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..."