Listen to the silence

I am currently seeing two patients who are suffering from a huge fear of flying. Is is not only the fear do plumiting helplessly to earth from 30,000 feet as much as just being trapped in a long aluminum tube without any chance of getting out for hours. Relax, sit back, enjoy the time off. Fat chance But I did. I got on a plane and flew out here in six hours. On the plane i read a great article on panic attacks. The plane landed, we picked up a car and three hours later we were up on the high desert. Joshua Tree National Park. Amazing rock formations, spectacular cactus, and high, flat arid lands that go on for ever. We walked the trails, gazed at the rocks, and wondered at the creation of it all. At one point as my friends walked on I climbed up on a rock formation. I climbed up and over several layers of rocks on top of rocks. I stood and looked over the long stretch of valley, flat, dry, accentuated with those beautiful Joshua cacti. I took a slow deep breath and realized, suddenly, there was no wind, there were no birds, there was no traffic. I held my breath and realized there was a kind of complete silence that I have not heard for years. The sky was clear,the rocks were immovable, the world was still and so quiet. I stood there on top of a small rock pile,looking over the valley, listening closely to the silence. I could not take a picture of it, I couldn't record it, I couldn't put It up on Facebook to share with my "friends.". I could only be there, in the moment, being me in the world, letting the moment envelope me; just being. Maybe five of the most alive minutes in months. The my wife called, wondering what happened to me. I rejoined my friends, and became part of society again. But more than before, being me, in the moment.Grateful to just be alive.

By contrat

Sometimes it gets tough:  my first patient was in a wheelchair and his bones are deteriorating and there isn't much anyone can do.  My second patient was talking about another relapse to heroin and was feeling suicidal, my third has been out of work for twenty months and has lost hope .... with five more to come..

But the last three days, because of family obligations, I have been forced to get home in time to spend at least an hour with someone who is almost 16 months old.

Now I know clearly how to recognize the symptoms when someone has the complete opposite of depression: Joy, excitement and exuberance!

From throwing a ball and watching it hit the wall and come back --- what could be funnier than that?  How about hide and  not-hide, or making funny sounds.  Hysterical! Amazing! Fantastic!

The world is full of wondrous, joyous, ever surprising events happening every minute.  And you don't have to look very far to find them.

And you can keep going until bed-time.

But go to bed without too much fussing so we can do it again tomorrow morning at 6:42.

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.