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?