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.

Good Bye "Rita"

I went to work again today.  I am doing clinical work on an almost weekly basis.  I am trying to help a limited number of patients get where they want to be, and still carrying a few others who will never get there.  Today I said good bye to one of those who fit into the later category.

"Rita", ( all the details have been changed) I will call her, is even older than I am, and she is in much worse shape physically. I first saw her over thirty years ago for a brief period of time.  I saw her five years after that, and ten years after that, and finally, three years ago she really came to see me on a regular basis.  Last year I saw her only four times as she was physically unable to get to my office.  She was brought to this last appointment by her son, and she hobbled in on a cane.

Rita first came to see me on the insistence of her doctor who told her he would commit her if she didn't keep her appointment.  In those days it was much easier to send someone, especially a woman, into the hospital, and they would often stay there for months.  She was one of those women who was well known around the community.  Some thought she was volatile, others just called her nuts.

She always dressed very provocatively, which made it difficult for people to realize how smart she really was. She ran her own insurance agency and she knew her business well, and ran it honestly.  But she was ultra-sensitive to personal slights, and was overly suspicious of people's motives.

Over the years she came to trust me, mostly because I helped her stay out of the hospital.  She finally let me know about many of the thoughts she had about who was plotting against her, and how people took advantage of her.  I came to understand that the lines between what was real and what was distortions were very slight.  She wanted attention; she wanted affection, many people took advantage of that.  Because to that her fears and suspicions became exaggerated over the years. The more distrustful she became the nastier she was to people, which, of course made them pull away from her and avoid her.  She knew they were talking about her, and they were.

Now she lives in the back room of her son's house.  She hides from her son's wife.  Her only consistent contact comes when she talks to her former husband on the phone.  She pushed him away years ago.  He didn't want to leave, but now he is down south and won't come back.

The last few times she came in, including this final one, she retold some of the earlier stories of what had happened to her, how people mistreated her, and how she had responded.  It is fascinating to see how those stories have changed over the years.  In this last retelling she now recalls events as having much less conflict than in her earlier accounts.  She also has a much more positive memory of how she acted in many situations.   She now remembers herself as avoiding trouble when before she had been the victor in epic battles.

This may be because she no longer feels the power of the anger she used to have, or she just as mellowed and wants everyone to remember her as quiet and sweet.

We had a comforting last session.  We reviewed a lot of what we had been through together, but now we can leave it all in a more comfortable context.

Her children, who battled with her for years, and whose lives she certainly made very difficult, will all be with her for the holidays.  For her that it is Shakespearean: All's Well That Ends Well.

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.