Tuesday, February 09, 2010


I have written about this woman before, just over a year ago on January 28,2009. She is a fascinating mix of strengths and weaknesses. A mixture of psychological, neurological, traumatic, and also bureaucratic difficulties. She is very articulate, with a good sense of humor, but she gets disoriented very easily, is always anxious and in fear of harm, slightly paranoid, but from experience. She is also a hoarder, as bad as any of the cases you see on TV. (Boy, that is a sick, exploitive show, but that will be another post).

I received a call from a nurse who is part of her treatment team. They went to her house and realized that she is probably not taking her medication as prescribed because she can't find half the bottles that are lost in the mess. They also saw that she has three check-books she can't find, as well as several checks and money-orders that she has received. All lost in the piles.

They told me that they want to send in a visiting nurse, at least every other day to give her her meds, and also they would like to assign someone to be her payee who would manage her money, so her bills will get paid on time and her money will get put into a bank account.

This seemed reasonable, and probably helpful, so I brought it up to the woman at her next session. The idea made her very nervous, and she made me promise to tell them that she did not need, or want, those services.

As we discussed why, the reasons became clear, and reasonable. Although, in some ways she could see the benefit of them "helping" her that way, she really felt like they would be taking away her freedom to be who she is. They would clean up her place and make her throw away many things they viewed as trash, that she viewed as having useful potential, and/or things she was attached to. Yes, she attached to almost everything, but she felt strongly that everything had a purpose.

She felt the same about medication. She felt that if she took all the pills they gave her, she would be less anxious, but paradoxically, that would make her more anxious. She had a history of being abused by her mother, and then by a boyfriend, and finally by a husband who almost killed her --- see she does get very attached to things and people and can't let go. But from these experiences she feels that if she is not anxious she is much more vulnerable, She feels her anxiety protects her.

Also, she feels that on the medication, she would feel less anxious, but she would feel much less of everything, including, much less like being herself. And despite all of her flaws and hang-ups, she has come to enjoy being who she is. She feels hat she is a very nice person who happens to care too much about everything and everybody. She feels that the world would be better if more people were more like her. Instead there is a medical establishment that tries to make people, neat, clean, quiet and respectable. Zombies. She doesn't want that; she wants to stay alive.

So, I agreed to call them off.

Wednesday, February 03, 2010

Newsweek again

I don't like to go over the same material lots of time -- although isn't that what most of life is anyway? But my wife still gets Newsweek -- she's been getting it since high school, and that was a while ago. And while she may be one of the two dozen people who actually subscribe to what at one time was a magazine that measured the pulse of the nation, it still has enough power to bother me.

The cover story is by Sharon Begely, the woman who trashed on psychotherapy a couple of months ago and got so many of us therapists all riled up. Well now she has taken her sensationalist approach to journalism and focused on anti-depressant medication. Again, as is her usual style, she reads a couple of articles and takes the most extreme view and turns it into the truth. This time she feels she has discovered The Placebo Effect, which is something that has been around for about forty years. She highlights the fact that most anti-depressant medications are slightly, if any, more effective than a placebo. This is stuff I think that even I, a derivative thinker, have written about on this very blog about two years ago. (if it wasn't so late I'd dig up the post).

The following article in the same magazine was written by a psychiatrist who took the opposite position and extolled the effectiveness and life-saving value of anti-depressants.

This kind of shit is exactly what our President Obama was talking about the other day. He said that discussion and debate are vanishing in this country and it is all point-counter point, with extreme positions and conflict.

The truth about anti-depressants is very complex. Their effectiveness varies greatly depending upon who is taking them, for what, for how long, and how sensitive their body is to chemicals and side-effects.

In many ways the reason these drugs are so wide-spread has more to do with drug company marketing and profits that their actual effectiveness as mind changing agents. It is also true that they can be addicting, and that they usually cause weight gain.
But, these drugs also have been very helpful to millions of people, for reasons that involve a complex interaction of factors.

Hardly anyone, not drug companies, the FDA, clinical researchers who want to get more funding, or the doctors who give out the pills has the time, the skills, the resources, or the money to really do an objective study to tease out all of the factors. We end up with Yes/No divisiveness and half truths.

It has always been this way; back to the time of when we blamed witches and demons.

Monday, February 01, 2010


These days about half of my new clients call me to make an appointment, the other, mostly younger half send an email. I don't usually get walk-ins. But I did today.

He was sitting in a chair in the waiting room. My scheduled client was already there, so I didn't think he was coming to see me, but I also knew that the other therapist who is usually in the office on Monday afternoon had left. He looked up quizzically as I came out to greet my expected client, so I returned the puzzled gaze. He then asked if I was who I am, and I replied that I was.

Then this gentlemen stood up and asked if I had an appointment available in the not too distant future. By the time he finished asking he was up to his full height of about 6' 4". He was a large, powerful looking gentleman, weighing about 280 pounds, with big shoulders showing through his leather jacket. His hair was slicked straight back and his eyes were dark and direct. There were black and red strands of the top of a tattoo reaching around his neck.

"I need some anger management." he said in a soft voice.

I gave him an appointment anyway.