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.

LCDs — Not the lights

Today if you mention LCDs most people think of the bright lights that run on very little energy.  As good  an invention as they are, that’s not what I’m talking about.  What I want to talk about in this post is how it’s human, and even primate nature, to quickly sink to the Lowest Common Denominator — and I’m talking about thoughts and behaviors here, not math.

It has been well documented by many studies that even monkeys, apes and bonobos will get upset when they feel they are begin treated unfairly   When a monkey does a trick and gets some raisins, he may be happy. But then if the monkey next to him does the same trick and he gets a much more desirable banana, it’s been shown that the first monkey is not going to do that trick again unless he gets a banana, even though he’s depriving himself of a few raisins.

That’s what is going on today, all over the world, and I’m not just talking about income and wealth disparity, although that certainly plays a big part.  

I read a few things in the paper the last few days that were upsetting to me.  One is that junior high and high school students are asked what they felt was more important:  personal achievement, their own happiness, or helping others.  22% said helping others. That’s not good.

How many times in this space have I asked the question: “What’s So Funny about Peace, Love and Understanding??”

https://vimeo.com/43308455

Here is the answer, and I certainly don’t blame the kids who gave their answers.  They have learned, based upon the world they live in, and I think this is true for kids from Palo Alto to Mumbai, that there are too many people who are just looking out for themselves, and if you offer to help, they will take advantage of you, and treat you like a fool for letting it happen.  If you put an orange on the table and say lets share some fruit, the first person who comes along is likely to run off with the orange and not leave anything behind.  After this happens a couple of time, no one leaves an orange, or even a grape.

What makes it even worse is that this kind of behavior is totally unnecessary.  Perhaps for the first time in this earth’s history we actually have enough food, air, water, housing and video games for everyone to have a reasonable amount.  But the idea of helping others to attain a reasonable quality of life is almost unthinkable because too many people are grabbing everything they can for themselves.

Once this behavior gets started, even if it is just by the small minority that I call the Lowest Common Denominator, then it doesn’t take too long before everyone learns to be defensive.  Everyone is taking and no one is giving.  

You can see it in traffic patterns.  Drive along nicely and cooperatively.  Then a person cuts you off, and then another, and even though it might delay your drip by 1/3 of s second, it just doesn’t feel fair.  So the next time someone tries to cut in right before the off ramp, you don’t let them.  They should wait their turn and  get in line with the rest of us, especially if they’re driving that $55,000 SUV.

Drive carefully my friends.  And maybe next time blow them a kiss instead of flipping the bird. At least they may be confused for a second, and the denominator may get raised a couple of points.

So much stress, so unnecessary.

Why all this?

My girls are stressed. They are worried about wild animals and poison ivy.  But they are four and five years old and they have just been able to realize that the world is full of danger, especially if they're away from Mommy or Daddy. It's a normal reaction.  They have found out that the world is full of difficulties, but that's never going to change.  The difficulties these two little girls face are ripples in the water compared to the waves that most of the children of the world have to deal with, but everything can look ominous when you're four.

What saddens me more is how much fear and stress so many adults seem to be carrying around, and I'm not talking about the folks who are risking their lives to find safety, fleeing from countries where governments and rebels kill everyone in their path.  I'm referring to people who are trying to earn a living, support a family, pay for college, plan for retirement, take care of a sick or old person -- all the things that happen in a life.

I've been reading the book Sapiens by Yuval Noah Harari. In the early part of the book he makes the point that the move from the life of the hunter/gatherer to the agricultural way of life was a big step for civilization, but not a good move for most of the people the vast majority were peasants and had to work the land as long as the sun was up.  A few nobles and royalty lived the life of leisure. Now, I can't say that I agree with this, as I have not interviewed too many hunter/ gatherers. The lives of some of the  adolescent street kids I see actually seem to depend upon many of the same skills that helped the survival of our very early ancestors, and the lives of these kids is certainly quite stressful, so I'm not sure I agree with him.

But the point is this, technological advances, whether it is the ability to harvest wheat, develop GMO crops, find directions with a GPS, or ask Siri how to make onion soup, are all ways that make life easier, but also have the unintended consequence of making life go faster, and thus making people more stressed.

One hundred years ago, when T.R. was president, he would work from 9 Am to noon.  He would send out letters and and wait two weeks to get an answer.  Now everything is instantaneous. The result is that people have to work all the time. If you open an email people expect an answer, immediately.  Now people won't read their emails.

Even fifty years ago most people worked 9 to 5, went home, had a cocktail, watched TV and went to bed.  Now people can work at home, but they also feel the pressure to be working 24 hours a day.

AND, since everything is running constantly, businesses have learned to charge on a subscription basis.  There are fewer things you own; that can be paid for once and that's it.  Every month we pay for cable TV, protective software, phones, cloud storage, data, software,.  Medical companies have caught on.  Drug companies have developed medicines we need to take a pill a week or every day for the rest of our lives.  Nothing is cured; we pay on subscription.  Oxygen tanks are rented, breathing machines are leased.

That means we have to keep on working to make the monthtly payments.  Even a mortgage had a 30 year limit. Iinternet, wireless and medicines go on for ever.

It's supposed to make us healthier, but it creates stress.

So don't worry, the coyotes who roam suburbia won't eat you, but the corporations, who are just there to make a living -- except for places like Volkswagen who knew they were cheating us-- will help keep the stress level high.  And stress corrupts our immune system, which makes us more vulnerable to depression, cancer, diabetes, and just plain irritable pissed-offedness, which stresses relationships.

I don't know if there is a way out, except all of my patients who are over seventy seem to have found the TV station that plays only shows that ran before 1972.  Gun Smoke, Mayberry, and Leave It to Beaver seem very reassuring as the antidote to stress.  Fox News brings on heart attacks.

back at it

After nearly three months I returned to my cozy corner office and sat mostly in the same chair and saw people I had not seen all summer, and one whom I had not seen for ten years.

I spent the whole day there, just one day, but it was certainly enough immerse me over my head in the reality of what goes on this side of the bridge.

I had spent the summer near the beach, watching and swimming as the tides rolled in and out.  Back in my office, by eleven o'clock, after just three hours, I had a much more intense feeling of what it is like to fight against the tide.

None of the people I saw were crazy.  None of them even had bad judgment, even though it could be said they made mistakes, most of their bad behaviors were the consequence of having only bad options available.

By eleven o'clock I had heard what had happened over the interim to realize that not everyone's summer was as blissful as mine.  People suffered with losses of love, money and health. There were  financial losses which were made worse by vindictive family conflicts over the scraps that were left.  These losses were due to illnesses, business decisions made in distant countries, and deceit.

In addition, people talked about the death and dying of close friends and family members. Now there is often a new layer of troubles, which has become more common over the past five years. It is the return of adult children to their parents' home. Often these children, ranging in age from twenty-five to forty, return after a divorce, and bring a child or two with them.  In some cases it is only the grandchild who is now part of the home, as that child's father or mother is lost somewhere out there, due to some addiction, or just total defeat.

Unemployment is down, but the jobs many people have now pay less, have no permanence, and can be very stressful.

Yet, almost all of the people I met with were resilient. With a little support they seem to find a way to carry-on. In the darkness there is a lot o dark humor.  Speaking of her sixteen year-old daughter one woman said:"She broke my heart and went to live with her father.  I was pleased to see how she ripped his heart out and stomped on it, but now she has come back to me."

 My role is to help them sort through options and anticipate consequences, even when the options are few.  My hope is to give them hope that there is some reward for just continuing the process.  That's what we all do anyway.

What adds to the sadness is how little trust there is now in so many of the institutions that we used to rely on to stabilize our world. To a large extent our government is a mess, our religions are being used as often to create conflict as they are to offer comfort, so many businesses seem to be slightly sleazy if not outright corrupt, and the way forward seems very uncertain.

But individually, each person is genuine, sincere, kind and caring, to the best of their abilities, under the circumstances. They attempt to ride over each wave looking for moments of peace and happiness.

The contradictions are everywhere.  The tide comes in, the tide goes out.

Sanity?wh

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

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

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

Think about it.

It can't happen can it?

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

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

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

We haven quite found them yet.

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

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.

Why I am not always the best Therapist

In some ways I'm not the best therapist for today's conditions.  That's not why I am slowing down, I have another seventeen reasons for that, but it seems to be true.

Sure, sure I can see a lot of progress in the people I see in therapy.  About 45% do well and I push them out after a year or so and their lives are easier, happier and they function better.  Another 35% do REALLY well, and they come up from the depths of torture and despair and put something together like a relationship or just happiness and that makes me feel better.  Another 20% don't.

But, as I said in my last post  (you can click back and read it, if you haven't already), the world, especially work, is much more fast-paced and stressful than it was when I opened this practice of psychotherapy.  For many of my patients I find that part of what we do is strategize how to deal with that stress -- not just breathe deeply, but how to prioritize, how to deal with a bad boss, how to deal with the huge, constant demands that a corporation. large or small, places on an employee.

Years ago, in the 90s, when managed care was clearly going to continue to be an intrusive pain in the ass, even before they began reducing fees, I decided to expand my revenue base and do some direct consulting to some local businesses. One was to a company that made stuff, and another was to a local financial services company.  My job was to help higher, but not top, management make their employees more productive.

Well, the company that made stuff, made some real crappy stuff and treated their employees terribly.  The financial services company had a business model that was either just this side or just over the line of being sleazy.

In my head, although I didn't actually say it, my best advice would have been to get the hell out of that business.  I didn't do much consulting after that.

I often still feel that way when I deal with my stressed-out patients now.

But I also realize that they don't have too many choices, and having and holding a job is very important these days.

But since I left working at a community mental health center in 1981, I have not had a boss. I set my own hours.  No one really tells me how to work, although I do consult and collaborate. Insurance companies set most of the payments I get, but at least I don't have to deal with the worst of them.  Many of my colleagues don't take insurance payments at all.  I didn't want to go that way, but it was my choice.

Whenever I see an opportunity I try to encourage people, especially younger ones, to try to do their own thing, build their own business, do something they want to get up and go and do.

But that isn't easily done, especially if you are part of a family that needs to be supported and given some stability.

But it's tough to see so many people feeling so much stress, and having so little control of it.
A lot of them are much better at it than I ever was or will be.

The $ factor.

I thought I had posted it here, but I only sent it out as a tweet:
"40% of my patients problems could be greatly improved, if not completely cured, by $35,000."

(I tweet @therapistmumble, but it's hardly worth following because I tweet about once a month).

On the front page of today's NYT "Review: section is an article by Moises Velasquez Manoff (that's a name for the new world) which gives a lot of research support to the concept that the poor suffer in many ways -- health, longevity, depression, etc, much more than people who are financially comfortable.

http://opinionator.blogs.nytimes.com/2013/07/27/status-and-stress/?_r=0

Now, to most of you this probably comes as a "Duh!"

But, unfortunately, too many people in this gold ol' U.S. of A. seem not only aware of that fact, but happy about it. We are getting back to where we were in 1964, of blaming the victim, and using the poor to make the rich feel better.

This is not a prescription for the long-term success of any society.

More Tech Fallout

One thing that I see very often in my office, that our nation and our government is struggling to deal with, is how the fantastic new advances in technology is changing everyone's lives and minds.  We act differently, we think differently, we relate different, and certainly every business in America works differently because of the digital changes that have happened just in the last five years.  I date the latest major transformation to 2007, when the iPhone first went on sale.

For many people the new technology has made jobs easier, or even just made them possible.  People can, and do work from everywhere.  But so many people are being put out of work, and so many are just not necessary.

The latest to come into my office is an angry 37 year old man who has been wit the company for 11 years.  Which company; the phone company. He knows, but he won't really admit, that they just don't need him any more.  He is an installer and repairman for land lines.  The landline business is fading as quickly as the video store rental business.  The phone company could probably get by with about 1/3 of the workers they have.  It is only the union that keeps hanging on.

But, the phone company, being a big corporation, is using technology to get rid of the people.  They have GPS systems tracking their every move, they send the workers out with hand-held devices that report back as each task is done, each job is started, each is completed, and how quickly the worker moves from one to the next.  Then they raise the expectations of what is expected in a day.  Then they raise them again.  Then they get on the worker for not meeting expectations.

Stress, conflict and misery.

My patient knows his time is limited and he should learn new skills and find his way in the new world. Instead his fear and uncertainty is turned into anger at the company.  The company would probably do better to take him and many of his colleagues and retrain them.  Teach them to deal with wireless technology.  Teach them how to operate the cloud. At least give them the opportunity.

But that would involve using skills that most big corporations don't have. So, things will end badly, and more people end up in my office.

And so do their families.