Sunday, May 30, 2010

Treatment Failures (?)

I was pleased to see the brief discussion about trying to treat an addict who lies. This is common. Many addicts lie. They lie to themselves, so it is easy for them to lie to others.

In my last post I was not saying that I was angry at this patient for lying to me, nor was I totally surprised. I was disappointed, both in him, for promising to try to to be honest, and with myself, for allowing it to happen again.

It is not very difficult to determine why he lied. He needed letters for his probation officer. He didn't know if I would cover for him, and he probably didn't want to put me in that position.

I probably would not have told his probation officer, at least not before making several other attempts at getting him to change. Then what? I can't be sure. Drinking alcohol, even getting wildly, obnoxiously drunk, is not against the law. But if it is a condition of your probation that you can't drink, then it becomes against the law for you.

We all joined in the cover-up, especially over the last month. Everyone kind of likes this guy. The people who run the alcohol monitoring program liked him, and were also probably sick of him. So was probation. He didn't break any other rules: he showed up to every appointment, he did his community service, he paid his fines, he stayed out of trouble. I think everyone involved (except his wife) decided not to push too much and let it go.

Now he is out of the system. He doesn't need me for letters, nad probation doesn't need me to cover their ass.

Now the qustions are completely different. Does he need treatment? Who determines that? Does he want treatment? That's up to him. Can he benefit from treatment? That depends upon why he thinks he would be coming. Am I the best one to treat him? How can I believe anything he says? How much does that matter?

We still have an appointment set up from before his wife called and told me what she has been living with. If she shows-up for that appointment we will try to answer all of those questions before proceeding.

I'd like to be able to believe his answers. But then, Obama thought he could believe BP.

Tuesday, May 25, 2010


Over a year ago I posted about a guy I had been seeing for almost two years who got drunk six weeks before he was about to get off probation, scuffled with a cop and ended up in jail for a month or so.

Well, he came out of jail, entered rehab, and went back on probation. In the beginning of his new probationary period he was put into a program that met almost every day, and monitored him closely. He had to stay sober for ninety consecutive days to get out of the program. He failed three times, lasting between fifty and eighty days. After those failures they told him he had to stay in the program until his probation is up, which will be Friday. And it will be Friday.

He has still been seeing me almost every week, and for a while he had been honest with me, telling me when he had been drinking and getting away with it. But over the last five months he had been telling me all the time how much he has learned, how much better his life is, how humble he had become, and how well he was doing with his new AA friends. He told me he was sorry that he had wasted so much of his life; but now he was sober.

I know that he needs me to write monthly letters to his probation officer. So I guess he couldn't risk telling me the truth. We had been talking a lot, especially this last month, about my concern that once he is off probation, and no one is watching, that his urge to drink will become very powerful.

He was very insightful and reassuring. He told me his strategies and back-up plans. He also told me that his wife has been watching him closely, and that she would probably cut him free if he began to drink again.


Yesterday, I got a call from his wife asking me if it was true that on Friday, the day his probation ends, that I promised him I would get him into rehab.


Didn't I know that he has been drinking about three days a week for the last two months, and that he has somehow managed to stay clear of getting tested.


I guess the probation department is sick of him. I can't imagine that a substance abuse program that has someone checking on him one to three times a week really couldn't figure this out --- even if I didn't. They run tests, breath and urine.

I guess they figure that if he isn't in real trouble then his drinking is his problem, and his wife's.

Well, I am not going to turn him in. His wife told me not to call him because her life would be hell, and she doesn't want him to go to jail.

I don't either. And I will try to get him into rehab as soon as his probation ends. And when he gets out, I doubt that I will take him back as a client. I have a tendency, as I have mentioned, to try and bring out the best in people, I have higher expectations for them then they have themselves, and I think that sometimes it frightens them.

Drinking is not against the law. If he gets loud and belligerent and obnoxious, he runs the risk of getting in trouble. He also runs the risk of losing his wife. But he has lost a wife before this one.

Addictions are very powerful. They, whatever substance one chooses, can make you feel better, for a while, then anything else in the world.

That makes the rest of the world so disappointing, and so much more difficult to be a part of.

Tuesday, May 18, 2010

I let it go on blog day

Today is "blog for mental health day" in case you were uninformed. I expect by now that you have already read countless mental health bloggers. If you want more you can find them today at

But I don't think they would be thrilled with my post today. You see today I let one slide.

I had just finished a session with Al, who got so depressed because his girl won't talk to him even though he has sent her eleven text messages telling her that he has realized how wrong he has been. he was just a lump of hapless rejection. Of course he has a tough history of parental rejection and oppression going back to when he was three, so this hurt hit him badly.

Then I got a call from Ben. He said left a message saying he just got out of jail, but he wasn't a criminal. He went to jail for illegal gun possession. He had a gun because he wanted to blow his brains out. Then, in jail, he said they put him on the wrong medication and it really messed up his mind. He was looking for help, for the right drugs and for therapy.

Was this true? Is this really what he was seeking? Quite possibly.

But today. I really didn't feel I could offer all that to him. I referred him to the full-service clinic at the other end of my building. They have people who do therapy, give drugs, do home visits, and take his insurance.

Nothing personal, but today I didn't want to do all that.

Tuesday, May 11, 2010

Falling Down

I continue to be amazed at the growing number of people out there who just can't cut it. It seems that the skills that it takes to keep functioning, productive and effective in our society are increasing month by month. More and more people seem to be getting confused, discouraged, or just plain overwhelmed.

Yes, the people who come to see me have difficulties. That is a given. But at least they are trying to deal with them. But they all bring with them stories of family members and friends who are worse off than they are, and who have become burdens to the families and friends who already have difficult lives.

Much of it is economic, as it is now very difficult to survive with a low-end job. Many, many jobs pay from $8 to $20 an hour. Almost all the service, retail and food related jobs. No one can really survive on that. Maybe if you're 24, and share an apartment, but you can't make a life. Yet, it is difficult work, with only a very narrow path to improvement.

But also the amount of drugs, alcohol, confusion, ineptitude, racial and sex discrimination, that is out there just adds to it all. Every day I get calls from people hoping to find a way to get on SSDI. The demands of a job, a family, and making a life become too much. They just don't want to do it any more. And once you fall behind it is so difficult to catch up. The welfare rules are complex and humiliating. The banks and credit system will screw you once you step into it too deeply, the computer-run bureaucracy, both the public and corporate ones, are impenetrable. People get angry. There seems to be anger everywhere. Changes come too quickly, no one seems to know what's next, or how to prepare for it.

There is a very strong feeling out there that things are not fair, that the rules are different for different people, the deck is stacked, and that there are no longer any standards of morals and justice. That seems to be the feelings of people on both the political right and left, but they each see different enemies.

What I see going on is this: AND I'm the one who KNOWS!

1. America has become much too much about the money. It always has been, but now it is worse and obvious. There is a lot of publicity about people who do not work hard yet acquire unspeakable amounts of money. Some people are just clever, some are heavily leveraged, and many just made money with the money they were born with. But now it is clearer that many people have become rich by bending the rules, a lot. And they get rewarded for it. No one really stops them.

2. People who see this expect that they too should be granted and easy, party, fun-filled life, without working too hard. They resent that they have to work hard every day. They feel exploited and angry. And now, with all of the new technology, everyone expects to be a star. We all have something to say, no matter how trite, trivial or meaningless. We all Tweet, Facebook, blog and YouTube. (Here I am, ranting on!)

But I have so many clients who have kids, brothers or close friends who spend hours and hours on-line, never see the light of day, and can't earn a living. Between Facebook, Pogo, and porn, their lives are complete. But they have no real skills.

Fifty, sixty years ago, it seems to me through the heavy fog of distorted memory, my father went to work eight to ten hours a day, six days a week. He was happy to be making money and have a warm home and a couple of annoying kids. He had come from Eastern Europe as a kid, and he was happy to be safe, and be able to keep what he worked for. He didn't expect life to be easy, He didn't want to be a star. He knew the world wasn't fair, as many of his relatives had been arbitrarily murdered by the Nazis. But he was willing to work, and he took satisfaction from it.

Much of that seem hard to find today. The Mexican, Chinese and Vietnamese are doing our dirty work. So many Americans seem to want to stay home and play video war games. The threat to our country certainly does not come sneaking across the border. It is right here in front of the 54 inch screen.

Thursday, May 06, 2010

The week of the oil spill

Sometimes it is difficult to even know where to start. It's like getting hit with a rogue wave, knocked down, rolled over, washed out, pushed back and left dazed and confused on a beach six miles away. "What the fuck just happen?"

This week was like that. Maybe because it's May. May is always a volatile month. The sap rises, gets in the brain, thinking goes haywire.

There were so many stunning incidents that it would take pages and pages to describe them all in the complex context that wold give them justice.

Couple #1. After waiting ten ears for him to clean up his act so they could be together. They unite as a loving ecstatic couple,spend three years building a life, learning to trust, and then she cheats on him with a high-powered business colleague. Comes home, cries, asks for forgiveness.

Couple #2. Six months ago, when they were, again, both very drunk, her got into a jealous rage and beat her badly. He went to jail. She got sober and started her new life. She realized he was a liar, a manipulator, and an addict. Without him she was relaxed, competent and sober. I knew what had happened (as I am sure you have also) when she missed her appointment last week. Today her friend called to see if I could get her committed because she was back with him, getting drunk and beaten.

Couple #3. Last year she came to see me to deal with the grief over her son who had killed himself. This year her brother, who had been a nasty drunk for years came to live with her for three months while he went through the dying process. He died last month. Today she called to tell me that the tests on her husband showed that he has lung cancer and it is also in his liver.

Couple #4. They are getting divorced, for many very valid reasons. But he still misses her. He is basically a hapless, inept kind of shelp, but he wasn't going to be passive this time. So he got drunk and tried to come and see her. When the door didn't open he pushed out the air-conditioner and jumped into the living room. But it was the wrong apartment so now he's in jail.

Alice, on crutches, has a spasm, fell down and smashed her good knee and now can't walk at all.

Bruce, just getting somewhat free of panic attacks, took a walk to get outside on the beautiful spring day, see the sun and be happy. He took a deep breath, filled up with pollen, couldn't breathe, vomited, almost fainted, had a panic attack, won't leave the house again.

Carla, who is nuts, just plain nuts, in many different annoying ways, and has been for years, is in trouble with the court for being stupid and annoying. She wants to get a psychological evaluation to prove that she is not nuts. I won't do that for her because: 1. I am her therapist (for the little good does that does for either of us). 2. because I don't want to show her that she is nuts, and 3. I don't do evaluations. So she has been calling every psychologist in the county and explaining, her own unique way, what she wants them to do. Then she leaves them my phone # to arrange the appointment as if I am running a concierge service. I have already received six very confused calls.

Of course there is more, but that is the general flavor of how the week has gone. The question is not Why is this happening? I actually can give very reasoned, precise explanations for all of this. The question is not even, What should I do about this? There are several things I can see I need to do in order to begin to repair the damage.

But really, it's just like the oil spill. It comes from not having a safety valve. It gets into everything. It is so hard to clean up, the effects will linger for years.

It can take 125 years for 500 artisans and craftsman to build a cathedral.

One person can blow it up in thirty seconds.