The way we are going

They are making artificial blood, but it still kills too many people.

There is an artificial heart, that works for a while.

Artificial skin can be used in some circumstances.

There are many examples of artificial limbs that work well.

Lots if artificial hair.

Silicone breasts

redone noses, faces, lips, chins,

artificial hips, knees, shoulders.

Brains?, well not yet,

BUT

in Switzerland there is a company that has linked over 2000 IBM microchips that can handle 22.8 trillion operations per second. Each is supposed to represent a neuron and the hope is that this will mimic brain functioning, and with enough electricity swarming through it they hope it can generate a mind.

I hope it has good parents.

a Really Great (Great) Grandfather

T was talking about his father, which is something we often do in therapy.

His father was was in and out of his life for many years. T was most raised by his grand-parents. His grandfather was caring, but a bit too harsh.

Then T began to give more a a family perspective about what was expected of the men in his family. He said a lot began with his great-grandfather who was rich and owned a lot of land, and people usually did what he asked.

I guess that was true of the women too because, T went on to say, his great-grandfather had 42 children, with at least 17 different women.

That sets quite a standard for the men of the family.

my old brain.

So, it is finally Spring here and everyone seems to be outside doing all kinds of rejuvenating stuff. How can you live in California without Spring?

I'm taking a walk around town, just checking everything out and I pass a window with the shade drawn. Before I realized it I was singing "All the shades were pulled and drawn, way down tight." Those words are from a song called "Silhouettes" which was very popular when I was probably in Jr. High school, and that was a while ago.

The words just flowed out. I must have remembered about 90% of them correctly.

Is this a good thing and I have access to a good memory, or am I getting like my father-in-law and I don't know what decade I'm living in? Hard to tell.

I know that music helps connect everything, so that with the tune, it is easier to remember the song as one until.

It is even more true that when there is emotion connected to something the memory remains stronger ( although not necessarily accurate). There certainly are a lot of emotions connected to Jr High love songs.

Anyway, I also remember that the song was sung by The Rays, and that about month later a group called The Silhouettes came out with a song that also hit #1 on the charts (Do they still have charts?) That was called "Get a Job" a refrain I still sing to several of my clients.

old brains

We often go and visit my wife's father. He's going to be 94 soon. Until last year he was doing pretty well, but last spring he contracted pneumonia and, although he recovered physically from that, it seems the stay in the hospital knocked out his mental equilibrium.

Now he often doesn't know what decade he is in. Often he is 16, back in the town where he was born, looking for his neighbors. Sometimes he is fifty and waiting to be picked up to play golf. There are lots of other disorienting things. It's sad that brains tend to shrink with age and then confusing things happen.

Would it have been better if he stayed more involved with others and had more interactions to keep him alert? He was never that naturally social. His wife did all the arranging. Once she died he slowly withdrew.

But, I don't know. He's 94. What can you expect?

At the doctor's recommendation we gave him Zoloft. We gave him one pill at a sub-therapeutic level to try it out. The next night he was up all night making phone calls, mostly to people who had been dead for twenty years. He called 911 because his wife was missing.

We didn't give him another pill.

Really, he should come and live with us, but we have too many stairs and we are not home enough. (I'm saying this just in case my kids read this.)

At 93 I'm buying a motorcycle. If I remember.

Irrationality

A couple of weeks ago I spent a day down at the Tech School where I got to see some terrific stuff they are trying to put together. They had robots with cool eyebrows, and big 3-D models of ho my opinions differed from everyone else.

The main speaker was Dan Ariel who wrote a new book about how people really don't make rational decisions, even about money.

So, I went up to him and I said "Duh."

And he said that economic theory is based on the belief that people are rational and will act in their best interest.

Like who they allow to beat them up when they're married I said.

He looked at me kind of strange and worried.

So then I said, like trading Credit Default Swaps.

Then he knew what I was talking about.


Dr. Phil tells people, rationally, with common sense, what they should do.

Nobody really listens to him either.

But he made $96,000,000

and he doesn't even have a license.

Here they come again

Here is the real problem. They call themselves "Health Care Companies" or health Management Companies" or some other misleading euphemism. But the truth is they are financial companies. So, when they come after me and tell me to fill out their Patient Outcome Management Forms, of their Patient Wellness Assessment Forms, or TOP Patient survey, I get upset.

They tell me that they are trying to help me make clearer diagnoses. Or they tell me they are trying to help their subscribers find the best clinical matches. It's all a lot of shit.

All they are trying to do is trying to find ways to justify their existence AND to pay us less.

Two of the major conditions necessary for successful psychotherapy are trust and understanding. I don't trust these companies, and I don't think they really have any understanding of what we do. I don't want their "suggestions" of how I should do treatment. If they know hoe to do it they should be out here doing it. Their suggestions don't come from any research that I respect. The symptoms they want me to treat are not symptoms that I really care about -- they are symptoms, not the problem.
They will go away when the issues are addressed.

But now it is fashionable for each company to begin to make their therapists accountable and monitor their effectiveness. Except they really don't know how to do that.

It's all about the money. They've collected it from the subscribers and they don't really want to give it away to us, the care-givers. An adversarial system of health care is never a good one.

worse than it is

Today is Monday, and somehow on Monday I see some of the most difficult, most chronic people that I have to deal with.

I have been practicing in this city for twenty-seven years. I began here the month after John Lennon was killed, so it's easy to remember.

In a practice like this each year I see between 150 or 175 different clients. Usually, about 50 to 60 get carried over to the next year. After 27 years I have learned that the average length of time that anyone spends in treatment with me is bi-modal. It is either six months or eighteen months.

But every year I get one or two people whose lives, or whose minds, are a mess. They stick around for a while. After a while they begin to accumulate.

Today it seemed like everyone I saw was someone I had seen forever, and that I would see until the day I died. But that isn't true.

I checked my records and found that of the 66 people I have seen this year 17 of them I have seen for five years or longer. That is 1/4 of all the folks I see. By the end of the year I will have about 100 people will have finished therapy. But not these folks.

I checked further and noticed that five of those 17 people account for 58% of the phone calls I get.

They are troubled, in constant crisis, some are more than a bit narcissistic, need guidance, reassurance, attention, and seem to have some sense that having a therapist means having a super-mother with a huge breast.

It is these people that have driven some of my colleagues out of business.

I try to set limits. They now know that just because the leave four messages doesn't mean they will get a return call. Life goes on.

another angry client

I have been seeing Mary for a long time. She doesn't drink much anymore and she hasn't been in a fight for a long time, but she is still an angry woman.

Almost two years ago I began to see another woman, Kate. Kate had led an interesting but pretty difficult life: Her mother was a drunk and her father walked out on the mother and three young children. But Kate had survived this, and several other terrible times, with humor, persistence and the hope of a decent life.

About a month ago Kate left the man she had been living with for the past fifteen years. She realized that she had spent all that time waiting on him, spending money on him, listening to his complaints about the world, and protecting him from the consequences of his own actions.

Two weeks ago Mary came in to her session roaring at me. How could I do this? Do I ruin every one's life? Who can believe that therapy does any good anyway?

It turns out that the man Kate left is Mary's brother. Mary took that as an affront to her whole family -- although she had always said that the members of her family where selfish, useless, and dishonest.

What Mary is really angry at is that she knows that Kate will have a better life. Things will still be tough for Mary, and now her brother will be looking to her to help do all those things that Kate has always done for him.

Some guys are like that.

The Beatles were right

I have been seeing Jake for almost a year. He really struggles with anxiety attacks, especially in social situations, and with bouts of depression. Sometimes it got so bad he would be crying and hitting his head as he drove home from work.

He is about 26, and has been suffering since high school. He has friends, he has a pretty good job, and he functions, but he was not happy. He was often miserable. He has tried several medications and some of them would help for a while, but he couldn't stand the side effects. He settled on a mild anti-depressant, that maybe helped a little.

Because of his anxiety Jake has felt most anxious around women. He had hardly dated, and that made him feel more like a loser. He had a brief relationship with a girl when he was in high school, but that ended in disaster. There was this one other woman whom he liked, but he was never sure if she like him so he was afraid to pursue her.

For weeks that was part of what we discussed in our session. Finally, he understood that maybe she was waiting for him to show he was interested before she would show him that she was.

Well, that turned out to be the case. This woman, who does seem to have her own issues, has been keeping her eye on him for two years, hoping he would approach her.

Now, two months later, they are seeing a lot of each other, and they have some kind of understanding that they are a couple.

Jake is happy, and happy in a way that he has never been. He feels like he a a part of the world. He is hardly anxioius and not depressed. He gets out of bed, goes to work and smiles.

I don't know what would happen if she changes her mind, but that doesn't seem imminent.

Love is the answer: the healer of all wounds, the source of all hope, the force that parts the clouds and brings out the sun. The Beatles were right.

they had sex with other people

After poor governor Spitzer went down in flames it seems that it has suddenly become very trendy for people of note to go public with the fact that they have had sex with people other than the ones to whom they are married.

This comes as quite a surprise -- but only to people in this country.

America, born from the Puritan Ethic still can't seem to admit, openly, that most people really like to have sex.


Sex is programed into our genes so that we can keep the species going. Over millions of years we have evolved to really like something that is really necessary. If sex was like taking out the garbage we wouldn't have 6.4 billion people in the world.

Sex strengthens the bonds between people, it enhances self-esteem, it is a great tension release, it promotes harmony and it feels really good.

Most people, but especially men will not turn down an opportunity to have sex, unless the fallout is really negative.

The fallout is often negative, which is very good for my business.

I can't remember the source, but someone read a quote to me recently:

"The most powerful people in the world are rich while men and beautiful women."

gone

Rarely, but sometimes, things get a bit scary.

I am working with a woman who I have seen for a long time and she is doing very well/ But still, at the slightest mention of the wrong thing, she will dissociate. She really, really goes away and isn't there.

It can happen in an instant. Her lip curls, her brow knits and her eyes glaze over and she doesn't hear or respond for anywhere from thirty seconds to two minutes. She says that if it happens at home and no one knows what to do she will be "away" for much longer. She really can't tell how long.

She says it feels like she is floating out there. She can't feel her body and she really can't control her mind, or tell me where she goes or what she is thinking. She just goes away.

I can bring her back slowly, but she is exhausted. She says her body stays numb for a while, she cries, and then she get very angry.

She knows what it relates to, and we can see what triggered it afterward, but the trigger can seem very remote until we look at it.

Such a strong reaction makes it difficult to work on the underlying trauma because the mere mention of thinking about working on it can be the trigger.

Thankfully, otherwise, she has worked very hard to put together and maintain a successful life.

I have a great deal of admiration for her

away and back

I was up in the mountains for a couple of days, hidden from the world surrounded by family. I was without the computer and even out of cell-phone range, being on the wrong side of the mountain.

It's tough to read the paper after that. I see that people are still very involved in blowing each other up.

I spend hour after hour trying to move people, one at a time, slowly in a direction that will improve their lives. But the tide is always running against them. And then we have a leader who makes jokes about how the economy is going through kind of a rough patch, and the future of the war is kind of hazy, and he giggles and dances as if he has done nothing that could upset anyone.

We have the reformist governor who spends $4200 for some kind of sex. Led slightly astray by a bit of lust. What kind of people are running the show here?

But at least we don't have suicide bombers. I'm sure we do suicide missions, and assassinations, and torture.

I have a client who whines because everything has been done to him, which may be true, but that's no excuse. Everything is being done to all of us. We live in the best time there every has been to be alive. You just have to ignore that 40% of the world lives in extreme poverty and several groups are still intent on slaughtering several others.

That's just the way it is.

Then he said

Harry came back to see me. I saw him for a few months last year, and about three years ago I saw him for a year.

Harry is a major vice-president at a company you would recognize. He comes to me because he gets stressed out, and we have to keep on eye on his drinking. He also worries about having another marriage fail.

But Harry is obviously smart, alert, and does well with people. He didn't get where he is because his father owned the business. He knows how to deal with the world.

As the session wound down Harry began to tell me about things he's been reading and thinking about. He talked about new DNA technology, which is something I follow pretty closely. But slowly the thread of his conversation drifted and soon he was then telling me that he is convinced that part of our DNA has been improved by mixing with space invaders. He went on to say that he thinks he has met some "helpers" who have come from other galaxies, and that they are really all around us, just waiting for us to ask for their help and guidance. Earth is really just a big laboratory to them.

"That's not how I interpreted the data," I replied.

marathon

Back in the office. Tuesday and Wednesday were full days. In ways the vacation was really good, but in other ways it makes it difficult to miss a step in the process. Therapy is usually done a week at a time, and for me, after things are moving I often shift to two weeks.

But therapy has a rhythm; it is slightly different for each client, but they fall into it. Each person can only tolerate a certain level of working on each obstacle, each person will change only so fast, and unlike the TV show, the change is usually slow.

By Thursday I was feeling roughed-up a bit. I was still a bit jet-lagged. Still waking up too early and fading earlier than usual. I knew going in I had ten appointments and I didn't know how I would hold up. People kind of get offended if you fall asleep in their session. (I've only done that once, and she was really boring and I was taking antihistamines).

But I saw my first appointment and she was struggling with the similarities between her husband and her father, and soon she was crying. My second appointment just came back from his mother's funeral so that was very busy, and then, suddenly it seemed. it was seven o'clock and I had only hour left to go.

It's like basketball, or marathon running; you can get in a zone and things seem more intense, and it's easier to focus, and you feel like you know exactly what you're doing.

When people ask: "How do you stand to listen to every one's problems?" I try to tell them that it's not like that at all. It's like being handed a different puzzle every hour and it's your job to work with someone you like to try and put the pieces together. It's fun and it's fascinating, especially when it works.

But then I came home

The trip was good. It really cleared my mind. I was out of range and out of touch. I don't have a Blackberry and I only checked email once.

Most people go for outer warmth, but we went to the land of drizzle and mist, where the sea crashes against the rocks and cliffs, but once you open the big wooden door all is warm and welcoming. You sit down, have a pint, listen to the fiddle and there is good craic.

During the day we saw the castles and the ruins, and the Tidy Towns with each house painted a different color. At night we ate fish and potatoes or lamb and potatoes, or fish and potatoes or lamb and potatoes. My wife had the chicken. A question is answered with a story.

Then we flew home.

I checked my voicemail and had 99 new messages. There would have been more but the box was full.

Thankfully, 19 were hang-ups, six were from Jake who was telling me how each person in his life had done him wrong, and fifty were from L, who chronicled each time someone broke into her house, stole a carrot or some coffee, removed a stitch from her sweatpants, scratched a bracelet, used her make-up, tampered with her phone, turned down the volume on her DVR,or replaced the left shoe of the pair she just bought with one that was slightly smaller.

I had told her to keep a list while I was gone, so as not to fill my mailbox, but she could not restrain herself. When I called her and complained she said she was sorry.

Half of the remaining two dozen calls were from insurance companies or lawyers seeking information that I won't give them, the other half were from old clients seeking new appointments, and some new people too.

I should be all caught up by April.

It's always good to go away.

lawyers came and went

So the lawyers came. I told them not to, but they did.

Two of them drove three hours to my office to talk about a a client who had been in a car accident that no one saw.

They asked me if I believed her version of what happened. I said I accepted what she said. They asked me if I made any attempt to verify anything she said. I said, why should I?

They said doesn't the truth matter?

I said, she is my client, to me it is her truth that matters. When she came to see me I told her I wasn't about going to court. If she wanted to learn to deal with the pain she said she felt, and the depression, and work on getting back to her job and her life, then fine. I would be her therapist.

I told the lawyer I had been her therapist, and now, two years later,four years after the accident, she is back at work and I had not seen her for six months. I felt I did my job.

They asked me if the accident was more of a factor in her depression than the terrible divorce she went through two years before the accident.

I told them that she felt she got hurt in the accident and the pain kept her from working. She fell into debt and got depressed and overwhelmed. But, if she hadn't been divorced she wouldn't have been driving there to meet her new boyfriend. But if she never married that abusive first husband she wouldn't have gotten divorced. But if her parents had not been fighting so much she may have taken more time to consider whom to marry in the first place.

That's what I think, I said.

The lawyers left. But they paid me first. I don't think they will come back soon.


Anyway, I'm off for a week to find someplace a bit warmer.

"In Treatment"

From what I can tell the HBO show "In Treatment" is pretty cool. The therapist is pretty good, has a cool accent and has problems. His clients are attractive, dramatic, wildly verbal, very smart, challenging and diverse.

Just like my practice.

Except not.

I think it's good that the thing is on TV. Anything that gets folks to think about therapy, instead of just taking some pills, is a good thing.

Maybe my clients will see the show, rush in, spill their guts in half an hour. Then I can say a few pithy things that bring eye-popping insight. Their lives will dramatically change, and we can all break for a commercial.

This weeks I sat through thirty four hours of treatment, most of which were surprisingly like the previous session I had with each of these clients. Yes, things are changing, but the grass is growing and the paint is drying too.

But if I could compress ten to eighteen months of treatment into six weeks, it could look pretty much like the show.

I have to work on the accent. (and my chin).

hints for kids

Last time I wrote a bit about how many people have just missed the boat and are just hanging around, blaming the world.

I read an interesting article by an interesting woman, Dr. Dweck, who happens to be a professor at Stanford. She writes a lot about child raising and success. What she says makes a lot of sense, and she has some research to prove it. It also agrees with something I wrote about a few months ago, so I am even more impressed.

What she says is that if you praise children for being smart, or talented, or in anyway naturally gifted, then you may be doing them some harm.

Americans are much too taken with the idea of I.Q, or some form of innate ability. But, as I said, most people,except for some pretty rare brains, are pretty much the same. The difference comes really in how hard people work at things, and how well they learn to not be frustrated by mistakes.

Dr. Dweck makes a strong case for praising children for their effort, persistence and creativity. It is that skill that will carry them further in the world, and help them through difficult times.

Children, and adults, who are given the impression that they are brilliant or exceptionally talented get to feel that they should not need to work hard; that things should come naturally. Then, if they don't do something well, their bubble pops and they often don't have the skill to keep going.

It is important for kids, and adults, to learn that the process is where the fun is. The challenge of learning, creating, working, problem solving, and over-coming challenges, often after many tries, is where the greatest satisfaction in life lies. Yes, the final achievement is important. But it is always they getting there that makes us feel alive, worthwhile and accomplished.

Don't wanna do it

It's a new month. I have to pay the bills from the practice; the rent, the water, the phone. I have to pay the bills at home. And it's a weekend, I have to clean and fix stuff, and I'm not good at fixing things.

I don't want to do it. I want to just start drinking and watch the Pats in their quest for perfection.

What still amazes me is how many people there are out there that don't do it. It varies from people who don't pay their taxes, to people who don't pay their bills, to people who don't clean up to people who just don't do anything.

It seems that almost every family has one. Someone, in their thirties, forties and up, who just have a room in the attic or the basement, or hang around the house and don't do anything. Sometimes they drink too much, but often they just can't cope, so they don't.

I'm not talking about people with cancer, or brain injury, or developmental disorders, I'm talking about people who are fairly intelligent,may or may not be friendly, but who somehow missed a beat, dropped out, and never got it back. Then they give up trying and expect that it's OK.


It takes so much energy from so many other people to drag these folks along. Usually, there is one parent who enables them, and always has. One parent who worries, and forgives, and gives just one more chance or one last gift of $50 to $50,000.

Bills, food, laundry, cars, hospitals, and on top of that melt-downs.

There are so many of these folks, but you hardly see them, because they don't come out. And no one talks about them because they are such an embarrassment.

I'm not sure of the solution, but they are frustrating to deal with in therapy. I have a few from some of the wealthiest families in this small city. Lonely, entitled, anxious, angry, and somehow missing the drive to fight their way out of it.

Usually, with some kind of excuse.

They wouldn't last long with Belichick.

almost alone

It is my belief that humans are social animals. that is why therapy really works better than medication. Interpersonal relationships, caring, compassion,and understanding, make a huge difference in keeping people healthy and happy.

So when Charlie comes in a tells me how his life is so much better now it is difficult for me to let it go at that. Although I do believe him.

He works from home, leaning over his computer, making sure that the software for some national utility company works and that the seven state region keeps functioning. When he is not on call he goes into his wood shop and carves very beautiful wooden animal replicas. He has showed me pictures.

When he has finished carving, he puts them on the shelves he built, with the two dozen others.

Charlie is married. His wife goes off to work each day. On the weekend she sees her family. He stays home. He cooks. My impression is they say about twenty words a week. If they have sex he's happy.

He has no plans to show anyone his carvings, besides his wife. I get to see the pictures.

The problem for me is that he is such a nice guy. He would hate my saying this, but he is really sweet. People should get to know him. He would like them; they would really like him. He is smart and interesting. At least I think so. I look forward to seeing him.

Yes, his mother left him to run off with the coke dealer,and his father beat him and humiliated him. He was fat and quiet at school and the kids made his life hell. But that was twenty years ago.

He doesn't want to risk it. He is happy where he is.

But he comes to therapy, regularly. He has a real relationship with me. Maybe he will learn from that, or maybe that's enough.