Monday, December 23, 2013

Again,'Tiz the Season

We have passed the moment of most darkness, but it is still crappy out there.  It is dark, damp, piercingly cold and windy.  "Tiz the Season once again.  Perhaps I'll drive around and look for over-lighted houses to perk me up.  I took the girls out to do that the other night.  They are 2 and 3 years-old cousins.  They were delighted, but confused about the whole thing.

Me too.

I am not going to work for these two weeks.  I left the office with very mixed feelings.  The last day was too extreme. Two of the people  I saw are doing very well and were headed out to happy holidays. But two others falling apart physically.  One is very old and things are starting to not work.  The other is quite young and his diagnosis is very scary.

But Alice  (see 12/9 post) came back in and a doctor had given her something for her pain which she was enjoying very much.  As her pain subsided Alice was once again very much alive and hoping to stay that way.  She was again filled with rage and thoughts of vengeance; back to her sweet old self.

So, to all of you who do not wish to impale your brother or throw your mother off the train this Holiday Season.  I wish you all the best.

Be warm, kind and respectful to all around you, no matter their views, or foolishness. We are all really just the products of our physical being and the experiences we have been through. We are all searching for a few rays of happiness.  We each have the power to give some of that to one another.


Monday, December 16, 2013

Why I am not always the best Therapist

In some ways I'm not the best therapist for today's conditions.  That's not why I am slowing down, I have another seventeen reasons for that, but it seems to be true.

Sure, sure I can see a lot of progress in the people I see in therapy.  About 45% do well and I push them out after a year or so and their lives are easier, happier and they function better.  Another 35% do REALLY well, and they come up from the depths of torture and despair and put something together like a relationship or just happiness and that makes me feel better.  Another 20% don't.

But, as I said in my last post  (you can click back and read it, if you haven't already), the world, especially work, is much more fast-paced and stressful than it was when I opened this practice of psychotherapy.  For many of my patients I find that part of what we do is strategize how to deal with that stress -- not just breathe deeply, but how to prioritize, how to deal with a bad boss, how to deal with the huge, constant demands that a corporation. large or small, places on an employee.

Years ago, in the 90s, when managed care was clearly going to continue to be an intrusive pain in the ass, even before they began reducing fees, I decided to expand my revenue base and do some direct consulting to some local businesses. One was to a company that made stuff, and another was to a local financial services company.  My job was to help higher, but not top, management make their employees more productive.

Well, the company that made stuff, made some real crappy stuff and treated their employees terribly.  The financial services company had a business model that was either just this side or just over the line of being sleazy.

In my head, although I didn't actually say it, my best advice would have been to get the hell out of that business.  I didn't do much consulting after that.

I often still feel that way when I deal with my stressed-out patients now.

But I also realize that they don't have too many choices, and having and holding a job is very important these days.

But since I left working at a community mental health center in 1981, I have not had a boss. I set my own hours.  No one really tells me how to work, although I do consult and collaborate. Insurance companies set most of the payments I get, but at least I don't have to deal with the worst of them.  Many of my colleagues don't take insurance payments at all.  I didn't want to go that way, but it was my choice.

Whenever I see an opportunity I try to encourage people, especially younger ones, to try to do their own thing, build their own business, do something they want to get up and go and do.

But that isn't easily done, especially if you are part of a family that needs to be supported and given some stability.

But it's tough to see so many people feeling so much stress, and having so little control of it.
A lot of them are much better at it than I ever was or will be.

Friday, December 13, 2013

Big Data 2

Yesterday:  A couple of my patients were talking about how stressful and how constant their jobs were.  Later I met with a few of my colleagues for our annual gathering and we joked about how much money we weren't making.  Most of us can track at least a 20% fee reduction from insurance companies over the last eight years -- beginning long before Obamacare.

Part of the reason work is stressful is the result of how we live in a global economy and many jobs, from running a chain store to developing software to track weather satellites, is often done by teams from all over the world who work together virtually.  That means that someone is always working on it, and everyone is always part of the process, so everyone is "on" almost all the time.  Another reason, and here we begin to get into Big Data, is that costs are tracked all the time too.  Data comes from everyone's computer about who is doing how much of what.  It becomes clear from the data when someone's job is no longer needed, then they can be cut, just like turning off a machine.  It makes it easier because the person who cuts someone else out of the job has no real idea who that person is because they may be working a thousand miles away and not across the hall.

Then because people get cut so easily everyone knows that jobs are not only hard to find, they are hard to keep, so just having a job is a good thing.  That means the employer won't have to pay as much because people want to work, and people know they can be replaced easily, either by someone else looking for work, or else by a machine that won't complain.

Because so many people work in ways that are connected to some kind of electronics, whether it is a big office workstation, a hand-held box scanner or a GPS, all kinds of data about how fast people work, who follows rules, who creates better methods and who creates trouble is monitored and algorithms are developed to pick out the "good" workers and weed out the "bad" ones.

The pressure to get something done seems much more intense than it was ten years ago, and certainly much more than it was twenty-five years ago, pre-email, when you could go home from work and not have constant up-dates.

The pressure is great, but to what end?  Most jobs seem to be help business get get better organized so that they can sell me stuff I don't need and probably didn't ever think I wanted.  Most airplane travelers are business travelers who travel to help businesses run other business to make something, somewhere that someone else will sell to me.  While they are traveling they go to hotels and restaurants and use cars and use business machines to keep in touch and to track how they doing, and how much gets made and sold.

It all seems to go around and round.  It creates a lot of stress, but it gives people jobs so that they can have families and buy stuff for their families, which keeps the businesses going

Now everything everyone buys is tracked and priced and that allows someone to advertise to whoever bought what they did to buy more of it, quicker and maybe cheaper.  Which is good because I just got a $900 sweater for $9.99, and if I buy another I get another one free, but I don't need three sweaters, but I  may some day.

Should we sorry about this?  Should we get off the grid?  Keep all our data private, away from the NSA, and Google and Amazon and Macy's and Walmart and Target, or should we just buy another sweater and keep it all chrunning along?

And it's been three years and the US hasnt started a new war.

Monday, December 09, 2013

Holiday Season is Mixed

'Tis the Holiday Season again, as we all know.

We are less than two weeks away from the Solstice, at which time we will begin to get our light returned to us on this side of the globe.  It is spending its allotted time down on the Southern Hemisphere right now.

Last week, to kick off the holiday season, David Brooks, the esteemed columnist of the NY Times wrote a piece explaining why it is not good for anyone to commit suicide.  A cheery topic, and I'm not quite sure why he picked it, except that some statistics came out showing that suicide rate around the world seem to be increasing.

Mr. Brooks said it's a bad idea because most people who attempt suicide and somehow fail, later to report that they are able to reach a point at which they are happy to be alive.  Also, he said, suicide is selfish, and it hurts the people who are still alive.  This is often, although not always, true also.

Now, I'm not for suicide, except perhaps if you (perhaps me) get old, are in great pain, can hardly remember who you are, and have no chance of improvement except to take huge amounts of drugs which will made your pain less but your awarenes of self negligible.

I have spent lots of time convincing people to stay alive another day or two, just to see if they feel better, or see some other option.  I generally feel that we all will be dead for a really long time, and that we are only alive for a short time, so we should see what happens with the time we have.

But I appreciate that some people spend the time they have in misery and desperation, and despite the wisdom of others, it often feels like the stress, the pain, the losses, the agony, just isn't worth hanging around for.

I spent an hour with Alice (not her real name, and not the exact details) last week.

She is now almost sixty, and looks about eighty.  Her pain began as soon as her mother decided that Alice looked too much like her father.  Soon after Alice's birth her mother stopped liking the father, and Alice along with him.  Because of this resemblance, the mother rejected Alice.  She would beat her, demean her, scream at her and lock her in a room.  The mother did this to half of her six children. The other half she favored.

Alice survived because of an aunt and her older sister who both tried to protect her.  But her life was never smooth.  When she was fourteen her brother brought some of his friends home so they could rape her.  She broke three of her brother's ribs with a candle stick, and sent one of his friends' to the hospital with a concussion.  That got her into a "girls' school.'

Her one real love relationship died of an overdose.  Her other attempts to be with a man were much less than successful.  These relationships were often violent.  Alice was in many fights, had many rages when she almost killed someone, and was often badly beaten herself.

From the ages of 17 to 53 she drank very heavily.  Then she stopped.

Now she is calmer, sober, but alone and in great pain.  Her father has been dead a long time but her mother, almost ninety live on, with a sister, and still swears at Alice.  Alice and that sister are the only two of the six who are still alive. Two died of cancer, one in a motorcycle accident and one was murdered.

Now Alice needs a new hip. She walks with great difficulty. Her wrists are so bad that she can't open her car door without a great deal of pain.  She is probably brain damaged a bit from all the fights and alcohol.  Every joint hurts.  She trusts no one.

She said that she often wishes she was dead.  She won't kill herself because,... because that's not what she does.  She is a survivor.

So we talk about what we can try to do to make her life a bit better.  She isn't religious.  She didn't think God was on her side.  She doesn't believe in love.  She hardly believes in "like."
But when she takes a couple of Percocets, she can get comfortable enough to be curious about what will happen next.

I hope your holidays bring you closer to someone who you can like and trust.