What Next for Sammy?

The last post, the one about Sammy, is about a kid who had an unstable beginning, had a mother who spent years pleading for help, and she is still searching today. His problems are complex and multi-determined, so no one treatment will work for him. Drugs only made things worse, as he really got to like Xanax and Klonipin, so he stole them from his mother, and anyone else who had them.  Psychotherapy was difficult.  Perhaps if I was able to see him three times a week, but his mother couldn’t get him to me that often and insurance wouldn’t pay for that.

A treatment plan that may have worked would have been if he could have been placed in a therapeutic day school, beginning in around third grade when his difficulties became obvious.  He didn’t need to be sent away, and that would have probably made things worse.  But if he could have lived with his mother and brother, and gone to a school with small classes and counseling, where, over time, people would have gotten to know him.  it would have given him a much better chance.

There are three or four schools like that around here. By around here I mean an hour to two hours away.  They would have been expensive for the town, and those special schools filled up early. The town and an advocate would have had to push hard and often to get him in.  But since the school regarded Sammy’s mother as a pain in the ass, and thought that her family was just trash, they were not going to give Sammy what he needed.

The mental health system didn’t offer much.  He didn’t need to be hospitalized, so it was up to me, out there by myself, to do what I could. I was able to get him into a couple of special classes, mostly for academic help, but as I said he was a tough kid to bond with, so the teachers gave up quickly.

Now that he is in his early twenties his problems are considered criminal.  He was caught with a Class A substance.  That means he was arrested.  The criminal justice system may be the only place that he will get treatment.  With so many over-dosing happening now in New England the courts are trying to find more treatment options for people with addictions. But someone will have to determine if he is “motivated.”  Really, it should be part of the job of the treatment program to find a way to get him motivated, and to care about himself.  But that is a much more complex task.

As  it is now Sammy is just another casualty of the “War on Drugs.” The “War on Drugs” now ranks with other recent wars in American history, such as Viet Nan and the invasion of Iraq, as worse than a total failure. 

I’ll discuss that next time.

Another Year is Here!

The end of one year and the beginning of a new one seems to bring out a moment of reflection and evaluation in a lot of folks.  I am grateful for that as several of my patients from years back have taken the time to send me a message.  They usually just say that they remember me, and that I was helpful.  Some say more than that, giving me credit for things I don’t remember saying, or for transformations that happened during the time that they were in therapy.  I certainly enjoy reading those messages.  

That’s the good part of the year’s end transition.  The more upsetting part is that when one patient contacts me to say good things, it reminds me of some of the other people I was seeing at the same time.  Memories get linked the way.  I don’t like how much my memories of the people I didn’t help that much overshadow the good feelings I get from those who did well.

Yesterday, I went through that whole cycle while sitting here at my desk as the early sunset came pouring through the window, making reading on my computer screen difficult. A message from one person led to to search for the name of another.  I quickly found what I expected. He was arrested last year for the possession of a Class A substance.

“Sammy” was a young man I saw about five years ago.  He was sixteen the last time we met. He was brought to see me by his mother, who I had been seeing at the time.  He was very ambivalent about coming.  He wasn’t the ideal psychotherapy candidate. He was untrusting.  He couldn’t make eye-contact. He was almost non-verbal.  If he spoke at all it was in one word sentences.  Two words made a paragraph.

All of this he came by honestly.  His father had drifted away when the boy was about four. The father had a drug problems of his own, and probably many other problems in addition.  His mother was very hard-working, very depressed and she herself had come from a family that was so messed-up it would take about sixteen pages to just give an overview.  So, when she would get involved with some men who wanted to save her it was never good for her children.  A couple of the men were especially harsh on Sammy, who was sullen, disrespectful, and not very cooperative.

I could go on and on, and I should actually, but no one reads two-hundred page blog posts. But the message is that “mental health issues” are very complex.  They don’t lend themselves to clear, consistent solutions.  Sammy was the kind of kid who, if I really wanted to help him I should have taken him home.  I could have said to my wife, “Hey, this is Sammy.  We are going to wash him, feed him, and keep him with us for five to ten years.  We will sand end him to school here, where there is a good school system, and we will go to school once or twice a month to make sure we are on working together.  We will try to limit his time playing video games and then try to help him make one or two friends.  We will try and protect him from being bullied, and show him that he is talented and capable.  We will try to make sure he smokes only a limited amount of pot.

It probably would have also helped if his mother came to live with us on weekends so he would know that she didn’t abandon him. If he went to be with her on weekends those two days would have probably undone whatever was gained during the five days he stayed with us.

But I din’t take him home. I have this rule about not taking any patients home. Even if I did I don’t know how successful an intervention it would have been. I’m not his uncle.  His uncle is in jail.

I did go to several meetings at his school.  I tried to get one of the school counselors to see him because his mother was having so much difficulty to get away from work in order to get him to my office. The school essentially told me that they didn’t like him because he was sullen, withdrawn and difficult.  Essentially, they blamed him for having all of his problems. and even encouraged him to drop out and go away.

These memories bother me.  When I read about people who are homeless, or people being shot by police for brandishing a stick or having a lump in their pocket, I think about Sammy.  When I know that there are thousands of young men getting thrown into jail, or dying in messy apartments of drug over doses, I think about all of the Sammys I’ve seen.

The underlying causes are probably genetic, partially.  Certainly abuse, poverty, and lack of supervision and encouragement don’t help.  The lack of resources, support, and concern by the community adds to the problem.  Then his difficulties get defined as a crime which makes everything worse. 

So now I don’t know.  I don’t know if he is in jail or just on probation.  I don’t know if he will be scared enough, or get enough support to stay our of further trouble. Can he get a job and make enough money to support himself?  Is he capable of having any kind of real relationship with anyone?  

I know that he really never did anything wrong, or actually hurt anyone. He’s not a criminal unless being poor, depressed, confused, bullied and pushed aside is a crime. I know that his mother still cares.  She is still out there trying to get him into a rehab, but the beds are full and the treatment is short.

The rest of the world doesn’t really care about him and all of the Sammys.  They are difficult and embarrassing.  Eventually they just get swept up and put in the trash. The real problem is that treatment is too complex, and more importantly, too expensive.

I know I tried.  But it wasn’t enough.

Presentation -- 1

I've been busy. It has been much more difficult than I ever thought with this unstructured schedule  for me to know where I am and what I'm supposed to do next.  Time fills up quickly, and often far in advance because many people think that I'n not doing much, and therefore they think I could be available to do stuff for them.

Also, many more of my friends aren't doing much any more so they are now available for us to get together and try to figure out a way to be relevant.

Yes, I still work three days a month.  In fact I am going to work tomorrow and I have a very full day. I will be seeing people who feel that their time with me is valuable and well-spent. For most of them, I can see that their lives are improving. Perhaps I am part of that process.

But also, during this time, I am putting together a presentation to give at the fall convention of our Psychological Association.   I am not a very widely published psychologist.  Most of my work has been seeing patients, but every four or five years I get the urge, and a strong urge it is, to tell my profession that most of them are headed in the wrong direction, and this presentation will be more of the same.

But, I've been right before and I'm right this time.

I have spoken in the past, beginning in 1993, about how the world is changing and we are not keeping up.  The insights and methodologies of the vast majority of mental health professionals is both inefficient and often ineffective.  Psychotherapy can work very well for many people, but the process can, and often does, take years, or even forever. There is not enough time or people available to even take a chip out of the huge block of psychological and emotional difficulties that are created by the kind of world we live in now.

Technological and medical research has done a fantastic job of finding ways to treat, and sometimes cure, many of the worst medical conditions that confront humans, but emotional difficulties are so complex that few people know how to do more than target one or two specific symptoms.  But everyone has about eight to two hundred different difficulties facing them these days.  That's why progress is so difficult.

So, I'm working on the paper.  I hope to have time to explain some of it here.  I'm older now, so I have all the answers.  Stay tuned.

Let's Get Happy

I’ve been reading the Sunday papers, and mostly that upsets me, especially when I see that so much really is about issues relating to mental health.  I was going to write, again, about how these issues are handled badly, inefficiently, or mishandled, if they are handled at all.  For many mental health issues the police are the first responders., Some police are very skilled and sensitive, while there are others, who we see of the news, who beat people, humiliate them, or shoot them.

I also question both the motives and the sanity of many of the people who have managed to push themselves into a position of power, either economically or politically. These days, with money being such a factor in how our country is run, it seems as if business owners, the heads of big corporations and just your regular very, very rich people, have all become intertwined.  They then anoint themselves as the “ruling elite,” and set out to inflict their values and views upon the rest of us. Meanwhile most of “the rest of us” is too busy scratching out a living and struggling to find a few moments of peace and relaxation to pay too much attention to how many of the decisions made by those “ruling elites” is making it much more difficult for “the rest of us” to scratch out a living and find a few moments of peace and relaxation.

Then I read a article about the secrets of success and going viral on the Internet.  It turns out that complaining about how things are bad is not one of them.  Everyone knows things are bad; everyone is complaining. What most people are looking for is a brief respite from all of the complaints that I listed above. It's enough already.

But, if I can come up with an enticing heading, with the emotional promise of a short-cut to happiness, and include a cute, heartwarming picture, that will make them happy, everyone will flock to my site.

How misguided I've been to complain, to talk about the deficiencies of mental heath treatment, or how difficult it may be to make big changes in your life, even if it may be helpful to know that.

So, let's skip that and have a good time.

Here's some good advice to make you happy:

Sing, dance and fall in love!
www.youtube.com/watch?v=D1ZYhVpdXbQ