Monday, September 30, 2013

A clinical observation

Over the years of dealing with many people and hearing about thousands of relationships I have concluded, from the anecdotal evidence of my observations, that it becomes much more difficult to end a relationship, no matter how difficult, unrewarding, and troublesome it has become, after you have had sex with that person three or more times.

Seems to be the case...

Wednesday, September 25, 2013

The short answer

"A Mister Richard Fader from Fort Lee New Jersey writes:".......(most of you probably get that, right?)

Anyway, more than one of the questions I received was from far away and it asked, simply, if I thought that there would ever be a time when the people of the world would get along better, and that greedy, power-hungry people would no longer have such a strong influence.

I replied:
I do think that, overall, the world has become more civilized and there is really less torture, fewer huge wars,     and more are  people getting along better. I don't know if you have a chance to read Steven Pinker's 
"Angles of Our Better Nature" but he makes a good case for that.

Yet, it is obvious we are not close to the great wave of human harmony.  I think the global climate change has 
put pressures on countries to fight for basic resources that are becoming more scarce.  
That is a lot of what underlies the problems in the Middle East and northern Africa today. 

I also think that technology has made life so much more efficient that it is becoming more difficult 
for people to find meaningful work, if they can find work at all.

Until those problems are solved in a manner that gives everyone a chance to survive and have a 
decent, but not decadent lifestyle, there will be fighting and trouble.

Take good care of yourself.

Monday, September 23, 2013

social anxiety

I am slowly reading through the comments and questions I have received from my Listserve post ten days ago.  I am going through them when I can, but I also have have my day-job, the three grand-kids, a wedding I attended, a bit of time with the wife and friends, and then the Sox clinched the pennant and the patriots caught the ball and won another game.

But a few of the questions were about how to deal with social anxiety.  As one woman put it:

I'm in a field that requires a lot of 
networking, but I have a lot of social anxiety when I spend time with these 
people outside a professional setting. I don't feel like I belong, that I have 
any right to be there. I get seized by dread. Any advice?

These feeling on not belonging, not being worthy, feeling conspicuous, and constantly
lacking, are very common, much more than anyone who has them realizes, mostly because 
no one talks about them.  But they can be very powerful, and they put a great strain on a
person's life, and a strain on the lives of others who depend upon them.

I have treated many, many people who have many different shades of anxiety disorders, and most of them make a great deal of progress and function much better.  Only a few are ever  completely free of  those feelings and are never bothered again.

It is because of this I am fairly certain there is some genetic component to this.  Some          people are designed to be more sensitive and more reactive.  There are good parts to that, 
to being more aware of how other people feel, and what is going on around you, but it can 
get way overdone and make a person so uncomfortable and be such a strain that it greatly   limits their lives.

That isn't to say that the cause is totally genetic; that is never the case.  But when someone who is prone to anxiety is put through circumstances of great stress, ambiguity, or is with  people or in circumstances that they cannot control, they are vulnerable to panic attacks     and strong feelings of anxiety, doom and dread.  

Given all that, this was my reply to the people who asked about social anxiety:

Social anxiety really sucks.
some tips:
1.  When you go into an social setting don't expect to be fine; that will only disappoint you and make it seem worse.  Expect the anxiety and sit with it. See if you can let it pas through you.
2.  Of course you belong -- we are all united by our real insignificance -- even if you don't feel it.  if you are surrounded by people and feel tense, just sit and observe.  Don't pressure yourself to talk until you want to.  Try to pay attention to the conversation more than your internal feelings.  If you can show people you are actually listening to them they will be very flattered and they will think you're a great person.
So, that was my "Internet Advice," It's worth about as much as she paid for it.  I hope it was helpful.  Anxiety increases when people try to control things that are not within their power to control.  Your mind churns and churns trying to find a solution.  Then you feel that your mind is out of control and you must be crazy.  That's when things get worse.
Anyway, I hope that none of you feel like that today.  
Enjoy the beautiful Autumn weather. ( and forgive me for the disjointed formatting, I'm not sure where it came from.)

Thursday, September 19, 2013

the task ahead

I am almost finished telling everyone who sent a request that I will get to their question some time in the next -- who knows when --- but I will.

In my message to the Listserve I said I would answer questions and of the 260 responses, a bit more than half seem to be legitimate questions.  In the piece I wrote I stated that nothing that people do surprises me anymore. After reading the comments, I find I am not surprised, I am a bit saddened that there are so many people out there who are not only struggling with so much, but are also searching for a way to find help.

As I have said in the past, I am not a fan of psychiatric diagnoses.  I feel that these labels only mark people as "sick" when they are really just dealing with the shit the world has handed them, often from the moment they meet their parents.

The causes of upset and strife are similar all over the world: stress, loss, loneliness, illness, trauma, and inadequate resources.  These are the factors I usually look at when I try to define a problem and then set about looking for a solution; something that is always a joint process with the patient.

The sad part to me is that there are so many terrible situations that people are reporting, and I hope to be answering them really soon.  The other side of the picture is that only one percent of the readers of the List felt the need to respond, so the other 99% either thought what I said was OK or useless, but they are moving on well enough without me.

In some ways that's comforting.

Sunday, September 15, 2013

A comment about the comments

The comments in question are not the comments on this blog, which are mostly Forsythia's welcome and supportive comments.  But I have been reading the emails that I have been receiving from the post on the Listserve on Friday.  There are over 200 of them, and most took me up on the offer to ask me any kind of question about relationships.

The questions have come from all over the world,literally: China, Portugal, Brazil, UK, Australia, Italy, South Africa, India, and at least twenty U.S. states.  I believe I have heard from every continent that is not covered in ice.  Some of the questions are very specific and about the relationship the questioner is in.  Some are very general and ask for the kind of general guidance that I am reluctant to give. And others are from people who are dealing with emotional difficulties, the kind that I deal with in my office.  In fact, I hope to make a few referrals if i get more specific information of where the questioner is located.

Many people state in their email that they have not  sought help, and have not asked their question before.  Several have said that they feel more comfortable asking someone who they don't really know, who is hundreds of miles away.

Again, it shows how much confidentiality, and the fear of being judged plays such an important role in establishing a therapeutic relationship; any relationship really.

I hope that over the next few weeks I will have time and permission to post some of the questions, and my marvelously wise answers here.  But now I have to go and change my grandson's diaper.

Be patient kid, you're acting like you're two weeks old.  Oh, right.......

Saturday, September 14, 2013

The Listserve

A year or two ago, someone in NYC began an Internet project called The Listserve.  He or she got about 24,000 people to sign up to get an email a day from a randomly selected person who had subscribed.  I have been reading these emails fro about a year.

A two days ago I was randomly selected.  What I posted is written below.  But before you read that I want you to notice that at the end of the post I invited people to ask me any question they wanted, since you already know how impressed I am with my own knowledge.

Well, so far, less than two days later, I have received over 200 comments and questions.  In the coming days I will post some of the question I received, and my very clever answers.  That will be easier than thinking up things on my own.

Here is what I posted:

Hello Listserve:

            I am considerably older than most of those who have already posted 
their messages on this site, and thus I have lost most of my armor of idealism .  
Much of this is due to the experiences I have had working as a Psychologist in 
Massachusetts mill cities for almost forty years.  I feel I have seen almost 
everything humanity can offer.  I no longer question whether something is good 
or bad; I just see it as fascinating.

            There is nothing anyone can do that would surprise me any more.  
Anything my wildest imagination can produce someone out there is doing it, and 
they are doing it thinking it will bring them happiness or satisfaction.  Most 
of the time it doesn’t.

            I would give you all advice, because I know, better than Dr. Phil, 
what you should do with your life, but more than that I know that you wouldn’t 
listen. That's not how people change.  Change has to come through emotional 
experience.  Perhaps in three years you might think back and say, “maybe that 
guy was on to something.”

            I am a big believer in the saying “When the student is ready, the 
teacher appears.”

            Humans are a work in progress, an intriguing but flawed species.  If 
you haven’t realized by now, please take notice: the world is almost always run 
by character-disordered people.  Kings, Queens, generals, presidents, tyrants, 
business leaders, billionaires, market movers, and celebrates are usually 
greedy, power-hungry narcissists, or else they have that missionary zeal and are 
self-righteous.  That’s not always true, only about 90% of the time.

            Most people are basically kind and caring. They want to get along, 
have a few satisfying relationships – which is difficult enough-- contribute 
something to the good of the world and then relax and enjoy their family and 
friends.  But then someone comes along who wants to grab power and take control  
of everyone and everything.  He (it almost always is a he) identifies some small 
difference as a huge threat, then gathers a group of devoted followers to save 
his people from it, and everything goes downhill from there.   Just look at 
history, and look at what’s going on now.

            As I said, I am old, I am wise, and I know everything about human 
relationships.  If you want an answer just send me the question.  I won’t expect 
you to take my advice.

Tuesday, September 10, 2013

Diagnostic discussion

Given all of the talk about how helpful, accurate or scientific psychiatric diagnoses are, and how embarrassing DSM V is, there is an attempt o bring some hope to psychiatry in an article in the Sunday NYT Review section.  In that piece, Dr. Eric Kandel, a Noble Prize winner in physiology, tries to make the case that we are well on the way to having better diagnostics through brain research.

In his explanation he gives a very positive nod to the use of psychotherapy as an effective treatment for mental disorders.  Along the way he re-labels psychotherapy as a brain-treatment, and takes a slap at therapists lack of scientific rigor, but his view of therapy is general very positive.

He makes a case, that is much more hopeful than real, that further study of neuroscience, genetics, and bio-chemistry will eventually, in years to come, reveal the underlying causes of mental disorders, and greatly improve diagnosis and treatment.

I certainly agree with Dr. Kandel that these sciences are of great importance to the understanding of some of the contributing causes of emotional and behavioral irregularities but, given who he is and where he comes from, he is trapped in a very reductionist, medical model.  If psychotherapy is a “biological brain-treatment” as he states, so is a family, a sub-culture, and a romantic relationship.  These things also have a major impact on how a person feels and behaves, and they cause many major changes in the brain.  Until we learn how to integrate all of these factors into our attempts at understanding what causes what,  we will be still fumbling around with inaccurate half-truths.

At present, diagnoses are often as much a political act as they are a science.  They are descriptions of what is considered, at the time, unacceptable behaviors.  What is unacceptable changes with the culture, and the soical values of the times.  There are many, many examples, from hysteria to homosexuality, that were illnesses then, but are seen as acceptable now.  I am sure what is now called bi-polar disorder in ten years will have four different names.

Yes, our mind is a product of our brain, but our brain reacts to what is happening in the world around it as much as what is happening inside our skulls.

That’s my view, even without a Nobel prize.