I'm Not an Algorithm

 As we all know it is the shopping season.  There are many more ways to shop now than before.  There are many ways to try to get a bargain, or to just give away money on a little plastic card.  We can shop on-line, we can shop through apps, we can go to the store and have it shipped home, we can shop at home and to and pick it up.  They say we will have drones doing the delivery soon, but it hasn't happened yet.

The Cloud knows what you have bought, what you are thinking about buying where you looked for it, a pretty much what you are willing to pay to anything and everything.  We all get ads for things we have bought or just looked at.  "If you looked at this you'll probably like that. If you live in this zip code and you looked at that store, and you bought this, you listen to this music, you read these books and web sites, then you think like this, vote like that, and have these needs.  They are correct a lot of the time.

A couple of weeks ago I was at a conference where people were taking about the mood apps, behavior apps and health apps they were designing and using for themselves and their patients.  Stay fit, eat right, relieve stress, exercise, breathe, do it all with friends and family.  Think happy thoughts, look at scenes of nature, call your mother, think out of the box, but stay in the box.

I'm old, and I get a bit antsy with all of this.  It seems to be that the goal is to get everyone to be mildly happy, to get along, to pay our bills and buy stuff.

I asked if anyone was designing an app to be grumpy, sarcastic, and oppositional.  Unless we have enough people like that, nothing will change.  We will listen to the music we already like, talk to the people we know, read about things we agree with, and not get upset.

It all sounds very pleasant, like too much mac and cheese.  You know what that can do to you.

The Gentics of Ferguson?

The crisis in Ferguson, MO, continues, with lots of heated debate on both sides.  It is an excellent example of how complex our lives have become. Because we humans are such complex creatures, with uniquely evolved brains that allow us to plan, compute, design and build, we seem to have created an environment in which many of our ancient innate tendencies have become counter-productive

I have been reading all about Ferguson, talking about it with to some of my poorer, angry patients – people who aren’t prejudiced, they tell me, but who feel that Blacks are getting all the breaks—and also reading E.O. Wilson’s new book The Meaning of Human Existence. (How’s that for taking on a big topic at an old age?)

Wilson makes that point that there are two kinds of adaptations our genes have made over the past few million years.  One kind is to increase the likeliness that the genetic material of our individual selves, and our specific children, survive.  Whatever gives us an advantage: size, speed, tool making, problem solving, more fertile sperm, bigger hips, cuter smiles, anything that will increase the likelihood of a next generation, and of one after that, will remain a part of our genetic material, while those who do not have enough of those traits will drop out over time.

The second kind of genetic adaptation, that Dr. Wilson points out, is that we keep  the kind of genes that help our group survive.  We are one of the few creatures in the history of the earth who have learned the benefits of group cohesion.  Certain, very successful colonies of ants are among the few others.  People seem to have evolved to control the earth in the space of the larger creatures, while those ants not only out number us by billions, they are by far the most successful at surviving and multiplying of all the creatures.

Humans have very evolved skills at discerning what others are thinking, at communicating our moods, at anticipating threats. We have learned how and when it we should lead and when to follow, and when to act altruistically so that it helps our group.  We have learned that stronger groups get more resources, eat better, and raise the chances that more of our children will survive.  This is true of the ants also.

Some of that is what makes our racial problems so difficult.  We live in a country that professes to welcome all people, and offer all people equal opportunity.  Yet, Black people have never really been seen as part of that.  Many have ancestors who were brought here by force and were used as a source of energy, and not regarded as people.  Many people live in white enclaves and have very little contact with Black people.  They don’t know them as people.  They see them as part of a competitive group.

This was probably true of Officer Wilson.  I don’t know how many Black people are his close friends, probably not too many.  It was too easy for him to quickly classify Michael, Brown as a “demon,” which makes him not a human, not somebody’s child, but a part of a competitive group.  I am sure that this was not conscious.  His brain acted way faster than his mind had a chance to think.  It was all primitive emotion, acting to survive. Also, he had a badge and a gun, which gave him a very different mind-set than Michael Brown, who must have felt cornered by an enemy.

If America is to finally going to do better, we have to know one another as people.  To do that we really need to integrate our neighborhoods and our schools and our social clubs.  Since I won’t hold my breathe for that, it would be helpful if we did have regular gatherings, social gatherings, of all kinds of people, all of whom bring all kinds of food, play all kinds of music, and really get to mix and meet. We have to take the “otherness away.”  We have to have some real relationships.

This should happen in Ferguson, Boston, Selma, Topeka, L.A. and Akron; all over. For far too long our politicians have used the formation of opposing interest groups to split this country apart.  That is easy to do, and it works.  Except only in the short-run.  We have already put some people on reservations and keep them apart.  We already had a Civil War, from which we have never totally recovered.   Perhaps we could realize that it’s time to learn that the people in this country should be considered all a part of same group, and that we are not each other’s enemies.

That’s tough.  It goes against some of our genetic predispositions.  But the world is different.; we are all much more interconnected.  We are not separated by mountains and live in independent tribes.  That world, of 1000 years ago, will never be again.  There is no guarantee that the U.S. can do well in this new one if it goes to war with itself with tanks and automatic weapons.  We have to adapt.

NYT -- old rules -- not to follow

It is a bit of an embarrassment to the professions of anyone who does psychotherapy that the NYT would publish this piece.  Perhaps, this happens only in New York, where people still follow Woody Allen into psychoanalysis.

http://opinionator.blogs.nytimes.com/2014/11/22/the-rules-of-psychotherapy/#more-155056

Dr. Weiss is struggling by adhering to techniques that are a hundred years old and largely discredited.  It is good to see that as a psychiatrist she still does psychotherapy, as almost all psychiatrists outside of major cities only prescribe medications.  But if she is going to do therapy she should learn that things have changed.  That the relationship between the patient and therapist is very important and that, although it needs to be structured, and it is not a friendship, there certainly needs to be warmth and acceptance.  Then, there are many other approaches that have proven to be more successful than long-term psychodynamic treatment.

What I also find interesting is the wide range of comments that have been posted.  The differences in understanding the causes of depression are certainly very striking. Depression is a very serious condition, and a very complex one.  It often, but not always has some genetic component.  It also involves family history, job history, a history of loss or trauma, brain damage, illness, pain, unemployment, poverty, racism, and addictions.  It is not a “disease” with one clear cause.

Therefore the treatments have to vary accordingly, and should hopefully involve many disciplines, including, psychologists, geneticists, neurologists, social workers, and other branches of medicine if they are relevant.  Such treatments are very rarely available in our world of specialists who just do their own job.  That is why Dr. Weiss’s patient is still in treatment, and still suffering, many years later.

         

Eating Health: Can't or Won't

Brain science keeps rolling along -- much faster that psychotherapy science I'm afraid. I rad a study this week about some researchers in Montreal found that both children and adults seek out high calorie foods, even when they understand the concept of obesity.

http://nymag.com/scienceofus/2014/10/eating-healthy-vs-your-own-brain.html

We are programmed to eat to stay alive.  We are programmed to grab what we can before it runs away or before winter sets in.  Perhaps that's especially true in Canada.

But what the study also makes clear is that we are hardly aware of all the factors that go into our decisions.  Our brains are wired to help us act quickly and in our best interest. Or at least in the best interest of where are way-back ancestors lived 200,000 years ago.  That was before Domino's had a pizza delivery app.

Eat healthy my friends, (and drink wisely too).

ADHD in Today's NYT

            The lead article in today’s Review section of the NY  Times is by Richard Friedman, who is a professor of clinical psychiatry at the Weill Cornell Medical College.

http://www.nytimes.com/2014/11/02/opinion/sunday/a-natural-fix-for-adhd.html?_r=0

            For a short piece he gives a good over-all look at what ADHD is and isn’t.  What I was most impressed with is the wide range of factors he cites, as well as all the new machines that are used in these studies.

            The studies he cites use things that were not available twenty, ten and in some cases even two years ago.  These include PET scans and fMris to look at brains, but also macines to examine genetic differences.

            Dr(?) Friedman also puts ADHD in a social and cultural context.  He talks about how schools now demand greater concentration and conformity.  He also mentions that video games are so stimulating and can seem so exciting compared to sitting in a class, trying to listen. You shouldn't blame or stigmatize a kid for something he can't do.

            With all of this new machinery we can now see differences in brains and genes that we couldn’t even imagine ten years ago.  But a different brain is not necessarily a bad brain. Differences can show the world how to improve and differences are what help humans evolve and adapt.

            But still, it’s not fun to have your four year-old rip apart everything in his room and throw his toys out the window.  There are multiple causes for that kind of behavior, not just fewer dopamine receptors.

A day in the office

This week I was back in my office for a day.  It isn't really my office any more, I rent it from another psychologist who is now in it three or four days a week.  He is young, energetic and idealistic, just like I was at his age.  He is only 63.

The people I am still seeing are people I really want to see.  I feel I can finish up with them in six to nine months and get them through whatever it is they are going through.  For one it is college, for another through a bad divorce, for another away from his mother and on his own.  Stuff like that.

But yet, after being away for a while, it seams to difficult, just for them to get from here to there.  They are so tied down and burdened by their past, their family, their non-supportive relationship, their lack of financial resources, and even their health.

It's like dragging someone who is underwater back up to the surface, but they are weighted down with about nine chains tied to iron balls.  Each chain has to be worked on and broken.  And we are working underwater, where we can hardly breathe.

But still, these are all great people.  Like all of us, they are slightly crazy, but no more than most. And sometimes they can be very funny.

So we keep chipping away.

But it is really a relief to not have to go back and do it for another seven to nine hours again the next day.  I won't mention that to the young man who is in my old office.

No Guts, No Glory

So I'm back here at my desk after a major transition and a very long summer.  It's a beautiful fall here and I will soon be our admiring the leaves on what could be the last warm day of the year here in New England.  But before that I want to return to commenting on some of the things that thrill or bother me, especially about my profession --"Mental Health Professional," and how and why it's such a struggle.

Last Sunday, 10/12/14, The Boston Globe's Magazine Section was called "Decoding the Brain." They had four articles about recent brain research.  The one that intrigued me most was called " Gut Instincts."  It was a curious yet striking example of what has happened to my thinking, but has not yet spread very quickly through the profession.

Very briefly, the piece describes a case in which someone who had some very disabling obsessive-compulsive symptoms, and was pulling out his hair, was able to free himself from these behaviors by changing his diet and adding strong probiotics.  The article quotes Dr. James Greenblatt, of Walden Behavioral Care, as saying that research is quite clear that the GI tract affects brain health."

The article, which was written by Elizabeth Gehrman, also stated that "All the interest marked a fundamental change in the way scientists and medical professionals view the connection between the brain and the gut."  I believe that we all have to continue to change how we view the entire brain/body relationship.  And I don't mean in the now very prevalent way of people just learning to relax, meditate and stay "mindful." I mean in the other direction. Lots of things in our bodies affect the brain, such as diet, toxins, injuries, fatigue, lack of stimulation, over-stimulation, heat, cold, and so much of the stimulation that is constantly coming in through all of our senses.

All of this is being processed all the time by the brain.  And the brain creates your mind as a part of all this process.

The more we mental health people see this as a constant process of the world, the body, and the brain all interacting, and spend less time and effort trying to fix people's "minds," the more effective mental health care can become.

Need Help?

One day Max feel down in the snow.
  He yelled, "Help me, help me."

Jake ran over and lay in the snow beside him.

Max got up and walked away.

Late word on Robin Williams, et al

Like most people. I really enjoyed watching Robin Williams.  He was the follow-up to Jonathan Winters and before that Oscar Levant, who were also terribly self- tortured but marvelously funny.  Robin also won the favor of a lot of us by playing a very good therapist in Good Will Hunting.  Most of the therapists in movies are played as pretty messed-up, (although Billy Crystal was OK in Analyse This).

It was well known that Robin Williams suffered from a bipolar type disorder.  He clearly had manic moments, although if they served to make a million people laugh I don't know if that gets classified as an illness or a talent.  It's the awful moments of despair and hopelessness that are the worst and most dangerous aspect of that condition. Writing a novel on the wall with lipstick, as one of my patients once attempted to do, is really disruptive, but not fatal.

There have been other high profile suicides, and now so many homicides, that call attention to the need for more mental health care, but then quickly fade, and not much changes.  There were many tributes to  Mr. Williams for a week or so, and I'm sure there will be some more, and a movie, but not much will change in the way we deal with people who are searching for a way out of despair, most of whom are just tortured and not famous.

Part of the problem is that just adding more mental health care doesn't always work.  This is a good example of that. I am sure that Mr. Williams probably was under someone's care at some points in his life, and probably had a therapist right up until he died.  I don't know if that was true, but he had access to the best care, from any and all kind of professionals, but that wasn't enough.

Mental health care is not that effective because the mind is just a part of the very complex creature we call humans.  Our thoughts and feelings are not under our direct control, they are the result of many complex forces.  Psychology and/or psychiatry really cannot be that effective in isolation.  Doing individual psychotherapy often feels like being one man in the water in front of an ocean liner, trying to steer it away from the rocks.  Not easily done.

What I have come to see more and more clearly, because of my long history as a therapist, and as a result of the explosion of information from other sciences, is that unless there is  a way to deal with the comprehensive nature of what creates human feelings and behaviors, the success rate in making positive changes occur will be severely limited.

The picture needs to include a person's genetic make-up, on many different levels, his or her family back ground, and the environment of their early years.  Also important are the sub-culture in which they live and it's values, and how well that sub-culture fits into the more general culture of their society.  Another major factor is a person's over-all physical health, past and present.

All of this is a big deal.  It is a very complex picture, with all of these forces causing chain-reactions upon each other.  But it is real.  Robin Williams was very complex.  Telling him that some of his thoughts and feelings were not accurate was not very helpful.  Medications probably made him feel worse.  I have seen both of those happen with many of my own patients.

Until we find better ways to coordinate all of our knowledge we will struggle with suicides, homicides, racial tensions, bad educational policies, and a great deal of added stress, tension and paranoia, much of which is really based on misunderstanding why people do the things they do. We are at the beginning of what could be an exciting time as more of the complexity of what makes up our lives becomes clearer.  But we all have to learn to talk to each other, combine our knowledge, respect each other's views, and find ways to work together.

more on Israel, Gaza, Syria, Ukrain, Russia, Alabama, Vermont, Obama and Boehner

If you are raised to believe that the Kool-Aide they are serving is manna from heaven, and that the Kool-Aide that others are drinking is the devil’s brew, then there is going to be trouble.

Science can tell us that it’s all Kool-Aide -- until it can pass some predictable tests.  It’s fine to believe whatever you want, but then recognize that your Kool-Aide and their Kool-Aide is really the same drink with different flavors, and the color you’re drinking is due to the accident of where you were born and who your parents are, more than any undeniable truth.

             If the scientific community could find a way to convince people of this, that would be one of it’s major contributions to the world.  But that has not happened over the last couple of thousand years,  since people divided themselves up into tribes.  But now, we have enough interconnectedness and enough information to know better.  But believing that all humans are equal in their insignificance would deny our “leaders” a lot of power, something they have always been very reluctant to relinquish.
            So people continue to find reasons to justify deprivation, torture, rape, death and destruction.  Believing in their hearts that it is the only way to survive. And once they beleive it,  it comes true.

Boston; Gaza; Vassar, MI; Chelsea, MA

            It rained today and I’m not working, so I got to read the paper, and check out blogs and tweets.  Depressing.

            It’s obvious that people are not being treated well all over the world.  There is lots of blame going around, and it’s true, everyone’s at fault.

            There is a big trial coming to a close in Boston in which the head of the state’s Probation Department is being accused of and giving out jobs as political favors.  It seems that a lot of people  got jobs or promotions in his department,  because of who advocated for them, not because they were the most qualified.

            The defense was kind of “So, doesn’t everybody?”

            And that’s a valid defense.  The people in the state legislature, and even some judges who “recommended” people for jobs never gave it a second thought.  They were doing favors for their friends and constituents. Isn't that what they are there for?

            That’s how we got the great financial mess of five years ago: people did what they were told to do, sell mortgages to anyone who wanted them.  Everyone was doing it.

            A certain group of people traded very risky derivatives, pretty much without realizing how much risk was involved, mostly because almost everyone in their circle of colleagues was doing the same thing, and everyone was making a lot of money doing it.  It seemed like a pretty attractive idea.

            Why are the people of Gaza shooting rockets into Israel?  Because many of them feel that Israel wants to drive them into the sea, and if you don’t feel that way you run the chance that your neighbors will shoot you.  Of course, the Israelis feel the same way about Hamas.  And this has been going on for seventy years.

            Why does a big brother smack his little brother.  Partly because he is bigger and he realizes this, and often because his father, who is even bigger, smacks him.

            What I am saying is what I learned from doing therapy for forty years, and what I learned from reading about Family Therapy.  Rarely is it one mean, crazy, evil individual who is the problem.  Almost always it is a system that either lazy and sloppy and then corrupted, or else the system becomes too efficient, too powerful and loses perspective.

            As individuals, we are all part of many systems, some we aren’t even aware of, like our families.  We just go with the flow and think as we have been raised to think—which  to all of us, is the “right” way.  At work we think the way the company does, because that’s what we are paid to do. Nationally, we all try to think about what is best for our country. What we think is best, seems to depend a lot on where in the country we are, what our neighbors think, and what we read.

Example: Child immigration:

            #1 – Vassar, MI --Why should we, as a community, take care of kids from Guatemala, whose parents sent them to the U.S. under false information?  If we put them in our schools it will be expensive.  They don’t know our language, they have different customs, they have lots of problems and few skills, and it will change the nature of our community, which we  have come to love.

That certainly seems like a reasonable concern.

            #2.  -- Chelsea, MA-- Poor innocent kids are fleeing from terrible dangerous conditions. If their own parents feel that it is probably better for them to get away and try to make it in America, how can we turn them away and send them back to a very dangerous place – especially when we have caused a lot of those problems by buying all those drugs, and exploiting many Central American countries.

            That is not unreasonable either.

            I have my own answer, but I really don’t know if it is the best answer.  But I do believe that by just staying around the folks we know, the ones who think the way we do, and then blaming and castigating those who think differently, that nothing will get resolved, and things will get worse.  That’s been history, from Helen of Troy to the Islamic State of Iraq.

However:

            It is very, very difficult to go against the tide, especially when everyone near you is being swept along so it appears as if nothing is moving, when in fact we are all about to go over the falls, again.

.

Do- Overs?

I have now gone for the longest time without seeing a patient in 42 years.  It still seems very strange.  I am also still getting messages, questions and requests from people I have seen in the past.  So many seem to think that I will still see them, even if I've closed the practice to everyone else.

Part of me feels as if I am waiting for the next stage of my life to emerge, and I guess I am, but a large part of me is very content to let that happen after the summer has slipped by.  We have been very busy down here at the beach house.  I had thought "wow" I will be here all summer I will have so much time to think and reflect.  But the truth is that although ideas have been racing through my head, between babies, friends, and activities, there has been no time to really make them clear or get them into any distilled form. I looked at the calendar and found that almost every day will be busy until September 14, at which time things will get busier as our last grandchild is expected then.

What has been interesting is that so many of the the thoughts that flare-up in my mind have been memories of things I did wrong.  Most of them relate to patients.  The things I did wrong with patients fall into a few major categories: there were many who I like so much that I underestimated how crazy they were, and thus encouraged them to keep trying at things they really couldn't do.  There were others who fooled me into believing they really wanted to get their act together and overcome the emotional and physical options they faced, but once they got some form of disability check they disappeared.  There were still other whom I just did not like.

These thought come up much more than memories of the many people who did well, the many who really thanked me, the many who kept in touch long after the treatment ended.  It would make me happier if my mind wandered in that direction.  But so far, it hasn't.

I guess I have what is called a high Zeigarnik Effect.  I remember the unfinished much more than the finished.  They say that has some evolutionary adaptive value and that's why it is so common.  I find it frustrating to remember how frustrated I often was. And now the world has moved on and there is nothing to be done.

I must learn to move on also.  The wind is blowing very hard off the water; it blows away as mcuh as it can.

Better this way

I have been mentioning some of the ambivalence I feel about giving up my practice; how I kind of feel as if I'm getting away with something.

It has only been about two or three weeks, but I can tell you one thing clearly:  not working is much easier and healthier than working ( if you have enough money).

During the last few years of working I could feel my body getting old.  The arthritis in my neck seemed to bother me more often and I found myself taking Ibuprofen once, twice or even three times a week.  I also had several minor problems with my back, knees and shoulders.

I think I can state pretty clearly now that a lot of it was from sitting so long, either in my "therapy chair" or at the computer.  Even in a very comfortable, supportive, good-posture chair,  I was sitting too long, holding my head in mostly the same position, and not moving much of my body.

In the past three weeks I have climbed a mountain, done a lot of chasing of three children under four, sometimes in and out of the water, rode my bike to and from town many times, walked the length of a long beach several times,moved tools around, moved garden stuff, gone up and down two-hundred flights of stairs just moving things and going places. and in general been much more active than any time in the last ten years.  All of this was done naturally, and in the flow of the day, not at a gym or doing some specific exercise routine, except for about ten minutes of stretching most days.

And I feel great.  I haven't even thought about taking any pain pills or needing some other remedies.
There is very little tension, more freedom, and less stiffness and hardly any pain.  I can't really run far or fast.  I'm not about to play basketball again, which I miss, and don't expect to challenge myself to perform amazing physical feats that would break me in half.

But, I think working, at least working full-time or more, in order to pay bills and help keep a family going,  is pretty hazardous to every one's health, especially after fifty-three. And I certainly was not in a physically demanding profession, which I guess, was part of the problem.

While not working, hard, ever, is not good for your mind, well-being or your place in the universe.

It helps a lot of enjoy whatever it is you're doing.  But even then, you can't be a goalie for very long.

Working/Not Working 1

Now, I’m not working.  I have closed the practice, had the party, climbed the mountain, took care of the grandchildren, and now we have settled in down at the beach house.  We have been coming down here on this week of July 4^th, not working this whole week, for many years now.  Some of the family come when they can – we have a daughter and granddaughter here now-- and friends drop by, and I watch fireworks.  None of that is new.

What is new is that we are not going home, and we know that.  So it doesn’t feel as if we have to take three days to de-stress, and then two days to gear back up again.  I am not thinking about how many people I will have to see and what shape they are in while I am gone, at least not in the way I did while I was actively seeing everyone.  I still wonder about many people.  I still get messages from several, which is nice, although a bit confusing.

But now this not working thing seems very real, and basically, it is very liberating.  If you look back on this blog two years ago (7/26/12), you will see that I was taking a vacation and that I was tired.  It was clear then that the profession was falling apart, and that it would be difficult for me to continue to work in the manner that I had been. 

Now, I don’t have to care.  I do care, but it isn’t about me.

It is very early for me in this new phase. I have worked with so many people who have had to make changes in their lives; for most of them it was not their choice.  I have seen how difficult changes can be, even if they seem to be what people want.  For me, my underlying feeling is one of freedom, relief, and energy.  But on top of that is a feeling of being  disoriented, unstructured, and a bit of anxiety.

The anxiety is that I still feel healthy, strong, and capable.  I should be doing something.   I believe that I will be doing something, and I think I know what it is. But the actual goal is still kind of vague, and the methodology is a complete mystery.

So we were talking tonight with some friends.  They asked how I was doing being retired.  I said I wasn’t retired,  I just closed my practice.   So, they asked, are you still working?  I said no, I’m not working now.

My wife chimed in and said, “He’s just unemployed.”

So that’s what I am during this time of transition.  I’m unemployed. But I know that if I’m offered a job, I won’t take it.  I have to make my own.

As I used to say at the end of so many of my patient’s notes, after a session in  which someone thought he was ready to do all the right things: “we’ll see.”

People on the Mountain

I want to thank Forsythia for the story about Feynman and the rabbis she posted as a comment to my last post.  That story represents so many of the things I’ve been writing about here. Also, I know many people who are rabbis, and others who are physicists, and they certainly do see the world differently

I think she meant it as a good example of showing that things are not always as they seem, and how much that doesn’t matter; you get to choose your own reality.  And that is sooo true, and the reason for so much conflict.  Conflict that comes from the clashes of people’s realities; from people’s experiences.  This is what I was talking about in my post on 6/16/14.

I experienced a perfect example of this yesterday.

As part of my “next stage” I set out to do things on the days that I am now not working that I could never do when I was working.  So I drove two hours, across the state line to NH and climbed Mt. Monadnock. The path I took was about 2.7 miles long, with about a 2400 vertical rise, and a very rocky climb.  It is so difficult I think the summit was only reached by less than a hundred people that day. Actually, I have been told that next to Mt. Fuji in Japan, it is the most climbed mountain in the world, although that may not be true. But hey, it’s still a mountain and this was not a paved path, these are big rocks to climb up and over.

On the way down I spoke to a family from the plains of Texas, who were happy to find a mountain to climb.  Some of them, ages 14 to 60, had never been to New England before.  The younger ones told me how they came to New England with some trepidation.  They had heard that everything here was fast-paced and crowded, and that most people were rude and angry.  But they were visiting in New Hampshire and they found that it was full of beautiful small towns, and the folks were very nice.

I told them that since they had come this far they should go all the way to Boston.  They will find it’s a beautiful city, and that most people are friendly and helpful, but probably a bit more reserved than they are in Texas.

I imagine this is kind of a red state – blue state thing, where the image they get is one of the crowded Northeast Corridor, with everyone making deals and paying high taxes.

I hope that travel is a broadening experience. Perhaps one of those girls will now decide to go to college in North Hampton.  That will certainly expose her to different ideas.

I don’t have too many prejudices about Texas.  I’ve only been to Austin, so that doesn’t count.  I do have some ideas about folks in the Florida panhandle. But I’m probably wrong.

inexact metaphors

A year ago I planned that I would close my practice this week.  I announced my decision to the people I worked with, and I slowly, slowly worked my way through the year. And, just like everything else that is set for a designated time in the future, it came to pass. I had planned for this to happen on the solstice; that seemed somehow to make it all be a part of the natural flow of things.

So, this evening, I took a slow walk at a few minutes after eight, waiting for 8:23, which was the official time that the sun would set on this, the longest day of the year. It was a beautiful day here in Southern New England.  The temperature was in the mid-seventies, the sky had  few big white clouds, the air was clear, the greens of the mid-June flowers, grasses and tress were all bright and fresh and came in a dozen different hues.

The sunset did not disappoint. The sky turned a darker shade of blue, the clouds turned to pink, rimed with silver.  The sun was going down on the longest day of the year, and also on the longest stretch of my career.

Except of course, the sun isn't really going down. As you know, it just the earth, still turning on it's axis, and right then our part of New England has turned away from the sun and is entering into the shadows.  The days are all almost exactly the same length, down to the micro-second.  Today it was just that we got more sunlight than on any other day of the year. The earth continues to circle the sun; well, it's really an ellipse. The sun continues to move around the center of the galaxy, and the galaxy is moving in a gravitational dance with the other galaxies in our cluster.

To most of us on earth it really doesn't feel that way.  It really feels as if the sun rises in the morning, gets pulled across the sky by a chariot, and then sets over on the other side of the neighborhood. That's the way it is with a lot of things: they feel like they're something meaningful, metaphorical, and magical -- but they're not, it's really just the same stuff happening over and over.  It's really just physics.

Just like me closing my practice.  But that's not physics as much as it's biology.  I'm getting older and I don't want to do that any more.

Can't Follow My Own Advice

I am closing my practice, basically.  Tomorrow I go and pack some boxes.  Next week i head to the water's edge.  It will be my job to make sure the tide comes in on time.

My mind is just beginning to take a different shape.  Sometimes I wonder if I will ever stop thinking about the work I have been doing for the past forty-two years.  Sometimes I wonder if two months from now, I will think about it at all.

Briefly, and I am sure I will elaborate upon this many times, one of the things I have learned is that we are all a product of our genetic make-up, mixed with all of our experiences. We are shaped by those things to the degree that we can never easily become something else.  The forces that have shaped each of us, individually, are so strong and pervasive that we don't even realize what they are.  They are so much a part of who we have become..

Try these:
You like watching sports, or playing sports, or you really think it's a total waste of time.

You think Obamacare is ruining America.
    You think people who think that are morons and bigots.

You love to watch The Bachlerette.
      Why would anyone ever watch that show?

There is no moral justification for a woman to get an abortion.
     Why should a woman be forced to radically change her life just because she had sex and got pregnant?
             Or maybe you don't think about abortion much, and really don't want to bother now.

and even this one:
   Jihadists are all crazy. How can anyone ever get so co-opted.
            The infidels, with their new ideas, have insulted God, and they must learn to respect God and his laws or the whole world will suffer.

These are just a very few of the ideas about which many people tend to disagree, vehemently. Yet, I have learned from dealing directly with all sorts of people, that very few of the folks who feel any way about any of those topics are truly evil people.  Yes, there exits a small percentage of narcissists and sociopaths, but those are really very few.

The overwhelming majority of people are convinced that the world is the way they experienced it.  They have learned, mostly from their family and community, to think and believe as they do. They have learned that it seems right to be religious, or not religious.  There are Capitalists and their are Socialists, and there are a lot of people who don't know the difference, or really care.

There are people who believe all kinds of "crazy ideas."  Many of them think that what I think is crazy ( including this). They will continue to stick with their ideas and values, especially if doing some gives them some measure of belongingness, happiness and comfort.

So what?

So, my advice is this: try to spend some time with people who are different from you.  You don't have to agree with them, but you have to respect what they think and do.  Try to discover what forces made them this way.  Try to understand.

If you do this you will really learn how the world works.  You may learn something about how to make it better --- if you can decide what "better" is.

From my many years as a clinician I know this is true.  Can I do it?  Do I really live this way?
Of course not.
Although I rarely show it, I have very little patience for those who disagree with me.
I think they're idiots.

But now, I think I'll try; hopefully, sometime soon.

Last Day

            Last September I returned to work after a three-week vacation.  At that time I knew that right about now my life would be changing, that I would, for all intents and purposes, be closing my practice.  In many was this was one of the longest years of my life.  The only things I can remember that rivaled these feeling of waiting, day by day, and noticing time moving, click by click, was when I was working to finish my dissertation, and waiting for the birth of my children.

            It still amazes me that something can seem to impossibly far away, and then, here it is.  Time passes. No matter what.  It really does.

            I saw the last six patients today.  Some I will see again, briefly in a few months, and a few I will follow by email, but really, my days of being a practicing psychotherapist are over, after forty-two years. 

            That’s enough.

           

            There are so many different feelings that it is difficult to sort out. This time it is about me, which for a therapist that’s different.  I have just spend the last few weeks saying good-bye to people, and being very concerned about how they were dealing with the change; with the loss.  I think I had prepared people very well, and most of the folks did very well.  Only two didn’t show up for their last appointment.  They both left messages saying they felt it would be better to just not go through that.

           Today, for the last tiem, I drove up and back in the heavy traffic that now fills the lanes between my office and my home during the three hours of rush hour that happen each morning and evening.  It was one of the very few times that I enjoyed the traffic.  Inching along, trying to get around the drivers on the phone or texting, who make things even worse.  This would be my last day of driving to work in traffic.  The lines and lines of exhausted, bored people wasting their time would no longer include me.

            Over the thirty-three years that I have driven to this small mill city the traffic has gotten much worse, much more tiring, much more aggravating.

            Won’t care any more.  I might get up early some mornings and drive two exits on the congested highway just to appreciate not having to go anywhere on time.

            Driving home, thinking about it all, what came to mind most vividly were the people who were the hardest to treat, who wouldn’t/couldn’t make the obvious changes that were necessary, but who continued to come back and frustrate me. I guess I am blessed with, or suffer from a high Zeigarnik Effect. And I really don't know what happened to them.

            So now, except for one or two more days of paperwork, I am very ready to see what is next.  I am sure that many reflections, ideas, and sentences that I never had time to finish will come floating up to my mind.  I have this delusion that I will now have the time to reflect on the last forty-two years.

            I hope to be writing a lot more in this very space.  So tell your friends and neighbors to come and join the discussion of a nameless psychological blogger with a pinball mind. If I don’t have to think about all the patients any more, I can begin to think about what I thought about all those patients, and what I really thought about the way I thought (got that?).

            Or maybe I won’t.  Maybe I’ll just do the shopping, do the cooking, take out the garbage and fix the sink.  But I don’t really know how to fix the sink.

            I’m sure it’s on YouTube. 

transition, part 11A

Melancholy:

Feeling, or making somebody feel, a thoughtful or gentle sadness.

            I am in the middle of withdrawing from over forty years of practicing, and continually trying to learn and perfect, the art and science of psychotherapy.  I use the term “withdrawing” in the medical sense, of going through a strange, physical reaction. Withdrawing from work is almost as hard as getting off of Effexor, which I believe to be an evil drug that no one is properly warned about its dangers  Except instead of sweats, trembling and nausea,  the overwhelming feeling is one of melancholy.

I am in the middle of a process that I know it is ending and I want it to end already.  I will be seventy at my next birthday.  I have been doing this for over forty years.  I still find it complex, fascinating and challenging, but once I realized I didn’t have to be doing this any more; that I didn’t have to worry about people who might get out of control, or too depressed,  or harm themselves, or flunk out of school, or get arrested, or pregnant, or too drunk, or even stabbed or shot – this is urban America after all--it just seemed as if, for the first time, I realized how much I’d been carrying around, and how exhausting it had been getting.

Saying good-bye to so many folks in so short a time has been very difficult.  I realize that some people have come to see me to get cover.  By that I mean they need a letter to get out of work, or school, or for their probation officer, or even to apply for disability benefits.  But most of the folks I see have come because they are suffering.  They suffer from psychological, emotional, and often physical pain.  They suffer because of loss, loneliness, confusion, stress, illness, and mostly because they have drawn a rotten hand to begin with.

People say that you have to play with the hand you’ve been dealt, and most of these folks have been dealt a bad hand: bad parents, bad neighborhoods, bad genes, bad illnesses, bad brains, been addicted, been too poor, or even too rich. They had to play that hand.  Getting new cards is very, very difficult.

After forty years of this I really feel that I did what I was cut out to do.  I put in a real effort.  I tried to learn my craft.  I feel I did some good, even more than that sometimes.

But I am a real child of the ‘60s.  We were going to change the world.  Make it fair, reasonable, bring justice, equality, and freedom.   And why not?  It was clear who the good guys were and what needed to be done.  Everyone around me seemed to understand that.

I guess that’s what happens when you surround yourself with people just like you.  It’s difficult to realize that the huge crowd over there, those folks jeering and throwing things, really believe that we are the ones who are wrong and crazy.

Yet, in my own, still naïve, still idealistic, still hopeful way,  I am still waiting for the answer to the obvious question: “(What's So Funny 'Bout) Peace, Love, and Understanding.”

Since I have not yet been given anything close to a satisfactory answer to that question, I am left, feeling

Melancholy.

still in transition

Spring is turning to summer. The sun stays longer in the sky.  We, up here in the colder states, are freer to roam outside and become active.  The pollen fills our sinuses and causes water to run from our eyes.

A year ago I  set the date of the Summer Solstice to mostly end my practice of psychotherapy. I have been attempting, in various ways, to help people deal with their lives and make helpful changes for over forty years.

Now it is my turn to try to make some significant changes.  This is proving to be an interesting experience.  To me it is a very mild form of what happened to Jill Bolte Taylor, the neurologist who realized she was having a stroke.  She had studied the brain for years, and now she was experiencing this phenomenon phenomenologically.  You can Google her TED talk.

What I am going through is much more mundane.  It happens every day; more frequently now as the population ages. What is good is that I have chosen to do this.  I have not been laid off or fired, or told not to practice because I reached the point where I couldn't remember any one's name.

Still, for me the time is filled with ambivalence, with both excitement and disappointment, with anticipation of freedom, but also the loss of direction that comes with the breaking of habits and routines.

My life has already changed in ways I didn't anticipate.  My wife and I have four new people in our lives ( well, three and half, it will be four in September).  This was something we knew would be coming but the reality is that, if we wish, these new beings could take up a great deal of time. And we do wish, mostly.

There are other things I really want to do.  Some of them are inexplicable to other people who think of retirement as a play time.  In my mind this could be a time to do the things that I was unable to do because my work took up so much time and effort.

These are things that for me are fascinating, but not necessarily easy.  No one is expecting anything from me, so I will have to do it on my own.  It is challenging, and kind of makes me anxious.  It's funny how I seem to avoid doing the things that I say I really want to do.

This is so much like so many of the patients I have seen over the last forty years.  It is the kind of thing I want to be studying.

or not.

not yet perfect

There is a lot of stuff we humans do, that we just do.  We don't really think about it.  It hardly helps us function.  It often gets in the way.  But we do it over and over. We do it mostly because at some time in our long genetic history it helped us adapt to a world that no longer exists.

We:

Eat too much

Get anxious over nothing

Get angry too fast

Repeat old behaviors

Let our hormones be our guide

on and on.

And if we get challenged about why we do it we can then think up a great rationalization.

That's what makes us "human" which is different from "humane."

Not their fault

Once again, I went away, lost focus, floated in the warm water of the deep South, just to get away from the endless sleet and cold.

I came back to the waining days of full-time practice.  These are more difficult than I had anticipated.  Forty-two years of psychotherapy, and still the world is full of troubles.  Yes, I feel I have been of some benefit to about 60% of of folks who have passed through my threshold and sat nervously telling me things they had never spoken about with anyone.  But the big picture, the changes in the structure of society that we, the idealistic children of the 60's, Peace, Love and Understanding, had hoped the world would move toward, has not happened.

Injustice, insensitivity, exploitation, still, in many cases, take over.  Even if it is a minority of the population, it is that minority that aspires to power and greed, and it makes it all so much more difficult for those who just want to live their own lives in peace and harmony.

The people I saw for treatment this week, the ones who remain as I have been winding down my caseload, are some of my favorite folks.  The folks who were dealt four cards in a game of seven-card-stud.

A woman whose mother was a prostitute and whose father was a drunk.  At the age of six she was told to "play quietly in the other room" while the men came and went. But now, sixty years later, after a long  struggle, filled with many terrible bruises and losses, she has found her way, and has learned that she can enjoy herself, her relationship and her life, despite everything that she has endured.

Another woman, also in her sixties ( so many of my patients are almost as old as I am), who has been a closet lesbian all her life.  It has made her anxious, paranoid, OCD, and ashamed. Suddenly she finds that can relax in this new world that has unexpectedly opened to her. This change is all very difficult for her, and she is amazed and mystified that maybe she has not been such a terrible freak of nature all along.

And me, just a product of my own time, place, family, subculture and genetic potential.  So I still wonder, tritely:

"What's so funny about Peace, Love and Understanding???"

The real underlying question, 1

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            Michael weighs approximately three-hundred-seventy pounds, give or take twenty on any different day.  He is forty-two years old and has been that heavy for at least a dozen years.  Because of his weight he cannot walk very far, and his back, knees and ankles hurt. Walking from the parking lot into my office is such a strain that he is breathing heavily and sweating by the time he arrives, and he sweat does not create a fragrance that will sell.  He knows that his weight has put a strain on his heart, that he has fatty deposits around his liver, and that he is living example of a health high-risk.

         Yet, at many of his appointments Michael comes in carrying a large container of caramel-mocha coffee.  He often talks about driving for an hour to find a special bakery, or to get pancakes with maple syrup. 

         Does Michael exercise? Yes, regularly. He walks on the treadmill in the building where he lives, for ten minutes, once a month.  He finds it exhausting and he hates it.

         Does Michael have psychological problems that contributed to his keeping his huge bulk?  Of course, he has a chaotic family history, he clearly has a sugar addiction, and he eats for many emotional reasons.  He also probably has some genetic factors that help him gain weight and keep the weight on.  Because of his weight he has social problems, and because of his social problems he eats.  He also eats too many of the kinds of foods that some corporations have spent millions of dollars designing so that people will crave those foods.

Of course, there are many more contributing factors that I won’t get into in this post.

So the question for all you psychotherapy friends out there is:

does Michael stay heavy because he really doesn’t want to change?  He doesn't have the will-power, or the motivation, the energy, or care enough to put in the huge, consistent effort it would take for him to lose weight?

Can Michael change if he really wants to?  Is it my job to make him really want to?

Or does Michael stay heavy because he can’t change?  Because there are too many factors, built up over too long a time, and they make it impossible for him to break his bad habits, fight off his addictions or even go for an operation that will allow him to lose weight?

Is there a difference?

Time only goes one way

One Time Dimension

            I am still working my way through Our Mathematical  Universe, by Max Tegmark, and having a good time doing that.   The book describes the current thinking about the Big Bang, cosmic expansion, the size and shape of our universe, and the reasons that it has turned out to be that way.

            Now I am on the part were he begins to describe the possibilities of other kinds of  universes, places that should exist, according to the current theories, but we may never be able to actually verify.  But he gives some limitations to even the strangeness of these places, that are basic to their existence, at least in the way that we understand the word existence.

           

One of these limitations struck me as a very important consideration for those of us who have deal with and explain people’s psychological existence, and usefulness.   On location 2781 of the Kindle editions Dr. Tegmark  states that it necessary for the stability of any universe to have only three space dimensions, and only one time dimension.  “With more than three space dimensions there are no stable atoms or solar systems.  With fewer, there’s no gravitation attraction.”  Ok, fine, I got that. (If you don’t, you can work on that yourself).

            Then he goes on to say, and this is the important part for me: “With more or less than one time dimension,  physics loses all predictive power, and there would be no point in evolving a brain.”

            What he is saying here, and I really agree with,  is that the major reason we have a brain and gain all of our knowledge, is for predictive purposes.  Those of us who survive and thrive are those of us who are best at figuring out what will be happening next, and then also figuring out how to deal with that.

            I have read before, I am pretty sure it was from Daniel Dennett, but he may have been quoting someone else, that the only real measure of intelligence is the ability to anticipate.   To me that means that a great deal of the measures we have of “IQ” are only of things that are one or two steps away from the real skills necessary to survive and be successful. Yes, it is probably helpful to be good at math, to have an extensive vocabulary, and to be able to put puzzle pieces together, but if you can’t figure out which way the bus will be coming down the street before you step off the curb, all those other skills won’t help much.

            We learn from out experiences, how the world works, that is why each of use thinks things work slightly differently.  Smart people can anticipate what is coming next.  Really smart people think about what will happen after that.

            Dr. Tegmark points out that this is only true if you live in a universe in which time only moves in one direction.  If time jumps all around, from past to future, to past , to present. It is useless to try to make any predictions., so don’t even bother developing a brain.  Thankfully, we live in the right kind of universe.  I hope you all can learn to take advantage of that.

Time keeps on slipping, slipping ,slipping....

It is clear that life does not slow down and give me time to reflect. I thought that by now I would begin to feel the effects of my diminishing work load, but no way will that ever happen on it's own. It seems that the changes in the world have meshed beautifully with the changes in my family to fill any possible moments I may have been hoping to use to do the things I often thought I would someday have the time to do, such as --very little.

 Such as stare at the sunset.
Think about where I've been and how I got here.
Think about where we've all been now that we are here.
Should the Celtics keep Rondo or trade him?
You know, important things.

But the inflow of information keeps coming and coming and coming.  So much that reaching a conclusion is difficult because there are always new facts coming in. And now, increasingly, some of the new information that comes in is from my own children, who send requests to help with their children.

I realize that my children's lives are really busier than mine, and really, busier than mine ever was. They and their spouses all have big jobs, are are all, in different ways, connected to people all around the globe, who seem to keep connecting at all times.  To varyng degrees, they all have to travel, stay for meetings, go to meetings, develop something, make decisions, on a deadline, and then be parents.

That's why they live close by.  I am one text message away from spending three hours with the kids or a phone cal away from spending next weekend taking one of them. And it's great.  Put on your wings and tu-tu, Grand-Pops is coming to make ducks out of Play-doh.

So today, which I had put aside to read somethings, think some things, and perhaps even write somethings, was a totally free Monday.  I stopped going to the office on Monday because I am cutting down my work.  But it followed four consecutive days of being with the lively, enthusiastic, creative creatures and prying the iPads out of their hands. And after four days with them I am left with fond memories, sore muscles and new viruses making me cough and sending me to the bathroom.

This is not a way to sit and think great thoughts and reflect upon my career as it approaches it's end.  But it is the way with life.  It keeps going, generating and re-generating.  And while great thoughts and brilliant insights are important, they don't come easily, just by sitting, and even when they do their impact is often minimal, and can even create a whole negative flurry if they are really transformative.

Grand-parenting on the other hand is important.  It can be one of the factors that separate the "haves" from the "have-nots" that everyone is beginning to realize has become a major problem. And the first duty of any grandparent, especially if the children in question are under three, is to make sure the kid thinks they are loved and protected, and that the world is interesting, and most of all fun. Once you establish the feeling that it should be fun to wake-up and fun to go find things to do, then life becomes easier, richer and valuable, especially if you are with people who want you there to have fun with.  Fun doing, experiencing, learning, creating, and making good things happen.

My reward is watching them smile, even if it from something as simple as a six-month old rolling a ball, or a ten year-old building a model of the entire universe, complete with two billion galaxies and black holes moving away from each other at just under the speed of light.

Well, that one is a bit more complicated.  Right now I'm going to bed.
Have fun.

Out There

I have always been very interested in cosmology -- as opposed to cosmetology, which never helped me very much.  I remember way back, reading about the discovery on the microwave background, in the mid-1960s, by two guys at Bell Labs, Arno Penzias and Robert Wilson.  It was the first real evidence that there was really a Big Bang.

The two great, almost unanswerable questions have often been of interest to the same people.  They attract me, partly because I always find myself thinking is big terms, and as my wife often points out, I get a bit sloppy with the details.

The two questions are "Where did we come from? -- How did ALL of THIS happen? and What is consciousness? -- How does that happen?

Even twenty years ago most scientists seem to feel that the answers to those questions was out of reach, and would stay that way for a long, long time.  Some even were ready to say that our little minds were not really capable of understanding all that.

Now, their doubts may be still true, but our little minds, or at least the combination of many little minds working with some great assists from wires, chips and 1s and 0s. have been able to come up with some very enticing ideas, and some fascinating possible explanations.  It may be proven at some point that all of these theories are just very clever ways of entertaining ourselves, but the whole process of searching for the answers seems much better and more useful than just walking away, or getting annoyed at the question.

I have just begun to read Our Mathematical Universe, by Max Tegmark, one of the physics professors at the local tech school. He is trying to make the case, and he admits that it is a bit beyond the usual realm, that the universe is really based on, and governed by, mathematics.

The scary part, and I have not really gotten that far into the book, is that from my own work with people, and trying to figure out why they do what they do, in terms of behaviors, thoughts, feelings, decisions, relationships and all, I have always had thoughts similar to that.

I do not think in numbers, or use beautiful mathematical formulas, but I have always felt that there are so many causes, factors and influences of behavior that a person's actions are really the result of all the combined, interactive influence of all of them, much more than having the person him/herself, make independent decisions.  I can remember way back when IBM was first becoming prominent and computers were beginning to become impressive machines, that I thought if this gets big enough, we could feed all the factors into this thing -- person, place, parents, culture, subculture, birth order, climate, genetics, nutrition, environmental toxins, diet, friends, school --- everything--- then we would be able to predict, with some degree of certainty, given what was happening to him or her, what he or she would do next.

We are not there yet.  But it is coming, kind of, and sooner than later.  And we will probably buy whatever it is they are selling, because that is what they will do with that information.

More of this, much more, later (and later).

Aging Out

Been a while.

I got away.  I couldn't stand the cold so I went somewhere warm.  It was beautiful.  Came back.  It's cold again.  "Why are we here?" asks the wife.  Answer is becoming more difficult to articulate.
....Well, the grandchildren are here....

Now I am spending two and a half days seeming patients.  I get out in the middle of Thursday and leave the office for the new, young guy.  He reminds me of myself as his age: energetic and idealistic.  He is only sixty-two.

But I didn't go home.  I had to stop on the way at a rehabilitation center (nursing home) and do an evaluation of Martin.  I first saw Martin around 1983. He was sent to me by his doctor, who hoped someone could help him.  Martin was well known around town, especially by the police.  He was angry and paranoid.  He was colorful and expressive.  His ideas of who was out to get him included not only the police, but the utility companies, and the air force.  His delusions about the air force was based upon the planes flying over his house.  This later morphed into being that the birds flying over his house had been trained to spy on him.

In those days that was considered crazy thinking.  Now, of course, how many drones look exactly like birds?

Martin was once good looking and charming, when he was not ranting against the world and getting in fights.  He fathered four boys with two different women.  He wasn't the greatest father, as he would wander off for a couple of years at a time.  Once in a while he would send each of the mothers a check.  He meant well, but really couldn't maintain any consist work, relationships or even state of mind.

About ten years ago one of his boys died in of either a fight, an overdose or a fall.  It was never quite clear, and was probably a bit of all three.  That really upset him and he became more depressed, angry and confrontive.  After a few years of that he calmed down, but was still in enough trouble to come and see me. He hoped that being in treatment could help him stay out of jail, which it did.

But now he is physically falling apart.  His circulation is bad, especially in his legs, so he falls down.  The last time he fell he broke his wrist, so he was put in this rehab center.  One of his son's contacted me and told me where he was and wanted me to help get the son to be his guardian.  That's why I went to visit.

Martin was very welcoming and happy to see me.  He was taking a bit of medication, something he had resisted for years, and it was helping his stay calm and almost reasonable.  He confided in me that he knew everyone was still watching him, but he was OK with that now.  They were nice about it now, even if it was all a cover-up.

His wrist was in a cast.  His knee was in a brace.  He sat in front of a walker, and held on to that so he could sit-up.  His roommate sat in a wheelchair.  There were people in the hall attached to chairs by a thin cord that would set off an alarm if they tried to get up.

Martin looked to me to be about a hundred and three.  It said in his chart that he is five years older than I am.  That's why I am not starting with any new patients.  I am finding that not working is a lot easier than working.  I didn't feel that way, way back when I was sixty-two.

Denial?

As I said a couple of posts ago, I am beginning the transition.  I am morphing from who I was and what I have been doing for the last forty years into whatever it is that comes next. It is an interesting time. I left work today(Thursday) in the middle of the afternoon.  Some young guy (62) now comes in and takes over my office.  I walked out into the parking lot and there were still cars in it.  I drove home and my wife was still on the phone, working.

If I haven't said it yet, I want to make it clear that I realize that I am very fortunate, and that I can do this out of choice.  I am getting older, but except for the reality that I can no longer run very fast, play basketball with people who are thirty years-old, and that I have much more trouble remembering names that I rarely use, I am in good shape.  I am nicked and bruised and sore in spots, but I am healthy. My skin is saggy and my legs are bowed, but I am fine.

I  also have enough money to be able to survive quite well. I am not buying a yacht, but I could buy a small boat and I am happy with my kayak. I am in a good relationship with someone who is certainly still interesting, to say the least.  Also, and very important, my two children are grown, all solidly self-supporting, both married and also in good relationships, and they now have their own children who are, so far, healthy, enthusiastic little bundles of joy and enthusiasm, when they're not fussy.  And all of these people live within twenty minutes of me.

So, with the fundamentals, things couldn't be better.

Given that, I am still trying to sort out what I want to do, what I can do, and what is important to do with the time that should be available since I won't be spending thirty-five hours doing clinical work and another ten to twenty hours doing the shit work I have to do to get paid, write letters, file reports, make phone calls...... all the stuff that goes with trying to be professional and get paid.

Well, the first thing I learned upon not working as much and getting older is it seems that unless I make a concerted effort to do other things, life will be spent doing things to stay alive. That includes more of what we used to call "daily life skills" in our evaluations.  Who knew they could take so long.  Dressing, cleaning, flossing, shopping, cooking, loading the dishwasher, emptying the dishwasher, reading the paper, checking on-line to see if what the paper said was accurate.

The next big thing, is getting the exercise that I haven't gotten since i played basketball. Go to a gym in the middle of the morning and who is there, women with rich husbands and old people.

Then there is the big one, going to some kind of doctor. My wife, unfortunately, has a complex medical condition, so she goes to the doctor more than she ever did.  I went with her last time, and just going to the big medical complex can ruin any positive outlook.  We are near Boston.  We really have the best medical care in the world. The best doctors, the best hospitals, the best research.  But who is there: old, sick people.  People shuffling along, people on walkers, people looking sunken in and ashen.

Most of these people are my age, some are younger, some are older, but everyone knows this is the next step, and the step after this is worse.

That's where denial comes in. Foe me it seems best to just keep going and ignore all you can. My shoulder hurts a little, so I don't throw any down-field blocks.  My knees can give me trouble so I don't jump, and if I do I try not to land.  My tooth got chipped, so I'm getting that fixed but it still bothers me. Still -- just keep going.

I know that I have ideas of good and semi-important things I want to do, but I don't have to do any of them.  No one has called up (or sent a text) asking me when I will be finished.  I realize that what I really need to do is relax, play and have fun. But exactly how to do that is still a bit vague.  I don't think I can go out into the street and find six friends and play Ring-a-levio, like I did sixty years ago.  I don't my wife will call me in when it gets dark.

For years it was a lot of fun just to rest and relax after a week of hard work.  Right now, in the afternoon, when I am accustomed to still having five hours of work ahead of me, I'm not that tired. So having fun means...I'm still not sure....and it feels kind of weird.  Not bad exactly, certainly less stressful, but still weird.

It's a pity the grand-girls don't live here so I would have someone to dance with. I'm sure they would lend me a tutu.