Sunday, July 28, 2013

The $ factor.

I thought I had posted it here, but I only sent it out as a tweet:
"40% of my patients problems could be greatly improved, if not completely cured, by $35,000."

(I tweet @therapistmumble, but it's hardly worth following because I tweet about once a month).

On the front page of today's NYT "Review: section is an article by Moises Velasquez Manoff (that's a name for the new world) which gives a lot of research support to the concept that the poor suffer in many ways -- health, longevity, depression, etc, much more than people who are financially comfortable.

Now, to most of you this probably comes as a "Duh!"

But, unfortunately, too many people in this gold ol' U.S. of A. seem not only aware of that fact, but happy about it. We are getting back to where we were in 1964, of blaming the victim, and using the poor to make the rich feel better.

This is not a prescription for the long-term success of any society.

Friday, July 26, 2013

Not enough

         In between session of running in and out of the water and jumping over tiny waves with my almost two year-old granddaughter, I was able to read parts of the NY Times on Sunday. As usually, there were many descriptions to some awful things that are going on around the world, which show the varied ways in which people can be horrible to each other.
         I read a few more positive things also, but one piece that I felt was the most relevant to me as a Psychologist was on the back page of the Review section, written by Nickolas A. Christakis, a sociologist and professor at Yale.

         I thought it was important because what he presents is very much like I have been saying for at least the last three years to the seven people who listen to me, and that is that our discipline, the science of Psychology and with it the practice of psychotherapy, have become too narrowly focused on the same specific areas we have already studied, and on variations of the same ways in which we have been practicing for seventy years.
         Clearly the practice of Psychology has resulted in many improvements in treatment, especially in how we deal with specific problems, such as PTSD, panic attacks, and even borderline personality.  But we have not taken any dramatic leap forward in conceptualization, and especially in the combining and utilization of knowledge from other branches of science.
         There are so many exciting things going on the fields of genetics, microbiology, and biochemistry that seem to be relevant to how we think and what we do.  It has also become clear to me, after over thirty years in practice, that the core of what we do is based upon a model devised by overly intellectual white Europeans early in the last century.  We can now see that there are so many other factors to consider, such as health, wealth, culture, sub-culture, information availability, and use of technology.
         All of these genetic, biochemical, sociological, and certainly political factors are constantly interacting  with each other in very complex ways and I feel strongly that if we are going to improve our understanding of the causes and influences of what makes people think, feel and act the way that they do, and therefore improve our treatment of those who suffer from it, we have to greatly expand our foundation of study. We have to be much more aggressive in our efforts to learn from, to interact with, and collaborate with others in other disciplines.
         As the market has been showing, unless we change, we will become more out of date and irrelevant.

Monday, July 15, 2013


I ended my last post by saying that in today's climate it may not always be good to teach a man to fish.

But, really, I didn't get the analogy exactly right.

If you give a man a fish, you can feed him for a day, even if he doesn't know how, or doesn't have the resources to cook it, if the fish is fresh enough.

But if you teach him to fish:

You can teach a man to fish, but are you going to buy him a boat, pay for the fuel, and then pay for the liability insurance?

He may get arrested for not having a license.

To get a license he may have to bribe people, or all the licenses may already be taken by corporate entities.

You may be introducing him to fierce territorial competition, for which he is unprepared.

There may not be enough fish due to over-fishing and lax regulation.

The fish that are left may be a health risk due to the polluted water they live in.

Did you also teach him to swim, or are you putting his life in danger?

And don't think farming is any better.

Nothing is that simple any more.

Sunday, July 14, 2013


Summer is certainly here.  The Big 4th of July Weekend has passed and everyone is in full summer mode.  Some are sitting on stoops, going to bar-b-ques, headed to the beach or the lake.  The city is full of events to keep the residents home to spend their money locally, or to entertain the tourists.  All the cities, large and small on the New England coast, from Newport, RI, to Bar Harbor ME are full and festive.  The visitors from Topeka probably think it's like that all year long.

For me, still working, still doing at least three full days a week, the divide between work and play is huge.  I feel so fortunate that my family, all three generations now, is happy, healthy, enthusiastic and even prosperous.  It becomes even more difficult to turn the pages of the Sunday paper and read about what goes on in Egypt, Mali, Syria, China, Spain, and even Florida and Texas.  It is even more painful to see what happens with our very own government, grinding to a halt in Washington, D.C, helping no one, solving nothing.

That is also what upsets me in my practice.  So many of the patients i have to deal with have problems that are due as much to politics as they are emotions, neurological, genetic or family dynamics.  I see a 58 year-old man who knows he will never be able to get a job that pays close to what he has had before. His unemployment support has ended.  His wife is exhausted from dealing with his feelings of hopelessness.

I see a 25 year-old woman who is working as a waitress and wants to go back to nursing school but she already has $32K in student loans.  Her father is dead and her mother makes $14 an hour.  She would have to take all of her courses, do her clinical rotations, and also be working full-time to support herself,. A friend of hers from high school, whose grades were never as good as hers, has father who is buying her a condo near school and paying all of her expenses.

I have about a dozen more examples for this: cases in which $25K would be much more help than two years of therapy.

Give a man a fish and you feed him for a day.  Teach him to fish and he will starve to death if there are no fish to catch.