Monday, July 27, 2015


It's still summer I've been blissed out down here, chasing the grandkids across the beach   They do funny, startling and often "crazy" things.

What's "crazy"?  That's a good question.  But let's take the opposite approach: what's "sane?"

Here's a brief thought experiment: what would it be like if everyone  the world was sane?

Think about it.

It can't happen can it?

Is there any way we could all agree?  Or, if we disagree to act respectively, be accepting, make reasonable adjustments and accommodations?

If we are all sane, would we have similar standards of what is fair, of what is reasonable?

I guess it goes back to Aristotle, who was looking for "ideals", and the perfect forms and pure ideas to guide us.

We haven quite found them yet.

That leads to disagreement, to tension, to conflict, to stress, to anger or depression, and there you go, You end up with ISIS, mass shootings and 16 Republican crazy people wanting to be President.

Tuesday, July 14, 2015

Epigenetics - 1

So much information comes pouring in, even when I’ve just been chasing the grandkids across the beach at low tide. I don’t turn on this computer as much any more, because, like most people these days, it seems to be too big and slow compared with all of the mobil devices that I take with me in a plastic bag. Still, so man new, exciting things are happening -- as well as the constant flow of repetitive atrocities and financial manipulations. 

Some of the new information came over the weekend in the very low-tech way, through newspapers.  Because of the glitch in the analogue delivery system we received three papers, one from New York, one from Boston and an extra from Cape Cod.  The Cape Cod gave us local facts and weather, and also a story and picture of a woman who had gone to high school with my son.  She was doing well here on The Cape, except she still had loads of student debt.  Too bad; student loans were another good attempt to put a band-aid on a severed leg. The unintended consequences  soon were mixed with a bit of good old American fraud and deception, and now it’s a crisis.

The NYT Magazine had a lead article by Susan Dominus about two pairs of identical twins who were somehow mix-up 26 years ago and raised as fraternal twins by the two different families.  The four men found each other through a series of connections and are being studied by geneticists and also epigeneticists.

The article focuses mainly on the reactions of the young men, and how they responded differently to the very confusing situation.  It raises the questions of who we are, and what it is that shapes us.  All that nature/nurture stuff.

Although this happened due to a drastic error in a rural medical system, it is relevant  now due to the increasing amount of ways in which families can be formed.  These days, with different kinds of marriages, and so many step-families, and people changing sexes, or just having difficulties having children, the laboratory is an increasingly major factor in the creation of people.

Repeatedly, over my long years of doing psychotherapy I have often  been frustrated by  feeling that I am working with someone whose emotional reactions to certain situations are way beyond what should be expected, even given some difficult situations.  I spent hours working with Lady R, who was very anxious, and saw possible danger in everything.  She did well in therapy, as she was thoughtful and very open to reassurances.  Long after we stopped our visits she would call me after a bad night of fears.  I would spend about fifteen minutes on the phone with her and she would be fine for six months. But i always had the impression that she was being knocked over by the waves of her life, even though they never came up as high as her knees.

By contrast, I have seen people who had awful family histories of physical and emotional abuse, as well as living in poverty, and yet these people were workers and survivors.  It was not as if their lives were without struggles or limitations, but they had developed coping mechanisms that held them steady when the waves of their lives where twelve feet high and threw them against the rocks.

Obviously, we all have genetic differences that shape our personality.  Since the turn of this millennium there has been an amazing amount of work sorting out the kinds of genes that play a part in predisposing each of us toward various emotional sensitivities, or lack of them.  The results of the Human Genome Project, and all the technology that has been developed to explore those areas has opened up vast new ways of adding dimensions to what influences how we all think feel and act.

However it has, somewhat surprisingly,  been discovered that this connection of genes to behavior is much more complex, and much less cause and effect than what was anticipated at first. It has become very clear that even if genes are identical in two people, their behavior has not been determined to be the same.  That is what this articles finally illustrates.  This is what the newer field of Epigenetics is all about. We are learning that Epigenetics is as important as our DNA.

I am now reading Nessa Carey’s book called “Epigenetic Revolution” which begins to explain how changes occur between the time that our DNA, which designs the formation of proteins, and the actual formation of those proteins.  It turns out that, contrary to what was expected ten years ago, a lot happens.  Slight changes occur which affect exactly how and when these proteins are formed. This leads to changes in or bodies, which leads to changes in our thoughts, feeling and behaviors. 

The result of all this is that what happens in your life influences how your genetic script gets played out.  But, it is also still true that what your genetic script is has a major influences on what happens in your life. One cannot overplay the other ( except in extreme cases).

The study of Epigenetics is to determine what affects the expression of our genes. this includes considerations of prenatal development, nutrition, toxins, air quality.  Also, physical and emotional factors play a strong roll, nurturing, family dynamics, structure, safety, stress, and all the other psycho-social elements that psychologists have focused on for years.

The point of this extra long explosion of a post is just to express my enthusiasm about how new science is revealing the complexity of human life.  Our millions of years of evolution have not produced a simple creature that responds to simple solutions.  Our mind, however you define it, comes to us as the result of the flow of many forces all interacting with each other all of the time. 

That is why perfect parents often have problem children.  That is why moral people can be corrupted and great leaders are awful individuals.  That is why happiness comes and goes, and difficulties can be rewarding. As the atmosphere changes, or our food intake changes, or relationships change, or the temperature gets hotter, or we get an infection, we can become different people.

We should, and we will, develop better ways of sorting out what forces help us express our better natures, and what and how to apply them.

Still, as Newton himself found baffling, when there are more than two, or maybe three moving parts interacting at the same time, the possible results increase exponentially and predictions become almost impossible.  With humans, the number of important influences are still being counted.

As I chase the two and four year-old across the beach, I hope that their obvious glee will help them feel that the world is a fun and exciting place to live. One wave may knock them over scare them, and it all could change.  Or they could learn that they can bounce back up and that their family can provide support and safety.  We are all working and hoping for the best.

Friday, July 10, 2015

I said to Them (last time)

Below is a bit I recently posted on a list for practicing Psychologists.  In my last post I mentioned that I was worried about the future of my profession and this describes my concern.
As usual I was mostly ignored or else told to shut-up.  At present, most psychologists in private practice are much more concerned about how they really don't fit into the changing health care system, and how their compensation is being reduced.
What I wrote is consistent with what I've been writing about for the last few years: that change is difficult, especially if it means a reduction in pay and learning new skills. Of course it is easier for me to say this all now because I no longer count on the money I make seeing patients.
It is also very possible that I am not just an outlier, or a perceptive critic who makes people uncomfortable, but just a cantankerous old man.
So be it!

Here is what I wrote:

When I was in grad school I drove a cab.  I had to make change quickly, and give people their money in denominations so that they could give some back to me.  Now no one makes change any more. Also, the taxi business is being destroyed by Uber.  Uber drivers don't give change.  Uber riders don't give tips. Yes, there are big problems with Uber, and taxis may, or may not give better service.  Pretty much the market decides. Taxis, just another profession that's disrupted.

I don't think there is, or should be a free market for mental health services.  The people who need it the most often can't afford it, don't know how to get it, don't know they need it, or don't want it. I also think that almost everyone on this list does an excellent job of doing what they can to improve the lives of their patients.  I think that many of will successfully develop a way to support yourselves, using the skills that they have.  If you do that, one of those skills needs to be in marketing.  The APA will give you some help in doing that, but 88% is up to you. (not a scientific %)

I have been in Independent Practice for about 35 years, doing mostly psychotherapy. Due to my age, a bit of financial stability, the changes in health care, and the sudden appearance of four grandchildren I have dramatically limited the number of clinical hours I do, and how I do them.

But, during the last ten years I have become aware of how much I felt the limitations of what my skills were, while also feeling ( of course ) that my skills were equal or better than anyone out there.  I did a lot of reading, exploring, talking and even taking courses in other fields. I now feel even more strongly that the advances in fields such as cognitive psychology, brain science, neurology, epidemiology, genetics, and now, epigenetics, and even criminology, architecture and paleontology offer insights into the determinants of behavior that most psychologists don't pay attention to.  Most of these fields have used new technologies and Big Data to peer into brains and bodies, to find patterns and relationships that were not even conceived of before the turn of the new millennium. 

Also, people's lives are very different.  People work differently, communicate differently, and form different types of relationships. Yes, I still think that having a safe, trusting, confidential therapeutic relationship  can be very comforting, and also produce many positive results. But really, it is not going to meet the needs of our fast-paced, stressful society. Also, several studies show, you don't necessarily need Ph.D. to be good at it.

I feel very strongly that if Clinical Psychology as a health profession is going to be relevant in ten years, we had all learn to combine our knowledge with other fields of study, to find ways of intervening on different levels, such as families, communities and health. We need to lean about mind-brain-body-genetic-environmental interactions.  Human behavior turns out to be very complex.  That's not a big surprise to anyone on this list. But there are tools and knowledge out there that did not exist when I was in grad school, and which hardly get even a passing mention in most of the current psychological literature.

Amazon, Facebook, Walmart and American political parties have become more skilled at influencing and shaping human behavior than both academic and clinical psychologist. That worries me.

Every time someone takes out a gun and kills a bunch of people in a movie theater, an elementary school, a high school, a college, a mall, a parking lot, a military base, a post office,  at his office, at a temple, a beauty parlor, a church, on his friends, on his family, or at a mental health clinic, just to name some of the recent ones, everyone says, "He had mental problem."
Well, what are we going to do about that? Isn't that our job?

I'm sure we can do a lot, and that's a lot of what we should be doing.

*    *     *     *     *     * 

That's what i said to them.The ones who replied mostly defended psychodynamic psychotherapy. Psychodynamic psychotherapy is fascinating for both the clinician and the patient.  It can also be very comforting.  But it often goes on for years and is not effective for people who are being smashed by life.

But I won't bother them again.  I will seek a more persuasive outlet.  Until then, I'll just occasionally spew it out here.

Thanks for enduring this one more time.

Tuesday, July 07, 2015

It Must Be Me

It's still summer.  Beautiful down here, as I said last time.  Friends, family, people, food, drinks, sun, sea, surf, stars.  Lots of stuff to do.

My wife and I played golf yesterday. We are not good golfers.  I have almost gotten to be mediocre, but I don't play enough.  I began to play because it is one of the few sports my wife will do.  She gets bored after nine holes.

We played on a hot afternoon at one of the local courses.  Since it's summer and busy we were paired up with a couple of guys who are about my age who were golfers.  The were buddies, and they said  they play about three or four times a week. They were were nice people and friendly to us.  They were very good at golf. At least a stroke a hole better than me, more on harder holes. But they didn't seem bothered by us whacking the ball around.  They were mildly competitive with each other. A lot of kidding back and forth.  They seemed to repeat things they had said to each other for years.

Often, when we are paired up with another couple, we get to know a bit about them: where they live down here, where they lived before, what they did, how many kids, grandkids, where they like to eat. just general stuff.  When we get paired up with men, they are polite but no information gets exchanged. These guys talked to each other about fishing, about grilling, and about watching golf on TV.  I don't know if they had wives and families.  They could even have been married to each other, although that seemed unlikely.  Although, really, they were. They seemed like guys who had worked at a job for many years, and now they were happy to be finsihed with it.  They were free now to do what they wanted.  They had earned that.

Today, I went out by myself in my kayak.  Paddled down the river and out into the Sound.  I paddled through the little waves out to the mound of rocks.  Looked at the land, sea and sky, and wondered again who I was and what I was thinking about.  I think about thinking too much.

My wife was busy all day so I stopped for some clams and a beer. I was going to sit at the outdoor bar and chat with the folks who were enjoying themselves, but as I passed I heard they were talking about drinking, and drinks.  The talk was a bit loud and a bit sloppy.  They obviously knew what they were talking about and had been at it for a while.

I just  moved on to a table.

I'm a  fun guy, but not in the ways that most people have fun.  I like to drink, but not that much.  I like to play golf, but the score doesn't matter. The only movies I like are strange and have been seen by about three dozen people.  I get bored by most novels.  I don't believe in happy endings. I love to talk to people, especially now that I don't have to help solve their problems, but I make jokes they don't understand, and references to things they never heard of. I think a lot of things are funny. Many of them are the things other people take seriously.  I think I'm funny.  I'm really good at entertaining myself.  I get all my jokes.

But I can't just relax and enjoy everything day after day.  I can't just take care of myself and let the rest of the world go off and do it's thing.  I know when it does things often turn out badly.  I worry about my kids and my grandkids.  I worry a lot about my profession.  Psychology, and the treatment of mental health issues are not evolving fast enough.  They are not keeping up with the rest of the sciences and with the way the world operates. Not effecient or effective.

But I've been at this for almost fifty years now.  It's time to put it down and let someone else pick it up.  I'm very fortunate to be as healthy and happy as I am.  Let it be.

But I can't.  Things should be better. It bothers me.  Some things have improved, but not enough.  People should care.  Most don't.  They are better than I am at just having a good time.  I'm almost jealous.
But I'd be bored.

I see it with my patients all the time.  Long-term habits are hard to break.

Sunday, July 05, 2015

Summa Time, Summa Time

Yes, it's summer.  We have been on The Cape for over a week now. The last few days in June were quiet, warm and lazy.  I rode my bike the mile into town and two cars passed me.  I walked in and ordered a sandwich, chatted with the deli-man, bought a bag of chips and rode home.  We took the grandkids to the beach and I chased them all over the hard sand of low tide. The sun set very late and quietly over the Bay.

I thought I could hear the rumble coming.  Still, I wasn't prepared.

Twenty-four hours later I rode my bike to town to buy sandwiches for everyone.  The road was packed.  I had to wait in order to make the left turn into the parking lot.  It was good I was on my bike as there were no places left to park.  The line to get a sandwich snaked around like the line to ride Thunder Mountain.  The deli-man, his brother, his cousin and the two guys they brought in from the Sandwich Maker's Union didn't have time to look up.  They just read the pieces of paper with orders written down on them and kept chopping and spreading mustard.

The beach parking lots were full. There was hardly any room to put the strollers for the grand-boys.  The tide was rolling in and almost all the soft sand was covered with people. People were chatting, sleeping, digging and flirting. Summer arrived!

It was the Fourth of July Weekend.

America was enjoying it's freedom.  Our family was together.  Other families surrounded us.  My nieces was in a house about a mile away with her husband.  His family was there.  Eighteen people and six dogs in a four bedroom house.  The family next door to us always brings everyone in for this holiday.  They have that house and another one near the beach.  They have lots of people, brothers, and a sister, husbands, wives and kids, ex-wives and step-kids, boyfriends and girlfriends, babies and dogs.  I never remember who is attached to whom. The smile and wave.  They all run a race against each other every years to see if the new wives are faster than the ex-wives.  Whatever.

A few hundred people turn out at night for the fireworks on the beach. Fireworks are not legal in Massachusetts. But for an hour there were almost as many fireworks going off as there were over Boston Harbor.  Lots of little puffs of color in the air, but also many, many big boomers lighting up the sky and filling the night with colors, lights and sounds, falling down on my head from two hundred feet above me. People sitting around bonfires, cheering each booming display. I sat down in the dark and a shadowy form next to me handed me a beer.

Thanks, I said. Enjoy your freedom.

Our kids and their kids all left in the morning to beat the traffic.  Other friends drove in from New York and brought their friends with them. No more changing diapers, just eating and drinking on the porch. They will leave Tuesday morning and other people are due to show up Tuesday night and more on Wednesday.

Somewhere in my mind I am aware of how fortunate I am, and as the real people realize, it is really about Family and Friends.  Yes, I know that somewhere out there some people really take Donald Trump seriously.  But that's their problem  I guess that's what freedom is all about.

I leave you with today's musical tribute: