Sunday, December 28, 2008

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.

Thursday, December 25, 2008


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!

Saturday, December 20, 2008

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.



Sunday, December 14, 2008

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.

Friday, December 12, 2008

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.

Wednesday, December 10, 2008

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.

Thursday, December 04, 2008

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.

Tuesday, December 02, 2008


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.