Thursday, April 26, 2007


Rome is old, like really old. The new parts are six hundred years old. The old parts are two thousand. That's kind of cool.

The momuments are all for the same things: the winners of the wars and the gods who helped them win. The losers get to be the slaves who build the monuments. Then the church took everything over and replaced the old gods with saints. I don't see too much difference.

There are few memorials to the losers, or to people who avoided wars and saved many lives. The Romans did a better job of anyone doing that. They had the Pax Romana that lasted a couple of hundred years. Then they began fighting among themselves. The new Italieans do that every couple of weeks.

The food makes it all worth it. Whatever the Romans and then the Italians did, they cooked well and now we have the vino and pasta to be thankful for.

Getting away is great. I hope everyone else is well.

Saturday, April 21, 2007

Taking off

Yes, there really is "mental illness," and sometimes the problem really is a chemical imbalance that completely distorts someone's thinking and makes them behave wildly irrational. Some people really do have brains that are off-kilter. Many of them respond, partially at least, to chemical treatments.

But that is not what concerns me today. Today I worry about how crazy, sick and off-base our culture is. The more I read about our current government, with it's war policy, energy, policy, science policy, law-enforcement attitudes, monetary policy, student loan scandals, on and on. The more I feel that the corruption is pervasive.

This is not new. This country, and probably every other country has had scandals, corruption, scoundrels, crooks, sleaze-bags and opportunists. Most people, given the chance, especially if they were sure they could get away with it, would take the money and run. I'm not saying I wouldn't.

But to design the whole government to not only keep your friends rich and in power, but to exploit those out of power, and keep them scared, seems to be a throw-back to five-hundred years ago.

It makes my job more difficult because my clients suffer, as they fight against forces that make their lives much more difficult, when this shouldn't be happening. Mortgage companies, insurance companies, credit card companies, for example, have gotten legislation passed that allows them to take people.s money and not give it back. 29% interest rates, New Orleans, healthcare, sub-prime loans, are some of the ways that people who just want to go to work and pay their bills are suffering.

We also are living in a hyper-capitalistic society. In order to keep all this money flowing into the right places the pressure is always on for people to spend and buy. I see some of my clients buying all kinds of ridiculous shit that they can't afford so that they can feel like they are part of America. $400 handbags, $700 cameras, $3000 HDTVs, quads, boats, Hummers,or Escalades. I have never seen so many women who have credit-card debt that they keep secret from their husbands, or men who buy expensive toys as soon as they get credit approval. It starts with the kids; so many eleven year-old girls feel pressured to buy brand-name clothes or they will not make it into the "in-crowd."

We have just seen what being on the "outs" will do. That poor, suffering, distorted creature wanted to go out and kill 'rich people." That isn't a random thought.

So, what am I going to do about it?

It's my wife's birthday. I am going to take a pile of American dollars, convert them into Euros and go to Italy. The next post you get from me will probably be from Rome, or perhaps there will be nothing for ten days as I just eat and drink and look at frescos and the lovely Sophias.

The only advice I leave with you is to save your money. Then you can come to Italy too.

Thursday, April 19, 2007

and another thing

Two things that bothered me today:

First, it bothers me when people lie to me. I know that when you get into a relationship you want a person who becomes important to you to think you are worthy so sometimes you shade the truth, but come on. I'm your therapist. If you have been drinking again, tell me, don't imply it or dance around it. If you lost your job because you told you boss to fuck-off, tell me what happened, don't try and spin it. These are the issues we are dealing with. Part of therapy is trying to deal with the world as it is. I won't get angry. I won't give-up on you, but I need to know what we are dealing with.

Second, and worse.
I begin to deal with a client or a couple. We begin to get to issues. It's the second, fourth or tenth session and they change or lose their job and lose their insurance. Or they were unemployed or the COBRA runs out, or they can't afford it. Or, worse, they become disabled, and since they paid for good disability insurance, they receive too much money to be eligible for Medicaid. They can buy insurance for 40% of their monthly gross income. So they are gone. The therapy ends while they are in crisis and need it the most.

I can only see a few people on a sliding scale. It shouldn't be left up to me to decide who gets treatment.

The American system of private health insurance still really sucks and is getting worse.

How many CEOS of major health care organizations, insurance companies, HMOs, large private hospitals, etc are making $1M to 22M? I don't begrudge them their salaries, but I think that everything over $350,00 should be taxed at 70%.

Tuesday, April 17, 2007

Dx 2

We had a good lively discussion about diagnoses. That was fun. I think I should make it clearer that I do believe there is mental illness. People ares still doing lots of work to determine what schizophrenia is, and there are always new theories, but it isn't clear. What is interesting is that there doesn't seem to be as many as there were before. I think many people who once had that dx are now seen as bipolar.

A real clinical endogenous depression seems to be one of the worst things anyone can endure. The treatments range wildly from therapy to pharmacology to shock treatments to brain surgery, and combinations of all of those. It is often very resistant to any treatment. Often people with depression are helped by medication so they can get going again, often they just feel weird or get fat.

Really, since I am not a psychiatrist, I only use the DSM IV diagnoses to fit into the insurance companies schema. What I really think is that there is one basic psychological problem, and that is the inability to regulate one's emotional responses. The people I see get too high or too low, too anxious or too lethargic. They react with too much anger, or they get frightened too quickly. In some ways, their emotions, and the behavior connected to them goes out of whack.

There are basically five causes of these dysfunctional reactions: loss, loneliness, stress, conflict, and some kind of physical problem. The physical problem can be that something is wrong with the brain, or the nerves, or that someone is reacting to chronic pain, or a terrible disease or a disfiguring accident.

Loss is anything from losing your wallet to the death of a child. It can include the loss of a job, or lots of money or a relationship, or even your ideals.

Loneliness includes isolation, rejection, and the lack of social skills and connections.

Conflict, to me means being in a situation in which you feel that you have to find a way to defend yourself against an opposing force. This can be in families, with a significant other, in abusive situation, on jobs, in bad neighborhoods or in wars.

Stress, is anything from the deadline at work to the trauma of waiting for a sexual abuser to creep into your room at night.

All of these causes create emotional reactions. It is when the reactions continue, and cannot be contained, and then seep over into the rest of someone's life that they become a problem.

Emotions are crucial for out survival. They are what guide us through life. Anxiety warns of danger, sadness helps us slow down and regroup, happiness is what keeps us going, anger defends us. disgust keeps us away from bad things, love and lust keep the species going. It is when these emotions last too long and get too intense, and when we feel that they are out of control and overwhelm us that they need to be treated as a problem.

Often the reactions include addictions or compulsions. These are attempts to control emotions that can work successfully for a while, but then probe to create more problems than they solve. Addictions can include anything from alcohol, to weed, to work, to yoga, to exercise to sex, to TV, to relationships. If it interferes with you getting to work and being happy, then it's an addiction.

That is the framework I work from. That is how I diagnose people and their problems. My intent is to help them get their emotions back under their control so they can get their jobs done and be happy.

If you don't like that framework feel free to comment, maybe I can learn something. Just don't get out of control.

Monday, April 16, 2007

Bad Things

I am certainly happy that I am not that guy's therapist; the guy who went berserk at Virginia Tech. I guess there will be all kinds of explanations later. I feel awful for the parents of the kids who died. I guess I feel worse for the kids.

I have had clients with close relatives who died on 9/11. I have had clients whose cousins were shot on the street here in our smallish city. Ours has always been a culture that has very mixed feelings about violence. Look who won the Best Picture Oscar.

On a smaller scale one of my most placid clients, who is literally a gray-haired old lady, told me this morning about how vengeful she has become.

She lives in an apartment on the second floor. Basically her whole life is going to work, coming home, feeding her cat, putting on Mozart and reading Jane Austin. She has lived alone for almost forty years following a very brief marriage.

The man upstairs, directly above her, who she describes as shy, and sweet, but a drunk, met a woman on the Internet. She came from Eastern Europe and married him. Then she found out he is a drunk and is only interested in oral sex.

Anyway, once this woman realized what she had gotten into and would come downstairs to my client and complain about her new husband. This went on for months until my client told her, as nicely as she could, that she couldn't take it any more. She tried to make it clear that it wasn't personal. She told her that she didn't have any friends, and she wanted it to stay that way.

So, the imported bride went back upstairs and soon she started moving furniture every day, dragging tables across the floor. Then she begins to drop heavy things onto the floor. The she seems to have rolled up the rug, and clomps, with heavy heels across the floor. Often she would flush the toilet seven times in a row.

These things would never happen once the husband came home at about ten-thirty every night. Once the door slammed, the dancing was over.

Well, my client got the message. She complained to the management and realized that wasn't going to do anything. So, this very quite woman, who has always taken the blame for anything that went wrong in the world, began to retaliate. She began to bang pipes, she stuck a boom-box with Credence Clearwater into the heating ducts and played it loud for four hours a day. Finally, she learned how to turn on the hot water in the bathtub at just the right flow volume that the pipes screech and rattle the whole building.

This worked. Four days later the woman knocked on her door, her face pale and trembling, saying that my client should stop.

The new peace lasted about two months, until this weekend. For some reason the noise began again. My client felt there were a few too many things hitting the floor.

So she brought out her big guns right away. She wasn't going to stand for any more dropped books or heavy boots walking up and back. That part is fine. I was happy she was defending herself.

What was striking was the glee with which she described the power of knowing she was making that woman miserable again. My client was not going to go easy. She was paying back a few mortar shells with "Shock and Awe." She was loving it.

* * * * *

I'll give three-to-one odds that it was some love/sex betrayal that sent this guy at VT over the edge. You can't mix hormones, rigidity and guns and get away with it. When I have rigid, angry guys I always ask about their guns, and if they will give them away for a while. Bad things can be avoided.

Sunday, April 15, 2007


Many of you, in your own blogs, talk about your diagnoses. That's different than talking about your difficulties, and it is more dangerous. If you happen to get labeled with a psychiatric diagnosis, don't get too hung-up on what it is or what it means about your brain. Whoever gave you the diagnosis had to give you something in order to get paid. If you are labeled as anxious, depressed, panicked, bipolar 1, bipolar 2, major depressed, minor depressed, ADD, ADHD, adjustment disorder with mixed disturbance of mood and conduct, dysthymia, or anything else, all it really means is that you have more bad days than most people.

There were two articles last week about how inaccurate these categories are, one in The New Yorker, by Jerome Groopman. He writes about the dangers of diagnosing a child with bipolar disorder, and how frequent it is happening. There is also an article in the new Harpers called "Manufacturing Depression" by Gary Greenberg. He talks about how diagnoses are more important to drug companies and insurance companies than to the people who are wearing them.

You see, drug and insurance companies want to get psychotherapy to seem much more medical than it is. If they get you to believe that being depressed is like catching a virus, then they can get you to follow a specific treatment protocol, usually some medication, to treat it.

But the diagnosis is never exact, and is never the same in two people. It is just a description of a few symptoms or behaviors. It is not how you feel, how you think or how your brain works.

Also, diagnoses are changing rapidly, there are trends and fads that seem to work better than the previous trend or fad, until everyone gets shoved into that and then it becomes almost meaningless.

Many of my clients now come to me with their diagnosis in hand. I have to tell them that they need to focus on their difficulties: how they think, feel and act, and what bothers them. If they can deal with that then their diagnosed condition, whatever it may be, will go away.

Everybody has a brain. Every brain is slightly different, with it's own strengths and weaknesses. Very, very few brains are broken.

So pay attention to what you are doing, and if what you're doing gets you in trouble, or makes you miserable, don't do that any more.

That's therapy.

Friday, April 13, 2007

Sue and Eve

See, especially in a small city, shit like this happens. I don't think I am over analyzing things; I think this is what it is:

About six years ago I began to see this woman, let's call her Sue. She was going through something at the time. It was her husband. He told her he was gay and he left for another guy. She was pretty upset at the time. That's understandable. We worked on that for almost a year, and then she got it together and went off.

Since then, I would see her when something came up. When she had doubts about a new job, or a new man, or when her mother died, I would see her. It came to about four times a year. I think I was helpful. She used the time well.


Then this last time,yesterday, she came in and after a while she got a bit upset with me (can you imagine!). She said that I wasn't helping, that I was telling her stuff she knew, and that my approach was too negative.

Yeah, so, that's what I do. What am I supposed to do, juggle? I only do that for eight year-olds.

Anyway, I maneuver my way around that, acknowledging that I make mistakes, and we go on to explore other things.

Then I begin to realize what she is really angry at me about. You see, she kinda liked this guy. She wasn't sure she liked him, but she liked that he liked her. He was giving her attention, and that was good.

But then, since she was keeping him as "just a friend," he began to tell her about another woman he was becoming interested in. Soon that other woman was all he was talking about. My client was not pleased with this kind of attention.

So, your are thinking, what's the point here?

Well, it turns out the woman this guy was so distracted by was Eve, the very same woman I had written about back on 3/14 in a post called "Rocks." It turns out that this guy was Carl.

Now Carl tells Sue all about Eve, and mentions several times that Eve is my client and that I am trying to help her. But Eve continues to bounce around with her life. Carl continues to be very distracted and very involved in trying to save Eve, and not paying attention to Sue. I think that now, Sue is upset with me for not getting Eve all settled and out of the picture. I also don't think Sue likes being associated with all of the chaos and goings on that Eve creates.

That's why, at least a good part of why, I think Sue is upset with me. But I'm not sure that I know how to tell her that, or if I will get the chance for a while. By then Eve will probably have been married and divorced.

Wednesday, April 11, 2007

kids 2

I don't see that many kids any more. I am seeing only three now who are under 12. I see a fair amount of surly adolescents, but they at least have the potential of being verbal.

Kids are a lot of work. It's not them. The actual time seeing them is fun. I get to play games and fool around. I get the kid to smile and regard me as some goofy adult. That helps him (mostly boys) relax and begin to open up.

But the kid usually isn't the problem, he is just dealing with something over his head. Sure, these days he comes in with a label - ADHD is still popular, but it's always more complicated than that. The kid never knows what the problem is, and he never wants to talk about it, and he doesn't even know how to talk about it.

Sometimes the kid is upset with the divorce, sometimes it's that the uncle died, or the father is in Iraq, or the mother is in the hospital. Those you can work through, with the help of the family.

It's when the family can't help, when they are too scattered, too angry, too overwhelmed, sick or dead, that the problems with the kid become very difficult to resolve. Then I have to try to teach parenting, get other relatives involved, talk to the school, set up after school activities, and be the father for the next six years.

Too much work.

So, if you can't take care of your kids, try not to have them.

I know, the skills needed to make a baby is very different from the skills set for raising a child, but that's not my fault.

Monday, April 09, 2007

Cuture wars

Did you catch the cute juxtaposition in the NY Times Magazine yesterday?

First they have an article about how Dan Schneider, the former child star from Head of the Class who now creates TV shows for the 7 to 12 year-old set. The article says that these kids control about $39B of purchasing power and that their parents give the kids the buying decision because they feel that the kids know more about movies, music, vacations spots, foods, cellphones and probably even politics and sex than they do.

But if you wonder how the world has gotten to be so mixed-up and upside down, that is quickly answered by the next article, which is about Pope Benedict XVI, the leader of a very established and adult institution of traditional values. His views on movies, music, vacations spots, foods, cellphones, and probably politics and sex, would blast the world back to the fourteen century.

I need not worry about the demand for my services.

Sunday, April 08, 2007


But sometimes it isn't negative.

Sometimes, even though it's all just for us, even though it may be delusional, it all seems just fine.

Get away for a while. Some time alone with the wife, see some friends, eat a little, drink a little, have a couple of giggles.

Yes, the world continues to fall apart: wars, famine, global warming, poverty, foolishness, arrogance, large expensive pocketbooks. And yes, I think that it is our fault.

But, it is a holiday and to quote Jonathan Edwards -- no not that Jonathan Edwards --

"Let's lay around the Shanty Mama, and get a good buzz on."

Tomorrow I go back to work.

Saturday, April 07, 2007

why I don't write books

It's too negative. There is no spirituality. There is no hopeful, inspirational, uplifting (unrealistic) message.

That's true.

But, this is what I have come to believe. (I could be wrong, but I'm not).

You, and me, and all of us current day humans, are the result of the complex interaction of who we are physiologically, with everything that has happened to us since we were born.

That means you begin with the DNA you have been given, which gives you physical characteristics, along with a certain individualized temperament. Then you have many interactions, such as with your parents, your environment, the culture, the food, the air, the architecture, your siblings, your friends, your teachers, and all kinds of media. These interactions determine whether certain pre-dispositions in your DNA get expressed through the interaction with your RNA, proteins, and other expressors or inhibitors. In other words, you learn things.

Some of the learning is conscious, some you just absorb. You form relationships. Your form habits. Sometimes they are the same thing.

There is psychotherapy and there is psychiatry.

The former, which is what I do, deals with the experiential end of it. As a therapist I try to create positive experiences that will help my clients move their lives in a certain direction.

Psychiatry, for the most part, at this time, deals with the biological They are reductionistic. They feel that if they can regulate your chemicals then you will feel differently. Which is true, to some extent. More true for some people than others.

As a therapist, I really have very few weapons to create these new experiences. I can talk to my clients. I can make funny faces, show a few dance moves, juggle, whistle and clap. But basically all I can do is create an experience.

I don't give drugs, do surgery, sprinkle fairy dust, lay-on hands, invoke spirits, or use highly focused proton beams.

I did get a phone call yesterday from a woman I have not seen for three years. She called to thank me for the work I did with her and her sister. She said they were both talking about it and that they felt that if they had not met with me they both would probably be dead now. She said thanks. She didn't even leave a number.

I guess, sometimes it's enough.

Wednesday, April 04, 2007


A major part of the training of any therapist is learning to deal with transference and counter-transference. People tend to like anyone who will listen to them, pay close attention and care. Some people mistake that for the wrong kind of caring and get a little too attached. As a therapist you have to keep the expectations of the relationship clear.

When I was young and handsome -- now I am older and distinguished -- I had several cases with struggling lonely young women who felt that someone they really could trust, someone who made them feel worthy and capable should be rewarded with some intense attention and affection. I remember from my second year in practice when a woman announced,as she sat there in her summer smock, that she had taken her underwear off before coming into the session. I don't remember what I said, but I remained professional.

There have been several such instances. I have learned to see them coming earlier so that I can structure things so that these delicate moments can be avoided.

That's why I was caught off guard today when I was seeing this client. I had mentioned him earlier when I wrote about his relationship with is father, in the entry "Just Folks." He began talking about the difficulty he was having in the relationship with the man he has been involved with for twelve years. He began to talk about his father. He began to talk about how I reminded him, in a good way about his father.

And then he began to play with himself. At first I wasn't sure. But then I was sure. Real sure.

"I guess temembering your father stimulates certain feelings," I said.

He smiled and asked if I ever did any role-playing.

I began a discussion of what boundaries are, and how some of the actions of his family had broken some very traditional boundaries. I let him know, clearly, that there were very stong boundaries in my office.

He took it fine. He was a bit disappointed, but he held together.

If he can continue to hold his boundaries together this can be very helpful for real therapy. If he can't, if he slips into crazy neediness, instead of dealing with therapeutic transference, we will be dealing with a transfer to a new therapist.

Tuesday, April 03, 2007

more love gone bad

They divorced after he had demeaned and degraded her for years. When she finally threw him out she needed a restraining order to get him to go. He couldn't believe she would ever do that. He really believed that she couldn't live without him, even though, of course, he's the one who can barely cope.

Now,seven years later, he is still fuming and full of resentment. He makes his feelings known to their children who are now twelve and ten. He also shows them he loves them buy buying them things with the money he should be sending in child support. He bought his twelve year-old daughter a phone that takes pictures, gets email, takes and receives videos, text messages and even makes phone calls. He told her not to tell her mother she had it.

A week later, at one in the morning, the mother caught her daughter sending text messages to a fourteen year-old boy. She took the phone away and put it in the draw. She aid the girl can't have it back until she is mature enough, and who knows when that will be.

Three days after the daughter's next visit with her father the mother received a summons in the mail. The father is taking her to small claims court for $250 because he says she stole the phone he gave his daughter.

Another fine use of the American Judicial System. I';; let you know how it turns out.

Sunday, April 01, 2007


I was taking a nice walk today with the wife. The signs of Spring were everywhere and the sight of the crocuses and the warmth in the air was uplifting and rejuvenating. It seems like we have survived another winter despite all of the woe that the events of family, clients and the world have heaped upon us.

As we walked we passed parks full of kids and their parents tossing balls up and back. We passed a father and his young son involved in an earnest conversation. We saw other families riding their bicycles together, complete with fancy gear and arrow shaped helmets.

Also, one of our local towns was highlighted on the front page of the NY Times today for the kind of pressure that is felt by talented, smart, attractive high school girls.

It has been a long time since I was fifteen, and although the houses and the neighborhoods we walked through have probably not changed much during that time, the prices of the houses has probably increased by almost twenty times. And partly, as a result of this, being a kid seems to have become much more difficult.

For kids, the pressure to know things, to learn how to do things, to master things, and to be able to express yourself has increased as much as the home prices. School, sports, dating. clothes, information, social interactions, the use of computers, cell-phones, video, video games, sports equipment, training programs, learning programs, rankings of schools, rankings of students, rankings of athletics is a constant in their lives. The use of good drugs, of bad drugs, of performance enhancing drugs, of mind expanding drugs, of mood altering drugs is part of their world. The number of divorced families, of blended families, of single parent families, of same sex parents, of lots of sex parents, of early sex in kids, has added lots of information, lots of choices, and lots of pressures for children to define themselves and make choices much earlier than before.

What I didn't see too much of was groups of kids, on their own, playing their own games, with no parents helping to organize it. I remember when spring meant going off at nine in the morning with a glove and a bat, and coming home at six, tired and dirty after playing 147 inning with other 10 to 14 year-olds who showed op at the park. We would play, make rules, argue a bit and then settle the argument so we could play some more.

Yes, I had to do some homework, and some of my friend had to practice the piano, but the intensity was not there. We were kids first and only. The day was just that day in time. It was not part of the plan for the all-important future. I had to learn how to read and write, add and subtract. I didn't have to be published by fifteen, or an Eagle Scout, a community organizer, a musical soloist, a computer programmer, or have two patents pending.

In my practice this week I will see five or six adolescents or young adults. Half of them come to me because they have been affected by the pressure and have anxiety disorders or eating disorders. Half are coming because they, or their parents have felt long ago that they couldn't compete in this environment, so they gave up and dropped out. They are lost in video games, music and pot.

In a large part this is due to economic factors. Everything is so expensive, and jobs are more specialized. There is less time to be carefree and still have the confidence that everything will work itself out in time. The fear is that the train leaves the station earlier and earlier and if you don't have the skills to get on you will be hopelessly left behind. In the near future their may not be good jobs for everybody, and this country is terrible when it comes to sharing and taking care of each other.

That will have to change or a carefree childhood will soon be over by five years-old.
And that won't make for happy people and a fun country. And what we need now, more than ever, are happy people and a fun country.