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.