Concentric circles 2

We live our lives in concentric circles.

I was talking to John the other day in my office.  He was having anxiety attacks, mostly about money.  He and his wife have four children.  He knew exactly how much was in his bank account.  He knew exactly what he would have to pay in five days when March began.  He knew when his wife got her paycheck and how much overtime she had worked this month.

In addition John knew how well his kids were doing in school.  He and his wife, Kathy, were very familiar with their teachers.  He had even spoken to the principal once or twice.  His three daughters were doing well, his son was charming. He was active with all the kids with their sports.  He and his wife were friends with the parents of the other kids on the teams.  They were all from the neighborhood.

Kathy was very friendly with four of the women on their street.  They knew everyone's children and tried to share carpools and after school supervision.  They also went out, either with or without their husbands, once or twice a month.  It was a good neighborhood.

That really was a far as their time and energy carried them.  John was an engineer and worked with lasers.  He had a couple of friends from work.  His wife worked in the office of a construction company.  She got along with everyone, but didn't socialize with them except at company events.

They also had extended family they were close to.  All of their parents were alive, although  Kathy's were divorced.  She was the only one of three children who kept in touch with her father, and he was not easy to get along with.  John's brother had gotten hurt at work a few years ago.  He was now living with their parents, so John was now visiting more often, but his brother's slow recovery bothered him.

The four kids, the extended family, their jobs, the homework, the sports, the house, that's a little bit more than they could really manage emotionally.  When the money got scarce they would get snippy with each other.  They were able to work most of the out in my office.

If I had asked they probably could have named two or three of the nine city councilors.  They knew who their Congress person was. They knew they would never vote for Donald Trump, or probably any of the Republicans, but that was more from their general outlook on life  and less from any deep knowledge. John knew much more about the Red Sox than any politician.

They also had extended family they were close to.  All of their parents were alive, although  Kathy's were divorced.  She was the only one of three children who kept in touch with her father, and he was not easy to get along with.  John brother had gotten hurt at work a few years ago.  He was now living with their parents, so John was now visiting more often, but his brother's slow recovery bothered him.

Life is full of many things like that.  Most people have to take care of what is closest to them first and work their way out, in concentric circles, into the broader world.  There are some people, mostly men, whose inner circle consists of just themselves.  it allows them stop skip the next one or two circles and just focus on their work, or being a bigger force in the larger world.  These types either have a strong family support system, that fills in all the gaps close to home, a lot of money that pays people to take care of those things, or they skip the family and community part and just take care of themselves.

What is happening in the world today, which causes lots of anxiety and stress, is that  everyone, everywhere  is more interconnected.  That makes all the circles are much more porous.  What happens in China can suddenly have an effect on John's work.  The coal plant in Ohio blows  carbon into the atmosphere and rides all the way to New England.  The price of oil affects so many people in different ways.  Fanatics in the Middle East still affect the price of oil. Shrimp from Thailand  is cheaper that shrimp from Louisiana.

All this makes people more anxious because they know they don't have control of these things.  No one does.  No one really can.

So you go back and try to just focus on your family, and then your community, and you hope that doing good there will spread outward to the other circles.  But now, with all of these constant sources of information, it becomes almost impossible to keep your head in the sand.

It forces people to pay attention.  It should make them think, but many people are just too tired, or too scared to take the time to think it all through ....If I do A, then B happens, and if B, then I can do C or D, and what would be better for me? For my family? community? country? world?

We need to think it through.  We need to talk to other people; people who think differently and find out why.  Then decide.   It's a very difficult task, but it pays off.

Concentric Circles 1

Within ten minutes of returning to work, I am immediately struck by the amount of difficulties that surround the people with difficulties. It is always hard to sort out cause and effect when so much is always descending on a person or a family.

I also have been reading and talking to colleagues, and I see that my profession is now touting their new successes, especially with “evidence based therapies” such as CBT and DBT and their spin-offs, as well as the re-discovering of “mindfullness.” And yes, these are good things, but when I look at the actual evidence, I see limited success, although there is often major successes with specific symptoms.

By that I mean, if you are phobic about driving on the highway, or about going to the dentist, a psychologist can help a lot.  If you are wondering about the depth of your fiancées love, then a psychologist can help you both sort our your feelings.  But if you are  like most of my patients then your list of difficulties is a bit more complex. You are in your 50s and lost your job. You feel pain from your joints and your parents are falling down.  One of your kids is taking drugs and the other is taking out another $45K to pay for college.  These are not different cases; this is always the way it happens in life. Just because you have one problem doesn’t prevent you from having another.  No, it actually increases your chances.

  I find that the therapy I offer people is very helpful.  They seem eager to come and talk to me.  We discuss how to deal with one problem while three others get worse.  I try and help people see other options, and to prioritize.  Still I see that the resources, financial, physical and emotional, that are available to create a solution are very limited, and quickly diminish. And the short-term fixes, which feel so good for the moment, like taking another drink, finding comfort with another person, saying home from work, quickly make everything worse.

Even knowing this I am still struck at how many people out there in this prosperous, energized, entrepreneurial country are just not functioning.  Yes, that’s why my patients come to me, but they also go to their extended families and find that their brothers, cousins, aunts and uncles are also stressed and falling apart. So many people are hiding, in houses and apartments, surrounded by piles of stuff, unpaid bills, and broken furniture.  The TV is on to either Fox News, the Home Shopping Network or a show about people who weigh 400 pounds.  The cat is on top of the TV and the turtle is dead in the corner.  

Everyone is on their phone, sending text messages, pictures of naked celebrities, animal videos and conspiracy theories to their friends and family who are all pretty much in the same predicament.

Yes, there are also plenty of people who are “The Makers” of this generation.  They are the ones who design the apps that all those people use to send the texts, videos and pictures.  These apps help some other “Makers” to sell other stuff, real and virtual, that those people can’t afford, but it keeps them entertained as they try to get through a day and then a week of being broke, depressed and lost.

I am old, and perhaps somewhat cynical, but maybe it was better when it everyone had to go to some boring job that made real things, like shoes, coats, cars, pocketbooks, or cabinets.  These were things that everyone made, everyone bought and everyone needed.  People felt as if they are part of the world. Now, instead of six hundred people in a factory, there are sixty machines making those things faster and cheaper.

I don’t expect that things will ever return to those conditions. I don’t want to idealize them.  I know that in many ways they were boring, unhealthy, exploitive and unsafe. But we have to find a new way forward.  We have to find ways to help everyone feel useful, connected and purposeful.

We have to learn to share and care, or this “Winners or Losers” shit will destroy us all. 

Really, it’s not that difficult: a little kindness, a little trust, a little understanding  make a big difference.

Remember, no matter what we do, or how important we think we are, we are all united by our own insignificance.  What saves us is not when someone is impressed, it’s when someone cares. Be the one who cares.

Miami

While I have a minute here, let me tell you some thoughts about Miami.
We drove out of the cold, even though it wasn't so cold this year, and all along the Eastern Sea Coast of the USA, down to the city of Miami.  We stayed there for three weeks.  We rented a condo on the 23rd floor of one of the many towers that line Biscayne Bay. We were on the city side.

Out place was not on Miami Beach.  We went to that side of the Bay a couple of times, but mostly that neighborhood is full of high priced hotels on the water, and lower priced, art deco renovations a few blocks from the beach.  They look great, and many of the renovations are very well done, but the place is a frat party. Now if I were single and forty years younger, opps, make that fifty years younger, I might have a good time on Miami Beach from 10 PM to 5 AM.  Seems like a lot of things can happen that could be fun for a brief time, and lead to heart-ache and hangovers later, and stories to tell for years after that.

But we are not in that market.  We went to Miami beach twice.  Once with my son and his family, including kids 2 and 4 years old, and once to swim in the ocean. We went in the morning when there was plenty of parking and the only folks around were either cleaning up from the night before, or asleep on lounges on the beach.

However, the city of Miami is the future.  The city is thriving. The building that is going on is amazing. The towers that were built on the bay fifteen years ago, rose to forty stories tall.  The ones built five years ago, next to or behind the first ones are sixty stories tall.  The ones they are building now are going to be eighty stories tall.  They are steel and glass with balconies.

I don't live there.  I go to visit, be warm and have some fun, so I don't spend much time thinking about where all the money for these places comes from.  Obviously, a lot of it is from South America. Money is safer in Miami  Who knows what can change quickly in Peru, Colombia, Bolivia or Venezuela, as well as Brazil and Argentina.  So people put their money in high rise condos in Miami.  They bank in Miami, they put their mistresses, the ones you see with the augmented breasts, walking their little dogs, into those buildings.

I have been told there is lots of money coming in from China too, and probably lots is smuggled out by some of the Russian oligarchs, and sheiks from the oil countries.  Not my problem.

But being in Miami is seeing the people of the future.  They come from everywhere, and they live, work and play together.  The first language of the city is Spanish.  There is Puerto Rican Spanish , as well as Mexican, Cuban, Haitian, and dialects from all over South and Central America. There is a lot of Brazilian Portuguese.  There is Moroccan and Canadian French.  Almost everyone speaks English, and there is still a tiny bit of Yiddish left, but that is almost gone.  Moved up to Boca. People switch languages in the middle of their sentences, using whatever word fits best.

The people range in color from whitish, to very Black, but most are some shade in-between.  The money seems to be distributed almost evenly among all of the colors, but not the neighborhoods.  Along the water there is money.  There are Maserati, Lamborghini, Bentley, and Ferrari, zipping along those streets.  Five blocks to the west, there is very little money.  There are lots of twenty year old Honda Civics driving slowly through the streets.

So many different  restaurants.  So many kinds of foods at all kinds of prices.  Our favorite serves food that is a Haitian/Asian fusion. So many different kids of music, all over the place. And while there are still many that play the music of the old culture, most of the newer stuff is a blend of three f or four cultures; Spanish,/hip-hop,/rock.  Jazz/Cuban/soul/Beethoven

It's all coming together down here and the rest of the country will follow.  It will make America a wonderful place to live, an whoever gets on the Supreme Court won't be able to stop it.

And soon all the buildings in Miami will be connected by beautifully colorful skywalks, as the first four or five stories will all be under water.

But as long as the kitchen is dry, things will be fine.

These times

We were away.  We drove home.  It was warm there.  It was cold here, but now it's warmer, and raining.

I had a great time in Miami.  It is the city of the future.  I will tell you why when I have the chance.

We had an interesting ride home.  We stopped in new places.  We also visited with good friends who live along the way.  They were all going through different things in their lives.  It was good to see them. But they were very busy, despite trying not to be.

We returned to mail, email, the kids, the grandkids, preparing for the work i had to do today, and then for next week.  Trying to do taxes, to deal with the neighbors, with other sick friends, with friends who are well, who are getting divorced after 42 years of marriage.  Others who want to get together, and have great idea of what we can do, but we can't find a common time until the end of April.

There is also the rest of the world, the crazy election, all of the changes going on in my profession, in the other sciences related to human behavior, that I want to have time to think about, but don't

and then it snowed
and then it rained.
then the two year old had trouble breathing so he went to the doctor and the doctor was worried so they sent him to the ER and that took three hours. We had to take care of his sister and worry about him, but he's ok.
Now the five year old is out of school, so we have to watch her, and then cover for the two year old whose day care is closed for the week.

And i am beginning to say goodbye to the rest of my patients as I will stop the direct clinical part of my work in June.
That's good and that's bad, but it's finally clear, but it's not easy.

And my life is good! and I am healthy!  Yet it is overflowing, and too much and too fast, with no time to reflect or draw conclusions or feel as if I am running my own existence.

Just running downhill, too fast, on top of wet leaves, hoping to to crash.

Set Free!

Yes, I promised my few dozen followers that in this new year I would have the time and the intention to set the record straight, and do so with regular blogging at this site.

So, I didn't.  Not yet.

No one has expressed too much disappointment, so I don't feel to guilty.  Especially since I believe that most of my followers are bots.

But I have been set free!  Set free by rejection.
If you remember, I think I wrote about how I presented some of my ideas at our the State Psychological  Conference.  I received such a mixed reaction to that, at the urging of my Division's program co-chairperson, I submitted a more extensive version for the national conference.

I guess she urged others also, because I was informed there were many, many submissions and mine was not chosen as one that the members would most want to attend.

Of course not!  That's why I submitted it.  They need to hear what is really going on.  They need to stop being so insulated and praiseworthy of group-think.

But now I'm free.  I no longer have to alter my thinking to be acceptable.  I no longer have to submit to any committees and try to follow the rules and submit the forms.

Now, when I get around to it, I start telling you all how it is.  A Psychological Memoir --Past, Present and Future.

But right now, we have left the not so cold weather of New England and tomorrow I am going to the beach.

Like always, the truth will have to wait.

Take care of yourselves until then.

Or, if you're a bot, unplug and then plug back in a minute later.

LCDs — Not the lights

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

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

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

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

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

https://vimeo.com/43308455

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

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

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

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

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

So much stress, so unnecessary.

The War on Drugs

I often check the police log of the local newspaper to see if any of my old patients will surprise me.  Last week a patient whom I had not seen for several years was listed as having been arrested for possession of a Class A substance.  This was not a surprise.  The young man had been struggling with many issues involving work, family and school for years.I remember working with his mother when he was a teenager to try and get him services that  would be more intensive than what I could offer him.  But he was a tough kid to work with, so no one put in the time to push for him to get into the very few places that may have been available.  Perhaps the court system will be his best chance of getting into a program.

There has been a lot of publicity over the last couple of years about the over-use and the illegal use of opioids, which has been leading to an increase in addiction and a noticeable  increase in deaths from overdoses.  Now that many of these deaths are of young adult, middle and upper class White people, it has become an “epidemic.” In response to this there have been more calls for restrictions on the use of many opium based pain medications as well as more treatment programs for people struggling with these drugs.  There are also calls to make treatment the alternative to criminal prosecution.

Of course, much of this problem is the result of the disastrous effects of the everlasting “War on Drugs.”  That war should now be regarded as one of the great failures of American war policy, right up there with the invasion of Iraq and Viet Nam. The only people who classify the War on Drugs as having any success are those who favor the mass incarceration of Black people for non-violent crimes, and the private prisons, who have made billions of dollars in profits from these incarcerations.

By any appraisal of the huge amount of time, money and the destruction of social fiber that has resulted from the War on Drugs will quickly reveal that the entire effort was worse than a failure.  There have been so many destructive  effects that still are undermining American health, safety and quality of life.

Here is a partial list of that pain and suffering this war as caused:

— the criminalization of acts that, if they hurt anyone at all, hurt the person using the drugs.

— that resulted in people being put in jail instead of getting treatment

— that resulted in them using jobs, and not being able to find new ones

—  often these people were deprived of getting driving licenses or voting

— they became burdens to their families

— they were regarded as weak willed, losers and worse

—  this kind of social rejection often led to the return to addiction

Despite the huge amount of time, money and effort devoted to fighting the War on Drugs the actual use of drugs never really diminished.  Illicit drugs are still widely used and distributed. They are distributed by illegal means, mostly being drug cartels.  The money goes to support illegal efforts and make criminals rich.  It is lost to the economy.  It is not taxed.  Thus it is a negative economic benefit. 

Those are the obvious failures. There are many secondary failures that have resulted from these policies.

— The amount of time, money and resources that police department have spent fighting a crime that did not have to be a crime

— a result of this was the development of  greater 

 adversarial conditions between the police and many people who would have trusted them.

— this led to a in a militarization of the the police

— the development of SWAT Teams to chase drug dealers

Also: a big increase in gun violence is related to the vast sums of money earned by drug dealers, the wars over their territories, the use of informants, and the entire unlawful importing, selling, buying and using of drugs.

None of that was necessary.

All of this has been a major factor in the corruption of governments in many countries around the world, especially in South and Central America, as well as many American local police forces.   The American addiction of drugs that are illegal has brought billions of dollars to huge illegal cartels.  There have been countless thousands of deaths in drug wars between cartels, in wars with police and armies, and of many people who were just in the wrong place, or innocent families who had relatives on the wrong team. It has helped to set a climate of corruption, opposition and distrust in many societies, especially in our own, as otherwise law abiding people learn to oppose the police. The need too afford illegal drugs has lead to many robberies and burglaries, even among family members.

The money from illegal drugs has financed revolutions in many countries included Columbia, Afghanistan and ISIS.  

The war on drugs has torn apart families.  The ideas of “Just say no” and “Tough Love”, would never have been necessary if taking drugs had never become a crime, and considered a moral disgrace. 

Treatments for drug “offenders” were much less effective and much more punitive than they would have been without the overlay of legal consequences. Mandated treatments are still a great expense to taxpayers and to the individuals involved.  They often set up requirements that make it difficult to hold on to a job, and they are often a waste of time and money since so many people are forced into treatments when they do not feel that is what they want to do.

Pharmaceutical companies were very active in combatting illegal drugs while promoting their own drugs.  Those lines became blurred and remain blurred today.  They want to sell a lot of pain-killers, but don’t want to be responsible for addictions.  They market drugs that they said would help learning, behavior and mood. But they were against other drugs that people knew made them feel happier or perform better. It is never clear how much drug manufacturers fight against the underground buying and selling of the drugs they manufacture. The pervasive message that a drug will make you feel better, no matter what the problem, has certainly become well established in our culture. People seek drugs for better health, performance and pleasure.  It is not clear why some are legal and some are not.

This is just a partial list of the harm done to people, their families, their communities, the country and the world by the War on Drugs.  This war, like almost all wars was started for political reasons.  The underlying factors were fear and racism.  One of the original fears were the fears of the changes that were happening in the sixties.  People were standing up to their government saying they didn't want to go to war.  Other people were asking for equal rights for women and minorities, especially African Americans.   The status quo was being threatened.  The people who were threatening were the hippies, Blacks and women.  They seemed to be the ones who like to take drugs. It became a big issue of the culture wars.

In just the last four years, since many of the older white people who were threatened are now busy carrying guns, and a non-threatened younger generation is more tolerant, changes are occurring.  There is finally a movement to look at the imbalance in prison sentences that have sent Black people to prison for crack, while white people who use powered cocaine get probation. The legalization of marijuana is slowly becoming acceptable, but there will be many disputes over who gets the money.

All of this is made even more distressing because there is an example of other ways to deal with drug use and abuse, and it has proved very successful.  For the past fifteen years Portugal has decriminalized all drug use. The problem was shifted from the justice system to the health department. 

- “If someone is found in the possession of less than a 10-day supply of anything from marijuana to heroin, he or she is sent to a three-person Commission for the Dissuasion of Drug Addiction, typically made up of a lawyer, a doctor and a social worker. The commission recommends treatment or a minor fine; otherwise, the person is sent off without any penalty. A vast majority of the time, there is no penalty.” —  Policy.mic.com

Since the drugs are available and affordable, and having them is legal, then their is no crime, so the crime rate is way down. There is no secondary crime, such as robberies.  The police will help you if you get sick or want treatment.  The user is not viewed as morally or psychologically deficient.  

And, not surprisingly, the rate of drug abuse has decreased over the years, and so did the spread of HIV.

Unfortunately, it is too late for my former patient to get treatment without having an arrest record to haunt him.  But recently, there are signs that people are realizing that there may be a better approach.  Like everything political in this country, change will not come easily or swiftly. So much depends on awareness, and then of changing the flow of money.  Many people, from drug makers and growers, illegal cartels, corrupt officials, drug companies and diversion programs are making money from the current system.  It will take working with families, courts, police, doctors, drug users and others in the health system to bring about change.  

Eventually, things will change.  The changes in our culture will continue, even if many people fear the unknown.  But our societies ideas about what is helpful, what is healthy, what is legal, and what is pleasurable are evolving. Also, new substances will be developed that will help blur all the lines.  

Until all of that is sorted out, take good care of yourselves and each other.

What Next for Sammy?

The last post, the one about Sammy, is about a kid who had an unstable beginning, had a mother who spent years pleading for help, and she is still searching today. His problems are complex and multi-determined, so no one treatment will work for him. Drugs only made things worse, as he really got to like Xanax and Klonipin, so he stole them from his mother, and anyone else who had them.  Psychotherapy was difficult.  Perhaps if I was able to see him three times a week, but his mother couldn’t get him to me that often and insurance wouldn’t pay for that.

A treatment plan that may have worked would have been if he could have been placed in a therapeutic day school, beginning in around third grade when his difficulties became obvious.  He didn’t need to be sent away, and that would have probably made things worse.  But if he could have lived with his mother and brother, and gone to a school with small classes and counseling, where, over time, people would have gotten to know him.  it would have given him a much better chance.

There are three or four schools like that around here. By around here I mean an hour to two hours away.  They would have been expensive for the town, and those special schools filled up early. The town and an advocate would have had to push hard and often to get him in.  But since the school regarded Sammy’s mother as a pain in the ass, and thought that her family was just trash, they were not going to give Sammy what he needed.

The mental health system didn’t offer much.  He didn’t need to be hospitalized, so it was up to me, out there by myself, to do what I could. I was able to get him into a couple of special classes, mostly for academic help, but as I said he was a tough kid to bond with, so the teachers gave up quickly.

Now that he is in his early twenties his problems are considered criminal.  He was caught with a Class A substance.  That means he was arrested.  The criminal justice system may be the only place that he will get treatment.  With so many over-dosing happening now in New England the courts are trying to find more treatment options for people with addictions. But someone will have to determine if he is “motivated.”  Really, it should be part of the job of the treatment program to find a way to get him motivated, and to care about himself.  But that is a much more complex task.

As  it is now Sammy is just another casualty of the “War on Drugs.” The “War on Drugs” now ranks with other recent wars in American history, such as Viet Nan and the invasion of Iraq, as worse than a total failure. 

I’ll discuss that next time.

Another Year is Here!

The end of one year and the beginning of a new one seems to bring out a moment of reflection and evaluation in a lot of folks.  I am grateful for that as several of my patients from years back have taken the time to send me a message.  They usually just say that they remember me, and that I was helpful.  Some say more than that, giving me credit for things I don’t remember saying, or for transformations that happened during the time that they were in therapy.  I certainly enjoy reading those messages.  

That’s the good part of the year’s end transition.  The more upsetting part is that when one patient contacts me to say good things, it reminds me of some of the other people I was seeing at the same time.  Memories get linked the way.  I don’t like how much my memories of the people I didn’t help that much overshadow the good feelings I get from those who did well.

Yesterday, I went through that whole cycle while sitting here at my desk as the early sunset came pouring through the window, making reading on my computer screen difficult. A message from one person led to to search for the name of another.  I quickly found what I expected. He was arrested last year for the possession of a Class A substance.

“Sammy” was a young man I saw about five years ago.  He was sixteen the last time we met. He was brought to see me by his mother, who I had been seeing at the time.  He was very ambivalent about coming.  He wasn’t the ideal psychotherapy candidate. He was untrusting.  He couldn’t make eye-contact. He was almost non-verbal.  If he spoke at all it was in one word sentences.  Two words made a paragraph.

All of this he came by honestly.  His father had drifted away when the boy was about four. The father had a drug problems of his own, and probably many other problems in addition.  His mother was very hard-working, very depressed and she herself had come from a family that was so messed-up it would take about sixteen pages to just give an overview.  So, when she would get involved with some men who wanted to save her it was never good for her children.  A couple of the men were especially harsh on Sammy, who was sullen, disrespectful, and not very cooperative.

I could go on and on, and I should actually, but no one reads two-hundred page blog posts. But the message is that “mental health issues” are very complex.  They don’t lend themselves to clear, consistent solutions.  Sammy was the kind of kid who, if I really wanted to help him I should have taken him home.  I could have said to my wife, “Hey, this is Sammy.  We are going to wash him, feed him, and keep him with us for five to ten years.  We will sand end him to school here, where there is a good school system, and we will go to school once or twice a month to make sure we are on working together.  We will try to limit his time playing video games and then try to help him make one or two friends.  We will try and protect him from being bullied, and show him that he is talented and capable.  We will try to make sure he smokes only a limited amount of pot.

It probably would have also helped if his mother came to live with us on weekends so he would know that she didn’t abandon him. If he went to be with her on weekends those two days would have probably undone whatever was gained during the five days he stayed with us.

But I din’t take him home. I have this rule about not taking any patients home. Even if I did I don’t know how successful an intervention it would have been. I’m not his uncle.  His uncle is in jail.

I did go to several meetings at his school.  I tried to get one of the school counselors to see him because his mother was having so much difficulty to get away from work in order to get him to my office. The school essentially told me that they didn’t like him because he was sullen, withdrawn and difficult.  Essentially, they blamed him for having all of his problems. and even encouraged him to drop out and go away.

These memories bother me.  When I read about people who are homeless, or people being shot by police for brandishing a stick or having a lump in their pocket, I think about Sammy.  When I know that there are thousands of young men getting thrown into jail, or dying in messy apartments of drug over doses, I think about all of the Sammys I’ve seen.

The underlying causes are probably genetic, partially.  Certainly abuse, poverty, and lack of supervision and encouragement don’t help.  The lack of resources, support, and concern by the community adds to the problem.  Then his difficulties get defined as a crime which makes everything worse. 

So now I don’t know.  I don’t know if he is in jail or just on probation.  I don’t know if he will be scared enough, or get enough support to stay our of further trouble. Can he get a job and make enough money to support himself?  Is he capable of having any kind of real relationship with anyone?  

I know that he really never did anything wrong, or actually hurt anyone. He’s not a criminal unless being poor, depressed, confused, bullied and pushed aside is a crime. I know that his mother still cares.  She is still out there trying to get him into a rehab, but the beds are full and the treatment is short.

The rest of the world doesn’t really care about him and all of the Sammys.  They are difficult and embarrassing.  Eventually they just get swept up and put in the trash. The real problem is that treatment is too complex, and more importantly, too expensive.

I know I tried.  But it wasn’t enough.

Another Year is Coming!

Another year is coming. not much we can do about it , except stop marking time.  Time, in many ways, is a concept invented by fairly modern men.  I say men because when they started marking time I don't think women had much influence, but I can't be sure. Some wife in ancient Babylonia may have told her husband not to come home late.  He might have answered, "Late?  I don't know what you're talking about.  I'll get home when I get home.  That's what happens."  But they didn't have Apple watches then, which do tell the time somehow, and also show the text message from your wife reminding you, and the  pop-up screen that tells you when to leave and what the traffic is on the way home, as well as the weather, and emails from work that tell you what you have to do when you get home -- so that being home with your wife won't be the same as she hoped it would be.

Others, like some physicists I know, explain that time is not invented, it is the fourth dimension, and it has existed as long as our universe has existed, and it may or may not have existed before that.  In our universe, the physical laws insist that time can only move in one direction, so that if you get home late, then you can't rearrange things and get home early. But that may be possible to do under the laws of a different universe.  There may, or may not be an infinite number of different universes (multiverses). One of the laws of our universe is that we can't get to another universe, not even using Star Wars warp-speed.  But if there is a unipole -- which allows for an opening into another universe, you may be the one to be drawn into it.  However, if that happens no one knows if you will be able, or if you will even want to come back.

Most of us just go along counting time in the usual way: seconds, minutes, hours, days, months, and then years.  A year signifies, roughly, the time it takes for the earth to take a trip around the sun.  We go through all the seasons, those of us who still live in places where there are seasons. So marking the end of the year, after 365 days -- 366 next year, is an occasion for a moment or two of reflection, and to regain the hope that the world will be better and that we each will use this demarcation in time to reprioritize our own lives so that we may live happier, healthier, more creatively and do things that make us pleased to be who we are.

So here is my brief list of New Year's resolution Do and Don't:

1.  lose weight -- if you've already tried to do this, and if you were not too successful, then don't bother.  The odds of any individual losing weight and keeping it off are very against you.  There are so many reasons, from genetic to physical to psychological that make it very difficult.

2. Exercise -- this one is a bit more achievable.  Anyone can get up from where they sit and walk around the block, go up and down a flight or two of stairs, do some push-ups, or strike some ago poses.  Exercise, moderate to vigorous, is good for your body and brain. There is a line, especially at my age, when instead of building up muscles, heart and lung capacity, I find it hurts and I get injured. Pain is a good indication of when what you're doing is wrong.

Have joined gyms in the past, not now.  To me they are boring.  The only good part is I got to listen to music, but it takes so much time to get there, change, shower and go home.  It's easier to walk around the block. I know a lot of people who have always exercised either through some activity they enjoyed or sports.  There are just as many who find that regular exercise is unpleasant and boring. It seems that the ones who like doing it, do it.  The others don't.  Changing from being one of those to the other is very difficult.

3, Mindfulness -- Boy is that the thing, isn't it.  Seems like a good idea, but I'm not sure if it is another health fad, or has real benefits that last.  They say it can clear your brain if you get good.  It's difficult to learn how to do it right if you're pretty anxious to begin with, and those are the people who it's supposed to help the most.  Try it if you wish.  There are many sites that will teach you how.  Be suspicious of the ones that try to sell you stuff.

4.  Blogging.  I'm going to blog on this site twice a week next year.  I now have the time to do it, and I find what I have to say quite fascinating.  I also want to see if I have the discipline and capacity to follow through.    I don't think I'd be a high pick on a fantasy-bloggin site.  We shall see.

But do this for me.  Try to enjoy yourself, in both ways that are important.  Way #1 is to have fun: laugh, be with people you like, do things that are easy and interesting, whatever it is for you -  movies, sports, kids, music, sex, staring out the window, hiding in the closet, tickling a three year-old.
Way #2:  Do something that brings satisfaction, that feeling of doing something for others, doing something that was difficult, figuring something out that was useful, fixing something that was broken, or creating something new that serves a purpose.  If you do #2, you will enjoy doing #1 much more.

2016 -- Wow -- Who Know!

Winter Sing

In constrast to my last post, I will now report that I have just returned from a delightful experience. Of course, being who I am, I felt the mirror image of what I saw, and that troubled me.

This morning I went to the "Winter Sing Concert"of one of my granddaughters at her nursery school. The singers ranged in age from 3 to 5, and were all smiling, giggling, active beautiful children.  They sang songs of  snowflakes melting on their faces, and other songs of the seasons.  Many of the songs were accentuated with hand gestures or body movements.  Most of the kids were paying attention most of the time.  They were smiling and waving at their parents and grandparents who filled the audience.

The concert was given in small but beautiful auditorium, on a small but beautiful campus, set on a hill overlooking the woods and a lake.   After the songs and dances were over we were taken back to my granddaughter's classroom for little snack and a look at their accomplishments.

My immediate reaction to the classroom was that I was jealous.  I wish I could go to a room just like that for three to six hours a day.  They had almost everything conceivable to encourage anyone to explore, play, create, express feelings, attempt new things, find new ideas, relate to others, work with others, work by yourself. or just sit and stare.  They had separate but overlapping areas for painting, coloring, drawing, music, writing,sculpture, piles of natural objects, piles of building objects, rolls of string, and shelves full of books.  There was room to use all of those things, and to combine as many as you wish.  There were very few rules, very few assignments,  nothing rigid, nothing judgmental, no dogma, no right or wrong. It is just a  fantastic place to come and play and see what you wanted to do and be with people to do it with.  And, the place is surrounded by paths through the woods, big and small sculptures, and fields for games and just running around.

Oh, of course, there was nothing electronic.

It was clear that the kids loved the whole thing.  They liked being there, they like each other, the teachers and the activities.  They ran around, they made pictures, stories, skits, games, and all kind of projects.  They worked alone, in small groups and in big groups. They resolved their differences.  They helped each other, the added on to each other's creations.   No, it wasn't perfect, but it was close.

It is in an environment like this that toddlers turn into children and take that with them when they become people.  They learn how to operate in the world and how to operate the world. They get some idea of how to get long, how to lead, how to follow, and how to go off and do their own thing.  Mostly, they learn that world is fun, fascinating, and that they can contribute.  This becomes part of them.

So, what's wrong with that.

Nothing. There is so little wrong that I wish every child could have that. Really,I wish I could be doing that.

The only thing that bothered me was seeing that 95% of the children were white.  100%  came from families who were at least in the top 5% of wealth. Every child had at least one parent or grandparent there, usually two, three or four.

I don't know all of the children and families, but the ones that I do know are really good people.  The kids are not spoiled, too much.  The families seem to have some sense that they are fortunate, and that they can have these kinds of privileges.  I don't fault them at all.

My realistic hope is that my granddaughter will realize how fortunate she is, and use her special opportunities to do good things that benefit more than just the few people around her.  At least she will see that the world is not really like that, and she should appreciate that she landed in the right spot.  It doesn't make her better or more valuable than any other child, but in some ways gives her a greater responsibility to be a good citizen.

My unrealistic hope is that somehow, our society, which at this moment,  is so crazy, competitive, divided and fearful, will realize that it would be worth it to find a way to give every child a opportunity to begin their lives in such an open, caring, accepting, encouraging and explorative atmosphere.

If we really want America to be the greatest, most innovative, creative, caring, prosperous, society, with a sense of unity and pride, then we should be eager to give everyone this kind of equal opportunity to stretch the limits of their talents and abilities.

The kids I saw today are all marvelous children.  Almost all of them will go on to have happy, secure, prosperous and healthy lives.  Many of the children from this area have gone on to do much more than that, and to use their skills and talents in the wider world.

From my work I know that as 3,4 and 5 year-olds, these kids are no greater or more special than any other kid.  If I could put any child into that room for three to six hours a day, and bring their families there too, 95% of those kids would grow up to be just like these kids, and the country and the world would be much better off for it.

We are, each of us, unique. We are each just as valuable.

Call me Crusty

That's Crusty, not Rusty or Grumpy. It's a variation on the theme.  It's an attempt at self-definition, because, as the transition continues, defining my place in the universe becomes elusive.
That's not necessarily a bad thing, but I had been so selfishly well defined for so long that it is an adjustment to be so free-floating.

Two days ago I spent the day being my old self.  I was back in my office being the good therapist. I still am a good therapist, which is still gratifying.  The people who came to see me are really pulling their lives together. Almost all of them will no longer need me, which is my goal. Sure, they would almost all continue to come, because it's always good to see a therapist. But they really can do as well without me, and I want them to realize that, and believe in their own judgement.

Even though I feel I m still good at what I used to do I no longer feel that doing that is good for me. Sitting too much is bad for my neck and my old, expanding prostate.  I also feel that there should be better ways of doing what I was doing, and I want to spend my time figuring out how that might happen.  I have some pretty clear ideas of what needs to be done and why.

But that doesn't mean that the world, or even more than seven of my colleagues will stop and listen, or really have any interest in what I have to say.  My profession, like every profession, has people who are respected and have risen to a place of authority. And, like other professions, those people are much more invested in keeping their ideas going than in exploring new ones.

Now, I have never cared much about respecting those who have become the visible leaders. There certainly are some of them who have done some great work and some very helpful thinking, and I have respect for them.  However, IMHO, most of those who are well known, are those who have the best marketing skills, or have latched on to someone who does it for them.

It is quite clear that marketing has not been my strong suit. Yes, I did what I needed to make my practice work, but after a bit of a push things ran smoothly. But beyond that I did little more than yell from the back bench.

No trumpeting Trump am I. Yet, if that kind of momentary garbage succeeds, do I want to be part of that parade. Makes me sad.  To see people so easily mislead, especially in this time when there are so many real, exciting, uplifting discoveries.

But primitive comes naturally, thought, refection, planning, walking up hill, looking for empirical evidence, takes more energy, and a bit of discipline.

So now, as I try to spread my own gospel, I have to wonder, am I just another old man screaming crazy ideas in the wilderness, or will persistence and fortitude, aided by the truth of my message eventually be persuasive.

It is the ancient therapist
   And he  stoppith one of three.....

An Almost Civil Disagreement

Max and I disagree.

But we are civil enough to at least attempt to discuss our differences.  We both admit that neither of us should expect to sway the other one at all.  We also will try to present our ideas in terms that could possibly be consistent with the other person’s values.  But really, since we certainly don’t share values, we have a tough time understanding why the other person is such a moron, especially when the truth is so obvious.

However, to begin with, we actually both agree.  We agree that our great country, the land of the free and home of the brave; home of the creative, the entrepreneurial; beacon of hope to the world, with a government of the people, by the people and for the people, — is a mess, and headed in the wrong direction.  We also agree that part of the problem is how terribly divided the population is, and that this division has become more hostile and disrespectful. 

We disagree about America’s priorities, more specifically about what to do about taxes, health care, big government, wages, education, race relations, immigration, refugees, war, weapons, guns, banks, the Fed, welfare, climate control, energy policy, Donald Trump, Hillary Clinton, All of the Bushes, Israel, Muslims, Christians, Jews, China, the Middle East, the whole defense budget, cities, suburbs, sex, the electoral college, the right to vote, abortion, transgendered people, soda and salt, and many, many other ways in which people care, govern and relate to each other.

We have some overlap in our ideas about Russia, job training, Ben Carson and gay people.

If you want to know more specifically what his positions are, then watch Fox News and read the Wall Street Journal.  He has those positions down pat, almost word for word. My ideas, which I like to think are the result of hours of thought and refection, after reading many sources, are actually close to what you get from the New York Times and NPR.

Not surprisingly, Max was raised in a rich semi-rural suburb in Virginia.  I was born in Brooklyn, NYC.  Really, that’s all you need to know.

Here are some of my generalizations of where we disagree.  If you want to read what Max  thinks, then you can go find his web page. He believes that people should be self-reliant.

Max believes in good and evil.

I believe in cause and effect.

Max believes that the most basic American freedom is the opportunity to make as much money as you can, and that the government should stop messing around with that.

I believe that America’s greatness comes from how it guarantees freedom of speech and thought. The government is there to protect us all equally from being exploited, intimidated or harmed by anyone. I also believe that the government should do whatever it can to help all of us improve our lives, liberty and pursuit of happiness.

Max says he believes that all people are created equal and are free to do whatever they want with their lives.

I believe that the rich and powerful have always, always, exploited those who are poorer and weaker, and that they very rarely give up their advantages without a struggle, often with violence, but not always.

Although he hides behind euphemisms, Max believes that some people, mostly those like him, are intrinsically worth more than others, due to their native endowments.

I believe that we are all equal in our insignificance.

Max believes that men and women are equal, but also that they are basically different, and they should both keep to what they are best at doing.

I believe that is bullshit, sexist and exploitive.

I believe in science, and in using data to see what is going on and to help make the best decisions.

Max feels that science can be confusing and can be used to prove anything, and that good, common sense is enough to decide what should be done.

I believe that due to rapid advances in science and technology, shifts in population dynamics, and climate change, this country is going through a major transition, and once all of those things are recognized and accepted, and we learn how to integrate all of these new things into how we live and work together, our country will be much better and stronger.

Max agrees with all of that except that last three words.  He would substitute weaker and worse.

I think we both would like to find some common ground, but we don’t know where.

We have tried talking.  We have even tried listening.  But we both have very strong core beliefs that we can’t give up. It makes compromise difficult.

Bang, Bang....Again

Bang, bang.  another white man fires an assault weapon into a crowd of unsuspecting people. He is not a Muslim. He was hardly on anyone’s list of really dangerous people.  It’s just another shooting that will make the headlines for a day, or maybe two, and then, like all the others, just fade away onto the long list of pissed-off, white men shooting people they don’t know. That is, unless the bullet went through your husband, sister or child. There have been about one school shooting a week, just at schools, since the massacre at Sandy Hook.

Already, it is clear that the explanation for this man’s behavior, as with all of them, is that he has”mental health difficulties.” This is a concern of mine since I am a mental health professional.

But this one at Planned Parenthood, in November, 2015, has upset me, perhaps even more than the others. This one appears to be much more of an American Terrorist who has been motivated and encouraged by the current level of political antipathy.  But I doubt that Carly Fiorina, or Fox News feels that they have any blood on their hands.

I followed the messages on Twitter that were responding to the shooting as the man was being surrounded by the police.  So many of them were supportive of his invasion into Planned Parenthood.  I realize that it was Twitter, and that is the place to say as many outrageous and inflammatory things as possible, but so many people, many of whom seemed to base their comments on religion, felt that the shooting was somehow justified.

What frightened me was how these messages were full of the same kind of certainty, and the same kind of blind religious fervor that makes everyone fear ISIS.  But that is a part of the freedom that America offers — the freedom to believe anything you want, and to turn in into a public truth.

None of these thoughts are completely new or wildly insightful.  It just becomes increasingly upsetting for me, as I age, to see that even though so many aspects of our lives have changed, evolved and improved, these improvements are always followed by a strong paranoia about change. At some level there must be a genetic predisposition to fear differences.  Changes in the way we live makes things feel different. People fear change. Fear is a more powerful and protective emotion than curiosity.  We have to feel safe, and somewhat secure within ourselves to be curious. Fear takes that away.

Fear distorts our judgment about how dangerous a threat really is. The fears people have can be mollified by classifying the dangerous person as an outlier.  We always say that the person who frightens us has mental health problems.  He is not one of us, just like the foreigners, the Muslims and, very often, African-Americans.  Politicians know that fear is very powerful, and they often inflate it, to distract everyone from calm, rational, reasoning; from finding a response that may be beneficial, that could lead to a solution beyond just placing blame.  Stoking fear has always been a very successful strategy. 

Any American is much more likely to be harmed by a disturbed white man with a rapid-fire weapon than by a band of ISIL jihadists. But I guess we accept that danger as part of the great American tradition of freedom of expression mixed with the right to bear arms. 

That’s what frightens me.

A Holiday Hint, from me and Rosanne

        I would like to begin by wishing everyone a happy, and healthy holiday season, whatever your holiday may be,  I realize that for many the holidays are full of stress and expectations.  There are already many excellent pieces of advice and guidance posted all over the Internet.  They range from how to deal with your crazy uncle to how to deal with your turkey trauma, and how to come out to your family on the holiday. Read them carefully, and take from them what you can.

I have been a psychotherapist for over forty years. I believe I have seen or heard about almost every aspect of the human condition by now.  I still get surprised from time to time, but I don’t think there is anything that one human could do to another that would shock me.  My view of interpersonal behavior is that it is often distressing and depressing, but just as often it can be uplifting and inspiring. 

Over the years I have gained a great appreciation of how complex human behavior really is.  All of our thoughts, feelings and behaviors are shaped by so many factors, both within us and around us. And all of these influences are interacting with each other all of the time. Nothing stays static, there is never a break, life continues.  It is usually almost impossible for us to really understand why we are acting or reacting the way we are at any certain moment.

I often quote one of my favorite philosophers on that subject, many of you may remember her, the great, and unfortunately late, Rosanne Roseannadanna.  In almost all of her short philosophical statements she would say:

“It goes to show you, it’s always something.  If it isn’t one thing, it’s another.”

To that I would add that it is often more than one thing; it can be many, all at once.   You get demands, ideas, expectations and affection  from your parents, your spouse, and your kids.   This happens at the same time that good and bad things are going on with your job or at school.  The immediate state of your health can make things dramatically better or worse.  Other things, such as your friends, your house, the weather, and your finances also are playing a part.

This is especially true during the holiday season. This is a time full of a constant stream of emotions,both positive and negative, which are more intense than usual. There may be feelings of inclusion and feelings of exclusion.  You may experience feelings of great joy, but they can also be mixed with strong feelings of sadness and loss.

The only advice I would like to give is very general: take good care of yourself.  You can do this by being more aware of what is going on around you, and who is doing what to whom.  Try to anticipate what will come next and prepare a way to deal with it.  And, once you are feeling mostly okay, then take good care of those around you.  That’s really what all these holidays are about.

Good Bye "Rita"

I went to work again today.  I am doing clinical work on an almost weekly basis.  I am trying to help a limited number of patients get where they want to be, and still carrying a few others who will never get there.  Today I said good bye to one of those who fit into the later category.

"Rita", ( all the details have been changed) I will call her, is even older than I am, and she is in much worse shape physically. I first saw her over thirty years ago for a brief period of time.  I saw her five years after that, and ten years after that, and finally, three years ago she really came to see me on a regular basis.  Last year I saw her only four times as she was physically unable to get to my office.  She was brought to this last appointment by her son, and she hobbled in on a cane.

Rita first came to see me on the insistence of her doctor who told her he would commit her if she didn't keep her appointment.  In those days it was much easier to send someone, especially a woman, into the hospital, and they would often stay there for months.  She was one of those women who was well known around the community.  Some thought she was volatile, others just called her nuts.

She always dressed very provocatively, which made it difficult for people to realize how smart she really was. She ran her own insurance agency and she knew her business well, and ran it honestly.  But she was ultra-sensitive to personal slights, and was overly suspicious of people's motives.

Over the years she came to trust me, mostly because I helped her stay out of the hospital.  She finally let me know about many of the thoughts she had about who was plotting against her, and how people took advantage of her.  I came to understand that the lines between what was real and what was distortions were very slight.  She wanted attention; she wanted affection, many people took advantage of that.  Because to that her fears and suspicions became exaggerated over the years. The more distrustful she became the nastier she was to people, which, of course made them pull away from her and avoid her.  She knew they were talking about her, and they were.

Now she lives in the back room of her son's house.  She hides from her son's wife.  Her only consistent contact comes when she talks to her former husband on the phone.  She pushed him away years ago.  He didn't want to leave, but now he is down south and won't come back.

The last few times she came in, including this final one, she retold some of the earlier stories of what had happened to her, how people mistreated her, and how she had responded.  It is fascinating to see how those stories have changed over the years.  In this last retelling she now recalls events as having much less conflict than in her earlier accounts.  She also has a much more positive memory of how she acted in many situations.   She now remembers herself as avoiding trouble when before she had been the victor in epic battles.

This may be because she no longer feels the power of the anger she used to have, or she just as mellowed and wants everyone to remember her as quiet and sweet.

We had a comforting last session.  We reviewed a lot of what we had been through together, but now we can leave it all in a more comfortable context.

Her children, who battled with her for years, and whose lives she certainly made very difficult, will all be with her for the holidays.  For her that it is Shakespearean: All's Well That Ends Well.