American Dream?

After a very fulfilling, enjoyable, gratifying long weekend spent down at a cottage by the Bay which was filled with what is now three generations of family, I drove to work today and was very aware of the huge difference between the fortunate life that I lead and the lives of many of my patients. On the drive I heard that NPR is going to do a series all summer long about the state of "The American Dream."

I have often told people that the most brilliant thing I have ever done in my life was to be born two years ahead of the Baby Boomers. That meant that when I applied to college, not that many people were applying yet, when I bought a house the big wave of home buyers would follow me and my house would be worth more.  My children were two years ahead of most Boomer's kids. I went to grad school when the government wanted psychologists, so they paid me to go --very unlike today. I had enough money to begin to buy stocks in 1979.  Although I made a zillions bad stock purchases I did buy MSFT, RIMM and AAPL when they were new companies and that made up of all the losses
( missed GOOG, I have not yet bought FB).

My wife is still good-looking and still a force whose ideas need to be constantly considered.  My kids are healthy, employed and already own their own homes.  Their kids are round and cute and curious and smiling. We all went to the beach, played golf, had cook-outs. There are always a few ripples in this perfect picture; I only hope they are enough to drive the jinx away.

Every year of the thirty years that I have worked has felt as if our social environment has made my job more difficult. There was AIDS in the 80s, and lots of divorces.  There was crack and lots of bad drugs in the 90s, as well as perverted priest and rampant speculation. There have been huge changes in how we live and think which have been brought about by technology. There were the credit card and re-mortgaging binges of the 0's that were a big part of what led to the world financial collapse.

But I have never seen so many people who feel helpless and hopeless when they look to the future.  This is felt most dramatically by people in their mid-20s and mid-50s.  There are not enough jobs for either of those groups.  The younger ones can't get started and the older ones have been tossed aside.  The combination of a global workforce, the economic slow-down and technological worker replacement has hurt people not only financially, but in their sense of purpose. It is very difficult to gain any traction in your life when you feel the world doesn't need you.

I do believe that many people will realize that it is foolish to try to jump through corporate hoops and to live your life chasing after money and fame.  I believe that eventually many parts of our society will establish a more worthy sense of values that will guide them towards happier more meaningful lives. But I am struck by the number of people, young and old, who are really lost and cannot function well in our new, more complex, more interconnected world. Many young people are lost to video games, Facebook, pot and pills.  Many older people, who are still too young for Social Security, seem to be trying to become pathetic enough to go on disability.

Some people feel they were screwed by the system ( and they were).  Others really don't know what it means to work hard and take care of themselves.  Often, it's the same people.

The American Dream is that things will always be getting better.  I think many of us need to decide what "better" means.  Then we can figure out how to get there.

Tech is Taking us Somewhere

Despite my age, and that I sometimes have difficulty in figuring out how to operate the remote control devices of entertainment systems that are not my own, I have been fascinated by the impact of technology upon our lives. Since as recently as 2007, when the first iPhone was put on sale, there are very few aspects of our lives that have remain unchanged by technology.

How we work, where we work, how we bank, how we shop, how we date, how we teach, how we learn, how we meet people, how we communicate, what we read, what we see, what we think about, how we think, how we feel about the world, our friends, our real selves, our projected selves....... all of that and more has been altered by the use of Os and 1s being magically transmitted over cables and through the air.

This is not going to stop, so where is it all going?

One trend that will definitely continue and gain momentum, is that so much more about you will be known and much of it will be generally available.  There are so many new and improving ways to explore, measure and view, what is going on with your physical self. We can see the blood and electricity flow through your brain.  We can get a printout of your personal genomes. We can do CAT scams and MRIs of all of your body to see what works, what is broken what is twisted and what is missing. You can get an app that will constantly measure your heart  rate, blood oxygen, blood pressure,caloric intake, caloric usage, all on your wrist.  All of this can be stored in "the cloud" and can be retrieved by your physician, perhaps by anybody.

In addition there is all the information we ourselves choose to put out there about ourselves, on Facebook, Linkedin, Twitter, Tumblr,YouTube, Match, and the hundreds of other sites that we click on, shop at, comment on. At MIT they are creating devices that can almost immediately conjure up an entire profile of a person as he or she walks by you, based upon their image, and everything about them that has been placed on the web.

As with everything, there will be positive and negative aspects of all of this.  But that won't matter that much because these things will, to some extent happen.  What does matter is what the effects will be, both intended and unintended. This should help us be better equipped to stay healthy and prepare ourselves for our own, individual futures.  We should be able to have an easier time finding people who we will enjoy getting to know and spending time.

But, at least as I feel so far, we will continue to be overwhelmed with information.  We will have to find away to sort, select and evaluate what is real, true and important. We will have to learn to deal with  how we feel the electronic presentation of ourselves really reflects who we are. We will have to see how all of this affects how we evaluate other people, and how we think of ourselves in relation to the world.

It will all be very different, and have much more of an impact than the changes brought about by older technologies, such as when so many people began spending their time watching TV.

In many ways the medium is still the message. But now, so much of the medium is us.

More Tech Fallout

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

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

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

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

Stress, conflict and misery.

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

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

And so do their families.

statistics

Intro:
Last week I began to write this as a blog post.  As I continued with it I thought it would be interesting to post it  on a list read by other practicing psychologists.  Part of this was in response to an editorial that I wrote about last week.  I was curious to see if other therapists would really discuss what happens in their practices.

This is what I posted:

For no particular reason it seems to be the time to gather statistics and demographics.  We Psychologists, especially those of us who still accept payments health insurance companies, have been told for years that we had better be prepared to demonstrate that what we do is effective and efficient, as well as medically necessary.

Of course, there is no agreement on  how to define or measure any of those things.  Over the last four years three different insurance companies devised three different ways to attempt to do this.  They tried to survey either the therapists, patients or both about different ways in which the patients were functioning, suffering, changing, or just wasting time and money.   Within a years time, give or take, all three gave up the effort. All of the therapists were offended, felt intruded upon, and reported that the measures were misguided and not relevant.  The patients all objected to being subjected to Big Brother about confidential information, or else they couldn't understand the questions or where they came from or why they were being asked.

The insurance companies found a better, simpler way to deal with our effectiveness and efficiency: they reduced our pay.

So, tonight I decided to do some statistical evaluation, just to get a reading on how I was doing as a private practice therapist after 30 years.  I looked back to April of 2011 and picked out the first 50 people I saw  (there were 54) that month.  I do not claim this to be hard science.  I admit to nineteen flaws in my methodology, but hey, no one gave me a grant. But I thought it would be of interest to the folks of this division, as few people ever say in much detail what they do, how hard they work, or how it turns out.

Of the 50 people, a year later I am still seeing 29 ( 59%).  Of those, over half (16) of them I have already seen for over two years without any significant break.  But of those, there are only two that I still see weekly. The others are bi-weekly (6), monthly (6), or 4x a year (2).

Of the 21 people who terminated over the last year my rating scales of success in treatment ( held to a standard of consistency over 25 years, with a very high rater reliability, however the N of raters is 1.)  3 of the 21 did not do well at all, despite my efforts and skills.  3 did OK, and 15, in many ways accomplished what they hoped to realize from coming to see me.  Some of them really, really changed during the time they saw me.  Others,(4) I need to add, came with very specific problems such as an isolated phobia, a problem with a grow-up child or such., and they just wanted to sort out that matter.  Four others of the 15 came to get something specific from me, mostly relating to work or school, such as a letter or a report that they were not dangerous, or drug addicted, and could go back to work.

Of the 50 people, the rating scale shows that 36  (72%) did, or are doing well, or really well.  14 (28%)did not or are not.  Of those 14, I still have almost reasonable hope that 4 of them will still show significant improvement.  Of these 50 people, no one in the sample came for just one session, although that happens.  The shortest time in treatment was three sessions, and that was one of the people with a specific family problem.  Everyone in the sample got treatment for something that I feel was clearly "medically necessary."  Five people (10%), less than it feels like to me, have a diagnosis of "completely nuts," and will remain that way.

Yes, the rating scale is based on how I feel my patients did, with some feed-back from them.  But I believe this is fairly accurate.  I can tell that I enjoy seeing the people who are changing and doing well, and much less so when the therapy is not working. This year I have begun to implement use of Duncan and Miller's three question ratings, but not with everyone.

I can also (not) tell you that I averaged  $XXXX ( I wish) per hour of treatment.

I can do more analysis and determine how long I have been seeing everyone, and how severe their presenting problems are, and how that correlates with their socio-economic status (not as much as I thought), or with the success of treatment.  But I'm tired and this is enough for now.

I hope this was of interest and perhaps inspires others of you to evaluate your efforts.  It also helps to see who you work well with and who you don't, and see if that changes.

END OF POST


I was pleased that I did my own analysis and I think I will look at the figures more closely.  I did get several responses, but most of them talked about ways to do an analysis, or questions they were interested in looking at.  However, and this surprised and disappointed me, no one was revealing about their own practice.  No one talked about how long they see patients, or how successful they feel they are, and by what measurement.


I don't want to jump to conclusions, but it makes me wonder.  About a lot of things.

another sleaze

There is soooo much out there to try and keep track of that it gets ridiculous.  The idea of keeping up with the new research in brain chemistry, physiology, cognitive therapy, fMRI studies of someone's brain in every mood and situation, of behavioral genetics, of unconscious social forces ..... all kinds of stuff comes rolling in.  So often one study will contradict another one, or someone needs attention so he will hyperbolize even the slightest indication of a determining factor.

Then, this weekend, there was a series of articles in the NYT Magazine section, telling the world that depression is a complex disease of the brain, and that psychotherapy, which is often the most successful  treatment for it, hardly gets mentioned.

Now the psychiatrist who wrote about the brain disease did discuss two things I agree with; first that most of the current psychiatric medications don't work for most people, and second, that the term "depression"  probably covers several very different conditions, some of which really are caused by a malfunctioning brain, and others which are really reactions to terrible, stressful situations. But then he went back to treating the brain, as if it was "the mind" which it isn't, yet.

There was also an article in the Magazine about taking LSD when you're old and dying.  this is stuff I have known about, and I am looking forward to .....but not yet.

Then there was the article  in the Review section by Jonathan Alpert, sleaze-bag who decided that psychotherapy often goes on too long and is done that way because therapist are unskilled and just want the money.  Now Mr. Alpert, who says he has an advanced degree in psychology, right there is showing what a sleaze he is.  He has a MA of some kind, and under NY licensing laws he should not imply that he is a psychologist.  He also has written some book about how to change your life in 28 days.

What is shocking, and harmful, is that the Times gave this guy space.  Somebody must be doing someone some kind of favors.

Anyone who has read this blog knows that I am not an advocate of endless therapy.  I have even written about it.  But some people need it. And to imply that most psychologists do it is the kind of thing that could discourage people who need help for seeking it, for fear that a therapist will entrap them forever.

He also says that what most people need is an aggressive therapist who will tell them what to do.  Clearly, this guy has not done much therapy.  80% of the people who come to see me know exactly what they should be doing.  It's finding out why they don't do it that is necessary, and then finding a way around those, often self-imposed obstacles that makes therapy work.  If you just need someone to tell you what to do, then send an email to Dr. Phil.

There is so much psychological garbage flowing through the Internet, it is a real shame that the Times has to add to the pile.

Money comes and goes

Last week I was messing around, trying to send a few pictures of my granddaughters to my friends.  I worked out this quick way to take them, edit them and send them, without even using words or anything.  Then I got a call from some guy in California offering me $500 million for the whole idea.  Can you imagine the nerve, $500 million.  I told him not to call again unless he would give me at least 2X that.  Now I'm working on something even better.  It only does pictures of kittens.


Nooo, that didn't really happen.  What did happen was that I was in my office seeing all kinds of people with all kinds of problems.  In fact, on one day last week I saw two different people whose father died, one person whose cat died, one person whose dog died and a woman whose husband was just diagnosed with cancer.  


 I was trying my best to do something for them using the limited powers of my skill set.  I realize they are limited because Medicare, followed by other, "private" insurance companies, cut what they pay me by 5%.  Medicare had been giving me raises of 3% +/-  per year, but this is an election year.   Two of the private companies have not raised what they pay me for 20 years!


But, I also read that the CEO of Liberty Mutual Insurance Company last year was paid $50,000,000.  That's I guess because of his brilliance at cutting what everyone else gets.  His board voted him that salary.  Of course, he pays his board $200,000 to come to four meetings a year and vote on his salary.  That is what they call a "free market."


Money comes, money goes.  If you think too much about it will drive you crazy, You will end up in my office, and I will not be getting rich by seeing you.

Me and Phil

 For the last hour, when I was not just watching the sun,sky and trees, I was reading the reviews of the books of Philip Roth. I guess he won another Mann-Booker Prize this year so there is more about him being written.  He is quoted in the NYT today saying that he no longer reads any fiction.  He said "he wised-up."

 He has written 53 books now. I have read four. He is now eighty, about thirteen years older than I am. He grew up and often writes about the area about five miles from where I went to high school. Some of the streets he mentioned in many of his stories are a block away from where I lived. Mr Roth is a bit more intense than I am, but many of his themes are the same that I deal with every day I'm in my office: family, the lasting effects of parents, sex, trying to determine the right thing, trying and failing to do the right thing, feeling guilty about not doing the right thing. sex,  struggling with relationships, struggling with religion over and over again, struggling aging, and struggling the crazy politics of America.

Reading Mr. Roth has always intrigued me and annoyed me.  I guess because our backgrounds are similar in some ways, and what he thinks about overlaps so much with what I see, and think about.  But he is soooo self-absorbed, and so pedantic that I find myself telling him to just shut up and cope. 
also, the thirteen years difference puts him in a different generation.  His views are shaped more by the depression, war and Holocaust than mine are. But he is so often correct,as  I can see even now as a scan several of his books through the graces of Amazon and Google.  I would not have this easy access to all these writings  even seven years ago, and now I can read it anywhere at any time.

Given that the world works that way now, with everything immediately available, everyone immediately visible, and much too much immediate knowledge, perhaps he's right.  Who needs the creations of a fiction writer when reality is constantly available, in all of it's complexity.

I guess there are still many who want to see the world in terms of good and evil, good guys and bad guys, right and wrong.  That is the fiction.

Listen to the silence

I am currently seeing two patients who are suffering from a huge fear of flying. Is is not only the fear do plumiting helplessly to earth from 30,000 feet as much as just being trapped in a long aluminum tube without any chance of getting out for hours. Relax, sit back, enjoy the time off. Fat chance But I did. I got on a plane and flew out here in six hours. On the plane i read a great article on panic attacks. The plane landed, we picked up a car and three hours later we were up on the high desert. Joshua Tree National Park. Amazing rock formations, spectacular cactus, and high, flat arid lands that go on for ever. We walked the trails, gazed at the rocks, and wondered at the creation of it all. At one point as my friends walked on I climbed up on a rock formation. I climbed up and over several layers of rocks on top of rocks. I stood and looked over the long stretch of valley, flat, dry, accentuated with those beautiful Joshua cacti. I took a slow deep breath and realized, suddenly, there was no wind, there were no birds, there was no traffic. I held my breath and realized there was a kind of complete silence that I have not heard for years. The sky was clear,the rocks were immovable, the world was still and so quiet. I stood there on top of a small rock pile,looking over the valley, listening closely to the silence. I could not take a picture of it, I couldn't record it, I couldn't put It up on Facebook to share with my "friends.". I could only be there, in the moment, being me in the world, letting the moment envelope me; just being. Maybe five of the most alive minutes in months. The my wife called, wondering what happened to me. I rejoined my friends, and became part of society again. But more than before, being me, in the moment.Grateful to just be alive.

By contrat

Sometimes it gets tough:  my first patient was in a wheelchair and his bones are deteriorating and there isn't much anyone can do.  My second patient was talking about another relapse to heroin and was feeling suicidal, my third has been out of work for twenty months and has lost hope .... with five more to come..

But the last three days, because of family obligations, I have been forced to get home in time to spend at least an hour with someone who is almost 16 months old.

Now I know clearly how to recognize the symptoms when someone has the complete opposite of depression: Joy, excitement and exuberance!

From throwing a ball and watching it hit the wall and come back --- what could be funnier than that?  How about hide and  not-hide, or making funny sounds.  Hysterical! Amazing! Fantastic!

The world is full of wondrous, joyous, ever surprising events happening every minute.  And you don't have to look very far to find them.

And you can keep going until bed-time.

But go to bed without too much fussing so we can do it again tomorrow morning at 6:42.

Talking, listening, and Not

   Some people talk a lot.  I get to see them in treatment.  Often I don’t have to say six words in the whole hour.  They want to hear what they have to say even more than I do.  Therapy often helps them as few other people will to listen to them that much.  Many of these people really do get to hear what they have to say, and it does them some good.

            Some people are very good listeners.  They don’t say much.  They pick up a lot of information and they roll it all around in their heads.  Many of these people have nimble, open minds, and they can take in new ideas and make use of them.  They may not say much, but they have a lot going on.

            While most people fancy themselves some combination of the two, and most people are, there are also those at the wrong ends of the spectrum.  There are those who talk a lot and really don’t know what the hell they are talking about, but they don’t want anyone else to talk, because it may prove frightening and embarrassing, as their lack of knowledge may become apparent to them, as it already is to most others.

            There are also those who don’t talk, but they don’t listen either.  They are stuck with the ideas that are already in their head, and do to fear, a rigid personality style, personal conviction, or just plain stubbornness, they are not very open to new ideas, and don’t want  to hear about them. Sometimes, these people make it even worse, when they think that other people ought to know what they are thinking and feeling, even though they have never said anything.  Then they get insulted when those other people don't respond correctly.

            Sometimes, especially in couples therapy we call that "a misunderstanding."  It is caused by the always popular "lack of communication."  But really, it is a serious form of magical thinking.

For this?

We have all this marvelous new technology:  The Facebook I love everyone, the Google I can be everywhere, and the Apple iBrain.  There is a commercial on that mocks people for learning this 15 seconds later than their friends.

But what is much of our newly discovered powers of search, find, learn, store, categorize, compare and retrieve.  Two things I read over the last week:

1.  The NYT Magazine article about how Target targets it's customers.  It has the data and it uses it to bring you back into their store.  Nothing sinister or illegal.  All their brain and computer power goes to get you to spend your money in their store.  Things you may want and need, and other things you may just get sucked into.  It's all fine with them. Just spend your money.

2.  The New Yorker article about the goings-on at the Davos World Economic Forum among the most  rich, most famous and most powerful, ends with a scientist and an entrepreneur walking out together.  The scientist is intrigued that the entrepreneur has decoded an algorithm of  human behavior.

What has he been able to track and predict?  He can tell when a gambler has lost so much money that he decides he must quit and leave the casino.  But with this new knowledge the casino can send someone up to him, give him a meal or a coupon that will lure him back into the room so that this poor loser will then give even more money that he does not have to the corporation that is raking it in.

Fighting world hunger?  Don't see it.  Finding out the algorithm for preventing wars between rival nations? Not unless there is a major profit.

Perhaps I'm just reading the wrong articles.

I should be listening to Rush.  He wants the new technology just for porn videos.

Win an Oscar

I looked at the list of nominees for The Best Picture of 2011.  It was a long list of meaningful movies.  Many of them had important messages, some more subtle than others. 


These messages are not new.  They keep coming around and around.  I think of them often myself.
 They are the basic themes of 56% of the novels, movies, documentaries and philisophical essays.

   The creativity is in finding new, somewhat relevant, clever ways to present them.

Ideas that always get attention:

1. The world is tough for humans to negotiate

2. Most people mean well, but are flawed

         A. Given a chance they will be selfish and greedy before they are compassionate and altruistic.

         B. Some people believe that this is the way it is and we should all do the best we can for ourselves.

         C. Others believe that we can, and should overcome our more base instincts and cooperate, so we can all live better.

3. The world is generally run by assholes

Most people want to live their lives, watch TV, get laid, Hang with friends, get a buzz on, and be left alone to do that.

The people who need to “Be someone” and have something to prove are the ones with the commitment and energy to get stuff done.  Most of them are narcissistic, ego-maniacal or have some kind of missionary zeal.  Not good.

This has always been so: crazy kings, crazy generals, crazy prophets, crazy clerics, crazy industrial tycoons, crazy bankers.

 People get sucked into thinking that these guys (and most of them are guys) are heroes. They are often charming and charismatic, but their ideas are usually about how “we are better than them” and how we should fight, steal, swindle, pound, drive away, or even kill “them.”

It almost always ends in pain and suffering for those who got sucked in, and even for those who weren’t paying attention.

4. Relationships are always difficult.

Anyone, especially those you love, won’t always do what you want him or her to do, so it pisses you off because they should.  It would make your life better

If you do find someone who always does what you want, you immediately realize that they have no judgment of their own, that they are lesser, and you punish them for it.

Almost everyone wants to fuck someone else, at least some of the time, and many, many people do.

--- and when they do it’s special, unique and they should be forgiven. But that won’t come easily.  People like to act surprised and to judge.

So now that task is to take those ideas as jumping off points and meld them into one story.  If I do that I may be able to explain all this in a way the world can understand, and that will bring about an amazing transformation of thought and action.

Of course there is this play called Julius Caesar.  ……. Or Caesar and Cleopatra, or something called Hamlet, or…….

Cultures, subcultures

A person's sub-culture, by which I mean the community that he or she identifies with and spends most of his or her time within, is such a powerful determinant of any one's emotions and behavior, but it is rarely discussed  by psychologists and psychiatrists, and  it is not given the influence that it deserves.

Psychiatry has become so biological over the past twenty years.  It is difficult to get any psychiatrist to talk about anything other than brain chemistry when they discuss a diagnosis or treatment.  Psychologists are more varied. They consider a great many family influences and the role of interpersonal relationships, and see how they greatly affect how people think, feel and behave.

Yet, the values, mores attitudes and behaviors of those who anyone sees himself as most like, do so much toward determining what they feel is the right thing to do, or think, or aspire to.

If both your parents are are collecting checks for disability, and your brother is selling drugs and your seventeen year-old cousin is having her second child, and you three best friends have already dropped out of high school, it will be very difficult for you to "pull yourself up by your boot straps" stay in school, go to college, look for, expect to get, and find a well paying job.

By comparison, if you go to a high school from which 98% of the kids graduate, and 94% of those go to college, you will probably not only expect to go to college, you will go.  You may feel badly that you are going off to State U, instead of Yale, but you expectations and aspirations will be so different from the person in the previous paragraph.

Now, this all seems pretty obvious.  What may not be so obvious to many people is that if almost all of the kids who live the lives in the first paragraph switched cribs with the kids in the second paragraph before they were fourteen months old, all of their lives would live up to the expectations of the new subculture.  I think that many people would not believe that, but I am sure of it. Here in America, people still like to believe that kids are born smart or not so smart.  That's not the case.  94.768% is learning how to learn, living up to expectations, and seeing how the world around you works.

I see so many smart, attractive, personable adolescents and young adults who all do marvelous things and live healthy, prosperous, creative enjoyable lives, if they get the opportunity.  But some of them have no one to show them the path, many even have people around them who are negative and discouraging.

I get great satisfaction when I can be part of the process that helps someone find a way to use their talents and skills.  But it is often disheartening to see how some people have so many more obstacles to fight through and overcome.  Forging a life is difficult enough for anyone.  The journey is much more difficult without a guide, or with someone stepping on your head.

We now also have so many examples of how growing up in a very religious community influences the way someone thinks, sees cause and effect and expects change.  What is "normal in that community may not fit in well in San Francisco, and vice-versa, with an emphasis on the"vice."

 No one can get from here to there alone; not John Wayne, and not Clarence Thomas. Our thinking, feeling and behaving is constantly being influenced by those around us, not matter how much we try to resist. Even the act of resistance is created by the living in the community.

None of this may be groundbreaking, but as John says:  Copy, Transform, Combine (repeat).
The more things get brought to light, the better.

Parenting fuss

Again, a new wave of books about how to raise you kids.  It all mostly began with Dr. Spock, who did a pretty good job. Since then there have been thousands, some have been decent, but most have been terrible.  Many have been very harmful. Many are really no more than political polemics created to develop true believers.

But now we are living in a time when the pressure on kids to grow-up quickly and learn the right skills is greatly magnified.  If you don't have a strong, sophisticated education it will be difficult to find a job or to create one for yourself.  Robots now do the kind of work that kept millions of people employed thirty years ago. Kids have to not only learn how to do things well, they have to do things better than others.  Harvard and MIT have only so many seats each year. Be strict, be tough, teach your kids to focus, to learn, to succeed and achieve. Fun will come for the satisfaction of achievement, play will come at 55.

Predictably, in three to five years there will be another huge pile of books written that will refute the ones coming out today.  Any parenting style that goes to any extreme may work for some kids, but will fail for most.  Every kid is different, every parent is different, every family is different and every time period is different. 

Parenting is wonderful, and should be the most engaging and productive thing that anyone does with his or her life.  But it involves a lot of time and a very delicate balancing act:

Independence but with structure
Fun and Happy, yet internalized delay of gratification
Achievement through pleasure, achievement through work
Intellectual development; emotional intelligence
Firm but Fair
Organized sports, or disorganized play
Discipline yet with Emotional self-regulation!
Learn the rules, but learn to think for yourself.
Solve problems traditionally, solve problems creatively
Play, roam, waste time, watch TV, make-up games, be a pain in the ass

A parent has to slowly instill all of these things in a smiling, running, teasing, messy, fussy, naturally playful totally innocent child.  I remember when my kids were young that as soon as I could determine out how much freedom and independence they could handle, they had grown and changed and their stage of life was different, the challenges they faced were different and I had to begin all over again.

I know that it is more difficult today with so much information, so much stimulation, so many more ways of measuring, and what seems to be much less time.

The one basic rule:  Pay Attention!!!

What seems to have improved is that Grand parenting is much easier and a great deal of fun.

Guilt

Over the past week I have had several people talk to me about how guilty they feel.  Now, I am not one of those therapists who feel that guilt is always a bad thing.  I think it is very important for someone to realize they have done something wrong, or bad, or offended someone, and to feel guilty about it.

Hopefully, guilt will be a motivator to do something good to relieve the guilt. People don't like to feel guilty, so I hope to help people find a good way to change things.

However, guilt can be so ingrained in a person's early in life that they just become overwhelmed and immobilized.  A parent, whose style is to let a child know that what they have done may not only not be the right thing, but that it hurt someone, in some unseen but emotional way, can plant the seeds of constant doubt.  Religion, as we all know, can be a big creator of guilt, which will lead to feelings of unworthyness.

But this week, one of the people I have been seeing really upped the whole guilt thing to a new level.  She was talking about how her mother always blamed her for having ruined her, the mother's life. The mother also was constantly letting this woman know all of her faults, all of her mistakes, and how they affected the family and the community.  The answer to any question about school, a friend, the family, her chores, her comments, was always that my patient was at fault; guilty unless proven innocent, and even then there were still major doubts.

To illustrate the result of such an upbringing, this woman told me that on 9/11/2001, very soon after the twin towers had tumbled and the planes all over the country were being grounded and the search for the terrorists had begun, she carefully reviewed her activities of the day, and wrote down where she was, and who she was with.  She said she did this really, without thinking about what she was doing.  It was not that she wanted to remember the day, she realized, she really wanted to make sure her alibi was in place.  She expected someone to come knocking on her door, but she was sure that this time she had nothing to do with it, and she needed to have the proof available.

Another not surprise

Americans it seems, more than those in any other country, like to avoid responsibility and also to seek a quick fix.

That's why it came as no surprise to anyone who has been in practice for more than ten years, to learn that the diagnosis of ADHD, is not as real or as widespread as it has become, and the the treatment of it, whatever it is, with stimulant medication is not effective.

In truth, a lot of what is called ADD, or ADHD, is the result of a chaotic environment, not enough consistent discipline, and certainly a lack of having learned self-discipline.

Now I don't want to run around pointing fingers and yelling "bad parent" at anyone who has been told their kid has ADD.  In truth, some teachers tried to pin that on my own son when he was ten, and the description may have even fit me for a couple of years when I was a kid.

The reason for the increase in the diagnoses was two-fold:

1. the increase in the complexity of life.  Parents now are often both working, everyone is scurrying around.  Schools are more high paced, stimulation comes from everywhere and very rapidly.  Kids hardly have time to take a break and just have random, unplanned, un-educational fun, which is the kind that really leads to the most learning.  It is very difficult for young boys to sit still and focus for more than half an hour.  Most of them just are not built that way.

2.  The drug industry found a drug that works.  They failed to point out that the drug is a stimulant (speed) and that it helps everyone focus, from seven year-olds to eight-seven year-olds.  They also did not report the studies that show the effectiveness wears off over time, and that their are often side-effects, such as headaches, sleeplessness and stunted growth.

But, once again, there was money to be made.  And the drugs do make a difference, for a while.  But they don't really help anyone learn, and they seem to hinder people learning how to learn, or learning to control themselves.

There have been so many times when I have had a parent tell me that their son won't do his homework, but  if he is interested in something: science, football, skateboarding, girls; then he will learn all he can about it.  That is NOT a symptom of ADD.  It shows that the kid is motivated to do what he feels is relevant.

Many psychologists have made a living on testing and diagnosing brain pathologies, and ADD is right up there.  But everyone has a brain, and every brain is slightly different.  Still, we can all learn to do what we need to do.  We are all good at finding ways at doing what we want to do, under pressure we can do what is necessary, unless we give ourselves an excuse.

It is also interesting to note that something like 94% of people taking medicine for ADD are in the U.S. of A.   Is it something in the soil?

Well, I guess you can't blame your brain any more if you work is late and you watched re-runs of Cheers instead of getting it finished.  You might have to tell everyone, including yourself, that you just didn't want to do it.

Back Again

So, i went away.  I had a very busy week from January 16 to 20,including having to go to a funeral. Fortunately, this was the funeral of a friend's parent, and not of a friend.  Those are getting closer, I know, but at least not yet.

Then I went away.  Took off to the South to find some sea and sun.  Being of this transitional age, we now have friends who are there when we get there.  More and more of them are taking time, many are taking much more time than we are.  They are either older, richer, or laid-off and letting it all go.  So this trip was different.  I usually go away with just my wife and maybe we will meet someone as we travel, as we have gotten good at stranger-travel conversation.  I find that interesting to talk to people from other cultures, like Mississippi, which we did last year.  Now we are meeting our own friends, and this time we meet with their friends, each of whom had brought along a friend.

So there we were, at one time there were more than a dozen of us; old wrinkled people, charming, well read, well intentioned, but certainly not as attractive as any of us once were.  It's a shame.  I realized how much I like to be with attractive people.  It tinges things with a bit of excitement.

Now we talk about art and food and wine. (I don't like wine, I'm a beer or whiskey {not whisky} guy). These folks were very interesting, well read, well traveled, successful.  We were way down at the Southern end of the country, but we all had lived most of our lives up here within a twenty mile radius of each other.  Small world? His kid had played basketball for the same high school my kid played for, only four years earlier, but we had never met. They were business people, an artist, a writer,an editor,  a couple of teachers.

But everyone was kind of a bit confused about what comes next.  Do we just amuse ourselves, or can we find a way to help the world do a little better.  We all agreed that it certainly needed the help.  No one was particularly asking for out help, except to send checks.  But all of us were amazed and disturbed to see that how the people who want to be leaders are so full of fury, venom and destruction.  Any talk of compromise or conciliation at any level, from the neighborhood to between two nations, was only seen as a sign of weakness.

I am back now, dealing with 18 messages, six new people in the middle of crises, with fewer people offering any way out. I won't be taking time off again for a while.

30 1/2

With the readjustment of my schedule, plus the introduction of two beautiful granddaughters into my world, there has been a big shift in my life.  I have three and a half work days followed by three and a half days with little or no work. 

The two worlds are radically different. Often, on a day that I am not working, even the idea of having to make a phone call seems like such an intrusion.  I have to gear up, rearrange my mind and actively remember how to do it.  On the days that I do work I am up two hours earlier.  I stretch faithfully, I join the flow of heavy traffic and I am deeply immersed in the world.

Wednesday of this week was one of those work days that were the original inspiration for me to begin this blog.  It seemed as if the whole world, in its many variations was parading into my office. I had ten consecutive hours of appointments, each unique and totally different that the previous.  It was well after 7 PM, when I cleaned off my desk, and realized that my impression of the day was totally Fellini-esque.  8 1/2 all over.

Most of you are too young to have experienced 8 1/2 at it's original time.  The movie is perfect and marvelously done, yet has not real plot, makes little sense,  and it may or may not mean what you think.  The images are still so memorable and grab that sense of how life is, at those times when life overwhelming and incomprehensible. From the first scene of being trapped in a traffic jam and having a panic attack alone in car, to the end, the parade of the characters, it was an exact description of the feeling of last Wednesday.

The clowns, the acrobats, the jugglers, the beautiful women, the painted women, the fretting businessmen, the sad wives, the lost unfaithful husbands, and the director who is searching, searching for an underlying theme.

That is what I do after  a day like that.  I still do it after thirty years of doing therapy.
Who are these people?  How did they get like this?  What can I do for them?
and then, a the meta-level--

Why is the world like this?  Why do people do these things to each other?  If, as many of my patients say, "everything happens for a reason"  why is it that I don't see the reason---
except to continue on, searching for the reason. Or ,as the Guido character in the movie says: "I have nothing to say, but I want to say it."

I stopped on the way home that night and bought a pizza.  The next morning I was back in the office.  A woman came in and told me how she was proud that she has been making progress.  She has recycled six (out of 12 -- probably really 30) clean, empty plastic orange juice bottles that could have had be re-used many times for many purposes.

She did it, but then she cried.

Change is difficult.

Reality is hard to define.

Books 2

After sitting in a small comfortable room talking to people for roughly an hour at a time for thirty years, certain phrases become part of my repertoire.  One thing that I often say to people who are in the middle of making some changes in their lives is this:

"You have to use the small part of you mind that is conscious to make sure you do what you want to be doing."

I am not a Freudian, so I am not saying that you have to overrule your Id, and repress you unconscious impulses.  Although, in a different way I am.

What I really mean by the sentence I quoted above is described very well in the book Thinking, Fast and Slow, by Dr, Daniel Kahneman.  He describes to types of thinking, one is fast, emotional, responsive and not subject to reflection.  He calls this, cleverly, System 1.  System 2, is what I deal with in therapy.  Slow, contemplative, thinking about thinking, reasoning, more rational, planning.

System 1 is much more primitive and emotional.  It is there to help us survive in a tough world.  If we are going to catch food instead of be food we have to learn how to react quickly, using very little information to make decisions.

However, in the world we live in now, things are much more complex, and thankfully, more civilized. The people who do best are those who can see the longer-term consequences of their actions:

Getting angry and smacking someone is System 1.  Getting angry and realizing that smacking someone will lead to bad things for them and for you, and thus learning to rephrase your argument so that you can negotiate with your adversary, is System 2.

As I said, learning to use System 2 is what therapy is all about.

In some ways I have been saying that in this blog.  To publish a book these days it helps to have a "platform" to give you credibility.  Dr. Kahneman won a Noble prize for this work.  He has a bigger platform than I do.  HIs book is easy to rad and helpful.

I think it's always helpful to think about what your thinking about, although it can get tiresome. Then you need to take a break and watch football.

Books, (1)

Hey, Happy New Year.

I hope you're all well and had a good holiday week and now you're rested and ready to make this year, 2012, the best ever.  Of course, we have one more day off tomorrow before we have to put in all that effort.

But this is it.  This can be the best year ever.  We know how to do it; we just don't agree.

Anyway, over the holiday I have not worked too much.  Part of what I have been doing is reading, and two of the books are long, heavy, academic kind of things that interest me.  I started one mystery and it was really well written, with good characters and a clever plot, but by the middle of it the events became either predictable or ridiculous.  I'm not good at letting those things slide, so I went back to these somewhat ponderous academic books.

The first, which I will deal with briefly here, is Steven Pinker's  "The Better Angels of Our Nature."  He takes about 700 pages to make the point that we, humans, have become more caring and less violent over the last few centuries.  In order to make his point he fills hundreds of pages of descriptions of the kinds of torture and gore, rape and slavery that were common for centuries. Most of that, he maintains, is either being eliminated or is at least frowned upon, when forever it was just part of human life. 

The point he makes, which is a different stance for him, is that we are not genetically programmed to be violent and murderous.  He shows how the growth of civilizations around the world have really served to civilize people.  We now care about things that were never even considered as possible, such as equal right s for women, a punishment being too cruel and inhuman, not hanging people for robbery, racial equality, the right to a fair trial, democracy, and the big one, which really has just begun to take hold in the last fifty years, that wars are not worth the trouble, and that they can be avoided.

This is a major new idea, and for most people it just became even a discussion in the 1960s when a lot of soft, educated, rich Americans, like me, were willing to put reason ahead of patriotism to not get hurt. This had always been unheard of, and often resulted in executions.

Certainly, there are still many people who feel that anyone who is of a different race, and women and anyone who is different in any way: gay, foreign, Muslim, etc, is still basically inferior, and because of that they can be easily slaughtered.  But that way of thinking, which was once so unquestioned, is now questioned almost all the time.

The biggest example I think, of Pinker's point, is that right now most of the developed world is in a big economic slump, and jobs and money are scarce all over the world.  But no one is threatening to go to war over it.  In the history of the world, that is something really new.

So, enjoy that idea, and Happy New Year.  Let's work together to make it the best yet.