Thursday, May 31, 2007

No Shows

Two people didn't show up today. No call, no word, just didn't come.

One really bothered me; the other, I'm not so surprised.

The one that bothered me I had only seen once. He was a young man who wasn't born in this country. Very few people of his ethnic background come to therapy, but he was pretty desperate. He had come to this country when he was very young. He got lost in the shuffle, joined a gang, did a few rough things and his life wasn't going anywhere.

Then he met a woman, actually his cousin's wife, and they fell in love. He changed his life for her. Eventually they got married and had a kid. He got a job, worked hard, got promoted, loved being a father.

But, she left him and he was devastated. He drank himself stupid for a few months and almost lost his job. They encouraged him to see me.

He came in and was very articulate, and very aware of his feelings and how he has been lost, hurt and confused. He seemed to be a good candidate to work through that loss, plus a lot of the other stuff he had reacted to -- but then he didn't come back.

There could be a reason. I will try to find out tomorrow. It is very frustrating. Those things bother me. I take it personally.

The other guy who didn't come had come four times before. He was having panic attacks and I helped him get some benzos to calm himself down. By the fourth visit the doctor felt he should begin to cut them down and depend more on the SSRIs. This time agreed with the doctor.

I am not that surprised he didn't come. I am disappointed because he was really beginning to learn how therapy could help him. I think he was looking for those pills because his wife wanted them. The doctor had alerted me that she was known for her drug-seeking behavior. She may be dragging him to another doctor. Maybe I will find out about that too. Maybe not.

That doesn't bother me as much.

Tuesday, May 29, 2007

mixed about children

I've been seeing and hearing about all the new children being born through IVF. I have known some great examples of families who couldn't have children who have found a way, with a boost from science, to be able to achieve the world's most gratifying experience of having a needy, time-consuming, resource draining, emotion sucking creature wander your home for twenty years. Few people who ever had one would actually trade them in, despite frequent threats.

But I am also disturbed by what I have read and what I have seen first hand. That is that couples in their late thirties or forties, who have struggled for year to have a child, who then take all kind of drugs, and sometimes purchase eggs. This process often leads to multiple births. Multiple birth children are usually underweight and often premature. This makes them very high risk for all kinds complications.

Families now come to me and my colleagues with twins or triplets, one or two of whom have special needs ranging from learning disabilities to large developmental disorders. All of these kids need and deserve love and delicate handling. The truth is that this kind of attention is very expensive for towns and schools. It is also very draining on the parents and the extended family. It often totally rules the life of the family and community for many years.

It is a very complex situation, and I don't want to seem mean or an ogre for implying that some people shouldn't have children, but it also seems very selfish to go to these extreme measures to satisfy a need when there can be so many severe consequences that are ignored. Any couple who has two, three or four successfully implanted embryos should really think about what they are really getting themselves and their communities into, and not just he miracle of life. Medicine now has ways to keep children alive, even when their lives are very limited and their future holds no prospect of improvement, and without extraordinary measures they would not survive the first two months. This takes millions of dollars and thousands of hours.

Any doctor or clinic that only talks about how successful their birth-rate is, while not clearly delineating the dangers and realistic expectations should be taken out of business.

Thursday, May 24, 2007

As time goes by

I don't really care about the newest direction my profession is taking. Yes, everything is chemical and biological and if we regulated our chemicals our lives would be pleasant and smooth. But what is it that puts all of our brains and body chemicals our of whack?

80% of all difficulties begin with our intimate relationships. We struggle with the ones we love: our partners, our children, our parents. We want them to love us, we want them to do for us, and they should behave as we want, as well as respect and appreciate us.

Of course, they want that from us. And so the struggle begins.

These examples are just from today:

Jack, 75, came to see me last year. he and the woman he had lived with for six years had split up because her 45 year old son caused too many problems. He realized she wasn't going to take him back. That took two session. On Tuesday he came in telling me that he was having difficulty trusting his new girlfriend, who is only 60. But he was falling for her. Today he called in a panic. I think the feelings are not as mutual as he had hoped.

Ed, who has panic attacks, came in today with his wife Judy. They are in their late 50s. They have been together since they were teenagers. That is except for the few years that she was married to someone else. The truth is, they were together then also. They screamed at each other lovingly for the whole hour.

A new couple, Mike and Rose came in. They have been together 12 years. Mike is very successful. He runs a very profitable business. Rose is really movie-star gorgeous. But, they have had sex eight times over the last nine years. She says she can understand why he is upset, (yes, I could understand why he is upset, especially sleeping next to her). But, she told him, he shouldn't take it personally. Sex just isn't her thing. Then she really tore him to shreds for being so angry at her. She told him that his anger is certainly not going to solve the problem -- which is true.
But, when pushed, they both said they wanted the marriage and they still cared about each other. This will get complicated; that's all I can say at this point.

Paul and Nancy are in their mid-thirties and have been married for two years. a first marriage for each. It's time to have a baby. But, are we ready? Do we really love each other enough? What about all our arguments, and the fact that her father abandoned the family and his mother went nuts? How do we know for sure?

So, I head off to the long weekend dazzled by these thoughts of love and romance. May we all live happily ever after.

Tuesday, May 22, 2007

Signs of Spring

May is the cruelest month, and even though that was probably written about other circumstances, it has often been true in my world. I have not checked recent statistics but May is often the most dangerous month for suicides. I guess the winter is depressing, and everyone understands that, but come spring, if things don't get better, then they get dangerous.

Spring is the time when the sap begins to run through the trees and through the veins of people with difficulties. Everything escalates, everything becomes more intense. Last week I received many more calls for new appointments, and most of them were from people I had not seen for a year or more, but who felt the need to get stabilized before things fall apart.

Another sign of spring is that I get at least one thin, sensitive, artistic, contemplative, gay adolescent. They usually come in, as this one did yesterday,upset by the state of the world and man's inhumanity to man. He was well read in philosophy. He was vegetarian. He had a boyfriend and tons of girlfriends.

Like most of them he thought all of his difficulties were due to the weight of the world. The fact that he was gay, that his father was a drunk and disappeared, that his mother was depressed, that his stepfather was clearly very uncomfortable around him and that his brother's friends beat him up, were all denied as part of the reason that he was upset.

Some of then young men are more fragile than others. Sometimes they just need to learn how to leave their families and all of their family's difficulties and go out on their own. Sometimes they are using this as a way to bring attention to all the problems, and sometimes, as may be the case this time, they are really overwhelmed with all of their emotions and in danger of falling apart.

It is difficult to know if a sixteen year-old kid is really gay, in rebellion, or just confused. But these days there is so much sexuality beginning in Jr. High that everything can get intense and confused pretty early.

Take the time to smell the flowers. That's the good part of spring. That and the Sox beating the Yankees.

Sunday, May 20, 2007

Summer of Love

I see from the NY Times Arts section that this summer is the 40th anniversary of the year the hippies went public. The human-be-in and all the concerts. The drugs, the very shorts skirts and the anti-war movement. They are all being brought back by festivals and museums. Now, it has become a branding experience.

I don't remember it that way. I remember those summers very clearly. 1966, 67 and 68, were very intense times and very formative for me. I was finishing college and beginning graduate school. I was beginning the relationship that continues to this day. Myself and most of my friends were very concerned about the future of the world.

We were really, really concerned about what kind of world we wanted to live in and how we could build it. We didn't trust the politicians, and they were all exposed as liars. We wanted things to be different. We wanted things to be more honest, more equal and more just. That was much more important than caring about our own wealth or creature comfort. We expected that we would be comfortable, but not much beyond that. None of my friends even wondered about how to get rich.

For about twelve years, from about 1966 through 1978, things seemed to be going in that direction. We ended the war. We got rid of Nixon and Ford. The civil rights movement really made a difference, as did the women's rights, and eventually gay rights. Homosexuality stopped being classified as a disease in the early '70s. From 1960 though 1980, the gap between the rich and and poor was narrowed significantly. America was finally doing some good things.

During those years I worked as a psychologist in a community mental health center. We did a lot of preventive work that no one today has even heard of. We went into schools, housing projects and police departments. We were the first to alert people about child abuse and addictions. We were beginning to learn how to prevent them, or to catch these problems at a very early stage.

But then Carter proved to be an inept leader and Reagan took over. He is the one who changed the tax codes and economy (which really wasn't doing that well) so that the rich could stay rich and get richer, and the poor got stuck with the bill. He also said that all of these preventative programs were a form of socialism, and we can't have that. Why should a government care about it's people? That's BIG government. A government should just watch out for money.

It was his supporters who revised the history of the 60s to look like all the hippies wer a bunch of drug-crazed narcissists.

I don't remember my friends like that at all. We were idealistic, and a bit naive, but many of them did, and continue to do a lot of good work.

Thursday, May 17, 2007

nine years

She was not happy today. Really, she hasn't been happy for a long time, which is why she is in therapy. She has been in therapy for nine years; the last two with me.

She is great to have as a patient. She is expressive, articulate, insightful and understanding. She makes connections and comes up with causal connections. But she really hasn't changed much, and today she was upset about it.

She had struggled for years before she first sought therapy. She had always been independent, obstinate really. She had been defiant as a child and didn't want anyone telling her what to as an adult. But when she ended up in the ER having her stomach pumped she realized she had better get some help.

Now, five psychiatrists, four therapists, two hospitalizations and a day program later, how is her life going? Not that well.

She is out of work and on SSDI. She wants to work but she doesn't feel at all ready to meet the demands. She has stopped drinking fairly recently. Drinking had been her first attempt to deal with all the terrible feelings. In a way it had been successful. It helped her through the day. But before she stopped drinking she was having alcoholic rages and black-outs.

She has tried at least a dozen different medications. Of the three she takes now she feels that two are really helping to stabilize her moods. She hopes that their effects will last for a while.

She isn't suicidal anymore. Her self-destructive behaviors and thoughts have greatly diminished. But she still is anxious most of the time. She often feels overwhelmed, and is plagued with self-doubt. She cries most evenings. She has a great deal of trouble sleeping, and the knot in her chest never goes away.

At times like these I feel almost powerless. She is a really fine, caring, intelligent person whose while life is a struggle. Her difficulties are a clear interaction between the highly reactive temperament she was born with, and never having anyone who could comfort her and help her modulate her own moods. Instead, from an early age, she was screamed at, bullied and demeaned.

Working with her now, at forty-five, we can only undo and redo things inch by painful inch. I would love to get into the mechanism and reset the dials and give the works a good tune-up. But all I can do is talk to her.

Tuesday, May 15, 2007


That last post. I'm pretty sure I wrote about that situation before. I can't even find it myself, but I know I wrote about it when my client was able to assert herself and get the harassment to stop.

But, like so many things that go on in my profession, and in life, change comes with great difficulty. Problems that are solved can come back. Sometimes they take a different form, sometimes they come right back at you.

Part of what we are supposed to believe is that if something is difficult to do, especially something social, such as speaking in front of groups, making cold calls, asserting yourself, meeting new people, confronting someone's anger, or seducing women, that doing it, and then doing it again, will make it easier.

It turns out that such is not always true. You make that big presentation, you do a decent job, but still, you never want to do it again. You stand up to that bully, and you get your head beaten in.

Problems can be solved; it is much more difficult to really reach in there and change people.

Monday, May 14, 2007

apartment dwellers

I guess it isn't easy living in an apartment. I actually live in a box, but more about that later.

The woman who lives above my client came here as an Internet bride from Eastern Europe. She knew that America was the land of opportunity and she was eager to find her way here. She wooed a man electronically, and who knows what she promised him. He is nineteen years older than she is, and a drunk, but he was the key that opened the gate to riches.

The woman came here found a job, performed her sexual duties for about a year and then found a second job. She has now been here about six years. Each year she takes a large chunk of her hard-earned American money and goes home to the ancient hills for the summer.

My client had been her friend for more than the first two years. My client had listened to stories of the old country and endless complaints about the man who has outlived his usefulness. After a while, my client, who has several issues of her own, politely told this woman that the time she could spend with her was limited. She was tired and tense and all of this negativity made her nervous. (Don't take it personally, but I don't like you).

Anyway, she did take it personally. She went upstairs, rolled up the rugs, and since then has been moving furniture, dropping books, banging pots, flushing the toilet six or seven times in a row, and tap dancing in her ten pound boots.

My client has be defending herself by running the cold water at just the right volume so that the pipes vibrate. She also puts on her old disco CDs very loudly.

Tomorrow the woman will leave for her trip back home. There will be peace in the apartment.

It's not just my clients who have difficulties. The ones who need the help the most are the ones who have no idea that they do.

Right George?

Saturday, May 12, 2007

Mother's Day 2

It's about twenty minutes until Mother's Day. The countdown has begun. Our children are far away and their mother is fast asleep. Tomorrow she will get phone calls. Mother's Day once was the busiest day for the telephone company. Now, everyone is on the phone all the time so it's probably impossible to tell. When all this cell-phone stuff started I wondered what everyone had to say that was so important. But just yesterday I got a picture of a drawbridge sent from my son's cell phone, and the day before that I got a message from my daughter's Blackberry that she was meeting an old friend of mine. Then I got a message from his Blackberry that he had met her.

What could be cooler than that?

I was talking to a client of mine who works in software, and he is worried that his job is about to go to India. I figured that my job is one of the few that can't be sent overseas. Sure, people try to do therapy over the phone, or by webcam, or even telepathically, but don't be fooled. Insist on the real thing. Despite all the technology there will never be anything as beneficial as real, person-to-person contact. As any modern materialist, reductionist will tell you, it stirs up all the right chemicals in the brain.

I know that my job often gives a distorted picture of how the world actually works. I know that there really are a whole lot of great mother's out there. Most mothers have nurtured their children, protected them, encouraged them and loved them, as well as they possibly could. I hope yours did. It makes life easier.

So, if you can, pay Mom a real live visit. Take her bowling, steam-up a pot of spinach, buy her a new kite, play a game of jacks, let her win at poker, gather the family around and watch "Gremlins" once more time. There's nothing like real, human contact.

Happy Mother's Day! If you don't have a mother, or you can't be with yours, or you chose not to because it really isn't worth the aggravation, then you don't have to feel guilty about watching the Sox.

Thursday, May 10, 2007

Mother's Day

It's the run-up to Mother's Day. I hear about mothers a lot, and it certainly isn't all positive. I wrote about it before, back on March 3. But now, with Mother's Day approaching I am hearing about it again.

For most of my clients Mother's Day brings up a lot of ambivalence. Many of the people I see have come to terms with the realization that their mothers were limited, but most did the best they could. Still, to make a call to Mom and have to spend an hour hearing about your failings does not make that warm, fuzzy connection. Or to hear that Mom is sick and aches, and hurts worse than anyone and always did. Or to hear that, at seventy, Mom is making breakfast for her third boyfriend of the year and her twenty-third of the decade.

Most of the women I see, who are also mothers, feel they need to make the call, to put forth the effort, even if it is just a gesture. The men I see, if their mothers fall into that kind of category, won't bother.

I hope that you all have fonder memories, and that your visits and calls on Mother's Day bring a smile, and even a tasty treat. Most mothers are really some of the best people we will even know, and one of, if not the biggest influence in our lives.

Me, I remember Mom. She tried hard as a mother. If she erred, it was in over-praising her skinny little prince instead of being too critical. She gone now, I miss her opinions. She never would have survived Bush. She died nine years ago, on Mother's Day.

Tuesday, May 08, 2007

clever comback?

So we were sitting there, the three of us, in the middle of the session. It was a second marriage for each of them. The marriage was in its third year. They both wanted to avoid the mistakes of the last time.

She had been pushed around a bit by her first husband so she was making sure that it wouldn't happen again. He said something kind of negative about her daughter, she quickly shot back a remark to let him know he was out of place.

He looked a bit hurt, and confused that she would come at him with such force. He stammered, and gave a whiny reply.

She looked at me and said: "You'd think he had a vagina between his legs, wouldn't you?"

An interesting comeback, especially from a woman who has been abused.

Sunday, May 06, 2007

movie review "Crazy Love"

I saw a movie today that I would recommend to those of you who enjoy seeing up close the extent to which love and lust makes people do wildly irrational things. The good thing about this movie was that it was a documentary, so it wasn't a romantic fantasy. The bad thing was that it is one of those "independent" films, so most of you probably won't find it screened anywhere near you.

The film is called "Crazy Love" and it follows the course of the relationship between Bert Pugach and Linda Riss. This couple were often on the front page of NY tabloids in the late 1950s, and again in the early 70s. He was totally obsessed with her but his wife wouldn't give him a divorce, so she broke it off with him. When she became engaged to another man, Burt hired someone to throw lye into her eyes so that no one else would be with her. Bert eventually got arrested and went to jail for fourteen years for that.

By the time he got out of jail his wife had divorced him. He continued to pursue Linda, who was now almost totally blind. At the time the movie was made, which was last year, Burt was 79 and Linda was 68, and they had been married for 33 years.

It was interesting because he, obviously, is a crazy obsessive narcissist, who cares not what he does to people, while she really seemed to want to get rid of him. But after she was disfigured and blind she made the best deal she could, which was to live off of him and have him take care of her for the rest of her life.

The last fifteen minutes of the film show her nagging the hell out of him, and he seeming to still love just being with her ( even though he did cheat on her too).

I have seen many couples in therapy in which the man is crazy-possessive and jealous, but the women seems to take it as an indication that he really cares. In general, we in the therapy field don't seem to deem this kind of relationship very "healthy." But, sometimes, what the hell do we know.

Friday, May 04, 2007


During my over thirty years as a therapist I have had six people who have died while they were seeing me, only two of them can be questioned as deaths that were somewhat related to psychological reasons. Both were alcohol related and more accidental then intentional, but I don't think that either of the men who died would stay the were regretful.

I have seen many people about whom I wonder what it is that keeps them alive. But it apparent that life is precious and I believe, really does have a force of it's own. There is a drive to survive, and very few people will give up without a fight.

That is very different from having suicidal thoughts. These thoughts are common, but still very scary. They come from frustration, loss, loneliness and humiliation. They also come from chemical shifts in the brain.

I have seen a woman on and off for years who once realized, while she was standing in her kitchen, cooking for her unappreciative family, that she could just pick up one of those big knives and plunge it into her heart. This thought has plagued her for years. She gets anxious when she enters the kitchen, and sometimes when she is driving her car.

Each times she comes we talk about the pressures she feels, and how she can never please people, and them we spend half the time discussing the difference between thoughts and actions. She is really in very good control of her actions, but no one is really in good control of their thoughts. Thoughts come from everywhere and go everywhere. We have a process that lets us pay attention to some thoughts and not to others. No one seems quite sure what that process is, but it generally works.

But once you have thought about suicide, and the thought has sacred you, it becomes difficult to not think that you have had that thought. And if you don't think it, then you can't really pay attention to the fact that you are not thinking it, or else, of course, you will be thinking about it.

But don't worry, if the thought worries you it's an indication that you don't have anything to worry about.

Thursday, May 03, 2007

SSRI warnings

Yes I'm back, thanks. Italy was wonderful. it is all it is cracked up to be. I really felt away. Didn't really worry too much about anyone until the last couple of days when some of the people walking by began to remind me of my clients. It is surprising how the gene pool seems to have lingering effects. The clients I was reminded of all have last names that end in vowels.

Back to work, and it was difficult to walk into the building and see that it was all the same. By the second hour I could remember how the process is supposed to work, and I was cruising along. I notice how before a vacation I can make myself know that I am so exhausted, and now that I'm back it seems so easy, even after a day of traveling for twenty hours. I was eager to see everyone again.

Opened up the paper this morning to see that they are putting a black-box warning on SSRIs. They warn that people up to the ago of 26 are at risk of impulsive suicidal actions when they are on these drugs. They state that the incidence is low and that the beneficial effects of the drugs should be considered when deciding whether to prescribe or not.

I don't want to get into another discussion about how useful medication is. What interests me here is to wonder about what process must be at work in the brain. You give someone a drug that allows the chemicals that make someone feel more stable and content to remain in their brains, and sometimes it makes them want to kill themselves. Why is that?

Does it allow then to lose the inhibitions that were keeping these actions in check, or does it just radically alter their emotional state?

In older people, especially those over 65, SSRI seems to decrease suicidal thoughts. Is this because older people are more prone to hopelessness and this allows them not to care so much, while in younger people it allows them to care too much?

All of this speculation is probably way off the mark. The brain is very complicated, and it is attached to the rest of the body. The body does strange things, and it often does them with other people. Now, we know that other people are certainly strange, so anything can happen in these interactions.

Just today a woman was telling me that she gets very jealous when she feels that her boyfriend is cheating on her. She says she can tell he is because he lies to her in the same manner that she lies to him. "He's just like me in that way. That's why I love him." But it drives me crazy that he lies to me."

"But you lie to him?" says I, knowing that means nothing.

"Yes" she says, "but that doesn't bother me. I know what I'm doing, and I know that I can keep it under control."

Now, if we put her on medication, would she do more of it or less of it?

I happen to know that it wouldn't make any difference because she does the same things when she is on medication as when she isn't.

But still, what makes young people react to the drug that way? And more to my point, is that a question that we can expect to answer or are we in a new world that is only brains and chemicals and physical processes, where such things as motivations, intentions, and personal decisions are antiquated concepts?

Or maybe I've been walking around too many walled cities who fought each other over pasta and olive oil.