Other Choices/ Other Realities/ More Questions

Way back in 2015 I was feeling swept along by a rapid river of changes. So many new ways of communicating, learning, moving, building and exploring were all coming at me at once. I was concerned that the changes were so pervasive and affected so many aspects of our lives that we have been unable to keep track of them. Most of us were just trying our best to act as if we know what we’re doing. All the while we were in the midst of realizing that in order to survive we would need to develop new skills. How we relate to each other is also changing, as cultures from all over the world merge and new lifestyles emerge. In many ways, we are changing our bodies, brains and minds, both directly and indirectly.

As my interest in all of these innovations grew I became excited, and wanted to be a part of the whatever the future would bring. I began to read books and articles (see below), attend conferences and trade shows, and learn about new companies.  All of the people I met were extolling how we would soon have our lives transformed at the touch of a screen or just by uttering a command or asking a question. I began to believe that these changes would have more of an impact on our lives than just the thrill of capturing animated warriors, who were posing virtually, in the park across the street.

Fantastic!

I was eagerly anticipating driverless cars, a cure for Alzheimer’s, genetically modified tofu that tasted like Boston cream pie, enriching relationships with new people from all over the world; new, cheap, sustainable sources of energy, and more time with my grandchildren.

But in the Spring and Summer of 2016 the clouds began to form as the political landscape began to dominate the forecasts and darken the future . There seemed to be a resentment growing and an anger brewing in many people. These people began to feel overwhelmed. The changes that I found so exciting, they felt were ruining their lives. People began to express how uncomfortable they felt with new people and the new lifestyles. They were unclear if it was the Chinese, Mexicans or robots taking their jobs. They were not happy that it often took pushing buttons on three remotes to find the TV show that used to be there if you pushed one “on” button. And where has Bill O’Reilly gone?

People seemed to want to stop, or at least slow down, the flow of these changes and reestablish the sense of security that came with living with what felt familiar, even if that feeling only came from nostalgia and nothing that really ever was.

But the pace of change has not stopped. New things quickly began to get old and newer new things were arriving. Every next thing seemed more complex and different, and whatever it did, it did it faster than before. New books kept coming, and so did web sites, articles, studies and ideas. But now, the tone began to change. There were questions raised about whether these new things were really bringing insight, knowledge, ease, comfort or joy. People began to focus on the downside of all of these changes. Who were these new people? Is Artificial Intelligence smarter than I am? How did so many people know I needed a hub cap? How do they know what kind of medicine I’m taking? Who else knows so much about me? Can I trust the new information I am being given? Can I trust my employer? Can I trust my government?

We are learning, once again, that every new technology that humans develop brings many changes, and they all come with mixed results. This has been true for fire, axes, wheels, agriculture, gun powder, internal combustion engines, plastics, nuclear energy, Twinkies, digital computers, the Internet, and now CRISPR, Artificial Intelligence and Deep Learning.

Like all of those innovations, there has never much discussion about how and when to use these new tools. There have been very few times in the history of human civilization when any planning or preparation of this kind has been done. What usually happens is that a group of creative folks come up with something new. Sometimes, if they’re in the right spot at the right time, it either fills a need or creates it’s own need. Then other people figure out different ways to use it. Some of those ways work and sometimes it blows up. Clear examples of this are the internal combustion engine and the iPhone.

But soon after every innovation, the same kinds of societal difficulties begin to appear

Who gets to own it and control it?

Governments, Corporations? Individuals?

How much power does it bring to whoever controls it?

Who gets to use it?

How much does it cost, and who gets the money?

Who else is necessary? Who gets included? Who gets excluded?

Usually, the ones who develop whatever is new get to profit and to control it’s distribution and use, at least for a while.

Then, if it becomes a very powerful tool, it gets taken over by a government or corporation. If the developer is powerful and well managed, such as Apple or Ford, then they keep their advantage for a while. They get to make the market and attempt to ward off competition. The public has to pay for it, or not have it.

Problems almost always arise because the distribution and use of whatever is new and powerful is never equal across any society. The new advantages almost always go to those who had the old advantages; those with the power, access and money. This creates anger and resentment in those who are left with old tools to deal with new problems. If you are left with your horse and buggy or a land-line, you suffer.

What adds to today’s confusion, is that many of the new tools and machines that have been designed to bring us a marvelous new future of happiness, creativity and freedom, are also being used to distract, manipulate and control us. Tools are just tools, whether they are axes or Deep Learning. They can be used to cut up firewood, or chop off your hand. They can be used to treat your medical problems or change your political beliefs. It depends upon who can get them, who knows how to use them, and what their goals are.

There has never been a successful way to limit or plan the usage and distribution on any new technology. Occasionally, a government will decide that it must be the one to control something. That is usually true for any major military item, from a tank to a nuclear weapon. But we are seeing that even those can fall into the hands of non-governmental fringe groups, as so many “independent” military suppliers exist around the world. Thankfully, so far, it has not happened for nuclear weapons.

Another factor is that the confusion creates more confusion. One of the major new creations has been instant world-wide communications. Everything changes so quickly, and everybody knows about it immediately. An idea can spread so fast that is difficult to sort out all of the interpretations of what is happening. Everyone has an opinion that is usually based on partial facts. Communications run through many channels at once. Often what comes out is distorted or incomprehensible. Eventually, the truth becomes clear: “Meet the new boss/Same as the old boss.” (trite but true)

The ideal, the “mission statements” behind many of these new developments, is to make the world a safer, healthier, smarter, and more harmonious place for everyone. But that requires a complex set of skills that our species has talked about for a few thousand years, but is yet to show that it is capable of performing. This includes caring about people we don’t know, sharing with those who don’t have as much, and the other ideas from the enlightenment, such as freedom, justice and equality for all. Those are my values, revised to really include everyone. I’m not ready to give up on them.

I’ve seen those things written down in a few places, but it seems as soon as there are a few dollars left unguarded on the table, the ideals seem to vanish.

But perhaps, maybe, this time, we can devise the right algorithm that can lead enough people in the right direction, and convince both the rich and greedy, AND the angry and confused, that if things are better for all of us, then things are better for all of us. And if you need a yacht that badly, you can still have it.

We are at a tipping point. The future still looks cloudy. We all will have an influence, either active or passive.

*     *     *     *     *     *     *     *

Some of the Books that are relevant:

Thinking Fast and Slow, Daniel Kahneman, 2011

The Gene Machine, by Donnie Richmond, 2017

The Body Builders, by Adamd Piere 2017

To Be a Machine, by Mark O’Connell, 2017

Our Grandchildren ReDesigned, by Michael Bess, 2016

Homo Deus, by Yuval Harari, 2017

Thinking Machines, by Luke Dormehl, 2017

Heart of the Machine by Richard Yonck, 2017

From Bacteria to Bach and Back, by Daniel Dennett, 2017

The Inevitable, by Kevin Kelly, 2016

From the Web:

Oliver Cameron’s transmission about the technologies of self-driving cars

Backchannel, on Medium

Future Tense, ASU and Slate

Mate Labs

The Who

Many, many others

Fear Pushes Back:

“We have Nothing to Fear, but Fear Itself “— FDR

For the price of a cup of coffee I have garnered a table on the ground floor of the Koch Institute for Cancer Research at MIT. I spent part of the morning listening to papers being delivered at Neurotech 2016 which describe the new and fascinating ways that many neuro-labs are probing into brains to help solve neurological mysteries. There are now technologies that have allowed people to seek answers to questions we didn’t even know to ask ten years ago.

There is irony of course, sitting here at this Koch Institute, which is funded by the same family that also funds some of the most conservative political issues in our country. They did not fund Trump, but their money did help spread exaggerated fear about what is happening in America. It is this fear that is pushing back against the adoption of many of the new technological and scientific advances that are being developed right here on this campus, and at other places all around the country and the world. It is the fear of change.

Trump, the Republican right, the Alt-right, the rightwing reactionary parties that are growing all over the world, and even ISIS, have aimed their messages at that fear. They are appealing to people to hold on to the traditional ways that have worked for centuries. In most cases these are the extreme form of the traditional ways. In many cases the arguments are based upon the unprovable and unfounded beliefs that were the guiding principles of the world before the scientific method of thought began to take hold. In other cases the arguments are put forth by those who have run the traditional power structure, as they struggle to stay in power. They have been feeling that their influence is being eroded by forces that they don’t quite understand and they can’t control. Their response is to clamp down more controls. They justify doing this by raising fears about the usual scapegoats; people who are different, ideas that are different, and any redistribution of power.

There is enough truth in this fear of change to attract almost half the world into being willing to give up much of their freedoms to feel safe. I know, from being a therapist for so many years, how difficult and frightening change can be. Even when the change is obviously for the better, most people resist.

I have spent decades working with people who struggle to stop eating at McDonald’s, stop hitting their kids, stop spending more money than they have. They understand that they need to study to pass a test and exercise to stay healthy. It would help if they could tell people what they want instead of being angry all the time. They haven’t learned that if you promised someone you would do something, do it.

When I talk about these things in therapy people agree that those are the things they want to do. They are almost all capable of change, but it takes months and years for it to happen. The biggest obstacle is fear. Feeling bad has become familiar. How does anyone know what the change will fee like?

If we move away from the being lead by old, White men, who will replace them? Will it be better? For whom? What’s the guarantee?

If I have been told all my life that there is one true god, and these people have a different god, or no god at all, how can I trust them? They are blasphemers. They are infidels.

Many wmen realize that they are as smart, capable and creative as any man. They see that they can prove themselves in the world, and be proud of their accomplishments. But many of them wonder if that freedom is worth giving up their male protectors and the financial support that often goes with it. They feel safer being supportive and nurturing. Why take on challenges when dependency is easier?

All these changes are frightening. I feel much safer if I carry a gun. Everyone on TV carries a gun and shoots the bad-guys. I want to be a hero, protect my family, and shoot bad guys too. Good guy Americans have always shot bad guys (and Indians, [and Black people, but we never talk about that]).

Changes are coming from all over. Almost all jobs have changed, or have been lost. Marriage is between anyone. People from so many countries are moving to other countries. Some are running away from being killed by militias or bombs from their own government. Some come here to start a business and make money. Some come here to pick fruit or cut your lawn. How can I tell which ones are terrorists?

There are so many new ways to communicated and get information. How do I know whom to believe? Facebook? The New York Times? Fox News, My friend Leslie? My doctor? The ads on TV? A priest? A neurobiologist?

When the changes get scary people want to hide. They want a big strong Daddy to protect them and make the decisions. They want a father, who knows best, just like in 1959, when nice White families lived in small towns with quirky neighbors and the same newspapers were delivered to everyone’s door. But we now know that comforting Cliff Huxtable turned out to be Bill Cosby, the rapist. We already know that our new leader-to-be is an overly sensitive narcissist, who retaliates against any criticism. But many are willing to give up some freedoms to feel safe, even when the danger is really slight.

As i sit here in this coffee shop, and go across the street to the conference, I see who it is who is making all of these changes. It is people from all over the world working together, sharing knowledge, trying to correct mistakes, trying to solve the mysteries of life. They are men and women who are all different colors, sizes, styles and backgrounds. Most of them are doing it because it is fascinating, helpful and exciting. Money is hardly a consideration. They want knowledge. They want to make the world better. They are amazed that given what we know today, so many people can still get so angry at each other over such irrelevant things.

What are these diverse groups of people doing? Here in this building they are developing new ways to fight cancer. Some of the treatments are already in use. They were not available five years ago. In the building a cross the street, where the conference is being held, a woman named Canan Dagneviren is describing how she is building “a mechanically-adaptive, mirco-fabricated device for chronic treatment of neurological disorders.”

Dr. Dagneviren was born and educated in Turkey, and then she came to do her graduate work in the U.S. She may or may not be a Muslim. I am sure that many people in the U.S. would yell at her to go back to where she came from. I am sure that the in-flow of people like her, who would love to come here to study, explore and create, will be diminished because of the unwelcoming atmosphere that has been created by this election.

The funding for this research comes from a combination of foundation money and a lot of government grants. But the flow of the government money has been cut by a conservative Congress. It will be worse under Trump, a man who doesn’t understand science, doesn’t want change and seems frightened of innovation.

But even he, with all of his Presidential powers can’t stop the changes from coming. They are pouring in over the fibre-optic network. They are moving in next door. They are the electric, self-driving cars that will be on the highway. They are keeping us healthy. They are warming our planet. They are taking away our jobs. They are making some new people very rich.

These new technologies could be saving the lives of many more people. They could be feeding many hungry people all around the world. They could be controlling greenhouse gases. They could be helping us all live longer, healthier, more prosperous and creative lives. But obstacles get thrown in their path because people are afraid of change. Unfortunately, the backlash seems to always be a part of the process. Change, even when it is clearly beneficial, never comes easily. Adaptation and evolution can take a long time, and many species don’t survive.

I'm back.

I'm starting to write about new things.  The past was prologue.  

I'm putting some test drafts here for the 20 of your to read.  I have not done anything to broaden the readership of this blog, but that may happen.  We'll see.

Something’s Happening Here

1. Realization

Way back In the Spring of 2012 I was sitting across across from  Carrie, an attractive, articulate, sixteen year-old young woman.  She had come to me because she was having panic attacks. These attacks often came when she was studying for exams at school.  She said sometimes she felt as if her head was going to explode, and at other times that she couldn’t breathe.  Carrie spoke in a very animated fashion about how difficult it was for her to maintain her excellent grades and still keep up with the constant influx from her social connections.  As she spoke her voice cracked a little and her dark hair fell in front of her dark eyes that would fill, but not overflow with tears.  Her parents, Sandra and Joyce, were sitting in my waiting room, while her friends, many of them, were wondering where she was and why she was not answering their text messages that were making her phone ping every thirty seconds.

I have been a psychotherapist for over forty years and have been closely involved in thousands of people’s lives, yet that was the memorable moment when it became undeniably obvious to me that I was living in a new world; a world that is not only creating changes in how we all live, it is creating changes in who we all are. Changes that will alter the basic make-up of our species,.

The changes are technological, environmental, genetic, and societal.  The most powerful changes are the result of how all of those factors interact.  This new world will increasingly require  people to learn different skills in order to adapt and succeed.  Many of the ways of thinking and acting that were adaptive and helpful two or three generations ago, are no longer useful; others are now counter-productive. The time and effort that our ancestors needed to learn how to hunt or to grow for food has been replaced by knowing how to talk to Siri or an Amazon Echo.

Our grandparents lived in a world that was very different from the one that their grandparents lived in.  The early twentieth century was a time of change, especially compared to the early nineteenth century. It was a time of significant industrial and mechanical advances. The pace of that change has continued to increase so that now, in the early twenty-first century, we live with constant change.  We expect it to continue. But as we are changing the world, the world is changing us. 

For thousands of years the personalities, beliefs, and behaviors of all people have been shaped by the same basic forces: our genetics, then our families, then our communities, and we are all also limited or enhanced by our general health.

Who we all are, as individuals, begins with our own genetic structure, 99.9% of which we share with every other member of our homo sapiens family. We are all the product of millions of years of evolution. All human babies are born with the genetic scripts that have been passed from generation to generation, with occasional mutations, for two-hundred thousand years. 

Next, we are all plunked into a family grouping, whatever shape  takes:  two parents, a tribe, a refugee camp, a single parent, a mother and a sperm donor, whatever.  This “family” immediately begins to teach us their version of how the world works.  We all quickly begin to understand how we are expected to behave in order to get what we need.. We have to adapt to that specific environment to survive.  Babies are very dependent so we all had to learn fast.

The third powerful influence on our behavior is the community, the subculture in which we find ourselves as we emerge into the world.  This consists of our friends, our school, our church, our neighborhood, our diet, the climate,  and all of the experiences that we find outside of our family, which now, of course, includes all of the Internet and social media.

These three factors interact with each other to shape us all. To this mix of influences we have to add our health.  If we are strong and robust we can partake in much of what we wish.  If we have a major illness or deformity, our lives will be different, not worse necessarily, but different. If we are obviously different in some way it will cause many people to react to us differently. Most people will be kind and helpful, but others will be mean, many will just look away.  We, in turn, will react to their reactions to us. Everything interacts.

Combined, these influences shape what we  believe, and how we think, feel and act.  It has been this way since our ancestors first walked upright and formed groups.

To me, Carrie is the symbol of how these basic, long-standing forces are beginning to change. The pace of these changes will only increase.  Carrie was conceived in a petri dish.  An egg was taken from one of her mothers and fertilized with sperm from an anonymous man who was selected from a profile in a data base.  Her parents were not allowed to be married at the time, but they were living together. As soon as the law was changed they got married. Carrie has a little brother now, and they all live in a happy, caring family.  The community in which Carrie lives accepts her family without question. These are circumstances that her grandparents would not have believed possible.

The visit with Carrie happened in 2012, and already so much from that time seems out of date. This is mainly due to new technologies, and to the new scientific knowledge that these technologies have helped us acquire.  The aspects of Carrie’s life that seemed unusual then are commonplace and well accepted now. In just the past few years there  have been changes in all of the basic powerful forces.  There has been constant scientific advances in our understanding our own genetics., many new variations in the definition of a family; major shifts in demographics and composition of societies around the world, and significant advances in medicine.

All of these changes have affected the expectations of how Carrie will live her life. The skills she is learning, and how she learns them, are changing.   Her life will be vastly different than the life I lived, growing up in the middle of the twentieth century.  All of these things are not only changing how people behave, they are changing our DNA, our bodies and our minds.  Some of it is intentional; most of it is not.  The more we all are aware of what is happening to us, the better prepared we will be to make good use of the changes we feel are beneficial.  We also need to stay vigilant,so that we can avoid the ones we don’t wish to have thrust upon us.

Questions:

1. Do you know anyone who has two mothers or two fathers?

What do think of it?  How old are you?

Are there some kinds of family combinations that would make you uncomfortable?

Polygamy?  Three fathers with six children?

2, Take a look at yourself in a mirror.

Are you White?  Do you realize how that has affected your life?

Are you tall?  Well endowed? Have a symmetrical face?

3, How close are you to the members of your family?

Do you feel you have absorbed their values, or have you explicitly rejected them?

4.  What is your favorite piece of digital equipment?

How long have you had it?

When will you need to replace it?

Did you think you needed it before you learned there was one?

The End is Coming!! At least for me

It’s getting near the end for me as a hands-on clinician.  It’s been a long trip.  I feel almost very good about all I’ve done.  I find it interesting that I still feel very haunted by the people who baffled and frustrated me.  I also feel very gratified by the people who have done well and gone on to better lives.  This is especially true for almost all of the final group of people, I’m seeing, especially the ones I saw today.  The are all ending well.

I still hope to be productive.  I still feel there is so much to be done and that the methods most mental health people use, while very helpful, are also very limited and not really up to the task of meeting the needs of our society.

We are beginning to do better with many physical diseases and disabilities, but psychological and emotional problems are so much more complex.  They rarely, if ever, have just one cause.

We are also living during a very strange and stressful time of transition. Yes, the world has always been stressful, and  for the last hundred years there have been major, dramatic changes in the lives of people all over the world, ever since the beginning of the industrial revolution.  But now the pace of change is accelerating, and the rules of life are changing.  The skills people need to do well and prosper are very different than the ones that were required for me to make a living and raise a family.  Things were much more predictable then.

So many of my patents now live with so much stress because of work and finances.  Companies are being bought every day.  Companies that never make the news, but they are bought and most of the people are let go.  New companies start, but most of them don’t make it.  There is a great deal of loyalty to employees in the beginning, but it can disappear with one bad quarter, or if the company does so well that it gets bought, a few people get rich and the rest get unemployment.

I am thankful my kids seem to be stable and skillful, at least for now.  Even they have a different outlook on the world than I did.  They know that things can change, and they would have no control over it.

My grandchildren are beautiful, charming, creative, brilliant and having fun.  The oldest is 5 1/2.  What will ten years do to her?  Will the stress of school, competition, change, college, social networks, constant media in-put, and robots become overwhelming?  Or will our families, societies, governments and business learn to adjust in ways that make life interesting, meaningful  and fun?

I don’t know.  I think that is the uncertainty that is driving so much of this angry, confusing election cycle.

Will we be scared, mistrustful and selfish, just to save ourselves? Or will we finally overcome some of those interpersonal barriers and use all of our new technologies to make things better for all of us?  

I think we will know a little more in a few months, but the change and the chaos still have a few years before more is figured out.  

In many ways it is a relief for me to become more of an observer and commenter, than to have to try to help everyone navigate through all the uncertainties. 

Keep your eyes open.  Think about what’s coming.  Think about what you want to do.  Think about what you should do after that.  It takes an effort to make sure we take the time to reflect and not just react, especially when things seem to be different than they were ten minutes ago.

An Almost Civil Disagreement

Max and I disagree.

But we are civil enough to at least attempt to discuss our differences.  We both admit that neither of us should expect to sway the other one at all.  We also will try to present our ideas in terms that could possibly be consistent with the other person’s values.  But really, since we certainly don’t share values, we have a tough time understanding why the other person is such a moron, especially when the truth is so obvious.

However, to begin with, we actually both agree.  We agree that our great country, the land of the free and home of the brave; home of the creative, the entrepreneurial; beacon of hope to the world, with a government of the people, by the people and for the people, — is a mess, and headed in the wrong direction.  We also agree that part of the problem is how terribly divided the population is, and that this division has become more hostile and disrespectful. 

We disagree about America’s priorities, more specifically about what to do about taxes, health care, big government, wages, education, race relations, immigration, refugees, war, weapons, guns, banks, the Fed, welfare, climate control, energy policy, Donald Trump, Hillary Clinton, All of the Bushes, Israel, Muslims, Christians, Jews, China, the Middle East, the whole defense budget, cities, suburbs, sex, the electoral college, the right to vote, abortion, transgendered people, soda and salt, and many, many other ways in which people care, govern and relate to each other.

We have some overlap in our ideas about Russia, job training, Ben Carson and gay people.

If you want to know more specifically what his positions are, then watch Fox News and read the Wall Street Journal.  He has those positions down pat, almost word for word. My ideas, which I like to think are the result of hours of thought and refection, after reading many sources, are actually close to what you get from the New York Times and NPR.

Not surprisingly, Max was raised in a rich semi-rural suburb in Virginia.  I was born in Brooklyn, NYC.  Really, that’s all you need to know.

Here are some of my generalizations of where we disagree.  If you want to read what Max  thinks, then you can go find his web page. He believes that people should be self-reliant.

Max believes in good and evil.

I believe in cause and effect.

Max believes that the most basic American freedom is the opportunity to make as much money as you can, and that the government should stop messing around with that.

I believe that America’s greatness comes from how it guarantees freedom of speech and thought. The government is there to protect us all equally from being exploited, intimidated or harmed by anyone. I also believe that the government should do whatever it can to help all of us improve our lives, liberty and pursuit of happiness.

Max says he believes that all people are created equal and are free to do whatever they want with their lives.

I believe that the rich and powerful have always, always, exploited those who are poorer and weaker, and that they very rarely give up their advantages without a struggle, often with violence, but not always.

Although he hides behind euphemisms, Max believes that some people, mostly those like him, are intrinsically worth more than others, due to their native endowments.

I believe that we are all equal in our insignificance.

Max believes that men and women are equal, but also that they are basically different, and they should both keep to what they are best at doing.

I believe that is bullshit, sexist and exploitive.

I believe in science, and in using data to see what is going on and to help make the best decisions.

Max feels that science can be confusing and can be used to prove anything, and that good, common sense is enough to decide what should be done.

I believe that due to rapid advances in science and technology, shifts in population dynamics, and climate change, this country is going through a major transition, and once all of those things are recognized and accepted, and we learn how to integrate all of these new things into how we live and work together, our country will be much better and stronger.

Max agrees with all of that except that last three words.  He would substitute weaker and worse.

I think we both would like to find some common ground, but we don’t know where.

We have tried talking.  We have even tried listening.  But we both have very strong core beliefs that we can’t give up. It makes compromise difficult.

I said to Them (last time)

Intro:
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.

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!!

Turn, Turn, Turn

I went away for a while where everything was warm and relaxed. At the end of a good time I realized that it was one of the very few times that I didn't want to go back to work.  This year, 2013, has been different.  I knew things were changing but it really feels as if the roof is falling in. When I came home I tried to write it all down and after about six pages of telling myself what was going on I realized that there have been several changes piled on top of each other which reate more confusion, more work and less money.  So, I condensed it all into this:

Last November I took a trip to Italy and reflected upon how our profession was changing.  Change was coming, but I thought it would be manageable, and that I had a few years to continue to ease toward retirement.  

But 2013 hit, and with it the S**t hit the fan.  It all comes down to letters and numbers.  The first one is something I have been writing to my Senators about at thee to five month intervals, but the issue and the threat of drastic cuts never goes away.

The other four are either hitting us now or are on the horizon, coming rapidly to shore.  

SGR

EMR

90834

DSM V

PQRS

What all these letters and numbers seem to mean is that an individual independent psychologist, working in his/her own ideal office, who wishes to be able to see the entire range of people who seek services, and that means those people who need to use their insurance to cover the cost, will have a great deal of difficulty to find the time, and to meet the cost of adapting to those changes.

In some ways we created our own difficulties by marketing our services so well.  I remember, a long time ago, when I first opened my practice one of the biggest concerns we had was that people were reluctant to come and see us because of the stigma of needing help.  Now it seems, everyone comes for help, for almost everything that affects them: stress, relationship problems, work problems,bad judgement, bad behavior, excessive behavior, passive behavior........

Now the problem has become:  Who is going to pay for all of this?

It does seem as if, except in upper middle class, well educated neighborhoods, the model of sitting face to face  with one patient in your comfortable office and talking about the ripple effects of their parents' interactions is sooooo 20th Century.

I am not saying that what is coming will be better or worse, but it is coming. 

I just may not be a part of it. I'm not sure I can afford it.

And here is the musical accompaniment:

http://www.youtube.com/watch?v=L9EKqQWPjyo

Reflections While Away, 1

Note: Forgive the formatting:  I don't know why this happened. 

Two weeks ago I left the country. I realize that most of you had no idea, nor cared that I was away, but that's OK.

I won't take it personally.




While I was away I did some thinking about my profession and my life.  Now that I have returned I would like to share those thoughts with those of you who share my 

profession I am going to post this on several lists that I follow, so if you are also on      those lists don’t bother to read it all again.  If you would like to respond, that would be   fun. I would like some reactions. The great thing about sharing things way is that if you don't care, the delete button is milliseconds away.




Three weeks ago Div 42 of the American Psychological Association, Independent
Practice, held a conference to discuss ways in which a private practice can
develop and flourish.  I was unable
to attend the conference, but many who went seemed enthused. 




Two weeks ago, on Saturday, October 13, I gave a brief talk at a Massachusetts
Psychological Association Conference. I spoke about the possibility of using
technology to enhance psychotherapy. 
At that conference Suzanne Bennett Johnson, the President of APA, gave
the keynote address.  She made it
clear that the way most Psychologists will be using their skills in the next
ten years will be very different than how they operated even five years ago. 




I took
notice, people took notice; things are changing.  Some people want to adapt, some      people want to help build a
new system, some people want to circle the wagons and defend old positions,
some want to get completely out of the system, and many are just getting
anxious.

The next day, October 15, my wife and I took off from Logan Airport in Boston and
headed to Napoli, Italy and from there we drove to the Amalfi Coast It was a
trip to celebrate my wife’s birthday, paid for in part because we are getting
old. The good part about getting old in the USA, especially if you have been
self-employed, is that your medical expenses drop considerably. It may be  "socialism" but we had each been paying $750 a
month for health insurance, and now we pay about 1/4 of that. I have been
getting Medicare for over two and a half years; that’s a considerable saving.




The bad part of getting old is that a week before we left for the trip my wife’s cousin
died.  He was one of the few cousins I enjoyed being with, families being how they are, and he was only three years older than me. That made it seem all the more important   that we take the trip, see the sights, eat the food, drink the wine and enjoy and
appreciate each other, the world, and being alive, and basically healthy.

As the
plane was flying over the Atlantic Ocean, I sat in the semi-darkness with my
brain drifting around the way it does when there is not really enough oxygen,
I’m not really sleeping, but I’m not really very alert.  I thought about the conferences,  my own
professional past and future, and where I fit into all of this.

I realized that when, in the early 1960s, I decided to major in Psychology as an
undergraduate, and then go on to graduate school, I conceived that becoming a
Psychologist would be helping to build a new and better science.  At the time it seemed     that Psychology
was very intellectual, philosophical, and then scientific.  It seemed to involved questions such as "What is a Good Life?  How can we
help people live it, and How can we help people get along?” as much as the
dealings with the brain, the nerves, the neuro-chemicals and the genes.  Much of the    “science” at the time was
based on phenomenology and introspection. 

Graduate school was still full of Freud and the Post-Freudians, as well as the
Behaviorists. But beyond that, who we read, and argued about was Aristotle,
John Locke, David Hume, Emanuel Kant, Martin Buber, and J.P. Satre as well as
Albert Camus.  We studies “Theoriesof Personality,” many of which now seems like “made-up stuff.”  The Psychologists we talked about also included Kurt Lewin, Fritz Perls,Ram Dass and Jay Haley ( All Men! My wife always    points out). It was the '60s and '70s, so there was Humanism, and Gestalt, and T-Groups,and Radical Feminists.        Psychiatrists were still classifying homosexuality as a disease.

There was a war going on that everyone paid attention to, and there was sense that
the world needed to be changed –and that it could be changed – and that we were
going to be ones to do that. 
Everything had a bit of a political overtone. Money was not the major
focus. The government, NIMH, paid me to go to graduate school.  Community mental   health centers were opening up, and they needed well-trained Psychologists to run       them.

So, on this journey along the Amalfi Coast, in addition to the walks on the cliffs
over the oceans, the amazing food, the cheap but excellent wine, the stress
free time with my charming wife, I spent some time thinking about what has
happened in the thirty-eight years since I earned my Ph.D. and what I think
will, and/or should happen now.

I also, that while I was away, there has been a lot of meaningful, and
personal discussions on these lists about these topics, and I found those very
illuminating and fascinating. Clearly, many people are feeling the rumblings.




 Over the next few days I hope to create
several more posts.  I will try to
explain my thoughts about all this as I was walking, eating and drinking through
some of the most spectacular places on earth. 




Perhaps,
as Fritz Perls said:


“The only difference between the wise man and the fool is
that the wise man knows he is playing.”





Perhaps not.

Tx M