Saturday, December 25, 2010

Greetings of the Season!


I hope all of you out there in the blogosphere had a happy, healthy, joyeaux day celebrating whatever you choose to celebrate.  And here in the US of A we celebrate the joy of allowing everyone to choose what they celebrate.

Health and Happiness
       Peace and Prosperity
            although it still seems to be that too many people feel that the last two are antithetical.

Still, I do hope that you are all enjoying the day, and hopefully the rest of your lives, and not creating too many problems for your therapists.

I leave you with this greeting:

As soon as you realize that almost everything people act on is irrational
   Then human behavior begins to make sense.

Love and Kisses of the Season.

Thursday, December 23, 2010

A wrinkle in time

She is the fourth of six children, all girls.  What is worse is that, in a rhythm of brilliance, her parents decided that each girl's name should begin and end in A.  Alicia, Alexia, Aurora, Ava and the other two. it gets confusing.  But you know, things like that are not a helpful beginning.

And then, when the youngest one was about four, the father dropped dead. Also, not helpful.

About three months ago she came back to see me after an almost two year absence. 

The first time I saw her she was a real mess, just not functioning.  Her husband had left her, she was crying all the time and she began collecting things.  She was collecting things that had been discarded and was creatively finding a use for them. But she was not keeping up with the creative part.  However she could not part with any of the things she had collected.  She identified with all of them, as something of value, which had been discarded by someone who didn't see the value.

Slowly she responded to treatment, which stopped when she pulled herself together enough to get back to work. That was good.

But now she is back, and wants things to be better.  Now she is 62 years old. She cries. Things are bad and she doesn't know what she did that was so wrong, or what she can do about it now.

When you see her now she looks like an attractive, middle age woman.  She dresses well, she even carries herself well.  What you don't see was that twenty, thirty, forty years ago she was really quite beautiful.  You would unconsciously pick her out of a crowd and watch her walk by.  Many people did.  That was part of the problem.

The other part, of course is that after her father died her mother was overwhelmed, so she just screamed at all her girls and beat them down. Literally if necessary. So this woman learned to hang back, stay silent, and wait until what was expected of her was clear. When someone told her what to do, she did it, as long as they didn't get angry at her.

That made her vulnerable to people who came along,  who were attracted to her, and began to possess her and control her.  Her first boyfriend tried to keep her out of sight, as he knew everyone was after her.  When she got away from him the next one was nicer to her, but also very controlling.

Finally she settled with an older man who seemed to appreciate her.  He was wealthy and seemed to feel that she was a symbol of his success.  He took her places and showed her off.  She was well taken care of.

But then she had children and he had little time for her and them.  He was out in the world making money. She soon realized that he was spending time with younger, beautiful women too.

So she went to work, but never really felt that she was smart enough.  She had the sense that all of the doors opened for her because she was so attractive. But she really didn't think about it.  That's just the way things happened.

Eventually she was having a long-term affair with one of her bosses.  He was good to her, just like her husband was good to the women he was with. They were rich.  They sent their kids to prep school.

At some point her boss' wife left him.  She thought this was her chance to change partners and have a good, real life.  But that was not the case.  After a year or two of promises that man married another, more dynamic woman.  She was devastated. She was devastated, angry and depressed. 

She went home and confronted her husband about their marriage, about how there was no relationship, how it was really a sham.  He agreed.  She though he would want to make it better.  She was wrong.  He left.

But she still had her job, even though she tried to stay away from her boss.  But about a year after his new marriage he came to her and suggested that they rekindle their affair.  When she refused him, saying how worthless that idea seemed to her, he raped her. 

It was soon after that  I saw her the first time.  As I said, she was a mess. It took her months to tell me about the rape.

Now she has a much smaller job and has a boyfriend who is a nothing and does not treat her that well. Her kids are distant.  He ex-husband is wealthy, alone and alcoholic.  She has no idea what happened to her ex-boss, but she knows his business is closed.

But now, for the first time, after 62 years, she feels almost ready to make he own decisions.  She wants to learn how to decide what she wants to do, and not expect other people, men, to do it for her.  She wants to tell the people she doesn't like, who take advantage of her skills, charm and passivity, to fuck-off.

But she's never done that.

But perhaps now she will be able to do that.  She is not that beautiful any more.  The people who are trying to control her are not that powerful.  She may be able to set herself free.

Monday, December 20, 2010

3 directions at once

If you let it; if you don't push hard to make your own way, the flow of life will take you in certain directions.  I tell this to my patients all the time.  You have the "will" and the ability to push back, and make things happen in other ways, but there is a general flow to things that will happen naturally, just because of age, place and other external circumstances, and they exert a constant pressure to make things happen.

(as an aside--- I can remember walking through the streets on NYC when I was an impressionable, philosophical thirteen year-old.  I looked up in the sky and saw the words "Time" and "Life" flashed up on the top of a huge silver building.  For an instant I thought, wow, this city really wants you to stop and think  about what is going on in your life.  But the next thing that flashed across the sky said "Sports Illustrated" and I realized that they only wanted me to buy something.  I have been aware of that since then.)

As I reach this stage of my life I find that I am letting things flow, and the current is pulling me in three directions.  The first, and newest, is that I am aware of how much time I spend thinking about my granddaughter, and how different it is from how I thought about my children.  As a new parent you have to watch the kid moment to moment: to feed it, change it, watch it sleep, breathe and to wander what it wants and needs right then.  That's what parents need to do.

As a grandparent I find that I keep wondering about my new off-spring longer-term.  I think about how she is now, tiny and cuddly, and how much that will change so quickly, and I find myself considering all the possibilities, good, bad, marvelous and indifferent. What will she encounter and what choices she will have to make?  What will be the world that she will deal with.  With my own kids it was certainly moment to moment: deal with feeding, deal with sleeping, deal with sounds, words, sitting, crawling, walking.  But now I wonder about things that this girl will encounter, probably long after I am around for her to tell me about them.

In the meantime my life is beginning to change in other ways.  I will soon reach an age when, despite Republican opposition, I will be able to receive checks from my government just for staying alive, whether I work, pay taxes, or just decide to watch "Housewives of New Jersey."  The money is nice, but it really isn't a deciding factor as much as it is a demarcation of time.  It is time to alter my schedule after thirty years of coming to the same city and sitting hour after hour,  looking people in the eye and asking them "what the fuck did you do that for? You nuts or something?"  I am being pushed, by my granddaughter and others in my family to use my time and energy to explore different things. 

In theory this is a good idea, in practice, it is very difficult for me to not take new patients, and to not feel guilty about that.  I am supposed look around and find new things to do, and there seem to be so many, but I have to learn to let myself do some of them.

I intend to do some of this over the next six months.  I am trying to challenge myself to do interesting, worthwhile things, while not stressing about it.  I hope that they are very different from the things I do now.  I really hope that they don't involve "helping people'" which is what so many of my friends who have worked other jobs all their lives are trying to do.  I feel I have done that for forty years.  I want to learn to waste time.  Not easy.

But still, after I type this, I am going to work.  I will see a row of patients who I want to see, each of which is struggling in their own way to get through this holiday season.  I seem to be of some help to all of them, as they keep coming -- and none of these people need letters send to anyone. One has lost his job and is having the first rough holiday ever.  Another is now estranged from her family for very good reasons, another has a very sick child and a husband who is freaking out because of it --- on and on it goes.  I am still very into that, at least once I get to the office.

The biggest change is now the contrast between working and not working.  It is a bigger transition from thinking about my family to getting my head back into work. The world is opening up.  The river has divided into three broad streams and each seems to be going through the rapids.  So far I have been able to steer clear of the rocks.

Tuesday, December 14, 2010

I am an excuse

I still take a few hours away from tossing the sleeping child around to keep my practice going.  It is the holiday season, and who would want to miss hearing about all of the family dramas that occur this time of year when families gather to rip open old scars, and bleed out of old wounds.

But before I get into tales of toppling Xmas tress and inter-familial lust, I want to comment on a phenomenon that has been rapidly increasing:  that is how people and agencies use me as an excuse.  I find that in the last two years I have been writing more letters for people than ever before.  Having a psychiatric diagnosis, or being in therapy, can open doors to more services, or close doors to scary places.

I write letters to probation officers, to tell them that their wards are benefiting form "Anger Management." I also write letters to the court  for people who don't feel they can serve on a jury. Panic attacks or PTSD, will certainly free you from that civic responsibility.

I write letters to allow undergraduates to return after a semester of bad judgement -- drinking, fighting, stalking, missing classes, leaving classes, not finishing assignments.  These lapses can all be forgiven if you have ADD, depression, panic attacks, a substance abuse problem, an anger problem, or just "problems."

I write letters to get people out of work, and then get them back into work, using pretty much the same letters I use for people going to school.

With the terrible job situation, more people are applying for disability, because really, there are no jobs that many marginally adjusted people can cope with these days.  Car mechanics, laborers, and other semi-skilled or unskilled work has become mush more complex and much less available than even fifteen years ago.  Machines can do most of what people had once earned $12 to $18 an hour to do.

In many ways these schools, agencies, institutions and individuals are all just passing on the responsibility to me.  No one wants to make a decision about who is just not acceptable, or who can be re-classified as "unable" and therefore reap some kind of benefit.  I don't really get to make that decision, I get to be the cover for it.

Usually, I make a concerted effort to give as accurate and descriptive a summary of what the person's strengths and weaknesses are.  With that, the person receiving the letter has to decide what is acceptable.
Often, I feel that I have to make a strong case for someone whose difficulties are real, but may not be obvious, since psychological problems are not as visible as shattered knees.

But really, these are philosophical issues involving the question of "free will," although no one wants to acknowledge that.  I am being asked to determine if this person "can't" do something, or if they simply "won't" do it.  Will they be able to do so later, or will they never get there?  Could they do this last year, so why can't they do it now, or could they never do it and they need help?

These are very complex, and the judgements are based on very subjective evidence.  The definition of terms, the clarifications of circumstances, the delineation of expectations, and the understanding of capabilities all come into this determination.

Most of the letters consist of about three to five sentences.

I try very hard not to let people take advantage of me, but then again, someone who puts in that much time and effort to fool their therapist probably has a problem.

Wednesday, December 08, 2010


There really is so much to write about, as parts of the world seem to be falling apart, while parts go blithely along, seemingly unaffected, even though they too are being corrupted.

Having a warm, round, large cheeked, snugly little thing resting peacefully between my shoulder and my neck not only takes a lot of time away from blogging, but puts everything in a new perspective. Watching the formation of one's own next generation makes me sad about how little really changes in the relationships between states, and between individuals.  Just when I reach the stage where it all seems like a performance piece that is done solely  for my entertainment, I realize that this little lump in my arms has a good chance to be here at the turning of the next century, and that will be long after Medicare, Social Security, and Afghanistan have used up all of the available money.  There is no certainty that any of those problems, as well as what to do about energy or the air we breathe, will be settled by then.  The solutions our generation seems to come up with has been to make a lot of noise, have blustering confrontations, often using guided bombs or suicide bombers, or just radio and TV rhetoric, and then actually do absolutely nothing. We do seem to be able to blame the Democrats, Republicans, Koreans, Chinese, Palestinians, Israelis, Iranians, Muslims, Jews, Irish, Swedish women who consent to sex and then change their mind.  Wki-leakers, Wike-pee-ers, the rich, and the poor.

Of course, all of the above are to blame, but no one seems to want to be part of a solution.

Handing all of this off to this little pink lump does not seem to be the way I would like to be remembered, especially if in seventy years she is left to breathe through a mask and shift through the rubble.  But my standing on the street corner yelling as loud as I can will not really effect much change, as those places are already full, as are most of the airwaves and  and millions of virtual bullhorns. 

The best I can do for now is to give her comfort, make sure she knows she is loved, and make sure she learns the value of peace, love and understanding.  She also needs to know how to work hard, and have fun.

But right now, when it's my turn, I will hold her so that her mother can take a shower and her father can sleep.

Wednesday, December 01, 2010

Cycles, the marvelous and the tragic

Well, she's a week old and it certainly is marvelous and amazing, and I haven't even spent enough time with her.  Her mother, my daughter, seems to be taking to her new role very well. Both she and the father seem really pleased to be parents and are smoothly shifting the focus of their now radically different lives,  are feeling the rewards of doing that.  The baby herself, whose identity I will protect to keep her from being hounded by the millions who are following this, is doing a very good job of being a week old.  She is already living up to her billing as beautiful, brilliant and creative. What else is a grandfather to think.

She certainly knows how to snuggle right in there and sleep off those heavy feedings.

Every birth seems to innately bring forth hope that there is a bright future, and that we will all do what we can to make the world happy and safe for this child and that she carry on with enthusiasm.

However, and when you reach my stage of life you know there is always a however, during these last two weeks at work I have been overwhelmed with stories of sickness and death.  By now you are well aware that i always deal with aggravation, stress, loss, conflict, loneliness, just plain old craziness, but recently there seems to be more severe illness and death than I was prepared for. Perhaps the contrast has made me feel it so intensely.

Two of my patients have just completed weeks of caring for their dying brothers, both of whom were in their fifties.  One of these patients buried her brother and the next week was told that her husband had lung cancer. 

It may be because of my age, and that many of my patients tend to be older now too, but so many of them have parents who are crumbling or dying or dead.  This process is never clear or easy.  The care that is necessary, the expense, and what is most difficult is the decisions that have to be made.  Usually, there are no good choices.  How to let people die, what to treat, when to stop, who decides, and based on what.  With all of the new possible treatments the lines get very blurry.

These are difficulties that everyone deals with, and there is really so little I can do to help.  I help people sort out their feelings, especially if their relationships with these people were not smooth, but endings are always difficult and always bad. If it is sudden people are shocked, and when it is drawn out then people are exhausted and horrified.

In addition, I have recently gotten three new patients who have come to talk about suicides in their families.  And then the Sheriff of our county was accused of corruption and responded to the charges by locking himself in a hotel room and blowing his brains out.  All of my depressed patients reacted to that.

Also, so many people seem to be related to people with the terrible, chronic, fatal diseases: Parkinson's. ALS, MS, cirrhosis or some of the more insidious forms of cancer.  I sit and wonder when it will descend on me.  I wonder about the pain in my stomach, until I realize that I haven't eaten lunch.  I worry about my prostate as I run to the bathroom, but I can still see that it is related to how much coffee I have that morning.  Why am I so tired? Why did I drop my pen twice today?

That's why it is great to feel with warmth of a new little snuggle-bunny, with fat, smooth cheeks, who has a hundred healthy years in front of her to enjoy whatever life brings.  It is better to live with hope and enthusiasm than to be scared of losing it.  Even if it means denying reality for a while.

Friday, November 26, 2010

Finally, on Thanksgiving

It's been a couple of weeks since I managed to scribble anything down here.  Mostly I've been preoccupied, as the holidays are always very busy at work, families being what they are, nurturing, caring, and warm, while at the same time being judgmental, angry, competitive, duplicitous and full of silent scorn.  It makes the season jolly.

But, this year we had one of the most unique and exciting Thanksgiving celebrations, as our first grandchild, a beautiful daughter, was born right in the middle of the turkey, stuffing and sweet potatoes  (and Patriot victory). She was more than a week overdue, so already she is showing a flare for timing and drama.  The whole family was gathered and waiting for the fatherly updates by test message. Being a female was a real crowd pleaser, and the whole group broke into cheers and applause. My daughter, the mother, was trying hard not to wish for a girl, although it was clear that she was.  She and her husband had steadfastly held out early knowledge of the gender, so it came as a happy surprise.

Today were the first visits, in small groups by most of the interested family members.  I got to hold my granddaughter and sneak off into a corner and tell her a few secrets about how the world works.  Just stuff she should know about whom to trust and how to have a good time.

What is amazing is how good and self-contained a one day old person can be.  She had a few little fusses, but was able to find comfort in the warmth of who ever was holding her, and also from her own hands and fingers.  When she became really wet or hungry, she was able to ask for help.  She learned that people are there for her.  She responded by settling right down and snuggling in close. It is fascinating to see how well, at one day old, she can already interact.  Whether she continues to be so successful, and becomes happy and self-assured, or whether she loses that ability to comfort herself and becomes anxious and fretful depends, to a great degree, upon how her environment, especially her parents, react to her.  I have a lot of faith in these parents.

She is coming into the world during an unsettled time, but I think that could be said for any time since the death of Ramesses II, the Pharaoh of Egypt in 1213 B.C.  There rarely has been a good time, as far as societies and nation-states are concerned.  But as far as her own immediate family, she could not be more fortunate.  Her parents are attractive, accomplished, educated, and financially sound.  They seem to get along with each other quite well, and both were very eager to have this child.  These parents are surrounded by over-zealous grandparents, who are each more than willing to fuss, and coo and help this child along.

Not a bad start.  I hope she feels that her first day was a success. She did very well.

Friday, November 12, 2010

To Do List

It's Friday.  I get to stay home and clean up all the administrative work for the week.

1. Wait for baby (still)

2. 5 return calls to clients

3. two calls to doctors

4. one call to lawyer -- conversation made no sense, we talk two different languages

5. Report for long-term disability

6. Report for short-term disability

7. 9 (count 'em) requests to three different insurance companies to authorize more sessions until the end of the year. This includes the "convenience" of going on line, having to put in a new password, after proving that I am who I am, filling out five different screens full of senseless information, and still not knowing if the new sessions will be paid.

8. Still waiting for baby

9. record incoming payments

10. send out list for this weeks billing

11. Two calls to track down two clients who "disappeared" who should know better but don't

12. 5 return emails to clients -- this is new over the last three years.

13. Write to Senator again to tell him not to cut Medicare payments from Medicare, the SGR issue

14. Watch videos of Celtics beating Heat

The easy part is seeing the clients.

Saturday, November 06, 2010

the next big thing

It's not that I haven't been thinking, is just that I haven't been writing.  I wanted to give two or three examples of the frustrations I have, based on my last post.  But then the election got kind of heated, and my friend came from across the mountains, and mostly, we are waiting for this baby to arrive.

I guess a new generation kind of changes things, from what I've been told.  Having a sleeping, eating, crying dependent person enter your world can become the focus of attention, especially as this will be the first of the next generation.  I won't have to get up in the middle of the night that often, I don't think, yet.

But, she, my daughter, is in the end stages of cooking this thing.  Could be today, could be another week.

I've heard this has been done before.  But not by me.  And, like others, being a bit solipsistic, mine is probably the most beautiful, smartest, most clever, with the greatest potential.

Maybe next week I will post 500 pictures.

Right now we just sit and wait, and try not to worry.

Tuesday, October 26, 2010

But, you said

I have probably mentioned it before, but it burned me again this week.  One of my biggest flaws as a therapist is that I often underestimate the craziness of some of my patients.

I am easy to talk to; I am good at that.  I am also very accepting of almost anything, or at least appear to be, that way people relax and tell me everything.  That is helpful.  Often, when they relax and tell me all the stuff they do, it becomes clear  to them, as well as me that they are doing a lot of just plain old crazy shit.  They say the wrong things to the wrong people.  They over-react.  They feel really badly over nothing.  They carry grudges and forget why.  They mope around about things that were said to them ten years ago. They worry about things they said ten years ago.  Because of all this they don't show up for work, or don't pay their bills, or don't clean their houses.  All kinds of stuff.

Often, after we talk about it, it seems very clear to them, that not only should they change those behaviors, but after a while they are very capable of making those changes.  That's great.  Case almost closed.

But they don't.  They go out, and thirty-six hours later, the very same situation arises, the one we discussed, and practiced in the session, and they fuck-up again.

Sometimes it's even worse.  Many of my patients, especially the ones I thought were almost better and ready to be set free, not only make the same mistakes, again and again, they often create fantastic, unimaginable new ones, that go way beyond the old ones. This results in a new form of complex, destructive, painful chaos.

This can be annoying.

Wednesday, October 20, 2010

My reasoning

Today I was talking to one of the gentlemen I meet with regularly.  We were examining how anxious he still gets when he talks to a woman with whom he might want to begin a relationship.  He is in his mid-thirties, and still single. This anxiety has limited him badly.

We discussed how he had been a poor kid in a rich town, with parents who were awkward, often embarrassing, and always discouraging.  He could see how this has planted a strong reaction in him that he is not allowed to approach an attractive accomplished woman, even though he has grown to be an attractive, accomplished man.  It isn't the woman that makes him anxious.  He feels that someone else, some unnamed authority, with suddenly sweep in and and pull him out of the picture, telling him that he is not good enough and should not be doing this.

I mention this here because of what I have been talking about for the last week, that it is important to have someone like me, someone who is a bit out of step, who questions, who is not completely comfortable with the way things are run, to be your therapist. My reasoning is that, despite all my education, and all the research on internal intra-psychic factors, despite all the claims of biology, brain chemistry, genetics and psycho-neurological explanations, I feel that a great deal of the actual causes of what is called psychopathology are cultural.

Many of the people I treat are those who, for many reasons, sometimes gross and sometimes subtle, do not fit it well with the general flow of their surrounding culture.  They may have a different body-type, a different learning style, a different sexual preference, a different energy level, a unique reaction to stress or anger, or just be more sensitive than most people.  Usually, if these people have families that are accepting, or a circle of friends, or even one caring teacher, they can do very well.  But when the culture around someone becomes uncomfortable with someone, that person will often become even more uncomfortable being themselves.  This can lead to them acting in a way that others will consider odd, or even "crazy."

I think it can be a very powerful tool in treatment to be aware of what it is like to want to resist the pressure of conformity and societal norms.  It can be very validating to a person who feels as if he or she is an outcast, that they can still be OK, or even better than that, that they are strong.

I am familiar with several therapists who, because of their own nature, take the opposite stance.  They feel that part of treatment should be helping people learn to fit in, and to get along, and follow the rules and expectations of their culture.  Currently, there is a great deal of pressure from insurance companies that send out treatment guidelines, and in psychiatry, to see the goal of treatment as getting people to be calm, reasonable and pleasant.

I can understand that approach, but I don't agree with it.  In truth, I don't think it works; I don't even think it can work.  It can even cause a lot of harm to try and help someone to be what they don't want to be, and in many cases, can't be.

Sunday, October 17, 2010

Perhaps, not so extreme

Before I write about why It is good to find a therapist who has some of my views, I would like to make slightly clearer what my views are.  That is why I write this blog anyway, to figure that out for myself.

So, we were driving back, over the weekend, on the coastal route.  We stopped along the way to see a friend, who happens, of all things to be a religious leader.  She is a good friend, and we know and accept each other.  She is even a Yankee fan, and I still call her a close friend.

We arrived at the time she was about to do some religious leading, so we attended.  She was doing an admirable job of leading, and I was not following very closely, but I was turning the pages in the book of prayers.  In the book I came upon a quote, but I can't find the quote anywhere though Google, so I will have to paraphrase it -- but maybe it was just put there for ME to see, or maybe they paraphrased it themselves.

Anyway, it was from Martin Buber, and it said something like:

"If people come to you and ask for help with their troubles, do not say something pious, and tell them to pray, and that God will provide.  Act as if there is no God, and that it is up to you to do all that is in your power to help them solve their problems."

That is the kind of religion I can be comfortable with.

Also, I said that I have a great deal of difficulty with Patriotism, especially when it leads to war.  Well, that is certainly true, but that does not mean that I am necessarily a pacifist.  I strongly believe that every country and every society has more than it's share of assholes.  And that there are people in other countries who do want to blow us up and take our money and rape our women.  We are a rich and aggressive country; so we need to defend ourselves.  Too often we are jerks about it, and do it badly, in the wrong places and for the wrong reasons. But we do need to watch out.

What do I think is important?

Basically, life.  I think that being alive is amazing, and can be full of fantastic, fun and satisfying experiences, sometimes, when it isn't tedious and boring, or it isn't full of pain and suffering.

Life, especially human life, is very precious, and should be treated that way.  No one life is more important than any other.  You have the responsibility of living your life as best as you can, in a way that you have determined.

We are all united by our insignificance --except to ourselves and those we love.

Wednesday, October 13, 2010

Floating down the wrong tributary

Took off from work again.  My wife tells me to do it; to practice for when I get old, although she tells me that I am old.  But I'm not.
So we took off and drove out of New England and headed South.  We are here, on the water, tomorrow I will cross the Bridge-Tunnel as I have long wanted to do.

But yesterday, waking up hungry, we decided to eat a regional breakfast, but since we couldn't find that we stumbled into Denny's, a place I had only been in once before.  The service was fine, the breakfast was everything they said it would be. Except the company was different.

Two men sat behind us, and after a while my wife and I stopped talking and began to listen to a conversation that is not what we hear in our social circle, although it may be more common in yours.
One man seemed to be about sixty and the other seemed close to seventy.  They were dressed neatly in clothes that could have come from Wal-Mart. They talked openly and with feeling.  They were talking about a man they knew who was in a bit of trouble.  The man's business was not doing well and the land he had for sale was not selling.  That left him unable to support his wife, and her son, who was in a wheelchair.  But the man also was spending a great deal of time with another woman, and this was not good.  The two men having the discussion were upset because they felt that the man about whom they were talking was headed for hell, and if the moment of the rapture occurred, he would be left behind, and therefore doomed. They were not sure how to deal with him and his situation.  One of the men wanted to approach him and warn him, but he felt sure it would ruin their friendship.

Now, I realize that this conversation was a bit extreme, but it again brought up to me how much I do not buy into many of the most important mind-sets that define most Americans. My thinking is partly a result of what I do, and what I do is the result of who I am.  Despite my efforts to get along, I am still out of step, off the main-stream, floating down my own tributary towards my own distant, probably unattainable sea. This is unsettling to me in two ways.  First, how far out of the mainstream I am, and second, how loose, sloppy and lazy the thinking of the mainstream is.

So here is the part where I drive many of you away.  Where I ruin any chance I have of getting anything published, because as an agent I once had said to me: you write very well, but you are much too complex, and you don't reward your readers with happy endings.  People would much rather read about clear paths to happy endings.  That sells.  Your shit about the world being very complex and most things ending with limited compromises with reality does NOT sell.


Why? you might ask, then do I persist.

The short answer lies most clearly in the things that I do not accept.  Yes, I understand the utility, the need, and the natural affiliation for certain things.  Yet, I cannot participate. I just can't.  I never have been able to.  I gave up trying in seventh grade. ( Perhaps I am still just an obstinant adolescent.)

The best examples that quickly come to mind are these: patriotism, religion and video games. These are becoming almost universal activities, and yet I have great difficulty joining in. Again, I understand them.  I see clearly why people join in. I see the joy, the fellowship and the comfort that is gained with participation.

But I can't do it.

To me patriotism and religion are just a bill of goods that are sold early and often by the powers that be to get the masses to go along with the program.  The program that is being sold is one that benefits the powers, almost always much more than it benefits the masses.  Yet patriotism and religion are sold in a way that if you don't buy into the concept, there is no place for you in the group. That is a powerful selling device, scorn and exclusion.

But why should I believe that my country is the best in the history of the world just because I happened to be born here? And this God-stuff is really about getting people to believe in the totally unbelievable.
They tell you to have faith, don't question the incomprehensible. Once they can get you to do that, then they can sell you anything.  You can fly.  You can be born again.  You will live in heaven.  You can charge it now and pay later.  You can buy that house you can't afford.  You can even believe some of the incomprehensible stuff that Sarah Palin talks about.

And yes, our soldiers are brave and valaint people, who sacrafice for the good of their country and do their assigned duty despite great and constant danger.  But I can't stop thinking that rather than their being out there defending our freedoms, they are out their defending the corporate economic structures.  These are kids that I have seen in therapy, who had trouble in high school, had trouble following the laws, and some trouble getting along with others, who respond well to the high level of structure in the military, who hope for a boost in life that they cannot find on their own, so the opt for three to twenty years of going off to foreign lands to kill people they don't know, for reasons that really are not that clear.
The reasons that are given them are often similar to the things they heard from their religious leaders.  That we are the good and the righteous, and they are the forces of evil.  Have faith.

The video game thing, is really a generational thing.  I can't get into wasting my time playing virtual basketball when I could be playing basketball.  I don't get a thrill being a virtual pimp.  Maybe a racing game or a flight simulator I could do for a while.  But, even though, as I said,  I'm not religious, I have this guilt about wasting time.  I feel that the best way to really waist time is to watch college football, especially two teams you have barely even heard of, but they sure can run up and down the field.

So that's me, sitting way over here on the side.  I can even get upset at how everyone feels good about putting on pink ribbons to fight breast cancer.  Not because that isn't a good idea, but because the money goes mostly to the big cancer research institutes that are seeking treatments for the cancer that women get, and not to prevention.  Real prevention would attack the toxins and pollutants that run rampant though our food, air and water.  But few people are is looking at that because that would point out the need for change.

Well, this has gone on too long already. I have more concerns, but who needs to listen.  As the man said (Voltaire) 'Surely, this is the best of all possible worlds.'  We are fine, you and me.   ( unless we are the ones with cancer, or the ones wounded in the army, or condemned by the church for being turned on by the wrong kind of person, or... but hey, enough all ready.

Next time I will tell you why, even though I am not the greatest follower of American credo, it would be to your advantage to consult with a therapist like me, if you ever feel the need to consult with a therapist at all.

Wednesday, October 06, 2010


I was taking a break.  I walked down the corridor to the bathroom in between appointments.  I do this three to six times a day, depending mostly on how much coffee I drink. I thought  I had ten minutes to not deal with anyone.

I opened the door with my key and there was a guy standing near the sink.  He had several kinds of soap and anti-bacterial creams and was squirting them onto his hands and rubbing the combination over his body.  He was about thirty years old and looked a bit dishevelled.

I nodded and smiled, as is usually done at such times, and went over to the urinal in the corner.

He began to talk to me, which is not usual bathroom etiquette.  I soon realized he was not making much sense.

He was here to see  his counselor,but she wasn't here, and he goes to see his parents every weekend, and am I a counselor, and could he ask me a question?  Yeah, he had a question.  And his parents are not doing that well, and he tries to take care of them.  But he could use a counselor, and I sound like I'd be a good counselor --- even though I had only said 'hi".

Then I went over to the sink to wash my hands and he began pointing to his heart, and then tapping on his heart.  He wondered if I could help him and if he could ask me something. I said that he could ask.

I had this speech in my head about how, even though I was a counselor, I had all the cases I could handle, and how could I say nicely that I didn't have time for him, which fortunately is true.  I have that message on my answering message, so I felt it was legitimate.

But he kept tapping his heart and asking if he could ask me something, for about five or six repetitions.

Finally he asked me if I could give him money to take the bus to go see his parents.  He needed $6.50.

I was very relieved that it was only money he was after.  I gave him $2 and fled, feeling as if I got away cheap.

Thursday, September 30, 2010

The men

I am currently seeing a lot of couples.  I think it's related to the recession; stress is high, tempers are short, a lot of people are in tougher circumstances.  What's worse is that many of these people thought they were doing things right but working, trying to watch expenses, trying to plan step-by step for a house, a car, a kid, a vacation.  But then someone lost a job, or lost the over-time or the expected bonus, and the stock market went down, or someone got sick, and suddenly, ever expense is a hurdle and life isn't as much fun any more. And that makes them angry.

So, blame your spouse!  That's the easiest solution.

With the couples I see the men are of two very distinct varieties, either too loud, too active, too controlling, too quick tempered, and either border on being abusive or sometimes go over that line.
Or else they are the opposite; too passive.  The can't decide, don't fight, don't respond, freeze-up in a crisis, and would rather watch TV and hope the problem gets solved, usually by the wife.

I guess the men in the middle have figured out how to deal with difficulty either by making a decision and getting things done, or by doing what they are told to do.  I do believe there are some people who actually do both. They can negotiate, collaborate, come to an agreement and then act.  All of that is great if it happens but it isn't always necessary.

In the cases I see the therapeutic interventions are easy, either:  cut the shit, or get off your ass.

Easier said than done, but the direction is clear.

The women are not without their own difficulties, but are much more varied in how they act out their angst.

Tuesday, September 28, 2010

Love, alternative forms

Last night in my office I spent the last hour of my day listening to a couple trade insults, barbs, accusations, blame, resentments and recriminations for 45 minutes.  It was a rollicking emotional time.

For the last seven minutes, after they were emotionally spent, I got them to see what they really wanted from each other, which was basically, that after about 20 years of this kind of a relationship, they each wanted to know that the other one still cared enough to keep it going for another 20 years. 

Once they agreed on that, they left happy. 

I think I'll skip a week of going through that again.  That marriage will last.

Friday, September 24, 2010

The patient stream

People come to me in streaks; that makes me feel good.  I've seen several neighborhoods.  I get a couple, then they refer their neighbor, then the kid across the street, then his uncle.  It's good to know that someone thought I was worth the effort of driving across town, or even from twenty miles away, and much more, even.

What's great for me is to get different perspectives on the same stuff that happens.  I have seen several sets of sisters, or cousins.  A few times I've seen four, five or even six people from the same work place.  I can never mention that I see the other people, even if they are the ones who made the referral.  If someone brings up that they know their friend is coming to me, I just kind of nod.  I really enjoy hearing about my patients from other patients and getting a different view of them then the one they bring in about themselves. I can't say that Suzy, in the next cubicle, thinks you're a slob, but it's helpful to know.

Once I had a woman who was having an affair with a married man.  He was making all kinds of promises to her, and telling her that he was three weeks away from leaving his wife.  About three weeks later a couple came to see me about their marriage.  Sure enough,  from the information that I had already it was clear enough to me that he was the man in question, although what he was telling his wife was quite different than what I had heard from his girlfriend.  But, I really couldn't say anything, I just kind of let things play out.  I did kind of warn the "other woman" that things were not going to break in her favor, but I probably would have done that anyway.

Over just the last month I seem to have tapped into another vein of patients --- other psychologists.  I am not sure if they knew each other or if they came from very different sources, but I am seeing four other Ph.D. psychologists now.

Three of them make great patients.  They come with notes and speculations about all of their thoughts, motivations, unconscious demons, and deeper underlying internal processes.  They send me emails in the middle of the night. They are working at it. 

From my vantage point they are way over-doing it.  I'm not that kind of therapist.  I don't try and uncover every last possible psychological nick and scratch that may have cause a psychic bruise at some time.  I'm more of a kind of a "let's just get on with it and feel better" guy. But the intellectual churning can be fun for a while.  And I am old(er) so they look to me for approval of their self examination.  All I have to say is " Well, what do you think?"

The fourth one is just nuts.  She's angry and screaming, and in a terrible, chaotic relationship, with a guy who has more issues than that pop-up box has tissues.  But she has a full practice and she's probably good at it.  She's right out there and very expressive. She certainly lets you know how she feels, and she reacts quickly and intensely.

I don't think I would want to be her client if I was a man, given what she expects in her own relationship.  But, then again, that could be really good for some guys to hear about it.

This is an interesting profession.  You never really know what's going to happen once the door closes.

Tuesday, September 21, 2010

Inside trashing

My battered profession continues to take it's lumps.  The press, the clients, the insurance companies and now it's an inside job.  The Past President of the American Psychological Association, Alan Kazdin, gave an invited lecture in which he said that psychotherapy, as it is practiced today, is inefficient and elitist.  It is slow and works with people one or few at a time, while the mental health problems that are facing this country are huge.  He said that there is a need for new approaches, and that psychologists/therapists should not sit in their offices and wait for people to come to them, they should devise way to get out and treat the problems where they exist.

He's not wrong. He just twenty-eight years late.  I don't know how old he is but he must be younger than I am.  He was probably not riding on his high horse in the 1970s when the community mental health movement was taking hold.  I was working in another city at the time, another New England Mill city much like the one I am in now.  I was running a small Mental Health Center that was funded by state and federal funds, as well as payments from the people we were treating.

We had programs that went into schools, brought new parents together, worked with kids in housing projects, consulted to policemen, had follow-up care for the seriously mentally ill. We had the early formation of alcohol and drug education programs and outreach. We even were dealing with domestic violence and racism.  We were doing lots of cool stuff.

I remember that I really enjoyed working with about twenty-five kids in a concrete building in a not very good part of town.  I would meet them twice a week after school and help them organize activities, or figure out school, or complain about the way they were being treated.  Once, when were organizing a weekend dance,  I didn't want there to be trouble, as that could give the whole program a bad rap with the community.  I asked some of the bigger kids what we should do if the "bad element" showed up and wanted to be disruptive.  They broke out laughing.  They explained that if I was to ask around town for the four names of who was considered the "bad element" I would find out that they were sitting right next to me.

But all that ended quickly in the 80s, with Reagan.  I am sure that what we did would be very quickly labeled as "Socialism" by many in the media today.  Dr Kazdin is not really searching for new, innovative ideas.  Like many, many visionaries, especially in Psychology, he is just recycling old ones.

Tuesday, September 14, 2010


Jane, who commented on my last post, brings up an interesting and complex point: "Who is responsible for the mess that many people, the economy and our country is in?

Clearly, there is more than enough blame to go around two or three times.  In the early 2000s government lowered interest rates, especially for home mortgages.  That encouraged everyone to refinance and take money out of their homes.  Many people did this and used the money to spend on stuff they wanted but didn't really need.  I had lots and lots of clients who did this. Added to this, many mortgage companies intentionally sold mortgages to people whom they knew could not afford to keep paying them Some of those people were foolish, some were just lied to

But many people knew what they were doing. They wanted to turn the rising value of their home into cash.  They were encouraged to do so by many ads, from mortgage companies, and by other consumable type products, especially bigger homes and SUV, and all the stuff that went into them.   But I didn't do that, and I don't think Jane did either.

Meanwhile the government was waging two wars costing trillions of dollars.  The real goals of those wars are still not very clear. This still continues.

Then, since so many people were buying and selling mortgages, and it was somehow assumed by all of the country's brilliant financial minds that home prices cold only go up, banks invented mortgage default swaps, so they could increase their profits and leverage all of their bets.  The government at the time, led by Alan Greenspan, decided that these kind of business did not need to be regulated. The :free markets" would regulate themselves.

So then, in 2008, housing prices began to drop and the economy feel completely apart.

Should the government have done nothing and let it all go completely to hell?  They decided they needed to help or the world economy would collapse.  So they helped out the banks, who were some of the biggest crooks of all.  They felt they had to, which they probably did. But people got angry at the government, and the banks, for needing and taking tax payer money, while most tax payers who had financial problems were not given too much --- although unemployment benefits were allowed to keep going for a long time.

Then nobody had as much money, and no place to get it, so they stopped buying.  So business stopped selling, so they laid people off.  So things go worse.

 Then the government tried to get things going by pouring money into some places.  But it isn't enough, nothing is happening fast enough, the deficit is growing to frightening level.  Everyone is angry, except for the bankers, and other people who are very rich and are paying for ads and lobbyists to keep them rich.

Again, I think that in order to get things right a lot of people who seem to have major disagreements about what to do will have to decide to work together, make compromises, look at the whole picture, and decide to make the country whole again, and to pull people together.  I think Obama was a bit naive for almost two years, thinking he could do that.  There are some powerful people who just want to see him fail, just for their own benefit.

Now, I would rather put my faith, and I agree I have very little of it, in a government that I elect, than let my economy be run by insurance companies, banks, oil companies, Rupert Murdock and the Koch brothers,  who have already shown how willing they are to screw us out of our last dollar, which they will do if the government steps aside and calls that a "free market."

Unfortunately, I don't see much hope of getting enough people in business, banking and government to work together.  The "freedom" some people are screaming about seems to be mostly about tearing everything and everyone apart.  I hear very little about people offering to sacrifice and to work together to make things better for all.

Yes, I hope everyone out there took care of themselves.  If you didn't it is partly you own fault for getting sucked in, and partly because the rules are stacked against you, and those who are doing the stacking want to run the government too.

I know a lot of my clients are suffering during this time of economic distress.  I do not see many places for long-lasting job growth.  We had one great twenty-year growth spurt due to new technologies.  We followed that with money from a housing bubble and debt spending, from both the government and citizens. Now what?  Green Energy?  America's Got Talent?

Today was primary election day.  I went to vote early.  I voted for some incumbants and some new people.  I tried to vote for people who made sense, and weren't just angry.  I was there for ten minutes.  Two other people came in to vote.

Is this the freedom we are sending people across the globe to protect?

Friday, September 10, 2010

money therapy

It is my belief, as a result of my years of sitting, listening and mumbling, that a great deal of what is called "psychopathology" is really a result of the culture of the times coming down upon a person's life and mind.  The American Psychiatric Association, as evidenced by the forthcoming DSM V, is going in the opposite direction.  They are trying to classify many behaviors, such as being addicted to the internet, or compulsive shopping, (although these changes will only be put in the appendix for now)  as basically "brain disorders."

I don't see it that way.  I also am currently having a very tough time having to treat so many people who are unemployed or underemployed, or who are stuck in jobs they hate because they know they will have a very tough time getting another job.

Yes, I am sure the the stress of not being able to meet your mortgage payment, or struggling to feed you kids, or even losing your vacation home, creates changes in your brain.  But the real causes of these depressions and anxieties are based in the workings of our society. We have a system in which the financial conditions of many families can vary greatly from year to year.  Our culture encourages consumerism; the desire for unnecessary goods. Some segments of our culture purposely and by specific design, allowed many people to accumulate a great deal of debt to buy these things.  This helped some people get very rich, while many others are now getting poor.
. I see many marriages that after many good years, are now under great stress. Many people are not only scared and struggling, their self-image has been shattered.  After months in a downward spiral they are left feeling helpless and powerless in a way that many have never felt in their lives. They are angry because they feel duped.  They feel that they did what they were told and followed the American Dream, and now they are being left out, and even blamed for it.

Treating these individuals and couples is very difficult because what would really be the best thing I could do is find a way for them to make money.  I work on that, to help them brainstorm, or network, or make use of skills that they didn't realize could be put to use. But it's very tough.  Not many places are hiring, and very few new ventures can get capital, and many fewer people will spend money anyway.

What also bothers me is how many of these hurt and angry people have been sucked in to be angry at their own government, which currently is trying anything it can to help.  I don't think they would really prefer to be at the mercy of the oil companies, insurance companies and banks, but they don't seem to see that that will be who benefits from their political stance.

However, I am not surprised.  Fear and anger do not usually help rational, longer-term planning and thinking, but they always have been a major factor in political behavior.

 But whenever I get a new patient now, I find I really, really hope they have a way to support themselves.  I can't do money therapy.

Thursday, September 09, 2010

High Tech, Blown Away

I have seen this guy for a while.  He's a real techie: hides in his basement, does a lot of sophisticated software consulting.  He comes to see me because his wife hopes I can teach him to be verbal, which he can be if you talk about his stuff, but that bores her.

Anyway, that's not the topic.

He is working with his new Apple, and to be good he is trying to do things that relate to the family.  So he puts together pictures of his son and himself.  On the new Apple software there is a dazzling new feature that allows you to highlight a face and click on it.  Then the machine will scan all of the 2100 or so pictures you have in your iPhoto and it will pull up all the pictures with that face in it.  Amazing stuff.

So he does that for him and his son and about fifty pictures of them appear.  Then he sees, among the pictures, that there are two very old photos from when he was a kid, and the focus of the app is on a guy who was a friend of the family.  He enlarges the shot of the guy wearing a dark suit, then he enlarges a shot of himself dressed in a similar fashion.  Then he examines the pictures and he said to himself that the software is pretty good, because he sees how similar they look.  Then he goes back to putting together a family album and the event fades away.

Two weeks alter he is talking to his mother, and he tells her that he will send her the album, and she is all happy and they are joking around.  In that spirit he tells her about the picture of the old family friend, and he says, without thinking really,that from the looks of it, that guy could have been his father.

Suddenly, the phone goes silent.  After a long pause his mother says: "I really don't want to go into that."

The guy is 41 years old.  Even though his life is exactly the same, it has suddenly become totally different.

Tuesday, August 31, 2010

Upon my return

There is something very comforting to me about returning to my office.  I did not get the "back to school jitters."  Starting about thirty hours before I returned I was getting eager to see how most people were faring.  I was not eager to see how everyone was doing as some people will not be changing much. They make my life tough.

But I guess it is very easy for me, after all these years to settle back into my role, to return to the task, to try to move things forward.  It's not easy, but it feels like the place I should be. I should be thinking, at this stage of my life, of how to make changes in myself.  I know that they won't come to me.  But I don't.  I go back to what I do; what I know.

But three weeks is really a long time it seems because a lot had changed for many people. It seems that some people need a good dope-slap every week or two or they tend to wander off the rails.  Is this psychotherapy?  I guess.

AB got upset at her parents and tried to jump out of the car -- in the middle of traffic at 40 mph.  They put her in the hospital for three days and on meds.  I don't know if that was the best solution, but everyone got worried.

CD, under pressure from his girlfriend, turned himself in to the probation officer he had not seen in four months.  I will see him next week when he gets out.

Paul, you remember him, called  to say he would like to come back, but he is in FL, trying to stay sober.  He will call when he returns.  I will see him if he calls.

EF's father died. as did GH's mother. IJ's husband's father had a heart attack. JK put her brother in hospice.  They won't let him drink.

LM got evicted. but she found a new place.  She left her boyfriend behind.

MN said her husband slapped her. She had accused him of cheating on her -- after she came home from spending the afternoon in bed with the man across the street.

OP is going back to school.  Two days after she signed up for classes, her husband lost his job.  Good he can stay home with the kids.  But who will pay the mortgage?

RS called.  Her cancer is gone.  She was strong and up-beat through seven months of treatment.  Now she wants to come in and cry, in private, in my office.

There is something very unsettling going on out there.  Everyone feels that things are bad and about to get worse.  No one has any trust.  The current divisive political system cannot deal with things.  Things are very complex, and many disparent people will need to work together to make things better.

They won't. Not a chance.

It's only Tuesday.

Sunday, August 29, 2010


Yes, it was a totally gorgeous day.  The sky was totally blue, the waves rolling in slowly to the beach, The sun was warm but there was a slight breeze off the water.  A few boats bobbed in the distance. Kids frolicked in and out of the water, splashing and screaming, dunking and diving. It was a day that should never end.

But slowly the sun began to sink toward that side of the water. It was bringing summer to a close.  Time to clean up the house, put the chairs away, and pack it in.  Yes, we will be back next weekend, unless the hurricane drives us away, but the vacation is over. I did my best to squeeze every drop out of it.

Put on some old,  melancholy Townes Van Zandt tunes, go to the dump, take one last shower outside:

"Don't let the sunshine fool ya
Don't let the bluebirds tool ya
Don't let the women do ya
Put your hand in mine"
     ----TVZ  (1944 - 1997)

We're going home.
Back to work.

Wednesday, August 25, 2010

When it rains

It rained for a few days down here near the water.  Some nerve. The forces of Nature do not always honor my requests. We think that somehow we can control that, but in truth we are losing control rapidly and creating more chaos and destruction. But that is another topic.

When it rains here I get to read many things from various sources.  I read several articles about how too much "screen time" is not good for our brains. The average game app is played for about three minutes while waiting for the dentist, or a line to move or a wife to get dressed.  We can now not only fill up every vacant second, but we often double or triple fill by turning on music, watching TV and texting a friend, all at the same time.  Many studies show that this only confuses our brains, inhibits learning and limits creativity.

I also read a good article that (again) trashed on my profession.  It was about the "Legends of Psychotherapy" conference held last month in California.  I will write about that next time.

But I read a column by David Brooks in the NYT that I want to comment on.  I usually like to read his stuff.  He is a thoughtful conservative,which I am obviously not, but he often makes a good case.  What he wrote about last Tuesday is something I strongly agree with, and have really been talking about in many ways here. -- In the article he wrote about how we usually only read things we agree with, but I don't think that was why I liked it so much, but who knows.

He wrote about "mental flabbiness" that has become rampant in our culture.  People have become lazy thinkers.  With all the information that is constantly available there is less time to consider what is real, what is worthwhile, and what to do with all of these bits of information.

Brooks quotes Charlie Munger of Berkshire Hathaway who lists our natural weakness: confirmation bias; we pick out evidence that supports our views, and we are cognitive misers; we try to think as little as possible.

I often see in my practice how people are very vulnerable to slip-shod thinking, surface conclusions.  People easily settle for simple solutions, based on distorted half-truths, that are harmful to them.  That's why there is so much debt, so many kids on prescribed drugs, so many obese people and so much free-floating, misdirected anger.  It's not that people are stupid, it's that they have been encouraged to be lazy thinkers.  Our society calls for it.

If you are a lazy thinker you are much more likely to buy a shitty product at an exorbitant price, and to think you need it.  You will get angry at Obama because you think he's a Muslim.  You will eat bacon cheeseburgers and then go to Jenny Craig.  You will believe that climate change is a hoax because you don't want to put any limits on the energy you use or the waste you create. You will blame "illegal aliens" for taking you job, when you never really wanted to work fourteen hours a day picking lettuce. You will think it's normal for women who are 5'4" and weigh 118 lbs to have Double D tits. You will believe that your six month old son should be watching a computer program that teaches him sounds and colors and shapes, when you should be holding him and cooing to him yourself.

It's no wonder my business is booming.

I made the mistake of picking up my messages today.  I have almost as many new people wanting appointments as I do people who I was seeing before I left.

The world is very complex.  Take the time to think about it. It is good to think -- Try thinking this way: If I do this then this will happen.  If is even better to think -- If I do this then this will happen, and that will make this or this happen and I have to be ready for that too.  But that is difficult.  It takes time.  It takes some kind of reflection and consideration.  We are all capable of it, but it's difficult. You may have to give up some time playing "Angry Birds."  At least in the beginning.  Then this thinking thing gets easier. Then it gets to be kind of fun.

Try it.  You will save on your therapy bills.

Sunday, August 22, 2010

Out of office, and out

I am still away.  It's kind of weird to be away this long.  It is good for my head.  I think of some of my clients once in a while and wonder what's going on.  I kind of miss them, mostly just as people, but not really the work of figuring out what to do and how to make it happen. I think of some of them and it seems as if through a fog.  They are from such a different part of my life.  I am here, in this vacation spot with friends and family wandering in and out. I talk or don't talk.  I don't have to pay much attention if I don't feel like it. Some people drone on about whatever.... It's great: I don't have to listen.  When I do respond I don't have to make much sense.  That certainly takes the burden off.

I'm like that.  My mind takes what someone is saying and shoots off, usually in a totally unrelated direction.  It jumps and skips steps.  Then I make a comment about where it has led me.  People kind of look up and then go back to whatever they were talking about.  Most of my friends expect that. They often can comment, and we go on from there.   That's why we are still friends.  The other ones, like my wife's friends' husbands, they don't know quite how to respond, or how the hell to deal with me.

Sometimes we talk about golf.

I have been getting to exercise a lot more.  It surprising how well you can take care of yourself when you don't have to take care of anyone else. I get to stretch, and then to really exert myself in a few ways, which I had not been doing since my eye got messed up.  I was surprised at how much I missed that. Getting my heart pumping and sweating and breathing heavy really makes me feel alive and part of it; whatever "it" is.  Some people hate to feel that way.  I really missed it.

What is sad is how little it takes to make that happen now. But hey, as the song says: " I can go as fast as I used to, and I can go as long as I used to, but I can't go that fast for that long any more."

Sometimes when I take my grand-dog (the one in the picture there) for a walk, and she pulls me around for two miles, I count that as exercise.  I never would have used to do that.

Just trying to stay healthy.  Just trying to stay alive.  Just trying to keep my wits about me without embarrassing my wife too much.

Just sometimes.

Wednesday, August 18, 2010

being away

I've been away.  I still am.  I went to the mountains far away.  That was away. Just me and my wife of many years.  We went up and down the big mountains.  Up, up into the snow. I rode a bicycle through the woods, up and down hills, on narrow paths through the trees and over the streams.  My wife got a massage.

Now we are back at the house near the ocean.  This is the place people come. We open the doors and have friends. That is good. It sometimes amazes me.  I didn't think I was that social, but this is fun.

I called in to my voicemail.  I had only fifteen messages now that L doesn't call any more.  They were mostly from people asking for appointments, telling me why they wanted to come and see me.

I am not in work mode, so my first reaction was "What the fuck are you telling me all this for? Your life is a mess and I am on vacation. Leave me alone.  Don't tell me about your substance abuse problems while I am sitting here getting drunk with my friends.  Don't fill my head with your relationship woes on my anniversary.

Then I heard a message that one of my younger patients was in the hospital for a rash act.  I felt sad. I thought of what i needed to do to help her learn to deal with being upset. I called and set up an appointment to see her ---

when I get back.

Saturday, August 07, 2010

Out of Here

This was a difficult week as I am leaving for three weeks, one in the high mountains and two by the sea.  I have certainly been looking forward to it, and now the time has arrived.

What has been difficult is that so many of my clients have been giving me shit about going away.  "Didn't you have a vacation in July?" they inquire.

And so many people seem to remember that Richard Dryfus, Bill Murray movie "What About Bob?" It must have been mentioned ten times this week.

Yes, almost everyone adds that they appreciate that I should get a chance to clea my head once in a while, but how will they survive?

Actually, some of them will take the opportunity to mess-up their lives for a while, make a stupid decision, give in to an impulsive desire, explode at the wrong moment, or on the wrong person.

Maybe not.  Maybe they have learned; change does occur.

We shall see.

I'm not going to think about it.

Tuesday, August 03, 2010

scientific insight?

There was an article a couple of weeks ago in one paper, and then it was recycled to another paper recently.  It talked about how political scientists have "discovered" that even when you give people clear, definitive and indisputable factual information, and even if it comes from a reliable, unbiased source -- if the information does not agree with what a person already believes, then, most likely, the information will be discounted and the person will go on believing whatever he or she is comfortable believing.

If you believe that Obama is a socialist, if you believe that your wife is cheating on you, if you believe that chewing a handful of iron filings will cure your diabetes, often nothing, no matter how scientifically proven, will change that belief.  You will select and focus on information that you feel supports that belief.

This was like the "discovery" a few years ago by economists that people do not always make the most rational economic decisions, and (much) more often than not, they will make economic choices that are not in their best interest.  For decades economics were based upon the idea that the "economic person" was rational, and that given all of the necessary information, most people would make the rational decision.  For decades they wondered why their models never worked well at making predictions.  The team that documented this irrationality won a Nobel Prize or something.

As a psychologists, who deals every day with people who make major decisions that affect their lives, in romance, money, work, schooling, interpersonal interactions, drinking, eating, sex and sleeping, all I can say in response to these major "discoveries" is:


Also, remember what Woody Allen called people who think that everyone is after them----


Friday, July 30, 2010

Must have been something he said

That was quite a week wasn't it?  Just buzzed passed so fast you'd  think it was one of those old Camaros, you know, the ones before the first gas crisis, the ones with the big engines, the little body and rear-wheel drive, that would spin out a lot and were fatal on snow.  Yep. that's the kind of week it was. varrrom.

 And everyone showed up, almost, except for Danny, who really has not made much progress in 18 months.  But why should he, his parents still pay for everything.  He gets angry when they won't give him his allowance, even if he did spend last week's money on cocaine.

But everyone else.  Angela brought in her husband. They have been separated for two months. He was angry, dominating, and mean. He was outspoken and direct and it was clear what he expected things to happen his way.  That's why Angela kind of snuck around behind his back.  She felt she could never negotiate with him, he just rode right over anything she said.  But running up $45, 000 in secret credit cards did kind of come as a shock.  Especially since it was the third time she promised never to do that again. I think that is a very American form of pathology; I have seen it much more often than I expected.

I had one open hour, but Stan called and needed to come in ASAP.  I have not seen Stan for four years.  Stan has not worked for four years.  He's had some problems.  He's been jumpy, irritable, depressed and isolated.  He doesn't finish things, he drinks a bit too much, and he has temper outbursts -- all of which made keeping a job difficult.  He couldn't come to treatment earlier because he didn't have insurance.  Now that he has completely run out of money he can get insurance from the State.

Stan showed me his arm.  He had a scar with seven stitches.  He turned his arm over and showed me another scar with four stitches.  The second one is where the knife came out.  It must have been something he said.

Marla lost two pounds, now she is six pounds under four-hundred -- but it's a start -- I think.

Alicia and Martin: still no sex.

Phoebe, out of the hospital and into a one-month residential treatment program.  Out of that in three days after when she told them she was very upset and did not feel safe alone, the one staff member handed her a coloring book and went back to talking on her phone.  Phoebe is going into a day program for two weeks.

Those and twenty-eight others: loss, loneliness, addictions, stress, conflict, illness, doubt, broke, bored or burdened.

My last appointment was Sheila and Mark.  They came in snarling and tense.  They left tearful and arm in arm.  A good end to the week.

Today I spent time in the kayak, bobbing up and down on the slow rolling not very high waves.  The cormorants were back in their usual positions, on a rock, with their wings spread out to dry. As I drifted I could hear the noise of running screaming and laughing on the beach. The sun was moving lower, turning the few clouds pink.

I am very aware that I am a week older. I am very aware that I can't stop time.

It was a good week.  I love summer, even if the Red Sox suck.

The dance continues, doesn't it Mr. Fellini?

Sunday, July 25, 2010

Glorious! .... yet

Another glorious weekend down by the water.  This time down at the beach house watching the tide go out.  We sat with friends, eating and drinking, discussing not much of anything. Again, in my life, the world seems to be doing what it should, pretty much.

It's at these times that I realize how fortunate I am that my wife and kids, and their spouses, and soon their kids, and I are all healthy, and even somewhat prosperous.  I look in the paper and often see that people my age are dead.  I walk down a winding path through scrub pines, go up a sandy hill, and  from there, on a bluff, I can overlook the entire expanse of my favorite beach, with it's large curve, and it's small, but rolling and lapping waves. Except now, I realize that it was not only me who felt that this spot was so special.  For now there is a new bench to sit on, and linger and watch the sunset from this spot.  The bench has a plaque that says it was dedicated to a great guy, someone I never knew.  He was eight months older than me, and now he's a bench.

I read something else in the paper today also.  There was a line that mentioned that the top twenty hedge-fund and money managers in the US made in ten minutes last year, the amount of money that the average American worker made ALL year.  Something is wrong there.  It is psychologically de-stabilizing for that to be going on.

What's worse is that these people --- and they did nothing wrong or illegal (probably, well maybe), didn't really produce anything that did our society any good.  They just moved money around, mostly following the directions of computer algorithms. 

Something is not good.  that should not be valued more than nurses, scientists, business people who actually make something, or deliver a service someone wants to pay for, or even street cleaners and garbage collectors, who work hard to keep us healthy.

Not good.  What do you think Justice Roberts?

Wednesday, July 21, 2010

While that was happening...

I am still often amazed by two very obvious occurrences, which kind of shows how little I have matured over all these years.  First is the huge dichotomy between my work world and my home world.  I come from  a fairly stable background and, considering all the radical and unstable ideas that rattle around in my mind, I have lived a fairly measured and reasonable life.  In many ways I have made fairly conservative decisions, and they have helped me and my family life pretty well, avoiding major crashes, crises, turmoil and upheaval.  It certainly hasn't been perfect, and I can list a dozen or so bad decisions right off the top of my head, but really, compared to what I see and deal with on an hourly basis at work, my own life chugs along.  And still now, whenever I see a chance to take a big risk, make a major change, throw caution to the wind, fly in the face of reason, defy all odds --- I don't do it.  Sometimes I admire those who do and who can, but that admiration has faded over the years, especially the more I have had the professional responsibility to pick through the wreckage.

The second constant occurrence, which is related to the first, is that while I am away from work, wandering around through my reasonable, fun but not overly exciting existence, my patients continue to live their lives of chaos, destruction, pain, aggravation and foolishness. At the very same moment!

That means that while I was sitting on that deck, sipping a high-priced gin and tonic, watching the sun go down on a glorious day over Boston Harbor, many of my patients were doing their best to make my work more complicated. (I know that was why they did these things.)

Some of the troubles happen to some of the same people I wrote about on May 5th. One is Alice, who while I was feeling so good, was lying in great pain, unable to move, as she had a seizure in her bedroom and feel off her bed, smashing her good knee, and couldn't get up.

Also, Saturday night a couple who I had been working with, who had been trying to overcome serious disagreements, lost control, and began throwing things and belting each other.  She came to the appointment on Monday; he left the state.

At the same time, a woman I have been seeing for a long time, who had been doing so well over the last few months that she was only seeing me once or twice a month, became so frustrated by the pain from her various physical ailments, in her back, feet and knees, that she locked herself in her room and began to drink, after being sober of almost two years.  When she woke up the house was a mess, with many things in unfathomable places.

Yet another woman, a complete recounting of her history would include four Shakespearean tragedies, was home with her sons and two of her son's girlfriends when she realized her home was surrounded by the police SWAT team.  Seven officers came in and she expected at least two of her three n'are- do-well son's to be carted off, but no, they arrested the beautiful but ditsy girlfriend for breaking into a liquor store.  (she was back in the house five hours later).

Phoebe, who did not hurt herself when I was away, but still said she wanted to, spent Saturday night in a hospital, where she felt safe and is doing better.

Archie, who did not have the nerve to call the woman he had been chatting with on-line, spent Saturday night in his basement, watching porn.

Martin and Alicia, who I have been trying to get to spend time together instead of fighting about the kids all the time, left the kids with her mother, went out and had a good time.  Maybe next time they will figure out a time and place to have sex and be even happier.

Lia, who I had seen last year with her husband, came back to treatment by herself to tell me that she has left her husband, and that last Saturday night, while I sat on the deck, she was in NYC to reunite with her first love, from twenty-five years ago, when they were both seventeen in Toronto.

Lots goes on, all at once.

Sunday, July 18, 2010

Olives and Chicken Wings

I sit having a gin and tonic on a wooden deck overlooking Boston Harbor on a hot summer evening. The sun now finds it's way through the buildings and hits the white sails of the two and three masted ships on the same side as the wind that pushes them toward the outer islands.  The ferries come and go, crisscrossing from shore to shore. The harbor cruises chug in lazy circles, with more boisterous crowds, drinking and laughing, full of vacationers from Detroit who are amazed to find Boston so warm, sunny and welcoming.

Life is not always  mean. Certainly not mine. Away from work the world can seem beautiful, friendly and hopeful. I watch families walk beside the harbor with children jumping from rock to rock, laughing and teasing.  Couples wrap themselves around each other despite the heat, which is alleviated by a sweet, salty  breeze that blows off the harbor.  Walk further to the fancy hotel that hovers over the water and a bride is standing, smiling, being photographed with her hair and dress blowing in that breeze.  Passers-by blow her kisses and she smiles. Someone believes in love, or at least in marriage, which, from my work bias, is even more of a risk, but rest of my life tells me otherwise.

Nibble on olives and chicken wings, as the gin adds a rosy glow to the already strawberry blonde light that bounces off the big, steel bridge, built high over the water.  Boston looks prosperous and happy, and for the most part it is.  People are relaxed and smiling and enjoying themselves.  They have come from all over the world to be here, on this kind of a day, in this kind of a place and they have been rewarded.
We have evolved as creatures in a way that allows us to be mellow, content, sociable, and relaxed, even if only for a day.  That's what summer is for.  Many people seem very able to appreciate that.

Smile and nod at strangers, laugh and talk with your friends, hug the ones you love. Spread it around.  Help the world have a good time. It's the best thing we can all do for each other.

Friday, July 16, 2010

What's so funny about...

What happened to this week?  Whooosshhh, just like the sound of my iPhone sending an text.  Gone, zipped off with hardly a trace.  I went back to work, each day was full of people coming and going at the wrong times, wanting more time, missing appointments since I was out a week. Everything seemed off schedule. Two new people who had to wait for me to return, didn't even show-up.   Too long to wair?

It shouldn't be that hard.  I was there, in the office, every day, on time.  But when your life is a mess nothing is easy.

"I understand that your aunt hung herself in the next apartment and died leaving two children, aged ten and six, but your appointment was at 1, and somehow you forgot?  But that's OK because the person who was scheduled for tomorrow at 1 showed-up for your appointment, so I can see you tomorrow.  I guess everything happens for a reason -- but I'm not sure I can say that about your aunt.

A week off has a lot to be said for it, especially when it's hot and humid and you're down by the water.  But it really isn't as interesting as sitting here being amazed by stories of how people screwed up their lives during the time I was away.  Loneliness, illness, stress, conflict, addictions, death and general stupidity are the basic diagnostic categories I work with, but they don't come with billing codes.  And the last one applies to both the insurance companies and the current chaos of health-insurance reform.

 Life is complex.  It can be difficult and unforgiving.  Our society does not make it easy or offer much relief.  Jobs are scarce, money is tight, and important things, like an education, are getting wildly expensive.  The feeling out there is like riding on the sleigh in the winter in old Russia.  If you fall behind the wolves will get you and tear you apart.  The rich and well-protected have no trouble going on without you.  They have learned how not to look back.

This has always been true. We all can justify what we do to take care of ourselves.  For some reason, when I was a naive child of the '60s I had the strong belief that everyone wanted that to change.  There was no reason why it shouldn't.  We were smart, educated, rich and aware.  Make Love Not War! 

"What's so funny about Peace, Love and Understanding?"

I still don't know the answer, but I fear that everyone else does.

Friday, July 09, 2010

still summer

The high point of the day was kayaking past the cormorants.  (no laptop in the boat)

The tide was coming in, the wind was blowing out.

That was after Phoebe's mother called to say that Phoebe  ( who I have not seen in two years) broke up with her boyfriend and came home.  She is thinking suicidal thoughts.

I called her and told her not to.  I will see her Monday morning, during the time I had saved to open a week's worth of mail.

It can all wait until Monday.

The cormorants told me that, as they were drying their wings in the sun.

Thursday, July 08, 2010

therapists on the beach

It's summer again.  You can tell because it is really hot.  Is it that Global Warming thing, or is it just hot?  You can also tell by the number of bugs that are flying around my computer screen and crawling across my keyboard.  I can't squish them into the keys because the screen will turn colors and flip pages.  I can only blow them away.  But then they think I'm a wimp and take advantage of my lack of power.

When it is summer I go down to the beach, especially when it's hot, like it was today.  Usually when I go to the local beach it is just full of vacationing families playing family games and splashing each other until the youngest kid begins to cry.  If I go to the bigger beach a half hour away there is a much greater chance of being surrounded by vacationing NY psychiatrists.

But today there were a couple of NY therapists on my beach.  I kind of knew one of them and he knew the others so we talked about our practices a bit and complained about insurance companies, and did some of the things that therapists do when they suddenly find themselves bunched together.

These guys are from NYC.  They charge a lot more than I do, and I think they get more.  They make their patients bill the insurance, and that way, since they don't sign contacts with insurance companies, they can charge what they want.  I am not too thrilled with that, but I understand that they play in a different market and they serve a population that can pay.  Rich people have problems too.

What does bother me is that they seem to see their clients two or three times a week, and they do so for months, and often for years.  Even for years and years.

Now it is rare when you read here that I am in favor of anything that insurance companies do, but if I kept getting bills for three sessions a week, and it continued for year after year, I would be upset too.

The basis for my being upset comes from the word "therapy."  If someone comes to me for "therapy: I take it to mean that I will treat them for something that is wrong, with the goal that it will get better, with the understanding that whatever is wrong, it can and will get better, or else there is no reason for treatment.

To me, endless treatment is not "therapy." It is hand-holding at a high price.  It also encourages dependency, while therapy encourages independence.

I guess the competition in NYC is great enough that therapists have time to see people three times a week.  I rarely see people twice a week, and when I do, it is to keep them out of the hospital, and I feel they are on the edge. If I saw someone three times a week, for more than two weeks, they would be in the hospital the next week.

I don't mind them having a different business model, but I do mind how it makes the whole profession look inefficient, and perhaps incompetent, AND at a very high price.  I mean, if you're sixty-two years old, how many years can spend talking about your mother. You only lived with her for eighteen, and you've talked about her for forty.  Let's get to the part where you grow-up and change your life!

Monday, July 05, 2010

Recollections (revised) Part 1A

I don't talk about dreams much in therapy.  I don't ask about them, nor do I think that they are the window into the unconscious. But sometimes they do trigger interesting discussions.  In many ways they are kind of the neurological cleaning out of the flotsam left in the brain at the end of the day. For me, I know that I have to be more careful about what I read after I get into bed.  I often fall asleep and then suffer with blurred visions of the Taliban or Sarah Palin running through my mind, disturbing my rest.

But I had a dream the other day which was clearer than most and the feelings that came with it stayed with me for a while, making me wonder what is going on in my own head.  In the first part of the dream I was an MC of a big party, like a wedding or something.  I was making all kinds of clever cracks, entertaining everyone.  But that quickly morphed into a scene where someone, a good friend, was telling me how I had insulted his mother, and that she was very hurt by things that I said.  The dream then quickly shifted to an image of me and this same kid, whose mother I had insulted, riding on a bus.  He was saying to me something like, "isn't this great, we are finally growing up and going off to college."  I sat there, on the bus, on one of those plastic seats of city buses.  I was nodding in agreement, but I said, yes this really is great, but I feel as if I have done all this before."

When I awoke from the dream I was in a good mood.  I remembered those parts of the dream very clearly and I loved the irony of the last line.  I enjoyed how good I was at recognizing, as I rode of to college, that I had already done that, even though, in the dream, I was confused by what I was feeling.

All of this made be reflect upon what I was really like when I shuffled off to college. What I remember clearly, was that unlike in the dream,  when I went to college the real time, I had little insight and even less  perspective.  I was really pretty clueless about how the world worked, and what I could do to make it work better.  I was having a tough time figuring out where I fit into the whole scheme of things.

I already had developed a very quick and sarcastic wit, mostly because I needed something to protect me, as I was very skinny and did not project an image of physical power.  But my wit was very unconventional and disarming.  One of my high school teachers told me that I was really funny, even if most of what I said went right over the head of most of my classmates.  He added that he hoped that the things I said would not get me killed some day, if per chance, someone did get the joke.

But even in high school my attitude about the world was becoming established. Because I was slighter than most of the boys, and this was because I was younger than most of the boys due to my mother sending me off to school early,  Look, she said, he's smart enough and he's just wasting his time being a pain in the ass at home.  So they started me at school two days after I turned five.  I didn't have to wait for the next year.  I was about ten months younger than most of the kids in my class, which, in fourth grade, is a lot.

I think I had to protect myself by paying closer attention to what other kids were doing and thinking.  I got to be a pretty good at predicting what people were going to do.  I could tell what songs were going to be "hits" the first time I heard them.  I could tell which I my friends were going to be dumped by their girlfriends.  This sense of observation developed to the degree that I began to be a ble to tell which of my teachers really didn't know what they were talking about. I had some really good teachers, and some who were real phonies. Some of them knew that I knew, and that wasn't helpful for me in school, but I knew that this kind of knowledge was what I really should be leaning.

The more I paid attention, and by my Junior year, it was a lot, I developed an awareness that most people were being played for suckers.  They were being lured to put their efforts, beliefs and money into things that were either, illusionary, worthless, harmful or nuts.  At the time it was things like big houses, constant new cars, and bomb shelters.  I also was confused by all the fuss made about religion and patriotism.  I didn't get it.  For me it just didn't make sense to get all worked up because I happened to be born in a certain place.  I mean, I am that different from the people who happened to be born over there?

I didn't get it .  And no one did a very good job explaining it to me.

So I made a lot of sly, kind of sideways remarks. I knew enough not to say anything directly, especially about religion and patriotism.  I could tell that could get me in real trouble.  So I remained, just kind of confused. I had no solution.  I had nothing else to offer in their place, so I kept a lot of it quiet. I didn't really know what to say.

I also realized, that few other kids that I knew even gave these things a thought. They did what was being done around them.  They just kind of accepted that this was the way it was, and went on.  Most of my friends were much more concerned with hitting a baseball and getting their hands up under a girl's sweater.
With that, we shared a common interest, so I was accepted and did Ok.

Because of my confusion I was voted the "most individualistic" kid out of about 700 in my class.  That meant that people thought I was weird, but I guess I was clever enough to make it seem interesting.

And that's why I became a psychologist. 

I thought, geez, if what I'm thinking about is so weird, what the hell is everyone else really thinking about?

For the past forty years, people have been coming in and telling me.  So that part has worked out.