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.