Monday, January 20, 2014


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.

Wednesday, January 08, 2014

Reading and Thinking

Back to work, for now, and chugging away.  But also, at other times reading.
Two interesting articles about what is happening in our times and what is coming soon, are in fairly popular magazines.  The first is an excellent description of the agony of living with chronic, life-long panic and anxiety.  It is the cover story of this month, January/February, 2014, Atlantic.   It is written by the editor of the magazine, Scott Stossel.  He is unflinchingly honest about how anxiety seeps into almost every action in his life.  He talks about the many ways he has tried to cope with it, and how much he still struggles.

For anyone who has  ever had a panic attack I think this would be very helpful reading, unless of course, thinking about anxiety makes you anxious.

Related to that is an article in last week's (January 6, 2014) New Yorker.  It called The Gene Factory, and it is written by Michael Specter. The article is a description of BGI --Beijing Genome Institute, which is a Chinese company that is sequencing the  genes of all sorts of living organisms, from viruses to people with all different kinds of diseases as well as, and this is the new part, personality traits.

The article talks about how China does not have much in the way of what the West considers strict moral or ethical guidelines.  This company is much freer to attempt to find  a genetic basis for cognitive and personality traits that could lead to more desirable citizens. They are gathering the genes of people who test higher on I.Q. tests, or on other tests for creativity.  They are putting down the first steps for something that has been avoided in this country, the quest for designer babies.

On of the frightening differences is that in China it might be the State that is doing the designing more than the parents.  What traits the government may find desirable may be worrisome for the rest of the world.

Of course, China is the country that sends dozens of the children who are projected to grow tallest of to be trained in basketball from a very young age.  The results have not brought many victories.

So many questions about the causes and treatments of human illness, behaviors, and activities rushed through my mind upon reading both of these articles on successive days.  It is clear to me, especially when I deal with people who have always had trouble with such things as panic attacks, that at least part of why it happens to them is that they have some genetic predisposition to be more sensitive and reactive to certain kinds of stimuli, especially social pressures.

But surely, it is much more than that.  Complex behaviors are always the results of complex interactions between a person's physical make-up, the current physical state, their individual history of experiences, which includes their family, their community and their culture.  It is also affected by so many other factors such as nutrition, temperature, stress, interpersonal relationship, past current and projected, and just random events.

Still, with Big Data, and fast gene sequencing machines, as well as comprehensive computerized medical records, academic records, work history, so many trends and interactions and patterns will be found as more people feed all of this data, for millions of people, into machines that compute and compile millions of digits a second.

How much do we want to know about ourselves, our talents our possibilities, positive and negative?  How much would we change?

Of course, we all want to know about everyone else.

In fifteen years some guy will be casting his eye on my granddaughter.  I'm going to want to know who he is.

Monday, January 06, 2014

2014 and Me

Again, Happy New Year to all of you in the bloggosphere who happen to stop by.  The weather has been really lousy here in New England, but it is January and I am older than I was, so what should I expect?

I mention getting older because that is what this year will be about. This year, more than just trying to help other people to make some kinds of changes in their lives, I will be attempting to make a major change in mine.  From now until the next solstice, the one in June with the most sunshine of the year, I will be reducing the number of patients I see each week.  My goal, which is being monitored by my wife and family, is to have sent almost everyone on their way by the time the sun goes down on that day.  I will then take the entire summer off, and if I return to work as a therapist at all, it will be on a very limited basis with a very different model of treatment.

Sounds like a plan, but like all plans, especially those made at the beginning of a calendar year, the execution and follow-through are really what counts.

I have little doubt that this will come to pass.  most of my friends know already and I have begun to let my patients know. It is part of the rotten state of health care in the US at present that making good referrals for some of the people I see will be very difficult.  The changes in insurance, and who takes what, the the lack of good mental health providers, and the huge changes in how services are delivered........but that is all part of why I am letting this model go.

The real difficulty I am already beginning to experience is with me.  What will I do? What will it feel like? Will I get anything done?  and what do I mean by getting anything done? Changing my life will certainly be the biggest challenge of this year, not dealing with anyone else.

I have many vague ideas about how to relax, reduce stress, be a grand-pops, play, read and think.  But the lack of structure is very intimidating after more than 40 years of going to work five days a week.

It is easy to find ways to enjoy life.  It seems that it will be more difficult to find ways to get satisfaction from doing that. Why this is true for me is not yet clear.  Some it is that there still seems to be so much thatneeds to be done.  Some of it is just vanity.  I need to feel important.

I will probably have more time to see what Life in Merlin is like.

Wednesday, January 01, 2014

New, for the New Year

New Year --2014.  On that, most of us agree.  What the new year will hold seems to be less clear than for almost any year I can remember.

Part of that is, perhaps because I am old, the pace of change seems to be accelerating. More than ever, people expect changes.  They expect life to be different; technology is mostly responsible.  New phones, new apps, new ways to track your life.  There will be new ways that other can track your life.  New ways that we do business.  Do business with new people, new people from new places, who bring with them new ideas.

More data, new data, Big data.  New algorithms: in genetics, in demographic, in sales. Bringing good news,  New ways to track diseases, epidemics, climate change, money flows, where the crops grow, where the fish swim, how much, how many, how good.

Bringing bad news: how to blow things ups, randomly.. How to shoot the enemy, your family, random people in the street, at a mall, at school.

So many new things, even including programs that create programs and robots that build robots,

The economy: better or worse, for the few or the many.  The stock market, more up, flat down, down big, who knows?  Most people are too baffled to even try to predict.

The mid-term election?  The Middle East? Fracking?  Cities, countries, art, music, literature,biology, chemistry, astonomy, food, fun, families, casues, cures.

There will be more changes in 2014 than there were during the thousand years from 500 to 1500. But it is world wide and there is no central authority -- not that I would wish it -- so no one really has any idea how this year will play out.

Right now it seems very exciting, but also risky and confusing, with the possibility of so many unintended consequences, and so many random events that could have a major impact because we are all so much more inter-connected.

So, figure out what part you would like to have in it all, which may just be wondering who will win Dancing with the Stars, or perhaps how to suck all the greenhouse gases out of the atmosphere, or how to teach your kid to dance, and get to it.

Good luck!!