not yet perfect

There is a lot of stuff we humans do, that we just do.  We don't really think about it.  It hardly helps us function.  It often gets in the way.  But we do it over and over. We do it mostly because at some time in our long genetic history it helped us adapt to a world that no longer exists.

We:

Eat too much

Get anxious over nothing

Get angry too fast

Repeat old behaviors

Let our hormones be our guide

on and on.

And if we get challenged about why we do it we can then think up a great rationalization.

That's what makes us "human" which is different from "humane."

Not their fault

Once again, I went away, lost focus, floated in the warm water of the deep South, just to get away from the endless sleet and cold.

I came back to the waining days of full-time practice.  These are more difficult than I had anticipated.  Forty-two years of psychotherapy, and still the world is full of troubles.  Yes, I feel I have been of some benefit to about 60% of of folks who have passed through my threshold and sat nervously telling me things they had never spoken about with anyone.  But the big picture, the changes in the structure of society that we, the idealistic children of the 60's, Peace, Love and Understanding, had hoped the world would move toward, has not happened.

Injustice, insensitivity, exploitation, still, in many cases, take over.  Even if it is a minority of the population, it is that minority that aspires to power and greed, and it makes it all so much more difficult for those who just want to live their own lives in peace and harmony.

The people I saw for treatment this week, the ones who remain as I have been winding down my caseload, are some of my favorite folks.  The folks who were dealt four cards in a game of seven-card-stud.

A woman whose mother was a prostitute and whose father was a drunk.  At the age of six she was told to "play quietly in the other room" while the men came and went. But now, sixty years later, after a long  struggle, filled with many terrible bruises and losses, she has found her way, and has learned that she can enjoy herself, her relationship and her life, despite everything that she has endured.

Another woman, also in her sixties ( so many of my patients are almost as old as I am), who has been a closet lesbian all her life.  It has made her anxious, paranoid, OCD, and ashamed. Suddenly she finds that can relax in this new world that has unexpectedly opened to her. This change is all very difficult for her, and she is amazed and mystified that maybe she has not been such a terrible freak of nature all along.

And me, just a product of my own time, place, family, subculture and genetic potential.  So I still wonder, tritely:

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

The real underlying question, 1

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            Michael weighs approximately three-hundred-seventy pounds, give or take twenty on any different day.  He is forty-two years old and has been that heavy for at least a dozen years.  Because of his weight he cannot walk very far, and his back, knees and ankles hurt. Walking from the parking lot into my office is such a strain that he is breathing heavily and sweating by the time he arrives, and he sweat does not create a fragrance that will sell.  He knows that his weight has put a strain on his heart, that he has fatty deposits around his liver, and that he is living example of a health high-risk.

         Yet, at many of his appointments Michael comes in carrying a large container of caramel-mocha coffee.  He often talks about driving for an hour to find a special bakery, or to get pancakes with maple syrup. 

         Does Michael exercise? Yes, regularly. He walks on the treadmill in the building where he lives, for ten minutes, once a month.  He finds it exhausting and he hates it.

         Does Michael have psychological problems that contributed to his keeping his huge bulk?  Of course, he has a chaotic family history, he clearly has a sugar addiction, and he eats for many emotional reasons.  He also probably has some genetic factors that help him gain weight and keep the weight on.  Because of his weight he has social problems, and because of his social problems he eats.  He also eats too many of the kinds of foods that some corporations have spent millions of dollars designing so that people will crave those foods.

Of course, there are many more contributing factors that I won’t get into in this post.

So the question for all you psychotherapy friends out there is:

does Michael stay heavy because he really doesn’t want to change?  He doesn't have the will-power, or the motivation, the energy, or care enough to put in the huge, consistent effort it would take for him to lose weight?

Can Michael change if he really wants to?  Is it my job to make him really want to?

Or does Michael stay heavy because he can’t change?  Because there are too many factors, built up over too long a time, and they make it impossible for him to break his bad habits, fight off his addictions or even go for an operation that will allow him to lose weight?

Is there a difference?

Time only goes one way

One Time Dimension

            I am still working my way through Our Mathematical  Universe, by Max Tegmark, and having a good time doing that.   The book describes the current thinking about the Big Bang, cosmic expansion, the size and shape of our universe, and the reasons that it has turned out to be that way.

            Now I am on the part were he begins to describe the possibilities of other kinds of  universes, places that should exist, according to the current theories, but we may never be able to actually verify.  But he gives some limitations to even the strangeness of these places, that are basic to their existence, at least in the way that we understand the word existence.

           

One of these limitations struck me as a very important consideration for those of us who have deal with and explain people’s psychological existence, and usefulness.   On location 2781 of the Kindle editions Dr. Tegmark  states that it necessary for the stability of any universe to have only three space dimensions, and only one time dimension.  “With more than three space dimensions there are no stable atoms or solar systems.  With fewer, there’s no gravitation attraction.”  Ok, fine, I got that. (If you don’t, you can work on that yourself).

            Then he goes on to say, and this is the important part for me: “With more or less than one time dimension,  physics loses all predictive power, and there would be no point in evolving a brain.”

            What he is saying here, and I really agree with,  is that the major reason we have a brain and gain all of our knowledge, is for predictive purposes.  Those of us who survive and thrive are those of us who are best at figuring out what will be happening next, and then also figuring out how to deal with that.

            I have read before, I am pretty sure it was from Daniel Dennett, but he may have been quoting someone else, that the only real measure of intelligence is the ability to anticipate.   To me that means that a great deal of the measures we have of “IQ” are only of things that are one or two steps away from the real skills necessary to survive and be successful. Yes, it is probably helpful to be good at math, to have an extensive vocabulary, and to be able to put puzzle pieces together, but if you can’t figure out which way the bus will be coming down the street before you step off the curb, all those other skills won’t help much.

            We learn from out experiences, how the world works, that is why each of use thinks things work slightly differently.  Smart people can anticipate what is coming next.  Really smart people think about what will happen after that.

            Dr. Tegmark points out that this is only true if you live in a universe in which time only moves in one direction.  If time jumps all around, from past to future, to past , to present. It is useless to try to make any predictions., so don’t even bother developing a brain.  Thankfully, we live in the right kind of universe.  I hope you all can learn to take advantage of that.

Time keeps on slipping, slipping ,slipping....

It is clear that life does not slow down and give me time to reflect. I thought that by now I would begin to feel the effects of my diminishing work load, but no way will that ever happen on it's own. It seems that the changes in the world have meshed beautifully with the changes in my family to fill any possible moments I may have been hoping to use to do the things I often thought I would someday have the time to do, such as --very little.

 Such as stare at the sunset.
Think about where I've been and how I got here.
Think about where we've all been now that we are here.
Should the Celtics keep Rondo or trade him?
You know, important things.

But the inflow of information keeps coming and coming and coming.  So much that reaching a conclusion is difficult because there are always new facts coming in. And now, increasingly, some of the new information that comes in is from my own children, who send requests to help with their children.

I realize that my children's lives are really busier than mine, and really, busier than mine ever was. They and their spouses all have big jobs, are are all, in different ways, connected to people all around the globe, who seem to keep connecting at all times.  To varyng degrees, they all have to travel, stay for meetings, go to meetings, develop something, make decisions, on a deadline, and then be parents.

That's why they live close by.  I am one text message away from spending three hours with the kids or a phone cal away from spending next weekend taking one of them. And it's great.  Put on your wings and tu-tu, Grand-Pops is coming to make ducks out of Play-doh.

So today, which I had put aside to read somethings, think some things, and perhaps even write somethings, was a totally free Monday.  I stopped going to the office on Monday because I am cutting down my work.  But it followed four consecutive days of being with the lively, enthusiastic, creative creatures and prying the iPads out of their hands. And after four days with them I am left with fond memories, sore muscles and new viruses making me cough and sending me to the bathroom.

This is not a way to sit and think great thoughts and reflect upon my career as it approaches it's end.  But it is the way with life.  It keeps going, generating and re-generating.  And while great thoughts and brilliant insights are important, they don't come easily, just by sitting, and even when they do their impact is often minimal, and can even create a whole negative flurry if they are really transformative.

Grand-parenting on the other hand is important.  It can be one of the factors that separate the "haves" from the "have-nots" that everyone is beginning to realize has become a major problem. And the first duty of any grandparent, especially if the children in question are under three, is to make sure the kid thinks they are loved and protected, and that the world is interesting, and most of all fun. Once you establish the feeling that it should be fun to wake-up and fun to go find things to do, then life becomes easier, richer and valuable, especially if you are with people who want you there to have fun with.  Fun doing, experiencing, learning, creating, and making good things happen.

My reward is watching them smile, even if it from something as simple as a six-month old rolling a ball, or a ten year-old building a model of the entire universe, complete with two billion galaxies and black holes moving away from each other at just under the speed of light.

Well, that one is a bit more complicated.  Right now I'm going to bed.
Have fun.

Out There

I have always been very interested in cosmology -- as opposed to cosmetology, which never helped me very much.  I remember way back, reading about the discovery on the microwave background, in the mid-1960s, by two guys at Bell Labs, Arno Penzias and Robert Wilson.  It was the first real evidence that there was really a Big Bang.

The two great, almost unanswerable questions have often been of interest to the same people.  They attract me, partly because I always find myself thinking is big terms, and as my wife often points out, I get a bit sloppy with the details.

The two questions are "Where did we come from? -- How did ALL of THIS happen? and What is consciousness? -- How does that happen?

Even twenty years ago most scientists seem to feel that the answers to those questions was out of reach, and would stay that way for a long, long time.  Some even were ready to say that our little minds were not really capable of understanding all that.

Now, their doubts may be still true, but our little minds, or at least the combination of many little minds working with some great assists from wires, chips and 1s and 0s. have been able to come up with some very enticing ideas, and some fascinating possible explanations.  It may be proven at some point that all of these theories are just very clever ways of entertaining ourselves, but the whole process of searching for the answers seems much better and more useful than just walking away, or getting annoyed at the question.

I have just begun to read Our Mathematical Universe, by Max Tegmark, one of the physics professors at the local tech school. He is trying to make the case, and he admits that it is a bit beyond the usual realm, that the universe is really based on, and governed by, mathematics.

The scary part, and I have not really gotten that far into the book, is that from my own work with people, and trying to figure out why they do what they do, in terms of behaviors, thoughts, feelings, decisions, relationships and all, I have always had thoughts similar to that.

I do not think in numbers, or use beautiful mathematical formulas, but I have always felt that there are so many causes, factors and influences of behavior that a person's actions are really the result of all the combined, interactive influence of all of them, much more than having the person him/herself, make independent decisions.  I can remember way back when IBM was first becoming prominent and computers were beginning to become impressive machines, that I thought if this gets big enough, we could feed all the factors into this thing -- person, place, parents, culture, subculture, birth order, climate, genetics, nutrition, environmental toxins, diet, friends, school --- everything--- then we would be able to predict, with some degree of certainty, given what was happening to him or her, what he or she would do next.

We are not there yet.  But it is coming, kind of, and sooner than later.  And we will probably buy whatever it is they are selling, because that is what they will do with that information.

More of this, much more, later (and later).

Aging Out

Been a while.

I got away.  I couldn't stand the cold so I went somewhere warm.  It was beautiful.  Came back.  It's cold again.  "Why are we here?" asks the wife.  Answer is becoming more difficult to articulate.
....Well, the grandchildren are here....

Now I am spending two and a half days seeming patients.  I get out in the middle of Thursday and leave the office for the new, young guy.  He reminds me of myself as his age: energetic and idealistic.  He is only sixty-two.

But I didn't go home.  I had to stop on the way at a rehabilitation center (nursing home) and do an evaluation of Martin.  I first saw Martin around 1983. He was sent to me by his doctor, who hoped someone could help him.  Martin was well known around town, especially by the police.  He was angry and paranoid.  He was colorful and expressive.  His ideas of who was out to get him included not only the police, but the utility companies, and the air force.  His delusions about the air force was based upon the planes flying over his house.  This later morphed into being that the birds flying over his house had been trained to spy on him.

In those days that was considered crazy thinking.  Now, of course, how many drones look exactly like birds?

Martin was once good looking and charming, when he was not ranting against the world and getting in fights.  He fathered four boys with two different women.  He wasn't the greatest father, as he would wander off for a couple of years at a time.  Once in a while he would send each of the mothers a check.  He meant well, but really couldn't maintain any consist work, relationships or even state of mind.

About ten years ago one of his boys died in of either a fight, an overdose or a fall.  It was never quite clear, and was probably a bit of all three.  That really upset him and he became more depressed, angry and confrontive.  After a few years of that he calmed down, but was still in enough trouble to come and see me. He hoped that being in treatment could help him stay out of jail, which it did.

But now he is physically falling apart.  His circulation is bad, especially in his legs, so he falls down.  The last time he fell he broke his wrist, so he was put in this rehab center.  One of his son's contacted me and told me where he was and wanted me to help get the son to be his guardian.  That's why I went to visit.

Martin was very welcoming and happy to see me.  He was taking a bit of medication, something he had resisted for years, and it was helping his stay calm and almost reasonable.  He confided in me that he knew everyone was still watching him, but he was OK with that now.  They were nice about it now, even if it was all a cover-up.

His wrist was in a cast.  His knee was in a brace.  He sat in front of a walker, and held on to that so he could sit-up.  His roommate sat in a wheelchair.  There were people in the hall attached to chairs by a thin cord that would set off an alarm if they tried to get up.

Martin looked to me to be about a hundred and three.  It said in his chart that he is five years older than I am.  That's why I am not starting with any new patients.  I am finding that not working is a lot easier than working.  I didn't feel that way, way back when I was sixty-two.

Denial?

As I said a couple of posts ago, I am beginning the transition.  I am morphing from who I was and what I have been doing for the last forty years into whatever it is that comes next. It is an interesting time. I left work today(Thursday) in the middle of the afternoon.  Some young guy (62) now comes in and takes over my office.  I walked out into the parking lot and there were still cars in it.  I drove home and my wife was still on the phone, working.

If I haven't said it yet, I want to make it clear that I realize that I am very fortunate, and that I can do this out of choice.  I am getting older, but except for the reality that I can no longer run very fast, play basketball with people who are thirty years-old, and that I have much more trouble remembering names that I rarely use, I am in good shape.  I am nicked and bruised and sore in spots, but I am healthy. My skin is saggy and my legs are bowed, but I am fine.

I  also have enough money to be able to survive quite well. I am not buying a yacht, but I could buy a small boat and I am happy with my kayak. I am in a good relationship with someone who is certainly still interesting, to say the least.  Also, and very important, my two children are grown, all solidly self-supporting, both married and also in good relationships, and they now have their own children who are, so far, healthy, enthusiastic little bundles of joy and enthusiasm, when they're not fussy.  And all of these people live within twenty minutes of me.

So, with the fundamentals, things couldn't be better.

Given that, I am still trying to sort out what I want to do, what I can do, and what is important to do with the time that should be available since I won't be spending thirty-five hours doing clinical work and another ten to twenty hours doing the shit work I have to do to get paid, write letters, file reports, make phone calls...... all the stuff that goes with trying to be professional and get paid.

Well, the first thing I learned upon not working as much and getting older is it seems that unless I make a concerted effort to do other things, life will be spent doing things to stay alive. That includes more of what we used to call "daily life skills" in our evaluations.  Who knew they could take so long.  Dressing, cleaning, flossing, shopping, cooking, loading the dishwasher, emptying the dishwasher, reading the paper, checking on-line to see if what the paper said was accurate.

The next big thing, is getting the exercise that I haven't gotten since i played basketball. Go to a gym in the middle of the morning and who is there, women with rich husbands and old people.

Then there is the big one, going to some kind of doctor. My wife, unfortunately, has a complex medical condition, so she goes to the doctor more than she ever did.  I went with her last time, and just going to the big medical complex can ruin any positive outlook.  We are near Boston.  We really have the best medical care in the world. The best doctors, the best hospitals, the best research.  But who is there: old, sick people.  People shuffling along, people on walkers, people looking sunken in and ashen.

Most of these people are my age, some are younger, some are older, but everyone knows this is the next step, and the step after this is worse.

That's where denial comes in. Foe me it seems best to just keep going and ignore all you can. My shoulder hurts a little, so I don't throw any down-field blocks.  My knees can give me trouble so I don't jump, and if I do I try not to land.  My tooth got chipped, so I'm getting that fixed but it still bothers me. Still -- just keep going.

I know that I have ideas of good and semi-important things I want to do, but I don't have to do any of them.  No one has called up (or sent a text) asking me when I will be finished.  I realize that what I really need to do is relax, play and have fun. But exactly how to do that is still a bit vague.  I don't think I can go out into the street and find six friends and play Ring-a-levio, like I did sixty years ago.  I don't my wife will call me in when it gets dark.

For years it was a lot of fun just to rest and relax after a week of hard work.  Right now, in the afternoon, when I am accustomed to still having five hours of work ahead of me, I'm not that tired. So having fun means...I'm still not sure....and it feels kind of weird.  Not bad exactly, certainly less stressful, but still weird.

It's a pity the grand-girls don't live here so I would have someone to dance with. I'm sure they would lend me a tutu.

Reading and Thinking

Back to work, for now, and chugging away.  But also, at other times reading.
Two interesting articles about what is happening in our times and what is coming soon, are in fairly popular magazines.  The first is an excellent description of the agony of living with chronic, life-long panic and anxiety.  It is the cover story of this month, January/February, 2014, Atlantic.   It is written by the editor of the magazine, Scott Stossel.  He is unflinchingly honest about how anxiety seeps into almost every action in his life.  He talks about the many ways he has tried to cope with it, and how much he still struggles.

For anyone who has  ever had a panic attack I think this would be very helpful reading, unless of course, thinking about anxiety makes you anxious.

Related to that is an article in last week's (January 6, 2014) New Yorker.  It called The Gene Factory, and it is written by Michael Specter. The article is a description of BGI --Beijing Genome Institute, which is a Chinese company that is sequencing the  genes of all sorts of living organisms, from viruses to people with all different kinds of diseases as well as, and this is the new part, personality traits.

The article talks about how China does not have much in the way of what the West considers strict moral or ethical guidelines.  This company is much freer to attempt to find  a genetic basis for cognitive and personality traits that could lead to more desirable citizens. They are gathering the genes of people who test higher on I.Q. tests, or on other tests for creativity.  They are putting down the first steps for something that has been avoided in this country, the quest for designer babies.

On of the frightening differences is that in China it might be the State that is doing the designing more than the parents.  What traits the government may find desirable may be worrisome for the rest of the world.

Of course, China is the country that sends dozens of the children who are projected to grow tallest of to be trained in basketball from a very young age.  The results have not brought many victories.

So many questions about the causes and treatments of human illness, behaviors, and activities rushed through my mind upon reading both of these articles on successive days.  It is clear to me, especially when I deal with people who have always had trouble with such things as panic attacks, that at least part of why it happens to them is that they have some genetic predisposition to be more sensitive and reactive to certain kinds of stimuli, especially social pressures.

But surely, it is much more than that.  Complex behaviors are always the results of complex interactions between a person's physical make-up, the current physical state, their individual history of experiences, which includes their family, their community and their culture.  It is also affected by so many other factors such as nutrition, temperature, stress, interpersonal relationship, past current and projected, and just random events.

Still, with Big Data, and fast gene sequencing machines, as well as comprehensive computerized medical records, academic records, work history, so many trends and interactions and patterns will be found as more people feed all of this data, for millions of people, into machines that compute and compile millions of digits a second.

How much do we want to know about ourselves, our talents our possibilities, positive and negative?  How much would we change?

Of course, we all want to know about everyone else.

In fifteen years some guy will be casting his eye on my granddaughter.  I'm going to want to know who he is.

2014 and Me

Again, Happy New Year to all of you in the bloggosphere who happen to stop by.  The weather has been really lousy here in New England, but it is January and I am older than I was, so what should I expect?

I mention getting older because that is what this year will be about. This year, more than just trying to help other people to make some kinds of changes in their lives, I will be attempting to make a major change in mine.  From now until the next solstice, the one in June with the most sunshine of the year, I will be reducing the number of patients I see each week.  My goal, which is being monitored by my wife and family, is to have sent almost everyone on their way by the time the sun goes down on that day.  I will then take the entire summer off, and if I return to work as a therapist at all, it will be on a very limited basis with a very different model of treatment.

Sounds like a plan, but like all plans, especially those made at the beginning of a calendar year, the execution and follow-through are really what counts.

I have little doubt that this will come to pass.  most of my friends know already and I have begun to let my patients know. It is part of the rotten state of health care in the US at present that making good referrals for some of the people I see will be very difficult.  The changes in insurance, and who takes what, the the lack of good mental health providers, and the huge changes in how services are delivered........but that is all part of why I am letting this model go.

The real difficulty I am already beginning to experience is with me.  What will I do? What will it feel like? Will I get anything done?  and what do I mean by getting anything done? Changing my life will certainly be the biggest challenge of this year, not dealing with anyone else.

I have many vague ideas about how to relax, reduce stress, be a grand-pops, play, read and think.  But the lack of structure is very intimidating after more than 40 years of going to work five days a week.

It is easy to find ways to enjoy life.  It seems that it will be more difficult to find ways to get satisfaction from doing that. Why this is true for me is not yet clear.  Some it is that there still seems to be so much thatneeds to be done.  Some of it is just vanity.  I need to feel important.

I will probably have more time to see what Life in Merlin is like.

New, for the New Year

New Year --2014.  On that, most of us agree.  What the new year will hold seems to be less clear than for almost any year I can remember.

Part of that is, perhaps because I am old, the pace of change seems to be accelerating. More than ever, people expect changes.  They expect life to be different; technology is mostly responsible.  New phones, new apps, new ways to track your life.  There will be new ways that other can track your life.  New ways that we do business.  Do business with new people, new people from new places, who bring with them new ideas.

More data, new data, Big data.  New algorithms: in genetics, in demographic, in sales. Bringing good news,  New ways to track diseases, epidemics, climate change, money flows, where the crops grow, where the fish swim, how much, how many, how good.

Bringing bad news: how to blow things ups, randomly.. How to shoot the enemy, your family, random people in the street, at a mall, at school.

So many new things, even including programs that create programs and robots that build robots,

The economy: better or worse, for the few or the many.  The stock market, more up, flat down, down big, who knows?  Most people are too baffled to even try to predict.

The mid-term election?  The Middle East? Fracking?  Cities, countries, art, music, literature,biology, chemistry, astonomy, food, fun, families, casues, cures.

There will be more changes in 2014 than there were during the thousand years from 500 to 1500. But it is world wide and there is no central authority -- not that I would wish it -- so no one really has any idea how this year will play out.

Right now it seems very exciting, but also risky and confusing, with the possibility of so many unintended consequences, and so many random events that could have a major impact because we are all so much more inter-connected.

So, figure out what part you would like to have in it all, which may just be wondering who will win Dancing with the Stars, or perhaps how to suck all the greenhouse gases out of the atmosphere, or how to teach your kid to dance, and get to it.

Good luck!!

Again,'Tiz the Season

We have passed the moment of most darkness, but it is still crappy out there.  It is dark, damp, piercingly cold and windy.  "Tiz the Season once again.  Perhaps I'll drive around and look for over-lighted houses to perk me up.  I took the girls out to do that the other night.  They are 2 and 3 years-old cousins.  They were delighted, but confused about the whole thing.

Me too.

I am not going to work for these two weeks.  I left the office with very mixed feelings.  The last day was too extreme. Two of the people  I saw are doing very well and were headed out to happy holidays. But two others falling apart physically.  One is very old and things are starting to not work.  The other is quite young and his diagnosis is very scary.

But Alice  (see 12/9 post) came back in and a doctor had given her something for her pain which she was enjoying very much.  As her pain subsided Alice was once again very much alive and hoping to stay that way.  She was again filled with rage and thoughts of vengeance; back to her sweet old self.

So, to all of you who do not wish to impale your brother or throw your mother off the train this Holiday Season.  I wish you all the best.

Be warm, kind and respectful to all around you, no matter their views, or foolishness. We are all really just the products of our physical being and the experiences we have been through. We are all searching for a few rays of happiness.  We each have the power to give some of that to one another.

Enjoy.

Why I am not always the best Therapist

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

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

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

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

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

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

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

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

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

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

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

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

Big Data 2

Yesterday:  A couple of my patients were talking about how stressful and how constant their jobs were.  Later I met with a few of my colleagues for our annual gathering and we joked about how much money we weren't making.  Most of us can track at least a 20% fee reduction from insurance companies over the last eight years -- beginning long before Obamacare.

Part of the reason work is stressful is the result of how we live in a global economy and many jobs, from running a chain store to developing software to track weather satellites, is often done by teams from all over the world who work together virtually.  That means that someone is always working on it, and everyone is always part of the process, so everyone is "on" almost all the time.  Another reason, and here we begin to get into Big Data, is that costs are tracked all the time too.  Data comes from everyone's computer about who is doing how much of what.  It becomes clear from the data when someone's job is no longer needed, then they can be cut, just like turning off a machine.  It makes it easier because the person who cuts someone else out of the job has no real idea who that person is because they may be working a thousand miles away and not across the hall.

Then because people get cut so easily everyone knows that jobs are not only hard to find, they are hard to keep, so just having a job is a good thing.  That means the employer won't have to pay as much because people want to work, and people know they can be replaced easily, either by someone else looking for work, or else by a machine that won't complain.

Because so many people work in ways that are connected to some kind of electronics, whether it is a big office workstation, a hand-held box scanner or a GPS, all kinds of data about how fast people work, who follows rules, who creates better methods and who creates trouble is monitored and algorithms are developed to pick out the "good" workers and weed out the "bad" ones.

The pressure to get something done seems much more intense than it was ten years ago, and certainly much more than it was twenty-five years ago, pre-email, when you could go home from work and not have constant up-dates.

The pressure is great, but to what end?  Most jobs seem to be help business get get better organized so that they can sell me stuff I don't need and probably didn't ever think I wanted.  Most airplane travelers are business travelers who travel to help businesses run other business to make something, somewhere that someone else will sell to me.  While they are traveling they go to hotels and restaurants and use cars and use business machines to keep in touch and to track how they doing, and how much gets made and sold.

It all seems to go around and round.  It creates a lot of stress, but it gives people jobs so that they can have families and buy stuff for their families, which keeps the businesses going

Now everything everyone buys is tracked and priced and that allows someone to advertise to whoever bought what they did to buy more of it, quicker and maybe cheaper.  Which is good because I just got a $900 sweater for $9.99, and if I buy another I get another one free, but I don't need three sweaters, but I  may some day.

Should we sorry about this?  Should we get off the grid?  Keep all our data private, away from the NSA, and Google and Amazon and Macy's and Walmart and Target, or should we just buy another sweater and keep it all chrunning along?

And it's been three years and the US hasnt started a new war.

Holiday Season is Mixed

'Tis the Holiday Season again, as we all know.

We are less than two weeks away from the Solstice, at which time we will begin to get our light returned to us on this side of the globe.  It is spending its allotted time down on the Southern Hemisphere right now.

Last week, to kick off the holiday season, David Brooks, the esteemed columnist of the NY Times wrote a piece explaining why it is not good for anyone to commit suicide.  A cheery topic, and I'm not quite sure why he picked it, except that some statistics came out showing that suicide rate around the world seem to be increasing.

Mr. Brooks said it's a bad idea because most people who attempt suicide and somehow fail, later to report that they are able to reach a point at which they are happy to be alive.  Also, he said, suicide is selfish, and it hurts the people who are still alive.  This is often, although not always, true also.

Now, I'm not for suicide, except perhaps if you (perhaps me) get old, are in great pain, can hardly remember who you are, and have no chance of improvement except to take huge amounts of drugs which will made your pain less but your awarenes of self negligible.

I have spent lots of time convincing people to stay alive another day or two, just to see if they feel better, or see some other option.  I generally feel that we all will be dead for a really long time, and that we are only alive for a short time, so we should see what happens with the time we have.

But I appreciate that some people spend the time they have in misery and desperation, and despite the wisdom of others, it often feels like the stress, the pain, the losses, the agony, just isn't worth hanging around for.

I spent an hour with Alice (not her real name, and not the exact details) last week.

She is now almost sixty, and looks about eighty.  Her pain began as soon as her mother decided that Alice looked too much like her father.  Soon after Alice's birth her mother stopped liking the father, and Alice along with him.  Because of this resemblance, the mother rejected Alice.  She would beat her, demean her, scream at her and lock her in a room.  The mother did this to half of her six children. The other half she favored.

Alice survived because of an aunt and her older sister who both tried to protect her.  But her life was never smooth.  When she was fourteen her brother brought some of his friends home so they could rape her.  She broke three of her brother's ribs with a candle stick, and sent one of his friends' to the hospital with a concussion.  That got her into a "girls' school.'

Her one real love relationship died of an overdose.  Her other attempts to be with a man were much less than successful.  These relationships were often violent.  Alice was in many fights, had many rages when she almost killed someone, and was often badly beaten herself.

From the ages of 17 to 53 she drank very heavily.  Then she stopped.

Now she is calmer, sober, but alone and in great pain.  Her father has been dead a long time but her mother, almost ninety live on, with a sister, and still swears at Alice.  Alice and that sister are the only two of the six who are still alive. Two died of cancer, one in a motorcycle accident and one was murdered.

Now Alice needs a new hip. She walks with great difficulty. Her wrists are so bad that she can't open her car door without a great deal of pain.  She is probably brain damaged a bit from all the fights and alcohol.  Every joint hurts.  She trusts no one.

She said that she often wishes she was dead.  She won't kill herself because,... because that's not what she does.  She is a survivor.

So we talk about what we can try to do to make her life a bit better.  She isn't religious.  She didn't think God was on her side.  She doesn't believe in love.  She hardly believes in "like."
But when she takes a couple of Percocets, she can get comfortable enough to be curious about what will happen next.

I hope your holidays bring you closer to someone who you can like and trust.

He Passed!

I am still working, and more and more my work frightens me a bit.  There are so many things that can happen that we can't control.

One of the things that makes me scared is the unexplained increase in Autism Spectrum Disorders.  About ten years ago I was a bit skeptical.  Was this being over-diagnoses?  Were kids who were a little odd or a bit removed getting labels that would hurt their lives?  Or were they getting labels so that they could qualify for more educational services?

I didn't know.

But as the years went by and I saw more families with these boys, mostly boys, I was convinced by the evidence that something was happening.

Now, this is a Spectrum disorder, and some of these kids are different, but fine.  They miss some social cues, and they over-focus, but they can be well-adjusted and productive.  But others are further down the Spectrum.  Some need help, some need a lot of help, and some are just overwhelmingly non-functional.

And the numbers seem to be increasing. According to recent data 1 in 52 boys are on the Spectrum.  That's almost 2%.  There seem to be some contributing factors, such as older parents, especially older fathers, but the real cause is not clear.

At the end of August my third grandchild, and first grandson was born.  I had no reason to suspect that anything was wrong, but I have seen how much time and attention and effort a special needs child can absorb from a whole family, and I would do it if that was necessary, because what else do you do, but I would prefer not to.

But now he boy is over two months old.  He looks at my face, old and puffy as it is.  He looks in my eyes as I hold him.  He reaches out to be held.  He now smiles when I play with him and move his hands and he coos back at me when I coo at him.

He's fine.  He passed.  I'm don't have to worry.

In six months I'll buy him a truck and a basketball.

I did that for his older sister too, but now all she wants is her tu-tu and to dance!  How does this happen?

Anyway, Lets all Dance!!

Happy Holiday if you Can.

Big Data

I'm reading the MIT Magazine.  They highlight 35 innovators under 35, about half my age.  Many of them use Big Data to see trends, make predictions, help the world.  Amazing stuff.

One person has constructed software that predict outbreaks of cholera, another has learned to show traffic patterns that can help reduce fuel consumption and help people shop locally.  Another does genetic screening for recessive diseases.  A pharmacist in Ghana has an app that will tell people if the medicine they are taking is real or fake -- a lot of it is fake in third world countries.  On and on, great stuff.

It was Big Data that led to the new statin drug recommendations -- that half the wold should take more pills.  Now there is a reaction to that.  People don't feel that Big Data captures them, and their individuality.

Psychotherapy does not led itself to Big Data.  That is it's strength.  IT assumes that everyone is an individual; everyone is unique.  And we are.  People respond so much better when they are treated as a special. unique individual.

But Big Data sees things that no individual can.  We are all a contributor and a victim of our times.  We breathe the air and drink the water and eat the processed food.  We think the thoughts that come all the media of the day, and those around us.  Things happen because other things happen.  If you can see what is happening you can help, or prevent other things from happening.

But I'm ME, we all cry out.  None of us exactly fit the profile of who WE all are. We can't forget that.

Very difficult to find the balance. Who to trust.  How to decide what to do.

Not That Good

It's pretty clear to me now that I am in the process of winding down my practice.  I've been in a "private" practice in this city since 1981.  The reasons for my starting to close down and move along have been discussed here in several ways, and will be again.  But not today.

But, I have been looking back as well as forward and I can see that having a practice like this as mostly what I wanted to do.  My first choice would have been to be part of a real community mental health program, such as the one I was sent to school for, and where I had my first job.  These were places where people could go for evaluations and treatment of social, emotional and learning problems, and also for neighborhood problems and community issues.  We were just learning how to do preventive work, educational work and consult with other agencies when President Reagan decided that this sounded like Socialism and his government wouldn't pay for those things.

So, we got licensed and went into private practices and then we got paid by insurance companies.  That model was good for treating the kind of problems people brought to us, but  treating them one by one, which was often kind of frustrating, since many of them really were caused by what was happening in the community, or society at the time -- still true.

Also, looking back I can see how successful I was at treating people with relationship difficulties, with anxiety and panic problems, with many forms of depression, with loss, loneliness, addictions, and many of the other things that disrupt and deplete people's lives. Often that was very gratifying.

But we, mental health professionals: Psychologists, Psychiatrists and all the others, still have very little  success treating the real destructive kind of "mental illness," the kind that rips families and communities apart.  That is we offer very little help to the person who is angry, obnoxious, aggressive, upsetting and destructive.  These are people who get about six diagnoses during their lifetime, including Borderline Personality, Major Depression, Bipolar Disorder, Antisocial personality, Oppositional Disorder, and other such names that don't identify an underlying cause as much as they are just descriptive.

We offer these people many medications, dialectical behavior therapy, cognitive behavior therapy, and many other kinds of treatment that don't work, mostly because the people don't attend, don't follow, get angry and frustrated easily and leave.

There are many people who are afflicted, if that is what it is.  They bring heart-break and havoc to their families, they take too many drugs, make bad decisions, and cause problems in the community. I feel, that because so many of the tasks required in today's society are complex, and demand much more interpersonal interactions, and at a quicker pace than previously, that more people break-down and reach their breaking point.  Then they get angry, stop functioning, don't pay their bills, get in arguments and fights, and end up either in legal trouble or in bed for weeks. When they get out of bed they are further behind, angrier, and cause more problems.

I have seen many for therapy, and then they don't return.  I hear about so many more because their families suffer come to me for help.  They don't know whether to try to help or cut ties, and neither strategy is successful.

It's very sad.  We have all kinds of labels, but no real treatment.  The cause is probably a combination of genetics, family, community, timing, diet, toxins and luck.  But then what?

That is the real problesm in mental illness, and we don't have a clue.

Boston Strong ! ? !

I live close to Boston.  I went to college near Boston, where I met my wife.  We left for graduate school, but came back to be near our friends, and be part of the culture that is in Boston, Cambridge and around here.  We raised our kids close to Boston and they are raising their kids here.

There was a parade in Boston yesterday so that people could line the streets and cheer for the Red Sox, who had just won the World Series.  I didn't go to the parade, although I did watch six minutes of it on TV.  I don't go to any of the games, although I did watch many hours of the playoffs on TV.  I went to two Red Sox games this year.  I enjoy baseball.  I played a lot as a kid, and for several more years of softball in my fifties and sixties.

Many writers, analysts, bloggers, pundits, sports people and politicians are talking about how this baseball team was very helpful to the city after the bombings that occurred during the Boston Marathon,  a signature event of the city.  I agree.  This was one of the greatest bonding moments any city could have. Better than anything that could be planned or staged.

First, you have to realize how much sports means to Boston, especially pro sports, especially the Red Sox.  The Sox are like football in Ohio or Alabama. They are more important than surfing is in California or skiing is in Colorado.  We are not that outgoing here in New England, but everyone will comment on the Sox, even if you don't care about baseball.  A strong woman candidate lost an election for Senate because she didn't know who pitched for the Sox.  Even my wife watched the World Series, and dropped her knitting when Jonny Gomes hit that three-run dinger.

Ten years ago, in 2003, when Pedro couldn't finish against the Yankees, so many of my patients were just bummed out for two weeks it was hard to talk about anything else.

So this year, after the bombing, it was clear that the city began to pull together for the Sox,  The Sox who came in last, last year.  It clear that the Sox would show that the city, the region, was not to be denied.  That it could be knocked down, but we get up again, and that we get along, as a team, with each other.

I came to Boston as a student. So many people do.  So did the bombers.  We need students, we value intellect, study, research, innovation, technology, and everyone who does that.  We value everyone from everywhere.  If you walk around MIT, Harvard, BU, BC, Tufts, Northeastern, and the rest of the fifty or sixty colleges and universities that are in and around Boston, you see people from all over the world: China, Africa, Europe, the Middle East, Latin America, Mississippi. They are what makes this an exciting, stimulating, fascinating place to be.  Two angry, discouraged brothers, whose sense of decency went off the rails, are not going to change that.

We, all of us in and around the city wanted a way to show that.  We still cared, we still like and respect each other, we still get along -- differently from the way we did in the 50s, 60s, and 70s, when we didn't get along that well -- and when the Sox kept losing.

The Red Sox helped us to do that.  The players were from about fifteen different US states, as well as  the Dominican Republic, Aruba, Venezuela and Japan. I think two are from New England. We cheered for them, they played for us. Everyone had a good time. There was a big parade.  No one got hurt.

Boston will continue to be vibrant, stimulating and welcoming. Bring you willingness to learn, to collaborate, to build and create.  That includes all ideas from all cultures and backgrounds. Skills of pitching and hitting are also welcome.

She asked......

Ok, so that craziness and symbolic dance to please the powers that pay for it is over.  The National Parks are open, so that helps me, and others will get their food stamps, Head Start visits, cancer treatments, cosmic research, NSA surveillance, EPA protection, meat inspection, and paid for developing a big stealth jet that will never be finished.

I will be off to Yosemite soon, to visit a place I have always wanted to see.  I did not expect that it would be part of a political statement.  But, as I said in my Listserve post:  Nothing surprises me.  Nothing is too absurd, especially when it is exploitative, when those who have tell those who don't that they should suck it up.

Meanwhile I have been slowly responding to the hundred of questions I received last month.  people seem to care.  When I finally respond, most of them respond to my response, which is nice.  I now have a couple of hundred new email pals from all over the world.

Here is one example, here is only a part of what she wrote:

I am dating a man, actually engaged to him, who has "cheated" on me several times...cheated by engaging with women/old flames via social media twice in two years (suggestive texting)...and once he snuck off to go dancing, where he met a woman, and kept the flirtation going (no sex/only kissing) for a few weeks before he ended it.

All smoke and no flame, I guess you could say.  But I don't like it.  Not one bit.  

I responded:

Good question; sorry for the delay in responding.

My thoughts: (and read every disclaimer possible into these)
If he really, really is only doing these flirtations on-line, or by text, and he really wouldn't act on them if given the chance  (can anyone believe that? even him?)  But if that is true, then you have to remember that he is fifty, and I remember that as a dangerous age for men. It is really a time when we don't want to feel as if we are slipping into irrelevancy.  We are too slow for basketball and have to play "Senior" sports.  It's all about still being attractive.

But, if it really makes you uncomfortable, and you are worth it to him, he should be able to control it.  You can confront him gently.  Tell him how much he means to you and how much this makes you feel queasy and how you think less of him and his insecurities.  And also tell him that if it continues, you will not only leave him, but that your parting shot could make him unable to operate for a couple of months.

Give him that whole " hell hath no fury..." routine.

Forgive me for taking so long to reply, but I received hundreds of questions, and I still have my day job so it is taking me a while to get to them all.

All the Best!

Political, Slipping away

I have been very busy, and when I'm not busy being busy I have been busy answering the literally hundreds of questions I have received from around the world.  They mostly have been about how to get along with a significant other or how to find meaning in life.

I mean, good luck with those.  I will post my answers more often than I have been, I hope, if I'm not busy.

But right now I have to make a brief comment about the obvious: The U.S. government is fucked-up.  But I don't want to spread the blame equally, I think that 94% of it goes to the right-wing wing nuts who feel that spending money to keep middle class and poor people healthy and financially solvent is the worst thing that a government can do. But now they seem to have changed their mind about what they are upset about, and it seems to be that now they are upset because everyone can see they are a bunch of sore-loser blowhards who backed themselves in a corner and the President is pointing this out.

They thought they would be clever and hold the world up for ransom, and they still might.  But hopefully, this is another step in the beginning of the end of those who feel that the purpose of the United States is for white men to make as much money as they can, any way they can.  I know that five members of the  Supreme Court still believe that, so that will cause more trouble, but most of the country is turning away from that.

Obamacare is a huge social program, and it is the beginning of a slide toward government health care. That will prove to be widely accepted and greatly appreciated.  I do believe that everyone should be on Medicare, and then be allowed by buy their own supplemental plan, and that something like that is thirty years away, but maybe sooner.  For in twenty years most of the Tea Party will be in nursing homes trying to vote for Ronald Reagan again. By then the video game generation, who seem to be the kind of folks who care about each other collectively, if they are not blowing each other away and stealing each other's cars, will take for grantedthe benefits of universal health care, and not mind paying more taxes for it.

A clinical observation

Over the years of dealing with many people and hearing about thousands of relationships I have concluded, from the anecdotal evidence of my observations, that it becomes much more difficult to end a relationship, no matter how difficult, unrewarding, and troublesome it has become, after you have had sex with that person three or more times.

Seems to be the case...

The short answer

"A Mister Richard Fader from Fort Lee New Jersey writes:".......(most of you probably get that, right?)

Anyway, more than one of the questions I received was from far away and it asked, simply, if I thought that there would ever be a time when the people of the world would get along better, and that greedy, power-hungry people would no longer have such a strong influence.

I replied:

I do think that, overall, the world has become more civilized and there is really less torture, fewer huge wars,     and more are  people getting along better. I don't know if you have a chance to read Steven Pinker's 

"Angles of Our Better Nature" but he makes a good case for that.

Yet, it is obvious we are not close to the great wave of human harmony.  I think the global climate change has 

put pressures on countries to fight for basic resources that are becoming more scarce.  
That is a lot of what underlies the problems in the Middle East and northern Africa today. 

I also think that technology has made life so much more efficient that it is becoming more difficult 
for people to find meaningful work, if they can find work at all.

Until those problems are solved in a manner that gives everyone a chance to survive and have a 

decent, but not decadent lifestyle, there will be fighting and trouble.

Take good care of yourself.

social anxiety

I am slowly reading through the comments and questions I have received from my Listserve post ten days ago.  I am going through them when I can, but I also have have my day-job, the three grand-kids, a wedding I attended, a bit of time with the wife and friends, and then the Sox clinched the pennant and the patriots caught the ball and won another game.

But a few of the questions were about how to deal with social anxiety.  As one woman put it:

I'm in a field that requires a lot of 
networking, but I have a lot of social anxiety when I spend time with these 
people outside a professional setting. I don't feel like I belong, that I have 
any right to be there. I get seized by dread. Any advice?

These feeling on not belonging, not being worthy, feeling conspicuous, and constantly

lacking, are very common, much more than anyone who has them realizes, mostly because 

no one talks about them.  But they can be very powerful, and they put a great strain on a

person's life, and a strain on the lives of others who depend upon them.

I have treated many, many people who have many different shades of anxiety disorders, and most of them make a great deal of progress and function much better.  Only a few are ever  completely free of  those feelings and are never bothered again.

It is because of this I am fairly certain there is some genetic component to this.  Some          people are designed to be more sensitive and more reactive.  There are good parts to that, 

to being more aware of how other people feel, and what is going on around you, but it can 

get way overdone and make a person so uncomfortable and be such a strain that it greatly   limits their lives.

That isn't to say that the cause is totally genetic; that is never the case.  But when someone who is prone to anxiety is put through circumstances of great stress, ambiguity, or is with  people or in circumstances that they cannot control, they are vulnerable to panic attacks     and strong feelings of anxiety, doom and dread.  

Given all that, this was my reply to the people who asked about social anxiety:

Social anxiety really sucks.

 some tips:

 1.  When you go into an social setting don't expect to be fine; that will only disappoint you and make it seem worse.  Expect the anxiety and sit with it. See if you can let it pas through you.







 2.  Of course you belong -- we are all united by our real insignificance -- even if you don't feel it.  if you are surrounded by people and feel tense, just sit and observe.  Don't pressure yourself to talk until you want to.  Try to pay attention to the conversation more than your internal feelings.  If you can show people you are actually listening to them they will be very flattered and they will think you're a great person.







So, that was my "Internet Advice," It's worth about as much as she paid for it.  I hope it was helpful.  Anxiety increases when people try to control things that are not within their power to control.  Your mind churns and churns trying to find a solution.  Then you feel that your mind is out of control and you must be crazy.  That's when things get worse.




Anyway, I hope that none of you feel like that today.  



Enjoy the beautiful Autumn weather. ( and forgive me for the disjointed formatting, I'm not sure where it came from.)

the task ahead

I am almost finished telling everyone who sent a request that I will get to their question some time in the next -- who knows when --- but I will.

In my message to the Listserve I said I would answer questions and of the 260 responses, a bit more than half seem to be legitimate questions.  In the piece I wrote I stated that nothing that people do surprises me anymore. After reading the comments, I find I am not surprised, I am a bit saddened that there are so many people out there who are not only struggling with so much, but are also searching for a way to find help.

As I have said in the past, I am not a fan of psychiatric diagnoses.  I feel that these labels only mark people as "sick" when they are really just dealing with the shit the world has handed them, often from the moment they meet their parents.

The causes of upset and strife are similar all over the world: stress, loss, loneliness, illness, trauma, and inadequate resources.  These are the factors I usually look at when I try to define a problem and then set about looking for a solution; something that is always a joint process with the patient.

The sad part to me is that there are so many terrible situations that people are reporting, and I hope to be answering them really soon.  The other side of the picture is that only one percent of the readers of the List felt the need to respond, so the other 99% either thought what I said was OK or useless, but they are moving on well enough without me.

In some ways that's comforting.

A comment about the comments

The comments in question are not the comments on this blog, which are mostly Forsythia's welcome and supportive comments.  But I have been reading the emails that I have been receiving from the post on the Listserve on Friday.  There are over 200 of them, and most took me up on the offer to ask me any kind of question about relationships.

The questions have come from all over the world,literally: China, Portugal, Brazil, UK, Australia, Italy, South Africa, India, and at least twenty U.S. states.  I believe I have heard from every continent that is not covered in ice.  Some of the questions are very specific and about the relationship the questioner is in.  Some are very general and ask for the kind of general guidance that I am reluctant to give. And others are from people who are dealing with emotional difficulties, the kind that I deal with in my office.  In fact, I hope to make a few referrals if i get more specific information of where the questioner is located.

Many people state in their email that they have not  sought help, and have not asked their question before.  Several have said that they feel more comfortable asking someone who they don't really know, who is hundreds of miles away.

Again, it shows how much confidentiality, and the fear of being judged plays such an important role in establishing a therapeutic relationship; any relationship really.

I hope that over the next few weeks I will have time and permission to post some of the questions, and my marvelously wise answers here.  But now I have to go and change my grandson's diaper.

Be patient kid, you're acting like you're two weeks old.  Oh, right.......

The Listserve

A year or two ago, someone in NYC began an Internet project called The Listserve.  He or she got about 24,000 people to sign up to get an email a day from a randomly selected person who had subscribed.  I have been reading these emails fro about a year.

A two days ago I was randomly selected.  What I posted is written below.  But before you read that I want you to notice that at the end of the post I invited people to ask me any question they wanted, since you already know how impressed I am with my own knowledge.

Well, so far, less than two days later, I have received over 200 comments and questions.  In the coming days I will post some of the question I received, and my very clever answers.  That will be easier than thinking up things on my own.

Here is what I posted:

Hello Listserve:

            I am considerably older than most of those who have already posted 
their messages on this site, and thus I have lost most of my armor of idealism .  
Much of this is due to the experiences I have had working as a Psychologist in 
Massachusetts mill cities for almost forty years.  I feel I have seen almost 
everything humanity can offer.  I no longer question whether something is good 
or bad; I just see it as fascinating.

            There is nothing anyone can do that would surprise me any more.  
Anything my wildest imagination can produce someone out there is doing it, and 
they are doing it thinking it will bring them happiness or satisfaction.  Most 
of the time it doesn’t.

            I would give you all advice, because I know, better than Dr. Phil, 
what you should do with your life, but more than that I know that you wouldn’t 
listen. That's not how people change.  Change has to come through emotional 
experience.  Perhaps in three years you might think back and say, “maybe that 
guy was on to something.”

            I am a big believer in the saying “When the student is ready, the 
teacher appears.”

            Humans are a work in progress, an intriguing but flawed species.  If 
you haven’t realized by now, please take notice: the world is almost always run 
by character-disordered people.  Kings, Queens, generals, presidents, tyrants, 
business leaders, billionaires, market movers, and celebrates are usually 
greedy, power-hungry narcissists, or else they have that missionary zeal and are 
self-righteous.  That’s not always true, only about 90% of the time.

            Most people are basically kind and caring. They want to get along, 
have a few satisfying relationships – which is difficult enough-- contribute 
something to the good of the world and then relax and enjoy their family and 
friends.  But then someone comes along who wants to grab power and take control  
of everyone and everything.  He (it almost always is a he) identifies some small 
difference as a huge threat, then gathers a group of devoted followers to save 
his people from it, and everything goes downhill from there.   Just look at 
history, and look at what’s going on now.

            As I said, I am old, I am wise, and I know everything about human 
relationships.  If you want an answer just send me the question.  I won’t expect 
you to take my advice.

Diagnostic discussion

Given all of the talk about how helpful, accurate or scientific psychiatric diagnoses are, and how embarrassing DSM V is, there is an attempt o bring some hope to psychiatry in an article in the Sunday NYT Review section.  In that piece, Dr. Eric Kandel, a Noble Prize winner in physiology, tries to make the case that we are well on the way to having better diagnostics through brain research.

In his explanation he gives a very positive nod to the use of psychotherapy as an effective treatment for mental disorders.  Along the way he re-labels psychotherapy as a brain-treatment, and takes a slap at therapists lack of scientific rigor, but his view of therapy is general very positive.

He makes a case, that is much more hopeful than real, that further study of neuroscience, genetics, and bio-chemistry will eventually, in years to come, reveal the underlying causes of mental disorders, and greatly improve diagnosis and treatment.

I certainly agree with Dr. Kandel that these sciences are of great importance to the understanding of some of the contributing causes of emotional and behavioral irregularities but, given who he is and where he comes from, he is trapped in a very reductionist, medical model.  If psychotherapy is a “biological brain-treatment” as he states, so is a family, a sub-culture, and a romantic relationship.  These things also have a major impact on how a person feels and behaves, and they cause many major changes in the brain.  Until we learn how to integrate all of these factors into our attempts at understanding what causes what,  we will be still fumbling around with inaccurate half-truths.

At present, diagnoses are often as much a political act as they are a science.  They are descriptions of what is considered, at the time, unacceptable behaviors.  What is unacceptable changes with the culture, and the soical values of the times.  There are many, many examples, from hysteria to homosexuality, that were illnesses then, but are seen as acceptable now.  I am sure what is now called bi-polar disorder in ten years will have four different names.

Yes, our mind is a product of our brain, but our brain reacts to what is happening in the world around it as much as what is happening inside our skulls.

That’s my view, even without a Nobel prize.

August -- gone

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

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

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

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

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

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

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

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

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

Quick Fix

I am away from my office for a few weeks, wandering around near the water, doing a pretty good job of not thinking about those I left behind.

Down here I get to talk to friends, and friends of friends, and just see what they do and hear about what they think.  I don't have to do anything about it, which makes life much easier.

But what I hear can be pretty distressing, and that is, even more than before, people are going for the quick fix.  Psychotherapy seems to have lost some of its panache; it takes too long, it costs too much,  and it can be painful to think about the bad things, or to confront difficult problems.  These days it is much easier to find a life coach, a motivational speaker, a spiritual healing, an body-mind energy consultant, a brain-ionizer, a vitiman dispenser, or just a guru to show you the path.

Now, the quick fix has always had allure, for centuries.  But many years ago the fix seemed to be more through suffering, sacrifice and prayer.  Today it seems to be through self-indulgence, self-appreciation, fulfillment and money.  And who can say no to that.

The trouble is, of course, that the quick fix rarely works.  What these kinds of fixers seem to miss is that they are fighting against all of a person's biological history, genetics, family history, interpersonal history, cultural and sub-cultural patterns, and financial resources.

Usually the effects of a weekend pep-talk and a few exercises feels really good, and lasts for anywhere from three hours to three weeks, sometimes a couple of months.  But almost always, those entrenched thought and behavioral patterns creep back in and take over.

However, the bigger problem is, that psychotherapy also, often takes a great deal of time, and still isn't that effective.  That process too has to fight against all of a person's biological history, genetics, family history, interpersonal history, cultural and sub-cultural patterns, and financial resources. Some of these we can confront and work through, others, such as genetics, social class, finances and sub-culture, are often cannot be influenced by verbal interactions that happen in an office for an hour 9 now 45 minutes according to most insurance companies), a week.

There are things that I would strongly recommend that a coach can be necessary;

-- Sports

-- Financial planning

But, with both of those, be careful, find someone with a successful history, the longer the better, and make sure that what they said they did really happpened.