Saturday, December 30, 2006

Us, Together 2

Of course, not everyone has endured the kind of treatment that Judy has. Most parents are much better, and most really care and want the best for their children. Yet, I see people, in their 30s, 40s, and 50s who still feel scarred by what their parents did or didn't do to them. A personal coldness, an judgmental atmosphere, or even the opposite, of parents doing too much or expecting too little, sometimes can have what seem to be a huge impact.

I saw a 57 year-old woman last week who came in crying because her 37 year-old son called her on Christmas to tell her what a rotten mother she had been. He reeled off examples from when he was seven, ten and thirteen. Now, he is quite successful and seemingly established in his own life. She has no idea why he needs to express these feelings now.

She knows she wasn't perfect. She also knows that she really didn't get much help from the boy's father, who just forgave everything the kid did. She also knows that she tried to do the best she could, and he never seems to recognize that.

It would probably help if this man had children of his own. That would allow him to see how difficult it is to make decisions about when to be tough and when to console.

But, again, I bring this up to illustrate how relationships are overwhelmingly the driving force in anyone's life. We have entered a time when we are offered biological explanations for all of out moods and behaviors. Chemical imbalances or genetic irregularities are taking the blame for anyone who deviates from being pleasant.

That ain't what's happening. If your mother, your boyfriend or your boss isn't happy with you, you will feel it and react, in one way or another. You also have the power to bring joy, sorrow, support or anxiety into another person's life. We are all doing all of these things, all of the time.

Even now, in our little community of bloggers, we have already established a new kind of virtual supportive relationships.

It's a new world, but we are in it for the same basic reasons.

Friday, December 29, 2006

Us, Together 1

"Things derive their being and nature by mutual dependence, and are nothing in themselves."
--Nagarjuna, 2nd century Buddist philosopher

"An elementary particle is not an independently existing, unanalyzable entity. It is, in essence, a set of relationships that reach outward to other things."
--H.P. Stapp, 20th century physicist

And so it is with us. We are people; we intereact. It is the interpersonal interaction that brings all meaning to our lives. How people react to what we do, think, say, work, create, fight or destroy. That is the strongest of all motivations: to please others, to compete with others, to impress others, to defeat others, or to win another's favor.

85% of the problems I deal with in my cozy little office have to do with interpersonal relationships gone awray. The worst are when those who are supposed to love and protect you fail to do that. When parents neglect, reject or abuse their children.

The families I mention in these writings are all attempting to find their way to some happiness. But when parents are flawed, in that they are so burdened with their own troubled, so angry at the world, or just plain crazy, then what chance does a kid have?

Judy was the fifth of six children, born to a mother who fancied herself a spiritualist. She immediately felt that Judy was the devil-child. She treated her differently and harshly from before she was a year old. She screamed at her, degraded her, hit her, fed her leftovers, locked her in her room and inflicted many other physical and emotional scars.
Now, forty years lateer, in my office, Judy is trying to recover from years of alcoholism, prostitution, brawls, abusive relationships, and deep depressions. She still speaks to her mother twice a year, and each time it enrages her. One of her fondest memories is the time, at sixteen, when she fought back and broke three of her mother's ribs.

The best her mother can now offer, is that she "never took to her." Judy suspects she really has a different father, and that her birth led to the heartbreak and eventual death of her father six years later. But she doesn't know for sure.

She is working hard to find the sense of dignity and worth that two parents are supposed to instill. We are making progress, but no pills really help in cases like this. It takes other people to make anyone feel good.

Thursday, December 28, 2006

after xmas

I hope you all got some of what you wanted from the great gift-giver and indulgence fairy of corporate sponsored desire. Part of my job is to clean up the mess; the ribbons, wrapping paper and emotional scars. To whit:

One of my clients got a divorce for Christmas. After the shock, she was kind of pleased. She is not leaving without the Escalade and boucoup dollars.

Another woman had a glass of holiday cheer. It was her first sip is four years. We just got her into detox today.

Another story was second hand. A client went to his parent's house for the holiday. After seven vodka drinks his sister stood up and pointed to the picture of their dead uncle and announced that he was the one who raped her when she was thirteen. That brought the caroling to a close.

One the positive side, S has remained sober for three weeks and smiled when his family drank and fought. D and L cooked for their parents for the first time and received some acknowledgment that they may really be adults. Mary went to church to gaze upon her favorite priest and the organist gave her a present and told her he would like to see her.

L said one of her energy bars is missing.

Life is complex. There are many forces, such as the wind and the tides, and our genetic make-up, that we have no control over. There are other parts of our lives, such as whom we choose to spend time with, and what we do during that time, that it feels like we can control. If we can't really control it, at least we have some in-put. It is my job to help people take advantage of that little bit of influence they have on making things happened the way they want to have them happen.

I hope you are doing that for yourself.

Wednesday, December 27, 2006

Psych Meds III

Here's something to think about.

Down at NIMH, (that's our government, honey)a team of researchers, led by Carlos Zarate, have been looking for a way to relieve the symptoms of treatment resistant depression as quickly as possible.

What they have come up with is to give an intravenous injection of ketamine hydrochloride to eighteen depressed people. Ketamine hydrochloride is an anesthetic, most commonly used by veterinarians. It is also a party drug known as "Special K."

When compared to other people who were given a placebo, the ketamine subjects showed significant improvement, measured by the Hamiliton Depression Rating Scale.

So, the folks at NIMH are having a dance party? While my adolescent boys are being busted for pot.

I wonder what "faith-based" George would think about this?

Tuesday, December 26, 2006

Alice and Grandma

Hope you all had a good holiday. I head back tomorrow to see and hear the adventures that my clients enjoyed or endured, while exchanging the gifts and sharp-tongued remarks that only families can share.

I already know that Alice had a particularly interesting few days because as she was finishing her shopping she received a call from the Assisted Living facility that her grandmother was living in. They let her know that grandma had been taken to the hospital. Alice is 45, her mother, Dolly is in her late 60s, Grandma is in her eighties.

Alice called grandma who responded by demanding to know how she found out that she had suffered a heart attack. But before she could answer Grandma went into a tirade about how no one cared about her, especially Dolly, but Alice also never answered her phone when grandma calls her, so she is useless and inconsiderate and Grandma is hoping to die, and she won't tell anyone about it. She ended by telling Alice to make sure she didn't tell her mother that grandma was in the hospital.

Alice promptly called her mother. But mother already knew. But still, mother was waiting to see if Alice would call and tell her. That way she could blame Alice as the source of the news, and not the secret source she had who had informed her. Dolly then called her grandma. But grandma told her that when she had the heart attack she was all by herself, which proved that nobody cared, and she hung up.

Dolly then called Alice and yelled at her for being so mean to grandma. Dolly said that Alice knew that Dolly and grandma were on the outs, so she should have made more of an effort to know what was happening to grandma, even though grandma wouldn't speak to Alice either.

Meanwhile, Grandma called Tony, who is Alice's 25 year-old son. Grandma had been talking to Tony and secretly sending him money because Tony was still living at home with Alice and not working, unless you consider staying in-touch with his great-grandmother a job. She said she was about to send him more money so that it wouldn't end up in the hands of Dolly, or her sister, Debbie, or Alice, or her brother Rick. She felt that Tony should have it, because he is the only one in the family with any feelings. Tony was more than happy to agree.

Tony then found his mother, Alice, and yelled at her for not taking the calls from grandma, that she didn't make.

Alice told me all this in a session right before Christmas and asked me how she should handle her family relationships.

I told her she should make Tony pay rent.

Thursday, December 21, 2006


It's the Solstice!

It's the shortest day of the year! The original winter holiday. The one that started it all. Build a fire, pray for the powers-that-be to return the sun to us, to make out days longer, and bring forth a renewal of plant and spirit.

It is tough sometimes to wish everyone Peace and Happiness when my own government seems so dedicated to making war and misery.

Yet, the irony is that my very own family is doing very well. The knotty little nucleus of the few I surround myself with seem to be negotiating the slides and spills of life as if they were riding a white-water raft. My two adult children are in good jobs, with good futures, doing good things, and even have health insurance. They both sem to be in good relationships with people who are also doing well, and are smart, attractive and fun to be with. My charming and attractive wife is rolling through the days with spirit and verve, issuing commands and complaints with sparkling enthusiasm.

If you move away from our little circle by just one ring of relationship you run into some disruptions and dysfunctionals, but that's what families are for. We don't have globs of varied relatives, but the few we have are certainly varied and colorful.

Beyond that, as we dance around or bonfire of rejuvenation, the people of the world are the same mess of conflict and exploitation that they always have been. Despite all the marvelous advances in technology, medicine, communications, science and understanding, many individuals and huge groups of people are still hoping to rape, rob, cheat,control, plunder, destroy and annihilate other individuals or other large groups of people.

We are very interesting creatures, with the capacity for language, reason, logic,and abstract thinking. Yet, as I can see from all the people who visit with me here in this cozy office, most people don't take advantage of those abilities. We are aggressive, and defensive. We rely primarily on habit and emotion; the more primitive parts of our brains.

Yet, there can be a lot of satisfaction in that; greed, lust and gluttony can bring great pleasure, especially at this time of year.

So dance on! Look, the sun is coming up!

Tuesday, December 19, 2006

Psych Meds II

Someone, who remains anonymous, asked: "What about our medicated society?"

I spoke a little about his once in late September, but it is a major concern of mine. I have to deal with medication much more now than I did ten years ago. Many people now come to me and expect to get some pills (which I can't give), and there is a big push on by the powers-that-be to get people to see medication as the first option.

I received a little folder in the mail today from Aetna that described how they are designing "scientific" treatment protocols. They are also encouraging, and paying for, PCPs to screen for depression, and then hand out medications. The insurance companies and the drug companies want you to think of drugs first. They want you to believe that whenever you feel bad that a pill can make it better. By extension they want you to think that your bad mood is a biological condition, and maybe it has nothing to do with you life. Your anxiety, according to them, just fell from the sky, you caught depression from someone who sat next to you at the airport. All psychological and emotional problems can be reduced to their physiological components, and then be treated with drugs that will realign your physiology.

This is really a political/economic stance as much as it is a medical one.

First, let me say that I do feel that medications can be a very effective part of a treatment plan. I have seen them help some people dramatically. Many people they help slightly; they take the edge off, reduce some anxiety or depression. For many others they cause weight gain, headaches, dizziness, irritation and sexual dysfunction.

But my major objection is how the insurance/drug industry plays into the "Less thought is better" aspect of the American psychological mind-set. If you life sucks because your wife left, or you screw-up your job, or you dropped the ball, take a pill. It will calm you down, and then cheer you up. If you can't focus, or get bad grades, take a pill; it will help == and it will.

But, often, this kind of medication will help you accept what is wrong with your life more than it will help you do something about it.

Now, in therapy, I spend too much time with people who are switching medications, or are too spaced out, or falling asleep because of their pills. Their emotions have become disconnected from their lives.

Yes, if you are terribly immobilized from depression you should take medication. If you are having intrusive, crazy thoughts, take some medication. But, in truth, I have not seen great benefits from the huge acceptance of psychiatric medication.

I have had many clients who have told me that they feel that they can't cry any more, or they don't get sad, but they don't get happy. One person told me he felt like he was living with emotional oven-mitts on.

But we are living in American when profits drive everything. More companies make more money from medications than they do from therapy. I don't have any of those beautiful drug salespeople knocking on my door. Billions of dollars are not riding on what I recommend.

I also don't offer easy solutions. Therapy can be, should be, difficult and sometimes painful.

But, most of the really independent research that I have read shows that the effects of psychotherapy last much longer.

Friday, December 15, 2006

Rolling and Tumbling lives


My four o'clock appointment was happy because all of her sons were home. The middle son has been out of juvey for three weeks and has learned some respect. The older one is only drinking heavy on weekends. The woman who picks him up and takes him to work comes in to bed with him each morning as a way to perk-up the day. The sound of it grosses out he youngest kid who has not left for school, but in the evening all his calm. She is down to three shots of tequila a night. She says it's better than any anti-depressant, and she's tried them all.

My five o'clock appointment comes from the bankruptcy negotiations that his firm and the acquiring firm need about ten lawyers to even begin. He is afraid that he will loose both his wife and his girlfriend when most of the money is gone. He is up to five shots of facy Scotch each night.

My six o'clock is feeling better. He has been totally honest and totally descriptive about his extra- curricular sexual encounters and his adventures in pornland. The more he describes the terrible, hurtful and slightly perverted things he did the more his wife get turned on and attracted to him. It seems that the problems will be resolved, at least in the short run. Sometimes crisis leads to growth.

The seven o'clock is simple. He is beginning to eat again. Two months ago he alomst choked on a scallop that slipped into his wind-pipe. Since then he has been afraid to put anything in his mouth. He has lost twelve pounds. I don't know if I should finish the de-sensitization process, or wait until he looses another ten pounds.

Then I come home and my house if full of relatives since one has left her husband and had him arrested. There are babies, and sisters, and brother-in-laws and daughters, all being supportive and telling all kinds of stories. I would like to tell her exactly how it will play out and help her skip all the steps that I know she will have to go through, but I know it doesn't work taht way, and also, I'm just a therapist and no one listens to me. Everyone else has real jobs.

2. Awhile ago I mentioned that I was involved with doctors. For now I can only, again, quote Leonard:

My friends are gone
And my head is gray
I ache in the places that I used to play
And I'm crazy for love,
But I'm not comin' on,
I'm just paying my rent everyday
in the Tower of Song ....

Monday, December 11, 2006

The jingle of plastic

Jingle, jingle, jingle;

KaChing, KaChing, KaChing.

It's that time of year again, when people love to run up those purchases with the vague sense that they will be able to pay them off before they start again next year.

R is an attractive woman in her mid-forties. She sits on one end of the couch half- turning toward her husband, who sits at the other end, looking a bit forlorn.

R is already wearing her red reindeer sweater. The red shows up her newly refreshed blond hair, and it is complimented by her bright red nails. She has a tight black skirt over seasonal red and green tights, which are tucked into her shiny black boots. She is clearly well turned out and well maintained. She is doing a good, but probably expensive job of holding back time.

She and her heavy-set, rumpled husband are with me to work on some long-standing issues of trust and honesty. He is a builder, and a while ago he had collaborated a little too closely with one of his clients. But S. has had a few things to cover up of her own.

In the last session some things were alluded to, but not made clear. Now that they were brave enough to come back, they have already gone through some implying and some equivocating, and it was now time to get to reality.

Through her tears it was difficult, but not impossible to make out the number $32,000.

This was the amount charged on three credit cards that were kept secret from last year until now. Last year, when he sold two houses, a chunk of those proceeds went to paying off the cards that no longer exist. He thought the problem was over. The cards were destroyed. But, like many other addictions, this one just went underground until it exploded.

This was my fourth such revelation in the last two weeks. Not all were $32K, but, they were all excessive, relative to the income, and all were secret. They seem to surface around the shopping season, when the credit line needs to be extended.

This is a particularly American addiction. From why I read the Chinese may be catching it, but their banking system has not reached the point of mailing every person three credit card solicitations a week. It's like mailing a drunk a bottle of Jack every Friday. And now, if you miss a payment, the interest rates can get to 30%, which means you will never catch up.

Credit cards like this didn't exist thirty years ago. You had to bounce checks then, and that was much harder to continue.

But the problem is fed by so many streams: people who never had access to things want them badly. People who are unsure of themselves need to show the world their style. People who think they deserve it, (and they do) but they can see that they're not going to get it. People want their children to have what they never had.

Some people just love to shop -- I have seen many people who never even take the tags off, and have rebuilt their garage into a big closet, and are back in the stores.

But also, more than before, the celebrity lifestyle is so, well, celebrated. The brand-name this, the designer that,trucks,handbags, boots, jewelry, breasts, as well as the expensive martinis and the limos, all cost a lot of money. And the bill doesn't even have to show up. If you click a button it gets sent right to your email address -- no paper for anyone to find. It's all too easy.

Enjoy the holiday, but if you are hiding the tab, even from yourself, come clean before you realize you can't pay the heating bills that will come after New Years. Find out what's really missing in your life. Putting all that cashmere into the furnace doesn't generate a lot of warmth.

Sunday, December 10, 2006


The other Kramer, Dr. Peter Kramer, of "Listening to Prozac" fame, wrote a new book that is critical of Freud, although he stopped short of screaming racial slurs about him.

Critical of Freud? Stop the presses on that one. Now, a hundred years after Siggy started scribbling notes about what he thought was going on, Dr. Kramer, upon review, finds that he was mistaken.

I agree. Yes, Freud was, in some way a genius, but it turns out that he was much more of a marketing genius than a scientific genius.

The scientific geniuses, like say the big ones such as Newton, Copernicus,Darwin,and Einstein, all used scientific methods. They all proposed theories in a manner that could be tested and verified by experiments. Freud, by contrast, made stuff up, and said that things worked that way because that's what he thought. And he thought about it a lot, almost as much as he thought about sex. It was his thinking, and writing and talking and asking, and theorizing about sex, that made him popular. What he had to say about it was, as Dr, Kramer says, mostly wrong.

However, it didn't take a hundred years to figure that out.

What Dr. Kramer says, in this interview here in the paper, is that he misses Freud because no one thinks about grand theories of personality any more. Now, almost everything is neuro-biological. He says that we really don't have the concept of "mind" any more. He admits people seem to use theirs, especially during therapy, but he doesn't really know what it is.

Too bad he feels that way, but he is a psychiatrist, and they kind of get lost in the biology of it all, and forget that all those neurons, synapses, tissues, chemicals and electrical impulses connect in a very dynamic way that we, non-psychiatrists, experience as our minds. We also feel that this "mind" creates "thoughts" many of which we can direct and even express -- as I am doing here.

Therefore, psychotherapy is a process which helps you to use your "mind" to help regulate your "emotions" and your "behaviors" so that you can be "happy" and work and get along with people (which is how Freud described being mentally healthy -- and he was right about that).

The other Kramer was screaming racial slurs, and he should go into therapy so he can get better control of himself.

Friday, December 08, 2006

L and W

It seems that L, who I wrote about a couple of posts ago, and our President, George W Bush, have a similar view of reality. They are both stuck in a paradigm of persecution, they are furious at the enemy, and they don't see their own role in creating the situation. Both live with a very distorted view of reality.

The bigger problem is that while L is a pain in the ass to me and the local PD; because of GWB, people die. There are also other consequences.

I have seen four families directly affected by the war in Iraq. I have seen two soldiers, and the effects have been clearly devastating. They both came back from the sands of the Middle East scared and withdrawn. They have both been having a great deal of trouble with jobs and relationships.

I have also seen a family with a son who has been sent over twice. I have not seen the son. The family is tense all the time. They fight with each other in ways they never used to. For a while everyone was supportive. They sold lots of those stick-on ribbons that say "Support the Troops." Now, their friends just worry about them and their son. People seem to stay away.

Another family has a girl who had a high school sweetheart who had enlisted in his Senior year. The war started in the semester he was about to graduate. They got married before he left. They had not even gone out that long and they probably never would have married in other circumstances. But it was romantic and dramatic.

Last I heard he had done three tours. She forgot who he was. She went out with all of his friends and eventually divorced him. She felt terrible and was afraid it would kill him. She was with him about two months of the three years. Both their lives are completely sent off track. It will take a few years to re-group.

But GWB says he feels for these people,(but not much for the 100,000 who have died in Iraq).

It is unethical to diagnose from a distance, but the man is delusional, and unlike L, we and the world pay dearly for it.

Wednesday, December 06, 2006

Health care --ME

So now it's about me. It's about my health care and what a problem that is.
Why? Because I don't trust our system and I don't really trust doctors, although it's nothing personal.

Despite my best efforts I am getting older. Yes, I feel fine. I go to they gym, my arms are still well defined. Last summer my pitching (lobbing) was superb, and I had my best year at the plate of the last three years.

BUT, if you look at me, I look old(er). My cheeks are falling to where my face would be square if I didn't have the extra chin to make it round. My eyelids are sagging down. The hair I have is silver, but most of it is gone. Nowhere am I confused with Leonardo DiCaprio. Hasn't happened since before he was born.

And now this. I go to the doctor at the urging of some of my family because some of my male friends are reporting problems. I have my PSA taken again. I did it two and half years go and it was high. I had a biopsy then and I was clear. Now I'm back and my PSA is higher. So, after a retest the doctor says we should do another biopsy.

I sounds like a good idea but
1. It isn't fun to have to clean out the canal, have all kinds of machines go in, take pictures and take samples. (This won't hurt that much for too long?)

Also, I have an insurance policy with a big deductible. That means I have to pay everyone. The doctor, the lab, the technicians, the pathologist.

BUT, maybe I have cancer and they will catch it.

BUT, maybe this is a bad test and this is how he makes his money.
Maybe the test will poke too many holes and make me sick.

It bothers me, because I was feeling fine.
I can see how people who are really sick, or sick for a while, or who think they may be or will be, get depressed.

The idea of cancer kind of hangs there like the smell of strong cheese. And this is treatable. I have about four friends who have been zapped or had the gland plucked out. But I can feel some of my energy and joy fade away under this cloud.

The idea of sickness and death is not appealing, not fun, and I like fun.

But we are human, and we are mortal.

Monday, December 04, 2006


Technorati Profile

Me and Marvin

In today's paper was a short interview with Marvin Minsky about the new book he has just written. It deals with emotions and how they are important. People, he says, are not just rational beings, emotions, he says, are a different way to think.

Now, I have been a fan of Dr. Minsky's for a long time. He is one of the guys who is a leader in the Artificial Intelligence field and has been for years. And he is a pretty intelligent guy himself. But I feel (see that I feel) that this issues is kind of a straw-man thing. I mean, who really thinks people make rational decisions? Almost all decisions are made on an emotional basis. They are either made to help you feel better, or stop you from feeling worse.

A lot of decisions are just made out of habit -- but the habits have been established from rewards and punishment, which is emotional learning.

Any problem, even something as bland as 43 x 71 = ?

If you get it right you feel better. Then you begin to think you are good at math, next thing you know, you like math better and you are getting more problems right.
Learning works better when it's fun, and or meaningful. Anything you learn without any emotion will not be recalled as well. (3053)

Too much emotion -- like trauma, leaves an indelible mark, often irreversible.

That is why, in my therapy, I try to keep them laughing or crying. That way they can learn to change, and remember it.
i.e. "The doctor told me this cute joke about the guy who used to hit his wife, and he ended up getting his testicles fried. Now I think of that every time I get pissed-off, and I don't hit her any more."

See, that's progress.

It will be a really long time before machines "care" about anything. Until then they won't be like humans. I think Marvin would agree.

Friday, December 01, 2006

"They've been in here"

Let me tell you about L. I've known her for almost ten years. I have not seen her consistently, she has gone away and come back. Each times she comes back it is with a completely new set of difficulties.

L was referred to me by a local MD who she had been plaguing for years. She always had things going wrong medically. By the time I saw her she had colostomy surgery as well as bladder surgery. She also reported hearing problems, as well as lots of dental things and other physical rearrangements that I can't recall.

She began to see me regularly for a while. She began to trust me and to tell me the things that had happened to her, and around her during her life. To go into the details now would take not a small book, but a large one.

Part of what I want to say here is that this is true of everyone. Even you. Even me, and my life looks so structured, regular and ordinary. But lives go on over time and they get very complex, with many minor characters playing roles, and major characters repeating the same scene slightly differently, hoping for a different ending/

L had a very religious mother, who, under stress, would pray for hours. L was one of four daughters, so the stress was pretty constant as it sounds like each of the daughters went in her own direction with vengeance. L was a good student, but sensitive, withdrawn and anorexic.

She had a marriage, a child, a divorce, and struggled as a single parent. She met another man and they both drank a bit too much together, so her ex-husband took the kid. The other man would hit her when he drank. So they kept separating and reuniting each time he got sober. But then he died of complications of being a sloppy drunk.

She was alone and depressed for a while, that is when the medical problems, real and imagined began. By the time I got to see her she was in her late 30s and isolated. She had the kind of job she could do by herself, and she was seeing no one but doctors. They were the only people she trusted.

I became one of those people, and after a year of seeing me she began to feel a little better and function a little better, and stopped getting operations. Then I didn't see her for a while.

When she returned to the confines of my comfy office a few years later she told me about having gotten involved with another man, and that was good sometimes and not good sometimes, but she gave up on the relationship because he was still too involved with his own kids, and they seemed to have tons of problems of their own.

While she was seeing me, and this was about three years ago now, she met a guy whom she had known before, way back in her past. This guy she knew to be a charmer and maybe somehow involved in the local drug trade, but not working for Pfizer or Merck.

She fell kind of hard for this guy, and from what I could tell he took quick advantage of that. I never asked for the details but I got the sense that L, a woman from a very strict Catholic family, turned and twisted herself through many positions and acts that she had never done before.

Sometime about the third week of this romance the guy didn't show up when she expected him, and he has not reappeared since.

At first she was upset, then broken hearted, but then her thinking began to get worse. She began to sense that it was obvious to he world that she had done things she should not have done. She began to withdraw again, but also to look over her shoulder a bit.

I tried very hard to work with her on this, to keep her out in the world, to deal with her heartbreak and guilt. At first I felt like we had made progress. Her fears seem to diminish. There were a few strange comments about salesgirls watching her, or other people being rude to her, but she was back doing things.

And then she faded away from me again. I didn't see her for six months or so.

By the time she came back she had lost it. She told me that the people in her neighborhood were talking about her. They were watching her come and go. They were checking out what she wore.

Two months later they were coming into her apartment. She could tell because there were spots on her clothes, or stitches ripped, or scratches on her jewelery. Also, her laundry had spots on it. Her shoes were being switched with others that were a slightly different size. Someone poked a hole in her boot. The cheese in her refrigerator had turned greeen.

Why would anyone to do this to her? Because they didn't want her to have nice clothes or a good life.

She began to call the police. They came. They checked things out. They left.
She called them back, and again, and again. Now they are sick of her and she is angry at them.

They have called me, and I have spoken to them. They are afraid to not respond. They and I can't do much because she is not really a danger to herself or anyone else.

When I try to be rational with her she talks right over me. When I want to get her to someone who can give her medication she gets furious. "It's their problem, those nuts who keep breaking in here. It's not me. Why should I go on pills?"

Now she has let me know that there are cameras in her apartment. Not to watch for intruders, but for the intruders to see where she hides things. Has she found them? No. When I asked her how much it bothers her to have cameras in her apartment she kind of smiled. "If they want to watch me all the time, they can go right ahead." She later told me that now she makes sure her hair is always washed and brushed.

Everyone wants to be a star.

What I'm telling you is that this is not at all rational or reasonable and L seems to know that. But it takes up almost all of her life. It's like an addiction, an obsession. It's with her all the time. She wouldn't know what to do without it. She does nothing a rational person would do to stop it, or to find out who it is. She had her locks changed once, but that didn't stop them.

When I tell her it would take 100 people and a half a million dollars to make all this happen she seems pleased. She is sure that the police are covering the evidence, the apartment management is also, and all her neighbors have been told to keep quiet. But she doesn't care. She is going to do whatever she wants. They can't stop her.

Sometimes I get three voice mail messages a day from her, listing what has been stained, snipped or stretched. I call her back twice a week and see her once a week. She rages on about how these nuts are trying to limit her life and not let her have nice things. She will go on as long as I listen. Then I tell her to calm down and take it easy for the rest of the evening. She says "thank you" very politely, and hangs up.

I don't know how it will end, or if it will. I had one case that was worse than this. For a while I saw a woman who clearly had been very attractive at one time, but when I saw her she was worse than L in her paranoia. She even thought the birds were spreading messages about her. Only once did she let it out that all this began when she was young and beautiful and had a long affair with a priest.

The irony of course is that L always said that the way everyone knew about her is from some website that was writing all about her.

Now who is to blame for that?

Thursday, November 30, 2006

missed lunch

I missed lunch today at the Four Seasons in NYC. Edgar Bronfman ws there, Nelson Peltz, Henry Kissinger, James Watson and a few others who can take the time away from their desks to rub elbows.

But it's Thursday and on Thursdays I see about ten hours of clients. I learned a few things, caught up on the adventures of what happened two weeks ago, since last Thursday was a holiday. I got to see that some people are really doing better. That helps the day go faster.

Here are a few highlights.

S has a job offer, didn't get drunk at all, and is letting the latest wrong man slip away by not returning his crazy phone messages.

Remember the couple I wrote about on 11/19 with the woman who panicked when she found the photos of her son. Well, the boy admitted he took them, and showed her how he did it. So, good; the father isn't a pedophile. But when she accused him he broke down and said that he had been on the computer, and that he is probably gay.

R was able to get her children to tell their father that they didn't want to go to Thanksgiving with the new woman in his life (they have been separated five months). How could she have ever loved and trusted such a scumbag. She cries.

The smack that went around this city over the weekend was bad. There were twenty-six overdoses and three deaths. D was cooking supper for her boyfriend and another couple when the boyfriend went to the bathroom. Five minutes later he didn't answer the knock. She popped the lock and found him blue on the floor. If she wasn't a nurse he would have been dead. He is still in the hospital. She thought he had been clean for over a year. How do you trust a junkie?

The same:
L called twice to say that there are stains on her coat and another hat is ruined because two of the stitches in the crown seem to have been cut. Why would someone break into her house just to do that. And where did they get a key, even after she had the locks changed?

Maybe tomorrow I will have tome for luch with Sandy Weill and Lou Dobbs.

Tuesday, November 28, 2006

It ain't all roses

This may come as a surprise to many of you out there, but in this job I do here in this cozy meeting room, I have to deal with some pretty weird people. I know, you thought that a job like this would be a good place to influence the powerful and mighty as they come in for their weekly or monthly chat, but that isn't always the case.

Oh, I have seen a few people whose names might perk your ears up, but without mentioning any names, they were drunks. I have seen some lesser lights and local stars, and some of them were pretty interesting, although many were tortured souls.

But, in the course of a day, I spend an hour with one or two folks who are just nuts. They have weird thoughts, they come to nutty conclusions, they don't make a lot of sense, and they tend to ramble on with great intensity, but no real point.

I have to dig deep into my clinical bag of tricks to devise the most effective response.

I often give a long, thoughtful look of deep reflection and then say "That's just crazy shit."

It's not usually too effective, but I feel it necessary to attempt to introduce some reality before the deluge of delusion.

Many of the other people I see are certainly not crazy, but they do seem to like to do weird stuff. but again, after years of clincal experience, nothing seems too weird any more, so what's the big deal.

As long as no one gets hurt -- including me.

I also see several people from very well-to-do families. But they are the losers of the family. Every family has one, some have several. Not all families can afford too many, but some can support two or three generations. Success does not always breed success.

So, here's hoping you are enjoying the holiday season, and for some of you, may the apple roll away from the tree.

Sunday, November 26, 2006

Non conforming, but not

There was the editorial in The Times today by Alan Ehrenhalt about conformity and non-conformity over the last 50 years here in America.

I lived through all that. I never conformed, but you'd never know that just by seeing my life. The sixties hit me about four years before everyone else. I was wandering The Village before I could drive, looking for what was cool, and what was going to change the world. Even then I knew it needed to be changed.

I was two blocks away from Dylan before anyone knew him. I probably passed him on the street. Maybe it would have been something. But since I didn't know what I was looking for I didn't see him. I went to college instead.

I was a writer in college, a maverick, iconoclast. I said sarcastic things that were clever. I was against things that needed to be opposed. But when I saw the line, the other side of which you got your head smashed hard with a billy club, I passed.

Last week, in The Times Book Review they highlighted those who crossed the line early and often. Hunter Thompston, Charles Bukowski, Allen Ginsberg, Courtney Love, and
Al Goldstein were up there, among others. They lived hard. They drank, they wrote, they screamed, they pissed their pants. They often died young.

Bipolar is what they would call them today, if they were unlucky enough to get near a psychiatrist.

I didn't do that. I went to graduate school. I raised my kids.

I sent around nasty notes. I campaigned hard for losing causes. I still tried to offend people when I could, while still keeping the marriage together. I played a lot of basketball without dunking.

Maybe that's why I enjoy so many clients who take it to the edge. I like to help them lean over without falling into the abyss, or maybe I catch them on the way down. I think they know that I feel some hint of admiration for their exaggerated, futile attempts.

The skill it takes to try something real and fail is greater than what it takes to follow the yellow brick road to success.

Friday, November 24, 2006

Papa at Thanksgiving

Almost everyone came for Thanksgiving. The one who didn't make it wasn't really expected, but it was good that we offered. We know how much she struggles and we realize that she has to hold it together any way she can. For the rest of us, the importance was just in being there. We sat together, ate together, and were together at the time when families should be together.

In complicated, extended ways, everyone here was family. All of us are tied together by my daughter and son-in-law. In many ways we are the modern American family which has gone through a process of mitosis and has regenerated laterally as well as vertically. One of those present was there with his four parent, and they even brought a couple of parents of their own. It made for an interesting inter-generational interweaving of bloodlines and fault-lines. The fault-lines have long been sealed over, but the tremors have not been completely forgotten. Still, everyone was warm and friendly, and everyone wanted to be there.

After everyone left, the dishes were put away, the chairs were folded and the leftovers stored, my wife and I took a breath. My wife asked me four times if things went well, and then four times what I thought of it all. Then I went upstairs to listen to the rain.

I read about the neurological arousal systems in mammals, mostly rats.

I read how "an individual's cell firing properties can also change continuously as a result of the state of the sensory periphery, the animal's past perceptual experiences, its internal brain dynamics, whether it is actively or passively sampling its environment, and the animal's expectations for the future.*

The article went on to say that we humans do that to. I was doing that all during Thanksgiving. I was sitting there, sometimes actively, sometimes passively, trying to figure out how I fit into the world and how I should react to it. At the moment my survival did not seem to be at stake. There was no cat chasing me. I was certainly not facing starvation, I did not sense any dangers lurking in the dark as the terrorists and suicide bombers are far away.

I, probably more than anyone at the table was conscious of how much I am plagued by thinking about what I am thinking about (or is it a choice?). I think about my place in the family, and the family's place in the world, and the power structure of the world and its history and its future, and how much of a part we all play in it.

For further clarification and insight I moved next to my ninety-three year-old father-in-law who has had more past perceptual experiences than all of us. I wondered what thoughts were going through his head after having amassed the wisdom of all of those years. His reply, paraphrased, was that he was wondering how much he could eat and when he could go home and rest.

There is an unquestionable basic evolutionary truth in that.

Of course, there is the next question which is: Beyond survival, what?

From watching TV today the answer is apparent -- Shopping.

Wednesday, November 22, 2006


I am off now for the long holiday weekend.
I have seen 24 hours of people in two and half days. I could have seen 100 if I had the time and could keep my head on straight.

Families are such wonderful things. All of December will be packed because of the "holiday season."

Here are some of the things I got to talk about as Thanksgiving approached:

The first Thanksgiving without Mom.

The first Thanksgiving after the divorce

The last one of the marriage, since we are separating after the holidays.

Who do I invite to Thanksgiving since last year one of my sisters seduced my other sister's husband?

I am going to my in-laws, but I'm nervous because my mother-in-law told my husband that for his birthday last month she wanted to pay for a divorce. She always acts nice around me.

I am not going to say anything this year. I am just going to sit and watch my aunts and uncles get angrier and angrier as they rehash the same arguments they have been having for twenty years. I will wait to see who throws the cranberry sauce first.

I am going to stay sober. You'd better or you will end up out on your ass.

I convinced the judge to give me my daughter for the holiday becasue I know my wife and hr boyfriend will be having cocaine instead of turkey.

My recently "born again" mother won't let me in the house because I'm living with my boyfriend. The fact that she had me two years before she was married doesn't seem to matter now.

I'm not letting my kids go with my not yet ex-husband if he has his girlfriend over there.

I have to stay home for the day, otherwise "they" will break into my house and cut the stitching out of the tops of my new hats.

And, of course three people who have no place to go and no one to be with. I know that two of them will get drunk.

I hope things are better where you are. Fourteen people will be squeezing into the little box I live in. I think I know most of them. I hope they feel welcome.

Sunday, November 19, 2006


When I was younger, over twenty years ago now, my office was in a different building with many other kinds of professional offices. As I would come and go I would often notice a woman who was considerably younger than I was even then. I would notice her because she was, well, noticeable. She was the kind of woman who had an abundance of physical attributes as well as a warm and friendly smile, and she carried herself well.

As it happened she worked in an office of a friend of mine and she would answer the phone and we would chat and then we would say hello more often as we passed along the way.

After a couple of years I moved out of that building, and, as is often the case with older men and beautiful young women who turn our heads, I forgot about her completely.

About five years after that she called me, and asked to see me professionally. This of course, ruined all of my forgotten fantasies because once someone is in the "client" category all that training comes into play and there are all sorts of boundaries and taboos that click into my brain.

This woman was having some conflict in her life. She was recently married and she had realized that some of her husband's habits that she had expected to be left with his bachelorhood were still present. The one that bothered her was his too frequent attention to pornography. (Why someone who had this woman for a wife needed pictures was a question that may or may not be clinically relevant.

At that time, over ten years ago, it had to do with magazines and the telephone. He came with her for some sessions and things seemed to be gotten under control. He was pretty open. He had some issues from his passed that he recognized. He had a history of some slightly unusual interests, but certainly nothing I had not heard of from other clients, and he was motivated to keep his wife happy.


All went well for another six or seven years. Then came the Internet and of course the access was too easy. Pictures, moves, some chat-rooms, some dirty-talk, stuff that goes on quite a bit through the use of our amazing technology.

What made things bit worse was that they now had some young children and his doing this in the house kind of freaked her out.

Yes, they were having some difficulties as a couple, the kids had limited their intimate moments, but when doesn't this happen, and money was more of a problem, and he said he just found a way to escape. He assured her that he had never met any real people, and didn't intend to.

Before they had come back to me they had been through several rounds of his promising to stop, but the lure of naked ladies two clicks away was too easy. But now that the kids were beginning to use the computer she couldn't tolerate it.

After being off-line for a couple of months, and being in therapy again they seemed to begin to build trust. He seemed to be under control, and they went away again.

Two years passed until yesterday. I received a phone call from the woman who is screaming and crying. She is going to kill him, throw him in jail, never see him again, get a restraining order. She had found pictures in their digital camera of what appeared to be their eleven year-old son. She was pretty sure it was his naked torso, his back, and then a blurry picture of his behind.

She immediately thinks that her husband has gone way over the line. That the sex stuff has driven him crazy and that she never should have trusted him or believed any of his attempts to make her comfortable. She is furious at herslef for leaving her kids in danger.

This is serious stuff.

Right away I'm thinking that I'm a mandated reporter, I have to tell about child abuse. I have to make sure that the kids are safe. I have to make sure that she is safe.

I ask her if she has talked to her husband or the children and she said no. Her husband is at his office -- he is now a lawyer. The kids are playing with their cousins. She picked up the camera to use it herself and saw the pictures in the memory.

I realize that if we call the cops this man's career could be over no matter what the truth is. So I told her to call him. Tell him to stay away from the house until she calms down and has more information.

I am going over the man in my brain. Did I believe him? Do I trust my clients too much in order to help them feel that someone understands? How could I have missed this? What clues were there? What did I really think? I also wonder why he would have left them in the camera.

She calls him, tells him to stay away. He, of course denies everything, but they all do.

She talks to the kids. Her son looks scared, her daughter clearly really doesn't know anything. She calls her sister. She calls her mother. They attempt to clam her down.

Her husband calls back crying, telling her to try and find the truth. She doesn't know if she can ever trust him again.

Two hours later. When she s going over the pictures, her son seems to be hanging around nervously. He tells her that he took the pictures of himself. He shows her how he did it, and that he didn't know how to erase them. She can see from the angle of the shots that they certainly look like they were done by a 12 year-old, who was holding the camera on himself and thought that a picture of his ass would be funny.

But, what does she do about her trust of her husband? Is there any way she can feel close and relaxed and trusting, or is it all too smashed to pieces?

I think now, pretty clearly, that it was the kid. That answer makes a lot of sense. It also makes everyone feel good, and that can be dangerous.

The consequences of being wrong, either way, are terrible.

Wednesday, November 15, 2006


We, as humans, certainly don't have it worked out yet.

Continuing on this theme of trying to figure out how much we have control over our own lives, one thing that has to be considered is how our hormonal drives make us crazy.

My speculative conclusion, based on repeated anecdotal evidence from my own practice,as well as from observing the people in the rest of my life, is that I see too many examples of the excesses of an evolutionary adaptive behavior.

One of, if not the most basic function we have driving us is to reproduce and to attempt to populate the world with our own progeny. Therefore it is important for the males to attempt to maximize the chances of their babies survival, even at the cost of other men's babies. Perhaps that explains much of the crazy primitive behaviors that seem so irrational and so out of control.

So many men go wild with jealousy once they have become sexually involved with a woman. They become controlling, restrictive, dominating,intimidating, paranoid and often violent. And too often, for too long a time, the women will come to me and say something like "Yes, he broke my jaw, but I still love him."

What the hell does that mean?

The men too, if they come to talk to me at all, will say, "I really didn't mean to hit her, but she wasn't listening." Which means she wasn't obeying his wishes that she give up everything in her life and tend to his needs and insecurities.

This is not just a lower class thing, it happens so often, and to so many couples, especially during those fertile years. Uber-Alpha males protecting their territory, and women being attracted to the scent of the Alpha.

Then, more often than not, when the marriage does end. The men become terrible parents, if they bother to stay around at all. Many of them, not the majority but many, just disappear and go on and get other women pregnant.

I guess the hormonal drive is directed at quantity rather than quality.

It certainly makes for another generation of business for me.

Saturday, November 11, 2006

Gift of Today

Today, up here in the amazing Northeast, was one of those gift days
that you can't expect but you have to take hold of when they appear.
Maybe it's just one of the results of global warming and it is a
harbinger of the end of civilization as we know it, but for today it
was warm and comforting.

We may not get a day this warm until
next April. But it was better than that because the sky had that extra
clarity that only comes with the tilt of the earth that brings autumn
to New England. I wandered down passed the newMcMansion they are
building that is reaching higher than it's neighbors to catch a view of
the water. It is a house that does not belong, should not be built, and
holds no real value except to curse whoever lives there with a life of
tacky egoism.

But once passed that blemish I was on the path of
the scrub-pines that led to the dunes. Up over the little rise and the
water burst visible. The dune-grass is a bright green and yellow, the
sky was perfect and the sea was almost flat. The waves came in
mesmerizing and methodically every nine seconds. They broke from each
end sending an arrow of shooting white curl to a roiling mid-point. The
white gulls sat on the hard packed brown sand where the water hadreceded
and waited for tide to bring in their next meal. One two-masted sloop
boobed halfway to the horizon with two bleached white sails. The sound
of the breaking waves rippled over the smooth stones.

All I could do was watch and nod and smile. It was clear that the earth will
survive all of us and everything we do to it. There will be other
creatures that will thrive on the pollution we leave behind.

Since I am not in Mumbai,Lagos, Darfur or Baghdad I could lull myself into allowing the feeling that allis right with the world. My wife, at this moment is happy, my children are healthy, beautiful and now self-sufficient.

I can survey the
length of the beach and can see no terrorists. That round woman with
the big black dog is kind of frightening, but I am not scared. For a
moment in time, at this spot, the world is good

Friday, November 10, 2006


It's right there on page 98 of "Freedom Evolves" by D. Dennet. He tries, and actually does a pretty good job, of explaining that we, as humans, have free will, but yet, also, our choices are determined by who we are, biologically, and by what we have experienced. The only alternative to that is completely random behavior, and that really isn't possible.

If you are going to be a psychotherapist, or if you are going to be in therapy, then you have to believe this. A large part of the job of being a therapist is to figure out why people are doing what they are doing, even when they say, as my clients did last Thursday, that they didn't mean to behave that way.

Take any confident, healthy 40 to 55 year-old man who has been married for a long time, dangle in front of him an attractive, eager, willing, smitten woman, and he is going to have trouble saying no (right, Bill?). It's partly biological.

But what about free will? Is the poor guy responsible for his behavior?

Of course he is. That's because we, as humans, have the capacity for thought and reflection. We can think about what we are doing AND, what we are going to do. Thinking is an experience. It adds to the long time of other experiences you have had that influence your behavior.

Therapy, to a large degree, is thinking. You think about how you feel and what makes you feel that way. You learn, hopefully, to think more before you act. You learn to make connections between actions and feelings. You learn to anticipate -- which is really what intelligence is all about. So, if you come to therapy you get smarter.

That is why our lives are determined by everything we are and everything that has happened to us, BUT it is still compatible with our having free will, and the responsibility for our actions and decisions.

If you want your life to improve, think about what you are doing. It's that simple.

But, of course, that isn't simple a all.

Tuesday, November 07, 2006

The Answer

Did you vote?

How did you decide? Was it determined by what you knew, what you thought, what happened in Iraq or who your parents were?

In some ways it we all of those. All the experiences of your life, interacting with all of your unique biological physiology, for all the years you have been alive, created that moment in time. Your decision.

Yet, you decided. It was your own decision. Or at least it felt like that.

If I get to know you better, which of course I hope I do, then it probably wouldn't be difficult for me to predict how you voted. Once I know how old you are, where you live, what you do to support yourself and how much money you have, I could take a pretty good guess. These factors matter. That's why some of you received many phone calls and some of you didn't.

If you have read much of this blog, you can certainly make a good guess about me.

So, we are not unique, we are programmed. Our behaviors are set.

Yet, as a therapist I have to believe that people can change. And I do believe that part of the process of therapy is to help people take control of their lives. But how can they do that if everything is lined-up in advance. There is so much that has already gone into you that you can't just turn it all around.

Even if you rebel against that statement, it's because you are the kind of person who tends to do that.

But you can.

Next time I will begin to tell you how.

Right now I will leave you with one word. This is a word I got from Daniel Dennet, who is still one of my favorite neuro-philosophers (although he kind of got too wound-up about religion).

The word is "compatiblist."

Sunday, November 05, 2006


So, I was thinking, why should I just jump up and explain all of human
behavior to the six of you out there reading all of this. Instead, I
will make it a big morechallenging and interesting. I will give you the answer, but you will have to choose the right one, or ones, from the following choices:

1. Their brains made them do it.

2. They are lazy, impulsive and immature

They have no real control of their behavior because they are really
part of a virtual reality that is controlled by computer chips placed
in the back of their necks.

4. Bipolar

5. Even though their behavior is determined by their genetics and their experience,
they can make choices and have responsibility for their actions.

6. Tom Brady

7. You can have free will if you want it; but if bad things happen it's because of circumstance, emotional difficulties, and abuse. Then
it is time to declare that you are an alcoholic and go into rehab.

8. Parts of some of the above.

Friday, November 03, 2006


Yesterday, Thursday, was a busy day for me.. Many people came to visit me in my office and tell me stuff.

One person told me that knew they should stop drinking. So, I said, "Good idea, stop drinking. Ten beers and two shots of Jack every night for thrity-six years is probably not making you fun to be around, and it isn't good for your future health."

A woman told me she thought she should get out of her marriage. The man she loves constantly scrams at her, gets in her face, breaks her dishes, swears at her, threatens her and even brandished a knife. After a lengthy discussion I explained to her how to call the cops and what to expect.

Later, a couple sat before me; the woman was outaged, the man was tearful and full of remorse. "I didn't mean to do it," he said It just happened."

"It just happened!?!" she screamed back at him. "You just happened to be naked on top of a naked woman sticking yourself inside of her? That just happened? You didn't mean it? "

We, all of us, are people. People are supposed to be the most rational of creatures, and maybe we are. But if we are it doesn't seem to be something we take advantage of much of the time.

If we have free will, and we can do what we want, why doens't that first client just stop drinking? When will the second one decide it's time to leave? Why didn't that loving husband realize the consequences of his actions, and act accordingly?

Or, do we really have more in common with ants and homing pidgins and just roll out the behaviors that have been designed by our genetic material?

Where did I get the blogger gene?

I will answer all of these questions soon, meantime, talk among yourselves.

Sunday, October 29, 2006


Related to my last two posts is a much more fundamental question, which is the subject of today's homily.

When you reach my age, and have dealt with as many people as I have, you get
to know how he world is run and it becomes apparent that it will
continue to be run that way. This is a bit discouraging because many
people whom I consider good, caring and hard working, as well as
myself, have put in a long and valiant effort to make thingsdifferent.

In some areas we have made significant progress, such as in race
relations, and woman's equality. But even with those things are not
solid and still not really equal. There has been amazing progress in
technology, and it has helped to find ways to combat diseases and keep
people healthy. However, none of these new benefits are evenly
distributed, and access is not given to all who need it. Not even close.

What I have come to consider as wisdom is the realization that I know that I believe in some things very strongly and with a good deal of certainty.
Yet, I know there are many good, hard-working people who think these
beliefs are wrong, nuts, and even evil. There are major differences in
this country thatopened up when I was in college and the divisions have
become wider and more hostile since then. One of the results of these
differences is our terrible health caresystem.

This is the basis of the difference. When I was forming my value system, based on
who I was and what I had learned, I decided to devote a good deal of my
efforts to a process that would help establish a better society for
everyone in my country, and hopefully, by outreach and example, to the
whole world. What I meant by a better society was one that would
diminish, if not eliminate, hunger, poverty, homelessness andillness, and also offer everyone, and I really mean everyone, an equal opportunity to seek their own happiness and prosperity.

I knew this was somewhat idealistic, and that it would be difficult, but it was a goal that I deeply internalized and has been a part of me since then. It has led me
into the profession I'm in, and has guided me in making decisions about
where and how I work, and how I raised my family. Some of the
philosophical underpinnings include one of the thoughts of John Dewey,
and perhaps, in my more radical moments, some of the thoughts of people
such as Isiah Berlin and Noam Chomsky.

I soon realized that there are many people in America who feel that such goals are somewhat subversive. They feel that the real beauty and strength of America is
that it offers everyone a chance to seek his fortune and make their own
lives as prosperous and lavish as possible. These people lean toward a
philosophy of social Darwinism, and the writings of William Buckley and
Ayn Rand. However, this has been has been altered by the recent wave of

This second philosophic view has been partly
responsible for the growth, power, entrepreneurial spirit and
creativity in this country. It has helped make some the the richest and
most powerful people and corporations in the history of the world, from
J.P. Morgan to Bill Gates, from Standard Oil to Microsoft. It is the
reason people still cross our borders in droves, both legally and
illegally, from all over the world to seek their fortune. More than any
other place in the world this country offers a great opportunity for
anyone to get rich.

That's true but ... that ideal has been corrupted.

The opportunities are not close to being equal. The power structure is
built, the dice are loaded, the die is cast, the laws are written so
that those with money get to make a lot more money. That, really is
what capitalism is,and we are living in a time of extreme capitalism.
The money, and the power that further enriches those who have comes
from those who don't, the poor and the vanishing middle class.

In any society where there are some people living lavishly there will be
many poor people struggling to keep-up. When you have conditions, like
we have now, when the money from the same people and corporations
controls both business and government, then those few people get to
stack the deck and make the rules. Then they make rules that keep
things rolling their way.

A good example of this is our health care system.The system is designed to by corporations, for corporations. There are insurance companies,pharmaceutical companies, HMOs, hospital corporations, labs, doctors, and other players all trying to make a profit. In addition there are the auxiliary players, such as marketers, sales people, account managers, caremanagers, billing services,and collection agencies. There are also manypeople working within companies who have to arrange and manage health benefits. All of this takes money away from what could go to actually
pay to keep the citizens of this country healthy.

A big change would be very helpful. But for change to occur many people have to pay
attention and put pressure on those in charge, or change those in
charge, so that when a choice is being made between profits for a few or
better health for many, we make the right choice.

Saturday, October 28, 2006


I am working on a new positing. I am trying to make it comprehensible -- I am like that, old fashioned. I think that my writing ought to make some sense, even if the ideas are ridiculous. But what happens? Life interferes.

Like what?

Like D deciding that the only way to pay off the mortgage is to kill himself, so we have to get him in a hospital, which he hates, so then the doctors call and I have to get him out. Or, L, whose father raped her, and yesterday he died, so that sets her off; and P, who now decides she will runs the games, and tells her manipulative boyfriend that she needs him, and then doens't show up, and won't answer her phone. There is always L, who calls to tell me that THEY have broken inot her house again and spilled chocolate pudding in her refrigerator.

But that's nothing compared to my own famiy. My sister-in-law in in her third marriage and this now guy is drunk and breaking her things. I guess she still doesn't made "good choices." My nephew is depressed and lies in bed all day. My sister calls, becasue I am The Therapist. "What should I do?" she asks, ten years too late. And my wife can't decide on how to re-do the livingroom. That certainly takes up time.

Who has time for blogging. People who sit home and put their kids to bed. My kid is moving here from the other coast this week. We need to give her some attention -- not that she wants it. But hey, that's life.

At least we get an extra hour tonight. That means tomorrow I may be able to write out, in some almost comprehensible form, what it is I want to say.

Until then. Live life to the fullest!

Tuesday, October 24, 2006

About the money

Now that UBH is buying Pacificare, the mental health of many more millions of people will be overseen by a huge national company that pays therapists at a terrible rate. As I mentioned below, this organization is not known for it's ethics or it's patient care. But, that's true of the entire American Medical Complex. The real fuction of the the American medical system, if you do an analysis of how it is designed, is to generate profits for corporations. The goal of providing the best care to the most people is far down the list, if it is on it at all.

That leaves me, as a clinician, with a choice. If I play within the system I get to treat many people who need treatment, people who have worked hard to get health insurance, or those who can't work and are given insurance by a government. If I do that, I have to conform to many rules and get slightly exploited, because I really don't get paid what my services are worth. Or, I can opt out of the system, not take insurance payments, charge what I wnnt, be beholden only to my clients, and offer complete confidentiality, BUT only see people who can afford to pay for themselves. This limits the population greatly, and makes me wonder if those are the only people I want to serve.

I could compromise and try to do both, but, in reality I would ave to set up two offfices because there are not enough people in this mill city who could really afford on-going, self-pay therapy. I would have to use two marketing strategies, two networks, two appraoches. It gets complicated.

It is a choice I shouldn't have to make, but our profession never really got it together to make a strong enough case for us as a necessary and valuable service. We are smart, but disorganzied. We are caring, but generally not aggressive. We are a tiny voice in the medical system, and we really aren't that medical.

So, we are stuck, and each of us has to decide.

Sunday, October 22, 2006

All A Board

Last night I drove out of the small city in which I work. I hit the highway ramp and headed south to the larger, more prosperous and fashionable city that is the hub of our area. I was going to attended a fund-raiser for a worthy cause. I am at the age, and almost of the status, when it is proper for one to do such things.
Two-thirds of the people who were in attendance were even older than I am. Seventy-five per-cent were wealthier, many much more so. Most of them are the retired, caring-wealthy. You could tell who was whom, as the retired rich came in ther fancy play clothes, some in black-tie, others bedecked in subtle, but clearly expensive jewels. This is not a showy city. Showy is bad form here. It is one of the few place left in this country where old money is more influential than new. Those of us who came from work on this weeknight, looked wearier, and a bit rumpled.
Wine was poured, good cheese and tiny lamb chops were passed. The board members of this worthy organization wore little badges. They air-kissed everyone. I was happy to see those I know. We were all doing a good thing and we were being feed, feted and entertained in return.
I began to think how several of these caring-wealthy had worked hard for most of their lives, and how for others, the money was always just there. But now, as they all aged, they wanted to make sure that they were known for doing good works and for "giving back." There were here because they wanted to help the less fortunate of one kind or another. The fund-raisers this season are for those stricken with varios illnesses, the poor, the war-torn, the war-weary, the persecuted, the prosecuted, those discriminated against, the lonely and the lost.
The people at the fund-raiser wanted to help turn the tide, right the wrong and relieve the misery-- perhaps some of which they may have (inadvertently) caused.
I realized, that what they were striving for was what I do. I work with the lonely and lost, the sick and confused. Often many of my clients are poor and downtrodden, economically and soically disadvantaged. I also realized that the reimbursement I get for doing this work has been diminishing for years. For while the head of a so-called health care organization is being indicted for swindling tens of millions of dollars by rigging stock options, the amount that his organization pays psychologists has not changed for fifteen years. And that organization, much like the one run by the family of our current Senate Majority Leader, is busy buying other health care organizations and lowering the fees they pay to those who provide care.
Therefore doing this work, at least doing it in the way that benefits those who need it most, and those who go to work so that the burden on their health care costs can be shared, is a losing proposition.
It was then that I realized that I needed a Board of Directors for my practice. I need a group of caring-wealthy who will dress up and come to my party, and also raise a lot of money.
I will take the money and continue to do good work. I will help the sick and confused, the lost and the lonely, and even the soft and the spoiled if the Board so directs me. I will allow them to feel that their efforts, and their cash, is going to a good cause, and that together we can improve the world!
Any volunteers?


Friday, October 13, 2006


Cell phones have been a great technoligical advance. People now stay connected all the time. They walk around looking like mental patients of old; passiontely expressing themselves out into thin air.

But, if you are in a crazy, emeshed, jealous and/or possessive relationship then cell phone can enhance you world exponentially. It once was that lovers had to sit by the phone hoping it would ring. Or, when they called and no one was home they would either have to wait longingly, or drive around and search suspected hideaways. But now they know their lover has his/her phone with them all the time. If the call goes to voicemail something is wrong. They can keep calling or take the next step and start the text-message barrage. Some people would rather text-message anyway, just to be able to make a point without beign interruped.

Quick messages such as: "I love you, I miss you." are always meaningful
I need you now"

or the more inquiring: "Where are you?"
followed by "Are you with her?"

"I can't answer the phone becasue I'm having sex." is a good response.
(there are many variations of this that I don't need to post here, but you can imagine)

A good one is the always entertaining: "I have a gun to my head, if you don't answer the phone I will pull the trigger."
with variations like
" While waiting for your call I've just taken my sixteeth Xanex."

Picture phones can add to the intensity. You can be asked to prove wher you are, as in, "You told me you were at your brother's, show me your brother." or, the more pointed: "You didn't your sister would do me, well here she is, naked in my bed." that often leads to the end of a relatonship --- or murder.

You see, texting can be fun. But the of the new technologies are caller ID and The call log.
Many clandestine connections have been exposed by the foolish act of leaving one's cell-pone unguarded while going to the bathroom.

The evidence is there, you did call her, or she called you, twenty times in two days.

How many times can someone say "I only called her back to tell her to stop calling me," and still be believed. Really, one is too many.

So, take advantage of all the new technologies. They can certainly escalate the torment and torture of the kind of deeply twisted realtionship that so many people seem to crave. Soon, we will be able to have our own video feeds shining on us every moment.

We can all be the stars of our own soap operas. Constant, total, personal Reality TV at it's finest. The ultimate goal of so many Americans.

Wednesday, October 11, 2006

not so helpless anymore

L is a tall woman who is now almost sixty years old. She is still noticeably attractive, and still keeps her hair blonde and stylishly cut. She still receives the attention of men, even though she no longer wants it.
From the age of fifteen, when she first began sneaking out of the house to meet her first boyfriend, men and the hope of love, were the central theme of her life. Each man took over her life, and was possessive, directive and controlling.
She skipped college to get married. When she wanted to work there were terrible argurments, so she stayed home and had children. Eventually, she could no longer stand all the restrictions and the marriage fell apart.
It is not difficult to see what drove her husbands crazy. L still has a kind of helpless, little girl look that floats acros her face when she is upset. Men respnd to that by feeling caring and protective, but the protection comes at a price. The price, which took her forty years to learn, is that she remain dependent, docile, needy and giving. Each time she attempted to grow-up and become independent she ran into conflict. When she spoke about how often they just seemed to want her to play out their sexual fantasies she cried.

Now, she doesn't see the value in being part of a relationship. She finds her looks to almost be detrimental, as they still attract the wrong kind of man. She often shows up for her appointments with wearing sweatshirts, with her hair pulled up under a baseball cap. She has found a job that she can do mostly from home. She has a few women friends, who are almost all divorced, who she meets for coffee. Her ex-husbands either think she is crazy, or they still keep tabs on her because they still feel protective, and still want her back -- if she will give up her independence.
L won't do that now. She is struggling hard to finally define for herself who she is. It is not easy after all these years of being defined by other people. Sometimes she is lonely. Sometimes she is afraid that she really can't take care of herself. But mostly she cherishes her freedom. Finally.

Wednesday, October 04, 2006

mean times

Things get mean in America, especially around election time, and especially during the last six years. The spirit of competition, which is part of what has made this country the best place in the world for those who are ambitious and self-sufficient, has slipped over the line into a culture of very competitive greed. I see it in my practice every day.
The pressure is on to get rich and to avoid getting poor. People are realizing that there is little space in-between. If you slip behind, you will probably never catch up. The laws now allow 29% interest charges with all kinds of penalties. The mortgage business has lured many people into taking money out of their houses and now they have to pay it back at higher rates and they have less equity. If you are a minority or an"alien" it is much more difficult to get jobs, loans, or into good schools. The cost of college, even state colleges, is becoming ridiculously out of reach for most people who earn their money by working.
The stress this causes is good for my business, but it does not represent an increase in psychological problems as much as it is a cultural phenomenon. The pressure on those who do have jobs almost encourages them to lie or cheat. Competition in pharmaceticals, bio-tech, high-tech, and chemical, industries to beat the competition is huge. Even supermarket or big box competition is cut-throat. If you are going through a tough time, such as a divorce, a major illness in the family or something awful, like the death of a child, you may fall out of line and havea great deal trouble getting back in.
The effects this has on the high earners and the captialists are very different. They have worries and stresses, but they are very different. What they also have is control of the government, because the have money to use as influence. Therefore banks, brokerage houses, insurance companies and big industries set the agenda. Everyone else has to pay their charge card bills and mortgages. To do that a lot of people are spending their evenings saying "Welcome to Wal Mart."
Is change on the way? That is not clear. But who needs to worry about terrorists when you're about to lose your house, gangs are shooting you kid, or demented men are shotting girls in schools, anti-porn Congressmen are trying to get into kids' pants, or Bechtel makes tunnels that fall on people's heads. It is time to quote Pogo again:

"We have met the enemy, and he is US."

Sunday, October 01, 2006


This weekend we went with some friends to one of the better theater companies and saw a play called "The Pillowman." I hadn't read the reviews beforehand, so I didn't know what to expect. I saw the play and came home and looked up the reviews on-line. I learned that I had just seen a witty, Tony Award winning black comedy, with surpsing twists and startling insights.

What I thought I saw was a guresome three hours of torture, humiliation, child-abuse, child-murder, adult murder, more torture, ending with a man getting shot in he head on stage. It was a lot of laughs. Part of the message is that life is short and sad, but art endures. I wasn't buying it.

The day before I spent a professional hour with a man accused of exposing himself (he denies it). This man has been sexually abused by a family member and a priest. He is defensive, distrusting, distant and manipulative. I struggle to help him deal with his demons. I didn't find a lot of humor during that hour.

Most of the dramas I get taken to are about dysfunctional -- well, sick -- families. incestuous relationships, sociopathic brothers, controlling parents, serial killers. Either that or musical claptrap about overcoming your troubles with a song.

Life is tough, change doesn't come easily, and you still have to deal with all the crap, even after the dramatic moment is over.

But, what do I know, I only deal with bumers 32 hour a week.

Or, as Brian said,

as they nailed him to the cross:

"Always look on the bright side of Life..."


Friday, September 29, 2006

Psych. Meds 1

R, forty-one, is not too stable, prone to deep depressions, waves of anxiety and hours of scattered thinking. He is often unable to decide if he should brush his teeth or comb his hair, but he came into today's session wearing a more positive, hopeful expression. When The Therapist inquired about the origin of his postive mood, R explained that he realized that although he was still generally feeling pretty rotten, now he was beginning to see some signs that something may be changing. A while ago he began taking all of his medications, and doing so in the manner that they have been prescribed, instead of just taking a handful every once in a while. Since he has begun his new regiment he said that he now experiences moments when he feels he is improving. He sometimes reaches the point at whcih he often feels nothing at all. But, the most important thing, he concluded after considerable consideration, was that this was just the beginning.

"Well," responed The Therapist, "we have been working together for four months, and you do seem to have made some improvement. You leave your apartment now. You can shop and cook, and even go downstairs to visit you mother for short periods of time."

"Yes," responded R, but look at all my medications. I am just starting out. I take Atavan for my anxiety, Abilify for my thoughts, Ambien so I can sleep, Amytriptyline for my depression and Aderoll for my ADHD. I also have Allegra for my allergies and Alieve for the pains I get from taking all these pills.. Although these have helped me only slightly, I still have the rest of the alphabet to go."

(More on this will come soon)

Tuesday, September 26, 2006

Family History

There is a question on the standard in-take form that asks if there is any mental illness in the family. There was a time when I routinely asked that question, now I just check "yes," and try to find out who and where. I can't remember a family that didn't have it. That is not just the family of my clients, but also my friends, and of course, my relatives.

My own family has a few gems in it. My cousins are either doctors or they don't function. My mother was a bit depressed. Her father was a drunk ( think that was in DSM 1). My wife's family has a few ghosts walking around.

There are an amazing amount of people out there who can't cut it. They get depressed, withdrawn, agoraphbic, angry. lost, hopeless and just don't manage in the world. It takes a lot of effort and angst from a lot of people to keep them alive and unhappy.

Sometimes it seems like closing those big old state hospital, human warehouses wasn't the best idea.

When it was time to take old aunt Minnie off to the funny farm, just bundle her up and drop her off. The treatment may not have been the most efficient, and the costs to the state were considerable (No new taxes!), and the rights of the patients were not always considered, but it certainly made life at home a lot easier.


Monday, September 25, 2006

Mad, sad and bad

By definition, this is a strage business. The people who come to see me are not in the best of shape, mentally. They are not the happiest folks, and because of that, they are usually surrounded with chaos. Some of the chaos is the casue of their difficulties, some of it is the result of their difficulties. After a while, it becomes hard for them to be clear about which is the tail and which is the dog.
Just today I was talking to the man who works in the prison and has claustrophobia (has panic attacks once the doors close). He says that his job makes him feel ike he's in jail. Of course, he is. But he is good at his job. He is humane. He knows what he is doing. Prisoners get him a bit nervous. He thinks that many of them are bad people, and they are. I can't recommend medication for this guy or they won't let him carry a gun.
We talk about options. He can learn to calm down, or change jobs. He is having trouble doing either. We will work on the first option.

That was after I was talking to a sixty-two year old woman who has been afraid of men her entire life. She is charming and friendly, but has no use for anything more than that. Yesterday an admirer left a rose at her door. "Why me?" She asked. I'm flattered but it will only drive me away.
Maybe "just friends." Maybe.

Years ago, many years ago, I did research with a man named John Turner. It was so long ago his name won't appear if you Google him. But he had come up with three major factors of mental healh problems. He called them "mad," "sad" and "bad." it's still basically true. I have learned that they are not only basic, they all over-lap and interact.

And "mad" can be interpreted both way. And usually it is both, at the same time.

Friday, September 22, 2006


What is Your Therapist Thinking?

e sits there and stares at you, maybe he takes a few notes. He seems to be listening. He stares at you, looks away. Then he will mumble something that may be of great significance. It could be a life-changing intonation, such as a barely audible "huh," as he nods his head.

He may utter an amazingly perceptive comment like "You're still just pissed-off."

Or it could be a question that slices right through the soft tissues of your mind and reveals the diamond sparkle glow of the truth -- "Why the fuck would you do something like that?"

But what is really going on in the mind that resides behind those thick glasses that give him a kind of bug-eyed look? What is he really thinking about? What does he think about during those few moments in his life when he isn't thinking about you?

Stay tuned, you may find out.

Why Bother?
have to ask myself wh I am embarking on this venture. I am a slowly ageing psychologist, who is not all that technologically savvy. I could be spending this time learning hoe to play better golf, or taking up some productive hobby like scrimshaw or backgammon. But instead I am choosing to spew my mind's tomally into cyberspace.

I am a psychologist, a psychotherapist. Yesterday I did a brief caluclation and realized that I have spent almost, not quite but almost, 50,000 hours closed in a room intimately listening and talking to people. The hours are adding up. It's time to draw some conclusions.

But, after all this time I don't know all the answers. I know some answers. Thre are some thing I am pretty certain about, and I usually have pretty strong ideas about how and why people behave, think and feel. But sometimes I am not so sure, or my ideas have changed, my theories don't match the data, my predictions miss the mark.

So I am putting many of my thoughts into cyberspace. I have no idea who, if anyone will rad them. I hope to stimulate the thoughts of others, and hope that others will help clarify my thoughts.

I have seen and heard all kinds of things tht people do to themselves and others, almost all of thm in the hope of someone improving their lives, or making themselves feel better, or at least less worse. Nothing shocks me anymore, although I admit that I can still be surprised, Maybe awed is a better word.

Everything affects my thinking: what people say, how they act, sit, or squirm. I am also affected by money, politics, culture, my own relationships, and new research in psychology, psychiatry, neurology, physiology and evolutionary theory. I am also influenced by architechture, city planning, art, music, music, dance, film, drama and some, though few, novels. My moods are affected by most of the Boston sports teams, but I have learned to keep my expectations under control. I have a 34 - 12 record pitching softball for The Pub Team, but we haven't won the Big Game yet.

I am greatly influenced by my clients. I spend a great deal of time thinking about them and what I can do for them using the limited tools in my arsenal.

If you have any interest in psychology, psychotherapy, philosophy, or just in trying to decipher how or why people think, act, and feel the way they do I hope you take a few seconds to read what I post, and send a comment.