Floating down the wrong tributary

Took off from work again.  My wife tells me to do it; to practice for when I get old, although she tells me that I am old.  But I'm not.
So we took off and drove out of New England and headed South.  We are here, on the water, tomorrow I will cross the Bridge-Tunnel as I have long wanted to do.

But yesterday, waking up hungry, we decided to eat a regional breakfast, but since we couldn't find that we stumbled into Denny's, a place I had only been in once before.  The service was fine, the breakfast was everything they said it would be. Except the company was different.

Two men sat behind us, and after a while my wife and I stopped talking and began to listen to a conversation that is not what we hear in our social circle, although it may be more common in yours.
One man seemed to be about sixty and the other seemed close to seventy.  They were dressed neatly in clothes that could have come from Wal-Mart. They talked openly and with feeling.  They were talking about a man they knew who was in a bit of trouble.  The man's business was not doing well and the land he had for sale was not selling.  That left him unable to support his wife, and her son, who was in a wheelchair.  But the man also was spending a great deal of time with another woman, and this was not good.  The two men having the discussion were upset because they felt that the man about whom they were talking was headed for hell, and if the moment of the rapture occurred, he would be left behind, and therefore doomed. They were not sure how to deal with him and his situation.  One of the men wanted to approach him and warn him, but he felt sure it would ruin their friendship.

Now, I realize that this conversation was a bit extreme, but it again brought up to me how much I do not buy into many of the most important mind-sets that define most Americans. My thinking is partly a result of what I do, and what I do is the result of who I am.  Despite my efforts to get along, I am still out of step, off the main-stream, floating down my own tributary towards my own distant, probably unattainable sea. This is unsettling to me in two ways.  First, how far out of the mainstream I am, and second, how loose, sloppy and lazy the thinking of the mainstream is.

So here is the part where I drive many of you away.  Where I ruin any chance I have of getting anything published, because as an agent I once had said to me: you write very well, but you are much too complex, and you don't reward your readers with happy endings.  People would much rather read about clear paths to happy endings.  That sells.  Your shit about the world being very complex and most things ending with limited compromises with reality does NOT sell.

True.

Why? you might ask, then do I persist.

The short answer lies most clearly in the things that I do not accept.  Yes, I understand the utility, the need, and the natural affiliation for certain things.  Yet, I cannot participate. I just can't.  I never have been able to.  I gave up trying in seventh grade. ( Perhaps I am still just an obstinant adolescent.)

The best examples that quickly come to mind are these: patriotism, religion and video games. These are becoming almost universal activities, and yet I have great difficulty joining in. Again, I understand them.  I see clearly why people join in. I see the joy, the fellowship and the comfort that is gained with participation.

But I can't do it.

To me patriotism and religion are just a bill of goods that are sold early and often by the powers that be to get the masses to go along with the program.  The program that is being sold is one that benefits the powers, almost always much more than it benefits the masses.  Yet patriotism and religion are sold in a way that if you don't buy into the concept, there is no place for you in the group. That is a powerful selling device, scorn and exclusion.

But why should I believe that my country is the best in the history of the world just because I happened to be born here? And this God-stuff is really about getting people to believe in the totally unbelievable.
They tell you to have faith, don't question the incomprehensible. Once they can get you to do that, then they can sell you anything.  You can fly.  You can be born again.  You will live in heaven.  You can charge it now and pay later.  You can buy that house you can't afford.  You can even believe some of the incomprehensible stuff that Sarah Palin talks about.

And yes, our soldiers are brave and valaint people, who sacrafice for the good of their country and do their assigned duty despite great and constant danger.  But I can't stop thinking that rather than their being out there defending our freedoms, they are out their defending the corporate economic structures.  These are kids that I have seen in therapy, who had trouble in high school, had trouble following the laws, and some trouble getting along with others, who respond well to the high level of structure in the military, who hope for a boost in life that they cannot find on their own, so the opt for three to twenty years of going off to foreign lands to kill people they don't know, for reasons that really are not that clear.
The reasons that are given them are often similar to the things they heard from their religious leaders.  That we are the good and the righteous, and they are the forces of evil.  Have faith.

The video game thing, is really a generational thing.  I can't get into wasting my time playing virtual basketball when I could be playing basketball.  I don't get a thrill being a virtual pimp.  Maybe a racing game or a flight simulator I could do for a while.  But, even though, as I said,  I'm not religious, I have this guilt about wasting time.  I feel that the best way to really waist time is to watch college football, especially two teams you have barely even heard of, but they sure can run up and down the field.

So that's me, sitting way over here on the side.  I can even get upset at how everyone feels good about putting on pink ribbons to fight breast cancer.  Not because that isn't a good idea, but because the money goes mostly to the big cancer research institutes that are seeking treatments for the cancer that women get, and not to prevention.  Real prevention would attack the toxins and pollutants that run rampant though our food, air and water.  But few people are is looking at that because that would point out the need for change.

Well, this has gone on too long already. I have more concerns, but who needs to listen.  As the man said (Voltaire) 'Surely, this is the best of all possible worlds.'  We are fine, you and me.   ( unless we are the ones with cancer, or the ones wounded in the army, or condemned by the church for being turned on by the wrong kind of person, or... but hey, enough all ready.

Next time I will tell you why, even though I am not the greatest follower of American credo, it would be to your advantage to consult with a therapist like me, if you ever feel the need to consult with a therapist at all.

encounter

I was taking a break.  I walked down the corridor to the bathroom in between appointments.  I do this three to six times a day, depending mostly on how much coffee I drink. I thought  I had ten minutes to not deal with anyone.

I opened the door with my key and there was a guy standing near the sink.  He had several kinds of soap and anti-bacterial creams and was squirting them onto his hands and rubbing the combination over his body.  He was about thirty years old and looked a bit dishevelled.

I nodded and smiled, as is usually done at such times, and went over to the urinal in the corner.

He began to talk to me, which is not usual bathroom etiquette.  I soon realized he was not making much sense.

He was here to see  his counselor,but she wasn't here, and he goes to see his parents every weekend, and am I a counselor, and could he ask me a question?  Yeah, he had a question.  And his parents are not doing that well, and he tries to take care of them.  But he could use a counselor, and I sound like I'd be a good counselor --- even though I had only said 'hi".

Then I went over to the sink to wash my hands and he began pointing to his heart, and then tapping on his heart.  He wondered if I could help him and if he could ask me something. I said that he could ask.

I had this speech in my head about how, even though I was a counselor, I had all the cases I could handle, and how could I say nicely that I didn't have time for him, which fortunately is true.  I have that message on my answering message, so I felt it was legitimate.

But he kept tapping his heart and asking if he could ask me something, for about five or six repetitions.

Finally he asked me if I could give him money to take the bus to go see his parents.  He needed $6.50.

I was very relieved that it was only money he was after.  I gave him $2 and fled, feeling as if I got away cheap.

The men

I am currently seeing a lot of couples.  I think it's related to the recession; stress is high, tempers are short, a lot of people are in tougher circumstances.  What's worse is that many of these people thought they were doing things right but working, trying to watch expenses, trying to plan step-by step for a house, a car, a kid, a vacation.  But then someone lost a job, or lost the over-time or the expected bonus, and the stock market went down, or someone got sick, and suddenly, ever expense is a hurdle and life isn't as much fun any more. And that makes them angry.

So, blame your spouse!  That's the easiest solution.

With the couples I see the men are of two very distinct varieties, either too loud, too active, too controlling, too quick tempered, and either border on being abusive or sometimes go over that line.
Or else they are the opposite; too passive.  The can't decide, don't fight, don't respond, freeze-up in a crisis, and would rather watch TV and hope the problem gets solved, usually by the wife.

I guess the men in the middle have figured out how to deal with difficulty either by making a decision and getting things done, or by doing what they are told to do.  I do believe there are some people who actually do both. They can negotiate, collaborate, come to an agreement and then act.  All of that is great if it happens but it isn't always necessary.

In the cases I see the therapeutic interventions are easy, either:  cut the shit, or get off your ass.

Easier said than done, but the direction is clear.

The women are not without their own difficulties, but are much more varied in how they act out their angst.

Love, alternative forms

Last night in my office I spent the last hour of my day listening to a couple trade insults, barbs, accusations, blame, resentments and recriminations for 45 minutes.  It was a rollicking emotional time.

For the last seven minutes, after they were emotionally spent, I got them to see what they really wanted from each other, which was basically, that after about 20 years of this kind of a relationship, they each wanted to know that the other one still cared enough to keep it going for another 20 years. 

Once they agreed on that, they left happy. 

I think I'll skip a week of going through that again.  That marriage will last.

The patient stream

People come to me in streaks; that makes me feel good.  I've seen several neighborhoods.  I get a couple, then they refer their neighbor, then the kid across the street, then his uncle.  It's good to know that someone thought I was worth the effort of driving across town, or even from twenty miles away, and much more, even.

What's great for me is to get different perspectives on the same stuff that happens.  I have seen several sets of sisters, or cousins.  A few times I've seen four, five or even six people from the same work place.  I can never mention that I see the other people, even if they are the ones who made the referral.  If someone brings up that they know their friend is coming to me, I just kind of nod.  I really enjoy hearing about my patients from other patients and getting a different view of them then the one they bring in about themselves. I can't say that Suzy, in the next cubicle, thinks you're a slob, but it's helpful to know.

Once I had a woman who was having an affair with a married man.  He was making all kinds of promises to her, and telling her that he was three weeks away from leaving his wife.  About three weeks later a couple came to see me about their marriage.  Sure enough,  from the information that I had already it was clear enough to me that he was the man in question, although what he was telling his wife was quite different than what I had heard from his girlfriend.  But, I really couldn't say anything, I just kind of let things play out.  I did kind of warn the "other woman" that things were not going to break in her favor, but I probably would have done that anyway.

Over just the last month I seem to have tapped into another vein of patients --- other psychologists.  I am not sure if they knew each other or if they came from very different sources, but I am seeing four other Ph.D. psychologists now.

Three of them make great patients.  They come with notes and speculations about all of their thoughts, motivations, unconscious demons, and deeper underlying internal processes.  They send me emails in the middle of the night. They are working at it. 

From my vantage point they are way over-doing it.  I'm not that kind of therapist.  I don't try and uncover every last possible psychological nick and scratch that may have cause a psychic bruise at some time.  I'm more of a kind of a "let's just get on with it and feel better" guy. But the intellectual churning can be fun for a while.  And I am old(er) so they look to me for approval of their self examination.  All I have to say is " Well, what do you think?"

The fourth one is just nuts.  She's angry and screaming, and in a terrible, chaotic relationship, with a guy who has more issues than that pop-up box has tissues.  But she has a full practice and she's probably good at it.  She's right out there and very expressive. She certainly lets you know how she feels, and she reacts quickly and intensely.

I don't think I would want to be her client if I was a man, given what she expects in her own relationship.  But, then again, that could be really good for some guys to hear about it.

This is an interesting profession.  You never really know what's going to happen once the door closes.

Inside trashing

My battered profession continues to take it's lumps.  The press, the clients, the insurance companies and now it's an inside job.  The Past President of the American Psychological Association, Alan Kazdin, gave an invited lecture in which he said that psychotherapy, as it is practiced today, is inefficient and elitist.  It is slow and works with people one or few at a time, while the mental health problems that are facing this country are huge.  He said that there is a need for new approaches, and that psychologists/therapists should not sit in their offices and wait for people to come to them, they should devise way to get out and treat the problems where they exist.

He's not wrong. He just twenty-eight years late.  I don't know how old he is but he must be younger than I am.  He was probably not riding on his high horse in the 1970s when the community mental health movement was taking hold.  I was working in another city at the time, another New England Mill city much like the one I am in now.  I was running a small Mental Health Center that was funded by state and federal funds, as well as payments from the people we were treating.

We had programs that went into schools, brought new parents together, worked with kids in housing projects, consulted to policemen, had follow-up care for the seriously mentally ill. We had the early formation of alcohol and drug education programs and outreach. We even were dealing with domestic violence and racism.  We were doing lots of cool stuff.

I remember that I really enjoyed working with about twenty-five kids in a concrete building in a not very good part of town.  I would meet them twice a week after school and help them organize activities, or figure out school, or complain about the way they were being treated.  Once, when were organizing a weekend dance,  I didn't want there to be trouble, as that could give the whole program a bad rap with the community.  I asked some of the bigger kids what we should do if the "bad element" showed up and wanted to be disruptive.  They broke out laughing.  They explained that if I was to ask around town for the four names of who was considered the "bad element" I would find out that they were sitting right next to me.

But all that ended quickly in the 80s, with Reagan.  I am sure that what we did would be very quickly labeled as "Socialism" by many in the media today.  Dr Kazdin is not really searching for new, innovative ideas.  Like many, many visionaries, especially in Psychology, he is just recycling old ones.

culpability

Jane, who commented on my last post, brings up an interesting and complex point: "Who is responsible for the mess that many people, the economy and our country is in?

Clearly, there is more than enough blame to go around two or three times.  In the early 2000s government lowered interest rates, especially for home mortgages.  That encouraged everyone to refinance and take money out of their homes.  Many people did this and used the money to spend on stuff they wanted but didn't really need.  I had lots and lots of clients who did this. Added to this, many mortgage companies intentionally sold mortgages to people whom they knew could not afford to keep paying them Some of those people were foolish, some were just lied to

But many people knew what they were doing. They wanted to turn the rising value of their home into cash.  They were encouraged to do so by many ads, from mortgage companies, and by other consumable type products, especially bigger homes and SUV, and all the stuff that went into them.   But I didn't do that, and I don't think Jane did either.

Meanwhile the government was waging two wars costing trillions of dollars.  The real goals of those wars are still not very clear. This still continues.

Then, since so many people were buying and selling mortgages, and it was somehow assumed by all of the country's brilliant financial minds that home prices cold only go up, banks invented mortgage default swaps, so they could increase their profits and leverage all of their bets.  The government at the time, led by Alan Greenspan, decided that these kind of business did not need to be regulated. The :free markets" would regulate themselves.

So then, in 2008, housing prices began to drop and the economy feel completely apart.

Should the government have done nothing and let it all go completely to hell?  They decided they needed to help or the world economy would collapse.  So they helped out the banks, who were some of the biggest crooks of all.  They felt they had to, which they probably did. But people got angry at the government, and the banks, for needing and taking tax payer money, while most tax payers who had financial problems were not given too much --- although unemployment benefits were allowed to keep going for a long time.

Then nobody had as much money, and no place to get it, so they stopped buying.  So business stopped selling, so they laid people off.  So things go worse.

 Then the government tried to get things going by pouring money into some places.  But it isn't enough, nothing is happening fast enough, the deficit is growing to frightening level.  Everyone is angry, except for the bankers, and other people who are very rich and are paying for ads and lobbyists to keep them rich.

Again, I think that in order to get things right a lot of people who seem to have major disagreements about what to do will have to decide to work together, make compromises, look at the whole picture, and decide to make the country whole again, and to pull people together.  I think Obama was a bit naive for almost two years, thinking he could do that.  There are some powerful people who just want to see him fail, just for their own benefit.

Now, I would rather put my faith, and I agree I have very little of it, in a government that I elect, than let my economy be run by insurance companies, banks, oil companies, Rupert Murdock and the Koch brothers,  who have already shown how willing they are to screw us out of our last dollar, which they will do if the government steps aside and calls that a "free market."

Unfortunately, I don't see much hope of getting enough people in business, banking and government to work together.  The "freedom" some people are screaming about seems to be mostly about tearing everything and everyone apart.  I hear very little about people offering to sacrifice and to work together to make things better for all.

Yes, I hope everyone out there took care of themselves.  If you didn't it is partly you own fault for getting sucked in, and partly because the rules are stacked against you, and those who are doing the stacking want to run the government too.

I know a lot of my clients are suffering during this time of economic distress.  I do not see many places for long-lasting job growth.  We had one great twenty-year growth spurt due to new technologies.  We followed that with money from a housing bubble and debt spending, from both the government and citizens. Now what?  Green Energy?  America's Got Talent?

Today was primary election day.  I went to vote early.  I voted for some incumbants and some new people.  I tried to vote for people who made sense, and weren't just angry.  I was there for ten minutes.  Two other people came in to vote.

Is this the freedom we are sending people across the globe to protect?

money therapy

It is my belief, as a result of my years of sitting, listening and mumbling, that a great deal of what is called "psychopathology" is really a result of the culture of the times coming down upon a person's life and mind.  The American Psychiatric Association, as evidenced by the forthcoming DSM V, is going in the opposite direction.  They are trying to classify many behaviors, such as being addicted to the internet, or compulsive shopping, (although these changes will only be put in the appendix for now)  as basically "brain disorders."

I don't see it that way.  I also am currently having a very tough time having to treat so many people who are unemployed or underemployed, or who are stuck in jobs they hate because they know they will have a very tough time getting another job.

Yes, I am sure the the stress of not being able to meet your mortgage payment, or struggling to feed you kids, or even losing your vacation home, creates changes in your brain.  But the real causes of these depressions and anxieties are based in the workings of our society. We have a system in which the financial conditions of many families can vary greatly from year to year.  Our culture encourages consumerism; the desire for unnecessary goods. Some segments of our culture purposely and by specific design, allowed many people to accumulate a great deal of debt to buy these things.  This helped some people get very rich, while many others are now getting poor.
. I see many marriages that after many good years, are now under great stress. Many people are not only scared and struggling, their self-image has been shattered.  After months in a downward spiral they are left feeling helpless and powerless in a way that many have never felt in their lives. They are angry because they feel duped.  They feel that they did what they were told and followed the American Dream, and now they are being left out, and even blamed for it.

Treating these individuals and couples is very difficult because what would really be the best thing I could do is find a way for them to make money.  I work on that, to help them brainstorm, or network, or make use of skills that they didn't realize could be put to use. But it's very tough.  Not many places are hiring, and very few new ventures can get capital, and many fewer people will spend money anyway.

What also bothers me is how many of these hurt and angry people have been sucked in to be angry at their own government, which currently is trying anything it can to help.  I don't think they would really prefer to be at the mercy of the oil companies, insurance companies and banks, but they don't seem to see that that will be who benefits from their political stance.

However, I am not surprised.  Fear and anger do not usually help rational, longer-term planning and thinking, but they always have been a major factor in political behavior.

 But whenever I get a new patient now, I find I really, really hope they have a way to support themselves.  I can't do money therapy.

High Tech, Blown Away

I have seen this guy for a while.  He's a real techie: hides in his basement, does a lot of sophisticated software consulting.  He comes to see me because his wife hopes I can teach him to be verbal, which he can be if you talk about his stuff, but that bores her.

Anyway, that's not the topic.

He is working with his new Apple, and to be good he is trying to do things that relate to the family.  So he puts together pictures of his son and himself.  On the new Apple software there is a dazzling new feature that allows you to highlight a face and click on it.  Then the machine will scan all of the 2100 or so pictures you have in your iPhoto and it will pull up all the pictures with that face in it.  Amazing stuff.

So he does that for him and his son and about fifty pictures of them appear.  Then he sees, among the pictures, that there are two very old photos from when he was a kid, and the focus of the app is on a guy who was a friend of the family.  He enlarges the shot of the guy wearing a dark suit, then he enlarges a shot of himself dressed in a similar fashion.  Then he examines the pictures and he said to himself that the software is pretty good, because he sees how similar they look.  Then he goes back to putting together a family album and the event fades away.

Two weeks alter he is talking to his mother, and he tells her that he will send her the album, and she is all happy and they are joking around.  In that spirit he tells her about the picture of the old family friend, and he says, without thinking really,that from the looks of it, that guy could have been his father.

Suddenly, the phone goes silent.  After a long pause his mother says: "I really don't want to go into that."

The guy is 41 years old.  Even though his life is exactly the same, it has suddenly become totally different.

Upon my return

There is something very comforting to me about returning to my office.  I did not get the "back to school jitters."  Starting about thirty hours before I returned I was getting eager to see how most people were faring.  I was not eager to see how everyone was doing as some people will not be changing much. They make my life tough.

But I guess it is very easy for me, after all these years to settle back into my role, to return to the task, to try to move things forward.  It's not easy, but it feels like the place I should be. I should be thinking, at this stage of my life, of how to make changes in myself.  I know that they won't come to me.  But I don't.  I go back to what I do; what I know.

But three weeks is really a long time it seems because a lot had changed for many people. It seems that some people need a good dope-slap every week or two or they tend to wander off the rails.  Is this psychotherapy?  I guess.

AB got upset at her parents and tried to jump out of the car -- in the middle of traffic at 40 mph.  They put her in the hospital for three days and on meds.  I don't know if that was the best solution, but everyone got worried.

CD, under pressure from his girlfriend, turned himself in to the probation officer he had not seen in four months.  I will see him next week when he gets out.

Paul, you remember him, called  to say he would like to come back, but he is in FL, trying to stay sober.  He will call when he returns.  I will see him if he calls.

EF's father died. as did GH's mother. IJ's husband's father had a heart attack. JK put her brother in hospice.  They won't let him drink.

LM got evicted. but she found a new place.  She left her boyfriend behind.

MN said her husband slapped her. She had accused him of cheating on her -- after she came home from spending the afternoon in bed with the man across the street.

OP is going back to school.  Two days after she signed up for classes, her husband lost his job.  Good he can stay home with the kids.  But who will pay the mortgage?

RS called.  Her cancer is gone.  She was strong and up-beat through seven months of treatment.  Now she wants to come in and cry, in private, in my office.

There is something very unsettling going on out there.  Everyone feels that things are bad and about to get worse.  No one has any trust.  The current divisive political system cannot deal with things.  Things are very complex, and many disparent people will need to work together to make things better.

They won't. Not a chance.

It's only Tuesday.

leaving

Yes, it was a totally gorgeous day.  The sky was totally blue, the waves rolling in slowly to the beach, The sun was warm but there was a slight breeze off the water.  A few boats bobbed in the distance. Kids frolicked in and out of the water, splashing and screaming, dunking and diving. It was a day that should never end.

But slowly the sun began to sink toward that side of the water. It was bringing summer to a close.  Time to clean up the house, put the chairs away, and pack it in.  Yes, we will be back next weekend, unless the hurricane drives us away, but the vacation is over. I did my best to squeeze every drop out of it.

Put on some old,  melancholy Townes Van Zandt tunes, go to the dump, take one last shower outside:

"Don't let the sunshine fool ya
Don't let the bluebirds tool ya
Don't let the women do ya
Put your hand in mine"
     ----TVZ  (1944 - 1997)

We're going home.
Back to work.

When it rains

It rained for a few days down here near the water.  Some nerve. The forces of Nature do not always honor my requests. We think that somehow we can control that, but in truth we are losing control rapidly and creating more chaos and destruction. But that is another topic.

When it rains here I get to read many things from various sources.  I read several articles about how too much "screen time" is not good for our brains. The average game app is played for about three minutes while waiting for the dentist, or a line to move or a wife to get dressed.  We can now not only fill up every vacant second, but we often double or triple fill by turning on music, watching TV and texting a friend, all at the same time.  Many studies show that this only confuses our brains, inhibits learning and limits creativity.

I also read a good article that (again) trashed on my profession.  It was about the "Legends of Psychotherapy" conference held last month in California.  I will write about that next time.

But I read a column by David Brooks in the NYT that I want to comment on.  I usually like to read his stuff.  He is a thoughtful conservative,which I am obviously not, but he often makes a good case.  What he wrote about last Tuesday is something I strongly agree with, and have really been talking about in many ways here. -- In the article he wrote about how we usually only read things we agree with, but I don't think that was why I liked it so much, but who knows.

He wrote about "mental flabbiness" that has become rampant in our culture.  People have become lazy thinkers.  With all the information that is constantly available there is less time to consider what is real, what is worthwhile, and what to do with all of these bits of information.

Brooks quotes Charlie Munger of Berkshire Hathaway who lists our natural weakness: confirmation bias; we pick out evidence that supports our views, and we are cognitive misers; we try to think as little as possible.

I often see in my practice how people are very vulnerable to slip-shod thinking, surface conclusions.  People easily settle for simple solutions, based on distorted half-truths, that are harmful to them.  That's why there is so much debt, so many kids on prescribed drugs, so many obese people and so much free-floating, misdirected anger.  It's not that people are stupid, it's that they have been encouraged to be lazy thinkers.  Our society calls for it.

If you are a lazy thinker you are much more likely to buy a shitty product at an exorbitant price, and to think you need it.  You will get angry at Obama because you think he's a Muslim.  You will eat bacon cheeseburgers and then go to Jenny Craig.  You will believe that climate change is a hoax because you don't want to put any limits on the energy you use or the waste you create. You will blame "illegal aliens" for taking you job, when you never really wanted to work fourteen hours a day picking lettuce. You will think it's normal for women who are 5'4" and weigh 118 lbs to have Double D tits. You will believe that your six month old son should be watching a computer program that teaches him sounds and colors and shapes, when you should be holding him and cooing to him yourself.

It's no wonder my business is booming.

I made the mistake of picking up my messages today.  I have almost as many new people wanting appointments as I do people who I was seeing before I left.

The world is very complex.  Take the time to think about it. It is good to think -- Try thinking this way: If I do this then this will happen.  If is even better to think -- If I do this then this will happen, and that will make this or this happen and I have to be ready for that too.  But that is difficult.  It takes time.  It takes some kind of reflection and consideration.  We are all capable of it, but it's difficult. You may have to give up some time playing "Angry Birds."  At least in the beginning.  Then this thinking thing gets easier. Then it gets to be kind of fun.

Try it.  You will save on your therapy bills.

Out of office, and out of....it

I am still away.  It's kind of weird to be away this long.  It is good for my head.  I think of some of my clients once in a while and wonder what's going on.  I kind of miss them, mostly just as people, but not really the work of figuring out what to do and how to make it happen. I think of some of them and it seems as if through a fog.  They are from such a different part of my life.  I am here, in this vacation spot with friends and family wandering in and out. I talk or don't talk.  I don't have to pay much attention if I don't feel like it. Some people drone on about whatever.... It's great: I don't have to listen.  When I do respond I don't have to make much sense.  That certainly takes the burden off.

I'm like that.  My mind takes what someone is saying and shoots off, usually in a totally unrelated direction.  It jumps and skips steps.  Then I make a comment about where it has led me.  People kind of look up and then go back to whatever they were talking about.  Most of my friends expect that. They often can comment, and we go on from there.   That's why we are still friends.  The other ones, like my wife's friends' husbands, they don't know quite how to respond, or how the hell to deal with me.

Sometimes we talk about golf.

I have been getting to exercise a lot more.  It surprising how well you can take care of yourself when you don't have to take care of anyone else. I get to stretch, and then to really exert myself in a few ways, which I had not been doing since my eye got messed up.  I was surprised at how much I missed that. Getting my heart pumping and sweating and breathing heavy really makes me feel alive and part of it; whatever "it" is.  Some people hate to feel that way.  I really missed it.

What is sad is how little it takes to make that happen now. But hey, as the song says: " I can go as fast as I used to, and I can go as long as I used to, but I can't go that fast for that long any more."

Sometimes when I take my grand-dog (the one in the picture there) for a walk, and she pulls me around for two miles, I count that as exercise.  I never would have used to do that.

Just trying to stay healthy.  Just trying to stay alive.  Just trying to keep my wits about me without embarrassing my wife too much.

Just sometimes.

being away

I've been away.  I still am.  I went to the mountains far away.  That was away. Just me and my wife of many years.  We went up and down the big mountains.  Up, up into the snow. I rode a bicycle through the woods, up and down hills, on narrow paths through the trees and over the streams.  My wife got a massage.

Now we are back at the house near the ocean.  This is the place people come. We open the doors and have friends. That is good. It sometimes amazes me.  I didn't think I was that social, but this is fun.

I called in to my voicemail.  I had only fifteen messages now that L doesn't call any more.  They were mostly from people asking for appointments, telling me why they wanted to come and see me.

I am not in work mode, so my first reaction was "What the fuck are you telling me all this for? Your life is a mess and I am on vacation. Leave me alone.  Don't tell me about your substance abuse problems while I am sitting here getting drunk with my friends.  Don't fill my head with your relationship woes on my anniversary.

Then I heard a message that one of my younger patients was in the hospital for a rash act.  I felt sad. I thought of what i needed to do to help her learn to deal with being upset. I called and set up an appointment to see her ---

when I get back.

Out of Here

This was a difficult week as I am leaving for three weeks, one in the high mountains and two by the sea.  I have certainly been looking forward to it, and now the time has arrived.

What has been difficult is that so many of my clients have been giving me shit about going away.  "Didn't you have a vacation in July?" they inquire.

And so many people seem to remember that Richard Dryfus, Bill Murray movie "What About Bob?" It must have been mentioned ten times this week.

Yes, almost everyone adds that they appreciate that I should get a chance to clea my head once in a while, but how will they survive?

Actually, some of them will take the opportunity to mess-up their lives for a while, make a stupid decision, give in to an impulsive desire, explode at the wrong moment, or on the wrong person.

Maybe not.  Maybe they have learned; change does occur.

We shall see.

I'm not going to think about it.

scientific insight?

There was an article a couple of weeks ago in one paper, and then it was recycled to another paper recently.  It talked about how political scientists have "discovered" that even when you give people clear, definitive and indisputable factual information, and even if it comes from a reliable, unbiased source -- if the information does not agree with what a person already believes, then, most likely, the information will be discounted and the person will go on believing whatever he or she is comfortable believing.

If you believe that Obama is a socialist, if you believe that your wife is cheating on you, if you believe that chewing a handful of iron filings will cure your diabetes, often nothing, no matter how scientifically proven, will change that belief.  You will select and focus on information that you feel supports that belief.

This was like the "discovery" a few years ago by economists that people do not always make the most rational economic decisions, and (much) more often than not, they will make economic choices that are not in their best interest.  For decades economics were based upon the idea that the "economic person" was rational, and that given all of the necessary information, most people would make the rational decision.  For decades they wondered why their models never worked well at making predictions.  The team that documented this irrationality won a Nobel Prize or something.

As a psychologists, who deals every day with people who make major decisions that affect their lives, in romance, money, work, schooling, interpersonal interactions, drinking, eating, sex and sleeping, all I can say in response to these major "discoveries" is:

DUH!!

Also, remember what Woody Allen called people who think that everyone is after them----

perceptive.

Must have been something he said

That was quite a week wasn't it?  Just buzzed passed so fast you'd  think it was one of those old Camaros, you know, the ones before the first gas crisis, the ones with the big engines, the little body and rear-wheel drive, that would spin out a lot and were fatal on snow.  Yep. that's the kind of week it was. varrrom.

 And everyone showed up, almost, except for Danny, who really has not made much progress in 18 months.  But why should he, his parents still pay for everything.  He gets angry when they won't give him his allowance, even if he did spend last week's money on cocaine.

But everyone else.  Angela brought in her husband. They have been separated for two months. He was angry, dominating, and mean. He was outspoken and direct and it was clear what he expected things to happen his way.  That's why Angela kind of snuck around behind his back.  She felt she could never negotiate with him, he just rode right over anything she said.  But running up $45, 000 in secret credit cards did kind of come as a shock.  Especially since it was the third time she promised never to do that again. I think that is a very American form of pathology; I have seen it much more often than I expected.

I had one open hour, but Stan called and needed to come in ASAP.  I have not seen Stan for four years.  Stan has not worked for four years.  He's had some problems.  He's been jumpy, irritable, depressed and isolated.  He doesn't finish things, he drinks a bit too much, and he has temper outbursts -- all of which made keeping a job difficult.  He couldn't come to treatment earlier because he didn't have insurance.  Now that he has completely run out of money he can get insurance from the State.

Stan showed me his arm.  He had a scar with seven stitches.  He turned his arm over and showed me another scar with four stitches.  The second one is where the knife came out.  It must have been something he said.

Marla lost two pounds, now she is six pounds under four-hundred -- but it's a start -- I think.

Alicia and Martin: still no sex.

Phoebe, out of the hospital and into a one-month residential treatment program.  Out of that in three days after when she told them she was very upset and did not feel safe alone, the one staff member handed her a coloring book and went back to talking on her phone.  Phoebe is going into a day program for two weeks.

Those and twenty-eight others: loss, loneliness, addictions, stress, conflict, illness, doubt, broke, bored or burdened.

My last appointment was Sheila and Mark.  They came in snarling and tense.  They left tearful and arm in arm.  A good end to the week.

Today I spent time in the kayak, bobbing up and down on the slow rolling not very high waves.  The cormorants were back in their usual positions, on a rock, with their wings spread out to dry. As I drifted I could hear the noise of running screaming and laughing on the beach. The sun was moving lower, turning the few clouds pink.

I am very aware that I am a week older. I am very aware that I can't stop time.

It was a good week.  I love summer, even if the Red Sox suck.

The dance continues, doesn't it Mr. Fellini?

Glorious! .... yet

Another glorious weekend down by the water.  This time down at the beach house watching the tide go out.  We sat with friends, eating and drinking, discussing not much of anything. Again, in my life, the world seems to be doing what it should, pretty much.

It's at these times that I realize how fortunate I am that my wife and kids, and their spouses, and soon their kids, and I are all healthy, and even somewhat prosperous.  I look in the paper and often see that people my age are dead.  I walk down a winding path through scrub pines, go up a sandy hill, and  from there, on a bluff, I can overlook the entire expanse of my favorite beach, with it's large curve, and it's small, but rolling and lapping waves. Except now, I realize that it was not only me who felt that this spot was so special.  For now there is a new bench to sit on, and linger and watch the sunset from this spot.  The bench has a plaque that says it was dedicated to a great guy, someone I never knew.  He was eight months older than me, and now he's a bench.

I read something else in the paper today also.  There was a line that mentioned that the top twenty hedge-fund and money managers in the US made in ten minutes last year, the amount of money that the average American worker made ALL year.  Something is wrong there.  It is psychologically de-stabilizing for that to be going on.

What's worse is that these people --- and they did nothing wrong or illegal (probably, well maybe), didn't really produce anything that did our society any good.  They just moved money around, mostly following the directions of computer algorithms. 

Something is not good.  that should not be valued more than nurses, scientists, business people who actually make something, or deliver a service someone wants to pay for, or even street cleaners and garbage collectors, who work hard to keep us healthy.

Not good.  What do you think Justice Roberts?

While that was happening...

I am still often amazed by two very obvious occurrences, which kind of shows how little I have matured over all these years.  First is the huge dichotomy between my work world and my home world.  I come from  a fairly stable background and, considering all the radical and unstable ideas that rattle around in my mind, I have lived a fairly measured and reasonable life.  In many ways I have made fairly conservative decisions, and they have helped me and my family life pretty well, avoiding major crashes, crises, turmoil and upheaval.  It certainly hasn't been perfect, and I can list a dozen or so bad decisions right off the top of my head, but really, compared to what I see and deal with on an hourly basis at work, my own life chugs along.  And still now, whenever I see a chance to take a big risk, make a major change, throw caution to the wind, fly in the face of reason, defy all odds --- I don't do it.  Sometimes I admire those who do and who can, but that admiration has faded over the years, especially the more I have had the professional responsibility to pick through the wreckage.

The second constant occurrence, which is related to the first, is that while I am away from work, wandering around through my reasonable, fun but not overly exciting existence, my patients continue to live their lives of chaos, destruction, pain, aggravation and foolishness. At the very same moment!

That means that while I was sitting on that deck, sipping a high-priced gin and tonic, watching the sun go down on a glorious day over Boston Harbor, many of my patients were doing their best to make my work more complicated. (I know that was why they did these things.)

Some of the troubles happen to some of the same people I wrote about on May 5th. One is Alice, who while I was feeling so good, was lying in great pain, unable to move, as she had a seizure in her bedroom and feel off her bed, smashing her good knee, and couldn't get up.

Also, Saturday night a couple who I had been working with, who had been trying to overcome serious disagreements, lost control, and began throwing things and belting each other.  She came to the appointment on Monday; he left the state.

At the same time, a woman I have been seeing for a long time, who had been doing so well over the last few months that she was only seeing me once or twice a month, became so frustrated by the pain from her various physical ailments, in her back, feet and knees, that she locked herself in her room and began to drink, after being sober of almost two years.  When she woke up the house was a mess, with many things in unfathomable places.

Yet another woman, a complete recounting of her history would include four Shakespearean tragedies, was home with her sons and two of her son's girlfriends when she realized her home was surrounded by the police SWAT team.  Seven officers came in and she expected at least two of her three n'are- do-well son's to be carted off, but no, they arrested the beautiful but ditsy girlfriend for breaking into a liquor store.  (she was back in the house five hours later).

Phoebe, who did not hurt herself when I was away, but still said she wanted to, spent Saturday night in a hospital, where she felt safe and is doing better.

Archie, who did not have the nerve to call the woman he had been chatting with on-line, spent Saturday night in his basement, watching porn.

Martin and Alicia, who I have been trying to get to spend time together instead of fighting about the kids all the time, left the kids with her mother, went out and had a good time.  Maybe next time they will figure out a time and place to have sex and be even happier.

Lia, who I had seen last year with her husband, came back to treatment by herself to tell me that she has left her husband, and that last Saturday night, while I sat on the deck, she was in NYC to reunite with her first love, from twenty-five years ago, when they were both seventeen in Toronto.

Lots goes on, all at once.

Olives and Chicken Wings

I sit having a gin and tonic on a wooden deck overlooking Boston Harbor on a hot summer evening. The sun now finds it's way through the buildings and hits the white sails of the two and three masted ships on the same side as the wind that pushes them toward the outer islands.  The ferries come and go, crisscrossing from shore to shore. The harbor cruises chug in lazy circles, with more boisterous crowds, drinking and laughing, full of vacationers from Detroit who are amazed to find Boston so warm, sunny and welcoming.

Life is not always  mean. Certainly not mine. Away from work the world can seem beautiful, friendly and hopeful. I watch families walk beside the harbor with children jumping from rock to rock, laughing and teasing.  Couples wrap themselves around each other despite the heat, which is alleviated by a sweet, salty  breeze that blows off the harbor.  Walk further to the fancy hotel that hovers over the water and a bride is standing, smiling, being photographed with her hair and dress blowing in that breeze.  Passers-by blow her kisses and she smiles. Someone believes in love, or at least in marriage, which, from my work bias, is even more of a risk, but rest of my life tells me otherwise.

Nibble on olives and chicken wings, as the gin adds a rosy glow to the already strawberry blonde light that bounces off the big, steel bridge, built high over the water.  Boston looks prosperous and happy, and for the most part it is.  People are relaxed and smiling and enjoying themselves.  They have come from all over the world to be here, on this kind of a day, in this kind of a place and they have been rewarded.
We have evolved as creatures in a way that allows us to be mellow, content, sociable, and relaxed, even if only for a day.  That's what summer is for.  Many people seem very able to appreciate that.

Smile and nod at strangers, laugh and talk with your friends, hug the ones you love. Spread it around.  Help the world have a good time. It's the best thing we can all do for each other.

What's so funny about...

What happened to this week?  Whooosshhh, just like the sound of my iPhone sending an text.  Gone, zipped off with hardly a trace.  I went back to work, each day was full of people coming and going at the wrong times, wanting more time, missing appointments since I was out a week. Everything seemed off schedule. Two new people who had to wait for me to return, didn't even show-up.   Too long to wair?

It shouldn't be that hard.  I was there, in the office, every day, on time.  But when your life is a mess nothing is easy.

"I understand that your aunt hung herself in the next apartment and died leaving two children, aged ten and six, but your appointment was at 1, and somehow you forgot?  But that's OK because the person who was scheduled for tomorrow at 1 showed-up for your appointment, so I can see you tomorrow.  I guess everything happens for a reason -- but I'm not sure I can say that about your aunt.

A week off has a lot to be said for it, especially when it's hot and humid and you're down by the water.  But it really isn't as interesting as sitting here being amazed by stories of how people screwed up their lives during the time I was away.  Loneliness, illness, stress, conflict, addictions, death and general stupidity are the basic diagnostic categories I work with, but they don't come with billing codes.  And the last one applies to both the insurance companies and the current chaos of health-insurance reform.

 Life is complex.  It can be difficult and unforgiving.  Our society does not make it easy or offer much relief.  Jobs are scarce, money is tight, and important things, like an education, are getting wildly expensive.  The feeling out there is like riding on the sleigh in the winter in old Russia.  If you fall behind the wolves will get you and tear you apart.  The rich and well-protected have no trouble going on without you.  They have learned how not to look back.

This has always been true. We all can justify what we do to take care of ourselves.  For some reason, when I was a naive child of the '60s I had the strong belief that everyone wanted that to change.  There was no reason why it shouldn't.  We were smart, educated, rich and aware.  Make Love Not War! 

"What's so funny about Peace, Love and Understanding?"

I still don't know the answer, but I fear that everyone else does.

still summer

The high point of the day was kayaking past the cormorants.  (no laptop in the boat)

The tide was coming in, the wind was blowing out.

That was after Phoebe's mother called to say that Phoebe  ( who I have not seen in two years) broke up with her boyfriend and came home.  She is thinking suicidal thoughts.

I called her and told her not to.  I will see her Monday morning, during the time I had saved to open a week's worth of mail.

It can all wait until Monday.

The cormorants told me that, as they were drying their wings in the sun.

therapists on the beach

It's summer again.  You can tell because it is really hot.  Is it that Global Warming thing, or is it just hot?  You can also tell by the number of bugs that are flying around my computer screen and crawling across my keyboard.  I can't squish them into the keys because the screen will turn colors and flip pages.  I can only blow them away.  But then they think I'm a wimp and take advantage of my lack of power.

When it is summer I go down to the beach, especially when it's hot, like it was today.  Usually when I go to the local beach it is just full of vacationing families playing family games and splashing each other until the youngest kid begins to cry.  If I go to the bigger beach a half hour away there is a much greater chance of being surrounded by vacationing NY psychiatrists.

But today there were a couple of NY therapists on my beach.  I kind of knew one of them and he knew the others so we talked about our practices a bit and complained about insurance companies, and did some of the things that therapists do when they suddenly find themselves bunched together.

These guys are from NYC.  They charge a lot more than I do, and I think they get more.  They make their patients bill the insurance, and that way, since they don't sign contacts with insurance companies, they can charge what they want.  I am not too thrilled with that, but I understand that they play in a different market and they serve a population that can pay.  Rich people have problems too.

What does bother me is that they seem to see their clients two or three times a week, and they do so for months, and often for years.  Even for years and years.

Now it is rare when you read here that I am in favor of anything that insurance companies do, but if I kept getting bills for three sessions a week, and it continued for year after year, I would be upset too.

The basis for my being upset comes from the word "therapy."  If someone comes to me for "therapy: I take it to mean that I will treat them for something that is wrong, with the goal that it will get better, with the understanding that whatever is wrong, it can and will get better, or else there is no reason for treatment.

To me, endless treatment is not "therapy." It is hand-holding at a high price.  It also encourages dependency, while therapy encourages independence.

I guess the competition in NYC is great enough that therapists have time to see people three times a week.  I rarely see people twice a week, and when I do, it is to keep them out of the hospital, and I feel they are on the edge. If I saw someone three times a week, for more than two weeks, they would be in the hospital the next week.

I don't mind them having a different business model, but I do mind how it makes the whole profession look inefficient, and perhaps incompetent, AND at a very high price.  I mean, if you're sixty-two years old, how many years can spend talking about your mother. You only lived with her for eighteen, and you've talked about her for forty.  Let's get to the part where you grow-up and change your life!

Recollections (revised) Part 1A

I don't talk about dreams much in therapy.  I don't ask about them, nor do I think that they are the window into the unconscious. But sometimes they do trigger interesting discussions.  In many ways they are kind of the neurological cleaning out of the flotsam left in the brain at the end of the day. For me, I know that I have to be more careful about what I read after I get into bed.  I often fall asleep and then suffer with blurred visions of the Taliban or Sarah Palin running through my mind, disturbing my rest.

But I had a dream the other day which was clearer than most and the feelings that came with it stayed with me for a while, making me wonder what is going on in my own head.  In the first part of the dream I was an MC of a big party, like a wedding or something.  I was making all kinds of clever cracks, entertaining everyone.  But that quickly morphed into a scene where someone, a good friend, was telling me how I had insulted his mother, and that she was very hurt by things that I said.  The dream then quickly shifted to an image of me and this same kid, whose mother I had insulted, riding on a bus.  He was saying to me something like, "isn't this great, we are finally growing up and going off to college."  I sat there, on the bus, on one of those plastic seats of city buses.  I was nodding in agreement, but I said, yes this really is great, but I feel as if I have done all this before."

When I awoke from the dream I was in a good mood.  I remembered those parts of the dream very clearly and I loved the irony of the last line.  I enjoyed how good I was at recognizing, as I rode of to college, that I had already done that, even though, in the dream, I was confused by what I was feeling.

All of this made be reflect upon what I was really like when I shuffled off to college. What I remember clearly, was that unlike in the dream,  when I went to college the real time, I had little insight and even less  perspective.  I was really pretty clueless about how the world worked, and what I could do to make it work better.  I was having a tough time figuring out where I fit into the whole scheme of things.

I already had developed a very quick and sarcastic wit, mostly because I needed something to protect me, as I was very skinny and did not project an image of physical power.  But my wit was very unconventional and disarming.  One of my high school teachers told me that I was really funny, even if most of what I said went right over the head of most of my classmates.  He added that he hoped that the things I said would not get me killed some day, if per chance, someone did get the joke.

But even in high school my attitude about the world was becoming established. Because I was slighter than most of the boys, and this was because I was younger than most of the boys due to my mother sending me off to school early,  Look, she said, he's smart enough and he's just wasting his time being a pain in the ass at home.  So they started me at school two days after I turned five.  I didn't have to wait for the next year.  I was about ten months younger than most of the kids in my class, which, in fourth grade, is a lot.

I think I had to protect myself by paying closer attention to what other kids were doing and thinking.  I got to be a pretty good at predicting what people were going to do.  I could tell what songs were going to be "hits" the first time I heard them.  I could tell which I my friends were going to be dumped by their girlfriends.  This sense of observation developed to the degree that I began to be a ble to tell which of my teachers really didn't know what they were talking about. I had some really good teachers, and some who were real phonies. Some of them knew that I knew, and that wasn't helpful for me in school, but I knew that this kind of knowledge was what I really should be leaning.

The more I paid attention, and by my Junior year, it was a lot, I developed an awareness that most people were being played for suckers.  They were being lured to put their efforts, beliefs and money into things that were either, illusionary, worthless, harmful or nuts.  At the time it was things like big houses, constant new cars, and bomb shelters.  I also was confused by all the fuss made about religion and patriotism.  I didn't get it.  For me it just didn't make sense to get all worked up because I happened to be born in a certain place.  I mean, I am that different from the people who happened to be born over there?

I didn't get it .  And no one did a very good job explaining it to me.

So I made a lot of sly, kind of sideways remarks. I knew enough not to say anything directly, especially about religion and patriotism.  I could tell that could get me in real trouble.  So I remained, just kind of confused. I had no solution.  I had nothing else to offer in their place, so I kept a lot of it quiet. I didn't really know what to say.

I also realized, that few other kids that I knew even gave these things a thought. They did what was being done around them.  They just kind of accepted that this was the way it was, and went on.  Most of my friends were much more concerned with hitting a baseball and getting their hands up under a girl's sweater.
With that, we shared a common interest, so I was accepted and did Ok.

Because of my confusion I was voted the "most individualistic" kid out of about 700 in my class.  That meant that people thought I was weird, but I guess I was clever enough to make it seem interesting.

And that's why I became a psychologist. 

I thought, geez, if what I'm thinking about is so weird, what the hell is everyone else really thinking about?

For the past forty years, people have been coming in and telling me.  So that part has worked out.

Not ready yet

I listened to the series that has been running on NPR the last few days about the use of fMRIs  and PET scans for brain imaging.  Many neuro-scientists have been studying the brains of various kinds of people and watching how their brains react in different situations.  They would like to see if they can determine if different kinds of behaviors cam be predicted by different brain patterns. I have read about, and read some of the stuff of the two neurologists who were discussed on the show, Kent Kehl and Jim Fallon.

In the last report they discussed the case of a man in Tennessee who sliced up a neighbor into little pieces, and then went after his wife with a machete.  In court, testifying for the defense, the neurologists showed that the man had a brain pattern and genetic pattern that is often associated with serial killers.  He was physiologically pre-disposed to be more violent and explosive.  This tendency was made manifest by the abuse he endured as a child.

Therefore, they argued, and the jury seemed to agree, this man was up against too many factors, and that he was much more destined than most people to lose control. 

This is fascinating stuff, which is why I have read about it.  Sometimes I feel that I would like to have a brain imaging machine in my office so I could tell the areas of the brain that were activated whn my clients were expressing certain emotions, or recalling specific events, such as today when a woman I have been seeing became enraged because the man who had abused her as a kid has appeared on a friend's page on Facebook.

But I think the use of brain images at this time can be very misleading, possibly very inaccurate and can be a very dangerous direction to go in.  I don't think we are close to having demonstrated that we can think that pictures of our brains can mean more than self-reports or actual behaviors. 

Yes, perhaps this man had more of a predisposition to lose control and he was "out of his mind" at the time he was slicing his neighbor into chunks.  But, a case could be easily made that anyone who slices his neighbor into chunks is "out of his mind." Is this man more a victim of his genes and the other person just "bad?"

The slippery slope factor here is that, because of the current fascination and belief in new technologies, there is a tendency to believe the machine more than the person.  So, if the brain scan shows a pattern that says you are depressed, then you are depressed, even if you don't feel that way.  Or the opposite could be true, that you feel very anxious and panicked, but your brain pattern does not fit that of a panicked person so your insurance will deny payment for treatment. (I realize that that is not about to happen because the price of the scan is about the same as a year or so of treatment.) but the point is that I hope we don't get sucked into the use of great a technology long before it is ready, and it may never be ready for that exacting a purpose.

However, we already have doctors who can look at a brain scan, and then begin hawking their pills, brain exercises, or electronic brain-wave massaging machines that will cure your depression, ADD, or help with your math SAT scores.

Sometimes they get good, measurable results. But in my skeptical mind I would file those results in the placebo file.

I hope you all enjoy feeling free this weekend, if you are in the USA or not.  Real freedom, the freedom to think and do what you wish, not just the freedom to let corporations make a lot of money.

Another political rant of an aging Boomer

Summer is here, we are hanging out with friends down near the beach. Lots of eating and drinking and loose talk.  The men, who are drunker than the women, begin to pontificate about the state of the world and what could have, should have been done.  The women shrug us off like they did our children when they were five years-old and hungry.

Eventually someone asks me, as an aging therapist, about my view of human nature, and I reply somewhat cryptically that I realize that I have become just "one of the many here among us." Now, I do not expect many of you to immediately get that somewhat poetic allusion, although I'm sure that several of you who thought they should have been at Woodstock may pick up on it.  There is a good chance my son will recognize what I'm talking about, and perhaps my daughter.

But it is true.  After all these years of working with people, and all of these years of observing American politics, and the politics of the whole world, that was the best I could come up with.

I remember when I was not that way, when I believed that people shared an underlying sense of values, that most religions were similar, that science was really the search for the truth, that people recognized the folly of war, and that technology would spread knowledge and that knowledge would lead to enlightenment.

It was very helpful and comforting to believe that, although at times it became kind of confusing and a bit disheartening.

Now my views have been changed by my experiences of seeing close up not only what societies will do to their own people, but what husbands and wives do to each other, and worse, what they do to their children.  I have also read lots of studies that show how totally irrational we are, such as the one done recently at MIT, that shows if you read someone's resume on a heavy clipboard, you will be more impressed with it than if you read it on a lighter weight clipboard.

Once you believe that, and I do.  Then what can you say about human nature.

Therefore, I am now just one of the "many here among us who think that life is but a joke."
(B.Dylan, All Along the Watchtower)

If 250 years of democracy produces Sarah Palin as a viable political force, isn't that a good joke.

I'm not saying that this is a bad thing.  Jokes are good.  It is healthy to laugh. Studies have shown that too.

New Mac

I hope to be posting more now that I have my new MacBook.  I can take it with me everywhere and all the time.  I was not the only one in the store who didn't buy a new iPhone or an iPad, but I certainly was in the minority.  Apple certainly seems to have tapped into whatever is the tempo of the time, or perhaps help create it.

I do not have a Facebook page, partly because I don't want to have to not "friend" clients, and mostly because I don't have any more time.  I waste enough writing these rambling thoughts here, and sending them out to people I mostly don't know.  If I had to be coherent and stay in-touch with the people who really were my "friends" then it would become a burden.

And who has time for Facebook?  Probably many of you do. It's really a generational thing.  For us olders, it takes time away from the time wasting habits we developed before all of this instant technology.  I still get one weekly and three monthly magazines, and that does not include the professional journals.  Those journals are soooo last century.  By the time something is submitted, vetted, edited and published, it is either very arcane to begin with, or has been out on the Internet for months, if not years.

I am also on a couple of professional Lists, and they are full of Chicken Little Psychologists who alert me to every possible threat to the profession, possible ethics violation, acts of Congress that need to be responded to ( and I do), and money trends that rumble through the insurance world, none of which have ever been to our benefit.   But the information is there, and I have to have it.

These lists also alert me to the exciting new developments that are revolutionizing our profession.  Most of them turn out to be clever new words that describe a theory or concept that fell out of favor ten years ago when someone else coined a clever new word for something that had been popular ten years before that. But the information is there, and I have to have it.

I also get many more of my referrals or appointment changes through email, as well as updates from current and former clients -- which I think is helpful and informative, but it takes so much time. I'm not on my computer all day like so many people, because I have to actually sit and talk to people.  So, at the end of the day, or when I get home, I have 150 emails, about ten of which are really informative. But it takes a lot of time. So who has time for Facebook?

I get business because of Facebook.  Those old high school sweet-hearts  seem to pop up just when the marriage is getting very bumpy, and even if nothing actually happens, I hear the phrase "you were talking to HER" much more often in my office now than I ever had in the past.

I know that all of this new "instant" technology has had definite changes in how we think, respond, conceptualize and create.  There is a lot of new research going on trying to determine how all of this "screen time" is affecting developing brains.  And I'm sure it is.

Whether these changes in the brain will hurt the creativity of future generations, as I have already read somewhere, or does playing video games lead to violence or ADHD, the later of which is certainly possible.  It doesn't matter.

From what I saw at the Apple store, being constantly hooked into technology is here to stay, or at least until it is replaced by something lighter, faster and even more omnipresent.

Sitting in silence, staring off into space once was the province of catatonic schizophrenics, but I bet now it will become a luxury, and people will pay $1000 a day to go to some spa in the woods and sit next to a tree, while a highly skilled staff member locks away your iPad for thirty-six hours.

Maybe by next summer I'll have one up and running right here on the Cape.  Make your reservations now.



NB:  The dog is my grand-dog.  She is bigger now and better behaved. Very affectionate, very fast, but a bit skittish.

Googlized

I received a big yellow envelop in the mail this week.  It was from Google.  They congratulated me that the listing of my practice on Google Maps Business was one of the most popular in my area. I am one of only 250,000 businesses  in the whole country to receive this distinction. I also received a Favorite Place window sticker to display, with my own QR code right on it, so people can use their phones to go directly to my listing. So many people have clicked on to see my crinkled eye and somewhat smiling face. Several clicked further to look at my web-page. 

I need to redesign my web-page.  Being an early adapter I put it up in 1999 and have only revised it once when I removed my "Health Care Plan for America."  But that is a different story.

Now, I don't know if this is a real honor or if this is a way for them to just generate more money by getting me to buy more services.  But why always be so cynical?  (Isn't it obvious why?)

Then as I reflected a bit more I became a bit sad:  My psychotherapy practice is one of the most popular local business in my area?  What does that say about my area?  Shouldn't it be a cool restaurant or clothing store, or even a flower shop?  Did I out-do Wal-Mart?

How terrible are things that so many people are out there looking for psychotherapists? I wish I could take my honor as a boost for me personally, instead I feel kind of bad for the social state of my community.

I would feel better if more people clicked on the Happy Times Dance Band and Social Club.

But nope, the world wants more therapy.

Happy Daze

Let's cheer up a bit.  If you've been reading along here, you know that I often use this blog to let out my frustrations and exasperations that come with the role that I have chosen to take.  But I want to add a bit of balance.  It's not all that terrible.  The folks I see, and the hours I spend do not make me feel that life is always tragic and cruel.  I am not doing this for punishment, nor do I do it to gloat over other people's misery. Also, I can't say I do it for the money, as there are certainly easier ways to make lots more money, although none are more fascinating.

Really, doing this stuff is mostly rewarding, both mentally and emotionally.  Being a part of the process of someone making difficult, positive changes in their lives is very exciting and fulfilling.  Seeing people treat others better, insisting that they get treated better, and learning to take better care of themselves is exhilarating.  It's like watching someone grow-up in time-lapse photography.  They are shedding their old selves and grow new, more colorful, creative and successful new ones.

Yes, human life on earth is often unfair, capricious, and even absurd.  So, nu? It can also be whimsical, warm and sexy.

Each case is a puzzle that I have to help put together.

A woman came to see me and she was depressed.  The puzzle: why is she depressed and what can I do about it?  How can we, she and I, rearrange the pieces of her life so that the depression will disperse.  Or is it just brain chemistry?

I find out that her mother died when she was six, and two years later her father remarried.  He paid more attention to his new wife than he did to her.  To me, that is a big piece of the puzzle. 

Then we have to see how that affects her now.  How does she behave in other relationships?  How does she react to loss, or prospect of loss?  How much can she trust men? If her father didn't value her enough, how much value does she give herself?  Many more.

Then what can we do to change how she feels, reacts and behaves so that things will change?  That is the puzzle.  I believe that if she changes how she acts and thinks, she will change how she feels.  She will change her brain chemistry. I have done things like that.  It works. It's rewarding and fun.

Some puzzles I can't solve.  I can't get the pieces to fit.  Or I think I can get the pieces to fit, but the client doesn't like the way they fit, so it doesn't work.  Then I feel as if I didn't really find the right solution.

What do I do then?
I put it in my blog.

Sometimes the Extremes are Real

I deal with a lot of shit that goes on in people's lives: illness, trauma, loss, loneliness, conflict, stress, and more things that don't really fall into categories,  just the amazing things that people mange to do to each other. Most of that stuff gets worse over time, as it continually takes up more space in people's minds.

But sometimes awful things happen out side of their mind; just plain awful things that they then have to deal with.  Most often it happens to people who already have had awful things happen to them.

This week's example is Marla, a woman I have been seeing for a long time.  I began a few years a go with Marla because she had a terrible drinking problem.  Her family, who helped create the problem by having a mother who would often promise her that she would amount to nothing, and a father who would occasionally get drunk and try to fondle her.

Marla found that when she drank she didn't feel so bad.  Her parents, realizing she had a problem with alcohol, responding by going to court and taking custody of her son.  They presented a huge, elaborately exaggerated case, mostly so they could get the child support checks that came for the boy.  Marla was send out to find her own way to sobriety and self-reliance.

Once away from her family however, Marla has begun to do quite well.  She has been sober for two years and she is now back in college, doing well.  Fighting to maintain her low self-esteem she tells me that she knows she is not smart, but she has this quirky thing she does:  If she reads the books and goes to class, she does very well on tests.  She can't explain it.

Having grown up learning to distrust the people whom you should be able to trust the most, it is not surprising that she has few friends and generally stays away from people.  But, over time she met a guy at her all night job, and they became involved. This relationship was in-place when I met her, and it had been going on for years. He seemed to be genuinely caring and committed to her, despite his being married to someone else, and the father to children whom he also cared about.  But when Marla was upset he would call me to alert me, or he would bring her to my office when he felt she was in danger of becoming too depressed and isolated.

After years of this, this man, whom we shall call Harvey, began to have an increasing amount of trouble in his own family.  His affair with Marla had been known and tolerated, but as his kids grew-up the tensions with them and the rest of the family, and probably others, all seemed to mount.  Harvey had once called me but we agreed that since I was Marla's therapist it would be better if he had his own. So I never knew the real details of the stress he was under.

Two weeks ago Marla came to my office, and after talking about her visits with her son she became even more silent then usual.  When pushed, she said she had heard from Harvey and he had said that it seemed a good time for them to not see each other for a while.  She said that when she questioned him, he then said he was just having a bad day, and things would be fine.  But she had not heard from him for four days now and didn't know if she should call him.  She knew he was stressed out and she didn't want to bother him, and make his life even more difficult.

Yesterday Marla showed up, a day before he scheduled appointment.  The appointment I was waiting for  was late so Marla came in, sat down and stared at the floor. "You're not going to believe this."she said.
"Harvey is dead. He was dead last week, that's why he never called.  He was dead three hours after I spoke to him."

"How did he die?"

No one is saying. My son is the one who found it in the paper.  The obituary only said that he died suddenly.

That can mean all kinds of things.  It certainly makes one wonder, but I don't actually know.

Marla said that she knew his father had died early of a heart attack.  Maybe that was it.

Maybe.

Marla left the office.  She said she was going for a long walk.  She has been known to walk twenty- seven miles to deal with her depression.

She called in today to say she was OK.  Going to walk in the other direction.

May has ended

May is tougher than you think. It always is. People naturally think that the Christmas holidays are psychologically rough times, and they are, but May is worse.

Why? I am never sure.

My best theory is that, like trees, the sap rises into people's brains and they get all kinds of ideas. In May it gets warm and people begin to act on things they have been thinking about all winter. I live in a climate where we have a real winter. The people here have not all moved down to where the beaches will be covered with oil.

I get more almost suicides in May. More couples break-up for ridiculous reasons, after being stuck together all winter. More bosses screw their secretaries, especially now that Xmas parties are more restrained. More housewives screw the plumbers. (I have two plumbers as clients). More money is spent foolishly. More people who remained sober since Christmas, break-out in May, usually with disastrous consequences.

I'm happy that it is now June. The ledges on the high bridges are empty again. Bring out the BBQ, spend time with the family. Fill up the above ground pool, mow the lawn. Chill out, enjoy the summer.

the "May-nia" is over.

Treatment Failures (?)

I was pleased to see the brief discussion about trying to treat an addict who lies. This is common. Many addicts lie. They lie to themselves, so it is easy for them to lie to others.

In my last post I was not saying that I was angry at this patient for lying to me, nor was I totally surprised. I was disappointed, both in him, for promising to try to to be honest, and with myself, for allowing it to happen again.

It is not very difficult to determine why he lied. He needed letters for his probation officer. He didn't know if I would cover for him, and he probably didn't want to put me in that position.

I probably would not have told his probation officer, at least not before making several other attempts at getting him to change. Then what? I can't be sure. Drinking alcohol, even getting wildly, obnoxiously drunk, is not against the law. But if it is a condition of your probation that you can't drink, then it becomes against the law for you.

We all joined in the cover-up, especially over the last month. Everyone kind of likes this guy. The people who run the alcohol monitoring program liked him, and were also probably sick of him. So was probation. He didn't break any other rules: he showed up to every appointment, he did his community service, he paid his fines, he stayed out of trouble. I think everyone involved (except his wife) decided not to push too much and let it go.

Now he is out of the system. He doesn't need me for letters, nad probation doesn't need me to cover their ass.

Now the qustions are completely different. Does he need treatment? Who determines that? Does he want treatment? That's up to him. Can he benefit from treatment? That depends upon why he thinks he would be coming. Am I the best one to treat him? How can I believe anything he says? How much does that matter?

We still have an appointment set up from before his wife called and told me what she has been living with. If she shows-up for that appointment we will try to answer all of those questions before proceeding.

I'd like to be able to believe his answers. But then, Obama thought he could believe BP.

Again!!

Over a year ago I posted about a guy I had been seeing for almost two years who got drunk six weeks before he was about to get off probation, scuffled with a cop and ended up in jail for a month or so.

Well, he came out of jail, entered rehab, and went back on probation. In the beginning of his new probationary period he was put into a program that met almost every day, and monitored him closely. He had to stay sober for ninety consecutive days to get out of the program. He failed three times, lasting between fifty and eighty days. After those failures they told him he had to stay in the program until his probation is up, which will be Friday. And it will be Friday.

He has still been seeing me almost every week, and for a while he had been honest with me, telling me when he had been drinking and getting away with it. But over the last five months he had been telling me all the time how much he has learned, how much better his life is, how humble he had become, and how well he was doing with his new AA friends. He told me he was sorry that he had wasted so much of his life; but now he was sober.

I know that he needs me to write monthly letters to his probation officer. So I guess he couldn't risk telling me the truth. We had been talking a lot, especially this last month, about my concern that once he is off probation, and no one is watching, that his urge to drink will become very powerful.

He was very insightful and reassuring. He told me his strategies and back-up plans. He also told me that his wife has been watching him closely, and that she would probably cut him free if he began to drink again.

Bullshit.

Yesterday, I got a call from his wife asking me if it was true that on Friday, the day his probation ends, that I promised him I would get him into rehab.

What?

Didn't I know that he has been drinking about three days a week for the last two months, and that he has somehow managed to stay clear of getting tested.

Oh.

I guess the probation department is sick of him. I can't imagine that a substance abuse program that has someone checking on him one to three times a week really couldn't figure this out --- even if I didn't. They run tests, breath and urine.

I guess they figure that if he isn't in real trouble then his drinking is his problem, and his wife's.

Well, I am not going to turn him in. His wife told me not to call him because her life would be hell, and she doesn't want him to go to jail.

I don't either. And I will try to get him into rehab as soon as his probation ends. And when he gets out, I doubt that I will take him back as a client. I have a tendency, as I have mentioned, to try and bring out the best in people, I have higher expectations for them then they have themselves, and I think that sometimes it frightens them.

Drinking is not against the law. If he gets loud and belligerent and obnoxious, he runs the risk of getting in trouble. He also runs the risk of losing his wife. But he has lost a wife before this one.

Addictions are very powerful. They, whatever substance one chooses, can make you feel better, for a while, then anything else in the world.

That makes the rest of the world so disappointing, and so much more difficult to be a part of.

I let it go on blog day

Today is "blog for mental health day" in case you were uninformed. I expect by now that you have already read countless mental health bloggers. If you want more you can find them today at www.yourmindyourbody.org.

But I don't think they would be thrilled with my post today. You see today I let one slide.

I had just finished a session with Al, who got so depressed because his girl won't talk to him even though he has sent her eleven text messages telling her that he has realized how wrong he has been. he was just a lump of hapless rejection. Of course he has a tough history of parental rejection and oppression going back to when he was three, so this hurt hit him badly.

Then I got a call from Ben. He said left a message saying he just got out of jail, but he wasn't a criminal. He went to jail for illegal gun possession. He had a gun because he wanted to blow his brains out. Then, in jail, he said they put him on the wrong medication and it really messed up his mind. He was looking for help, for the right drugs and for therapy.

Was this true? Is this really what he was seeking? Quite possibly.

But today. I really didn't feel I could offer all that to him. I referred him to the full-service clinic at the other end of my building. They have people who do therapy, give drugs, do home visits, and take his insurance.

Nothing personal, but today I didn't want to do all that.

Falling Down

I continue to be amazed at the growing number of people out there who just can't cut it. It seems that the skills that it takes to keep functioning, productive and effective in our society are increasing month by month. More and more people seem to be getting confused, discouraged, or just plain overwhelmed.

Yes, the people who come to see me have difficulties. That is a given. But at least they are trying to deal with them. But they all bring with them stories of family members and friends who are worse off than they are, and who have become burdens to the families and friends who already have difficult lives.

Much of it is economic, as it is now very difficult to survive with a low-end job. Many, many jobs pay from $8 to $20 an hour. Almost all the service, retail and food related jobs. No one can really survive on that. Maybe if you're 24, and share an apartment, but you can't make a life. Yet, it is difficult work, with only a very narrow path to improvement.

But also the amount of drugs, alcohol, confusion, ineptitude, racial and sex discrimination, that is out there just adds to it all. Every day I get calls from people hoping to find a way to get on SSDI. The demands of a job, a family, and making a life become too much. They just don't want to do it any more. And once you fall behind it is so difficult to catch up. The welfare rules are complex and humiliating. The banks and credit system will screw you once you step into it too deeply, the computer-run bureaucracy, both the public and corporate ones, are impenetrable. People get angry. There seems to be anger everywhere. Changes come too quickly, no one seems to know what's next, or how to prepare for it.

There is a very strong feeling out there that things are not fair, that the rules are different for different people, the deck is stacked, and that there are no longer any standards of morals and justice. That seems to be the feelings of people on both the political right and left, but they each see different enemies.

What I see going on is this: AND I'm the one who KNOWS!

1. America has become much too much about the money. It always has been, but now it is worse and obvious. There is a lot of publicity about people who do not work hard yet acquire unspeakable amounts of money. Some people are just clever, some are heavily leveraged, and many just made money with the money they were born with. But now it is clearer that many people have become rich by bending the rules, a lot. And they get rewarded for it. No one really stops them.

2. People who see this expect that they too should be granted and easy, party, fun-filled life, without working too hard. They resent that they have to work hard every day. They feel exploited and angry. And now, with all of the new technology, everyone expects to be a star. We all have something to say, no matter how trite, trivial or meaningless. We all Tweet, Facebook, blog and YouTube. (Here I am, ranting on!)

But I have so many clients who have kids, brothers or close friends who spend hours and hours on-line, never see the light of day, and can't earn a living. Between Facebook, Pogo, and porn, their lives are complete. But they have no real skills.

Fifty, sixty years ago, it seems to me through the heavy fog of distorted memory, my father went to work eight to ten hours a day, six days a week. He was happy to be making money and have a warm home and a couple of annoying kids. He had come from Eastern Europe as a kid, and he was happy to be safe, and be able to keep what he worked for. He didn't expect life to be easy, He didn't want to be a star. He knew the world wasn't fair, as many of his relatives had been arbitrarily murdered by the Nazis. But he was willing to work, and he took satisfaction from it.

Much of that seem hard to find today. The Mexican, Chinese and Vietnamese are doing our dirty work. So many Americans seem to want to stay home and play video war games. The threat to our country certainly does not come sneaking across the border. It is right here in front of the 54 inch screen.

The week of the oil spill

Sometimes it is difficult to even know where to start. It's like getting hit with a rogue wave, knocked down, rolled over, washed out, pushed back and left dazed and confused on a beach six miles away. "What the fuck just happen?"

This week was like that. Maybe because it's May. May is always a volatile month. The sap rises, gets in the brain, thinking goes haywire.

There were so many stunning incidents that it would take pages and pages to describe them all in the complex context that wold give them justice.

Couple #1. After waiting ten ears for him to clean up his act so they could be together. They unite as a loving ecstatic couple,spend three years building a life, learning to trust, and then she cheats on him with a high-powered business colleague. Comes home, cries, asks for forgiveness.

Couple #2. Six months ago, when they were, again, both very drunk, her got into a jealous rage and beat her badly. He went to jail. She got sober and started her new life. She realized he was a liar, a manipulator, and an addict. Without him she was relaxed, competent and sober. I knew what had happened (as I am sure you have also) when she missed her appointment last week. Today her friend called to see if I could get her committed because she was back with him, getting drunk and beaten.

Couple #3. Last year she came to see me to deal with the grief over her son who had killed himself. This year her brother, who had been a nasty drunk for years came to live with her for three months while he went through the dying process. He died last month. Today she called to tell me that the tests on her husband showed that he has lung cancer and it is also in his liver.

Couple #4. They are getting divorced, for many very valid reasons. But he still misses her. He is basically a hapless, inept kind of shelp, but he wasn't going to be passive this time. So he got drunk and tried to come and see her. When the door didn't open he pushed out the air-conditioner and jumped into the living room. But it was the wrong apartment so now he's in jail.

Alice, on crutches, has a spasm, fell down and smashed her good knee and now can't walk at all.

Bruce, just getting somewhat free of panic attacks, took a walk to get outside on the beautiful spring day, see the sun and be happy. He took a deep breath, filled up with pollen, couldn't breathe, vomited, almost fainted, had a panic attack, won't leave the house again.

Carla, who is nuts, just plain nuts, in many different annoying ways, and has been for years, is in trouble with the court for being stupid and annoying. She wants to get a psychological evaluation to prove that she is not nuts. I won't do that for her because: 1. I am her therapist (for the little good does that does for either of us). 2. because I don't want to show her that she is nuts, and 3. I don't do evaluations. So she has been calling every psychologist in the county and explaining, her own unique way, what she wants them to do. Then she leaves them my phone # to arrange the appointment as if I am running a concierge service. I have already received six very confused calls.

Of course there is more, but that is the general flavor of how the week has gone. The question is not Why is this happening? I actually can give very reasoned, precise explanations for all of this. The question is not even, What should I do about this? There are several things I can see I need to do in order to begin to repair the damage.

But really, it's just like the oil spill. It comes from not having a safety valve. It gets into everything. It is so hard to clean up, the effects will linger for years.

It can take 125 years for 500 artisans and craftsman to build a cathedral.

One person can blow it up in thirty seconds.

1.