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 They get depressed, withdrawn, agoraphbic, angry.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.