing and food stamps. She knows how to scrape by with very little money. She encourages her son to do well in school, make friends, and participate. He seems to be doing that.

She isn't. She leaves the house once a week to shop, and one time every-other week to see me. Otherwise she doesn't want to have anything to do with anyone. She is on an Internet chat list for mothers of adolescents. She plays games on Facebook, but doesn't correspond with anyone. She reads a lot and works out on the floor to videos. She has no idea how long this self-imposed isolation will last.

She tells me that she is not as depressed as she has often been. She gets up everyday and takes care of herself and her son. She sees her current lifestyle as a choice, not a symptom. She knows there is the possibility of a richer, more active, more interesting life, but she really feels there is a greater possibility of more losses, rejection, emotional pain, and of being exploited.

It's not worth the effort, she says. It's not worth the risk.

It's her choice, not mine, but for now I have to honor it.

More examples

2011-10-17T15:13:00.000-07:00

The economic conditions have caused a lot of stress, anxiety, depression, feelings of helplessness, worthlessness, inadequacy and anger. These things are pretty obvious, but they are very detrimental to individuals and families.

As I said yesterday, my practice in this industrial city, is an indication of what is going on in the country. Five years ago I had several cases of couples coming in big SUVs, they were having alcohol and recreational drug problems, and sneaking off with their friends' husbands and wives. Several of the women were even flaunting their newer, bigger breasts. It was all with money they took got from remortgaging their homes.

Now, several of them are back, having lost the home, and at least one of the jobs. The crash has been devastating. They feel cheated, as they were only doing what the world was telling them to do, which was to pump up the economy.

Of the couples who have come back, most of them have figured out a way to stop blaming each other and pull together. That is good to see. It can really be a step-up, away from the foolishness and craziness. People are finally learning that having credit is not the same as having money. If the pain and suffering last a year or two I am sure the lesson will really sink in. If they manage to get a new job within about six months they may think they are brilliant and can get away with anything. Very few people really learn to plan, I think we are still short-term hunters and have to eat as much meat as we can before it rots.

There are many other ways that this economy is making people suffer, especially people in their early twenties, who have student loans and $12 jobs. They are lost and know they can't afford a marriage and a family. They drink beer and watch movies at home.

It seems as if the answer will have to come from local communities. People will have to learn to think small, not look to big government or big corporations who will not hire. They will have to find ways to trade with each other, build a community that keeps services and money flowing amongst themselves.

I see some signs of it among people who have lost jobs more than a year ago and realize they have to figure something out for themselves, something different. They now have cleaning businesses, repair businesses, cooking businesses, very basic stuff.

The older workers, from their mid-fifties up, make these kinds of transitions with a lot more difficulty. They do not welcome the challenge of starting over. They feel they have already deal with enough challenges.

But this is America in the New Millennium. We have been trained not to care.

More on tough times

2011-10-16T19:22:00.000-07:00

It is often said these days that we are going through the worst economic times in seventy years. The world is suffering from the bursting of bubbles, greed, high stakes foolishness and the fall out from chasing false values.

Seventy years ago there was a brand new field of psychotherapy. Freud was still leading the charge, very few people got to experience any kind of treatment besides being locked away in insane asylums, and the treatment anyone received was either totally ineffectual or harmful.

When I was training as a therapist I was made aware that the incidence of "mental illness" among those with less money and fewer resources was much greater than for those who were better off. There was always a great discussion over which was cause and which was effect. I still was trained, and for the most part was able to focus my practice, in dealing with problems that could primarily be described by a psychiatric diagnosis. I have discussed in here how inaccurate and often misleading those diagnoses can be, but the point I want to make is that I felt that I was treating psychological and emotional problems. Many of these problems, I always felt, were the result of conflicts in a person's close interpersonal relationships. Anger, loss, rejection, neglect, shame, scorn and loneliness were many of the themes that often came up in therapy.

I still deal with mostly with those same issues, along with addictions, chronic anxiety, hopeless and powerlessness, real and perceived. But these days I feel that a lot of these feelings are secondary problems. The underlying causes are economic.

There were no private practices of psychotherapy in the 1930s. Today I feel we have to differentiate between what is a normal reaction to not being able to find a job, or any reliable source of income, and dealing with all the consequences that brings. Anger, helplessness, shame, stress, family strife, disappointment, embarrassment, feelings of self-depreciation are common, but they are not pathological. We need to find ways to treat and change these feelings, but the best treatment would be a job.

My office is in an industrial city that is a bellweather for the economy. In the 1990s there were business in this city that had to hire buses to bring workers in from a city twelve miles away. Now those bus drivers are out of work along with a long line of others.

I will give more specific examples of what this does to people, the community and everyone's outlook on the world next time.

Sucked in to the Internet

2011-10-10T18:23:00.000-07:00

Friday was our day to take care of the oldest granddaughter, The Bird, ten months old. She is a city girl and accustomed to watching the sights, sounds, sirens, and special people who traverse the city streets, as she rolls in her stroller from her neighborhood to downtown.

Since I am already sure that the iconoclastic blood of her grandfather runs through her veins I took her down to partake of the folks who were putting on the demonstration, the folks of "Occupy Boston." We read the signs, nodded in appreciation as the folks played the drums, and sought out indications of agreement form passers-by. In general I felt sympathetic.

After we returned The Bird to her parents and went home I began to poke around on the Internet to see what kind of attention the demonstrators were receiving and what who was reacting in what ways. I read articles on about four sites, and read the comments, which always seem to bring out the worst in people. That was my downfall.

The comments on the Fox News site were confusing to me. I knew somehow those folks would be against the demonstrators, but I couldn't see how they would frame it since in many ways it seemed like the same issues that the Tea Party people were also trying to highlight. But somehow the Tea Party people were Patriots, while the Occupy people were hippie-Communists, trying to destroy America.

That where I made my mistake and decided to put in a post in support of the Occupy people and asking for some kind of clarification of their anger. Pretty rapidly I received four responses from people who seemed to be right there, waiting to respond. Two of the responses were just quick and nasty. I was called dirty, immature, and a Mamma's boy who expected to have everything handed to him. One was positive, thanking me for being supportive. The last one was a long message telling me that if I ever had real experience in the world, and not just from what my college professor told me, then I would know that America is only for those who help themselves. There is not a right to expect that corporations or the government should do anything for you expect to allow you to do whatever you want, unless you hurt somebody.

That one kind of intrigued me, so when I sat down again, about seven hours later, and really just to see what button I would push, I responded by telling the person that I have run a successful business for thirty years and I have learned that what is necessary for success is strong and dependable infrastructure provided by a good government, and that no business, and no person really, can survive in this complex society on his own, cooperation and interdependence is necessary for success, especially on a large scale, for a whole society.

In less than five minutes I received a long rambling answer telling me that it is written the Constitution that government should not do much of anything, and that people who expected more were trying to undermine the Exceptionalism of America and bring the greatest country on earth to its knees. He ended with this :

"Nothing you have said changesthose impressions one bit. Justbecause you have run a business doesn't mean you aren't an anti-Americanleftist. It just means you have noappreciation for the gift of being an American and therefore don't deserve ourconsideration of your ludicrous, ill-conceived opinions."

I am posting this here not to show that there are great divides and a total lack of communication across them, as much as to show that there are many, many people, mostly older, angry men, who are on their computers twenty hours a day, defending their world from the likes of me.

Just as I am sure that my granddaughter will absorb many of my values without realizing that it is a choice, I am sure that this person comes from a very different place, literally and figuratively than I do. The sub-culture he hangs around in, whether real or virtual, is very supportive of his beliefs, and it is only due to these advances in technology that we have the opportunity to irritate each other.

I think, in the long run, that may prove helpful to our society. If it doesn't cause another Civil War, it could be preventing one.

Greatness has no time for football

2011-10-07T18:24:00.000-07:00

If almost everyone was as driven and creative as Steve Jobs no one would make much money.

If everyone THOUGHT they were as creative as Steve Jobs no one would make any money.

It takes drive, passion and focus to be someone like the late Steve Jobs. Most creative people have great generativity: they have many, many ideas, some of them are brilliant and many of them are a waste of time. But what makes those people different than others is that they just keep on going.

I have had patients like that -- if they are not successful, if their ideas don't work, or even if the ideas are good but they can't find a way to get them developed or publicized, then they are diagnosed as bipolar- just someone whose mind is racing. If one of their ideas work then they become a success; if two hit it then they are geniuses. Steve Jobs had more than two.

I believe (almost) anyone can do (almost) anything they want if they put their mind, body, time, energy, passion and soul into it.

But they probably won't be able to do much else. I somehow don't think Mr. Jobs went to a lot of Sunday bar-b-ques with is buddies and watched a lot of football. Everything comes with trade-offs.

or maybe he was a Jets fan.

The new one

2011-10-03T17:58:00.000-07:00

Things went OK!
She (it's a she) is home now.
The mother was banged up a bit, but I hear childbrith can get nasty. But that was two days ago and now everyone is home.

All kinds of family clustered around to hold the pink bundle of warmth. The kid seemed to take it in stride, as long as she got feed every two or three hours. She is good tempered, very nicely shaped, and will keep getting better and better.

I am very appreciative that both of my granddaughters live within twenty minutes of where my wife and I have settled. I will see them often and stick my nose into their business. However, what I really would like would be to buy one of those big Victorian houses that fill up the next town, and put each family in on a different floor. I would give everyone their privacy, but I would have access to making sure that everything went along as I wish.

I am not a controlling person, that is certainly not my style, and I know that it doesn't work. I couldn't be in the profession I am in if I ever beleived that people would listen and do what they are told. But I like to have influence. There are ways to be a factor in what needs to happen and to apply a few gentle taps and make sure it goes that way.

Yes, you may say, but your children are parents now, and they will raise these kids in the way that is best for their famiies and their times. And yes, ther is some merit to that. My parents always stayed at some distance except for periodic visits, and my wife's parents vanished into the sunshine.

But I am now the patriarch of the family, and I will steer this ship, and I have a good idea what the course should be. Age and wisdom should be honored and respected.

So, when can we start playing Candy Land, or do we have do that with an App?

The Second One

2011-09-30T20:07:00.000-07:00

My son, my second born, is in the hospital right now, sitting next to his beautiful wife, waiting for her to bring forth his first born. They are going through what seems to be the commonplace medical machinations in order to induce the kid to come see the world. That is what my daughter went through ten months ago, and that is what happened twice to my wife, as both my kids were plucked out, rather than delivered.

So far, the first grandchild has been an overwhelming success. She is happy, curious, expressive, and she loves her Grand-Pops. Whenever she sees me coming she swerves around, looks at me and then gives me one of those wide, three-tooth smiles of welcome that make all the world worth surviving. I take those smiles very personally and I don't want to know if she treats anyone else as well. She looks at me, flaps her arms and raises her hands. My daughter was very similar and joyous at that age, although not as big.

So now a new one will enter our life-space very shortly. I was very hyped- while my daughter was giving birth. She was there with her husband and we all were trying to have Thanksgiving dinner. My mind was waiting to see who it would be, and also very focused on how my daughter was doing.

This time it's similar and different. I cannot know how my daughter felt, but I think I know exactly how my son is feeling, thinking and acting. Everything is almost exactly the same, except for text messaging. I can feel the excitement, confusion, anticipation, responsibility and joy that he is feeling. We have about a 57% overlap in personality, so I have a pretty clear idea.

I was 33 when I had him, and he is 32 now. the world is different but having a kid is very much the same. Is this a good time to be bringing a kid into the world? Who knows? Right now it seems like it could be better, or it could be worse. It is certainly better than being born in 1911, or 1930, or 1937.

I was born in 1945, and that turned out to be a pretty good stretch of time, but who could have predicted that. My son was born in 1979, which is proving to be better than 1989, but a lot can still happen.

Having a kid, if you think about it, is always a leap of faith and a vote of confidence. Of course, a lot of people don't think about it, and many of those kids end up in my office.

As a grandparent I see the sweep of time, the possibilites and the difficulties so much differently than I did as a parent. Being a parent is day to day, often hour to hour, especially in the beginning. As a grandparent it is the joy of a couple of hours, but also the awareness of the coming decades. What can be, what needs to happen, and what are the few little nudges I can add along the way to make things easier, happier and turn out right ( the way I think they should). These kidsare my legacy; things should not be left to chance.

But right now. the only concern is for the next two or three days and that he or she is healthy and robust. If that comes to pass, then being brilliant, creative, beautiful, caring, intuitive, a good dancer and a skilled point guard will all happen in time.

Right now we just wait for the next text message.

A click away

2011-09-26T17:51:00.000-07:00

Perhaps many of you saw the article in The Sunday NYT entitled "When your Therapist is Only a Click Away.

It described how the method of doing therapy over Sype is catching on, and that many people would have more access to therapy that way.

Of course most of the therapeutic community was not too thrilled with the idea, especially those of us who had to climb a fire-escape to peer through a window to watch Howdy Doody, before our family broke down (or saved up) to get our own TV. Most therapist agree that it is important to have a person-to-person meeting in order to have the kind of person-to-person relationship that is necessary for therapy to work.

I feel that being in the same room with patients is much more emotionally intense, much more revealing, and can lead to much faster changes. Talking to a screen, is a little weird for people my age (old). It makes me feel too much like my crazy aunt who had running conversations with the TV.

But it is certainly a generational thing. People under 40, and certainly under 28, have spent much of their lives in front of screens. That's how the world comes to them. So many people have worked in cubicles, staring a screen all day, now they work from home, staring at screens. But it must seem very natural to them to get and give information that way.

I just tried to download some puzzles to my phone. But this app wanted my personal info and my email, and then wanted me to post my results on Facebook and email them to seven friends. I don't want my friends to know I'm doing puzzles on my phone. But I guess lots of people do. Maybe that's why no one is working.

But the future of the Independent Practice of psychotherapy lies with those smart-phones. I can see that within five to ten years many people will have a "Therapist App" which will be a direct "Facetime" link to their therapist. Each of us in independent practice will have about ten to twenty clients, and we will be "on" all the time. Sixty ten minute conversations a day. "Get ready to talk to your boss" --Get back to work --- She looks cute to me, go talk to her -- How did that make you feel? That was an interesting conversation with your mother.

Real emotion, Real behavior; Real Time.

Heart rate, blood pressure, breathing rate, sweat glands, all kind of bio-feedback information will be measured instantly from the hand-held device.

All billed immediately through Pay-Pal.

It will not be the same as the therapy that we give now, sitting fairly close together, with pauses, silences and staring at the wall or the carpet. Having your therapist in your pocket could create all kinds of over-dependencies, or it could keep you shaped-up, as those little lies, exaggerations and omissions that people tell their therapists will become more difficult to get away with.

Things will be different. They already are. There are always trade-offs.

Perhaps five years is too long.

Character (?)

2011-09-23T17:27:00.000-07:00

I was reading last week's NYT Magazine. It is all about how to educate the rich and poor. The big article was about how something called "character" was as important in making headway in the struggle toward success as academic achievement.

A group of several psychologists and educators had this discussion about character and they seemed to come up with two complimentary, but distinct dimensions. One dimension had to do with what it really takes to succeed in this world, and the other had more to do with what it means to be a "good person."

The first one consisted of a bsic group of behavior traits. They labelled these as: grit, zest, curiosity, self-control, optimism, and gratitude. One more, emotional intelligence, I think includes many other traits.

The other dimension included behaviors such as being understanding, helpful, empathetic, and caring. It was much more about being good to others and making the world better for everyone.

I think all of this is good stuff and is really what is important to both individuals and society. I think it is sad that it falls to school to try and impart these kinds of thoughts and actions into people, when really this is what parenting is all about. But i guess parenting and families are in tough shape for many people these days. I see that a lot in my practice.

Not that it really ever been well done. What we now think of as abuse and destruction had long been a staple of family life, and still is in many parts of the world. But now we think that beatings, molestation, honor killings, degradation, silent scorn, rejection and expulsion are not usually the best methods of building character.

When I think of the list of traits of the first dimension: grit zest etc, the first person who comes to my mind is that 10 month old girl I spent two days with last weekend. She was certainly full of zest, curiosity and optimism. She displayed enough emotional intelligence to know how to play her grandmother for all she was worth. She was able to let us know what she wanted without flipping out, and was very gracious when she got what she asked for. Her whole body would shake and flap for joy when she was given a small pile of Cheerios.

What is great is that her parents, through a loving process of allowing, encouraging, structuring, and caring have already begun to instill in her things she will need to not oly survive, but to flourish. I think (boastfully) that I did a lot of that with my kids. What is sad is that so many kids don't get that because their parents are too exhausted, too poor, to unstable, or too unavailable for all kinds of reasons.

But if a kid is neglected, frightened, intimidated, forgotten, or discouraged for the first two years of it's life it becomes very difficult for a school to get him or her to undo the skills he needed to survie and to then learn these new ones. That's what I do in therapy, and it can take years.

I think it is worth trying. I think these qualities are really important. I do think that they are, and can be learned, to a great extent, although each child is born with a different temperament, which makes them more naturally energetic and/or sensitive. But it's a very tough job to retrain somebody, especially when you have to send them back to the environment in which other skills, such as silence, defensiveness and secrecy are more adaptive.

crawling and giggling

2011-09-19T18:21:00.000-07:00

It is a beautiful late summer day. The sun is beginning to slant at a different angle. It is fifteen degrees colder than it was last week. More people are in the neighborhood, looking busier, walking faster. Vacations are over, everyone is back from where they went, getting back to work.

Still, everyone I have been seeing is suffering from th economy in some way. The problem is world-wide. The necessary solutions are complex. Battle lines are being drawn, no one wants to be the victim, so everyone loses.

But this weekend I spent taking care of the ten-month old bundle of energy and amazement. She crawls, climbs, giggles and laughs out loud at everything that pleases her. What pleases her includes plastic bottles that spin, doors that have two sides, pulling herself up on a coffee table and taking everything off of it. Keys and cell=phones seem to be the biggest prizes, and gravity is something worth demonstrating over and over. However, making a ball go up in the air, against gravity, produces gales of laughter.

It will be years before this new, round, mostly pink person has any idea how skeptical her grandfather is about human judgement, and interpersonal interactions. The economy is good where she is. Her parents are very good to her. They keep her healthy and safe and encourage her to grow. She also has about fifteen other relatives and friends who smile back at her every time she smiles, which is most of the time.

Obviously, there will be another generation to keep this all going. There will be another member of our family from our other child, coming with two weeks. Despite all that is wrong with the world it is always thrilling and encouraging to spend time with a healthy, happy baby. It seems to bring out instinctual hope.

I realize that a lot of children are not a fortunate as this one. But the most imprtant factor is that any child feels safe, welcome and nurtured. I will do the best I can to help this one and the next one to explore, learn and be amazed. If they can enjoy doing that, and enjoy begin here, it will help everyone. everywhere.

All politics are local. As local as the kitchen floor.

2011-09-14T18:55:00.000-07:00

Whoa!
I've been away for a week and they changed the whole blogging format. I'm disoriented. I don't know if I can make sense in this box that hardly has borders. Perhaps my mind will slip outside the borders and rush away, out of control, down corridors of my building, bothering the people in the insurance agency, or the other doctors, or the bank investigators who are rarely seen, and when they do show up they wheel in those metal cases. What do they really know? Could they have prevented much of this if they really investigated? My mind wants to know.

She, that woman who seriously thinks she is running for President of the USA, actually said that getting a vaccine to prevent cancer will cause mental retardation? She believes in a non-influential government, but she doesn't believe in science, or health.

What does this say about the education system of America that people don't come up and demand that she go back to fourth grade. How does anyone take anything seriously if this is condoned?

When did Congress pass the law that rich people are right and poor people are wrong? That seems to be the law of the land now. I know several rich people who believe that. I have spoken to them, and I am not impressed with their ideas -- or their values.

I have patients who are poor and their lives are very difficult. I have patients who are rich and their lives are very stressful. I don't have happy patients; that's not my job.

But why be cynical on this beautiful day, which could be one of the last beautiful warm days of summer?

Because if you're not cynical they take your money, they tell lies, they get away with cheating, and they change the rules.

They are the corporations, the government, the churches, the elites, the rabble, the immigrants, the prejudiced.

They are everyone but me and you.

too many like him

2011-09-06T18:26:00.000-07:00

I have been back at work a while.

A mother called and told me her son wanted to see me. He said he was ready to talk and wanted to change. The young man was 23. he was good looking, strong, and had a job that expected regular attendance, strong physical effort, and good customer relations, He was more than able to do that, and he said his company thought he was excellent.

The only trouble was that he was still living at home and was spending most of his money on Oxys and Perc 30s. He said he felt better when he was high. His job was boring; his life was boring and getting high made everything easier to take. Except that he was broke.

He also realized that he was blowing out his brain cells.

But he really could come up with no alternative. He a quit the pills a couple times, but got bored and a bit depressed and had gone back to them. He said he hung out with six or ten other guys just like him, except half of them didn't have jobs any more.

He didn't like school. He hadn't put the effort in and didn't think he could now. He had been in a couple of relationships but the women didn't really think his being high so often was that attractive. He understood that. He didn't see any way that he could really get a good enough job in this economy that would allow him to really live independently. His father had worked hard for thirty years or so, had a haeart attack and now was disabled and couldn't do much of anything. His mother was still working but she thought she was about to be laid-off.

Why bother?

I offered him a way to figure out the answer to that question. Although he was certainly a polite kid, and seemed to have real insight into his condition, he declined. He did say he would consider taking Suboxone, if that would help him cut down on the pills. I think he was hoping that his insurance would pay for the Suboxone.

America's future is it's youth!

Fortuitous, coincidental or Divine Intervention?

2011-08-31T07:59:00.000-07:00

During the past year to year and a half I have been having a reoccurring problem with my neck and shoulder muscles. About once a week, more or less, these muscles would tighten up and cause a great deal of discomfort, sometimes it seems the discomfort would reach all the way to my stomach and make me feel a bit sick. I didn't know if it had to do with the way I had been sitting all day in my office, or if it was that I had bought a laptop and sat differently over the keyboard.

The answer has become apparent because some of the keys on my MacBook, the "S", "W" and "2", all in a row, just stopped working. I have had this laptop for about a year and a half, so that was why it was on the suspect list. I really like Apples, before this I used a Mac-Mini for six years.

So I ran down to the "Genius Bar" at my local Apple store and was told pretty abruptly that yes, the keys don't work, and that even though I didn't spill any coffee on them since it was over a year and I didn't buy the extended warranty they could fix it, but I had to leave it for a week, and it would cost me $180.

I asked if there was any other solution, and the kid said that I could use another keyboard.

I was in a bit of a state of shock because I thought that Apple was such a magical company that they could just sprinkle fairy dust on the keys and they would work again. I didn't make a decision what to do and took the machine back home. On the way home I realized that I had used a wireless keyboard for the Mac Mini for years. It was now way out of date, not the sleek, flat keyboard they sell now, but it was still an Apple, so I thought I would try that.

I went home and tried to connect the old keyboard and didn't have much luck. Then I began to Google though ideas about how to get it to work and after half an hour searching around I saw that someone posted a solution. Now, as you can tell since there are the letters "s" and "w' in this post, that it works.

What has also become clear is that when I use this old keyboard in front of the laptop I sit up much straighter, I don't hunch over to reach the smaller keys of the laptop and my shoulder has not hurt me for three weeks.

So, taking this all a needless step further -- why did this happen to me? Is this just good fortune that those keys broke? Did I cause them to break because I was in such a bad position that I was banging away in a destructive manner on those letters?

or

Did the gods of laptops and backaches smile down on me, and since I am such a blessed soul in their eyes they decided to offer me a solution that I was too blind, too lazy, or too cheap to see.

I only propose this last idea because it is the kind of thinking that seems to be pervasive in both my patients and in some of our national politics. It is the kind of sloppy, lazy, magical thinking that leads to trouble. When a candidate for the office of President can announce that she feels that the tornadoes and hurricanes we have been having are God's way of telling America to cut the deficit, then things are getting pretty scary.

When people are able to say openly as Rick Perry does, that God approves of his running for President, or as one of my patients does, that the people living above her have invented a noise machine that goes on when she comes home, goes off when she leaves, and knows when someone else is with her so that no one else can hear it, and this is being done to her to make her leave the apartment because they disapprove of some of the things she had done in her bedroom, we are dealing with problems. People tell me they won't go out on days with certain numbers in it, or that she went back to the guy who broke her nose because he said he was sorry, again. This is not good thinking. There are more effective ways to link cause and effect.

But so much of what people think about is totally preposterous, from extra-terrestrials, to get-rich scams, to waiting for The Rapture, to talk radio, that people become accustomed to sloppy, lazy, distorted thinking. It becomes easy to scapegoat minorities, to blame outside sources, to expect miracles, to get sucked in to advertising, and to be used, fleeced, manipulated and screwed, and then blame it on your spouse or the government.

In short, I don't think that God broke my laptop to keep me healthy, so that I could continue to keep typing and write such an illuminating blog.

I do appreciate the coincidence.

Irene is coming!

2011-08-26T19:52:00.000-07:00

After a week at work we have returned to the beach house. We are about 1/4 mile from the water, but our beach faces north, so we will get the back end of the storm. We await the fury of nature. We feel we are ready, although we really have not done much besides bring in some of the things from outside.

Like most humans we tend to believe a little too much in the positive, overestimate our own abilities, and base too much on what happened in the past. Last year we had similar, but not quite so dire warnings. I went down to the beach and took a "before" picture. The next day I returned to the same spot and took another picture -- they were identical.

This time will be different. But I am ready. I am seasoned, I am tough, I am ready for whatever the gods of wind, rain and the sea have to throw at me.

I only hope that the power doesn't go off because then we won't be able to run the dishwasher or do laundry.

Back at work

2011-08-24T18:06:00.000-07:00

I took three weeks off and came back yesterday.
Being off was more difficult than I thought. That is not a good thing.

Part of the problem is that we went down to the beach house and opened the doors and people poured in. All good friends, some we hadn't seen for years and others from around the corner. Most stayed for a night, or two or three, even four. It was great to see everyone but it was not the way I usually escape, which is to sit and make sure the tide is on schedule and not talk to anyone.

But that was only part of the difficulty. The other part was that, while most of my friends are doing quite well, many of their kids are not. This seems to be common, and distressing and too much like work, except that I can't do much about it.

These "kids" to which I refer, range in age from 24 to 38. One needs an operation and had to scramble to get health insurance. Another probably has the early signs of a chronic, debilitating disease. Those situations are distressing. But even more common are the kids who are struggling to find a decent job, to grow up and be independent. The problems are much more economic than psychological, but they become psychological, and are very distressing to their parents.

What becomes worse is that these kids either don't get married, because they can't afford it, or the marriages are falling apart, to a large extent because of economic pressure. When the marriages fall apart many of the kids come back to their parents. Many of them bring their very young children.

This is not good -- not good for the grand-kids, the kids or the people my age. It's not good for the country or the world. It didn't help the vacation.

Back in the office, I began seeing the patients I had been away from for three weeks. I wondered if my business would last or if the recession would change things even for me. But today, the second day back, I got several calls from people looking for help. The issues they want deal with involved themselves and their grown or almost grown kids. They needed to find their way in the world; they needed jobs, AND, to fight the boredom and depression many of the kids between 16 and 26 have been taking Percs and Oxys to ease the pain -- the psychological pain.

Things are not good out there , and once families begin to struggle the drop in quality of life can be swift and steep.

This is not good. But at lest in my office I can try, at least try, to do something about it.

But, I thought .. never mind

2011-08-18T18:35:00.000-07:00

I read in the NYT that big ideas are dead; no one thinks that way anymore. I guess there is no app for that. Naked celebrities getting divorced get more attention than the idea that there may be universes beyond our universe.

Jarod Lanier, who is a bit weird but seems to know things about the Internet, has noted that we are now constantly being flooded with new information. So many of my friends, relatives and even patients are constantly checking their mobile devices for news, texts, emails, Facebook updates, Tweets......
It has become annoying to be with them, because they are not with me. They are waiting for the word to come through the air, to tell them what to do next, what to think about, who to be.

It has become very difficult to pull all this information together in order to reach any kind of a well considered, thoughtful opinion because every second there is new information, and you may have to revise what you believe.

The stock market is up, and you're rich, an hour later it's down and you're poor .. because someone thinks that Ireland or Greece may have a bad quarter. The river is polluted, an asteriod may be coming, it is 106 degrees, there is a tornado in Des Plaines, Michelle Bachmann is gay, another bombing in Iraq, the Red Sox won, now they lost, unemployment is up Obama will lose, now it's down and he is OK, The Tea Party are idiots, nope, now they are morons, racists and homophobes. A kid was kidnapped, a kid drowned, a kid got sick and died, another kid fell off his bike. Does that mean I have to put a GPS and a helmet on my grandchild to keep her safe?

Too late for that -- parents are too hovering, nope they are too lax, nope they are putting too much pressure on their kids. You can't eat sugar or fats, nope artificial sweeteners are worse, corn syrup is even worse, sugar is good, eggs are bad, eaggs are good again, bacon is bad, bacon is good, tofu is tasteless.

We're all gonna die someday, might as well smoke, drink and screw. Everything in moderation, but you only live once and can't take it with you.

The proof is in the pudding. It's in his kiss. I can see it in his eyes.

"Everybody knows the dice are loaded
everybody rolls with their fingers crossed
everybody knows the war is over
everybody knows the good guys lost
everybody knows the fight was fixed
the poor stay poor, the rich get rich
that's how it goes,
Everybody knows "

L.C. (1988)

Tech 6, Past, Present and Future -- 1

2011-08-13T20:21:00.000-07:00

What is written below I wrote to post on a list for psychologists: I am putting it up here too because, if I get off my ass, I expect to use this space to see if I can explain what I am talking about in a way that makes sense. Almost everything runs differently in the world now than when I grew up. In most ways, the people in it are the same creatures they have always been, but it is still very unclear how we will all live and prosper peacefully, as the result of all these changes.

When I began to write this post I tried to explain the reasoning behind all my thinking. After about 4000 words I decided I may have to write that all for a different forum. But here are some bullet points.

After all the screaming about debt ceilings and deficits is over in Washington, The USA will still be left with an uncertain economy, and the major difficulty that will remain is from high unemployment.

The underlying causes of the current high unemployment is not from the Democrats or Republicans, it is from major changes in how the world works.

The two biggest ones are globalization and, even more so from technology. Every profession, and I use that word in its broadest sense, in the world today is performed differently than it was even ten years ago because of technology. Many professions have completely disappeared. Many jobs in the professions that remain have been eliminated, and are no longer necessary.

We are living in a world that could produce all that needs to be produced by employing about half the people who are working now. About 120 years ago 75% of American were farmers. Today that number is 2%. That is what is happening is many other professions.

Our job, which did not really exist during the last time of great unemployment, is probably one of the ones that is least impacted by technology. We base our skills on dealing directly with people, not machines.

But we, in our profession, are going to have to deal with this increase in unemployment, underemployment, and with those who have jobs, but are pushed to the breaking point by their employers who know that people are desperate to keep their jobs.

Those hardest hit by this change are men, and mostly men who are not that educated. Those are men who had jobs in manufacturing or in the trades. The trades held up well during the housing boom, but now that too, is over.

A rise in long-term unemployment of middle and working class men will result in a domino effect of bad things: depression leading to anger, leading to domestic violence, divorce, poverty, fatherless kids, addictions, lawlessness, and then more unemployed men. This will be even more true for the less educated and racial minorities. It is also effecting non-specialized recent college graduates, who have $70 or more in student loans and can only find work for $12 an hour.

We will see an increase in helplessness and hopelessness that may be labelled as psychiatric disorders but is really much more the result of social factors and global changes than it is an kind of inter-psychic or biological disorder.

There will be a much greater demand for treatment from people who will not be able to afford it. The treatment will be much more difficult because many of the factors that underlie the difficulties are way beyond the control of any therapist.

Perhaps I will be proven wrong, and things will improve and the advances in technology will somehow offer a way to keep everyone earning a living.
But, from what I am seeing in my own practice, what I have been reading, and even what I am hearing from my friends, the entire world economy is being restructured, and how this will effect this generation and the ones that follow is far from clear.

beach thinking

2011-08-11T20:31:00.000-07:00

It's beautiful on the beach. The sun gets low late in the afternoon, the waves come in, the breeze is gentle. A two-year old runs in and out of the water for an hour, giggling all the time.

I read my magazine. I realize that I am either brilliant or trite, and I can't figure out which. Many of the ideas in the magazine, quoting, of all people, Francis Fukuyama, are things I have written about here.

The reviewer of Fukuyama's new book, Mark Kingwell, who trashes on it, states that politics is largely the push and pull between personal desire and collective action, which is certainly what we are seeing, in it's extreme form, now.

There is also a discussion of "human nature" which includes this idea : "given the perfidy and at best thevery local, short-term rationality of humans, it can be no surprise that we often contrive to create systems that fail everybody and yet remain in place for many decades, if not centuries, until war, invasion, or Maltusian population crisis consigns them too the history book."

YES!

I would like to expand on how I agree with these ideas, and give examples from my practice and my life, that this is the way it is, but we have guests here at the beach, and right now I am helping a good friend go through the matches she has received from some dating web site.

Talk about short-term foolishness as a long-shot stab and long-term pay-off, this is it.

Smart?

2011-08-07T19:38:00.000-07:00

There is an article in one of my magazines that is based upon a few long-term studies about human longevity. The conclusion of the article is that there is a strong correlations between intelligence and longevity. While I certainly am not surprised at this conclusion, I feel that this finding is a bit of a tautology.

My profession, Psychology, especially here in the US of A, has always made a big deal out of "intelligence" It was the attempt to determine who was smarter than whom that first brought Psychology to prominence, as it was Psychologists who tested young men who were drafted in WWII to help pick the ones who seemed more qualified to be trained as officers.

America, more than other cultures I think, feel that "intelligence" is something you are born having more or less of, and that it is not something that can be trained, enhanced, or improved upon. Most Psychologists take it as a given that this quality, intelligence, is distributed across the population on a bell-shaped curve, with most people grouped in the middle, which is average, and the very smart, and very lacking, out at the edges.

My experience with all kinds of people has brought me to a different conclusion. I feel that there are some very few people with some very special abilities, and that their are some others who clearly, for clear biological reasons are lacking, but almost everyone has a wide range of talents that are unknown and untapped. I feel that most people could exhibit much more "intelligence" if they find a way to learn how to think more clearly. They can be taught by clever teachers, they can learn from watching clever parents or friends, or they can learn on their own, from seeing what works, and what doesn't. Usually, they have to be either pushed, encouraged, or somehow find themselves in a position in which they have to persevere to solve problems. To me, it is this trait of learned perseverance that really distinguishes who gets to called "smart" and who doesn't .

There are many things about our current culture that move people, especially kids, away from learning how to persevere. This includes labelling a kid as either smart, or not so smart, and also giving kids a diagnosis such as ADD or ADHD. Any time you put into someones head that they have some reasons to not succeed at something, anything, you diminish their chances of success.

For generations it was assumed that girls were not good at math and science and boys couldn't sew straight. But these things are not true. While it is true that everyone is born with a different brain, and some brains can more easily concentrate than others, and some can learn more quickly to spell, I feel that in all but the most extreme cases, very extreme cases, that people can learn how to best use the brain they have to get where they need to go in ways that is best for them.

Really, the whole concept of intelligence can be summarized in four words: "the ability to anticipate." Smart people are the ones who can see what is happening, and from that, figure out what will happen next. Really smart people are the ones who can see what is happening, figure out what will happen next, and from that, have some fairly good idea of what will happen after that. It is this third stage where most people fall down.

But, the point here is that the best overall indication of intelligence is survival. The whole purpose of having all the different skills that make up "intelligence" is to survive, and to have your babies survive.

I really bothers me when someone tells me that someone is "really smart" but never got his life together, and is living in his parent's basement. To me, either this guy is "really smart" in that he found a way to not care about the traditional trappings of success and is happy and content doing whatever he is doing in that basement. Or else, he is not really "that smart" because for some reason or other he could not figure out good answers to the puzzles of life.

Knowing what Shakespeare meant, knowing all the answers to Jeopardy, and being facile with calculus are certainly valuable and helpful skills, but it doesn't really make you "intelligent" in my opinion. Having those other skill could be very helpful, but not sufficient.

Being able to take good care of yourself, form and maintain good relationships, derive some real satisfaction from work and play, are better indications of being smart. They will also raise your likelihood of living a longer, happier, more fulfilling life.

Moments of summer

2011-08-03T20:19:00.000-07:00

Sitting, with friends, on deck, overlooking the harbor. The sky a high blue with while clouds moving across, reflected in the water. Boats bobbing up and down slowly, a few under sail moving closer or slowly diminishing toward the horizon. A first drink finished, a second one going slowly, with the knowledge that too much more would tip the balance, and that the feeling of love, companionship, tranquility, insight, and faith in the future of the world will fade soon, no matter what I do.

The beauty and appreciation of the moment is mixed with melancholy, knowing that I am older, a bit damaged, and that many, but not all, of my most creative, dynamic days are behind me. The tide comes in very dramatically at this spot. Many of the boats are older than I am; and they get to have several different owners and caretakers, but they don't care. A great many fish have been taken from the sea.

My friends and I have been at this beautiful spot before. Hopefully, we will all do this again, and laugh at the same silliness that is the world, knowing that we are a part of it.

Mid- Summer reflections

2011-07-31T19:54:00.000-07:00

Hey, look at this, I get distracted by all kinds of things, I don't blog for a while, and look what happens, the world goes nuts. I guess I'd better get back to this or else civilization as we know it may not survive. But, thinking about it, is that what we really want?

We were down here at the beach house when I stopped writing and just began talking to people, watching the tide come in, and just kind of hanging-out. It's kind of fun to just kind of sit around and listen to people run on about their families, their views, their good times and such, with me not having to do anything about it.

You say your mother's sick at 92, or your son's getting divorced, I feel for you, but I'm on vacation. I'll talk to anyone, even Republicans -- but most of them never listen, they just yell.

But then I went to the doctor and they sent me to other doctors, and the next thing you know I had three biopsies and two micro-surgeries and they tore my face apart. Two little spots that I couldn't even see. That wasn't even what they sent me to the dermatologist for. ot anything really serious, that could spread or get into my blood or my brain. But each time they took out some tissue they busted some blood vessels and the areas all around my eyes would turn purple, swell up and my eyes would close. I spent the better part of three weeks looking like I had just gone three rounds with Sugar Ray. Looked like I never learned how to duck away from a left-hook.

But now I'm back here at the beach house and I get to stay for a while. My time with the doctors is over, and I am left with a few blotches, a little swelling and a line down my cheek that looks like Zorro just rode by. They tell me it will all heal soon.

So now I have some time to sift through the year in my thoughts. I will be down here for a few weeks to watch the tides and entertain the people who seem to want to come to the beach in the summer and realize that they know my wife. No one really comes to see me(except for those two really weird guys) but everyone gets me as part of the package.

A lot has happened since last summer, some by design and some just because things happen. So I'm going to take a day or two and think about it.

And look, just since I've been writing, the governing bodies of the United States have gotten their shit together and may have an agreed to not destroy the world financial markets for absolutely no reason. Ah, Kubuki Theater, American style, all made-up and stylized, with movements and meanings, plots and endings known to all, but the performance must be held to make it meaningful, even if it isn't.

There once was a time when I believed that most people, as they grew-up, wanted to do things that would benefit many other people. That belief ended in Jr. High. Next was a time when I believed that people learned from what happened, and tried not to make the same kinds of drastic mistakes again. That phase of my thinking ended in college.

What I know now is that some people learn how to manipulate the hell out of other people, and they use that skill almost totally to benefit themselves.

Lincoln said "You can't fool all of the people, all of the time." But it is clear, especially with our wonderful new was of communicating, that you can fool a whole lot of people all of the time, and they will love you for it.

But I don't have to worry, I just got a letter from some guy in Nigeria, and I'm going to be rich......

On being "normal"

2011-07-07T19:34:00.000-07:00

I'm on vacation. The Israelis and the Palestinians are still on their own, helping to screw up the whole world, and I am doing nothing to stop them because it's summer.

The weather has been beautiful. We go down to the water. The tide comes in. Children run and splash and throw balls. Balls never go our of style.

Friends come to visit. Anyone who has a house within a mile of a large, scenic body of water knows how many friends they have. We talk. We talk about our other friends, about families, and now that we are older about the extended family. The families that our kids have married into and the people who are now attached to us. We talk about grandchildren, who are all charming, creative and soooo intelligent that it's sooo impressive.

As we talk to friends, and learn about all the people we know, as we observe the relationships of the people we know and love, and of those who we just know, or just know about, somethings become more clear:

My life is really good -- but still it is disappointing. Perhaps I could be doing more. More what?

Talking about everyone else is fascinating, and it shows how difficult life is; no one comes out unscathed.

Everybody is weird, once you really get to know them. The attempts to figure out how to solve the riddles of life take all forms. The solutions to each of life's problems vary very widely, but they all end up being incomplete.

The range of what is "normal" is so very wide. Anyone who is not paralyzed by doubt and fear, and feels optimistic about tomorrow is weird, but is normal. Anyone who is full of doom and gloom and is convinced that all good thing will come to an end, is considered realistic, but also is "normal." Anyone who has learned how to support themselves and to remain in a mutually beneficial relationship is considered normal, no matter what kinds of contortions they have to go through to make those two things happen. In many case, just being able to maintain one of those, either being self-supporting, or maintaining a good relationship is considered to be doing well enough to be considered "normal.

Beyond that, everyone does it differently; inefficiently really, and everyone is fucked-up.

I can't think of one person who really coasts through it all, all the time.

I can't think of one person I'd rather be than me, and I have some strange, weird and bad moments, just from what goes on inside of my head.

That's normal.

That's too bad. It should be better than this.

Just before I left

2011-06-24T19:39:00.000-07:00

As you know, in my head, I am ready to take the summer off. That granddaughter of mine is beginning to stack those plastic blocks and she needs someone to knock them over.

However, I am still working three full days a week. People still come in hour after hour, and when I am working I am working. It is mostly a good feeling. A couple of borderline personalities call and weep about how it seems to them that their lives are the worst in the world, but others are doing well and that is gratifying.

Yet, just as I was preparing to leap across the work/no work barrier, Arleen came in. She seemed a bit teary eyed, and a bit more disjointed that she had been recently. This is a woman who began treatment almost four years ago. She had been struggling with addictions, she had lost her job, was thrown out of her home by her crazy mother, had lost custody of her son, and became very self-destructive.

With a lot of work, fueled in part by a lot of justifiable anger, some of it at alcohol treatment programs and AA, she was able to not only get sober, but to get herself functioning, begin college, get her son back, and find an apartment close to her parents, to whom her son was still close.

She stayed strong and keep going despite, having to give up the long relationship she had with a married man. That was followed, a few months later, by his suicide. But Arleen kept on plugging.

However, a week ago, her sister, who was the older girl who had always been the favored child, split up with her third husband and moved into the mother's house. This was a bit upsetting because the mother lavished all kinds of help onto the sister; help which had always been denied to Arleen.

But things fell apart when Arleen came back to her own apartment, and found her sister in bed with some guy she had met two hours ago. There was beer and Jack Daniels spread all around the apartment, and the sister explaining that she knew she couldn't do this at the mother's place, but what was she supposed to do, give up sex? It was then that Arleen opened a beer and felt as if the world was just too much to handle.

She has been drinking a little bit on each of the five days since then. If she doesn't stop completely it is going to gt worse, and everything she had achieved will fall apart.

I am leaving for a four day weekend. I am trying to keep in touch with Arleen almost every day to give her some encouragement to stay sober. We had one good day. Today she had no minutes left on her phone, so it was disconnected.

Tomorrow I'm supposed to play golf.

Doing very little.

2011-06-19T18:58:00.000-07:00

I am surprised at how easy it becomes to do very little. It can become kind of infectious. There is so much to do when you don't do much, and then getting anything real done really gets in the way.

Summer arrives Tuesday. My work time is cut to three days a week. I expected to use the newly available time to do new exciting, physically and intellectually invigorating things. It's not really happening. A lot is happening instead, but nothing of any consequence. And that becomes easy, and I certainly can't say it isn't enjoyable.

I see friends, I cook, I do a few errands, that can take up almost all day, if I have all day to do it. I have even played golf. (talk about letting time just fade away) I'm even improving slightly. Today I went out in a kayak, then I got to see my kid (Happy Father's Day). Tomorrow is more of the same. Friends, errands, cooking. There is a grandchild to bother, and another one coming.

I thought that I would be reading, writing, thinking, exploring, with all the new available time. It's not happening. Can't even find time to sit with a book for a full hour.

I was able to watch the Bruins. They Won! That was fun, watching Marchand skate around punching people, and then scoring.

It's very easy doing not much. I don't like anything getting in the way. They days I work, I work, but they days that I don't, I don't want to be distracted from not doing much.

I still have things I have to get done, things that need to be done important things. Here is my list for the intermediate future:

1. Change the direction that mental health treatment is going in this country. It is being pushed off as much too biologically determined, and much to medical. That needs to change.

2. Explain the evolutionary process and purpose of consciousness. This is kind of a hobby of mine. This has not yet been explained to my satisfaction.

3. And also, help solve the Israel -- Palestine problem. That situation has dragged on for my whole life. It's enough already.

But, the summer is coming and I don't think I will get to any of this until at least early October. I have much too much "not much" to do, and lots of friends are coming up for the summer. There is a grandchild to bother.

can't shake that feeling

2011-06-09T17:59:00.000-07:00

I can't really shake it.

Contentment seems synonymous with resignation. If you're that impressed with yourself then you've done enough. But look around. The world is still a mess.

It may not be your fault, but you are still (at least partially) responsible.

What can I say; that's how I feel.

and unless you're part of the solution, you're part of the problem ( asshole ).

All that Sarah and I could accomplish together!

2011-06-05T19:08:00.000-07:00

Yes, forsythia I do often wonder if I have retained enough of my marbles to keep rolling along. I have noticed interesting things about the workings of my brain. I do forget names, and I"m not nearly as good as my wife at recognizing faces -- she once picked out a cousin of mine, who I had not seen for ten years of a concert crowd. But I find that I do remember the names of my patients ( you would hope), but also their kids, parents, significant others, length of their various marriages, lists of their illnesses, of their spouses' illness, infidelities, and tendencies, and so many other bits of personal minutia So, far so good.

I am also pleased with how well I can think, not only about problems, but about solutions. One of my reasons for writing this blog is to explore how complex human problems really are. How they involve so many complex interactions between inter-personal relationships, psychological tendencies, biological abilities, societal and cultural conditions, sub-cultural expectations, and even random, unpredictable events. This blog is part of a struggle to make sense of it all.

That is why I have so much of a fascination for Sarah Palin, who just came busting through our state a couple of days ago. For her, everything is simple, and she seems to have a quick, handy answer for almost everything; for even the most complex problems in the world!

Yes, I admit, I often can't understand what she is saying, or what she means. The times when I think I do understand what she is trying to say scare me even more, as I can't believe any rational person would really want to say something like that when other people may be listening.

This is what she said in Boston on Friday:

"He who warned, uh, the British that they weren't gonna be takin' away our arms, uh, by ringing those bells, and um, makin' sure as he's riding his horse through town to send those warning shots and bells that we were going to be sure and we were going to be free, and we were going to be armed." --Sarah Palin, on Paul Revere's midnight ride, June 3, 2011

Got that?

Yes, I may be smart, overly rational, and intrigued by complexity. But my charisma level is just in the average range, and my willingness to get out and humiliate myself in public is in the low-average range, excluding dancing.

But Sarah is an American phenomenon. She is a woman of this time and place. She is a genius in self-publicity, nervy unintelligible pronouncements, and she is off the charts in just plain Chutzpah.

If we could only magically combine our talents, blend together in a quest to right what is wrong with our country and the world. The whole Israeli - Palestine thing could be settled in a manner of hours.

Probably not enough magic just lying around.

a note in the chart

2011-06-02T09:18:00.000-07:00

R still ends up doing more things for other people than she should. Her extended family, her current significant other, her kids, his kids, her sister's kids, have all learned that they can depend upon her too much. She rallies and does things for them instead of herself. It makes her feel good, needed and respected. But it exhausts her, sometimes she knows that they take advantage of her when they should be learning to do things themselves. It also takes away most of the energy she needs to move her own life forward.

The New Narcissism -- tech 5

2011-05-24T18:52:00.000-07:00

It is a rising trend in the press now; it was even in Sunday's NYT, how Facebook, Twitter, instant messaging, Four Square and all of this instant mobile connectivity is making celebrities of us all. Everyone can see that the barrier to fame and notoriety is pretty low. Look at the Kardashians, or Snooky, and many other of our recent phenoms. All you have to do is be willing to sacrifice most of your dignity, and keep pushing it out there.

My girl Sarah (Palin) is one of the best examples. It seems more and more that all she cares about is keeping her name in the news and making money on it. She doesn't care what she says as long as she get coverage. How much you wanna bet that six months after she decides not to run for President she gets at least $1,000,000 to show it off in Playboy.

And why not. Two years ago a saw a fifteen year-old girl in treatment who had been devastated because her boyfriend had persuaded her to "sext" him a picture of her topless. Two months later they broke-up and everyone in school was talking about it. Devastated.

Now, I know that happens all the time, and most of the girls don't seem to give a shit. "Hey those are my tits and I'm proud of 'em."

In some ways it's awful, shocking, demoralizing and demeaning. But in others ways it's liberating, equalizing, and can give the power back to the women.

These technologies are rapidly changing the way people relate. They are changing how we communicate, our vocabulary, what we read, if we read, what we think, how we think, and how our brains work. It's changing our goals and standards of behavior.

Yes, there are many professors, psychologists even, who are writing lots of books and articles about how the world is going to hell, and it certainly is. But it always has been. Genghis Khan, The Crusades, The Spanish Inquisition, The American Civil War, WWI, not good times for humanity either.

If you watch TV, it's more and more about the trash in people's lives. Murder, divorce, bizarre happenings. Who would have wanted to be on TV the day after your 8 year-old daughter has been eaten by a shark, abducted by a pervert, lies in a coma for three months, now it's expected.

Sympathetic Host: "Mr. and Mrs. T, how do you feel after you 11 year-old son broke 27 bones imitating what he saw on Jack Ass?

" Well, we're kind of upset." But at least we're on TV!!

The technology is everywhere, immediately, and we all want our 15 minutes of fame, even though now it's down to six.

Not me. I just want to write about it here in my blog. For years and years I kept a journal that I wrote in every Sunday night. But you know what -- no one ever read it.

That's not true, my wife read a lot of it once. Afterwards she said:

"It sounds a lot like you."

Now that's true of so many of us --" A SuperStar in our own Minds!"

Agreeing with Amanda

2011-05-19T18:30:00.000-07:00

Hey, don't get me wrong either, I'm not actually complaining that I have too much time and enough money.
I'm just saying that it's weird.

I've worked pretty hard most of my life. I can't say I worked very hard. There are times I know that if I were more persistent, more driven, and more willing to put in the time to network and market, that perhaps I could have been better known, perhaps I could have been one of the "names" in psychology. I know as much as they do. I could have constructed a four-box model and written a book about it.

The models I build were mostly sixteen box models, with each box interacting with each other, with varying intensity, which differed under different circumstances. People thought I was very insightful, but that my stuff was too complex.

True, I said, then I went and played basketball. I played basketball because I really enjoyed playing basketball. I played basketball until I was 55. I can still shot pretty well. But I can't run too well any more, or play defense.

I always thought of myself as a wild guy, with crazy, far out ideas, outlandish perspectives, and novel approaches. All of this was true in my head.

However the life I led was much more of a tortoise than the hare. As therapist I tried to get people to anticipate the consequences of their actions, not just for the immediate, but for three, four, five steps ahead. I really put that into practice for myself.

Generally, more than not, it worked very well. I avoided doing many stupid things. But I also skipped quite a bit of drama and excitement. I don't drink too much. I don't bet on long shots. I don't get in fights. I don't jump off cliffs. I don't expect the chambermaid to do anything but clean the room.

And because of that I'm still married to the same woman. My kids are great kids, who are married to great people and now are having great kids.

Also, I have been very lucky. That helps a lot. I can't take personal credit for luck. I have been mostly very healthy. My own parents were nice people who cared about me. I did one great thing in my life; I was born two years before the baby boomers. It helped me buy things cheap and sell them for more money. Schools, jobs, stocks, houses, were easier for me to get because I was ahead of the competition. It made me brilliant!

Now, because of all that, I am settled and comfortable. (too bad)

But life is a process, not a game with a score and a beginning and end. I have had many clients who were the ne're do well sons of rich families. They had the money and the opportunity, but they didn't know how to struggles. They could always chose what they wanted to do. They often chose to do very little, and they felt very badly about themselves because they felt their lives consisted of one cop-out after another.

I am very fortunate that things have worked out for me. I have time, health and resources. I can choose what I want to do. I want to make that choice. I don't want to just let it all evolve.

Maybe solving the Israel - Palestine problem is a little out of my reach, but I am still working, and some of the couples I see are just as intractable.

And then I pick up my round-faced little granddaughter and she smiles up and me, and I never want to put her down.

sliding along toward

2011-05-17T18:33:00.000-07:00

This semi-retirment thing is still weird for me.

Work I understand. I did it for over forty years. The last 30 years I had my own practice up here in this charming, diverse, sometimes prosperous, sometimes struggling mill city up nestled in still cold New England.

Once things got rolling I averaged about 37 clinical hours a week. Then there was the billing, the phone calls, the forms, the letters; it was a 47 hour a week job.

Last year I got loose about working Friday and averaged about 33 hours a week. Three months ago I stopped working Monday, so I could "pursue other interests" as they say when they leave office. And I have lots of other things that interest me.

But,

It's easy to do what seems like very little. Where does the time go?

The time gets eaten up quickly with, of course, my wife's lists -- the "Now that you have time" stuff. This is not to be confused with fixing things. I don't fix things. I fiddle around with them until they break. I can fix people ( some of the time) not things.

I do cook, I shop, I clean up stuff, I move things around.

But most of the time has been going to, of all things, people. I went to NYC with a couple of friends. I see other friends more often. I see my rolling-over, smiling, gurgling grand-daughter.
Times-up.

I didn't go to work today. It was easy. I am much less tired at the end of the week. Actually "the week" doesn't end because it feels like it never really got started.

When you have kids, really until they have been out of the house for two years, you focus. You have to watch and take care of the kids, whether they want it, appreciate it or even think you are doing it, that is what your life is.

When your working, especially if you get satisfaction out of what you do, then you focus. That is what you're doing; you're working.

When the kids are young and you are working. Then you don't have any existential questions -- you are just doing. This is what you're supposed to be doing. Do your work, support the family, watch the kids, bother them. Relate to the wife too, that helps. Any break you get is a break to savor. But those are quick, and disappear.

Now, it's different. I can do what I want. I guess I can please myself.
But I know that it doesn't really matter how. Nobody cares, Nobody's counting. It's easy to just take it easy. The time slips away. The mind can wander and rest. It can remember, or in many cases, it can worry.

For me, a project is needed. I will have to manufacture a focus, as nothing intrinsic really exists. I tell this to many of my clients, that the meaning of their lives is up to them. Now it's my turn.

The difference between fun and senility often seems vague.

floating away

2011-05-16T12:40:00.000-07:00

See that picture of the bridge. It's on the Mighty Mississippi, just miles away from where they opened the sluice gates to save the oil refineries. I hope it works out for all the folks down there. It's quite a river. The Mississippi Delta really takes up most of Louisiana; water just keeps flowing down there, coming from everywhere else.

Ron Paul, the clever little man who is again running for President, feels that we, through our government, should not insure, or protect the people whose homes, farms and businesses are being flooded and washed away. It's nature, he reasons, and if this huge river is going to wipe them away, then maybe they shouldn't be there.

He has a point. But perhaps it's a little too simplistic. People have lived in towns along this river for a few hundred years now Yes, the population is increasing, but that is because we have been a successful society, and kept our people alive and healthy, so we build more houses. For years the river grew large in the spring, and often there were floods, but now there seem to be bigger ones, and more often. " Hundred Year Floods" seem to occur every three years now.

There is a very good, and probably scientifically provable, probability that the increase in these floods has been caused by the lack of regulation of pollution, climate change, and waste disposal. If people want to deny that, then more people will watch their stuff, and perhaps some of their relatives, float away.
And then be blamed for it.

But admitting that this is a more complex problem could mean more regulation, and that could be bad for business.

This kind of reasoning comes at the time when there are new studies being published by members of my profession that report that younger people in this country are much more narcissistic and much less empathetic than they were ten years ago, and even more significantly less than they were thirty years ago.

This seems to be related to three major factors:

1. Children's; lives are much more structured, much more guided by adult aspirations and directions. There is much less time for kids to do what my mother told me to do, or what I always wanted and expected to do as a kid, to "go out and play." I played with kids on block, or kids on the next block, or when we moved out of the city I played with kids in the park. We made up our own teams, our own rules, and often even our own games. If we wanted to have fun we had to get along. We had to negotiate, settle disputes, and enjoy being together. The kids who were demanding, overbearing or who cheated were left-out and avoided. They ruined the fun.

Today, when I drive around, in cities and suburbs, I see very few kids ever playing in the street, and in the parks it looks like all the activities are sports with uniforms, supervised by adults, often with paid referees. Everything is more competitive than cooperative. No kid is left alone because of the fear of kidnappers and perverts. Fear and competition is taking over from fun and cooperation.

2. This competition is often emphasized by parents, who are very competitive through their kids. Getting better grades, more activities, better scores, more coaching, in school, in sports, in music, in everything is important to get a step ahead in our capitalist, make it on your own world. Cooperation is often seen as a weakness, while using any means to find an advantage is rewarded.

3. The many kids who do not want, or cannot be that competitive, are the ones who stay home and play by themselves on video games. Yes, the often play virtually with other kids, but that is very different that playing WITH other kids, and discussing, negotiating, compromising and then competing. So many kids now play video basketball, with virtual swoops and dunks, but fewer are joing other kids and playing real pick-up basketball, and learning work together to pass, guard and set-up shots, even when you are 5 foot five inches tall.

When we played games we were often very competitive. It felt good to win. But if we were going to play the next day we had to stay friends with the kids we played against. Either they would be on our team the next day, or else we had to like and trust each other enough to want to play together the next day, and have a good time. There was a degree of friendship and respect, even to kids we hardly knew. You could go to any park in the state and the rules were pretty much the same, and the winning team got to stay on the court.

Bullying is more of a problem today because of these factors. Because of Facebook and email and text messages meanness can come from further away, and even be anonymous. There isn't the need to keep a relationship going to play again the next day.

The world is changing. Things happen much faster. Kids are exposed to somethings much sooner, but other things, like the kind of fun, chaos, exploration, negotiating, understanding, cooperation and friendship that they find on their own, without guidance, supervision or "enrichment programs," seems to be lost.

It creates a society in which a politician can say " Don't help them, they shouldn't have been living there." and to get away with it.

I don't agree with that. I feel badly for the people who have four feet of water in their living room. I know that if the wind blows a little harder here tomorrow, it could be me. And I didn't do anything to deserve that.

Interesting Question

2011-05-04T19:03:00.000-07:00

He was upset.
Mostly upset because she caught him. She had walked in many times and noticed that he quickly changed the site he was looking at on his computer. But then she found the CD with the male-bondage stuff going on.

She was upset.

She wanted to know if that meant that he was gay.

He insisted it didn't. He said he never had felt turned on by any live man, and he works with men. The idea of actually touching, holding, and being with a man is something he never thinks about, and he doesn't feel like he could actually be aroused by that.

It doesn't help that they haven't had sex in five years.

Really, and this is after an hour of talking to them, so this is a less than certain opinion, I don't think he's gay.

I think he is very anxious. Real live women scare him. He found some excuse five years ago to retreat from her. He found that getting turned on by porn was much easier, less threatening, and less judgmental. After a few years of porn he began to get a little bored and found several variations, and then variations on that. Who knows, the next step could have been sheep.

The real question is can he get reoriented to appreciate real, live women? Does he want to?

Does she want to? That's another very important question.

A New Model?

2011-05-01T18:32:00.000-07:00

Last time I wrote about how I can imagine that the way I do psychotherapy could change. New insights, new technologies, or convincing new evidence could, I hope, lead me towards a new way of doing things. I'd like to think that I'm flexible enough to change.

Yes, I do believe that interpersonal interaction, especially between humans, is very powerful, and is one of the most basic components of our psychological existence. But, that doesn't mean that the process can't be helped along.

There is a group of neuro-biologists on the west coast of the USA, the most prominent of them is a Dr. Christof Koch. Working with Dr Fried, who treats epileptic patients, they implanted electrodes in their brains in order to help treat their seizures. Slowly, they have been able to find some exact spots in a brain that hold a specific thought. And working with some talented computer programmers, they have found a way to have people's thoughts control which image appears on a screen just by thinking about what that image is. For example, they had a woman who thought about Josh Brolin and about Marilyn Monroe. They had electrodes placed on spots in her brain that represented their memories of each of those people. When she thought about Josh, his picture would appear. If she then began to think about Marilyn, Josh would fade and Marilyn would appear.

I feel that the implications of this technology for my work are tremendous. What if a person harbors very ambivalent thoughts about themselves, or something they did, or someone they are close to. If they could learn how to make one of those thoughts (and the feeling that goes with it) become more dominant, they could have much better control of their lives and emotions. The change process could go so much more quickly if someone was able to get immediate feedback, such as seeing a picture of what they want to see become clearer and clearer, the more they thought the good thoughts.

What about people who suffer with obsessive thoughts: is there a spot in their brain where these thoughts originate? Could we tap into it and help them to learn to think about it less, while thinking about something else more?

Done correctly, this could become the opposite of brain washing, which is when someone else has a strong influence over what you think or believe. People could be able to think and feel what they want, and learn to do so much more quickly than happens when they just talk about it. I could see up there on the screen, how well they were doing. How strong the thoughts and ideas are; how persistent is the idea we want to repress.

Of course, this implies a very reductionist philosophy, one that favors the stance that the brain controls the mind, more than the mind is controlling the brain.

But that raises the question of who (what?) controls the brain that controls the mind, if it is the person who is doing all the thinking for both the brain and the mind.

(I used to talk about this to my son. He would leave the room screaming.)

But if we can change what we think and feel more easily, just by thinking about it. That's what all this therapy stuff is about isn't it?

And what if there was an App for that?

Don't want to be Polaroid, or DEC

2011-04-28T19:36:00.000-07:00

There have been many big companies around here since I have opened my practice. Three that come to mind quickly were Polaroid, Digital Equipment Corp and Wang Labs. I used to like them because they all had great benefit packages and tried to take good care of their employees while they were making money. DEC and Polaroid were always two great companies to work for.

They only thing they did that hurt all their employees was go out of business. None of these three companies, and many others, lasted, because they couldn't turn the corner. They didn't see that a new world was taking shape around them. They had a model of operating that was successful, and they just kept following that success. Once you find something that works, its very, very hard to see when it's not working, especially if it did you so well in the past, and if there were always normal fluctuations.

When is a loss just a dip, and when is it the plunge of no return? You can't really know until it's too late.

In psychotherapy, with all the new technologies, and all of the new science, there are now many models of how to deal with emotional, psychological and behavioral difficulties. You can come and talk to me; which is the old model. Or you can take some complex new chemicals that may (or may not) affect your mind. You can take pictures of your brain with an exciting new brain observing machines. You can dip into your genetic code and try to rearrange things to alter you basic tendencies.

Some of these models have not had the kinks worked out of them yet. The odds are if you dip into your genetic code you may come out being a two-toed sloth, which may not be a bad life, but it is a risk.

But the model I have been using is old. It is very low-tech and inefficient. Some people come and see me for years and hardly change their lives that much at all. Treatment sometimes ends because I get bored. For many people this "talk therapy" model just doesn't work at all. For many cultures the idea of speaking about your strange inner thoughts to someone you don't know, to anyone really, would be a disgrace.

But so far, I continue to struggle along, using the same old model, adding a few new slide-steps, spin moves and slight-of-hand tricks to my repertoire, just to show that I keep up with the times. I don't think I will be the one to determine when the time has passed and other things work better.

So far, I don't see it happening. And the demand for my little dancing act is still strong. But high demand from the masses is no way to determine truth or validity. There is a high demand for the psychic around the corner, and she doesn't have to get pre-authorizations,
AND she does parties.

Tech 4

2011-04-26T18:46:00.000-07:00

There is so much stuff out there that just comes pouring in here, between newspapers, the too many magazines I still get, the web sites for all of them, all of the other news, science, psychology, web sites, chat rooms, list serves, journals, comments on the journals, etc, that it does get a bit overwhelming.

I am from the generation of having to go searching for information. Every bit of it seems like a find. I keep piles of it, knowing I will probably never get back to it. Even if I do I get distracted by new things. I am not that good a weeding out, and staying with a few regular sources. I try to get other view points, but there is so much noise out there. Everyone wants to be heard, and the only way to really get recognized is to be extreme and ridiculous.

Donald Trump for President? What could be more ridiculous?

Anyway, I read somewhere, I can no longer remember where, that it has become acceptable behavior, or at least commonplace, to be talking to someone who is with you, while at the same time holding a "text" conversation with someone else. So many people are texting constantly. Older people are constantly checking email. Facebook. Beeps, chirps and chimes abound. Information flows in. Where are you? What are you doing? What did you think of that? What is he saying? Get this done, Get back to me. On and on in a constantly flow.

I sit in my office, one on one with people. Most of them forget to turn off their phones until they ring, or beep or boop or rap, or erupt with heavy metal. Even then they sometimes take the call, fearing it is about their kids, or their boss, or something very vital. That has happened once out of about 200 times, that a kid was sick at school. Vital? An instant response expected.

There is a lot of discussion now about doing therapy by phone, or Skype, or even just by instant messaging. Is that better for people who can't reveal deep, dark secrets in a face to face setting?
Perhaps.

But my profession, the way I do it, remains very low tech. We assume that real, direct, in-person, interpersonal relationships are more telling, more real, and convey so much more emotion and intensity. It is so basic to being human.

Or, at least it was.

client called

2011-04-20T19:09:00.000-07:00

At least once a month I get a call from someone I have already seen, but who I have not seem for a while. Many people come to see me for six months to two years and that's about all I have to offer. But usually by then they have be transformed into amazingly creative, caring, successful, problem solving individuals, whom everyone wants to know a be around.

Often a new situation arises, or some of the fairy dust wears off and they find a reason to come back for a tune-up. This can happen after one to five years, and often happens again, one to five years later.

But while I was away I got a call from a woman who said that she had been waiting to call me for a while, and she was pretty sure it was me she wanted to see. I had seen her once before for a few sessions and put her life on the right track, but now, she felt the need to see me again.

She left her name, but I didn't recognize it. I called her when I got back, and she explained that she had left her married name, and I would remember her by her maiden name. Also, she is 50 now, and I had last seen her when she was 17, in 1978, and I was working on the other side of the state.

There are a few things she wants to talk about that have happened since then.

Fine, I'm looking forward to it.

away, and back

2011-04-16T20:04:00.000-07:00

I keep planning to do this thing on a regular basis, just for the discipline of it all. Sometimes I think it would really help me clear up my thoughts if I could write them here, trying to be coherent, two or three times a week (ha!). Other times I think that the kind of writing that goes into blogs, including this one, is hardly disciplined at all. It takes time and revisions to think through an idea, and to present it well.

It would possibly be more effective to blog regularly, once a week. To begin on Monday, add to it, review it, edit it and post it on Sunday. But hardly anyone, including me, expects that from a blog, so most blogs are read quickly, and anything that takes more than six minutes to read hardly gets read.

But, so far, I have had a tough time doing either.

My excuse this time is that I went away. That's a good enough excuse.

We packed up and got out of the long lingering cold weather and journeyed to the far off Southland.

First we visited that stately town on the bluff, Natchez, Mississippi. When we got there people asked us why we had come. They seemed a bit puzzled. Natchez turns out to be a smaller town than I expected. But otherwise, it was more than I expected.

We went there to see the river. And that was reason enough. A mile wide, muddy brown, swirling in seven directions at once as it pushed itself downstream, the mighty Mississippi lived up to its reputation. The people in the town said they respected and feared it a bit. It was not to be taken lightly. The currents were strong and unforgiving, especially at this time of year.

The town was charming, a beautiful example of the old South. The people were friendly, more than approachable, willing to talk, and happy to have some Yankees walk through. We saw the stately old homes. We ate some great Southern cookin', We drove a few miles up the Natchez Trace, which is something we hardly knew about. A beautiful road, that winds by itself all the way up to Nashville.

But then we turned around and drove south, following the river, through St. Francesville, La, a town of simple pleasures and unique treasures, right on the river. Then we drove past the oil refineries, and the tallest state capitol building in the country, which is in Baton Rouge. We also saw where the River takes a turn, and the oil tankers come and go, under yet another huge Mississippi River Bridge.

The rest of the week was spent in and around the Big Easy. The French Quarter, filled with tourists, music, a great deal of alcohol, better music, more alcohol, and great food. The Garden district, with funky Magazine Street, some of the best graveyards in the country, and some still remaining houses that were ruined in Katrina. We saw alligators in the Bayous, and ate shrimp, oysters and grits everywhere.

Now, we have returned to New England and are again, freezing our asses off.

It's great to get away. It's fun to talk to people who I don't have to try to help.

Again, I am left with the perception that I do not think in the manner of many of my countrymen. I do not immediately look for a business angle of for the faster pleasures. I always seem to feel that things are more complex than what is being presented.

Often, I am left feeling that I just make my own life more difficult, but it's too late to change that, and I don't want to anyway, because, even though I say I'm open minded, I know I'm right.

But they sure do have some big boats going up and down that river. I could sit in that warm sun, with a beer in my hand, and watch them go by all day. Not much complex about that.

Pissed off

2011-04-05T19:06:00.000-07:00

Back at work, and the pressure of cramming it all into three days still makes me uneasy. It gives me the luxury of being selective. I have to give some people more time between appointments. It forces me to choose even more; who to see and who to make wait. In many ways it's healthy for all of us. I can't just see people who want to unload on me. I want to put the time into those who will use the opportunity, whatever it is we do together, to move forward.

But so many people are so angry these days. There is such a feeling of distrust. People feel that their employer cannot be trusted, many are angry at the government, for reasons that are never clear, they are angry at the pressure they feel for money, with rising prices and stagnant wages. They are angry that so many people are angry. And everyone feels entitled to be angry in response.

For thirty years I have sat with couples who scream a each other, but now there are lines that are crossed much more often. Words are used that would never have been mentioned, very sharp verbal knives come out much quicker and cut much deeper. So many people seem to feel that relationships are just temporary. This city is very diverse, and yet this seems to cross many cultures. Men slip away; women are quick to pull back, they detach and give-up on the relationship quickly. It's not worth the effort to save it.

The drama of adolescents is much more intense also, and seems to be much meaner. Kids always found ways to put each other down and define a pecking order, and those on the bottom always suffered, but there seems to be a relentless need for some kids, often young girls, to destroy others, to drive them out of the group, to completely humiliate them. Everyone is at risk.

Tell me if I'm wrong. Maybe I just saw too many people today, after doing nothing yesterday. Nothing was kind of fun, but not very exciting. This is very exciting, but not really fun.

I worry, but...

2011-04-01T19:16:00.000-07:00

I go back to work now, and only work three days. It's very strange. I am trying to adjust but it is difficult. I take Monday and Friday off, so if the warm weather ever comes I will have long weekends to make sure the tide comes in. But on Mondays I still feel guilty. I wonder who gave me permission to stay home.

But work is easy. Three days is nothing. I could probably see a hundred people in three days, but I stop at 27. That's enough. Then I begin to get tired. But, by them, I'm done. I have a long weekend!.. It's a vacation!

I've been seeing a lot of people in their late 20s and early thirties, and I worry about them. The ones that reach me, here in this struggling old mill city and struggling themselves. Most of them are either still taking courses to finish college, have finished after five to ten years, or have dropped out. They have jobs they don't like, and make enough to pay the rent if they live together. They don't really make enough to get married and have a family.

They come from families that fell apart in their youth. They have fathers they rarely see. Their mothers have had several relationships that seem to last three to eight years, but are destined to end badly, or to just fade away. Many of those who I see really don't know how to expect something better.

Today's economic situation does not help. High paying jobs are scare and need specialized training.

So many of my clients, who are now 28 to 42, still live the life of a 23 year-old. They drink too much. They roll in and out of bed with friends and neighbors they hardly know. They rack up credit card debt that may or may not get paid in their lifetimes.

I see about five or six people like this now. Each of them seems to have six to ten friends who are really worse off then they are, but are too scared to come to treatment. Most of the ones that come to see me do so because they really want to do something about it. And most of them do. They slowly grow up, and do the difficult and/or boring things that growing up requires.

But it sounds like many, many of their friends don't. They continue to drink too much, to give-up on themselves, to let life just drift by.

I worry about them. There are many, many, of them who take too many drugs, still play too many video games, and skip work at Target or the supermarket or the call center, where they get paid $8.50 an hour.

But. in truth, although it seems as if our society is terrible, mean and demeaning, it has always been this way. In fact, it is probably better now.

Things were worse fifty years ago, much worse a hundred years ago, and inconceivably bad before that. But then, many people just got sick and died, and that was the way it was.

Now, with health care, machines, and the marvelous new technology, there is not only the expectation, but also the capability of finding ways for so many more people to live decently, and become comfortable and productive.

But, really, there is not the general will to care about too many people, especially if it may make you, me, or anyone, a bit more uncomfortable.

This is not new. It seems to be part of who we are.

tortoise vs. hare

2011-03-28T18:50:00.000-07:00

The two of the came in at successive hours. Both extreems of what you can be.

One, out there to make millions, talking, screaming, planning, forecasting out six months to ten years, putting things in motion: phone calls, emails, banners, social contacts, meetings all set-up. My job is to keep him just this side of psychotic. If he succeeds he will be thought of a brilliant. If it all blows up and falls apart; he will be just another bipolar disorder, needing more medication.
Look at the heads of many of your most successful start-ups and you will seem guys just like this. But you can look at the guys standing outside of the pub, flicking cigarettes and talking rag-time. The differences are slight.

The next hour the tortoise came in. He carefully obsesses over each detail of each decision. What are the possible reprecussions? What can go wrong? What will people think? Session after session he seems to go over the same things. But he slowly, cautiously moves forward, often aware of the price he pays for hesitating, but also knowing that worrying about the risk would have ruined everything anyway.

Thankfully, most people fall between these two. But we all have tendencies to go more one way than the other. Often people seem to choose areas of their lives to take risks and be a bit "out-there": business, investing, relationships, sports, drinking, drugs, sex, or just not doing their taxes. I am no longer surprised to find how many people seem measured, reasonable and secure, and yet will do one or two really wild, fucked up things, and do them over and over.

Keeps things interesting.

Non-tech - just not good

2011-03-23T18:22:00.000-07:00

A colleague of mine from across the city sent them to me. He has been seeing her in therapy for eight years. Another therapist we know has been seeing him for only three. They came to me, I thought, to work on their relationship.

But soon after they arrived the husband announced, pretty clearly, that the relationship was dead. From his years in therapy he had learned to finally express himself and to take steps to pull himself out of what was a long-term depression, that he didn't even realize he was in.

He said that for years he has felt unappreciated, disregarded, and demeaned. He said that he felt his wife was always bossing him around and he didn't like it. He wanted to get a divorce.

His wife broke into tears. She had not realized that he had reached this decision. She was still hoping to learn what she could do to save the marriage.

Fine, this happens, I often see people who know that the relationship is over. Sometimes they need a safe place to say everything. Then they leave. His wife was not in favor of ending the marriage, but she seemed to realize that she cannot stay in it by herself.

But this was different. After it was clear how this husband felt, I asked about his plans, and how he expected to move the process of ending the marriage forward.

He had no plans.

Did he expect to leave soon? Did he have a place to go? Would he work out temporary support payments? How did he want to tell the kids?

He didn't know.

I asked if he realized that now that he had laid this bomb out on the table, things would be different at home.

He said that he had been working for a long time to clear up his thoughts and express himself. Now that he had done that he was very pleased. But he had no idea of what the next step would be or when it would occur.

I think I can see why she bosses him around.

Really, there is a 50/50 chance that they will stay together. He got it out, he made her cry, that may be all he needed. Perhaps now he can assert himself in other ways that will make her happy, and then she can respect him and make him happy.

or, perhaps he is already screwing someone in his office and she makes him feel very special.

Tech 3, retail

2011-03-19T19:43:00.000-07:00

It is clear that books, music and newspapers have been drastically affected by the use of the Internet, but those are just the most visible. Every kind of retail sales has been totally changed by technology.

Yes, a few people go to the mall to hang-out and look at stuff, but I certainly don't expect any new malls to be built around here any more. Many are in bankruptcy, and most have obvious vacancies.

I love my iPad, but I am sure I ma putting more people out of business. These are jobs that will never come back. Retail is being condensed into a few leaders in on-line sites, and other sites that tell you where to find the best prices.

Have you been in a Staples story recently. You were probably one of three people wandering around the entire, huge, retail space.

I have had about six clients during the last year who have lost their jobs and began looking for work. Four have found jobs making much less money. Two are still looking, and they are skilled people who are looking very hard. They are draining the money of their extended families. Support for the unemployed has dried up with all of this "deficit" talk. The deficit will never get paid if no one is working, and no one can pay taxes.

My daughter, who has a job and is very busy, needed diapers for my grand-daughter. She went on-line at 5 PM and spend about three minutes clicking. The next morning, before 10 AM the diapers were delivered. I don't know what store she would have gone to, but it won't be there in five years. The jobs of the people who work there, and the rent that is being paid, will all disappear from our economy.

For everyone else, life is easier, probably cheaper, faster and more convenient.

Tech 2 -- People real or virtual

2011-03-14T17:56:00.000-07:00

This won't come as any real surprise to anyone who has been on a dating site, and many of my clients have told me many, many stories of their experiences with them, but I had the experience last week of turning virtual relationships into actual ones, and it was fascinating.

Years ago, at least fifteen, I met some other therapists at a psychology convention. We have managed to find each other several times after that, at other meetings. We have formed a group of about six of us, sometimes four can meet, sometimes it's a different four or five. But those meetings for me, happen about every three or four years and our fatherings last for about two, perhaps three hours.

However, we began to correspond on a small email list, and exchange ideas, comment on happenings and keep track of each others lives, both business and personal. It's been fun. They all seem like intelligent, caring guys, who share many of the same views I do.

Last week someone arranged for us to all meet to view a couple of games that we could enjoy. We are all kind of sports nuts, all within ten years of age -- I am the oldest, and all from very different parts of the country. We spent three full days together, watching games, talking, driving, drinking, eating, and just hanging around. It really worked pretty well, considering that we really didn't know each other that well.

What was most fascinating was that, although I got along with everyone, what I expected from each of them, how I thought they would talk, interact, take stands, lead, follow, be funny, be smart, know stuff, make decisions, be creative, be trite, all the ways that people interact ... I did not predict correctly.

People, all of them except one, were very different in "real" life. If I had to rank order who I expected to get along the best with, my order would have been wrong. What people say in emails, how they say it, and what it really means, sends a very different message.

As I said, people who have experiences with dating sites know this only too well.

A great virtual friendship has often been ruined by a brief meeting. It's not the same. This did not ruin anything, but alot has changed.

Tech 1

2011-03-08T18:57:00.000-08:00

This is my new theme: technology is changing our lives. It does not seem startling, but really it is, because the changes are much more far-reaching and long-lasting than people realize. for our old life-style it is a death by a million tiny cuts.

I am not one who believes that the great Singularity is coming, but things are very different.

My first post about it is simple. It began with a tiny insight.

I walked into the waiting room to bring in my next patient. There were four people there, waiting for everyone in our office. We have the best magazines of any waiting room I have every been in. We get, mostly for free, Yankee, People, Rolling Stone, Discover, and a few health and women's mags that I can't tell one form the other.

But, at that moment, and then I noticed for the rest of the day, one person, and she was about sixty, read a magazine. Twenty people were playing with their phones: texting, playing games, updating apps, on Facebook, all of that.

Piles of unread, fancy paper, wasted.

Is the world better or worse? Not a relevant question. this is the way it is and it will only become more so.

sinking low down

2011-02-27T18:07:00.000-08:00

I would say that I am low, blue, in a funk, but not depressed. Many of you seem to know what real depression is, and this isn't it. This is a bad day.

I woke up this morning and it was snowing. Not a good start. The snow drifts around here were beginning to diminish. I could almost see a car coming around a corner. The frost heave at the top of the driveway was being pushed back into the muck. The packed ice mounds had been surrounded by small, or large puddles.

But now there was new snow, covering the old snow. The sky was gray. the wind was damp and biting.

Sunday morning we read the papers. Middle class people all over the USA were fighting with each other. One group was trying to make sure that the very rich continued to get all the benefits, and that the few benefits that some middle class people still enjoy should be taken away, just to make things even.

Then we go to a movie club every other Sunday. We see a movie before it is released so we can start a buzz about it. We are the old cognoscente. Today we saw a movie called "Poetry." It was made in South Korea. We well acted, beautifully filmed, emotional, moving, 2 1/2 hours --- depressing as hell. About a 66 year-old woman raising her grandson on her own. She finds out that she is in the early stages of Alzheimer's, and that her 14 year-old grandson is involved in a gang rape, after which the victim had killed herself. Not too cheery.

Then, just to round out the day, I have spent the afternoon doing my taxes.

Going to work tomorrow will be like a min-vacation.

more churning

2011-02-23T18:11:00.000-08:00

What follows is a little propaganda for the good guys, who went to school a long time, worked hard and studied the art and science of what they do.

I did not mean to imply that a machine can be a better therapist than a trained, experienced, intuitive, sensitive clinician, I only meant to say that people will relate to a machine, and sometimes find it helpful.

Dogs are helpful too.

If I were to refer my best friend's sister to a therapist, I would refer her to a Ph.D. psychologist. As I said in the last post, having a Ph.D. does not guarantee that a person is a good therapist. There are many good therapists who do not have a Ph.D.

But the odds are better, if they do. It means they have learned about a lot more stuff: brains, culture, families, bodies, child development, learning theory, and how to evaluate research so as not to be fooled or manipulated. It means they have been supervised by several different supervisors, probably with several different orientations (MSWs usually get that too).

Also, although they may not be fantastic therapists all the time, seeing a Ph.D. really decreases the odds of getting a BAD therapist. There are bad therapists. They are not trained as well, they often think they know more than they do, they don't see boundaries clearly, they want to be Dr. Phil, or they are not aware of their own shit and how it can spill over everything.

Machines are usually insincere. They may sound like they care, but they don't.

still churning

2011-02-21T18:39:00.000-08:00

Since I wrote the last post there has been a lot of discussion on some of the lists I am on about the future of our profession. The pressure is building on any kind of health care provider like us, to cut costs, or to justify the added price.

The truth is that it will not be an easy task for our profession. Not that psychotherapy is not worthwhile, and we are actually a contributing factor in keeping of health care costs down. But, as I have said, I have hardly gotten an increase in payments in twenty years, and the one company that had increased payments on occasion, this year made some significant cuts.

That does not make me feel loved -- not here in America, where money is how we measure worth.

There are some studies that show that people who come for therapy have lower health care costs overall, mostly because they deal with their problems in life directly, and therefore develop fewer stress related disorders, or don't somaticize their complaints. But most health insurance companies don't look at anything over-all or long-term; they see that the cost of mental health services has been rising, so they want to cut it. For twenty years they have been trying to find ways to cut services, by limiting sessions, or limiting who they would pay, or trying to track diagnoses, or treatment outcomes. But all that gets very complicated, and people keep demanding to use our services, so now they just cut the fees.

The real question however, is how can we show what we do is effective, and is there a kind of therapist that does it better?

Well, I have found the answer to the first one, and I like it, but I'm not sure the insurance companies will accept it. Three psychological researchers, Duncan, Miller and Sparks have come up with a method to track how much the therapy is helping the client. Their basic method is this, and it's amazing: They ask the client "Is this therapy helping?" and a few, very few, other similar questions.
Their research shows that this method really can measure success. That's science, at its best.

Now, as to the question of who is a better therapist, well this is where the therapistmumbles begins to mumble. As people have reacted to my last post, it seems that getting a Ph.D. offers no certainty that it will make you a better therapist.

I am sure that it takes many qualities to be a good therapist. I think that the knowledge and understanding that a more comprehensive education, such as I got in graduate school, is one of them. But there are qualities, such as compassion, empthy and patience, that often come naturally to some people, and others can learn to be that way, to some extent, but you don't need five years and a dissertation to obtain those kinds of skills.

I also know that a large amount of what I learned in graduate school, those many years ago, I consider worthless information now. I also think that a great deal of what they are teaching now will suffer the same fate.

I got a Ph.D. because it seemed to add some wight and heft to my credentials. Mental health issues were still seen as almost mystical and incomprehensible then. Also, getting a MSW just seemed wimpy. I think my big degree helped me get esttablished in a private practice. Many (most?) people still don't really know the difference between a psychologist and a psychiatrist, but they also get confused between an LICSW and a welfare worker.

But the trend now is much more based on cost, and most Ph.D.s think they should get paid more than people who did not survive the obsticle course of obtaining that degree. That may put us at a disadvantage unless we can make a stronger case that demonstrates our superiority. So far, we have not done a convincing job.

I am afraid that a lot of wimpy people also can be good therapists.

Watson Wins, and continues on

2011-02-18T20:17:00.000-08:00

By now many of you know that the IBM computer "Watson" blew away the competition on Jeopardy, and showed that very clever algorithms, as well as four terabytes of hard disk storage, which it could rumble through in milliseconds, can dig up trivia faster than anybody we know.

Now, we sometimes play Jeopardy at home, but it's Old People Jeopardy, which works like this: some gives an answer, such as "She said ' just put your lips together and blow." Then, I would say " I know, I know, it was, it was the woman who was in those movies we used to see at the Brattle Theater. You know with what's his name, all the time around exam time. You that was the one about, was it the statue, no it was the hurricane. It was, it was, I know, Lauren Bacall. And I would get credit for that answer.

But Watson' hard drive is cleaner than that, and the algorithm makes it's associations differently, without all of the personal history and going to the movies during final exams, and of drinking too much coffee, and being all hyped-up and happy because of going to the movie with the woman who you are eventually going to marry, of all things, which is something that Watson has no concept about how that can feel.

However, Watson is going to be moving into the health care field. In a collaboration between IBM and Nuance, the company that has vastly improved speech recognition software. They will be using it to improve the diagnostic ability of doctors.

As the press release says:

IBM offered a scenario in which a doctor who is considering a patient diagnosis could use Watson's analytics technology and Nuance's voice and clinical language understanding solutions to consider all the related texts, reference materials, prior cases, and latest knowledge in journals and medical literature. Armed with this information, Watson could help medical professionals determine the most likely diagnosis and treatment options.

Clearly, the doctor part of this team is the most expendable. The doctor could just as easily be replaced by a nurse, and then by a "technician" and then by the kid who knows more about video games than he does body parts, but he is more comfortable relating to a machine.

Now don't say that this can't happen to psychotherapy. Perhaps you are thinking that psychotherapy is too personal, and that therapists are one of the last remaining professions that utilize the powerful healing value of genuine, human understanding and empathetic interpersonal interaction. And that is true, for that is probably the basic force that psychotherapy brings to bare.

However, many years ago, back in 1966, an MIT professor Joseph Weizenbaum, who was studying linguistics devised a program on a very early computer that would simulate client-centered therapy.

Weizenbaum, J., "ELIZA -- A computer program for the study of natural language communication
between man and machine", Communications of theACM 9(1):36-45, 1966.

This program gave students the chance to sit and tell their problems to a non-judgmental,
confidential machine, and they loved it. They talked to the machine about things that they
had never talked about with real people. It seems that so many students liked to talk to the machine so much that Dr. Weizenbaum became afraid that they were becoming dependent
on it, and he had to remove their access to it.

That program was a very early version of artificial intelligence, and it has been improved
and updated and has been used recently in the Turing Test contests that have been held for over a dozen years. There is a good article in the recent Atlantic about being the human in that contest.

So, here we have Watson, and IBM and Nuance, moving into medicine. Is that bad?
Probably yes and no.
Old people will still make a big fuss about wanting to have a human doctor to hear their
complaints, but younger people will probably have more faith in robotized medicine, have
grown up spending more hours with computers than people anyway. Many young people believe that machines are better at everything anyway. Many techies are waiting for the Great Singularity, when we will all be absorbed into the cloud and become one with the cosmic, computerized, web intelligence.

It's just that another whole bunch of professionals will be out of work.
They will be home playing video games.

{note: somehow the technology of this post could not provide consistent formatting, for
some reason that some of you may understand -- but not me.}

I have a Ph.D. (so what?)

2011-02-14T18:58:00.000-08:00

Wow, two weeks, and I thought I was keeping up. Life gets confusing when there are so many virtual conversations running through it. it wasn't this way before all this e-stuff and i-stuff. There was a times when I went to work and came home. I read magazines, tormented my kids, watched the Celtics and went to bed.

Now there is email, list serves, national small group conversations, international strange group communications, family pictures, and even friends who expect messages and responses. All of this is good, but it clutters up the mind. And I don't even do Facebook. It's not good for therapists to "friends" with people. We are not really too likable anyway. We tend to be shy, overly intellectual, too observant, and make people uncomfortable. If you meet an really out-going, energetic, up-beat psychologist; you know he either is all schtick, or else he hasn't been paying attention. All of us good therapists are sullen and depressed by how much we know about the world.

And, speaking of depression. The reason I have not been on this blog is that I have been in hot correspondence with other psychologists about the imminent demise of our profession. It may not be obvious to you, but the opportunity to see a Ph.D. Psychologist for psychotherapy is rapidly slipping away. We are being replaced by medications, neurological brain scans, and Master's level therapists.

I don't know if any of you care what degree your therapists has, and probably most of you who have been in therapy may not even know what the difference is between a psychiatrist, psychologist, MSW, MA, LICSW, MFT, and various other types of after-the-name letters that can make one seem to have the experience and/or training to help people having difficulties. I know that when many people don't know what to do they go to a psychic.

But, although psychotherapy done by a Ph.D. Psychologist has been reimbursed as a health insurance benefit for over thirty years, and will probably still continue to be covered, most people are being steered by those insurance companies to lesser trained people, who get paid even less than we do, and we have not had a fee increase in twenty years.

Even psychiatrists are seeing their role diminished as PCPs are being told to give anti-depressants to anyone who cries, and nurse-practitioners are now writing lots of the prescriptions for psychiatric medicines.

I know I can make the case that a Ph.D. Psychologist is more learned, better supervised, and probably has a more comprehensive understanding of all the many factors, physical, emotional, cultural, familial, genetic and inter-psychic, that determine how and why people think, feel and behave the way they do.

But does this make them better therapists? And how can we prove it?
AND
Does this matter to anyone by Ph.D. Psychologists.

I'm afraid not.

Puff, we disappear.

a new part of the problem

2011-02-01T18:58:00.000-08:00

It is snowing again. The rest of today's appointments are cancelled, and all of tomorrows are crossed off already. I have not been kept away from work for two days in a row since 1978. This will be a winter to remember. Until next year. It seems pretty clear that theses "hundred year storms" now happen almost every year.

Still there are those who will say that industrial production and energy sources have nothing to do with it. I guess it depends upon who is writing your pay-check.

But before the snow began I had the unenviable task of meeting with one of my patients. It was difficult because this fellow has endured some of the troubles of Job. He had been married and had two children with a charming woman, but much of the time she was out-of control. She often drank heavily, and when she did she acted out in many other ways, sometimes leaving the family, and vanishing for a week at a time. Sometimes her diappearances would end with a call from a hospital. He would take her home, and nothing would be explained. Sometimes some guy would call, just to see if she was OK.

About eight years ago, her luck ran out, and she died in an emergency room of a brain hemorrhage. This left my patient with two children, the oldest was eight.

But I began treatment with this man in October of this year, two months after the oldest boy committed suicide.

It is never easy to deal with parents who lose a child. That is not the natural order of things. At best it leaves gaping hole that can only be thinly sealed over, at worst it can be fatal to the parents.

Awful as it is when something tragic happens by accident or illness it is worse when a child does it to himself. I have had to deal with this twice before in my long career. One was somewhat easy to understand as the boy had been psychotic several times, and he had often done bizarre things which were unexplainable outside of his head. The other was completely incomprehensible, as the young person seemed popular, happy, and reasonable. Dealing with the grieving parents; all of whom were single parents at the time, can be pretty grueling, as there is nothing anyone can really do to bring about a desired result. It is already to late for that.

In this case the man had realized that his son was struggling. He knew that the boy had always felt like an outsider; he had actually mentioned it. He had brought him to a therapist a couple of years ago, but the boy didn't really open up. The father was pretty sure that his son had struggled with his sexuality, but he couldn't get him to talk about it. The young man had few friends. He was clearly anxious in social situations, and avoided them if he could, even with the family. He had been a good student and seemed to like school. He hardly ever missed a day. But more and more, he stayed by himself.

In this session though, this man brought up a point that I don't think would have been as important twenty or thirty years ago. He said that he knew from his own experiences, and he could see from his son, that life today is very, very competitive. It never seems to stop. It is true at work, in sports, at school, and even among friends. Outside of a family, there are very few really supportive networks in this country. Even churches are competitive.

This man had stayed out of work for a couple of years after his wife died, and he found that in order to get a job he had to not only compete with others for the job, but compete with others in his own company who had the same position (in sales and marketing) as he did. Trust and cooperation were talked about, but they put you at a disadvantage if they were actually practiced. Everyone seemed to understand that.

He feels that this hyper-competitiveness was part of what made his son just give up. He felt that the boy never had the confidence or the social skill to push himself through all of those situations that were constantly confronting him. Competition in school, or to make friends, or to run track, or to get a job, or even among friends playing video games.; it was always about beating someone, pushing someone out of the way, or looking for an advantage. If you couldn't do that, you would get knocked over and trampled upon, and then blamed for not being strong enough.

It runs rampant through my practice these days. I see people who are unemployed, and feel invisible because no one even acknowledges their calls or emails. People who are employed are being pressured to work harder to keep their jobs or they will be easily replaced. People with vital positions at businesses feel a great deal of pressure to meet deadlines, to beat the competition, to keep their company in businesses.

President Obama talked about the need for America to create and innovate. It's because the world has changed. Many basic jobs are now unnecessary. They have been replaced by technology. Farming, manufacturing, constructing, even selling, were things that people did for centuries in order to keep the world running. They are all done now, but by machines of some type, and they need only 5 to 10% of the people to get them done.

It is much harder to just find a job, do it well, take care of yourself and your family, and live a life. There is much more competition for much fewer spots, and the competition is not just from those around you, it's global. Someone in India can pick up that phone, write a piece of software, and even read an X-Ray just as well as you. Robots weld cars, mix medicines, answer phones, take tolls, guard buildings, run trains, and do it better than people.

Many people are very scared. And if you are hesitant and fragile to begin with, it could seem like too much, as it was, tragically, for this young man.

I believe that we live in a more difficult age than we realize. Most people don't even acknowledge the problem yet. I believe some of today's political craziness is the result of people who are aware of what is happening, and fear it so much that they need to work hard to deny its existence.

That makes arriving at a solution, or many different solutions, even more difficult.

We have to find new ways of living together on this planet. The current ways are leading to a greater concentration of wealth and power than any time since feudalism. It is not a healthy situation, nor one that can be peacefully sustained. Much of Egypt's current uprising was the result of very high unemployment among it's young adults.

It will be fascinating to see how they deal with that problem.

Weekend's End ( while still in transition)

2011-01-30T18:53:00.000-08:00

It's the end of the weekend. I have two hours left to do whatever I want, then go to bed, wake up and begin the new week.

It is kind of different now, as I consider slowing down at work. This is the first time in my life that I kind of feel that work could be optional. We have reached a stage were we seem to have enough money that I really don't have to work too hard. It's not that we are really up there with the bankers and the bond traders, but we are OK. What I earn from now on will help, and money is certainly a good things to have here in America in the age of the Tea Party, but it isn't crucial. I could hang around, drink coffee, read the paper, and visit my granddaughter, email my four friends, and still be able to pay all my bills.

Also, there is about two hundred feet of snow and ice out there. The roads are narrow, the driving is difficult, the cold is uncomfortable, and more snow is coming. That doesn't make me want to rush out and face the new challenges of the emotionally suffering.

But here, in the waning hours of the weekend, I just kind of stare out at nothing and let the time slip into the unstructured darkness. My granddaughter is being taken away for a week to seek warmer air. My wife is on the phone. I could read more of the paper, but I already know enough about what's happening to stay upset, and new fashions are not my thing.

It's kind of nice to just sit here, with no pressure, not doing anything for a while.

I'm not that good at it. I try and tell most of my clients to learn to do that. They need to get away from the stress, not be constantly churning, not worry about every detail all the time. Yet the world is in tough shape. There are so many families and many relationships and many children out there that are suffering and are a mess. They could all use time and thoughtful attention. There are too many people acting selfishly, or thinking sloppily and causing stress, strife, struggle, illness, injury and even death.
That's not good. It's not fair, it's not right.

But, that's not really new. It's kind of been going on for 20,000 years.

I'll see how I feel tomorrow.

Right now I'll take a Tums and maybe everything will feel better.

Bad Endings

2011-01-27T11:25:00.000-08:00

Zine El Abidine Ben Ali has has been thrown out of Tunisia. He ruled the country for twenty-five years, took a lot of money for himself, but stayed too long on the job.

Now it seems that President Hosni Mubarak of Egypt is having a tough time after thirty years. As is President Ali Abdullah Saleh. who may have held on too long in Yemen. The Middle East is trying to make changes.

But it isn't just rulers who seem to reach ignoble ends. I see several people in my practice who, given the difficult economic times here, are being forced out of jobs after successful careers: A long-time, well decorated member of a police force, an owner of a car dealership, an older lawyer who had been in practice for years. I am even seeing a very successful salesman for a national corporation, and it is clear that he has out-priced his usefulness. They are making it clear that after almost thirty years they want someone younger and cheaper. It has shades of Willie Loman.

it probably isn't fun being Brett Favre at this stage in his career.

Here I am trying to makes changes myself. My own profession is, again, going through turbulent times. Again they are looking for new ways to (not) pay us. We are being blamed for the high cost of health care, when we have not only not received an increase in fees for over a decade, but now most insurance companies are cutting back. It's easy to feel unappreciated.

So while I deal with my own feelings I have to deal with many people who feel that twenty to thirty years of their lives amount to almost nothing. It is difficult to convince them that they have done a good job, supported themselves and their families, and accomplished something worthwhile, when they are made to feel that they are no longer good enough, and no longer necessary.

There are few good endings, not too many gold watches any more. But at least most of my patients are doing better than the Ceausescus did on their way out.

transitions, still

2011-01-23T17:57:00.000-08:00

I was away.
I went somewhere it was warm. That was very nice. I kind of freaked out when I came down to the poll and it was full of people doing water aerobics. Some hot chick was leading a huge number of people, many of whom were my age, through a stress-less, non-strenuous routine of lifting and rotating their own limbs. I ran away as fast as my aging knees could carry me.

But it was 81 degree there. It is 8 here. I am still wondering why I came back.

I came back because I have a full week this week. I was supposed to keep cutting back so that I can free up a day a week to do other things. I can collect checks from out government soon. That should help defer the lost income.

But what will I do?

I am still very torn about how to manage my time. There is so much to read and learn about, but to what end. If I just keep it in my head, so what?

I could write more blog entries -- which I should, just to try and remain coherent -- but there is so much noise and confusion going on out here in the blogosphere. Everyone has an opinion, which is good. But no one, hardly even me, pays attention to anyone else. Yes, sometimes I do read one of your blogs, and sometimes I lean that you guys are doing something interesting, or struggling in a fascinating way, or just trying to get by, which is also fascinating. Many of you are doing and trying new things, which is encouraging.

But when it come to really changing anyone's mind, not much really happens. Everyone is a pundit. Everyone has an opinion. Usually, everyone is wrong.

I also see that few people are really interested in big-picture things, and that is the way I think. I am messy at details. But the details are what is interesting. yet, it is really big picture stuff that could benefit from change. Yet, what is also clear, is that it probably won't happen. At least not the way that I want it. ( won't everyone just LISTEN TO ME!! )

It's too easy to slip back into work. I can take more calls and take more cases and full up my hours, even if the pay gets worse and the obstacles to collecting that money become greater and more complicated. I won't admit it but it has become more tiring to keep up a full schedule after all these years.

But as I cut back the work becomes less fulfilling because I don't get to take new people, and I get stuck with the more chronic, unchanging folks who will never leave me until I force them to go away.

Maybe I will just use the free time to watch soap-operas --- too late, their not on any more.
Maybe I'll study astronomy, learn to cook better.
Then there is this grandchildren thing.......

By March, I promise you (me) I will be working one day less a week. No more than 25 clinical hours. Got that. Promise.

Let's see, wanna bet?

Dopamine ?

2011-01-13T19:31:00.000-08:00

Guess it's all about dopamine on the brain. Over these last holidays I have been seeing four couples, of many variations, who are parting. it is not gentle on the brain to lose your lover,no matter how intense the conflict, how strained or how long dried up the relationship. When they leave, they leave a gapping hole in your life, and they drain the brain of huge amounts Of dopamine. That's what all the pretty pictures on the colorful fMRIs show.

It's bad, it's sad, and their ain't no cure, except maybe country music.

In contrast, for months I have been seeing two men whom I have been working with to open up, to not try to be impressive, to just be the good,open, honest guys that they are. Suddenly, each of them has found romance. Each is now in a relationship that is over month old. With that, almost all of their doubts, anxieties and listlessness have vanished. Their negativity and cynicism is gone. Their world is now full of sunlight and color.

Love! Better than cocaine; longer lasting, but even more addictive. Much better than any psychotropic medicine ever concocted, or ever will be. No contest.

2011

2011-01-04T18:41:00.000-08:00

So, It's a new year. What are you gonna do?
Lose weight? Drink more? Learn to SCUBA dive? Bet on nothing but Black and #27?

This year is going to be different for me. How? I'm not sure yet, but I am being told that it's time to make changes.

Change come with difficulty. I know that.

All I expect to do is change one day a week. Soon, the government will send me checks so I won't have to work so hard. But what else is there to do? That's the question.

I can spend the time that I gain from not working to stretch, exercise, cook well, eat right, and get more rest, so that I can live longer, and have more time to stretch, exercise, cook well, eat right and try not to die. That doesn't seem too exciting.

Or maybe I will through caution to the wind and eat a lot of bacon-cheeseburgers and go heli-skiing until my knees fall off.

But I have been reading that doing and learning new things is the best way to rejuvenate my old brain and get it to perform better and longer in many different areas. So maybe, using this one a day week, I can learn to play the banjo and go to school and get a Ph.D. in genetics.

At least it will give me more time to write a blog. Have to keep my mind open to all possibilities and see what emerges.

Greetings of the Season!

2010-12-25T19:05:00.000-08:00

Yes!

I hope all of you out there in the blogosphere had a happy, healthy, joyeaux day celebrating whatever you choose to celebrate. And here in the US of A we celebrate the joy of allowing everyone to choose what they celebrate.

Health and Happiness
   Peace and Prosperity
   although it still seems to be that too many people feel that the last two are antithetical.

Still, I do hope that you are all enjoying the day, and hopefully the rest of your lives, and not creating too many problems for your therapists.

I leave you with this greeting:

As soon as you realize that almost everything people act on is irrational
   Then human behavior begins to make sense.

Love and Kisses of the Season.

A wrinkle in time

2010-12-23T19:35:00.000-08:00

She is the fourth of six children, all girls. What is worse is that, in a rhythm of brilliance, her parents decided that each girl's name should begin and end in A. Alicia, Alexia, Aurora, Ava and the other two. it gets confusing. But you know, things like that are not a helpful beginning.

And then, when the youngest one was about four, the father dropped dead. Also, not helpful.

About three months ago she came back to see me after an almost two year absence.

The first time I saw her she was a real mess, just not functioning. Her husband had left her, she was crying all the time and she began collecting things. She was collecting things that had been discarded and was creatively finding a use for them. But she was not keeping up with the creative part. However she could not part with any of the things she had collected. She identified with all of them, as something of value, which had been discarded by someone who didn't see the value.

Slowly she responded to treatment, which stopped when she pulled herself together enough to get back to work. That was good.

But now she is back, and wants things to be better. Now she is 62 years old. She cries. Things are bad and she doesn't know what she did that was so wrong, or what she can do about it now.

When you see her now she looks like an attractive, middle age woman. She dresses well, she even carries herself well. What you don't see was that twenty, thirty, forty years ago she was really quite beautiful. You would unconsciously pick her out of a crowd and watch her walk by. Many people did. That was part of the problem.

The other part, of course is that after her father died her mother was overwhelmed, so she just screamed at all her girls and beat them down. Literally if necessary. So this woman learned to hang back, stay silent, and wait until what was expected of her was clear. When someone told her what to do, she did it, as long as they didn't get angry at her.

That made her vulnerable to people who came along, who were attracted to her, and began to possess her and control her. Her first boyfriend tried to keep her out of sight, as he knew everyone was after her. When she got away from him the next one was nicer to her, but also very controlling.

Finally she settled with an older man who seemed to appreciate her. He was wealthy and seemed to feel that she was a symbol of his success. He took her places and showed her off. She was well taken care of.

But then she had children and he had little time for her and them. He was out in the world making money. She soon realized that he was spending time with younger, beautiful women too.

So she went to work, but never really felt that she was smart enough. She had the sense that all of the doors opened for her because she was so attractive. But she really didn't think about it. That's just the way things happened.

Eventually she was having a long-term affair with one of her bosses. He was good to her, just like her husband was good to the women he was with. They were rich. They sent their kids to prep school.

At some point her boss' wife left him. She thought this was her chance to change partners and have a good, real life. But that was not the case. After a year or two of promises that man married another, more dynamic woman. She was devastated. She was devastated, angry and depressed.

She went home and confronted her husband about their marriage, about how there was no relationship, how it was really a sham. He agreed. She though he would want to make it better. She was wrong. He left.

But she still had her job, even though she tried to stay away from her boss. But about a year after his new marriage he came to her and suggested that they rekindle their affair. When she refused him, saying how worthless that idea seemed to her, he raped her.

It was soon after that I saw her the first time. As I said, she was a mess. It took her months to tell me about the rape.

Now she has a much smaller job and has a boyfriend who is a nothing and does not treat her that well. Her kids are distant. He ex-husband is wealthy, alone and alcoholic. She has no idea what happened to her ex-boss, but she knows his business is closed.

But now, for the first time, after 62 years, she feels almost ready to make he own decisions. She wants to learn how to decide what she wants to do, and not expect other people, men, to do it for her. She wants to tell the people she doesn't like, who take advantage of her skills, charm and passivity, to fuck-off.

But she's never done that.

But perhaps now she will be able to do that. She is not that beautiful any more. The people who are trying to control her are not that powerful. She may be able to set herself free.

3 directions at once

2010-12-20T07:40:00.000-08:00

If you let it; if you don't push hard to make your own way, the flow of life will take you in certain directions. I tell this to my patients all the time. You have the "will" and the ability to push back, and make things happen in other ways, but there is a general flow to things that will happen naturally, just because of age, place and other external circumstances, and they exert a constant pressure to make things happen.

(as an aside--- I can remember walking through the streets on NYC when I was an impressionable, philosophical thirteen year-old. I looked up in the sky and saw the words "Time" and "Life" flashed up on the top of a huge silver building. For an instant I thought, wow, this city really wants you to stop and think about what is going on in your life. But the next thing that flashed across the sky said "Sports Illustrated" and I realized that they only wanted me to buy something. I have been aware of that since then.)

As I reach this stage of my life I find that I am letting things flow, and the current is pulling me in three directions. The first, and newest, is that I am aware of how much time I spend thinking about my granddaughter, and how different it is from how I thought about my children. As a new parent you have to watch the kid moment to moment: to feed it, change it, watch it sleep, breathe and to wander what it wants and needs right then. That's what parents need to do.

As a grandparent I find that I keep wondering about my new off-spring longer-term. I think about how she is now, tiny and cuddly, and how much that will change so quickly, and I find myself considering all the possibilities, good, bad, marvelous and indifferent. What will she encounter and what choices she will have to make? What will be the world that she will deal with. With my own kids it was certainly moment to moment: deal with feeding, deal with sleeping, deal with sounds, words, sitting, crawling, walking. But now I wonder about things that this girl will encounter, probably long after I am around for her to tell me about them.

In the meantime my life is beginning to change in other ways. I will soon reach an age when, despite Republican opposition, I will be able to receive checks from my government just for staying alive, whether I work, pay taxes, or just decide to watch "Housewives of New Jersey." The money is nice, but it really isn't a deciding factor as much as it is a demarcation of time. It is time to alter my schedule after thirty years of coming to the same city and sitting hour after hour, looking people in the eye and asking them "what the fuck did you do that for? You nuts or something?" I am being pushed, by my granddaughter and others in my family to use my time and energy to explore different things.

In theory this is a good idea, in practice, it is very difficult for me to not take new patients, and to not feel guilty about that. I am supposed look around and find new things to do, and there seem to be so many, but I have to learn to let myself do some of them.

I intend to do some of this over the next six months. I am trying to challenge myself to do interesting, worthwhile things, while not stressing about it. I hope that they are very different from the things I do now. I really hope that they don't involve "helping people'" which is what so many of my friends who have worked other jobs all their lives are trying to do. I feel I have done that for forty years. I want to learn to waste time. Not easy.

But still, after I type this, I am going to work. I will see a row of patients who I want to see, each of which is struggling in their own way to get through this holiday season. I seem to be of some help to all of them, as they keep coming -- and none of these people need letters send to anyone. One has lost his job and is having the first rough holiday ever. Another is now estranged from her family for very good reasons, another has a very sick child and a husband who is freaking out because of it --- on and on it goes. I am still very into that, at least once I get to the office.

The biggest change is now the contrast between working and not working. It is a bigger transition from thinking about my family to getting my head back into work. The world is opening up. The river has divided into three broad streams and each seems to be going through the rapids. So far I have been able to steer clear of the rocks.

I am an excuse

2010-12-14T18:48:00.000-08:00

I still take a few hours away from tossing the sleeping child around to keep my practice going. It is the holiday season, and who would want to miss hearing about all of the family dramas that occur this time of year when families gather to rip open old scars, and bleed out of old wounds.

But before I get into tales of toppling Xmas tress and inter-familial lust, I want to comment on a phenomenon that has been rapidly increasing: that is how people and agencies use me as an excuse. I find that in the last two years I have been writing more letters for people than ever before. Having a psychiatric diagnosis, or being in therapy, can open doors to more services, or close doors to scary places.

I write letters to probation officers, to tell them that their wards are benefiting form "Anger Management." I also write letters to the court for people who don't feel they can serve on a jury. Panic attacks or PTSD, will certainly free you from that civic responsibility.

I write letters to allow undergraduates to return after a semester of bad judgement -- drinking, fighting, stalking, missing classes, leaving classes, not finishing assignments. These lapses can all be forgiven if you have ADD, depression, panic attacks, a substance abuse problem, an anger problem, or just "problems."

I write letters to get people out of work, and then get them back into work, using pretty much the same letters I use for people going to school.

With the terrible job situation, more people are applying for disability, because really, there are no jobs that many marginally adjusted people can cope with these days. Car mechanics, laborers, and other semi-skilled or unskilled work has become mush more complex and much less available than even fifteen years ago. Machines can do most of what people had once earned $12 to $18 an hour to do.

In many ways these schools, agencies, institutions and individuals are all just passing on the responsibility to me. No one wants to make a decision about who is just not acceptable, or who can be re-classified as "unable" and therefore reap some kind of benefit. I don't really get to make that decision, I get to be the cover for it.

Usually, I make a concerted effort to give as accurate and descriptive a summary of what the person's strengths and weaknesses are. With that, the person receiving the letter has to decide what is acceptable.
Often, I feel that I have to make a strong case for someone whose difficulties are real, but may not be obvious, since psychological problems are not as visible as shattered knees.

But really, these are philosophical issues involving the question of "free will," although no one wants to acknowledge that. I am being asked to determine if this person "can't" do something, or if they simply "won't" do it. Will they be able to do so later, or will they never get there? Could they do this last year, so why can't they do it now, or could they never do it and they need help?

These are very complex, and the judgements are based on very subjective evidence. The definition of terms, the clarifications of circumstances, the delineation of expectations, and the understanding of capabilities all come into this determination.

Most of the letters consist of about three to five sentences.

I try very hard not to let people take advantage of me, but then again, someone who puts in that much time and effort to fool their therapist probably has a problem.

Legacy

2010-12-08T18:47:00.000-08:00

There really is so much to write about, as parts of the world seem to be falling apart, while parts go blithely along, seemingly unaffected, even though they too are being corrupted.

Having a warm, round, large cheeked, snugly little thing resting peacefully between my shoulder and my neck not only takes a lot of time away from blogging, but puts everything in a new perspective. Watching the formation of one's own next generation makes me sad about how little really changes in the relationships between states, and between individuals. Just when I reach the stage where it all seems like a performance piece that is done solely for my entertainment, I realize that this little lump in my arms has a good chance to be here at the turning of the next century, and that will be long after Medicare, Social Security, and Afghanistan have used up all of the available money. There is no certainty that any of those problems, as well as what to do about energy or the air we breathe, will be settled by then. The solutions our generation seems to come up with has been to make a lot of noise, have blustering confrontations, often using guided bombs or suicide bombers, or just radio and TV rhetoric, and then actually do absolutely nothing. We do seem to be able to blame the Democrats, Republicans, Koreans, Chinese, Palestinians, Israelis, Iranians, Muslims, Jews, Irish, Swedish women who consent to sex and then change their mind. Wki-leakers, Wike-pee-ers, the rich, and the poor.

Of course, all of the above are to blame, but no one seems to want to be part of a solution.

Handing all of this off to this little pink lump does not seem to be the way I would like to be remembered, especially if in seventy years she is left to breathe through a mask and shift through the rubble. But my standing on the street corner yelling as loud as I can will not really effect much change, as those places are already full, as are most of the airwaves and and millions of virtual bullhorns.

The best I can do for now is to give her comfort, make sure she knows she is loved, and make sure she learns the value of peace, love and understanding. She also needs to know how to work hard, and have fun.

But right now, when it's my turn, I will hold her so that her mother can take a shower and her father can sleep.

Cycles, the marvelous and the tragic

2010-12-01T18:26:00.000-08:00

Well, she's a week old and it certainly is marvelous and amazing, and I haven't even spent enough time with her. Her mother, my daughter, seems to be taking to her new role very well. Both she and the father seem really pleased to be parents and are smoothly shifting the focus of their now radically different lives, are feeling the rewards of doing that. The baby herself, whose identity I will protect to keep her from being hounded by the millions who are following this, is doing a very good job of being a week old. She is already living up to her billing as beautiful, brilliant and creative. What else is a grandfather to think.

She certainly knows how to snuggle right in there and sleep off those heavy feedings.

Every birth seems to innately bring forth hope that there is a bright future, and that we will all do what we can to make the world happy and safe for this child and that she carry on with enthusiasm.

However, and when you reach my stage of life you know there is always a however, during these last two weeks at work I have been overwhelmed with stories of sickness and death. By now you are well aware that i always deal with aggravation, stress, loss, conflict, loneliness, just plain old craziness, but recently there seems to be more severe illness and death than I was prepared for. Perhaps the contrast has made me feel it so intensely.

Two of my patients have just completed weeks of caring for their dying brothers, both of whom were in their fifties. One of these patients buried her brother and the next week was told that her husband had lung cancer.

It may be because of my age, and that many of my patients tend to be older now too, but so many of them have parents who are crumbling or dying or dead. This process is never clear or easy. The care that is necessary, the expense, and what is most difficult is the decisions that have to be made. Usually, there are no good choices. How to let people die, what to treat, when to stop, who decides, and based on what. With all of the new possible treatments the lines get very blurry.

These are difficulties that everyone deals with, and there is really so little I can do to help. I help people sort out their feelings, especially if their relationships with these people were not smooth, but endings are always difficult and always bad. If it is sudden people are shocked, and when it is drawn out then people are exhausted and horrified.

In addition, I have recently gotten three new patients who have come to talk about suicides in their families. And then the Sheriff of our county was accused of corruption and responded to the charges by locking himself in a hotel room and blowing his brains out. All of my depressed patients reacted to that.

Also, so many people seem to be related to people with the terrible, chronic, fatal diseases: Parkinson's. ALS, MS, cirrhosis or some of the more insidious forms of cancer. I sit and wonder when it will descend on me. I wonder about the pain in my stomach, until I realize that I haven't eaten lunch. I worry about my prostate as I run to the bathroom, but I can still see that it is related to how much coffee I have that morning. Why am I so tired? Why did I drop my pen twice today?

That's why it is great to feel with warmth of a new little snuggle-bunny, with fat, smooth cheeks, who has a hundred healthy years in front of her to enjoy whatever life brings. It is better to live with hope and enthusiasm than to be scared of losing it. Even if it means denying reality for a while.

Finally, on Thanksgiving

2010-11-26T18:48:00.000-08:00

It's been a couple of weeks since I managed to scribble anything down here. Mostly I've been preoccupied, as the holidays are always very busy at work, families being what they are, nurturing, caring, and warm, while at the same time being judgmental, angry, competitive, duplicitous and full of silent scorn. It makes the season jolly.

But, this year we had one of the most unique and exciting Thanksgiving celebrations, as our first grandchild, a beautiful daughter, was born right in the middle of the turkey, stuffing and sweet potatoes (and Patriot victory). She was more than a week overdue, so already she is showing a flare for timing and drama. The whole family was gathered and waiting for the fatherly updates by test message. Being a female was a real crowd pleaser, and the whole group broke into cheers and applause. My daughter, the mother, was trying hard not to wish for a girl, although it was clear that she was. She and her husband had steadfastly held out early knowledge of the gender, so it came as a happy surprise.

Today were the first visits, in small groups by most of the interested family members. I got to hold my granddaughter and sneak off into a corner and tell her a few secrets about how the world works. Just stuff she should know about whom to trust and how to have a good time.

What is amazing is how good and self-contained a one day old person can be. She had a few little fusses, but was able to find comfort in the warmth of who ever was holding her, and also from her own hands and fingers. When she became really wet or hungry, she was able to ask for help. She learned that people are there for her. She responded by settling right down and snuggling in close. It is fascinating to see how well, at one day old, she can already interact. Whether she continues to be so successful, and becomes happy and self-assured, or whether she loses that ability to comfort herself and becomes anxious and fretful depends, to a great degree, upon how her environment, especially her parents, react to her. I have a lot of faith in these parents.

She is coming into the world during an unsettled time, but I think that could be said for any time since the death of Ramesses II, the Pharaoh of Egypt in 1213 B.C. There rarely has been a good time, as far as societies and nation-states are concerned. But as far as her own immediate family, she could not be more fortunate. Her parents are attractive, accomplished, educated, and financially sound. They seem to get along with each other quite well, and both were very eager to have this child. These parents are surrounded by over-zealous grandparents, who are each more than willing to fuss, and coo and help this child along.

Not a bad start. I hope she feels that her first day was a success. She did very well.

To Do List

2010-11-12T18:54:00.000-08:00

It's Friday. I get to stay home and clean up all the administrative work for the week.

1. Wait for baby (still)

2. 5 return calls to clients

3. two calls to doctors

4. one call to lawyer -- conversation made no sense, we talk two different languages

5. Report for long-term disability

6. Report for short-term disability

7. 9 (count 'em) requests to three different insurance companies to authorize more sessions until the end of the year. This includes the "convenience" of going on line, having to put in a new password, after proving that I am who I am, filling out five different screens full of senseless information, and still not knowing if the new sessions will be paid.

8. Still waiting for baby

9. record incoming payments

10. send out list for this weeks billing

11. Two calls to track down two clients who "disappeared" who should know better but don't

12. 5 return emails to clients -- this is new over the last three years.

13. Write to Senator again to tell him not to cut Medicare payments from Medicare, the SGR issue

14. Watch videos of Celtics beating Heat

The easy part is seeing the clients.

the next big thing

2010-11-06T09:27:00.000-07:00

It's not that I haven't been thinking, is just that I haven't been writing. I wanted to give two or three examples of the frustrations I have, based on my last post. But then the election got kind of heated, and my friend came from across the mountains, and mostly, we are waiting for this baby to arrive.

I guess a new generation kind of changes things, from what I've been told. Having a sleeping, eating, crying dependent person enter your world can become the focus of attention, especially as this will be the first of the next generation. I won't have to get up in the middle of the night that often, I don't think, yet.

But, she, my daughter, is in the end stages of cooking this thing. Could be today, could be another week.

I've heard this has been done before. But not by me. And, like others, being a bit solipsistic, mine is probably the most beautiful, smartest, most clever, with the greatest potential.

Maybe next week I will post 500 pictures.

Right now we just sit and wait, and try not to worry.

But, you said

2010-10-26T19:29:00.000-07:00

I have probably mentioned it before, but it burned me again this week. One of my biggest flaws as a therapist is that I often underestimate the craziness of some of my patients.

I am easy to talk to; I am good at that. I am also very accepting of almost anything, or at least appear to be, that way people relax and tell me everything. That is helpful. Often, when they relax and tell me all the stuff they do, it becomes clear to them, as well as me that they are doing a lot of just plain old crazy shit. They say the wrong things to the wrong people. They over-react. They feel really badly over nothing. They carry grudges and forget why. They mope around about things that were said to them ten years ago. They worry about things they said ten years ago. Because of all this they don't show up for work, or don't pay their bills, or don't clean their houses. All kinds of stuff.

Often, after we talk about it, it seems very clear to them, that not only should they change those behaviors, but after a while they are very capable of making those changes. That's great. Case almost closed.

But they don't. They go out, and thirty-six hours later, the very same situation arises, the one we discussed, and practiced in the session, and they fuck-up again.

Sometimes it's even worse. Many of my patients, especially the ones I thought were almost better and ready to be set free, not only make the same mistakes, again and again, they often create fantastic, unimaginable new ones, that go way beyond the old ones. This results in a new form of complex, destructive, painful chaos.

This can be annoying.

My reasoning

2010-10-20T18:44:00.000-07:00

Today I was talking to one of the gentlemen I meet with regularly. We were examining how anxious he still gets when he talks to a woman with whom he might want to begin a relationship. He is in his mid-thirties, and still single. This anxiety has limited him badly.

We discussed how he had been a poor kid in a rich town, with parents who were awkward, often embarrassing, and always discouraging. He could see how this has planted a strong reaction in him that he is not allowed to approach an attractive accomplished woman, even though he has grown to be an attractive, accomplished man. It isn't the woman that makes him anxious. He feels that someone else, some unnamed authority, with suddenly sweep in and and pull him out of the picture, telling him that he is not good enough and should not be doing this.

I mention this here because of what I have been talking about for the last week, that it is important to have someone like me, someone who is a bit out of step, who questions, who is not completely comfortable with the way things are run, to be your therapist. My reasoning is that, despite all my education, and all the research on internal intra-psychic factors, despite all the claims of biology, brain chemistry, genetics and psycho-neurological explanations, I feel that a great deal of the actual causes of what is called psychopathology are cultural.

Many of the people I treat are those who, for many reasons, sometimes gross and sometimes subtle, do not fit it well with the general flow of their surrounding culture. They may have a different body-type, a different learning style, a different sexual preference, a different energy level, a unique reaction to stress or anger, or just be more sensitive than most people. Usually, if these people have families that are accepting, or a circle of friends, or even one caring teacher, they can do very well. But when the culture around someone becomes uncomfortable with someone, that person will often become even more uncomfortable being themselves. This can lead to them acting in a way that others will consider odd, or even "crazy."

I think it can be a very powerful tool in treatment to be aware of what it is like to want to resist the pressure of conformity and societal norms. It can be very validating to a person who feels as if he or she is an outcast, that they can still be OK, or even better than that, that they are strong.

I am familiar with several therapists who, because of their own nature, take the opposite stance. They feel that part of treatment should be helping people learn to fit in, and to get along, and follow the rules and expectations of their culture. Currently, there is a great deal of pressure from insurance companies that send out treatment guidelines, and in psychiatry, to see the goal of treatment as getting people to be calm, reasonable and pleasant.

I can understand that approach, but I don't agree with it. In truth, I don't think it works; I don't even think it can work. It can even cause a lot of harm to try and help someone to be what they don't want to be, and in many cases, can't be.

Perhaps, not so extreme

2010-10-17T17:59:00.000-07:00

Before I write about why It is good to find a therapist who has some of my views, I would like to make slightly clearer what my views are. That is why I write this blog anyway, to figure that out for myself.

So, we were driving back, over the weekend, on the coastal route. We stopped along the way to see a friend, who happens, of all things to be a religious leader. She is a good friend, and we know and accept each other. She is even a Yankee fan, and I still call her a close friend.

We arrived at the time she was about to do some religious leading, so we attended. She was doing an admirable job of leading, and I was not following very closely, but I was turning the pages in the book of prayers. In the book I came upon a quote, but I can't find the quote anywhere though Google, so I will have to paraphrase it -- but maybe it was just put there for ME to see, or maybe they paraphrased it themselves.

Anyway, it was from Martin Buber, and it said something like:

"If people come to you and ask for help with their troubles, do not say something pious, and tell them to pray, and that God will provide. Act as if there is no God, and that it is up to you to do all that is in your power to help them solve their problems."

That is the kind of religion I can be comfortable with.

Also, I said that I have a great deal of difficulty with Patriotism, especially when it leads to war. Well, that is certainly true, but that does not mean that I am necessarily a pacifist. I strongly believe that every country and every society has more than it's share of assholes. And that there are people in other countries who do want to blow us up and take our money and rape our women. We are a rich and aggressive country; so we need to defend ourselves. Too often we are jerks about it, and do it badly, in the wrong places and for the wrong reasons. But we do need to watch out.

What do I think is important?

Basically, life. I think that being alive is amazing, and can be full of fantastic, fun and satisfying experiences, sometimes, when it isn't tedious and boring, or it isn't full of pain and suffering.

Life, especially human life, is very precious, and should be treated that way. No one life is more important than any other. You have the responsibility of living your life as best as you can, in a way that you have determined.

We are all united by our insignificance --except to ourselves and those we love.

Floating down the wrong tributary

2010-10-13T19:10:00.000-07:00

Took off from work again. My wife tells me to do it; to practice for when I get old, although she tells me that I am old. But I'm not.
So we took off and drove out of New England and headed South. We are here, on the water, tomorrow I will cross the Bridge-Tunnel as I have long wanted to do.

But yesterday, waking up hungry, we decided to eat a regional breakfast, but since we couldn't find that we stumbled into Denny's, a place I had only been in once before. The service was fine, the breakfast was everything they said it would be. Except the company was different.

Two men sat behind us, and after a while my wife and I stopped talking and began to listen to a conversation that is not what we hear in our social circle, although it may be more common in yours.
One man seemed to be about sixty and the other seemed close to seventy. They were dressed neatly in clothes that could have come from Wal-Mart. They talked openly and with feeling. They were talking about a man they knew who was in a bit of trouble. The man's business was not doing well and the land he had for sale was not selling. That left him unable to support his wife, and her son, who was in a wheelchair. But the man also was spending a great deal of time with another woman, and this was not good. The two men having the discussion were upset because they felt that the man about whom they were talking was headed for hell, and if the moment of the rapture occurred, he would be left behind, and therefore doomed. They were not sure how to deal with him and his situation. One of the men wanted to approach him and warn him, but he felt sure it would ruin their friendship.

Now, I realize that this conversation was a bit extreme, but it again brought up to me how much I do not buy into many of the most important mind-sets that define most Americans. My thinking is partly a result of what I do, and what I do is the result of who I am. Despite my efforts to get along, I am still out of step, off the main-stream, floating down my own tributary towards my own distant, probably unattainable sea. This is unsettling to me in two ways. First, how far out of the mainstream I am, and second, how loose, sloppy and lazy the thinking of the mainstream is.

So here is the part where I drive many of you away. Where I ruin any chance I have of getting anything published, because as an agent I once had said to me: you write very well, but you are much too complex, and you don't reward your readers with happy endings. People would much rather read about clear paths to happy endings. That sells. Your shit about the world being very complex and most things ending with limited compromises with reality does NOT sell.

True.

Why? you might ask, then do I persist.

The short answer lies most clearly in the things that I do not accept. Yes, I understand the utility, the need, and the natural affiliation for certain things. Yet, I cannot participate. I just can't. I never have been able to. I gave up trying in seventh grade. ( Perhaps I am still just an obstinant adolescent.)

The best examples that quickly come to mind are these: patriotism, religion and video games. These are becoming almost universal activities, and yet I have great difficulty joining in. Again, I understand them. I see clearly why people join in. I see the joy, the fellowship and the comfort that is gained with participation.

But I can't do it.

To me patriotism and religion are just a bill of goods that are sold early and often by the powers that be to get the masses to go along with the program. The program that is being sold is one that benefits the powers, almost always much more than it benefits the masses. Yet patriotism and religion are sold in a way that if you don't buy into the concept, there is no place for you in the group. That is a powerful selling device, scorn and exclusion.

But why should I believe that my country is the best in the history of the world just because I happened to be born here? And this God-stuff is really about getting people to believe in the totally unbelievable.
They tell you to have faith, don't question the incomprehensible. Once they can get you to do that, then they can sell you anything. You can fly. You can be born again. You will live in heaven. You can charge it now and pay later. You can buy that house you can't afford. You can even believe some of the incomprehensible stuff that Sarah Palin talks about.

And yes, our soldiers are brave and valaint people, who sacrafice for the good of their country and do their assigned duty despite great and constant danger. But I can't stop thinking that rather than their being out there defending our freedoms, they are out their defending the corporate economic structures. These are kids that I have seen in therapy, who had trouble in high school, had trouble following the laws, and some trouble getting along with others, who respond well to the high level of structure in the military, who hope for a boost in life that they cannot find on their own, so the opt for three to twenty years of going off to foreign lands to kill people they don't know, for reasons that really are not that clear.
The reasons that are given them are often similar to the things they heard from their religious leaders. That we are the good and the righteous, and they are the forces of evil. Have faith.

The video game thing, is really a generational thing. I can't get into wasting my time playing virtual basketball when I could be playing basketball. I don't get a thrill being a virtual pimp. Maybe a racing game or a flight simulator I could do for a while. But, even though, as I said, I'm not religious, I have this guilt about wasting time. I feel that the best way to really waist time is to watch college football, especially two teams you have barely even heard of, but they sure can run up and down the field.

So that's me, sitting way over here on the side. I can even get upset at how everyone feels good about putting on pink ribbons to fight breast cancer. Not because that isn't a good idea, but because the money goes mostly to the big cancer research institutes that are seeking treatments for the cancer that women get, and not to prevention. Real prevention would attack the toxins and pollutants that run rampant though our food, air and water. But few people are is looking at that because that would point out the need for change.

Well, this has gone on too long already. I have more concerns, but who needs to listen. As the man said (Voltaire) 'Surely, this is the best of all possible worlds.' We are fine, you and me. ( unless we are the ones with cancer, or the ones wounded in the army, or condemned by the church for being turned on by the wrong kind of person, or... but hey, enough all ready.

Next time I will tell you why, even though I am not the greatest follower of American credo, it would be to your advantage to consult with a therapist like me, if you ever feel the need to consult with a therapist at all.

encounter

2010-10-06T18:10:00.000-07:00

I was taking a break. I walked down the corridor to the bathroom in between appointments. I do this three to six times a day, depending mostly on how much coffee I drink. I thought I had ten minutes to not deal with anyone.

I opened the door with my key and there was a guy standing near the sink. He had several kinds of soap and anti-bacterial creams and was squirting them onto his hands and rubbing the combination over his body. He was about thirty years old and looked a bit dishevelled.

I nodded and smiled, as is usually done at such times, and went over to the urinal in the corner.

He began to talk to me, which is not usual bathroom etiquette. I soon realized he was not making much sense.

He was here to see his counselor,but she wasn't here, and he goes to see his parents every weekend, and am I a counselor, and could he ask me a question? Yeah, he had a question. And his parents are not doing that well, and he tries to take care of them. But he could use a counselor, and I sound like I'd be a good counselor --- even though I had only said 'hi".

Then I went over to the sink to wash my hands and he began pointing to his heart, and then tapping on his heart. He wondered if I could help him and if he could ask me something. I said that he could ask.

I had this speech in my head about how, even though I was a counselor, I had all the cases I could handle, and how could I say nicely that I didn't have time for him, which fortunately is true. I have that message on my answering message, so I felt it was legitimate.

But he kept tapping his heart and asking if he could ask me something, for about five or six repetitions.

Finally he asked me if I could give him money to take the bus to go see his parents. He needed $6.50.

I was very relieved that it was only money he was after. I gave him $2 and fled, feeling as if I got away cheap.

The men

2010-09-30T18:19:00.000-07:00

I am currently seeing a lot of couples. I think it's related to the recession; stress is high, tempers are short, a lot of people are in tougher circumstances. What's worse is that many of these people thought they were doing things right but working, trying to watch expenses, trying to plan step-by step for a house, a car, a kid, a vacation. But then someone lost a job, or lost the over-time or the expected bonus, and the stock market went down, or someone got sick, and suddenly, ever expense is a hurdle and life isn't as much fun any more. And that makes them angry.

So, blame your spouse! That's the easiest solution.

With the couples I see the men are of two very distinct varieties, either too loud, too active, too controlling, too quick tempered, and either border on being abusive or sometimes go over that line.
Or else they are the opposite; too passive. The can't decide, don't fight, don't respond, freeze-up in a crisis, and would rather watch TV and hope the problem gets solved, usually by the wife.

I guess the men in the middle have figured out how to deal with difficulty either by making a decision and getting things done, or by doing what they are told to do. I do believe there are some people who actually do both. They can negotiate, collaborate, come to an agreement and then act. All of that is great if it happens but it isn't always necessary.

In the cases I see the therapeutic interventions are easy, either: cut the shit, or get off your ass.

Easier said than done, but the direction is clear.

The women are not without their own difficulties, but are much more varied in how they act out their angst.

Love, alternative forms

2010-09-28T18:57:00.000-07:00

Last night in my office I spent the last hour of my day listening to a couple trade insults, barbs, accusations, blame, resentments and recriminations for 45 minutes. It was a rollicking emotional time.

For the last seven minutes, after they were emotionally spent, I got them to see what they really wanted from each other, which was basically, that after about 20 years of this kind of a relationship, they each wanted to know that the other one still cared enough to keep it going for another 20 years.

Once they agreed on that, they left happy.

I think I'll skip a week of going through that again. That marriage will last.

The patient stream

2010-09-24T19:54:00.000-07:00

People come to me in streaks; that makes me feel good. I've seen several neighborhoods. I get a couple, then they refer their neighbor, then the kid across the street, then his uncle. It's good to know that someone thought I was worth the effort of driving across town, or even from twenty miles away, and much more, even.

What's great for me is to get different perspectives on the same stuff that happens. I have seen several sets of sisters, or cousins. A few times I've seen four, five or even six people from the same work place. I can never mention that I see the other people, even if they are the ones who made the referral. If someone brings up that they know their friend is coming to me, I just kind of nod. I really enjoy hearing about my patients from other patients and getting a different view of them then the one they bring in about themselves. I can't say that Suzy, in the next cubicle, thinks you're a slob, but it's helpful to know.

Once I had a woman who was having an affair with a married man. He was making all kinds of promises to her, and telling her that he was three weeks away from leaving his wife. About three weeks later a couple came to see me about their marriage. Sure enough, from the information that I had already it was clear enough to me that he was the man in question, although what he was telling his wife was quite different than what I had heard from his girlfriend. But, I really couldn't say anything, I just kind of let things play out. I did kind of warn the "other woman" that things were not going to break in her favor, but I probably would have done that anyway.

Over just the last month I seem to have tapped into another vein of patients --- other psychologists. I am not sure if they knew each other or if they came from very different sources, but I am seeing four other Ph.D. psychologists now.

Three of them make great patients. They come with notes and speculations about all of their thoughts, motivations, unconscious demons, and deeper underlying internal processes. They send me emails in the middle of the night. They are working at it.

From my vantage point they are way over-doing it. I'm not that kind of therapist. I don't try and uncover every last possible psychological nick and scratch that may have cause a psychic bruise at some time. I'm more of a kind of a "let's just get on with it and feel better" guy. But the intellectual churning can be fun for a while. And I am old(er) so they look to me for approval of their self examination. All I have to say is " Well, what do you think?"

The fourth one is just nuts. She's angry and screaming, and in a terrible, chaotic relationship, with a guy who has more issues than that pop-up box has tissues. But she has a full practice and she's probably good at it. She's right out there and very expressive. She certainly lets you know how she feels, and she reacts quickly and intensely.

I don't think I would want to be her client if I was a man, given what she expects in her own relationship. But, then again, that could be really good for some guys to hear about it.

This is an interesting profession. You never really know what's going to happen once the door closes.

Inside trashing

2010-09-21T19:18:00.000-07:00

My battered profession continues to take it's lumps. The press, the clients, the insurance companies and now it's an inside job. The Past President of the American Psychological Association, Alan Kazdin, gave an invited lecture in which he said that psychotherapy, as it is practiced today, is inefficient and elitist. It is slow and works with people one or few at a time, while the mental health problems that are facing this country are huge. He said that there is a need for new approaches, and that psychologists/therapists should not sit in their offices and wait for people to come to them, they should devise way to get out and treat the problems where they exist.

He's not wrong. He just twenty-eight years late. I don't know how old he is but he must be younger than I am. He was probably not riding on his high horse in the 1970s when the community mental health movement was taking hold. I was working in another city at the time, another New England Mill city much like the one I am in now. I was running a small Mental Health Center that was funded by state and federal funds, as well as payments from the people we were treating.

We had programs that went into schools, brought new parents together, worked with kids in housing projects, consulted to policemen, had follow-up care for the seriously mentally ill. We had the early formation of alcohol and drug education programs and outreach. We even were dealing with domestic violence and racism. We were doing lots of cool stuff.

I remember that I really enjoyed working with about twenty-five kids in a concrete building in a not very good part of town. I would meet them twice a week after school and help them organize activities, or figure out school, or complain about the way they were being treated. Once, when were organizing a weekend dance, I didn't want there to be trouble, as that could give the whole program a bad rap with the community. I asked some of the bigger kids what we should do if the "bad element" showed up and wanted to be disruptive. They broke out laughing. They explained that if I was to ask around town for the four names of who was considered the "bad element" I would find out that they were sitting right next to me.

But all that ended quickly in the 80s, with Reagan. I am sure that what we did would be very quickly labeled as "Socialism" by many in the media today. Dr Kazdin is not really searching for new, innovative ideas. Like many, many visionaries, especially in Psychology, he is just recycling old ones.

culpability

2010-09-14T17:50:00.000-07:00

Jane, who commented on my last post, brings up an interesting and complex point: "Who is responsible for the mess that many people, the economy and our country is in?

Clearly, there is more than enough blame to go around two or three times. In the early 2000s government lowered interest rates, especially for home mortgages. That encouraged everyone to refinance and take money out of their homes. Many people did this and used the money to spend on stuff they wanted but didn't really need. I had lots and lots of clients who did this. Added to this, many mortgage companies intentionally sold mortgages to people whom they knew could not afford to keep paying them Some of those people were foolish, some were just lied to

But many people knew what they were doing. They wanted to turn the rising value of their home into cash. They were encouraged to do so by many ads, from mortgage companies, and by other consumable type products, especially bigger homes and SUV, and all the stuff that went into them. But I didn't do that, and I don't think Jane did either.

Meanwhile the government was waging two wars costing trillions of dollars. The real goals of those wars are still not very clear. This still continues.

Then, since so many people were buying and selling mortgages, and it was somehow assumed by all of the country's brilliant financial minds that home prices cold only go up, banks invented mortgage default swaps, so they could increase their profits and leverage all of their bets. The government at the time, led by Alan Greenspan, decided that these kind of business did not need to be regulated. The :free markets" would regulate themselves.

So then, in 2008, housing prices began to drop and the economy feel completely apart.

Should the government have done nothing and let it all go completely to hell? They decided they needed to help or the world economy would collapse. So they helped out the banks, who were some of the biggest crooks of all. They felt they had to, which they probably did. But people got angry at the government, and the banks, for needing and taking tax payer money, while most tax payers who had financial problems were not given too much --- although unemployment benefits were allowed to keep going for a long time.

Then nobody had as much money, and no place to get it, so they stopped buying. So business stopped selling, so they laid people off. So things go worse.

Then the government tried to get things going by pouring money into some places. But it isn't enough, nothing is happening fast enough, the deficit is growing to frightening level. Everyone is angry, except for the bankers, and other people who are very rich and are paying for ads and lobbyists to keep them rich.

Again, I think that in order to get things right a lot of people who seem to have major disagreements about what to do will have to decide to work together, make compromises, look at the whole picture, and decide to make the country whole again, and to pull people together. I think Obama was a bit naive for almost two years, thinking he could do that. There are some powerful people who just want to see him fail, just for their own benefit.

Now, I would rather put my faith, and I agree I have very little of it, in a government that I elect, than let my economy be run by insurance companies, banks, oil companies, Rupert Murdock and the Koch brothers, who have already shown how willing they are to screw us out of our last dollar, which they will do if the government steps aside and calls that a "free market."

Unfortunately, I don't see much hope of getting enough people in business, banking and government to work together. The "freedom" some people are screaming about seems to be mostly about tearing everything and everyone apart. I hear very little about people offering to sacrifice and to work together to make things better for all.

Yes, I hope everyone out there took care of themselves. If you didn't it is partly you own fault for getting sucked in, and partly because the rules are stacked against you, and those who are doing the stacking want to run the government too.

I know a lot of my clients are suffering during this time of economic distress. I do not see many places for long-lasting job growth. We had one great twenty-year growth spurt due to new technologies. We followed that with money from a housing bubble and debt spending, from both the government and citizens. Now what? Green Energy? America's Got Talent?

Today was primary election day. I went to vote early. I voted for some incumbants and some new people. I tried to vote for people who made sense, and weren't just angry. I was there for ten minutes. Two other people came in to vote.

Is this the freedom we are sending people across the globe to protect?

money therapy

2010-09-10T19:18:00.000-07:00

It is my belief, as a result of my years of sitting, listening and mumbling, that a great deal of what is called "psychopathology" is really a result of the culture of the times coming down upon a person's life and mind. The American Psychiatric Association, as evidenced by the forthcoming DSM V, is going in the opposite direction. They are trying to classify many behaviors, such as being addicted to the internet, or compulsive shopping, (although these changes will only be put in the appendix for now) as basically "brain disorders."

I don't see it that way. I also am currently having a very tough time having to treat so many people who are unemployed or underemployed, or who are stuck in jobs they hate because they know they will have a very tough time getting another job.

Yes, I am sure the the stress of not being able to meet your mortgage payment, or struggling to feed you kids, or even losing your vacation home, creates changes in your brain. But the real causes of these depressions and anxieties are based in the workings of our society. We have a system in which the financial conditions of many families can vary greatly from year to year. Our culture encourages consumerism; the desire for unnecessary goods. Some segments of our culture purposely and by specific design, allowed many people to accumulate a great deal of debt to buy these things. This helped some people get very rich, while many others are now getting poor.
. I see many marriages that after many good years, are now under great stress. Many people are not only scared and struggling, their self-image has been shattered. After months in a downward spiral they are left feeling helpless and powerless in a way that many have never felt in their lives. They are angry because they feel duped. They feel that they did what they were told and followed the American Dream, and now they are being left out, and even blamed for it.

Treating these individuals and couples is very difficult because what would really be the best thing I could do is find a way for them to make money. I work on that, to help them brainstorm, or network, or make use of skills that they didn't realize could be put to use. But it's very tough. Not many places are hiring, and very few new ventures can get capital, and many fewer people will spend money anyway.

What also bothers me is how many of these hurt and angry people have been sucked in to be angry at their own government, which currently is trying anything it can to help. I don't think they would really prefer to be at the mercy of the oil companies, insurance companies and banks, but they don't seem to see that that will be who benefits from their political stance.

However, I am not surprised. Fear and anger do not usually help rational, longer-term planning and thinking, but they always have been a major factor in political behavior.

But whenever I get a new patient now, I find I really, really hope they have a way to support themselves. I can't do money therapy.

High Tech, Blown Away

2010-09-09T18:28:00.000-07:00

I have seen this guy for a while. He's a real techie: hides in his basement, does a lot of sophisticated software consulting. He comes to see me because his wife hopes I can teach him to be verbal, which he can be if you talk about his stuff, but that bores her.

Anyway, that's not the topic.

He is working with his new Apple, and to be good he is trying to do things that relate to the family. So he puts together pictures of his son and himself. On the new Apple software there is a dazzling new feature that allows you to highlight a face and click on it. Then the machine will scan all of the 2100 or so pictures you have in your iPhoto and it will pull up all the pictures with that face in it. Amazing stuff.

So he does that for him and his son and about fifty pictures of them appear. Then he sees, among the pictures, that there are two very old photos from when he was a kid, and the focus of the app is on a guy who was a friend of the family. He enlarges the shot of the guy wearing a dark suit, then he enlarges a shot of himself dressed in a similar fashion. Then he examines the pictures and he said to himself that the software is pretty good, because he sees how similar they look. Then he goes back to putting together a family album and the event fades away.

Two weeks alter he is talking to his mother, and he tells her that he will send her the album, and she is all happy and they are joking around. In that spirit he tells her about the picture of the old family friend, and he says, without thinking really,that from the looks of it, that guy could have been his father.

Suddenly, the phone goes silent. After a long pause his mother says: "I really don't want to go into that."

The guy is 41 years old. Even though his life is exactly the same, it has suddenly become totally different.

Upon my return

2010-08-31T19:00:00.000-07:00

There is something very comforting to me about returning to my office. I did not get the "back to school jitters." Starting about thirty hours before I returned I was getting eager to see how most people were faring. I was not eager to see how everyone was doing as some people will not be changing much. They make my life tough.

But I guess it is very easy for me, after all these years to settle back into my role, to return to the task, to try to move things forward. It's not easy, but it feels like the place I should be. I should be thinking, at this stage of my life, of how to make changes in myself. I know that they won't come to me. But I don't. I go back to what I do; what I know.

But three weeks is really a long time it seems because a lot had changed for many people. It seems that some people need a good dope-slap every week or two or they tend to wander off the rails. Is this psychotherapy? I guess.

AB got upset at her parents and tried to jump out of the car -- in the middle of traffic at 40 mph. They put her in the hospital for three days and on meds. I don't know if that was the best solution, but everyone got worried.

CD, under pressure from his girlfriend, turned himself in to the probation officer he had not seen in four months. I will see him next week when he gets out.

Paul, you remember him, called to say he would like to come back, but he is in FL, trying to stay sober. He will call when he returns. I will see him if he calls.

EF's father died. as did GH's mother. IJ's husband's father had a heart attack. JK put her brother in hospice. They won't let him drink.

LM got evicted. but she found a new place. She left her boyfriend behind.

MN said her husband slapped her. She had accused him of cheating on her -- after she came home from spending the afternoon in bed with the man across the street.

OP is going back to school. Two days after she signed up for classes, her husband lost his job. Good he can stay home with the kids. But who will pay the mortgage?

RS called. Her cancer is gone. She was strong and up-beat through seven months of treatment. Now she wants to come in and cry, in private, in my office.

There is something very unsettling going on out there. Everyone feels that things are bad and about to get worse. No one has any trust. The current divisive political system cannot deal with things. Things are very complex, and many disparent people will need to work together to make things better.

They won't. Not a chance.

It's only Tuesday.

leaving

2010-08-29T20:20:00.000-07:00

Yes, it was a totally gorgeous day. The sky was totally blue, the waves rolling in slowly to the beach, The sun was warm but there was a slight breeze off the water. A few boats bobbed in the distance. Kids frolicked in and out of the water, splashing and screaming, dunking and diving. It was a day that should never end.

But slowly the sun began to sink toward that side of the water. It was bringing summer to a close. Time to clean up the house, put the chairs away, and pack it in. Yes, we will be back next weekend, unless the hurricane drives us away, but the vacation is over. I did my best to squeeze every drop out of it.

Put on some old, melancholy Townes Van Zandt tunes, go to the dump, take one last shower outside:

"Don't let the sunshine fool ya
Don't let the bluebirds tool ya
Don't let the women do ya
Put your hand in mine"
----TVZ (1944 - 1997)

We're going home.
Back to work.

When it rains

2010-08-25T19:35:00.000-07:00

It rained for a few days down here near the water. Some nerve. The forces of Nature do not always honor my requests. We think that somehow we can control that, but in truth we are losing control rapidly and creating more chaos and destruction. But that is another topic.

When it rains here I get to read many things from various sources. I read several articles about how too much "screen time" is not good for our brains. The average game app is played for about three minutes while waiting for the dentist, or a line to move or a wife to get dressed. We can now not only fill up every vacant second, but we often double or triple fill by turning on music, watching TV and texting a friend, all at the same time. Many studies show that this only confuses our brains, inhibits learning and limits creativity.

I also read a good article that (again) trashed on my profession. It was about the "Legends of Psychotherapy" conference held last month in California. I will write about that next time.

But I read a column by David Brooks in the NYT that I want to comment on. I usually like to read his stuff. He is a thoughtful conservative,which I am obviously not, but he often makes a good case. What he wrote about last Tuesday is something I strongly agree with, and have really been talking about in many ways here. -- In the article he wrote about how we usually only read things we agree with, but I don't think that was why I liked it so much, but who knows.

He wrote about "mental flabbiness" that has become rampant in our culture. People have become lazy thinkers. With all the information that is constantly available there is less time to consider what is real, what is worthwhile, and what to do with all of these bits of information.

Brooks quotes Charlie Munger of Berkshire Hathaway who lists our natural weakness: confirmation bias; we pick out evidence that supports our views, and we are cognitive misers; we try to think as little as possible.

I often see in my practice how people are very vulnerable to slip-shod thinking, surface conclusions. People easily settle for simple solutions, based on distorted half-truths, that are harmful to them. That's why there is so much debt, so many kids on prescribed drugs, so many obese people and so much free-floating, misdirected anger. It's not that people are stupid, it's that they have been encouraged to be lazy thinkers. Our society calls for it.

If you are a lazy thinker you are much more likely to buy a shitty product at an exorbitant price, and to think you need it. You will get angry at Obama because you think he's a Muslim. You will eat bacon cheeseburgers and then go to Jenny Craig. You will believe that climate change is a hoax because you don't want to put any limits on the energy you use or the waste you create. You will blame "illegal aliens" for taking you job, when you never really wanted to work fourteen hours a day picking lettuce. You will think it's normal for women who are 5'4" and weigh 118 lbs to have Double D tits. You will believe that your six month old son should be watching a computer program that teaches him sounds and colors and shapes, when you should be holding him and cooing to him yourself.

It's no wonder my business is booming.

I made the mistake of picking up my messages today. I have almost as many new people wanting appointments as I do people who I was seeing before I left.

The world is very complex. Take the time to think about it. It is good to think -- Try thinking this way: If I do this then this will happen. If is even better to think -- If I do this then this will happen, and that will make this or this happen and I have to be ready for that too. But that is difficult. It takes time. It takes some kind of reflection and consideration. We are all capable of it, but it's difficult. You may have to give up some time playing "Angry Birds." At least in the beginning. Then this thinking thing gets easier. Then it gets to be kind of fun.

Try it. You will save on your therapy bills.

Out of office, and out of....it

2010-08-22T19:39:00.000-07:00

I am still away. It's kind of weird to be away this long. It is good for my head. I think of some of my clients once in a while and wonder what's going on. I kind of miss them, mostly just as people, but not really the work of figuring out what to do and how to make it happen. I think of some of them and it seems as if through a fog. They are from such a different part of my life. I am here, in this vacation spot with friends and family wandering in and out. I talk or don't talk. I don't have to pay much attention if I don't feel like it. Some people drone on about whatever.... It's great: I don't have to listen. When I do respond I don't have to make much sense. That certainly takes the burden off.

I'm like that. My mind takes what someone is saying and shoots off, usually in a totally unrelated direction. It jumps and skips steps. Then I make a comment about where it has led me. People kind of look up and then go back to whatever they were talking about. Most of my friends expect that. They often can comment, and we go on from there. That's why we are still friends. The other ones, like my wife's friends' husbands, they don't know quite how to respond, or how the hell to deal with me.

Sometimes we talk about golf.

I have been getting to exercise a lot more. It surprising how well you can take care of yourself when you don't have to take care of anyone else. I get to stretch, and then to really exert myself in a few ways, which I had not been doing since my eye got messed up. I was surprised at how much I missed that. Getting my heart pumping and sweating and breathing heavy really makes me feel alive and part of it; whatever "it" is. Some people hate to feel that way. I really missed it.

What is sad is how little it takes to make that happen now. But hey, as the song says: " I can go as fast as I used to, and I can go as long as I used to, but I can't go that fast for that long any more."

Sometimes when I take my grand-dog (the one in the picture there) for a walk, and she pulls me around for two miles, I count that as exercise. I never would have used to do that.

Just trying to stay healthy. Just trying to stay alive. Just trying to keep my wits about me without embarrassing my wife too much.

Just sometimes.

being away

2010-08-18T19:36:00.000-07:00

I've been away. I still am. I went to the mountains far away. That was away. Just me and my wife of many years. We went up and down the big mountains. Up, up into the snow. I rode a bicycle through the woods, up and down hills, on narrow paths through the trees and over the streams. My wife got a massage.

Now we are back at the house near the ocean. This is the place people come. We open the doors and have friends. That is good. It sometimes amazes me. I didn't think I was that social, but this is fun.

I called in to my voicemail. I had only fifteen messages now that L doesn't call any more. They were mostly from people asking for appointments, telling me why they wanted to come and see me.

I am not in work mode, so my first reaction was "What the fuck are you telling me all this for? Your life is a mess and I am on vacation. Leave me alone. Don't tell me about your substance abuse problems while I am sitting here getting drunk with my friends. Don't fill my head with your relationship woes on my anniversary.

Then I heard a message that one of my younger patients was in the hospital for a rash act. I felt sad. I thought of what i needed to do to help her learn to deal with being upset. I called and set up an appointment to see her ---

when I get back.

Out of Here

2010-08-07T18:33:00.000-07:00

This was a difficult week as I am leaving for three weeks, one in the high mountains and two by the sea. I have certainly been looking forward to it, and now the time has arrived.

What has been difficult is that so many of my clients have been giving me shit about going away. "Didn't you have a vacation in July?" they inquire.

And so many people seem to remember that Richard Dryfus, Bill Murray movie "What About Bob?" It must have been mentioned ten times this week.

Yes, almost everyone adds that they appreciate that I should get a chance to clea my head once in a while, but how will they survive?

Actually, some of them will take the opportunity to mess-up their lives for a while, make a stupid decision, give in to an impulsive desire, explode at the wrong moment, or on the wrong person.

Maybe not. Maybe they have learned; change does occur.

We shall see.

I'm not going to think about it.

scientific insight?

2010-08-03T18:44:00.000-07:00

There was an article a couple of weeks ago in one paper, and then it was recycled to another paper recently. It talked about how political scientists have "discovered" that even when you give people clear, definitive and indisputable factual information, and even if it comes from a reliable, unbiased source -- if the information does not agree with what a person already believes, then, most likely, the information will be discounted and the person will go on believing whatever he or she is comfortable believing.

If you believe that Obama is a socialist, if you believe that your wife is cheating on you, if you believe that chewing a handful of iron filings will cure your diabetes, often nothing, no matter how scientifically proven, will change that belief. You will select and focus on information that you feel supports that belief.

This was like the "discovery" a few years ago by economists that people do not always make the most rational economic decisions, and (much) more often than not, they will make economic choices that are not in their best interest. For decades economics were based upon the idea that the "economic person" was rational, and that given all of the necessary information, most people would make the rational decision. For decades they wondered why their models never worked well at making predictions. The team that documented this irrationality won a Nobel Prize or something.

As a psychologists, who deals every day with people who make major decisions that affect their lives, in romance, money, work, schooling, interpersonal interactions, drinking, eating, sex and sleeping, all I can say in response to these major "discoveries" is:

DUH!!

Also, remember what Woody Allen called people who think that everyone is after them----

perceptive.

Must have been something he said

2010-07-30T20:22:00.000-07:00

That was quite a week wasn't it? Just buzzed passed so fast you'd think it was one of those old Camaros, you know, the ones before the first gas crisis, the ones with the big engines, the little body and rear-wheel drive, that would spin out a lot and were fatal on snow. Yep. that's the kind of week it was. varrrom.

And everyone showed up, almost, except for Danny, who really has not made much progress in 18 months. But why should he, his parents still pay for everything. He gets angry when they won't give him his allowance, even if he did spend last week's money on cocaine.

But everyone else. Angela brought in her husband. They have been separated for two months. He was angry, dominating, and mean. He was outspoken and direct and it was clear what he expected things to happen his way. That's why Angela kind of snuck around behind his back. She felt she could never negotiate with him, he just rode right over anything she said. But running up $45, 000 in secret credit cards did kind of come as a shock. Especially since it was the third time she promised never to do that again. I think that is a very American form of pathology; I have seen it much more often than I expected.

I had one open hour, but Stan called and needed to come in ASAP. I have not seen Stan for four years. Stan has not worked for four years. He's had some problems. He's been jumpy, irritable, depressed and isolated. He doesn't finish things, he drinks a bit too much, and he has temper outbursts -- all of which made keeping a job difficult. He couldn't come to treatment earlier because he didn't have insurance. Now that he has completely run out of money he can get insurance from the State.

Stan showed me his arm. He had a scar with seven stitches. He turned his arm over and showed me another scar with four stitches. The second one is where the knife came out. It must have been something he said.

Marla lost two pounds, now she is six pounds under four-hundred -- but it's a start -- I think.

Alicia and Martin: still no sex.

Phoebe, out of the hospital and into a one-month residential treatment program. Out of that in three days after when she told them she was very upset and did not feel safe alone, the one staff member handed her a coloring book and went back to talking on her phone. Phoebe is going into a day program for two weeks.

Those and twenty-eight others: loss, loneliness, addictions, stress, conflict, illness, doubt, broke, bored or burdened.

My last appointment was Sheila and Mark. They came in snarling and tense. They left tearful and arm in arm. A good end to the week.

Today I spent time in the kayak, bobbing up and down on the slow rolling not very high waves. The cormorants were back in their usual positions, on a rock, with their wings spread out to dry. As I drifted I could hear the noise of running screaming and laughing on the beach. The sun was moving lower, turning the few clouds pink.

I am very aware that I am a week older. I am very aware that I can't stop time.

It was a good week. I love summer, even if the Red Sox suck.

The dance continues, doesn't it Mr. Fellini?

Glorious! .... yet

2010-07-25T19:04:00.000-07:00

Another glorious weekend down by the water. This time down at the beach house watching the tide go out. We sat with friends, eating and drinking, discussing not much of anything. Again, in my life, the world seems to be doing what it should, pretty much.

It's at these times that I realize how fortunate I am that my wife and kids, and their spouses, and soon their kids, and I are all healthy, and even somewhat prosperous. I look in the paper and often see that people my age are dead. I walk down a winding path through scrub pines, go up a sandy hill, and from there, on a bluff, I can overlook the entire expanse of my favorite beach, with it's large curve, and it's small, but rolling and lapping waves. Except now, I realize that it was not only me who felt that this spot was so special. For now there is a new bench to sit on, and linger and watch the sunset from this spot. The bench has a plaque that says it was dedicated to a great guy, someone I never knew. He was eight months older than me, and now he's a bench.

I read something else in the paper today also. There was a line that mentioned that the top twenty hedge-fund and money managers in the US made in ten minutes last year, the amount of money that the average American worker made ALL year. Something is wrong there. It is psychologically de-stabilizing for that to be going on.

What's worse is that these people --- and they did nothing wrong or illegal (probably, well maybe), didn't really produce anything that did our society any good. They just moved money around, mostly following the directions of computer algorithms.

Something is not good. that should not be valued more than nurses, scientists, business people who actually make something, or deliver a service someone wants to pay for, or even street cleaners and garbage collectors, who work hard to keep us healthy.

Not good. What do you think Justice Roberts?