Concentric circles 2

We live our lives in concentric circles.

I was talking to John the other day in my office.  He was having anxiety attacks, mostly about money.  He and his wife have four children.  He knew exactly how much was in his bank account.  He knew exactly what he would have to pay in five days when March began.  He knew when his wife got her paycheck and how much overtime she had worked this month.

In addition John knew how well his kids were doing in school.  He and his wife, Kathy, were very familiar with their teachers.  He had even spoken to the principal once or twice.  His three daughters were doing well, his son was charming. He was active with all the kids with their sports.  He and his wife were friends with the parents of the other kids on the teams.  They were all from the neighborhood.

Kathy was very friendly with four of the women on their street.  They knew everyone's children and tried to share carpools and after school supervision.  They also went out, either with or without their husbands, once or twice a month.  It was a good neighborhood.

That really was a far as their time and energy carried them.  John was an engineer and worked with lasers.  He had a couple of friends from work.  His wife worked in the office of a construction company.  She got along with everyone, but didn't socialize with them except at company events.

They also had extended family they were close to.  All of their parents were alive, although  Kathy's were divorced.  She was the only one of three children who kept in touch with her father, and he was not easy to get along with.  John's brother had gotten hurt at work a few years ago.  He was now living with their parents, so John was now visiting more often, but his brother's slow recovery bothered him.

The four kids, the extended family, their jobs, the homework, the sports, the house, that's a little bit more than they could really manage emotionally.  When the money got scarce they would get snippy with each other.  They were able to work most of the out in my office.

If I had asked they probably could have named two or three of the nine city councilors.  They knew who their Congress person was. They knew they would never vote for Donald Trump, or probably any of the Republicans, but that was more from their general outlook on life  and less from any deep knowledge. John knew much more about the Red Sox than any politician.

They also had extended family they were close to.  All of their parents were alive, although  Kathy's were divorced.  She was the only one of three children who kept in touch with her father, and he was not easy to get along with.  John brother had gotten hurt at work a few years ago.  He was now living with their parents, so John was now visiting more often, but his brother's slow recovery bothered him.

Life is full of many things like that.  Most people have to take care of what is closest to them first and work their way out, in concentric circles, into the broader world.  There are some people, mostly men, whose inner circle consists of just themselves.  it allows them stop skip the next one or two circles and just focus on their work, or being a bigger force in the larger world.  These types either have a strong family support system, that fills in all the gaps close to home, a lot of money that pays people to take care of those things, or they skip the family and community part and just take care of themselves.

What is happening in the world today, which causes lots of anxiety and stress, is that  everyone, everywhere  is more interconnected.  That makes all the circles are much more porous.  What happens in China can suddenly have an effect on John's work.  The coal plant in Ohio blows  carbon into the atmosphere and rides all the way to New England.  The price of oil affects so many people in different ways.  Fanatics in the Middle East still affect the price of oil. Shrimp from Thailand  is cheaper that shrimp from Louisiana.

All this makes people more anxious because they know they don't have control of these things.  No one does.  No one really can.

So you go back and try to just focus on your family, and then your community, and you hope that doing good there will spread outward to the other circles.  But now, with all of these constant sources of information, it becomes almost impossible to keep your head in the sand.

It forces people to pay attention.  It should make them think, but many people are just too tired, or too scared to take the time to think it all through ....If I do A, then B happens, and if B, then I can do C or D, and what would be better for me? For my family? community? country? world?

We need to think it through.  We need to talk to other people; people who think differently and find out why.  Then decide.   It's a very difficult task, but it pays off.

A Holiday Hint, from me and Rosanne

        I would like to begin by wishing everyone a happy, and healthy holiday season, whatever your holiday may be,  I realize that for many the holidays are full of stress and expectations.  There are already many excellent pieces of advice and guidance posted all over the Internet.  They range from how to deal with your crazy uncle to how to deal with your turkey trauma, and how to come out to your family on the holiday. Read them carefully, and take from them what you can.

I have been a psychotherapist for over forty years. I believe I have seen or heard about almost every aspect of the human condition by now.  I still get surprised from time to time, but I don’t think there is anything that one human could do to another that would shock me.  My view of interpersonal behavior is that it is often distressing and depressing, but just as often it can be uplifting and inspiring. 

Over the years I have gained a great appreciation of how complex human behavior really is.  All of our thoughts, feelings and behaviors are shaped by so many factors, both within us and around us. And all of these influences are interacting with each other all of the time. Nothing stays static, there is never a break, life continues.  It is usually almost impossible for us to really understand why we are acting or reacting the way we are at any certain moment.

I often quote one of my favorite philosophers on that subject, many of you may remember her, the great, and unfortunately late, Rosanne Roseannadanna.  In almost all of her short philosophical statements she would say:

“It goes to show you, it’s always something.  If it isn’t one thing, it’s another.”

To that I would add that it is often more than one thing; it can be many, all at once.   You get demands, ideas, expectations and affection  from your parents, your spouse, and your kids.   This happens at the same time that good and bad things are going on with your job or at school.  The immediate state of your health can make things dramatically better or worse.  Other things, such as your friends, your house, the weather, and your finances also are playing a part.

This is especially true during the holiday season. This is a time full of a constant stream of emotions,both positive and negative, which are more intense than usual. There may be feelings of inclusion and feelings of exclusion.  You may experience feelings of great joy, but they can also be mixed with strong feelings of sadness and loss.

The only advice I would like to give is very general: take good care of yourself.  You can do this by being more aware of what is going on around you, and who is doing what to whom.  Try to anticipate what will come next and prepare a way to deal with it.  And, once you are feeling mostly okay, then take good care of those around you.  That’s really what all these holidays are about.

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.

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:
www.youtube.com/watch?v=xeNAgBFmJpM

August -- gone

There is just over an hour left in August of 2013.

Quite a month.  It is so precious here in new England, and it goes by like a breath of salt air off the ocean.  Gone.

What happened this month, beside the world almost having everyone go to war again because a few crazy people can't share power?

I didn't work almost all of August.  More than ever I really enjoyed not going to the office.  The patients are all important and worth the effort, but the system has become even more complex and burdensome, and the big insurance companies continue to find ways to pay us less, and then blame it on Obama.

I did spend a lot of time with some crazy people, but they were not my patients, so I could just let them be interesting and let them prattle on about their views of the world, themselves and whatever it was they found so meaningful. Noy my problem.

Today was my daughter's birthday and, as it happens, my daughter-in-law's birthday, which makes things a bit hectic.  But now, to add to the confusion, my newest grandchild, and first grandson, was born yesterday.  He is a big, healthy boy, with two tired, proud parents and an almost two year-old sister who is still trying to figure out why her life is suddenly so different.

So the world reamins it's complex, unfiar, unaring, often cruel place, but my immediate, tightly knit, cloesely guarded spot in it remains remarkably, happy, prosperous, and almost all very healthy.

But now August is gone.  It is  that sweet, melancholy time when the light becomes sharper and golden, when things start up again and become more serious.  We put away the hammock and the kayak, and wonder where the time went.  We didn't get to take that five mile walk to the end of land to the lighthouse for the fifth year of planning to do so. I did paddle across Pleasant Bay.  I did take the girls to the beach and run in and out of the water, and in and out of the water, and in and out of the water.

Hopefully we will do it all again next year, with the boy sitting in the sand, and we try to stop him from eating it.

Positano

By the time we reached Positano it was almost three PM.  The clouds were closing in rapidly.  There is really only one winding road in Positano; first it goes all the way down one long cliff, then it hits bottom and goes up the other side of a very steep canyon.  Fortunately our hotel, The Villa Franca, was only three 178-degree turns from the top. 

 

The hotel is beautiful and positioned spectacularly.  It sits on the top of a cliff, looking almost 700 feet straight down into the sea.  Every room has a balcony that reaches out over something: the town, the sea, or the beach.  The staff is friendly and helpful, the food at breakfast and at the restaurant, was as good or better than anything in Boston.  Bring money.

 

 

The next day we walked down to the beach and back up again.  Someone told that the winding staircase we had climbed up on consisted of 877 steps.   Since it was now “off-season” the only people in the hotel were American sightseers, German hikers, and a couple of gorgeous models from Albania, with photographers following them around.

view from hotel, looking down at beach

view from boat, looking up at hotel -- white buidling on top of hill on left.

 

 

That afternoon, as my wife treated herself to a massage by the lovely Antonio, I sat on the deck on the top of the hotel with a drink in my hand and realized that I was feeling both marvelous and totally disoriented.  We were here; we were at the place we had set out to go.  I was literally on top of the mountain overlooking the world.

 

I appreciate that I have been incredibly fortunate.  I have had a great career, doing something both fascinating, and something I felt was intrinsically valuable, and it also, for many years, paid the bills.  I have had one, very good, long marriage.  We have two children, who both seem to be in good marriages themselves.  All four of them have very good jobs, doing interesting things. Each couple now has a charming, creative, beautiful, curious, affectionate daughter.  Both these young girls are enamored with their Pop-Pops.

 

I feel, like 70% of the therapists out there, that I am one of the top 5% in my profession.  But I also realize that the most brilliant thing I did with my life was that I was born two years before the big baby boom.  That gave me a step-up in almost everything I wanted to do.  I could get into a good, small liberal arts college, and then into graduate school, partly due to the lower number of applicants.  Three years after I bought a house millions of other people became ready to buy a house. I was part of the first wave of Psychologists to get licensed.  I left community mental health reluctantly, but when I began a private practice the competition was minimal, although the sigma of people going for treatment was still a factor.  I have been in practice in the same city, a mostly working-class mill city, with more prosperous suburbs, for thirty-one years.   I have been totally booked for the last twenty years.

 

But, sitting there, on top of the world, it was also easy to see how much I was a product of my times, and that times have changed.  The little talk I gave at the MPA conference was about how to use technology to enhance psychotherapy, but the real message was that people of this generation are different than the people of my generation.  Their values are different, the outlook and expectations are different, and their minds are different, due to how technology has given them access to information, and to each other.  And that makes the way they manage their relationships different.

 

All of this has made me see how much all theories, concepts and techniques of dealing with human behaviors are a reflection of the times in which they are espoused.  Sometimes it feels as if our profession has more in common with a newspaper than a web -site.  Just look at how kids are raised today, compared to thirty years ago; how many more people are in their lives.  How much they are exposed to. I’m already getting text messages from my granddaughter.  Look at how many subcultures are in the U.S. today, and how strong the effect of living in a Puerto Rican community vs. a Cambodian community vs., growing up in Chinese American family in a well to do suburb of Boston or San Jose. Compare that to the mind-set of a White Morman family in Utah, surrounded by nothing but White Morman families.

Is the best way to deal with the problems they face by meeting once a week for 50 minutes?

 

Yet, I also believe that there is nothing more comforting, and nothing more powerful to foster change, than a structured, face-to-face, well managed therapeutic relationship.  

 

For a while I thought about this while I was there, on top of the world, watching a ferry come in from Capri seven hundred feet below me.  I felt personally very fortunate, but still, as always, worried about the world.  It is not surprising that the world continues to change, now at a much faster pace than it did 1200 years ago when the church down at the beach in Positanto was built.  What is also becoming more apparent is that my life is in transition, as is my profession.

 

But there; at a place we had long wanted to come and see, I decided to try and relax and be in the moment.

 

ending treatment

I have been seeing Pauline for over three years. For almost two years she came every week, than it was every other week. Today we decided that we would meet once a month for the next three months, and that would be it.

She was a fascinating patient. She thought about things we said. She was a nurse, so she knew a lot about her own health and what to look for, and she wanted her life to get better.

Her problems were a combination of all the factors that affect how someone lives. She was a wound-up child who was crawling out of her crib at one-year old. Even then she hardly slept, and by the time she was three she was defiant.

Her father was over-bearing and tried to get her to behave by being loud and threatening. Her mother cried a lot. She married young and divorced early and was left raising two kids on her own. Along the way she developed an eating disorder and a drinking problem. By the time she reached me she had just bounced off the bottom of being frantic, drunk and suicidal. She had terrible panic attacks and had been isolated from the world. She had tried about eleven different medications, and an intensive group program. She is now on two medications that she agrees that she needs. They don't do wonders but without them she is awful.

During her time with me she got better, then got worse, and then slowly pulled herself together. And now we have reached a point when it seems to be enough for a while.

Her drinking has stopped. She is back working part-time. She had a terrible relationship with an older man, and now she is still sees him a lot, but they have learned how to deal with each other. Her being sober helps a lot and she is grateful that he stuck by her. He can still be selfish and irrational, but she has learned how to deal with him.

Her eating disorder lingers on. She won't go to a more intensive treatment program for it. She hardly even wants to talk about it. She finds ways to push it away sometimes, but it haunts her. I worry about how much it limits her, and so does she.

But over the last couple of months the tone of the sessions have changed and it is clear that we have reached a stable plateau, even if it isn't perfect. She is working, she has a relationship, she is out of debt, she is sober, and even enjoys herself once in a while.

She is a good example of how so many factors interact to make a life: genetics, family, environment, stress, health, other physiological factors, brain chemistry, as well as luck and random events.

We only have limited control of so many of these factors. We have to make the most of the leverage we have.