Talking, listening, and Not

   Some people talk a lot.  I get to see them in treatment.  Often I don’t have to say six words in the whole hour.  They want to hear what they have to say even more than I do.  Therapy often helps them as few other people will to listen to them that much.  Many of these people really do get to hear what they have to say, and it does them some good.

            Some people are very good listeners.  They don’t say much.  They pick up a lot of information and they roll it all around in their heads.  Many of these people have nimble, open minds, and they can take in new ideas and make use of them.  They may not say much, but they have a lot going on.

            While most people fancy themselves some combination of the two, and most people are, there are also those at the wrong ends of the spectrum.  There are those who talk a lot and really don’t know what the hell they are talking about, but they don’t want anyone else to talk, because it may prove frightening and embarrassing, as their lack of knowledge may become apparent to them, as it already is to most others.

            There are also those who don’t talk, but they don’t listen either.  They are stuck with the ideas that are already in their head, and do to fear, a rigid personality style, personal conviction, or just plain stubbornness, they are not very open to new ideas, and don’t want  to hear about them. Sometimes, these people make it even worse, when they think that other people ought to know what they are thinking and feeling, even though they have never said anything.  Then they get insulted when those other people don't respond correctly.

            Sometimes, especially in couples therapy we call that "a misunderstanding."  It is caused by the always popular "lack of communication."  But really, it is a serious form of magical thinking.

For this?

We have all this marvelous new technology:  The Facebook I love everyone, the Google I can be everywhere, and the Apple iBrain.  There is a commercial on that mocks people for learning this 15 seconds later than their friends.

But what is much of our newly discovered powers of search, find, learn, store, categorize, compare and retrieve.  Two things I read over the last week:

1.  The NYT Magazine article about how Target targets it's customers.  It has the data and it uses it to bring you back into their store.  Nothing sinister or illegal.  All their brain and computer power goes to get you to spend your money in their store.  Things you may want and need, and other things you may just get sucked into.  It's all fine with them. Just spend your money.

2.  The New Yorker article about the goings-on at the Davos World Economic Forum among the most  rich, most famous and most powerful, ends with a scientist and an entrepreneur walking out together.  The scientist is intrigued that the entrepreneur has decoded an algorithm of  human behavior.

What has he been able to track and predict?  He can tell when a gambler has lost so much money that he decides he must quit and leave the casino.  But with this new knowledge the casino can send someone up to him, give him a meal or a coupon that will lure him back into the room so that this poor loser will then give even more money that he does not have to the corporation that is raking it in.

Fighting world hunger?  Don't see it.  Finding out the algorithm for preventing wars between rival nations? Not unless there is a major profit.

Perhaps I'm just reading the wrong articles.

I should be listening to Rush.  He wants the new technology just for porn videos.

Win an Oscar

I looked at the list of nominees for The Best Picture of 2011.  It was a long list of meaningful movies.  Many of them had important messages, some more subtle than others. 


These messages are not new.  They keep coming around and around.  I think of them often myself.
 They are the basic themes of 56% of the novels, movies, documentaries and philisophical essays.

   The creativity is in finding new, somewhat relevant, clever ways to present them.

Ideas that always get attention:

1. The world is tough for humans to negotiate

2. Most people mean well, but are flawed

         A. Given a chance they will be selfish and greedy before they are compassionate and altruistic.

         B. Some people believe that this is the way it is and we should all do the best we can for ourselves.

         C. Others believe that we can, and should overcome our more base instincts and cooperate, so we can all live better.

3. The world is generally run by assholes

Most people want to live their lives, watch TV, get laid, Hang with friends, get a buzz on, and be left alone to do that.

The people who need to “Be someone” and have something to prove are the ones with the commitment and energy to get stuff done.  Most of them are narcissistic, ego-maniacal or have some kind of missionary zeal.  Not good.

This has always been so: crazy kings, crazy generals, crazy prophets, crazy clerics, crazy industrial tycoons, crazy bankers.

 People get sucked into thinking that these guys (and most of them are guys) are heroes. They are often charming and charismatic, but their ideas are usually about how “we are better than them” and how we should fight, steal, swindle, pound, drive away, or even kill “them.”

It almost always ends in pain and suffering for those who got sucked in, and even for those who weren’t paying attention.

4. Relationships are always difficult.

Anyone, especially those you love, won’t always do what you want him or her to do, so it pisses you off because they should.  It would make your life better

If you do find someone who always does what you want, you immediately realize that they have no judgment of their own, that they are lesser, and you punish them for it.

Almost everyone wants to fuck someone else, at least some of the time, and many, many people do.

--- and when they do it’s special, unique and they should be forgiven. But that won’t come easily.  People like to act surprised and to judge.

So now that task is to take those ideas as jumping off points and meld them into one story.  If I do that I may be able to explain all this in a way the world can understand, and that will bring about an amazing transformation of thought and action.

Of course there is this play called Julius Caesar.  ……. Or Caesar and Cleopatra, or something called Hamlet, or…….

Cultures, subcultures

A person's sub-culture, by which I mean the community that he or she identifies with and spends most of his or her time within, is such a powerful determinant of any one's emotions and behavior, but it is rarely discussed  by psychologists and psychiatrists, and  it is not given the influence that it deserves.

Psychiatry has become so biological over the past twenty years.  It is difficult to get any psychiatrist to talk about anything other than brain chemistry when they discuss a diagnosis or treatment.  Psychologists are more varied. They consider a great many family influences and the role of interpersonal relationships, and see how they greatly affect how people think, feel and behave.

Yet, the values, mores attitudes and behaviors of those who anyone sees himself as most like, do so much toward determining what they feel is the right thing to do, or think, or aspire to.

If both your parents are are collecting checks for disability, and your brother is selling drugs and your seventeen year-old cousin is having her second child, and you three best friends have already dropped out of high school, it will be very difficult for you to "pull yourself up by your boot straps" stay in school, go to college, look for, expect to get, and find a well paying job.

By comparison, if you go to a high school from which 98% of the kids graduate, and 94% of those go to college, you will probably not only expect to go to college, you will go.  You may feel badly that you are going off to State U, instead of Yale, but you expectations and aspirations will be so different from the person in the previous paragraph.

Now, this all seems pretty obvious.  What may not be so obvious to many people is that if almost all of the kids who live the lives in the first paragraph switched cribs with the kids in the second paragraph before they were fourteen months old, all of their lives would live up to the expectations of the new subculture.  I think that many people would not believe that, but I am sure of it. Here in America, people still like to believe that kids are born smart or not so smart.  That's not the case.  94.768% is learning how to learn, living up to expectations, and seeing how the world around you works.

I see so many smart, attractive, personable adolescents and young adults who all do marvelous things and live healthy, prosperous, creative enjoyable lives, if they get the opportunity.  But some of them have no one to show them the path, many even have people around them who are negative and discouraging.

I get great satisfaction when I can be part of the process that helps someone find a way to use their talents and skills.  But it is often disheartening to see how some people have so many more obstacles to fight through and overcome.  Forging a life is difficult enough for anyone.  The journey is much more difficult without a guide, or with someone stepping on your head.

We now also have so many examples of how growing up in a very religious community influences the way someone thinks, sees cause and effect and expects change.  What is "normal in that community may not fit in well in San Francisco, and vice-versa, with an emphasis on the"vice."

 No one can get from here to there alone; not John Wayne, and not Clarence Thomas. Our thinking, feeling and behaving is constantly being influenced by those around us, not matter how much we try to resist. Even the act of resistance is created by the living in the community.

None of this may be groundbreaking, but as John says:  Copy, Transform, Combine (repeat).
The more things get brought to light, the better.

Parenting fuss

Again, a new wave of books about how to raise you kids.  It all mostly began with Dr. Spock, who did a pretty good job. Since then there have been thousands, some have been decent, but most have been terrible.  Many have been very harmful. Many are really no more than political polemics created to develop true believers.

But now we are living in a time when the pressure on kids to grow-up quickly and learn the right skills is greatly magnified.  If you don't have a strong, sophisticated education it will be difficult to find a job or to create one for yourself.  Robots now do the kind of work that kept millions of people employed thirty years ago. Kids have to not only learn how to do things well, they have to do things better than others.  Harvard and MIT have only so many seats each year. Be strict, be tough, teach your kids to focus, to learn, to succeed and achieve. Fun will come for the satisfaction of achievement, play will come at 55.

Predictably, in three to five years there will be another huge pile of books written that will refute the ones coming out today.  Any parenting style that goes to any extreme may work for some kids, but will fail for most.  Every kid is different, every parent is different, every family is different and every time period is different. 

Parenting is wonderful, and should be the most engaging and productive thing that anyone does with his or her life.  But it involves a lot of time and a very delicate balancing act:

Independence but with structure
Fun and Happy, yet internalized delay of gratification
Achievement through pleasure, achievement through work
Intellectual development; emotional intelligence
Firm but Fair
Organized sports, or disorganized play
Discipline yet with Emotional self-regulation!
Learn the rules, but learn to think for yourself.
Solve problems traditionally, solve problems creatively
Play, roam, waste time, watch TV, make-up games, be a pain in the ass

A parent has to slowly instill all of these things in a smiling, running, teasing, messy, fussy, naturally playful totally innocent child.  I remember when my kids were young that as soon as I could determine out how much freedom and independence they could handle, they had grown and changed and their stage of life was different, the challenges they faced were different and I had to begin all over again.

I know that it is more difficult today with so much information, so much stimulation, so many more ways of measuring, and what seems to be much less time.

The one basic rule:  Pay Attention!!!

What seems to have improved is that Grand parenting is much easier and a great deal of fun.

Guilt

Over the past week I have had several people talk to me about how guilty they feel.  Now, I am not one of those therapists who feel that guilt is always a bad thing.  I think it is very important for someone to realize they have done something wrong, or bad, or offended someone, and to feel guilty about it.

Hopefully, guilt will be a motivator to do something good to relieve the guilt. People don't like to feel guilty, so I hope to help people find a good way to change things.

However, guilt can be so ingrained in a person's early in life that they just become overwhelmed and immobilized.  A parent, whose style is to let a child know that what they have done may not only not be the right thing, but that it hurt someone, in some unseen but emotional way, can plant the seeds of constant doubt.  Religion, as we all know, can be a big creator of guilt, which will lead to feelings of unworthyness.

But this week, one of the people I have been seeing really upped the whole guilt thing to a new level.  She was talking about how her mother always blamed her for having ruined her, the mother's life. The mother also was constantly letting this woman know all of her faults, all of her mistakes, and how they affected the family and the community.  The answer to any question about school, a friend, the family, her chores, her comments, was always that my patient was at fault; guilty unless proven innocent, and even then there were still major doubts.

To illustrate the result of such an upbringing, this woman told me that on 9/11/2001, very soon after the twin towers had tumbled and the planes all over the country were being grounded and the search for the terrorists had begun, she carefully reviewed her activities of the day, and wrote down where she was, and who she was with.  She said she did this really, without thinking about what she was doing.  It was not that she wanted to remember the day, she realized, she really wanted to make sure her alibi was in place.  She expected someone to come knocking on her door, but she was sure that this time she had nothing to do with it, and she needed to have the proof available.

Another not surprise

Americans it seems, more than those in any other country, like to avoid responsibility and also to seek a quick fix.

That's why it came as no surprise to anyone who has been in practice for more than ten years, to learn that the diagnosis of ADHD, is not as real or as widespread as it has become, and the the treatment of it, whatever it is, with stimulant medication is not effective.

In truth, a lot of what is called ADD, or ADHD, is the result of a chaotic environment, not enough consistent discipline, and certainly a lack of having learned self-discipline.

Now I don't want to run around pointing fingers and yelling "bad parent" at anyone who has been told their kid has ADD.  In truth, some teachers tried to pin that on my own son when he was ten, and the description may have even fit me for a couple of years when I was a kid.

The reason for the increase in the diagnoses was two-fold:

1. the increase in the complexity of life.  Parents now are often both working, everyone is scurrying around.  Schools are more high paced, stimulation comes from everywhere and very rapidly.  Kids hardly have time to take a break and just have random, unplanned, un-educational fun, which is the kind that really leads to the most learning.  It is very difficult for young boys to sit still and focus for more than half an hour.  Most of them just are not built that way.

2.  The drug industry found a drug that works.  They failed to point out that the drug is a stimulant (speed) and that it helps everyone focus, from seven year-olds to eight-seven year-olds.  They also did not report the studies that show the effectiveness wears off over time, and that their are often side-effects, such as headaches, sleeplessness and stunted growth.

But, once again, there was money to be made.  And the drugs do make a difference, for a while.  But they don't really help anyone learn, and they seem to hinder people learning how to learn, or learning to control themselves.

There have been so many times when I have had a parent tell me that their son won't do his homework, but  if he is interested in something: science, football, skateboarding, girls; then he will learn all he can about it.  That is NOT a symptom of ADD.  It shows that the kid is motivated to do what he feels is relevant.

Many psychologists have made a living on testing and diagnosing brain pathologies, and ADD is right up there.  But everyone has a brain, and every brain is slightly different.  Still, we can all learn to do what we need to do.  We are all good at finding ways at doing what we want to do, under pressure we can do what is necessary, unless we give ourselves an excuse.

It is also interesting to note that something like 94% of people taking medicine for ADD are in the U.S. of A.   Is it something in the soil?

Well, I guess you can't blame your brain any more if you work is late and you watched re-runs of Cheers instead of getting it finished.  You might have to tell everyone, including yourself, that you just didn't want to do it.

Back Again

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

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

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)

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

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

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

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

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

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

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

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

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

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

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. +

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

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

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

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

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 changes those impressions one bit.  Just because you have run a business doesn't mean you aren't an anti-American leftist.  It just means you have no appreciation for the gift of being an American and therefore don't deserve our consideration 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

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

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

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

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 (?)

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

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.

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

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!