Tuesday, November 26, 2013

He Passed!

I am still working, and more and more my work frightens me a bit.  There are so many things that can happen that we can't control.

One of the things that makes me scared is the unexplained increase in Autism Spectrum Disorders.  About ten years ago I was a bit skeptical.  Was this being over-diagnoses?  Were kids who were a little odd or a bit removed getting labels that would hurt their lives?  Or were they getting labels so that they could qualify for more educational services?

I didn't know.

But as the years went by and I saw more families with these boys, mostly boys, I was convinced by the evidence that something was happening.

Now, this is a Spectrum disorder, and some of these kids are different, but fine.  They miss some social cues, and they over-focus, but they can be well-adjusted and productive.  But others are further down the Spectrum.  Some need help, some need a lot of help, and some are just overwhelmingly non-functional.

And the numbers seem to be increasing. According to recent data 1 in 52 boys are on the Spectrum.  That's almost 2%.  There seem to be some contributing factors, such as older parents, especially older fathers, but the real cause is not clear.

At the end of August my third grandchild, and first grandson was born.  I had no reason to suspect that anything was wrong, but I have seen how much time and attention and effort a special needs child can absorb from a whole family, and I would do it if that was necessary, because what else do you do, but I would prefer not to.

But now he boy is over two months old.  He looks at my face, old and puffy as it is.  He looks in my eyes as I hold him.  He reaches out to be held.  He now smiles when I play with him and move his hands and he coos back at me when I coo at him.

He's fine.  He passed.  I'm don't have to worry.

In six months I'll buy him a truck and a basketball.

I did that for his older sister too, but now all she wants is her tu-tu and to dance!  How does this happen?

Anyway, Lets all Dance!!

Happy Holiday if you Can.

Thursday, November 21, 2013

Big Data

I'm reading the MIT Magazine.  They highlight 35 innovators under 35, about half my age.  Many of them use Big Data to see trends, make predictions, help the world.  Amazing stuff.

One person has constructed software that predict outbreaks of cholera, another has learned to show traffic patterns that can help reduce fuel consumption and help people shop locally.  Another does genetic screening for recessive diseases.  A pharmacist in Ghana has an app that will tell people if the medicine they are taking is real or fake -- a lot of it is fake in third world countries.  On and on, great stuff.

It was Big Data that led to the new statin drug recommendations -- that half the wold should take more pills.  Now there is a reaction to that.  People don't feel that Big Data captures them, and their individuality.

Psychotherapy does not led itself to Big Data.  That is it's strength.  IT assumes that everyone is an individual; everyone is unique.  And we are.  People respond so much better when they are treated as a special. unique individual.

But Big Data sees things that no individual can.  We are all a contributor and a victim of our times.  We breathe the air and drink the water and eat the processed food.  We think the thoughts that come all the media of the day, and those around us.  Things happen because other things happen.  If you can see what is happening you can help, or prevent other things from happening.

But I'm ME, we all cry out.  None of us exactly fit the profile of who WE all are. We can't forget that.

Very difficult to find the balance. Who to trust.  How to decide what to do.

Tuesday, November 19, 2013

Not That Good

It's pretty clear to me now that I am in the process of winding down my practice.  I've been in a "private" practice in this city since 1981.  The reasons for my starting to close down and move along have been discussed here in several ways, and will be again.  But not today.

But, I have been looking back as well as forward and I can see that having a practice like this as mostly what I wanted to do.  My first choice would have been to be part of a real community mental health program, such as the one I was sent to school for, and where I had my first job.  These were places where people could go for evaluations and treatment of social, emotional and learning problems, and also for neighborhood problems and community issues.  We were just learning how to do preventive work, educational work and consult with other agencies when President Reagan decided that this sounded like Socialism and his government wouldn't pay for those things.

So, we got licensed and went into private practices and then we got paid by insurance companies.  That model was good for treating the kind of problems people brought to us, but  treating them one by one, which was often kind of frustrating, since many of them really were caused by what was happening in the community, or society at the time -- still true.

Also, looking back I can see how successful I was at treating people with relationship difficulties, with anxiety and panic problems, with many forms of depression, with loss, loneliness, addictions, and many of the other things that disrupt and deplete people's lives. Often that was very gratifying.

But we, mental health professionals: Psychologists, Psychiatrists and all the others, still have very little  success treating the real destructive kind of "mental illness," the kind that rips families and communities apart.  That is we offer very little help to the person who is angry, obnoxious, aggressive, upsetting and destructive.  These are people who get about six diagnoses during their lifetime, including Borderline Personality, Major Depression, Bipolar Disorder, Antisocial personality, Oppositional Disorder, and other such names that don't identify an underlying cause as much as they are just descriptive.

We offer these people many medications, dialectical behavior therapy, cognitive behavior therapy, and many other kinds of treatment that don't work, mostly because the people don't attend, don't follow, get angry and frustrated easily and leave.

There are many people who are afflicted, if that is what it is.  They bring heart-break and havoc to their families, they take too many drugs, make bad decisions, and cause problems in the community. I feel, that because so many of the tasks required in today's society are complex, and demand much more interpersonal interactions, and at a quicker pace than previously, that more people break-down and reach their breaking point.  Then they get angry, stop functioning, don't pay their bills, get in arguments and fights, and end up either in legal trouble or in bed for weeks. When they get out of bed they are further behind, angrier, and cause more problems.

I have seen many for therapy, and then they don't return.  I hear about so many more because their families suffer come to me for help.  They don't know whether to try to help or cut ties, and neither strategy is successful.

It's very sad.  We have all kinds of labels, but no real treatment.  The cause is probably a combination of genetics, family, community, timing, diet, toxins and luck.  But then what?

That is the real problesm in mental illness, and we don't have a clue.

Sunday, November 03, 2013

Boston Strong ! ? !

I live close to Boston.  I went to college near Boston, where I met my wife.  We left for graduate school, but came back to be near our friends, and be part of the culture that is in Boston, Cambridge and around here.  We raised our kids close to Boston and they are raising their kids here.

There was a parade in Boston yesterday so that people could line the streets and cheer for the Red Sox, who had just won the World Series.  I didn't go to the parade, although I did watch six minutes of it on TV.  I don't go to any of the games, although I did watch many hours of the playoffs on TV.  I went to two Red Sox games this year.  I enjoy baseball.  I played a lot as a kid, and for several more years of softball in my fifties and sixties.

Many writers, analysts, bloggers, pundits, sports people and politicians are talking about how this baseball team was very helpful to the city after the bombings that occurred during the Boston Marathon,  a signature event of the city.  I agree.  This was one of the greatest bonding moments any city could have. Better than anything that could be planned or staged.

First, you have to realize how much sports means to Boston, especially pro sports, especially the Red Sox.  The Sox are like football in Ohio or Alabama. They are more important than surfing is in California or skiing is in Colorado.  We are not that outgoing here in New England, but everyone will comment on the Sox, even if you don't care about baseball.  A strong woman candidate lost an election for Senate because she didn't know who pitched for the Sox.  Even my wife watched the World Series, and dropped her knitting when Jonny Gomes hit that three-run dinger.

Ten years ago, in 2003, when Pedro couldn't finish against the Yankees, so many of my patients were just bummed out for two weeks it was hard to talk about anything else.

So this year, after the bombing, it was clear that the city began to pull together for the Sox,  The Sox who came in last, last year.  It clear that the Sox would show that the city, the region, was not to be denied.  That it could be knocked down, but we get up again, and that we get along, as a team, with each other.

I came to Boston as a student. So many people do.  So did the bombers.  We need students, we value intellect, study, research, innovation, technology, and everyone who does that.  We value everyone from everywhere.  If you walk around MIT, Harvard, BU, BC, Tufts, Northeastern, and the rest of the fifty or sixty colleges and universities that are in and around Boston, you see people from all over the world: China, Africa, Europe, the Middle East, Latin America, Mississippi. They are what makes this an exciting, stimulating, fascinating place to be.  Two angry, discouraged brothers, whose sense of decency went off the rails, are not going to change that.

We, all of us in and around the city wanted a way to show that.  We still cared, we still like and respect each other, we still get along -- differently from the way we did in the 50s, 60s, and 70s, when we didn't get along that well -- and when the Sox kept losing.

The Red Sox helped us to do that.  The players were from about fifteen different US states, as well as  the Dominican Republic, Aruba, Venezuela and Japan. I think two are from New England. We cheered for them, they played for us. Everyone had a good time. There was a big parade.  No one got hurt.

Boston will continue to be vibrant, stimulating and welcoming. Bring you willingness to learn, to collaborate, to build and create.  That includes all ideas from all cultures and backgrounds. Skills of pitching and hitting are also welcome.