Tuesday, January 31, 2012

Another not surprise

Americans it seems, more than those in any other country, like to avoid responsibility and also to seek a quick fix.

That's why it came as no surprise to anyone who has been in practice for more than ten years, to learn that the diagnosis of ADHD, is not as real or as widespread as it has become, and the the treatment of it, whatever it is, with stimulant medication is not effective.

In truth, a lot of what is called ADD, or ADHD, is the result of a chaotic environment, not enough consistent discipline, and certainly a lack of having learned self-discipline.

Now I don't want to run around pointing fingers and yelling "bad parent" at anyone who has been told their kid has ADD.  In truth, some teachers tried to pin that on my own son when he was ten, and the description may have even fit me for a couple of years when I was a kid.

The reason for the increase in the diagnoses was two-fold:

1. the increase in the complexity of life.  Parents now are often both working, everyone is scurrying around.  Schools are more high paced, stimulation comes from everywhere and very rapidly.  Kids hardly have time to take a break and just have random, unplanned, un-educational fun, which is the kind that really leads to the most learning.  It is very difficult for young boys to sit still and focus for more than half an hour.  Most of them just are not built that way.

2.  The drug industry found a drug that works.  They failed to point out that the drug is a stimulant (speed) and that it helps everyone focus, from seven year-olds to eight-seven year-olds.  They also did not report the studies that show the effectiveness wears off over time, and that their are often side-effects, such as headaches, sleeplessness and stunted growth.

But, once again, there was money to be made.  And the drugs do make a difference, for a while.  But they don't really help anyone learn, and they seem to hinder people learning how to learn, or learning to control themselves.

There have been so many times when I have had a parent tell me that their son won't do his homework, but  if he is interested in something: science, football, skateboarding, girls; then he will learn all he can about it.  That is NOT a symptom of ADD.  It shows that the kid is motivated to do what he feels is relevant.

Many psychologists have made a living on testing and diagnosing brain pathologies, and ADD is right up there.  But everyone has a brain, and every brain is slightly different.  Still, we can all learn to do what we need to do.  We are all good at finding ways at doing what we want to do, under pressure we can do what is necessary, unless we give ourselves an excuse.

It is also interesting to note that something like 94% of people taking medicine for ADD are in the U.S. of A.   Is it something in the soil?

Well, I guess you can't blame your brain any more if you work is late and you watched re-runs of Cheers instead of getting it finished.  You might have to tell everyone, including yourself, that you just didn't want to do it.

Monday, January 30, 2012

Back Again

So, i went away.  I had a very busy week from January 16 to 20,including having to go to a funeral. Fortunately, this was the funeral of a friend's parent, and not of a friend.  Those are getting closer, I know, but at least not yet.

Then I went away.  Took off to the South to find some sea and sun.  Being of this transitional age, we now have friends who are there when we get there.  More and more of them are taking time, many are taking much more time than we are.  They are either older, richer, or laid-off and letting it all go.  So this trip was different.  I usually go away with just my wife and maybe we will meet someone as we travel, as we have gotten good at stranger-travel conversation.  I find that interesting to talk to people from other cultures, like Mississippi, which we did last year.  Now we are meeting our own friends, and this time we meet with their friends, each of whom had brought along a friend.

So there we were, at one time there were more than a dozen of us; old wrinkled people, charming, well read, well intentioned, but certainly not as attractive as any of us once were.  It's a shame.  I realized how much I like to be with attractive people.  It tinges things with a bit of excitement.

Now we talk about art and food and wine. (I don't like wine, I'm a beer or whiskey {not whisky} guy). These folks were very interesting, well read, well traveled, successful.  We were way down at the Southern end of the country, but we all had lived most of our lives up here within a twenty mile radius of each other.  Small world? His kid had played basketball for the same high school my kid played for, only four years earlier, but we had never met. They were business people, an artist, a writer,an editor,  a couple of teachers.

But everyone was kind of a bit confused about what comes next.  Do we just amuse ourselves, or can we find a way to help the world do a little better.  We all agreed that it certainly needed the help.  No one was particularly asking for out help, except to send checks.  But all of us were amazed and disturbed to see that how the people who want to be leaders are so full of fury, venom and destruction.  Any talk of compromise or conciliation at any level, from the neighborhood to between two nations, was only seen as a sign of weakness.

I am back now, dealing with 18 messages, six new people in the middle of crises, with fewer people offering any way out. I won't be taking time off again for a while.

Friday, January 13, 2012

30 1/2

With the readjustment of my schedule, plus the introduction of two beautiful granddaughters into my world, there has been a big shift in my life.  I have three and a half work days followed by three and a half days with little or no work. 

The two worlds are radically different. Often, on a day that I am not working, even the idea of having to make a phone call seems like such an intrusion.  I have to gear up, rearrange my mind and actively remember how to do it.  On the days that I do work I am up two hours earlier.  I stretch faithfully, I join the flow of heavy traffic and I am deeply immersed in the world.

Wednesday of this week was one of those work days that were the original inspiration for me to begin this blog.  It seemed as if the whole world, in its many variations was parading into my office. I had ten consecutive hours of appointments, each unique and totally different that the previous.  It was well after 7 PM, when I cleaned off my desk, and realized that my impression of the day was totally Fellini-esque.  8 1/2 all over.

Most of you are too young to have experienced 8 1/2 at it's original time.  The movie is perfect and marvelously done, yet has not real plot, makes little sense,  and it may or may not mean what you think.  The images are still so memorable and grab that sense of how life is, at those times when life overwhelming and incomprehensible. From the first scene of being trapped in a traffic jam and having a panic attack alone in car, to the end, the parade of the characters, it was an exact description of the feeling of last Wednesday.

The clowns, the acrobats, the jugglers, the beautiful women, the painted women, the fretting businessmen, the sad wives, the lost unfaithful husbands, and the director who is searching, searching for an underlying theme.

That is what I do after  a day like that.  I still do it after thirty years of doing therapy.
Who are these people?  How did they get like this?  What can I do for them?
and then, a the meta-level--

Why is the world like this?  Why do people do these things to each other?  If, as many of my patients say, "everything happens for a reason"  why is it that I don't see the reason---
except to continue on, searching for the reason. Or ,as the Guido character in the movie says: "I have nothing to say, but I want to say it."

I stopped on the way home that night and bought a pizza.  The next morning I was back in the office.  A woman came in and told me how she was proud that she has been making progress.  She has recycled six (out of 12 -- probably really 30) clean, empty plastic orange juice bottles that could have had be re-used many times for many purposes.

She did it, but then she cried.

Change is difficult.

Reality is hard to define.

Saturday, January 07, 2012

Books 2

After sitting in a small comfortable room talking to people for roughly an hour at a time for thirty years, certain phrases become part of my repertoire.  One thing that I often say to people who are in the middle of making some changes in their lives is this:

"You have to use the small part of you mind that is conscious to make sure you do what you want to be doing."

I am not a Freudian, so I am not saying that you have to overrule your Id, and repress you unconscious impulses.  Although, in a different way I am.

What I really mean by the sentence I quoted above is described very well in the book Thinking, Fast and Slow, by Dr, Daniel Kahneman.  He describes to types of thinking, one is fast, emotional, responsive and not subject to reflection.  He calls this, cleverly, System 1.  System 2, is what I deal with in therapy.  Slow, contemplative, thinking about thinking, reasoning, more rational, planning.

System 1 is much more primitive and emotional.  It is there to help us survive in a tough world.  If we are going to catch food instead of be food we have to learn how to react quickly, using very little information to make decisions.

However, in the world we live in now, things are much more complex, and thankfully, more civilized. The people who do best are those who can see the longer-term consequences of their actions:

Getting angry and smacking someone is System 1.  Getting angry and realizing that smacking someone will lead to bad things for them and for you, and thus learning to rephrase your argument so that you can negotiate with your adversary, is System 2.

As I said, learning to use System 2 is what therapy is all about.

In some ways I have been saying that in this blog.  To publish a book these days it helps to have a "platform" to give you credibility.  Dr. Kahneman won a Noble prize for this work.  He has a bigger platform than I do.  HIs book is easy to rad and helpful.

I think it's always helpful to think about what your thinking about, although it can get tiresome. Then you need to take a break and watch football.

Sunday, January 01, 2012

Books, (1)

Hey, Happy New Year.

I hope you're all well and had a good holiday week and now you're rested and ready to make this year, 2012, the best ever.  Of course, we have one more day off tomorrow before we have to put in all that effort.

But this is it.  This can be the best year ever.  We know how to do it; we just don't agree.

Anyway, over the holiday I have not worked too much.  Part of what I have been doing is reading, and two of the books are long, heavy, academic kind of things that interest me.  I started one mystery and it was really well written, with good characters and a clever plot, but by the middle of it the events became either predictable or ridiculous.  I'm not good at letting those things slide, so I went back to these somewhat ponderous academic books.

The first, which I will deal with briefly here, is Steven Pinker's  "The Better Angels of Our Nature."  He takes about 700 pages to make the point that we, humans, have become more caring and less violent over the last few centuries.  In order to make his point he fills hundreds of pages of descriptions of the kinds of torture and gore, rape and slavery that were common for centuries. Most of that, he maintains, is either being eliminated or is at least frowned upon, when forever it was just part of human life. 

The point he makes, which is a different stance for him, is that we are not genetically programmed to be violent and murderous.  He shows how the growth of civilizations around the world have really served to civilize people.  We now care about things that were never even considered as possible, such as equal right s for women, a punishment being too cruel and inhuman, not hanging people for robbery, racial equality, the right to a fair trial, democracy, and the big one, which really has just begun to take hold in the last fifty years, that wars are not worth the trouble, and that they can be avoided.

This is a major new idea, and for most people it just became even a discussion in the 1960s when a lot of soft, educated, rich Americans, like me, were willing to put reason ahead of patriotism to not get hurt. This had always been unheard of, and often resulted in executions.

Certainly, there are still many people who feel that anyone who is of a different race, and women and anyone who is different in any way: gay, foreign, Muslim, etc, is still basically inferior, and because of that they can be easily slaughtered.  But that way of thinking, which was once so unquestioned, is now questioned almost all the time.

The biggest example I think, of Pinker's point, is that right now most of the developed world is in a big economic slump, and jobs and money are scarce all over the world.  But no one is threatening to go to war over it.  In the history of the world, that is something really new.

So, enjoy that idea, and Happy New Year.  Let's work together to make it the best yet.