Thoughts about the Boston Bomber

Almost two years after the horrifying explosions at the finish line of the Boston Marathon, the surviving suspected perpetrator of that act is going on trial.  The trial is expected to last two or three months. There seems to be enough evidence to convict him.  Most of the attention is focused on whether he should be put to death as a punishment.

To me, the death penalty is only part of the question, what is really the question is the whole trial.  If the  death penalty was dropped then the whole trial and all of it’s horror show could be avoided.  The trail will only incite more anti-terrorist, anti-Muslim, anti-non white, non Christian feelings.  It will provoke passions of revenge, for war, for proactive strikes against whomever doesn't like us anywhere in the world.

I believe that the kid is responsible for what he did, at least as far as the law and the state are concerned.  How much of a real choice he had to really consider what he was doing; I guess he didn’t. He was boxed in, he was persuaded. He became a believer in the jihadist mission.

I don’t know this kid.  I have had some contact with one of his high school teachers who feels shocked and mortified by what he did. Tsarnaev has been described by others in interviews with the press as a decent kid, who was more of a partier than political, more passive than an activist.

I read that his family are Muslims who live in Russia.  The Russians have persecuted Muslims for years.  The Muslims have committed many terrible terrorist acts in Russia in response.  So there has been an example in his culture of how to respond to feelings of persecution and marginalization.  Why this kid, who was going to college, had friends and was going to parties, felt so persecuted and marginalized is my question.

Most people blame his older brother, who seemed to have failed at boxing, at his marriage and a few other things and seemed to have very little going for him.  This is probably part of it.

What I would like to know is what has to transpire to make someone who doesn’t seem to be genetically hot-tempered, reach a level of alienation and rejection that he needs to call attention to his pain by killing total strangers who are just living their lives.  His pain overcame any feelings of empathy, any sense of humanity, or even the consequences on what this act would do to the value of his own life.  Did he "choose" this?  Was he challenged? Was he trapped?  Did he ever have doubts?

I doubt it will ever be explained.  I’m sure Mr. Tsarnaev can’t explain it himself.  He probably doesn’t even have accurate memories of what he was thinking at the time.

Now it’s just a news story.  Nothing really, will be learned.

Not Due to Climate Change: The Tammy Meyers Shooting

I rarely follow the latest media hyped (white) killing of the week, but I have found the shooting of  Tammy Meyers  to be a fascinating reflection of Americana.

First, it is a great example of something that really isn't what it appeared to be, and then it is an even better example of Thinking Fast, and not Slow. It seems that almost everyone involved did a lot of reacting and very little planning.  No one seemed to be thinking about probable outcomes.

Reality TV could not do a better job of highlighting the craziness in the current culture.  Guns and drugs in family life.

I have been doing a lot of reading about new discoveries which describe how our brains work. Our brains are marvelously complex products of evolution that can do amazing things. One of those things is the brain's ability to synthesize a huge amount of information very quickly.  However, it has been shown in many of these studies that in order to gain speed, the brain sacrifices accuracy.  We all do it, all the time.  In order to protect us, our brains rush to form an idea of what is going on, and based on that idea, we respond, usually quickly and emotionally. We have evolved to do that, so that we can catch food to eat, instead of being caught and eaten.

The downside of this, and I am paraphrasing one of the scientists, I think it was Dr. Michael Gazzaniga ( but maybe someone else) who said that humans are the only creature we know of who can make up a story, and then get themselves to believe it. But in many ways, that is what we all do, every day.  However, some people's stories offer a better picture of reality than others.

I fear that one of the stories that is common in the mind of some, certainly a minority, but still many, gun owners, is that guns really make them safer, and also that they are better shots than whomever their adversary may turn our to be.  

But in today's complex world, we don't need guns to catch food. They are only helpful in specific, structured situations, such as hunting seasons in the woods.  Taking a gun and going out to find the bad guys usually proves to be problematic. Adding drugs to the mix doesn't help either.  

The foolish, confusing, and truly tragic death of Tammy Meyers is an example of everyone involved getting caught up in their own story; stories that were believed too quickly; with no real consideration of what might happen next. And unlike the video game this resembles, there is no reset button.

Connect the dots: piles of snow and the ISIS killings.

            Today the sun came out for a few hours and the temperature rose to thirty-six degrees.  The snow around my house began to melt for the first time in weeks.  The seven-foot high piles are now only five feet high, the twenty-foot piles seem about the same.  The dripping off the icicles of mass destruction was constant.  Of course, now that the sun is setting, and the temperature is dropped, everything with freeze solid.

            As anyone who has paid any attention to any media knows, this has been an historic winter here in New England.  And it shows no sign of getting easier.  It will be very cold tomorrow, and more snow will come on Wednesday.

            Last winter did not have as much snow, but the cold came very early, before Thanksgiving and it stayed very cold until the middle of March.  This year seemed as if it was going to be an easy winter until the middle of January, but then everything changed.

            During this time there has been a group of religious zealots who say they are trying to bring about the end of the world.  Their stated goal is to incite a holy war between Muslim extremists, and the rest of the world, a war that will result in total destruction.  This kind of disruptive, oppositional thinking has attracted a following of people who seem to be either fed-up or frightened about things that are happening in the world today, including globalization, exploitation, multiculturalism, allowing women to think and mostly, worshiping the wrong God.

            For a while these were just two different things that upset me, and then I read the article in the February issue of Scientific American by Michael E. Webber that explains the interactive dependence of the availability of water, food and energy.  He shows clearly how the abundance of one of those can help create an abundance of all of them, and how a scarcity of any one of them can lead to the scarcity of the others.

            I also remember reading a few years ago (sorry, but I can’t cite the source right now) about how climate change has lead to the drought in Sudan and how that was large contributing factor in the civil war that broke out in that country.  It is also true that there has been a drought for the last few years in Syria, and that drought lead, as Dr. Webber ‘s thinking would predict, to a rise in food prices, which was a large part of why, after many years of being able to tolerate a repressive government in Syria, there was a revolt among the hungry and dissatisfied people. 

            That civil war has been going on for three years now, and has ruined the country.  Hundreds of thousands of people have died, and millions have been injured, displaced and traumatized.  That kind of chaos and instability easily spread to the neighboring counties that were already full of conflict and turmoil, and that allowed ISIS to rise and attract followers.

I believe that it is the same forces that has changed the climate and lead to a drought in Sudan and Syria that has lead to the long period of cold and heavy snows here in New England. There will not be a drought in New England this year; we will have too much water for a while, including some flooding.  But the states in the Western part of the U.S. are still in a continuing drought and there will be many struggles for water; water for crops, water for drinking, water for the fountains at the hotels in Las Vegas.

            This will lead to uncertainty, discontentment and anger.  I don’t think it will lead to a revolution.  But people will blame the government, the immigrants, and the corporations.

            How many people will realize that the world is now linked and interdependent in many complex ways?  Probably more than just me.

            But how many people are ready to make the significant changes?  Probably more than before, and hopefully enough to make a difference, but that remains to be seen. 

            When there is scarcity there is fear, and when there is fear most people worry most about themselves and their own families.  It’s hard to put it all in context when your livelihood is threatened.

Valentine Snow

            I am back in New England.  It is a Saturday night.  It is Valentine’s Day.  For most restaurants this is a confluence that they experience once or twice in a decade.  At the most romantic spots reservations must have been made months in advance. Take you Valentine out for a romantic evening of a few drinks, a candle light meal and some slow dancing. What could be better?

            But as I look out my window I can see no one.  Almost nothing is moving at the moment, everyone and everything is waiting for what they have been told will come next and come soon.     

            Right now there is four inches of glistening new snow that has fallen through out the afternoon.  It has covered over the piles of older snow and ice that have blown up against buildings or has been pushed by plows and snow blowers to clear the roads and walkways. Those piles now stand higher than I do.  The roads through these canyons of ice and snow are very narrow; there is room for one car or three people.  But no one and nothing is out on the roads.

            It is twenty-eight degrees but, at the moment, there is no wind, so it does not feel cold.  However, very soon, perhaps an hour,  we have been told, over and over, for the past four days, that the wind will begin to blow.  On it’s back it will bring more snow.  Then the wind will blow harder and harder and the snow will fall faster and faster, swirling around in circles, going up as well as down, going across the street and back again.  I will not be able to see the house across the street that right now stands so clear and white .

            The wind will blow harder and the snow will fall and the temperature will drop to zero.  The snow will pile on top of the snow that has already fallen on top of the snow and ice that already sits in huge piles and drifts. A blizzard.

           

            There have been blizzards before, many here in New England, usually, one or two a year.  This will be the fourth, this month.

            This weather development has made the news, the world knows about what is happening here in New England.  It is right up on the attention screens, along with the people who got shot in the head, the people who had their heads cut off, the price of oil, the newsman who lied, the newsman who died, and ads for diamonds and perfume that will stop tomorrow, after Valentine’s Day passes,   Oh, yes, and the kitty-cats that  looked so cute, doing…what?…..I don’t understand.

            In a month the snow will melt.  Then this year’s tornadoes will begin, followed by the big fires, and the big droughts will continues, but hose are not so photogenic.  Last June two people were killed in a small town in Iowa.  They were the first fatalities from a tornado in Iowa in ten years.

 I wonder how that town is doing now.  Do you?

Snow -- No Snow

We went away.
We slipped out just in time and headed south.
We arrived in Miami the day before it began to snow where we left.
Up there is snowed a lot.  Then it snowed again.
And again.

We missed the snow.
Well, really, the snow missed us, I didn't miss it at all.

It is dark out now, but I can see the lights on the causeway.
I can look to my right and see the city, to my left is the bay.

Miami is a very different culture than Boston.

Boston values intellect, tradition, hard work, and now, innovation
       (and football -- Go Pats!)
Miami is international, Latin, colorful, sensual, banking, big deals, big boats
Big parties

Bostonians can give you a knowing smile
In Miami they laugh out loud

Who is better?
Depends upon where you were raised, how old you are, what your temperament is, how much money you want to spend, where you come from, and how comfortable you are showing off your body.

Miami is warmer.
That's a big plus in January.  Not so great in July.

So Much New, Yet...

Since I have been seeing fewer patients I have had more time to read and hang around and talk to people.  Now, as before, I am reminded that I am a weird guy, as I do not read much about which celebrity is getting married again, or which teenage star has turned naughty, or even the in-depth coverage of which fanatical group is running wild, raping and killing, and calling it something else-- although I am kind of fascinated at how easily a person's mind can justify anything.

Mostly, I have been learning more about how we humans operate.  Since the start of the new millennium there has been so much progress in so many sciences, due to all the developments in new technologies.  I am constantly reading about new findings about how our brains work, and new genetic-environmental-behavior relationships, and new behavioral tendencies that we still carry that are the result of a million years of evolution.

We can now see that the effects of brain injury spread like pebbles in a pool, sending out waves to far shores.  A soldier comes back from one of our endless wars and is violent and depressed around his family.  How much is this due to his being inside a tank when an IED blew-up and his brain got rattled?  And this may have happened to him five times.

Then his family is frightened, his kids are upset, the community doesn't know what to do and the VA, like Forsythia says about other mental health clinics, is far away.

And the kid doesn't have to be a soldier.  He could be a high school football player.  He could have an alcoholic parent who smacks him around.  He could have gown up with diet of lots of fats and sugars.  He could have grown up next to a toxic waste dump or an oil refinery, or even a coal-fired power plant.

We are getting very clear evidence about how strong these effects can be.  But again, doing anything with this knowledge will be expensive.  It will be expensive to the people who are least affected by these factors.  That's why change is still off in the distance.

If "Personal Responsibility" means that I've gone mine and I'm keeping it, but you're fee to go find yours, then things will get worse before they get better.  But if it means that we are all responsible for the family, the community and the world we live in, then we have the knowledge and the technology to make marvelous lives for almost all of us.

It's not impossible.

Happy New Year, Bang, Bang

It's a new year.  I hope you are all healthy and happy, and that you and all those you love are safe and warm.

I am old and cynical, so take this for what it's worth, but 2015 does not hold much promise for being much better than 2014, except maybe for the Patriots -- that's the football team, not a bunch of Whooped-Up Americans.

For most people 2014 was kind of OK.  If you were rich you got richer.  Everyone else paid a little more and got paid a little less, but for most folks it wasn't too drastic.  If you were poor and struggling last year it looks like you will be poor and struggling this year. If you had psychological and emotional issues last year more of you will be able to get some kind of help, from some kind of somewhat trained helper.  They may give you a supportive place to list your difficulties.  They may offer some advice, the kind of which you knew before you saw them.  They may even help you see that you have some paths to choose that you didn't realize were open to you.  That can be very helpful.

But they won't be able to open any doors that are closed to you, or spend enough time with you so that you can retrain your brain to not be so reactive, or to learn totally new behavioral responses to stressful situations, or to change the stressful situation, or to change the fact that you may have chronic pain or a degenerative disease.

In short, there is still no really effective treatment for all the things we call "mental illness."

The guy who shot the two policeman in NYC, the kid who shot his adoptive mother and a couple of other people in Idaho, the veteran who shot his psychologist in Texas, and of course, the jihadists who killed so many people in Paris were all suffering from some form of discontentment.  I believe that  at sometime in their lives they had either actively sought help, or were at least known in their communities to be people who were "at risk."

Do we know what to do to help people who are "at risk?"  I think that most of the time we could figure out an answer.  Find a way to form a relationship, to not only offer help but to offer some resources so that they are able to use the help -- a place to live, job training, stable support people, food, warmth, trust, encouragement, understanding, new and better options to choose from.

But that is very time consuming and very expensive.  It's much simpler, easier, and cheaper just to wait until they go off the rails, and then shoot them.

there is always a well-known solution to every human problem — neat, plausible, and wrong.
-- H.L. Mencken.

I'm Not an Algorithm

 As we all know it is the shopping season.  There are many more ways to shop now than before.  There are many ways to try to get a bargain, or to just give away money on a little plastic card.  We can shop on-line, we can shop through apps, we can go to the store and have it shipped home, we can shop at home and to and pick it up.  They say we will have drones doing the delivery soon, but it hasn't happened yet.

The Cloud knows what you have bought, what you are thinking about buying where you looked for it, a pretty much what you are willing to pay to anything and everything.  We all get ads for things we have bought or just looked at.  "If you looked at this you'll probably like that. If you live in this zip code and you looked at that store, and you bought this, you listen to this music, you read these books and web sites, then you think like this, vote like that, and have these needs.  They are correct a lot of the time.

A couple of weeks ago I was at a conference where people were taking about the mood apps, behavior apps and health apps they were designing and using for themselves and their patients.  Stay fit, eat right, relieve stress, exercise, breathe, do it all with friends and family.  Think happy thoughts, look at scenes of nature, call your mother, think out of the box, but stay in the box.

I'm old, and I get a bit antsy with all of this.  It seems to be that the goal is to get everyone to be mildly happy, to get along, to pay our bills and buy stuff.

I asked if anyone was designing an app to be grumpy, sarcastic, and oppositional.  Unless we have enough people like that, nothing will change.  We will listen to the music we already like, talk to the people we know, read about things we agree with, and not get upset.

It all sounds very pleasant, like too much mac and cheese.  You know what that can do to you.

The Gentics of Ferguson?

The crisis in Ferguson, MO, continues, with lots of heated debate on both sides.  It is an excellent example of how complex our lives have become. Because we humans are such complex creatures, with uniquely evolved brains that allow us to plan, compute, design and build, we seem to have created an environment in which many of our ancient innate tendencies have become counter-productive

I have been reading all about Ferguson, talking about it with to some of my poorer, angry patients – people who aren’t prejudiced, they tell me, but who feel that Blacks are getting all the breaks—and also reading E.O. Wilson’s new book The Meaning of Human Existence. (How’s that for taking on a big topic at an old age?)

Wilson makes that point that there are two kinds of adaptations our genes have made over the past few million years.  One kind is to increase the likeliness that the genetic material of our individual selves, and our specific children, survive.  Whatever gives us an advantage: size, speed, tool making, problem solving, more fertile sperm, bigger hips, cuter smiles, anything that will increase the likelihood of a next generation, and of one after that, will remain a part of our genetic material, while those who do not have enough of those traits will drop out over time.

The second kind of genetic adaptation, that Dr. Wilson points out, is that we keep  the kind of genes that help our group survive.  We are one of the few creatures in the history of the earth who have learned the benefits of group cohesion.  Certain, very successful colonies of ants are among the few others.  People seem to have evolved to control the earth in the space of the larger creatures, while those ants not only out number us by billions, they are by far the most successful at surviving and multiplying of all the creatures.

Humans have very evolved skills at discerning what others are thinking, at communicating our moods, at anticipating threats. We have learned how and when it we should lead and when to follow, and when to act altruistically so that it helps our group.  We have learned that stronger groups get more resources, eat better, and raise the chances that more of our children will survive.  This is true of the ants also.

Some of that is what makes our racial problems so difficult.  We live in a country that professes to welcome all people, and offer all people equal opportunity.  Yet, Black people have never really been seen as part of that.  Many have ancestors who were brought here by force and were used as a source of energy, and not regarded as people.  Many people live in white enclaves and have very little contact with Black people.  They don’t know them as people.  They see them as part of a competitive group.

This was probably true of Officer Wilson.  I don’t know how many Black people are his close friends, probably not too many.  It was too easy for him to quickly classify Michael, Brown as a “demon,” which makes him not a human, not somebody’s child, but a part of a competitive group.  I am sure that this was not conscious.  His brain acted way faster than his mind had a chance to think.  It was all primitive emotion, acting to survive. Also, he had a badge and a gun, which gave him a very different mind-set than Michael Brown, who must have felt cornered by an enemy.

If America is to finally going to do better, we have to know one another as people.  To do that we really need to integrate our neighborhoods and our schools and our social clubs.  Since I won’t hold my breathe for that, it would be helpful if we did have regular gatherings, social gatherings, of all kinds of people, all of whom bring all kinds of food, play all kinds of music, and really get to mix and meet. We have to take the “otherness away.”  We have to have some real relationships.

This should happen in Ferguson, Boston, Selma, Topeka, L.A. and Akron; all over. For far too long our politicians have used the formation of opposing interest groups to split this country apart.  That is easy to do, and it works.  Except only in the short-run.  We have already put some people on reservations and keep them apart.  We already had a Civil War, from which we have never totally recovered.   Perhaps we could realize that it’s time to learn that the people in this country should be considered all a part of same group, and that we are not each other’s enemies.

That’s tough.  It goes against some of our genetic predispositions.  But the world is different.; we are all much more interconnected.  We are not separated by mountains and live in independent tribes.  That world, of 1000 years ago, will never be again.  There is no guarantee that the U.S. can do well in this new one if it goes to war with itself with tanks and automatic weapons.  We have to adapt.

NYT -- old rules -- not to follow

It is a bit of an embarrassment to the professions of anyone who does psychotherapy that the NYT would publish this piece.  Perhaps, this happens only in New York, where people still follow Woody Allen into psychoanalysis.

http://opinionator.blogs.nytimes.com/2014/11/22/the-rules-of-psychotherapy/#more-155056

Dr. Weiss is struggling by adhering to techniques that are a hundred years old and largely discredited.  It is good to see that as a psychiatrist she still does psychotherapy, as almost all psychiatrists outside of major cities only prescribe medications.  But if she is going to do therapy she should learn that things have changed.  That the relationship between the patient and therapist is very important and that, although it needs to be structured, and it is not a friendship, there certainly needs to be warmth and acceptance.  Then, there are many other approaches that have proven to be more successful than long-term psychodynamic treatment.

What I also find interesting is the wide range of comments that have been posted.  The differences in understanding the causes of depression are certainly very striking. Depression is a very serious condition, and a very complex one.  It often, but not always has some genetic component.  It also involves family history, job history, a history of loss or trauma, brain damage, illness, pain, unemployment, poverty, racism, and addictions.  It is not a “disease” with one clear cause.

Therefore the treatments have to vary accordingly, and should hopefully involve many disciplines, including, psychologists, geneticists, neurologists, social workers, and other branches of medicine if they are relevant.  Such treatments are very rarely available in our world of specialists who just do their own job.  That is why Dr. Weiss’s patient is still in treatment, and still suffering, many years later.

         

Eating Health: Can't or Won't

Brain science keeps rolling along -- much faster that psychotherapy science I'm afraid. I rad a study this week about some researchers in Montreal found that both children and adults seek out high calorie foods, even when they understand the concept of obesity.

http://nymag.com/scienceofus/2014/10/eating-healthy-vs-your-own-brain.html

We are programmed to eat to stay alive.  We are programmed to grab what we can before it runs away or before winter sets in.  Perhaps that's especially true in Canada.

But what the study also makes clear is that we are hardly aware of all the factors that go into our decisions.  Our brains are wired to help us act quickly and in our best interest. Or at least in the best interest of where are way-back ancestors lived 200,000 years ago.  That was before Domino's had a pizza delivery app.

Eat healthy my friends, (and drink wisely too).

ADHD in Today's NYT

            The lead article in today’s Review section of the NY  Times is by Richard Friedman, who is a professor of clinical psychiatry at the Weill Cornell Medical College.

http://www.nytimes.com/2014/11/02/opinion/sunday/a-natural-fix-for-adhd.html?_r=0

            For a short piece he gives a good over-all look at what ADHD is and isn’t.  What I was most impressed with is the wide range of factors he cites, as well as all the new machines that are used in these studies.

            The studies he cites use things that were not available twenty, ten and in some cases even two years ago.  These include PET scans and fMris to look at brains, but also macines to examine genetic differences.

            Dr(?) Friedman also puts ADHD in a social and cultural context.  He talks about how schools now demand greater concentration and conformity.  He also mentions that video games are so stimulating and can seem so exciting compared to sitting in a class, trying to listen. You shouldn't blame or stigmatize a kid for something he can't do.

            With all of this new machinery we can now see differences in brains and genes that we couldn’t even imagine ten years ago.  But a different brain is not necessarily a bad brain. Differences can show the world how to improve and differences are what help humans evolve and adapt.

            But still, it’s not fun to have your four year-old rip apart everything in his room and throw his toys out the window.  There are multiple causes for that kind of behavior, not just fewer dopamine receptors.

A day in the office

This week I was back in my office for a day.  It isn't really my office any more, I rent it from another psychologist who is now in it three or four days a week.  He is young, energetic and idealistic, just like I was at his age.  He is only 63.

The people I am still seeing are people I really want to see.  I feel I can finish up with them in six to nine months and get them through whatever it is they are going through.  For one it is college, for another through a bad divorce, for another away from his mother and on his own.  Stuff like that.

But yet, after being away for a while, it seams to difficult, just for them to get from here to there.  They are so tied down and burdened by their past, their family, their non-supportive relationship, their lack of financial resources, and even their health.

It's like dragging someone who is underwater back up to the surface, but they are weighted down with about nine chains tied to iron balls.  Each chain has to be worked on and broken.  And we are working underwater, where we can hardly breathe.

But still, these are all great people.  Like all of us, they are slightly crazy, but no more than most. And sometimes they can be very funny.

So we keep chipping away.

But it is really a relief to not have to go back and do it for another seven to nine hours again the next day.  I won't mention that to the young man who is in my old office.

No Guts, No Glory

So I'm back here at my desk after a major transition and a very long summer.  It's a beautiful fall here and I will soon be our admiring the leaves on what could be the last warm day of the year here in New England.  But before that I want to return to commenting on some of the things that thrill or bother me, especially about my profession --"Mental Health Professional," and how and why it's such a struggle.

Last Sunday, 10/12/14, The Boston Globe's Magazine Section was called "Decoding the Brain." They had four articles about recent brain research.  The one that intrigued me most was called " Gut Instincts."  It was a curious yet striking example of what has happened to my thinking, but has not yet spread very quickly through the profession.

Very briefly, the piece describes a case in which someone who had some very disabling obsessive-compulsive symptoms, and was pulling out his hair, was able to free himself from these behaviors by changing his diet and adding strong probiotics.  The article quotes Dr. James Greenblatt, of Walden Behavioral Care, as saying that research is quite clear that the GI tract affects brain health."

The article, which was written by Elizabeth Gehrman, also stated that "All the interest marked a fundamental change in the way scientists and medical professionals view the connection between the brain and the gut."  I believe that we all have to continue to change how we view the entire brain/body relationship.  And I don't mean in the now very prevalent way of people just learning to relax, meditate and stay "mindful." I mean in the other direction. Lots of things in our bodies affect the brain, such as diet, toxins, injuries, fatigue, lack of stimulation, over-stimulation, heat, cold, and so much of the stimulation that is constantly coming in through all of our senses.

All of this is being processed all the time by the brain.  And the brain creates your mind as a part of all this process.

The more we mental health people see this as a constant process of the world, the body, and the brain all interacting, and spend less time and effort trying to fix people's "minds," the more effective mental health care can become.

Need Help?

One day Max feel down in the snow.
  He yelled, "Help me, help me."

Jake ran over and lay in the snow beside him.

Max got up and walked away.

Late word on Robin Williams, et al

Like most people. I really enjoyed watching Robin Williams.  He was the follow-up to Jonathan Winters and before that Oscar Levant, who were also terribly self- tortured but marvelously funny.  Robin also won the favor of a lot of us by playing a very good therapist in Good Will Hunting.  Most of the therapists in movies are played as pretty messed-up, (although Billy Crystal was OK in Analyse This).

It was well known that Robin Williams suffered from a bipolar type disorder.  He clearly had manic moments, although if they served to make a million people laugh I don't know if that gets classified as an illness or a talent.  It's the awful moments of despair and hopelessness that are the worst and most dangerous aspect of that condition. Writing a novel on the wall with lipstick, as one of my patients once attempted to do, is really disruptive, but not fatal.

There have been other high profile suicides, and now so many homicides, that call attention to the need for more mental health care, but then quickly fade, and not much changes.  There were many tributes to  Mr. Williams for a week or so, and I'm sure there will be some more, and a movie, but not much will change in the way we deal with people who are searching for a way out of despair, most of whom are just tortured and not famous.

Part of the problem is that just adding more mental health care doesn't always work.  This is a good example of that. I am sure that Mr. Williams probably was under someone's care at some points in his life, and probably had a therapist right up until he died.  I don't know if that was true, but he had access to the best care, from any and all kind of professionals, but that wasn't enough.

Mental health care is not that effective because the mind is just a part of the very complex creature we call humans.  Our thoughts and feelings are not under our direct control, they are the result of many complex forces.  Psychology and/or psychiatry really cannot be that effective in isolation.  Doing individual psychotherapy often feels like being one man in the water in front of an ocean liner, trying to steer it away from the rocks.  Not easily done.

What I have come to see more and more clearly, because of my long history as a therapist, and as a result of the explosion of information from other sciences, is that unless there is  a way to deal with the comprehensive nature of what creates human feelings and behaviors, the success rate in making positive changes occur will be severely limited.

The picture needs to include a person's genetic make-up, on many different levels, his or her family back ground, and the environment of their early years.  Also important are the sub-culture in which they live and it's values, and how well that sub-culture fits into the more general culture of their society.  Another major factor is a person's over-all physical health, past and present.

All of this is a big deal.  It is a very complex picture, with all of these forces causing chain-reactions upon each other.  But it is real.  Robin Williams was very complex.  Telling him that some of his thoughts and feelings were not accurate was not very helpful.  Medications probably made him feel worse.  I have seen both of those happen with many of my own patients.

Until we find better ways to coordinate all of our knowledge we will struggle with suicides, homicides, racial tensions, bad educational policies, and a great deal of added stress, tension and paranoia, much of which is really based on misunderstanding why people do the things they do. We are at the beginning of what could be an exciting time as more of the complexity of what makes up our lives becomes clearer.  But we all have to learn to talk to each other, combine our knowledge, respect each other's views, and find ways to work together.

more on Israel, Gaza, Syria, Ukrain, Russia, Alabama, Vermont, Obama and Boehner

If you are raised to believe that the Kool-Aide they are serving is manna from heaven, and that the Kool-Aide that others are drinking is the devil’s brew, then there is going to be trouble.

Science can tell us that it’s all Kool-Aide -- until it can pass some predictable tests.  It’s fine to believe whatever you want, but then recognize that your Kool-Aide and their Kool-Aide is really the same drink with different flavors, and the color you’re drinking is due to the accident of where you were born and who your parents are, more than any undeniable truth.

             If the scientific community could find a way to convince people of this, that would be one of it’s major contributions to the world.  But that has not happened over the last couple of thousand years,  since people divided themselves up into tribes.  But now, we have enough interconnectedness and enough information to know better.  But believing that all humans are equal in their insignificance would deny our “leaders” a lot of power, something they have always been very reluctant to relinquish.
            So people continue to find reasons to justify deprivation, torture, rape, death and destruction.  Believing in their hearts that it is the only way to survive. And once they beleive it,  it comes true.

Boston; Gaza; Vassar, MI; Chelsea, MA

            It rained today and I’m not working, so I got to read the paper, and check out blogs and tweets.  Depressing.

            It’s obvious that people are not being treated well all over the world.  There is lots of blame going around, and it’s true, everyone’s at fault.

            There is a big trial coming to a close in Boston in which the head of the state’s Probation Department is being accused of and giving out jobs as political favors.  It seems that a lot of people  got jobs or promotions in his department,  because of who advocated for them, not because they were the most qualified.

            The defense was kind of “So, doesn’t everybody?”

            And that’s a valid defense.  The people in the state legislature, and even some judges who “recommended” people for jobs never gave it a second thought.  They were doing favors for their friends and constituents. Isn't that what they are there for?

            That’s how we got the great financial mess of five years ago: people did what they were told to do, sell mortgages to anyone who wanted them.  Everyone was doing it.

            A certain group of people traded very risky derivatives, pretty much without realizing how much risk was involved, mostly because almost everyone in their circle of colleagues was doing the same thing, and everyone was making a lot of money doing it.  It seemed like a pretty attractive idea.

            Why are the people of Gaza shooting rockets into Israel?  Because many of them feel that Israel wants to drive them into the sea, and if you don’t feel that way you run the chance that your neighbors will shoot you.  Of course, the Israelis feel the same way about Hamas.  And this has been going on for seventy years.

            Why does a big brother smack his little brother.  Partly because he is bigger and he realizes this, and often because his father, who is even bigger, smacks him.

            What I am saying is what I learned from doing therapy for forty years, and what I learned from reading about Family Therapy.  Rarely is it one mean, crazy, evil individual who is the problem.  Almost always it is a system that either lazy and sloppy and then corrupted, or else the system becomes too efficient, too powerful and loses perspective.

            As individuals, we are all part of many systems, some we aren’t even aware of, like our families.  We just go with the flow and think as we have been raised to think—which  to all of us, is the “right” way.  At work we think the way the company does, because that’s what we are paid to do. Nationally, we all try to think about what is best for our country. What we think is best, seems to depend a lot on where in the country we are, what our neighbors think, and what we read.

Example: Child immigration:

            #1 – Vassar, MI --Why should we, as a community, take care of kids from Guatemala, whose parents sent them to the U.S. under false information?  If we put them in our schools it will be expensive.  They don’t know our language, they have different customs, they have lots of problems and few skills, and it will change the nature of our community, which we  have come to love.

That certainly seems like a reasonable concern.

            #2.  -- Chelsea, MA-- Poor innocent kids are fleeing from terrible dangerous conditions. If their own parents feel that it is probably better for them to get away and try to make it in America, how can we turn them away and send them back to a very dangerous place – especially when we have caused a lot of those problems by buying all those drugs, and exploiting many Central American countries.

            That is not unreasonable either.

            I have my own answer, but I really don’t know if it is the best answer.  But I do believe that by just staying around the folks we know, the ones who think the way we do, and then blaming and castigating those who think differently, that nothing will get resolved, and things will get worse.  That’s been history, from Helen of Troy to the Islamic State of Iraq.

However:

            It is very, very difficult to go against the tide, especially when everyone near you is being swept along so it appears as if nothing is moving, when in fact we are all about to go over the falls, again.

.

Do- Overs?

I have now gone for the longest time without seeing a patient in 42 years.  It still seems very strange.  I am also still getting messages, questions and requests from people I have seen in the past.  So many seem to think that I will still see them, even if I've closed the practice to everyone else.

Part of me feels as if I am waiting for the next stage of my life to emerge, and I guess I am, but a large part of me is very content to let that happen after the summer has slipped by.  We have been very busy down here at the beach house.  I had thought "wow" I will be here all summer I will have so much time to think and reflect.  But the truth is that although ideas have been racing through my head, between babies, friends, and activities, there has been no time to really make them clear or get them into any distilled form. I looked at the calendar and found that almost every day will be busy until September 14, at which time things will get busier as our last grandchild is expected then.

What has been interesting is that so many of the the thoughts that flare-up in my mind have been memories of things I did wrong.  Most of them relate to patients.  The things I did wrong with patients fall into a few major categories: there were many who I like so much that I underestimated how crazy they were, and thus encouraged them to keep trying at things they really couldn't do.  There were others who fooled me into believing they really wanted to get their act together and overcome the emotional and physical options they faced, but once they got some form of disability check they disappeared.  There were still other whom I just did not like.

These thought come up much more than memories of the many people who did well, the many who really thanked me, the many who kept in touch long after the treatment ended.  It would make me happier if my mind wandered in that direction.  But so far, it hasn't.

I guess I have what is called a high Zeigarnik Effect.  I remember the unfinished much more than the finished.  They say that has some evolutionary adaptive value and that's why it is so common.  I find it frustrating to remember how frustrated I often was. And now the world has moved on and there is nothing to be done.

I must learn to move on also.  The wind is blowing very hard off the water; it blows away as mcuh as it can.

Better this way

I have been mentioning some of the ambivalence I feel about giving up my practice; how I kind of feel as if I'm getting away with something.

It has only been about two or three weeks, but I can tell you one thing clearly:  not working is much easier and healthier than working ( if you have enough money).

During the last few years of working I could feel my body getting old.  The arthritis in my neck seemed to bother me more often and I found myself taking Ibuprofen once, twice or even three times a week.  I also had several minor problems with my back, knees and shoulders.

I think I can state pretty clearly now that a lot of it was from sitting so long, either in my "therapy chair" or at the computer.  Even in a very comfortable, supportive, good-posture chair,  I was sitting too long, holding my head in mostly the same position, and not moving much of my body.

In the past three weeks I have climbed a mountain, done a lot of chasing of three children under four, sometimes in and out of the water, rode my bike to and from town many times, walked the length of a long beach several times,moved tools around, moved garden stuff, gone up and down two-hundred flights of stairs just moving things and going places. and in general been much more active than any time in the last ten years.  All of this was done naturally, and in the flow of the day, not at a gym or doing some specific exercise routine, except for about ten minutes of stretching most days.

And I feel great.  I haven't even thought about taking any pain pills or needing some other remedies.
There is very little tension, more freedom, and less stiffness and hardly any pain.  I can't really run far or fast.  I'm not about to play basketball again, which I miss, and don't expect to challenge myself to perform amazing physical feats that would break me in half.

But, I think working, at least working full-time or more, in order to pay bills and help keep a family going,  is pretty hazardous to every one's health, especially after fifty-three. And I certainly was not in a physically demanding profession, which I guess, was part of the problem.

While not working, hard, ever, is not good for your mind, well-being or your place in the universe.

It helps a lot of enjoy whatever it is you're doing.  But even then, you can't be a goalie for very long.