It's Dark

Look out the window. It's 8:30 and it's dark. It's been dark for hours.

And it's cold. Not actually that cold, but it's cold and getting colder and soon it will be very cold again.

It's New England, and it's winter. It supposed to be like this. We didn't move south to play in the hot humid. We stay here and watch the sun disappear behind the slate gray clouds. Then we go to bed under thick down comforters.

There is a condition called SAD, seasonal affective disorder. But, in 99.97% ( a rough estimate) of the time it's not a condition, it's reality. The dark affects people. It's so primitive, so visceral, it's a great thing.

Feel it.

Don't be afraid of you emotions. They are here to protect you. They tell you instantly what to like and what to fear. They have been wired into us over hundreds of thousands of years. Trust them. Don't try to hide from them or chase them away.

It's dark and it's cold. It's uncomfortable. It's even a little scary.

Have a little rum and go to bed with someone you love.

Make the winter work for you.

Greetings!

I hope that all of you out there in The Blogosphere are enjoying this season of a succession of holidays. The Solstice has passed, and slowly the light will be returned to us who reside here in the Northern Hemisphere. We expect it will help shed light on the truth and bring a rebirth of hope, honestly, caring and integrity. Hope springs eternal. That is one thing that humans do well.

So gather around those who are near and dear. I have read in respectable journals that two major aids to keeping you brain functioning well past four score and seven years are blueberries and friends.

So rejoice! Embrace and look to the light!

Me and the Medical world (again)

I had another incident of medical depression, and I wasn't even sick. I had an appointment to get my eyes checked by a new and more skilled specialist at a new place. The place turned out to be six floor medical factory, very efficiently run, but huge and depressing.

The staff were mostly nice, some more than others. They shuffle hundreds of people through each day, so it can't be too personal. They lead people through the maze of hallways , with the people following obediently behind, like mules on tethers. Most of the people, of course, are sick so that isn't too uplifting. Many are old and crumbling, and them come to be taped together for another six months, or six days. It is clear that so much of our medical expenses go to constantly slapping band-aids on what is really just natural deterioration.

I went from this waiting room to that sitting area, to this little room, to that next waiting room to the next little room. I was examined by very nice people and very high-tech equipment that beeped and flashed and spit out pictures and pages of printouts.

I sat and looked at the artwork on the walls of abstract local nature. I wondered if the artist had imagined that their heartfelt emotion laden images would end up here.

I heard a woman somewhere down the hall with the worst cough I had ever heard, and she continued her straining and hacking on and on, as nurses walked with frozen smiles down the corridor. I wondered how much coming here put me in danger of being sicker than I ever have been.

After an hour of this, the very competent doctor showed me some of the pictures and told me that my status was the same as the last visit with my previous doctor. She then offered me some new, very expensive treatments that I probably don't need, but are available. I asked how much they could help and she explained very clearly that they could be an improvement, but they may not actually work and then they would have to be re-done. She couldn't predict.

I thanked everyone and went home. It took me about four hours to shake the depression. It is clear to me how much worse I would feel if I actually were sick, and how powerful the psychological aspects of illness are.

My own office is not like this. I greet all my patients myself. We talk in a cozy room, with comfortable chairs for an hour. I do not in-put everything into a computer as we talk. I listen and smile and make little jokes.

In many ways psychotherapy is not medicine in the way the medicine is practiced in America today. That is probably why there is such a demand for it, and why it works so well.

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our next task

I sent this out today to many other psychologists, as part of a discussion about whether to push for a national health insurance plan:


At this time in our history, with "change" taking over our government, and the banks, mortgage companies, auto industry and who can guess what else being nationalized, the question about health care in America is a bigger question than just about National Health Insurance. Hopefully all of our thoughts about this issue are more complex than how much we will get paid for 90806.

IMHO, the best thing that could happen (I am not holding my breath here) is to have a bunch of doctors, therapists, patients, hospital people, non-patients, economists,and bureaucrats locked into a room somewhere. It would be their job to construct a health care system from the bottom up, to design a system that would do the best job of keeping America healthy at the most reasonable cost.

How much of our GNP should we spend keeping us healthy and alive? In this time of socializing everything I do not think we can let the desire for profit be the deciding factor in health care decisions. Every other developed country has found a way to pay for care without having sick people run the risk of going bankrupt.

Who will do triage and on what basis? Should Medicare spend $12K for a demented 97 year-old man to have his teeth removed and dentures built? How much do we spend to keep an infant alive who has a badly damaged cortex?

How much should mind/body interactions be part of the deciding factors? What would be the best education for a mental heath professional in the next twenty years? Is there any chance that someone can be educated to perform that function?

How would we pay for the development of the best new drugs, not just the most profitable ones? How many drugs are good for us anyway? How much should it cost people who don't live a healthy life-style, or is it part of our freedom to smoke and eat Whoppers, and then have the government pay for bariatric surgery?

The country is a mess. The world is a mess. That gives us an opportunity to tear things apart and build a new system Think outside the band-aid. Think outside the fifty-minute hour. Let's have a real discussion.

I think I will send this on to my friend, Barak. He asked for my in-put.

Hour by Hour

Last week I bought an appointment book for 2009. For me, and almost all of my colleagues, at least those over forty, and certainly over fifty, having a concrete, paper and pen, write it down appointment book is so much easier than anything electronic.

I moved my office a couple of months ago. I moved just down the hall. But in doing so I emptied out the shelves of the old office. I put over twenty appointment books into a big box and lugged them home for storage. All of them are Week-At-A-Glance types. My brain is set to see the whole week laid out before me. If the hours are not all filled in a feel a bit guilty, even though now, since I hurt my back, I am trying to leave spaces.

One thing I get from this job is a clear sense of time. Hour by hour, just like it is in the book. I feel the week, the month, the year, my life pass by. If I am sitting and talking to friends I can tell when the conversation has lasted fifty minutes. The timer in my brain goes off. I need to change positions, change topics, talk to someone new.

Yet, I don't feel my life is passing by. It seems much more like it is exactly the same. I am amazed that I have aged. I feel the same. I do the same thing -- although I am much better at it now -- and I just keep going, hour after hour. She is my "nine o'clock,"he is my "ten o'clock." Very often someone will take that spot for six months, a year, sometimes even two years, although usually if they are still coming after a year, they are coming less frequently,but some people last a long time. For a while I had all my ten o'clock appointments trained to bring coffee. But now only one is left. I have to get the new ones up to speed.

I picked up one of the appointment books that was ten years old. The hours were filled in. I could remember about ninety per-cent of the people; their faces, their dilemmas, and how they were when they left. About five people are seeing me now, although they all had been away for at least a couple of years, some have come back a few times But for most of them, I don't know where they are now. Their stories continue without me.

I'd love to have a big reunion and see how everything turned out. But HIPAA won't allow that.

creeping changes

This economic stuff is bad. Many people are either losing their jobs, or afraid that they could. Money is tight. People are finally afraid of credit cards/

These are not bad things.

Many of the couples I see who usually fought about money-- using it as one of their flash points, even if it wasn't the real issue they were fighting about, which is usually control, recognition, and who should carry the emotional load -- now they talk about survival.

In some ways people are very tense about making the bills. In some ways people are more relaxed because the pressure to make tons of money, to keep up, to buy more and bigger, is gone. Even the people who have money, have less.

Making tons of money is not trendy any more. It looks bad. If this were France in 1787 all those auto execs, and big bankers would be on their way to the guillotine. There is a lot of popular support for that.

There are signs that things are changing. Having a job seems more important than just making money. How you get your money is beginning to matter again.

May there will even be a return of things like ethics and integrity.

Well, let's not get carried away.

More about that

Thinking about my last couple of posting has made some things clearer about what is so compelling and also so difficult about this job.

It becomes clearer at holiday time when I am even busier than usual, both socially, and at work. What becomes clearer is that while I can really enjoy my time off, I often feel that when I am with people, it can be pretty boring. I mean, I like many, if not most of my friends and relatives, and it is good to see them, but in truth, no one has much to say. Or at least they don't say it.

My own kids kid me about the types of questions I ask. What are you doing? What are you reading? What are you listening to? What are you thinking about? What is really going on?!!

Yes, the politics are finally encouraging, the Celtics are doing well, adding the cranberries into the wine and then into the sauce makes it more interesting, but WHO are you and what are you BECOMING?!

Then I go to work and people tell me everything. They tell me things that they don't tell anyone. They tell me things that they have never told anyone. They tell me things that they don't even want to tell themselves. To me, these are the most intriguing and engaging conversations anyone can have.

Today I had a session with a very bright, attractive woman who told me that last night she spent an hour sitting on her kitchen floor with a knife placed just under her heart wondering if she could go through with it. She felt she had done things that if anyone found out about, she couldn't live knowing they knew. Then her husband came home and she jumped up and set the table. Today she went to work and no one had any idea what she had been thinking. She then told me why she had felt so badly.(I'm not going to tell you).

Yesterday I met a new young man who seemed like he had just come in from the wilderness. He had been out of school for two years and had been doing basically nothing but hiding in his room. But six months ago he read something on the Internet that opened an interest in psychology and philosophy and he has been reading and thinking since then. He was incredibly insightful, articulate and self-possessed, and yet he never knew his father and his mother has been screwing with guys in the other room for years, and no one knows how this kid thinks, or even that he can.

Of course there are downsides. These are very one-sided relationships. I realize that. The people I talk to come to me for help. that makes me feel good My friends don't put me in that position, but then, I don't have to help them. The responsibilities are different. But often, I don't need too much contact with people after thirty to forty hours of this. I get all listened out.

I'd rather watch a game.

Ring-ting-a-ling

Well it sure is holiday time. Many of my clients were out there last Friday at 5 AM ready and eager to spend money they don't have. At least no one was trampled to death in my area. That is kind of sick, don'tcha think? That shoppers have rally gotten that desperate.

This is always one of the busiest times for me. Some family gatherings are really great and nurturing and communal. Everyone gathers and buys gifts to show heir love and appreciation for each other. The warmth and love is what chases away the cold of the long winter nights. I actually see some people who have a family like that. The family has grand-parents who had eight kids and they all have kids, many of whom have kids, and they all get together for Christmas and share good tiding.

I actually have two members of that family who see me, and they give me very different views of what goes on, and who really likes whom, and what the underlying tensions and rivalries are. But at least everyone manages to pull it off for a day.

Most of my clients dread the holidays. I see about four Elanor Rigbys who will be alone unless a fourth cousin has some compassion, or the old man on the third floor invites them in. But if he serves wine they get nervous about his intentions and make sure they keep their knees tightly held together.

For many it is the guilt that brings families together. A mother can squeeze feelings of guilt an inadequacy out of a child for fifty years if she has the talent. And many do.

I also have two families in which one sister is now married to the former husband of another sister. That can make things a bit tense, unless families are rally into sharing.

So, if you have a therapist, make your appointments early. Therapy times fill up quickly around the holidays. Many of us therapists fill up many hours with appointments. It's better than being with our cousins.

The Letter

Before I get to wishing everyone a happy and healthy Thanksgiving, I would like to say, once again, that the job I have is "endlessly fascinating" {that's something my mother always said when she couldn't figure out what was going on} and also, often, a bit weird.

I worked hard this week for two days, getting people set to deal with whatever variation of family they have to co-exist with, when I got a letter. This is not the way I am usually introduced to people. These days a phone call, and now more often an email, is the method most people use to try to arrange a first appointment.

This letter was about seven single spaced typed pages. It gave pretty graphic descriptions of stuff that is supposedly going on in private in a town close to where I work. None of the exact details were included that would allow me to verify that the people mentioned actually exist.

The situation described in the letter was not actually that unique or that terrible. It was the letter itself, it's format, language and detail that makes me wonder what is really going on. who would write all this and why? I have my ideas, but ... those are just hypotheses.

At the end of the letter the writer said I would get a call after Thanksgiving to set up an appointment.

Perhaps things will be revealed.

Now, it is time to wish you all a Happy, Healthy and Prosperous, even in these times,
Thanksgiving.

Remember, appreciate the people around you. They are doing the best they can.

results of financial meltdown

I get to see some of the unexpected fallout from the downturn in American personal wealth. Yes, I have to deal with couples who have re-financed to pay their credit cards and now they can't pay their mortgage and their house isn't worth what they owe. Then they get tense and blame each other for it. All that stuff is commonplace.

What I see now are some things that are a bit unusual. I have two (2) situations in which there are three adults living in one house. In one case a man and two women, and the other a woman with two men. In both cases there was a marriage that was not going well. The resulting emotional distance morphed into one person becoming involved with a person outside the marriage. What followed were the usual hurt, anger, arguments, threats and general disruption

Then, as is often the case, one person threatens to move out. The other says fine, I am bringing my lover in. BUT, there is not enough money to move out and pay for another place to live.

In one case a man is living in the basement while his wife is screwing some guy in what once was his bedroom. In the other case the "other" woman is sleeping on the couch, while the family, kids and all, goes on with life as usual, treating this woman as if she is invisible.

Not a very emotionally enriching situation, but it does show that diplomacy and compromise is better than living at the shelter.

I am not sure how either of these will end.

Too much

As a discipline I try to post here every two or three days. It's supposed to be good for my brain, and it should help to live a more "considered life." But often, life gets in the way.

At those time I have so much to say and so much to sort out, but ther isn't time to do it.

Right now I have several personal and family experiences that illustrate how complex health care has become here in the U.S. of A. It's a mess but there are reasons for that, but it don't have time to get into that.

There is also so much going on with the family, and even more going on at work, and the world is going through a great deal of flux in politics, in the economy, and this has its ramifications on everyone, and everyone has their effects on the economy and politics.

And then the Internet connection won't even work for a while, for reasons that I totally can't understand, so I can't even get started.

"Still,tomorrow is going to be another working day,
and I'm trying to get some rest,
That's all I'm trying to get some rest."
P. Simon

More though times

Beside the financial crisis there seem to be other bad things that just pop up in clusters. Maybe it has to do with everyone being tense, but these things don't seem related.

My father-in-law, who I have mentioned here before, is 95 and has really been a tough old bird for many years. But now his body and mind are slipping away. It is taking a long time and is tough to watch. He fell and is in the hospital, but he isn't sure if he is in jail or visiting one of his old customers. When the nurse asked him what year it was he answered 1980, which was the last year he worked.

A good friend of ours is back taking chemo-therapy for a re-occurrence of her cancer. It is very difficult to know how well she will do. Then today, my son told me that one of his friends who had moved away and started a new life in a far-off land was shot and killed in a robbery.

We don't live in Baghdad or Mumbai but there are times when it feels like the world is crumbling around me. My wife gets upset, as well she should. I think I have developed too much of a clinical detachment. I have a circle of about six people, and if anything happened to them I would be rocked to the core, but beyond that, I can feel bad, but I have learned to just kind of shrug and go on.

It could be from working with so many people, and getting to care about them, at least to a point, and still realizing that in many cases, their lives are not going to improve that much.

Or it could be that I'm just really not that nice a guy.

Back at it.

The historic week has ended. I am envigrrated for a better world, but right now I have to deal with the one we have. That means that today I got up and went back to the office.

The misery business, as my father-in-law always called it, is booming. Financial pressure puts pressure on relationships; stress is everywhere. People are struggling, people are angry, people are sad. That's OK, that's what I have to deal with.

I'll tell you what's tough. It dealing with the narcissists. When people are in a difficult situation, or have difficulties in their heads, or are just difficult, that's fine. But when someone feels that all the troubles have been heaped upon them, and then they just sit there and complain that no one is lifting them off fast enough, that is when the job seems difficult and taxing.

Understanding your problems is helpful. Explaining is helpful.

Blaming is not.

Hey, don't blame me, I'm just the therapist.

Obama and Psychotherapy

If Mr. Obama can get people together and try to make significant changes in our society, then some of my clients can make the sustained effort necessary to get their lives going in the right direction. His administration can set the tone that we are working together to make things better.

"But," some of my clients will say in one form or another, "my life is difficult, I was dealt a bad hand, my father left when I was young, my mother was a starry-eyed hippie." Obviously, that can no longer be a lasting cause of bad behavior. Now that there is insight, change should follow. These clients may not have a totally devoted grandmother who will last with them until the very threshold of their greatest achievement, but they do have me. I am here, and I am attentive, and I will be at least until their insurance coverage runs out, and with the new parity bill that could be a long time.

So, let's use this as a time of transformation for all of us. Let us pay attention to each other, help each other along and begin to move in a good direction. But, also, let's raise the expectations of each of us, and we will all benefit.

YES!

I will admit that on Sunday I was very confident, but by Tuesday morning I could see a way that the election could be lost.

I sat with friends and family, trying to be friendly without telling everyone just to shut-up and pay attention. When PA was declared fairly quickly I began to relax. An hour later when Ohio was given to Obama I knew, like everyone else, that it was really going to happen. All the TV people seemed to know it all along.

For the first time in eight years I felt hopeful. I drove to work this morning and I did not cringe every time I heard the news. I felt I did not have to be embarrassed about how the people in my government were screwing up the economy, science, world trade, war, energy, the environment, health-care, health,and human relations.

Basically, I have some confidence that the people who will be running this country, while they certainly won't be perfect, and they certainly will be politicians, will at least be smart. They will understand that the world is complex. That it does not just consist of good-guys and bad-guys, and that the problems we have to deal with are difficult. I think they will have a better understanding that even if someone disagrees with them that doesn't make them terrible or stupid (although sometimes they are).

That's all I want, to feel that we have good people who are trying. For eight years I have felt we have had an administration and even a Congress who were stuck in their own mud and couldn't see passed their mind-set, and couldn't understand what they were seeing, and didn't try to understand it.

Now, we will have to wait and see. but I certainly do buy what Mr. Obama is selling, which is hope.

That is really a great deal of what I do in my own work. Get my clients to believe that their lives can be better. I know how necessary that is if any change is to occur.

Finally

It's funny about time, but if you don't do anything the world keeps turning and eventually, things come to pass.

This election has been going on for almost two years. I have really been pretty actively following it since last January. What with the wars never ending, the financial ups and downs and downs and downs, the current idiot President who has allowed the Justice Department, the Energy Department and the FDA to all become inept and corrupt, I have always felt that this is a crucial election.

Now, finally, I have seen my last client before I vote. I have encouraged all my clients to vote, but I don't get into politics unless they start. The election has really aroused more interest than even the Red Sox this year, and that was not the case four years ago. Four years ago many more local folks were intensely involved with the Sox, and their own local Senator was running for President. Now they seem to have awakened.

What happens next is completely unknown. The world is in a great mess, to a large degree because of how this country has been run for the last eight years. It will take years to clean it up. But at least, if the election goes well, the tone of national and international relations can change dramatically. The world will look at America differently, and we could be a bit different with each other.

But that has not happened yet. I am working tomorrow and then I will be watching every channel. Mostly I will be watching Florida. For me, that is the first major indication. Maybe I won't have to stay up until two in the morning.

six days away

The election is coming, so they say. Mr. Obama has been running for 21 months. Mr. McCain has been running, on and off, for eight years. The decisions, soon to be made by millions of Americans, some of whom have already completed the task, is less than a week away.

In many ways people have to decide if they want to protect themselves, their won interests and their own money, or they want o feel that they are a part of a larger society in which each of us has some relationship, and some important interactions with each other.

This economic melt-down is, to a large degree, the result of people not looking at, and not caring about, the consequences their actions may have upon the welfare of others. They trusted that their attempts to make money were basically honest, and although the things they did were risky, they didn't look, understand, or ever think about how inter-related we all are. There was all this talk about some kind of "invisible hand" running through free markets, and that would make everything balance, and determine a real and fair value of things.

Obviously, there were many flaws in that kind of thinking, just as their are flaws in "trickle-down economics."

America is a land of opportunity, but it can also be a very harsh place for those who slip and fall, or for those who never had the chance to stand up in the first place.

Should we look around and care about each other, even if it is at some cost to ourselves? Or, if we each do the best we can for ourselves, will things work out as they should?

To some extent, the people will decide.

The leaves, and times, are changing

Today was one of those days that they put in movies about New England. The was HD clear after the night's rain, the sky was a perfect autumn blue. The temperature was actually warmer than it should be, but no one complained. Here in Southern N. E. the leaves are at their peak, and because of the right amount of rain and temperature changes this is a good year for color. There are reds, yellows, orange, brown and even purple mixed against some still green. My neighborhood has big old trees, maple, oak, beech and pine, with occasional sassafras, walnut, tulip and even willow. The trees reach way up into the blue, each with it's own vibrant color.

As we walked we met other neighbors walking. We talked of the coming election, which seems like it will never come. Everyone in this small city is of the same mind on the election. We talk of the economy, and joke about keeping our jobs for another decade. Who really wanted to retire anyway? Some of these folks had real jobs and made real money. Some of them have retired. In some ways the great stock market crash represents huge changes in numbers, but no real change in the current lifestyle. But everyone knows that things a are different, and we will not be as plush as we had planned.

One friend, who does business in Europe said that the bad times have hit there hard now. The world blames the credit crazy U.S. for giving and then selling so many bad loans. But everybody bought them and tried to get rich. Now everyone is getting poor. Some much poorer than others.

For us older folks, there is some sense that we have been through some of this. We are not old enough to have been part of the depression of the 30s, but old enough to know that bubbles burst.

It just seems that the bubbles build and burst at a much faster rate now. People seem to be waiting around for the next one to begin. The idea of a slow, steady rise in the economy, based on real products and real work has not really taken hold yet.

Maybe new, "Green Energy" will sweep us up in a new wave of progress and everyone can ride that train back to wealth and consumption.

Or maybe not. Perhaps we will all be poor for a while, and stay home, have conversations and get to know each other.

But that's just an old man talking. Most of us will run around and keep in touch through text messages:
"Pizza?"
"2 late"
"OU812"

all fall down

I was away from blogging for almost a month. Why? Because there was too much else going on. Just one thing after another that needed to be taken care of. When I was done with all that my brain didn't have too many creative neurons firing. I went to bed.

I had to pay the bills for my practice, the bills for the house, and now the bills for my fading father-in-law. The car needed to be taken care of, so did my wife's car, not that I can do the work, but I had to drive it up and back. The house is being worked on and one day two guys were standing on the scaffold and staring right in on my desk.

Mr new doctor seems to question everything about my health. I have taken more tests than ever before, and I'm OK, just poorer. One wonders about why our health care is so expensive. "Just want to be sure." I wonder if it is my health, his pocket, or the lawyers he is really worried about.

I had to see my clients, see my kids and listen to my father-in-law not make sense and my wife get upset about it. I don't make much sense and she doesn't seem to care.

I took time to watch the leaves change color.

I did a bit to keep Obama moving in the right direction.

BUT, my life is a breeze compared to what I hear in my office, and usually my clients are not the ones who are the most lost, disorganized and overwhelmed, but they have to deal with people who are. A's mother is on cocaine and three months behind in her rent. B's brother is locked in a room and won't come out. C's sister came to live with her because her house has mold. Now she hasn't paid any rent, hasn't cleaned the room and disappears every weekend without any explanation. D's daughter has been suspened from school for fighting, three times.

This doesn't count all the illness that are impossible to deal with, Parkinson's Huntington's, ALS. These are the kinds of things tahat just suck life out of a whole family.

I hear about so many houses that haven't been cleaned in months, so many bills hat haven't been paid that people stop trying, so many lawns that haven't been mowed, so many roofs that haven't been fixed. Things are falling down.

It seems to me, and I've been doing this a while, that the pace of life, the price of life, and demands of keeping up have increased, partly because of technology, to the point where people can't keep up, and are dropping out.

Even without this financial mess, I think it's worse than it was, but maybe I'm just getting old.

Been so Long

Look at that. I just looked at the date of my last post and it was almost a month ago. I would have said maybe two weeks. It's amazing how life gets filled up with all kinds of stuff. I had even told myself that it would be good for my brain to keep writing often, but so much for my brain.

I have spent time having parts of my body poked and measured and scoped. Despite all their best efforts, and they really seem to be trying, they haven't found anything wrong with me yet. That's what you get for going to see a doctor.

I have also been doing what I said and trying to help the Obama campaign. The actual work I do has not been that meaningful. He has not yet called me to help do his mental health policy, although he should. I will lobby for that after I see that he wins.

I hope you noticed that the Mental Health Parity bill got stuck into the Huge Economic Recovery Package. It will be a slight help, although insurance companies will find ways around it. They didn't designate $770 million for mental health. They should have, as clearly everyone involved with this mess is nuts.

For me, the trouble mainly goes back to Reagan. It was he and his conservative crowd that decided that the purpose of America was to give everyone the opportunity to get rich. That was the only purpose. How anyone made money, how much it destroyed other people, other countries or the other values and fabric of our own society were not questions anyone even considered.

Also, those conservatives were the ones who began to target liberals as having useless tax and spend policies. While those criticisms were on target in some respects, what those people put in place were spend and spend policies. It has been the conservatives, and G W Bush more than anyone in history, who just spend money and build huge deficits. They created a climate of unregulated greed and here we are.

So, I am holding on to hope for the next couple of weeks. There are about 35% of the people would vote for the Republicans even if Sarah Palin herself were running. It does seem that for now, the independents and the often undecided voters have had enough of war, bad health care, a crappy economy, and watching this country fall into chaos and decline.

Even my most moribund clients are taking notice in this election. Only the ones who are chronically bitter and angry seem to be for McCain.

Great Theater

Wow!
All of this is better, and more unexpected and unpredictable than any TV show. Unfortunately, so many people seem to view this election as if it was "American Idol."

You have to have some kind of admiration for John McCain. You never know what he will do next, and you never quite know what he is thinking. While this may be great for a self proclaimed "maverick," it is really terrifying to think of a President acting that way. A little stability in a time of crisis could be helpful.

He "suspended" his campaign to run to Washington, as if anyone could suspend a Presidential campaign five weeks before the election. Did he mean that no one should pay attention to what he was doing? I don't think that was what he meant. I think what he meant was: watch me act like I'm concerned, but I rally don't quite know what I'm doing. He also may have been trying to find a way to eliminate the vice-presidential debate, before Sarah tells the world that she knows all about foreign policy because Putin flies over her house.

A good thing is that even many of my clients, many of whom don't pay much attention to who is running their country, are paying attention now. I also think that as Obama continues to be on TV all the time, in ads, in debates, inginterviews, people will begin to see him as Obama, the Liberal Democrat, but much less as Obama, the Black guy. He is just becoming familiar, and that is a good thing for this county.

Unfortunately, Palin is not doing the same for women. She is fulfilling the stereotype of the not too swift beauty-pageant lady, who wants to bring peace to the world but whose talent is baton twirling.

Obama survived the debate about foreign policy, which is supposed to be McCain's strength. It is impressive that McCain has been to all these countries and knows all these people, but his stace seems to be ready to go to war with them all. He doesn't seem to see that going to war hasn't been too successful over the last fifty years.

Obama's lead is building, but who knows, one explosion, a TV appearance by Satan on David Letterman, or Tina Fey coming out in support of McCain, and everything could swing the other way very quickly.

More Obama stuff

So, as I said, I am doing work for Obama. Today, since I live in a very blue state, I was called people in battleground states to see if they could do some work in theri neighborhood. I leaned a few things.
First, most people don't answer their phones, even if they have cell-phones. I think my wife is the last person who believes that if the phone rings you are supposed to answer it.
Second, i seems that so many people in America are moving and struggling. So many phones are disconnected, and so many people who signed up only two months ago are already someplace else.

There was some genuine enthusiasm, so it seems some people are paying attention.

I can't remember an election that has gotten this slimy this early. It seems that McCain will say anything he feels will be effective, but without any attention to truth. I guess he feels that Bush did it to him, so he can do it to Obama. "The Straight-Talk Express" seems to be completely derailed as he and Sarah have no contact with the press. They don't want to be accountable to anyone. Even the ladies on "The View" called him a liar, and he had nothing really to say.

It's sad, because there is so much at stake. For him to suddenly become a fiscal watch-dog, when he himself was censured by Congress during the last banking crisis is as ridiculous as it gets.

But that's they way things are going.

Also, That web-site that was posted as a response to my last post was interesting and worth checking out.

Should have seen it coming

About three years ago, looking back from what we know now, I should have known that the financial world was about to implode. At that time I was seeing the usual sixty different people in a month. What I realized even then was that about ten of the people I saw, who had been not doing too well professionally, were suddenly taking exams to become mortgage brokers. Even those who couldn't pass the exams were sell mortgages for their sleazy brother-in-law or cousin. The cousin was often the guy who sold mortgages, and to add to his profit margin, sold cocaine.

I had one woman who had a few relationship problems, but she was selling both real-estate and mortgages, and she was making many, many dollars. She worked constantly, looked stylish, networked with everyone, and knew everyone. Everyone thought they could be just like her.

Well, they couldn't.

But they all sold mortgages to their aunts and uncles and ner'-do-well brothers. They all seemed to have some sense that these people couldn't afford the payments. Many of the people taking the mortgages were taking money out of the houses they had owned for years, believing that the equity in the house would just continue to rise at 20% a year. Often they used the money to pay off the credit card debt they had gotten by buying SUVs, and the trips that came with them.

The banks were encouraging people to use the credit cards, and would sent new ones to people as soon as the old one was max-ed out. The mortgage companies were selling on the basis of low-rates that the Fed had dropped to get the economy going after the stock market bubble burst, without regard to creating a bubble in housing.

Then the bubble popped. Surprise!

It was completely unregulated. What made it worse was the brilliant investment bankers who devised "credit default swaps" and were leveraging derivatives on those at 30- 1.

Then the families who wanted it all now, and was encouraged to put it all on credit, was faced with the reality that they owned much more than they had in assets, and that they now had negative equity in their houses. It was over for everyone.

Now, John McCain wants to tell you he will reform all this, by stopping the greed of the "Fat Cats." Well those "Fat Cats" are the are Republicans he is counting on to finance is campaign. He forgets to tell you that. That's why he wants to keep the Bush tax cuts. That way they get to keep their money.

That's called getting tough.

It's OK (almost)

Well football is on. And football and HD TV were made for each other. We are here in America, watching football, drinking a beer, and everything is just fine.

It's easy to forget that we are fighting two wars, one for no reason, and one we are losing. It's easy not to think how today we had to pay taxes and so much of that money is going to to bombs and corruption.

It's easy to forget that houses are being foreclosed at a record rate, that unemployment is rising rapidly, that we are being fleeced by oil companies. It is these same companies that will make more money when we "drill, drill drill" and it won't make the price of gas cheaper.

It's easy to forget that the Justice Department is corrupt and run out of a religious/political office. It's easy not to look at the department of the interior that takes bribes and has sex with people from these same oil companies.

Mr. McCain says he wants to go to Washington and make changes. He doesn't say that he will change any of this. He won't stop the war that spends a couple of billion of my money each month. He won't change the people in these corrupt departments because they are all the same Republicans that are paying for his campaign. He won't change health care and make it affordable or efficient. He will go to Washington and change the face of the man in the White House. Everything else will be the same.

But, hey, football is on. My team is winning so everything must be right with America. Let's not bother with politics. That way we can act stupid, be happy and poor, and probably lose more of our sons and daughters in wars for the oil companies.
But that's a small price to pay for HDTV.

more discussion

It seems that, among others, we have a "Right-Wing-Radio-Republican" in our midst. There are hordes of people who have been out there for over twenty years now who have decided that the best way to enter into a political discussion is to scream, slander, debase, and just throw all kinds of hyperbolic charges at the opposition. It's the "all Democrats are dangerous," and "Liberalism is a disease" type of argument that only leads to greater divisions in the country. Everyone says they are against it untle they realize that it takes only 270 electoral votes to win.

But, as we can see from the last two Presidential elections, it works. Perhaps a lie is still a lie no matter how many times you say it, but then how many people still believe that Saddam Hussein had anything to do with 911?

Now we have McCain leading the cheers for Ms. Palin, as if she has become the next American Idol. Her qualifications seem about the same, cute, popular, and can give a good scripted come-back. Ms. Palin may be strong enough to be Vice-President, but she seems to be a kept hot-house flower who is not allowed to speak for herself without a card to read.

Once again, it's great theater. How many times can we run the 9/11 movie?

Obama must be amazed that McCain can flip from being the "experience" guy to being the "new change guy" just because he says so. Who has time to really see if it means anything when you really are worrying about making the next mortgage payment?

Oh, and on health-care. That's the field I work in. Everyday I see how intrusive, wasteful, inefficient, insensitive and expensive our "free-market" system is. It is designed to make people money (even me) much more than to keep people healthy.

discussion?

Well, we are beginning to get some reactions here. I can't quite call it a discussion when some of the folks seem pretty much off the wall. That often seems to be the way political discussions go these days. I don't know where the raping and killing part comes in. Are people really still that afraid of Black people?

Amanda -- please register and vote, even if it means using a couple of stamps. If I knew where you were I'd forward some to you.

One thing the Republicans are very skilled at is creating symbols. They have been running on the same issues for decades, but they really don't talk about issues. They get people to feel for patriotism, safety and loyalty -- and even when what they actually do is really harmful to the nation they still are able to get people to feel that it is more American somehow, to be that way.

McCain is now running ads that trash his own policies and his own party, and then he blames it on Obama. If McCain wins the only thing that is going to change is the face of the man in the White House, but he poses as St. Patrick, and about to drive all the snakes away.

I really do think that Obama wants to create more of a caring society atmosphere in this country than anything we have seen since FDR. McCain is a true believer in American Individualism -- which ends up beong every person for himself, which then results in those who have more power and influence taking advantage of that and depriving others of their opportunities. Something like good health care really takes the kind of cooperation that this country has not been good at.

Reactions to the Republicans

The Republicans are meeting now and I am watching it on TV.

I have two immediate reactions. NOTE: I am very biased.

1. The Republicans seem to glorify war. The short movie about the Navy Seal who died was moving, and really tragic. This really gallant young man died in a war that didn't need to be fought. He saved his comrades while fighting people who really offered no threat to this county. No one mentions that. The Republican honor soldiers as if they are fighting for the Republican Party, which, sadly, in some ways they were.

2. The Republican convention is always full of white people. This time they can't even find a few Black faces to put the cameras on. This time the convention is not only all white people, it is all old white people, probably all rich old white people. anyone from outside the country who looks in must feel that the USA is a homogeneous nation of war loving white people.

A large part of it is.

And, as Joe Lieberman says, John McCain is not your average Republican. That is true. He is much more often irrational, impulsive, and a man more comfortable in the world of forty years ago.

Just my thoughts. Feel free to react.

Juno in Juneaux?

I'm sure I'm not the first to make that bad pun, but I guess it has to be said. Of course, the daughter of the VP nominee is keeping her child, not looking for a more adult home like the kid in the movie. That's fine with me. I can certainly respect that decision.

What I am having a great deal of difficulty accepting is John McCain's decision. I think that Mrs. Palin and her entire family seem like a fine, likable, fun bunch of people. They read the Bible and they like to hunt, fish, drink and screw. There is nothing at all wrong with that.

BUT, it doesn't qualify her to be Vice-President of the United States! I have many friends who like to hunt, fish, drink and screw. I like them a lot and we have some really good times, but I'm not voting for them.

She basically may be very smart and a quick-study, but she has NO real experience running things. She has just taken an interest in foreign police in 2007 when her kid went off to war. Comparing her lack of experience to Obama's is like comparing someone in their first month of Single A ball to the Major League Rookie of the Year. They are several leagues apart.

Being a devout Christian does not count as a qualification, especially when you really have not managed to stick closely to those beliefs. Yes, we are all fallen, especially me, but that doesn't qualify me to be a heart-beat away from taking over if the oldest candidate ever skips three heart-beats in a row.

I don't blame her at all. She is probably a great woman, but I think it certainly shows how impulsive and manipulative John McCain can be, and I can't trust someone like that to run the country.

But, he doesn't want to fix health care, or make mortgage companies accountable, or relieve the middle class tax burden, and he does want to spend billions more on wars, and on looking for oil -- and she wants to keep drilling for oil everywhere too, that's one things she knows about. If that's your idea of change, then it's clear why they need to bring God into the picture.

Love,
Tx

What is important

Well you guys are correct. The goodness of life lies in the details, especially in the friends and family.

But, there is also the importance of pushing for your beliefs and causes, and that is what I will be doing over the next few weeks.
I feel that this country is at a very crucial, historic and vital crossroads. This election could be more important that any election since 1860. The two candidates hold very different views of how our government should work, what our country's role in the world should be, and what the basic values of this country will be.

While I do not feel that Mr. Obama is the great savior, I do feel that his message and the direction he wants to lead us in is so much more positive and helpful that Mr. McCain.

I know there are thousands of political blogs, and I will be writing about politics more than usual, but I will also be visiting many of the other blogs out there and hoping to draw people into a discussion about what kind of country they want to live in.

I am doing this for my own mental health, for my children's future, in order to help my clients find easier ways to have health care, get an education and stay out of debt.

This is important. Maybe we can all work together to get it done.

Sarah Palin

Although I am neither a woman nor and African American I sent the following letter off to The Globe today.

When Thurgood Marshall died and left the vacancy on the Supreme
Court President G. H. W. Bush must have felt the pressure to fill the
chair with an African American. He did so by finding a man who was
certainly an African American but not one who would bring the
perspective of that segment of our society on to the court. Quite the
opposite, he has shown himself to be opposed to many of positions of
most African Americans on many significant issues. But, even at his
nomination hearings Judge Thomas felt he was being attacked because he
was Black.

Now, John McCain has selected a woman as his running mate. And
yes, she is undeniably a true woman, and she certainly does represent a
portion of the population of women. But her views do not represent
those who have fought for decades for women's rights, for equality, for
power, and respect. She is a conservative Christian who is
anti-abortion, anti-gay, and whose major qualification to be
vice=president is that, as a woman, she can somewhat look like Hillary.
This seems to be a cynical and manipulative choice., and an attack on
feminist women the way Clarence Thomas has been an anathema to African
Americans.

OR, stated more simply:

Clarence Thomas is to Thurgood Marshall
as
Sarah Polin is to Hillary Clinton

Re-emerging

Now the summer is beginning to fade. I have been away from everything for a while. We have been wandering around down here,taking time off. It was something I needed to do more than I realized. The last few months, with the back pain, with other vague but unrealized health worries, had put the focus on me much more than ever before.

With that comes the awareness that at my age sickness can lead to crumbling, can lead to being wiped off this planet. Isaac Hayes was just slightly older than me. Gene Upshaw was my age, so were abut twenty per-cent of the people on the obituary pages. It all kind of spooked me out. Me who is supposed to be so full of perspective and so calming.

I spent so much time thinking about thinking that it all kind of got to be a bit too much. I couldn't think about it any more. Who I was, what I was doing, what I want to be, how I want to spend the rest of my time, what is really important to me, all these things kept swirling through my head burning a deep hole but leaving no answers.

So we came down here, as we do every year. I thought I could use the time to get away, and maybe I could figure things out. Maybe something clear would emerge.

So far I've spent time hanging out with friends and doing things that take up time. Even golf. It's been very beautiful. The weather, the sea, the rolling green, the blue sky, the golden sun. The time has been easy, fun and even sociable.

Yet, there remains the vague feeling of something not yet accomplished. I have not yet mastered the art of just taking care of myself. Making deals and keeping myself entertained somehow just never seems to be enough. I'm not sure why.

Must be something my mother did or said. Maybe it was my father.

Still, I'm not sure what it is that I am expecting.

So today, after almost two weeks away, I am beginning to schedule appointments for next week. For the first time is six weeks I don't feel afraid of it. I am even just beginning to look forward to seeing everyone -- well almost everyone -- again.

Yet, I have decided that I need to re-allocate my time, find out what is missing, and what it is I expect to do, not just return to what has always been done and keep the ball rolling down the same familiar hill.

As I have said here many times, change is difficult. Even for me. Hopefully, this blog will help hold me accountable.

Welcome friend

Hey, it's good to see you.
I'm glad you guys could come on down to the little summer place again. Seems like we get to see more people here than we do at home. Have a beer, that is, if you're still drinking.

So, what ya been doing? What ya been thinking? How about them Sox? Going to fold again, like they used to?
How about the world, Huh? Ya think we're going to make it, as a society? This new guy, he says he's a citizen of the world. The old guy, he still wants to go to war. Hates losing, thinks it's a footbal game, except lots of people die,

The new guy certainly can draw a crowd. The old guy is starting to sound kind of mean and bitter.

How come nobody wants the rights to off-shore wind?

How come Boston spent $20 billion, that right $20 billion to dig a hole under the city for a road, which gets clogged with gas guzzling cars, when they could have had the best mass-transit system in the world? And don't tell me I just thought of that because I said this ten years ago, maybe twelve.

Do you think we might have an American society that cares about each other, or should we stick with each of us trying to be millionaires and trying to sell each other crazy mortgages, big cars, fatty food, questionable drugs, insurance that doesn't pay for much, and reality TV. Lindsey? Brittany? Paris? Laura?

Do you want your daughterto be Hanna Montana?

"Wall Street got drunk" the guy said. I wonder how much he's still ben drinking. that's his only possible excuse for fucking up the world so badly.

So, how ya been? How are the kids? Any of them working? Max is 31 and still trying to be a video game tester. He plays "World Destruction" on his phone while he waits for his latte in the bus station. And you say Maggie's pregnant again. Great, you like the other two grand-kids, that you are raising. Maggie knows who the father is this time, that's cool.

As I said, how about them Sox?

human brains, !

Our brains have evolved over hundred of thousands of years. This convoluted mass of protoplasm is one of the most amazing and complex structures that nature has produced.

Yet, in our present complex culture, some of the basic responses our brains have developed are no longer always adaptive. The process of deciding when to rely on the more intrinsic responses, and when to think about could be the best choice is a good deal about what therapy is about.

Example 1: Our brains have learned to size-up a situation quickly and choose a course of action. Is that shape a friend or a foe? Is it food that I can capture or a tiger that will eat me? The sooner you decide, and decide correctly, the better off you would be.

But, the world is more complex now. The person coming to meet you is a nice guy, but he wants something. There is now time to get more information. It can be harmful to take a position and stick to it as conditions change. You have to learn how to re-evaluate all the time.

Example 2: Brains have learned to take the short-term gain over the long-term. We act like we are rational and can plan, but under pressure we don't. There may be six antelope out in the field, but we will grab this one right here, even if it frightens the rest away.
So I said to him, "You're thirty-two years old and she is seventeen, how come you thought it was a good idea to have sex with her.?"
"Well, she was there, she made herself available, and it seemed like a good idea at the time."
AND it probably was a good idea --- at the time. But not ten minutes later. And now everything is a mess.

The Difference

This was an interesting week.
Last week I was away, lolling around, stretching, eating, making sure the tide ran on schedule.

This week I was back at work. It was interesting, and mostly predictable to see who had done what while I was away. Some people worked hard to make their lives better. They thought about the things we had talked about, they tried to make some changes. They are the ones who make this job worth it.

Some people worked hard, and thought about things, but are still stuck. Their attempts at changes, both internal and external/interpersonal/environmental, did not make much difference. I feel badly, because they are trying, and maybe I should be figuring out things better.

Of course, others did little. They came to see me again, and tell me the same stuff, with a few new excuses about why it was too difficult to take their finger out of their nose. "I know," I tell them, "life's tough, but, in the end, it's your life to do with what you will."

The differences between groups one and two is usually somewhat apparent. There could unmovable people in their lives, their may be physical impediments, or financial ones, or sometimes it is a real brain thing. But, there is a reason that I think I understand.

Why the folks in group three choose, and I use that word intentionally, to suffer, I don't know. Mostly, they don't see it as a choice. Usually, I do. Sometimes, I can see what the choice gives them. I try to change it, but I can't. Sometimes I really can't tell why they just continue to wallow in their own psychic mud.

The people in group three seem to love coming to therapy. But coming to therapy isn't going to make changes in their lives. They have to use what they get from therapy to make changes. Sometimes that's a tough sell.

really doesn't matter

Went to the beach at night
the 5/8 moon showing itself thought the mist
one star visible
the sea was calm, the waves rolling slowly and rhythmically
one after another, one after another
we are specs in the universe
untiled by our insignificance
yet, we are all we have
and only have it briefly

take good care of yourself

I hope you mean a lot to you

$600 an hour?

A friend sent me information about an article in the NY Times bout some NY therapists who get $600 an hour. The article talks about how some of those therapists get sucked into pander a bit to these clients. I guess if someone is going to pay you $600 an hour it must be tough to say things that might drive them away.

As hourly workers go, $600 is right up there. I know there are lots of lawyers who charge more, but most of those charges are paid by big corporate entities. The people who get really rich these days are the ones who can leverage their money, either through many shares of stock, or selling thousands of copies of one thing, form diet books, to hula-hoops.

I truly doubt that these therapists who are getting about 6 times what I get are not saying anything more pithy or life-changing than what I say. As most of you realize by now, I am one of the most skilled and effective psychotherapist on the planet. I just have chose to market my services in some average mill city in New England. I guess that's my fault.

I still have not caved in to the American ideal that those who have more money are worth more as people. I ma not impressed, much to my wife's discontent.

Not that I am against money. If someone wants to send me a check for all of these words of wisdom I'd probably cash it. But, as you can see, I give it away for free -- which either makes me dumb or foolish,

or else makes these words priceless.

obviously

We are down here near the water for the 4th of July. We saw some fireworks, ate some burgers and dogs and even watch families run relay races carrying eggs on a spoon. It couldn't have been more All-American.

Yet, today, being on vacation I had time to read most of the Sunday paper. I read how Americans have been unwisely using up oil since 1973 when the price started to rise. I read that job security has almost totally vanished in this country for almost everyone. That came as a result of the capitalism that also gives a chance to everyone to become wildly wealthy.

I read how global warming is causing extreme weather, and that is leading to crop shortages, and that already has led to wars, which will get worse in the future. I also read about how our health care system is a mess, and the only real way out will be to get a single-payer national system.

These things are obvious, and they all have been for at least twenty years, most for forty years.

What is also obvious, is that we are still spending billions of dollars to send young men across the world to kill people they don't know, for reasons that are unclear.

But it's tough to change things here in America, as it is anywhere else in the world.

Despite all of our freedoms, which are many, and which should not be taken for granted. It is certainly true that living conditions are certainly better and more free than they were two-hundred years ago. But one thing has not changed: people with money and power will not give those things up easily, despite how unjust the conditions that their holding on to their means of acquiring that wealth might cause. Just look at how difficult it was to get rid of slavery.

As one soldier fighting in Afghanistan was quoted as saying: "It's been true for thousands of years: old, rich, powerful men talk tough -- young, poor, strong boys die."

The Gloucester Girls

There has been a big to-do around these parts about several of the 17, sixteen year-old women of Gloucester, MA who got pregnant this spring. It seems that for several of them these pregnancies happened by design and not by the usual kind of lack of planning. The suspicion is that some of the women (girls?) discussed this and planned to have and raise their children together.

I don' know them or what they were thinking, but I do know that in my practice I see three families who have young women, 16, 17 and 18 who are pregnant and who are very intent of keeping their babies.

Now I am not going to enter into a debate about abortion. The point I want to make her is that these young women -- only one of whom has even briefly entered my office to talk about what is going on -- seem to have no real idea of what is going on.

None of them are in a real relationship. All of them have had sex with several different guys. None of the fathers of these pregnancies seem to be taking a real responsible role. One of them cares, one is trying to pull away, and the third father seems to be a mystery.

But, t think that these young women see getting pregnant as the only way they can have something productive to do after they leave high school. They are all from chaotic backgrounds. None of them have had a real or substitute father around for years.

From what I have seen or heard of the women, they could be smart enough to put another kind of life together, but they really either don't know how, don't have the confidence, or don't seem to want to go through the long struggle to get educated, employed, married, settled and give their children a stable home.

In their simplistic form of thinking they feel they can work it backwards. If they have a kid, someone will provide a home, an income, and maybe even a partner.

I don't know. They're not talking. I'm not even sure they are thinking. But I do think it is a refection of what it feels like to be on the losing end of a very competitive, winner-take-all society.

more than diet and exercise

To me, as a psychologist, when I talk to clients about changing their life-style, it means much more than diet and exercise. The most important thing to me is for people to find ways to find comfort and eliminate stress.

This means more than deep breathing.

From my biased point of view, the best thing anyone can do is surround themselves with good people. That means people who love them, support them, and respect them. It also means that those people have the same expectations of you as you have of them.

Freud, who I don't quote too much, said that to be healthy you have to be able to work and love. I agree with that. Now, working may mean that you take care of kids, or a house, or just simply have found a way to pay your bills and be independent. Loving means that you can maintain a long-term relationship that is mutually rewarding, enriching and beneficial.

If where you work and the people you have around you constantly cause stress, aggravation, conflict and tension, then you won't do too well. You will get worn down, and have symptoms.

I realize that we can't all have control of who our families are, who employs us, and whoever else rambles into our lives and causes havoc.

The world now is full of paperwork, emails, computer menus, late fees, pre-authorizations, user fees, war and salmonella. In addition, our relatives (everyone has them) are angry, depressed, jealous, resentful and/or incapable.

So, making a life-style change can be very difficult, especially since you can't go around shooting people any more.

Even for me, to cut down the hours I spend sitting so that my back gets better, has not been easy. It should be, but it isn't.

But, I will get up from the computer now and stretch.

wholistic conclusions.

Now that the pain is almost gone, just a few tingles left, I have again realized things that I have known, but have been under a great deal of pressure ignore.

That is that treating symptoms, which is what modern medicine is geared to do, even including psychotherapy, is more often than not, a circular waste of time.

My pain was terrible, although I know others suffer much worse, as plain old Aleve was somewhat effective. My first priority was to get rid of the pain. Nothing can be achieved when the pain is so distracting.

But, if I want the pain to stay away I have to make many changes. What happened to my back took twenty years, and if I don't want it to return, I will have to make life-style changes.

My pain was the result of a knee injury, that was treated only as a knee injury. It was made worse by how I continued to play, work, work-out, sit, drive, sit, walk and sleep.

Yes, I can take steroids, pain-killers or get surgery, and treat the symptoms, but if I do that the symptoms will reoccur sometime after the treatments are over. That's because the problem of my out of line muscles and ligaments won't really be fixed.

If I stretch, walk, work-out differently, don't sit nine ours in a row with only five or ten minute breaks, don't slump over a computer when I'm not sitting in therapy, I can change my body and make it healthy.

As a therapist I know this is true too. The symptoms I see, such as anxiety, depression, panic, lack of energy, lack enthusiasm, drug abuse, impulsiveness, temper tantrums, and alike are all symptoms of problems that usually, not always, but almost always, require life-style changes.

That takes a lot of work; a lot of consistent, sustained work.

Insurance companies don't like that. They want us to pick a symptom, treat the symptom, and go on to the next case. That is cheaper in the short run, but it only means that people will soon be back with new symptoms and the same situation which has become worse.

This is true of many, many conditions: obesity, diabetes, high blood pressure, irritable bowel syndrome,colitis, even many forms of heart disease and some cancers.

But medicine doesn't work that way. We are expert at treating symptoms. The problems often remain, the symptoms reappear. The treatments continue. Many drugs are designed to be taken for the rest of the patient's life. That way the symptoms are gone and some people make a lot of money.

We are even worse at prevention.

Pain 4

Well, it's finally breaking up. The pain is abating, some flexibility is returning, my outlook is improving and there is hope on the horizon.

What is disappointing is how difficult it was to get real help, and how, in the end, I had to find it and do it myself.

So many people my age have been through this sciatica thing. Everyone has their own cure. That's mostly because, most of the time, it goes away by itself. So whatever anyone was doing at the time was what they believe in.

Because I always worked so hard to keep in shape, I really set myself up to be locked out of shape once my body shifted. I actually have spent about 20 years setting this up.

But getting help was not helpful. No one really looked at the whole picture of who I was,and what my muscles, ligaments and bones were doing. What I did for work (sit a lot), and how I worked out.

The doctor (MD) used "evidence based medicine" and recommended for me to follow the course of what most people would need. Unfortunately this course would be very slow, very expensive, involve a dozen different people, and then end up right where I am now-- stretching.

The chiropractor said rest, ice heat, which was fine in the beginning. He couldn't move my bones though, because the muscles were too tight.

The message people were great, but I can't get a message every day. They found the problem, but really didn't offer a solution.

I found all the stretches on Rebuild Your Back.com. I am doing 7 stretches 5 or 6 times a day and it works.

So, I am getting my life back. I have cut my schedule of clients 10 to 20%. I am trying not to get back to the 115% level that got me into this in the first place.

But people keep calling.

I guess they think I have something to say. Or else I just listen really good.

pain 3, the doctor

So, after suffering too long and trying alternative solutions I went to the medical doctor today. I haven't been to a regular doctor, except for my eyes, in years, so this was a new guy in a big medical complex.

He was easy to approach, thoughtful, and reasonable. He did a few pokes and squeezes and twists and agreed that yes, I had sciatica. He said it has lasted a bit more than normal so that isn't a good sign. Then he wrote orders for tests.

I left some blood there at the lab, so they can see if I have cancer, and then I'm supposed to get an MRI. I buy my own insurance and have a $2000 deductible, so this will probably eat all of it up, especially if I get the MRI, which they said is about $1200. In Taiwan an MRI costs $125. I will have to pay for his insight, for the lab, for, and later for the guy to read the MRI, then the new people at the back clinic, and then the Physical Tx people. by then it will be over $2K so I will only pay 20% or something, who knows.

But the medical alternatives seem to be drugs and/or surgery, and I'm not keen on either. He offered my a few drugs to control the pain. that was friendly, but they are not the kind that will dampen the inflammation and heal the problem. They are more the kind that many of my clients try to buy on the street.

He also offered me anti-inflammatory meds, but said it would be cheaper to just triple my doses of Advil.

So, I'm taking more Advil, I will give the acupressure guy and the chiropractor another week to work magic or else I get the MRI and enter the medical world, but I am very reluctant to do so. I guess, as a psychotherapist I remain an "alternative" kind of guy.

For now, I am back to my favorite weekend medication, which is Jamison. It doesn't do much for the future, but it makes the present brighter.

Everything in moderation!

pain 2 -- loss of arrogance

I didn't really realize it before, and I'm kind of startled by it, but now that I am going through this pain thing, it's become clear.

Part of what I've learned is how, as a therapist, I've been carrying around an underlying arrogance, and I don't think that's a good thing.

But somehow, even though I have even posted here about how aware I am that one slight random event can completely change your life, I guess I never really thought that would be me. Yes, I was grateful that nothing really terrible had happened to me, but like most people, I attributed it to my own abilities, foresight and planning.

Yes,I am a good, caring and understanding therapist, but I also always somewhat, put on a very subtle display as having a good life. I was in shape, I was financially sound, I have a long-term marriage,and my kids are grown and doing pretty well. I was not yet rich and famous, but perhaps that would come too. I guess, in some ways, I felt I was a good model. But it was also a kind of arrogance. Kind of "see, I can do it, you should do it too -- maybe not just like me, but like you want it.

Now, I've been in pain for six weeks. This is the kind of thing that is common, and happens to everyone, but it still isn't really over, and it has been very limiting and debilitating. Now, I can show that I can stand the pain and the adversity. I have many clients who have much worse and more chronic conditions, but I am still in the midst of mine.

And I don't like it. it sucks, I'm sick of it.I'm getting treatment and improving, but it's slow. I get worried that it won't end, I get tired and irritable.

The severity of what I am going through is also partly my fault because I don't ask for help. That's part of the arrogance. I had always worked these things out myself. A few pills, ice, stretching. So, I just kind of denied, or hid the problem. That was part of the arrogance too. I caoul handle my problems myself.

So, now I'm finished with that. I'm going for help wherever I can find it.

Anyone who can push the magic button will get a big kiss.

They say it will take time. That's what I say to all my clients.

But this is America -- I want to be better now.

pain 1

Wow, it's been a month. That's quite a while, even for a fading blogger like me.

Well, there was a reason, pain. I have this sciatica thing, pain, running right down my leg. It's mostly better, but it's still there. It makes it difficult to sit in a chair and type at a computer unless I sit exactly right.

I have learned a lot during this month, about myself, growing old, living with pain, and how I react.

I don't like it, this pain thing. I don't recommend it as a learning experience. But it seems now that I will survive.

It has given me insight into some of my clients, and into how no one can really tell how much pain you feel. So many people I see in my practice are sent to me because many doctors feel these people are in pain, but not THAT much pain. It's very difficult to tell.

Some people want drugs, some people want attention, some people want excuses. But many are just in pain, and it kind of sucks.

I will have a lot more to say about this. I've got to stand up now.

The way we are going

They are making artificial blood, but it still kills too many people.

There is an artificial heart, that works for a while.

Artificial skin can be used in some circumstances.

There are many examples of artificial limbs that work well.

Lots if artificial hair.

Silicone breasts

redone noses, faces, lips, chins,

artificial hips, knees, shoulders.

Brains?, well not yet,

BUT

in Switzerland there is a company that has linked over 2000 IBM microchips that can handle 22.8 trillion operations per second. Each is supposed to represent a neuron and the hope is that this will mimic brain functioning, and with enough electricity swarming through it they hope it can generate a mind.

I hope it has good parents.

a Really Great (Great) Grandfather

T was talking about his father, which is something we often do in therapy.

His father was was in and out of his life for many years. T was most raised by his grand-parents. His grandfather was caring, but a bit too harsh.

Then T began to give more a a family perspective about what was expected of the men in his family. He said a lot began with his great-grandfather who was rich and owned a lot of land, and people usually did what he asked.

I guess that was true of the women too because, T went on to say, his great-grandfather had 42 children, with at least 17 different women.

That sets quite a standard for the men of the family.

my old brain.

So, it is finally Spring here and everyone seems to be outside doing all kinds of rejuvenating stuff. How can you live in California without Spring?

I'm taking a walk around town, just checking everything out and I pass a window with the shade drawn. Before I realized it I was singing "All the shades were pulled and drawn, way down tight." Those words are from a song called "Silhouettes" which was very popular when I was probably in Jr. High school, and that was a while ago.

The words just flowed out. I must have remembered about 90% of them correctly.

Is this a good thing and I have access to a good memory, or am I getting like my father-in-law and I don't know what decade I'm living in? Hard to tell.

I know that music helps connect everything, so that with the tune, it is easier to remember the song as one until.

It is even more true that when there is emotion connected to something the memory remains stronger ( although not necessarily accurate). There certainly are a lot of emotions connected to Jr High love songs.

Anyway, I also remember that the song was sung by The Rays, and that about month later a group called The Silhouettes came out with a song that also hit #1 on the charts (Do they still have charts?) That was called "Get a Job" a refrain I still sing to several of my clients.

old brains

We often go and visit my wife's father. He's going to be 94 soon. Until last year he was doing pretty well, but last spring he contracted pneumonia and, although he recovered physically from that, it seems the stay in the hospital knocked out his mental equilibrium.

Now he often doesn't know what decade he is in. Often he is 16, back in the town where he was born, looking for his neighbors. Sometimes he is fifty and waiting to be picked up to play golf. There are lots of other disorienting things. It's sad that brains tend to shrink with age and then confusing things happen.

Would it have been better if he stayed more involved with others and had more interactions to keep him alert? He was never that naturally social. His wife did all the arranging. Once she died he slowly withdrew.

But, I don't know. He's 94. What can you expect?

At the doctor's recommendation we gave him Zoloft. We gave him one pill at a sub-therapeutic level to try it out. The next night he was up all night making phone calls, mostly to people who had been dead for twenty years. He called 911 because his wife was missing.

We didn't give him another pill.

Really, he should come and live with us, but we have too many stairs and we are not home enough. (I'm saying this just in case my kids read this.)

At 93 I'm buying a motorcycle. If I remember.

Irrationality

A couple of weeks ago I spent a day down at the Tech School where I got to see some terrific stuff they are trying to put together. They had robots with cool eyebrows, and big 3-D models of ho my opinions differed from everyone else.

The main speaker was Dan Ariel who wrote a new book about how people really don't make rational decisions, even about money.

So, I went up to him and I said "Duh."

And he said that economic theory is based on the belief that people are rational and will act in their best interest.

Like who they allow to beat them up when they're married I said.

He looked at me kind of strange and worried.

So then I said, like trading Credit Default Swaps.

Then he knew what I was talking about.


Dr. Phil tells people, rationally, with common sense, what they should do.

Nobody really listens to him either.

But he made $96,000,000

and he doesn't even have a license.

Here they come again

Here is the real problem. They call themselves "Health Care Companies" or health Management Companies" or some other misleading euphemism. But the truth is they are financial companies. So, when they come after me and tell me to fill out their Patient Outcome Management Forms, of their Patient Wellness Assessment Forms, or TOP Patient survey, I get upset.

They tell me that they are trying to help me make clearer diagnoses. Or they tell me they are trying to help their subscribers find the best clinical matches. It's all a lot of shit.

All they are trying to do is trying to find ways to justify their existence AND to pay us less.

Two of the major conditions necessary for successful psychotherapy are trust and understanding. I don't trust these companies, and I don't think they really have any understanding of what we do. I don't want their "suggestions" of how I should do treatment. If they know hoe to do it they should be out here doing it. Their suggestions don't come from any research that I respect. The symptoms they want me to treat are not symptoms that I really care about -- they are symptoms, not the problem.
They will go away when the issues are addressed.

But now it is fashionable for each company to begin to make their therapists accountable and monitor their effectiveness. Except they really don't know how to do that.

It's all about the money. They've collected it from the subscribers and they don't really want to give it away to us, the care-givers. An adversarial system of health care is never a good one.

worse than it is

Today is Monday, and somehow on Monday I see some of the most difficult, most chronic people that I have to deal with.

I have been practicing in this city for twenty-seven years. I began here the month after John Lennon was killed, so it's easy to remember.

In a practice like this each year I see between 150 or 175 different clients. Usually, about 50 to 60 get carried over to the next year. After 27 years I have learned that the average length of time that anyone spends in treatment with me is bi-modal. It is either six months or eighteen months.

But every year I get one or two people whose lives, or whose minds, are a mess. They stick around for a while. After a while they begin to accumulate.

Today it seemed like everyone I saw was someone I had seen forever, and that I would see until the day I died. But that isn't true.

I checked my records and found that of the 66 people I have seen this year 17 of them I have seen for five years or longer. That is 1/4 of all the folks I see. By the end of the year I will have about 100 people will have finished therapy. But not these folks.

I checked further and noticed that five of those 17 people account for 58% of the phone calls I get.

They are troubled, in constant crisis, some are more than a bit narcissistic, need guidance, reassurance, attention, and seem to have some sense that having a therapist means having a super-mother with a huge breast.

It is these people that have driven some of my colleagues out of business.

I try to set limits. They now know that just because the leave four messages doesn't mean they will get a return call. Life goes on.

another angry client

I have been seeing Mary for a long time. She doesn't drink much anymore and she hasn't been in a fight for a long time, but she is still an angry woman.

Almost two years ago I began to see another woman, Kate. Kate had led an interesting but pretty difficult life: Her mother was a drunk and her father walked out on the mother and three young children. But Kate had survived this, and several other terrible times, with humor, persistence and the hope of a decent life.

About a month ago Kate left the man she had been living with for the past fifteen years. She realized that she had spent all that time waiting on him, spending money on him, listening to his complaints about the world, and protecting him from the consequences of his own actions.

Two weeks ago Mary came in to her session roaring at me. How could I do this? Do I ruin every one's life? Who can believe that therapy does any good anyway?

It turns out that the man Kate left is Mary's brother. Mary took that as an affront to her whole family -- although she had always said that the members of her family where selfish, useless, and dishonest.

What Mary is really angry at is that she knows that Kate will have a better life. Things will still be tough for Mary, and now her brother will be looking to her to help do all those things that Kate has always done for him.

Some guys are like that.

The Beatles were right

I have been seeing Jake for almost a year. He really struggles with anxiety attacks, especially in social situations, and with bouts of depression. Sometimes it got so bad he would be crying and hitting his head as he drove home from work.

He is about 26, and has been suffering since high school. He has friends, he has a pretty good job, and he functions, but he was not happy. He was often miserable. He has tried several medications and some of them would help for a while, but he couldn't stand the side effects. He settled on a mild anti-depressant, that maybe helped a little.

Because of his anxiety Jake has felt most anxious around women. He had hardly dated, and that made him feel more like a loser. He had a brief relationship with a girl when he was in high school, but that ended in disaster. There was this one other woman whom he liked, but he was never sure if she like him so he was afraid to pursue her.

For weeks that was part of what we discussed in our session. Finally, he understood that maybe she was waiting for him to show he was interested before she would show him that she was.

Well, that turned out to be the case. This woman, who does seem to have her own issues, has been keeping her eye on him for two years, hoping he would approach her.

Now, two months later, they are seeing a lot of each other, and they have some kind of understanding that they are a couple.

Jake is happy, and happy in a way that he has never been. He feels like he a a part of the world. He is hardly anxioius and not depressed. He gets out of bed, goes to work and smiles.

I don't know what would happen if she changes her mind, but that doesn't seem imminent.

Love is the answer: the healer of all wounds, the source of all hope, the force that parts the clouds and brings out the sun. The Beatles were right.

they had sex with other people

After poor governor Spitzer went down in flames it seems that it has suddenly become very trendy for people of note to go public with the fact that they have had sex with people other than the ones to whom they are married.

This comes as quite a surprise -- but only to people in this country.

America, born from the Puritan Ethic still can't seem to admit, openly, that most people really like to have sex.


Sex is programed into our genes so that we can keep the species going. Over millions of years we have evolved to really like something that is really necessary. If sex was like taking out the garbage we wouldn't have 6.4 billion people in the world.

Sex strengthens the bonds between people, it enhances self-esteem, it is a great tension release, it promotes harmony and it feels really good.

Most people, but especially men will not turn down an opportunity to have sex, unless the fallout is really negative.

The fallout is often negative, which is very good for my business.

I can't remember the source, but someone read a quote to me recently:

"The most powerful people in the world are rich while men and beautiful women."

gone

Rarely, but sometimes, things get a bit scary.

I am working with a woman who I have seen for a long time and she is doing very well/ But still, at the slightest mention of the wrong thing, she will dissociate. She really, really goes away and isn't there.

It can happen in an instant. Her lip curls, her brow knits and her eyes glaze over and she doesn't hear or respond for anywhere from thirty seconds to two minutes. She says that if it happens at home and no one knows what to do she will be "away" for much longer. She really can't tell how long.

She says it feels like she is floating out there. She can't feel her body and she really can't control her mind, or tell me where she goes or what she is thinking. She just goes away.

I can bring her back slowly, but she is exhausted. She says her body stays numb for a while, she cries, and then she get very angry.

She knows what it relates to, and we can see what triggered it afterward, but the trigger can seem very remote until we look at it.

Such a strong reaction makes it difficult to work on the underlying trauma because the mere mention of thinking about working on it can be the trigger.

Thankfully, otherwise, she has worked very hard to put together and maintain a successful life.

I have a great deal of admiration for her

away and back

I was up in the mountains for a couple of days, hidden from the world surrounded by family. I was without the computer and even out of cell-phone range, being on the wrong side of the mountain.

It's tough to read the paper after that. I see that people are still very involved in blowing each other up.

I spend hour after hour trying to move people, one at a time, slowly in a direction that will improve their lives. But the tide is always running against them. And then we have a leader who makes jokes about how the economy is going through kind of a rough patch, and the future of the war is kind of hazy, and he giggles and dances as if he has done nothing that could upset anyone.

We have the reformist governor who spends $4200 for some kind of sex. Led slightly astray by a bit of lust. What kind of people are running the show here?

But at least we don't have suicide bombers. I'm sure we do suicide missions, and assassinations, and torture.

I have a client who whines because everything has been done to him, which may be true, but that's no excuse. Everything is being done to all of us. We live in the best time there every has been to be alive. You just have to ignore that 40% of the world lives in extreme poverty and several groups are still intent on slaughtering several others.

That's just the way it is.

Then he said

Harry came back to see me. I saw him for a few months last year, and about three years ago I saw him for a year.

Harry is a major vice-president at a company you would recognize. He comes to me because he gets stressed out, and we have to keep on eye on his drinking. He also worries about having another marriage fail.

But Harry is obviously smart, alert, and does well with people. He didn't get where he is because his father owned the business. He knows how to deal with the world.

As the session wound down Harry began to tell me about things he's been reading and thinking about. He talked about new DNA technology, which is something I follow pretty closely. But slowly the thread of his conversation drifted and soon he was then telling me that he is convinced that part of our DNA has been improved by mixing with space invaders. He went on to say that he thinks he has met some "helpers" who have come from other galaxies, and that they are really all around us, just waiting for us to ask for their help and guidance. Earth is really just a big laboratory to them.

"That's not how I interpreted the data," I replied.

marathon

Back in the office. Tuesday and Wednesday were full days. In ways the vacation was really good, but in other ways it makes it difficult to miss a step in the process. Therapy is usually done a week at a time, and for me, after things are moving I often shift to two weeks.

But therapy has a rhythm; it is slightly different for each client, but they fall into it. Each person can only tolerate a certain level of working on each obstacle, each person will change only so fast, and unlike the TV show, the change is usually slow.

By Thursday I was feeling roughed-up a bit. I was still a bit jet-lagged. Still waking up too early and fading earlier than usual. I knew going in I had ten appointments and I didn't know how I would hold up. People kind of get offended if you fall asleep in their session. (I've only done that once, and she was really boring and I was taking antihistamines).

But I saw my first appointment and she was struggling with the similarities between her husband and her father, and soon she was crying. My second appointment just came back from his mother's funeral so that was very busy, and then, suddenly it seemed. it was seven o'clock and I had only hour left to go.

It's like basketball, or marathon running; you can get in a zone and things seem more intense, and it's easier to focus, and you feel like you know exactly what you're doing.

When people ask: "How do you stand to listen to every one's problems?" I try to tell them that it's not like that at all. It's like being handed a different puzzle every hour and it's your job to work with someone you like to try and put the pieces together. It's fun and it's fascinating, especially when it works.

But then I came home

The trip was good. It really cleared my mind. I was out of range and out of touch. I don't have a Blackberry and I only checked email once.

Most people go for outer warmth, but we went to the land of drizzle and mist, where the sea crashes against the rocks and cliffs, but once you open the big wooden door all is warm and welcoming. You sit down, have a pint, listen to the fiddle and there is good craic.

During the day we saw the castles and the ruins, and the Tidy Towns with each house painted a different color. At night we ate fish and potatoes or lamb and potatoes, or fish and potatoes or lamb and potatoes. My wife had the chicken. A question is answered with a story.

Then we flew home.

I checked my voicemail and had 99 new messages. There would have been more but the box was full.

Thankfully, 19 were hang-ups, six were from Jake who was telling me how each person in his life had done him wrong, and fifty were from L, who chronicled each time someone broke into her house, stole a carrot or some coffee, removed a stitch from her sweatpants, scratched a bracelet, used her make-up, tampered with her phone, turned down the volume on her DVR,or replaced the left shoe of the pair she just bought with one that was slightly smaller.

I had told her to keep a list while I was gone, so as not to fill my mailbox, but she could not restrain herself. When I called her and complained she said she was sorry.

Half of the remaining two dozen calls were from insurance companies or lawyers seeking information that I won't give them, the other half were from old clients seeking new appointments, and some new people too.

I should be all caught up by April.

It's always good to go away.

lawyers came and went

So the lawyers came. I told them not to, but they did.

Two of them drove three hours to my office to talk about a a client who had been in a car accident that no one saw.

They asked me if I believed her version of what happened. I said I accepted what she said. They asked me if I made any attempt to verify anything she said. I said, why should I?

They said doesn't the truth matter?

I said, she is my client, to me it is her truth that matters. When she came to see me I told her I wasn't about going to court. If she wanted to learn to deal with the pain she said she felt, and the depression, and work on getting back to her job and her life, then fine. I would be her therapist.

I told the lawyer I had been her therapist, and now, two years later,four years after the accident, she is back at work and I had not seen her for six months. I felt I did my job.

They asked me if the accident was more of a factor in her depression than the terrible divorce she went through two years before the accident.

I told them that she felt she got hurt in the accident and the pain kept her from working. She fell into debt and got depressed and overwhelmed. But, if she hadn't been divorced she wouldn't have been driving there to meet her new boyfriend. But if she never married that abusive first husband she wouldn't have gotten divorced. But if her parents had not been fighting so much she may have taken more time to consider whom to marry in the first place.

That's what I think, I said.

The lawyers left. But they paid me first. I don't think they will come back soon.


Anyway, I'm off for a week to find someplace a bit warmer.