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Thursday, November 13, 2014

Me Before You: The Six Gift Take-away


Me Before You: Joj
We're already in gift-giving season. My favorites are the intangibles.

Yesterday was Veteran's Day in the USA, and coincidentally, I had just finished reading Me Before You., a book about disability. The story doesn't relabel disability as differently-abled. Will Traynor, before his accident, could do almost anything, but he no longer can.  

My daughter-in-law tossed the book at me, had knocked it off in a day. But it seemed sophomoric, at first, took me awhile to get into. But when someone else really likes something, you try a little harder. The word in Hollywood is that Emilia Clarke of Game of Thrones will star in a coming movie as Louisa Clark, no relation, and Sam Claflin of Hunger Games is a likely Will Traynor. So we'll keep the spoilers to a bare minimum.

  Chick lit, sure, but much to take away.
Me Before You-Jojo Moyes

Louisa Clark is an ordinary enough person, a really good person, the type of young adult who steps up when her upper-middle-age parents begin to struggle financially. She hands over her most of her paycheck, lives with them into her twenties, in a room the size of a closet. Although the young woman has troubles, she spares her family the grief and worry, keeps too much, perhaps, to herself.

Like most of the female gender, Louisa suffered a Negative Event in her not-so-long-ago past, that affects her adult choices. We're not sure if it is conscious or not, but she consistently chooses the safe, the familiar, the paths that eliminate risk, except in her choice of clothes. She can't help but attract attention via wardrobe. Some things, predilections, choices, die hard. Her clothes are the color in this novel, the delight. 

When she loses her job as a barista at a coffee shop, Louisa is forced to take a care-giver position. It is that or pole dancing. She keeps company with a man who has lost his ability to move his arms and legs, who is stuck in a motorized wheel chair. He used to do everything, ski, boat, travel, wheel and deal. Will Traynor had it all, until an accident took the capacity to enjoy whatever was left.

When we meet him he is paralyzed and totally helpless. He has a full-time nurse to change his colostomy bag, administer meds, bathe, dress, and get him in and out of bed. The patient is angry, sarcastic, hopeless and tortured. Life is physically and psychologically painful always. But Will has money. So we think: he has options, control over his future. There is a piece of us, those of us who are not in that one percent of the privileged wealthy, that assumes money is the answer to everything.

His emotional care giver, Louisa, has positive energy, a happy disposition. But anyone attending to Will is likely to be cut down. Anyone wishing to help him will fail at the purpose for hire: 
The mission, set out by Will's mother, not Will, who knows better: Motivate him. Help the boss find enjoyment, something good about living, a reason to ultimately choose to live it out, rather than end it somehow, some way.
Can Clark do that? Can anyone keep smiling when charged with making a miserable person happy, especially one with who refuses to embrace any semblance of happiness?  What do any of us do when we have a morose, depressed partner, parent, friend, or child. How do we stay sane? How do we stay positive, impervious to the infection of depression. For it is contagious, make no mistake.

How to do that is the real lesson of the novel, and a powerful, psychological take-away. Call the strategies  six gifts that a caregiver, friend, or relative can give to someone with a disability, gifts that might be appreciated, even if that person is extremely grumpy, especially so.

Because disability is much more that ____ happens. (Those of you who disagree or have different thoughts, please share in the comments below.)

(1) Gift One: Choice
Choice is usually compromised by disability. Able-bodied persons make choices all the time, from the type of tooth paste we use, to sleeping with or without socks, to running a company or merely putting in time at work that is either productive, or not. As able-bodied people, we can switch up what we want to do, don't depend upon others for most things. And the process of choice, for most of us regarding most things, is unconscious. 

Not so for those struggling with severe disabilities, the differently-abled, forced to hand over, surrender free will. There's no time for it. The work, the time, the energy, is in pain reduction, ambulation, feeding, eliminating, getting through the day in the most utilitarian fashion, getting the simplest things done. As the potential Great Eraser of Autonomy, severe, totally debilitating trauma, accidents, foster reliance upon others, dependency.  And independence, its opposite, is how we define adulthood. 

So enabling any choice, even little choices, is showering presents upon someone who is debilitated, who has the luxury of only too few. 

(2) Gift Two: Drop all assumptions. 
Like any of us in relationships, a caregiver is likely to project her own needs and wants in any given situation with her charge. It feels like empathy, but isn't. There is no real knowing what another person is thinking or feeling, not without asking. And yet our default is to behave as if.  This will make a grumpy person even grumpier, because usually we're wrong. Best to ask.  

To lose those personal projections, keep in mind that the protected classes:  race, color, religion, ethnicity, age, military status, gender, and yes, disability are legally protected because people treat people who are different, differently. They make to many assumptions.


(3) Gift Three: Teach less, learn more 
We are all different. Thus there is something to learn from everyone, whether they belong to a protected class or not. Each one of us is a foreign language. Try to learn a new one whenever you can.

Caregivers, like any service professionals with some training, teach. There are right ways, wrong ways of doing almost any little thing, so imparting the shoulds is a necessary evil, a part of the job. But to teach there must be a student, a willing audience, which means a hierarchy, one has more status than another. More important than relaying the shoulds, the empirical data, or knowledge, is hearing the pain, the frustration, actively listening and validating. There will be time to teach.

(4) Gift Four: Share
Most of us keep our shame, our lives, what makes us different, to ourselves. We don't trust others not to blab. But that concept: You're only as sick as your secrets, is worth considering, especially when in a relationship with a person with obvious trauma, even as a caregiver. The one with the physical impairment cannot keep his a secret. It's unfair.

Our emotional disabilities, the things that hold us back, are worth sharing. The details aren't necessary right away, we're entitled to our psychological privacy. But shame about negative events is self-destructive, implies a fear of exposure, anxiety, something missing socially. The way back is sharing some of it. Sharing with someone who has a physical disability works both ways, helps the one who shares, and the one who listens.

Why? When someone shares with us the process elevates our status. We merit the share, feel important. This is the intimacy, the glue of relationships. She shared. I must be good, trustworthy-- worthy of a good tell.


(5) Gift Five: Absorb the patient's frustration

Don't take anger, depression, sadness, frustration as your fault, although you may certainly have a part in the drama. Yours, however, is likely a very small part, if caregiver is your role. Taking negative affect (anger, frustration, depression) personally, minimizes the role of fate, the role of circumstance, luck, and the roles of others. We're not that important. Our job is to let it happen, another's negative affect, to encourage venting. Venting is survival, elemental to healing emotionally. Hearing it is a part of the job.  

(6)  Gift Six: Respect resistance. 
Helpers usually encounter resistance. When a routine is rejected, when someone who needs help pushes us away, best to wait, as long as possible. This means enduring long silences, and when they are long enough, asking for suggestions. Resistance is usually about powerlessness, lacking control, and we have to pay homage to it, because accepting that can take a long, long time. 

That said, some people like it that there is someone in bossy control of a situation. 
But the silence. The silence. Silence in any situation, especially a combative, resistant situation, can a good thing. Unless that person wants us to talk, to sing. Most of us aren't hired, not usually, to entertain. We have to get comfortable allowing our friends who have lost so much of what we take for granted, the chance to grieve, to resist.

Five Stars, Jo Jo Moyes. Not just chick lit.

therapydoc

Tuesday, October 28, 2014

Codependent on a Bicycle

Just because we own that we contribute to dysfunctional interactions (in our own special ways), doesn't mean we can stop. Codependency is like that.
Not shown, the blood.

This one could be a scene from a Woody Allen movie.

A therapist gets a text to learn that her grandchildren, toddlers, are at the park. "Want to stop by and see us? You pass right by going to work."

Well, it is on my way.

But something hangs her up and by the time her bicycle sidles up to the swingset, the grandkids are gone. Too bad, but it is the type of day a person just continues on her way and hums,  Ain't nothin' gonna break'a my stride. Nobody's gonna' slow me down. . .

The path she didn't take
It is that rare season that Chicagoans call  Indian Summer. Not only are the leaves every shade of red, green, and yellow, but the thermometer has punched a balmy 75 degrees and it is only 11:30 a.m.

Rather than detour west to the paved bike route along the river (read that safe), she opts for her secret "city" route. She has carefully mapped this one out:  wide residential streets, stoplights at the major intersections. Safe as it gets when it comes to biking in the city.
Indian Summer in Chicago

And it is so quiet, so tranquil, that for a split second she forgets to check for cars at an alley.

A driver, too, apparently isn't looking. He slams on his brakes, but too late. He knocks the bicyclist down, panics, and jumps out of the automobile shouting, "OMG, OMG, are you okay?  Let me help you up!"

"Just a second," she murmurs. "I feel broken."

"And I cycle, too, is the terrible part of this!  I know what it's like, dodging cars, and here I am, the idiot driver! And here you are, the innocent bicyclist!  OMG!"  Everything but, Speak to me!

You cycle, too.

This has never happened to her before. Falls have happened, minor injuries. Once, only once, stitches, quite a few that time. But no kisses from automobiles. And how many people can say, after all, that they've been hit by an automobile? Very few. They don't all survive, is the thing.

Her mind flashes to the white bicycles on New York City street corners, the ghost bicycles, somber memorials to bicyclists killed or hit on the streets.    

"Were you texting?" she manages to ask.

"No! I wasn't even on the phone."

"For real?"

"For real. Believe me."

"Well that's good, I guess."

She is still on her back. Her foot is in the air, bent at the knee. She sees this and slowly lowers it to the ground, straightening it out. The leg seems to work.

"It's not broken," she declares, lifting herself up on her elbows, turning her head and neck each way, scrunching her shoulders. "I'm okay."

He's about to cry, literally cry. "Thank God. Seriously. Let me help you up." He shoves his hand at hers.

"Hold on, cowboy. Let's take it slow."

A pause. He is so nervous, puts his hands through his thinning hair several times. "My office is right here, I can take you inside, you can . . ."

She's on her feet now, notices the damage:  a vertical line of puncture wounds just above her ankle. They are spaced remarkably the same distance as the spikes on her front gear sprocket. A detective could figure out the exact trajectory of the fall from this evidence, but for the life of her she can't understand why the holes are where they are. But they are there, for sure, and blood is dribbling, albeit not much blood.The cuts aren't deep.

"No worries," she blithely reassures him. "I carry disinfectant wipes everywhere I go."

In her backpack, where they have been waiting all summer for this very moment, are the Wet Ones. She disinfects as he tells her how he is usually a cautious person, but the pressure of making it to an important meeting has made him irresponsible.

"We all get close to an accident at one time or another. Within a fraction of an inch of something horrible. What's this important job that you do?" she asks.

He tells her. He's an accountant.

"I'm a social worker."

He keeps apologizing. So sorry. SO sorry. She can't help but feel for the guy.

Then she comes up with an idea. "We will throw my bike into your trunk and drive me to work, seeing as I am too shaken up to get back to riding. You will drop me off, get to your meeting. I will get ready for my patients, then seize the day.

It never occurs to her that there are other solutions.

His driving is terrifying, being the type of driver who has to look at the person he is talking to, not at the road.  She begins to pray between directing him to her office and wishing he would look at the road. When they finally get to the medical building, he fumbles in the glove box, fruitlessly searches his pockets for his "information. She becomes impatient, but won't let him know.

"Don't worry about it," she insists. "Just give me a call sometime, see how I'm doing. That would feel good. That would be enough." Her business card lands in his cup holder.

At the office she takes four ibuprofen* with a water cooler chaser, and texts a picture to her doctor, a fellow she calls FD. She texts him about a tetanus shot. Has she had one recently? He thinks so. She should take four ibuprofen* immediately; the circumstances warrant this. Then he offers to pick her up later in a car. "I'm good," she replies. "Not a dent to the bike."

Awhile later, her new friend calls, propitiously between patients. "I just wanted to make sure you have my number in case you need it for any reason," he drones seriously. He is not flirting, not at all.  "I didn't want to seem like a deadbeat. You know, this really is my worst nightmare."

Understood. "Let it be a lesson to both of us. Cars are annoying and can ruin our day."

At home with FD, the two of them sit down for a bite, go over the incident. He googles the intersection, tries to get a fix on where this happened. She looks up the name of the fellow who knocked her down. He works at a distinguished family business, has a clean, simple website. He could run for judge with this name and win, hands down.

"And it never occurred to you," FD asks, "to handle it another way?"

What other way?

"Well, it seems you were more concerned with his feelings than your own health, safety. You let him do you this favor, drive you to work, got into a car with a total stranger."

"Well, first of all, I could have taken him, if necessary, in a fight. And second of all, this is a nice Jewish boy. He seemed like a boy, to me, he was so nervous."

"You know you could have called the police. People do that."

"And then what?  He'd have a ticket, and there would be court. A total waste of time. And for what?"

"For the crime of hitting a biker. A person. Hitting people with your car is against the law, which is why he was so nervous."

She disagrees. "Number one: This was my bad. My job, as the invisible bicyclist, is to make eye contact at every intersection with drivers of automobiles. It is called good communication. Okay if I go first?  And I didn't make eye contact. Didn't even see the car!

Number two:  He was nervous because crashing into someone with your car conjures up catastrophic fears. The worst possible things can happen, and we're simply lucky that they didn't this time. Who wouldn't shake?"

Then FD hit her with the jugular, the more likely truth. "You didn't call the police because you were worried about his anxiety. You went into therapist mode. You could have cancelled out the afternoon. The police would have taken you to a hospital."

"Huge waste of time. Wouldn't let 'em."

"Think about it," he said, "The codependency thing."

And he passed her the salad.

therapydoc

*Friends, do NOT take 4 ibuprofen unless your doctor tells you that you should.  You only have one liver.

Tuesday, October 21, 2014

Not Very Zen

Warning: Do not read if you have issues with insect deaths at the hands of bullying humans.
Asian Japanese Lady Beetle suvivors



 Also, apologies in advance if this post offends any religion, be it mine or yours, I'm really sorry. It is all intended in good fun.

The story goes* that I graduated high school a semester early, but the University of Illinois didn't accept early admissions. My parents made higher education sound more appealing than a K-Mart job, so taking six introductory liberal arts classes at Roosevelt University managed to kill the time.

I took public transportation downtown.

One day a young man with frizzy sideburns and bluejeans sat down next to me on the train. Within seconds he started to mumble, or maybe chant. He did this for awhile, then seemingly satisfied, stopped. As he fished inside his backpack for a book, I asked what that was about.  He told me that he learned a mantra from a Zen master, and chanting the mantra made him calm and happy.

"Would you like to have my mantra, too?" he asked.

"Sure!"

It isn't every day that someone gives you a mantra, so I wrote it down. We didn't have Google to translate in those days, so the experience had an element of danger and excitement. Now, whenever I pass the mantra on as a cognitive behavioral self-relaxation tool, I sense this excitement with others, too, but add a warning: Before taking on this mantra, check out the meaning. Humming most things is relaxing, too.

But here you go. It is freeware.
nam-myoho-renge-kyo 


I repeated those words until they burned their way into my memory, but found the process, and the mantra, boring. So that was the end of that.  Suggesting mindfulness training, on well-scrutinized occasions, is as close as it gets to Buddhism in my life.
Gabriel Costans and Zen Master Tova

Except that once in awhile I get a random book in the mail from someone like Gabriel Costans who loves it. Gabriel requested a blog review in the most charming fashion, a promise that my karma will improve, certainly, if I open the book, and who doesn't need good karma?

The title, Zen Master Tova Tarantino Toshiba: the Illustrious and Delusional Abbess of Satire, indicates that Mr. Costans is associating with too many people of the tribe. That, or I don't know much about Buddhist names. But he is a psychologist and sincere, so there you go.

Zen Master Tova Tarantino Toshiba is an abbess and an ageless satirist, so it is likely the book is entirely satire, but because I  didn't finish it, I can't say quite yet. But many a true word is said in jest, and not understanding much about Buddhism, the pages, to me, are a mystery wrapped in an enigma, which is a part of the book's charm. The other part is that any book with short chapters, some as short as only a paragraph or a single page, at most two or three, is very appealing to those of us who are asleep before the head hits the pillow. 

To broaden our perspective on Buddhism, here is a snippet about Master Tova (Mistress Toshiba) and her reaction to fishermen using worms for bait. 
Let the Worms Go

There was no difference between one life and another to Mistress Toshiba. She respected all with equanimity, love, and tender care. . . . her compassion for worms . . . legendary. 

The nuns were were walking with their Mistress, on their way to market to sell their organic vegetables, when they passed some fishermen who were taking worms out of a bucket, putting them on their hooks, and casting them into the river.
To make a short story shorter, the Mistress knocks over the bucket, setting the worms free, and proceeds to convince the angry fishermen that they are on the wrong track, killing worms. She offers up her organic vegetables as a substitute for fish. We're not sure how this will effect her spiritual ecosystem, but are lead to believe that the cosmos is much better if worms can just be worms.

The story makes me feel guilty. Because here I am, powerless when insects cross my path. I smash them.

Note the astronomical difference between my reaction to a turtle a few weeks ago, and yesterday's response, now old news, to the Asian Lady Beetle.

Riding my bike along the river, I happened to look down to where the sidewalk meets the grass. There lurked a huge turtle determining whether or not to cross. Huge turtles are not something we see in Chicago, not unless we visit the zoo. We see raccoons and skunks, deer, coyotes and the cursed geese, but not turtles. It made me happy, seeing something new, but I didn't stop to take a picture, couldn't risk being late for work.

Fast forward to yesterday afternoon, after I attempted genocide on Asian Lady Beetles, FD, vacuum hose in hand, gently chastising me: "For someone who professes to like nature, you had no trouble attempting to eliminate an entire species. The beetles would have died on their own in a day or two."

And what if they had not?

Asian Lady Beetles, you may know, are not your everyday Ladybugs, not the kind that flitted by the light with ladylike grace in your mother's kitchen. The ladybugs of yore didn't swarm. You were lucky to see one or two of them, whereas the Japanese Asian Lady Beetles swarm and bite.  And they arrive in droves, hundreds of thousands of them, clinging to windows, walls, homes, babies, to the skirts and bodies of those of us in the Midwest. Certainly Chicago.  

The crisp fall weather spiked to the high sixties, and when I reached my office I couldn't wait to open all of the windows to let in some air.  The screens, unfortunately, harbored hundreds, seemingly thousands of these beetles. N= 9000.  That's N = 9000 against 1.

Adult and Childhood History enhances any narrative:

I never really liked bugs, but had no particular gripe against them, not until yellow jackets turned on the children in the neighborhood. Upon the advice of the entomology department at the University of Illinois, on one dark, cold October night, FD and I dressed in coats and ski masks and, poured liquid diazanon on the beehive buried in a hole on our front yard parkway. Running back to the house in fear and triumph, we could hear them scream.


Fast forward for a moment.

So. . . able to face bees, I'm cool, not about to become unglued by a few beetles. Yet every ounce of aggression stored in my moderately-sized female body shocked me into action when I saw. Mere fly swatters would not do. As the beetles taunted and laughed I reached for Raid, strong stuff, no Googling for solutions to this problem necessary.

The bug spray, under the sink where it should be, is half-full, as expected.

I crack open the window incrementally, begin to systematically exterminate twenty to thirty beetles at a time, all in a vertical up and down linear fashion. The bugs go flying across the yard with the full force of the spray, but some merely fall on the window sill.

All across the breadth of the sill poison drips, bugs drop.  They don't even try to fight back.  It is poignant, like a good war movie. I close the window and proceed to the next, feeling queasy but justified, this despite Mistress Tarentino's warning about my soul.  A few ladies fall to the carpeted office floor and I let them be, unwilling to sully my broom.

Not exactly sure what to do with the corpses, I go shopping.

FD sees an after-the-fact video (dead bugs that appear as popcorn kernels) and drops by with a screen mending kit. He asks for a vacuum cleaner.

He does a very nice job.  I thank him for fixing the screen and tell him that I feel very guilty about this, almost as bad as when we used the diazanon on the bees. It made me flash back to an even earlier childhood memory, a small child in pajamas, waking up in the middle of the night to the buzz of mosquitoes in her ear, flipping on the overhead to spot one clinging to the pink tinted bedroom wall. I swap him dead with a Highlights for Children.

Perhaps a support group.

therapydoc

*I might have told over stories in this post before. Eight years blogging, it happens.

Monday, October 20, 2014

How to Cope When the Status Changes

If it had only been one patient, I would have thought it idiosyncratic. But people are finding out on Facebook that their ex's are married, or engaged to be married, sometimes only months after they broke up. It can be a more than a moment of reckoning.
Marshall and Lily Got Married

Not judging the announcements, especially the videos. Who wouldn't post an incredible engagement/proposal video on Facebook? Isn't that the purpose of the video? These are works of art. A sixty to ninety minute montage entirely composed of five or six How I Asked ___ to Marry Me's couldn't be dull. After all, she might say no if it is.

Hearing that someone you know recently changed relationship status to become engaged or married, can be upsetting, no matter how we find out. Marshall and Lily, the token couple to take the plunge in How I Met Your Mother illustrate that marriage can be intimate and passionate, if you do it right. And it need not herald the end of relationships with single friends. A bar in common below your apartment helps. 


But I'm only on Season 3 and skip through most episodes, and confess to not having even made it past the first few seasons of Orange is the New Black or West Wing, now that Scandal is on the radar and that is getting boring, too. For for all I know, by the end of Season 9, Lily and Marshall are divorced, fighting over who gets to keep the teddy bear, a favorite blanket, or a child. That would be sad, their break-up, so don't tell me, not on Facebook, not here. I may skip to Season 9 one day soon.

It is subtle, the sudden death, the moment a person hears about an ex settling down with someone else. It can be as simple as a "Like" to a comment about something random.  But the Liker has a new name.

Or in a vulnerable moment, you might actually look to see who Facebook suggests as new friends. There she is, your ex, with another name, or an additional name, and it isn't the name her parents gave her.

Or the new profile pic is one of her with another person in a loving embrace, beatific smiles.

And here I thought nobody changed their name anymore, but that's not so.

Discussing this at a kiddish (food and drinks after prayers if you're Jewish), someone who knows these things informed me that it's an in your face thing, bragging about the new status, the new name.  But that's paranoid, I think. The in your face part is paranoid, not the bragging, telling the world. People do tend to want to tell the world, although many use discretion, when they are connecting with another for whole-life, not buying a term policy. This feel good, for many, if not most, is the first real feel good in a long time, and it is often about security, being a couple. Power in numbers.

So when we're faced with being alone again, naturally, as Gilbert O'Sullivan croons so well, and panic ensues. It is the original abandonment anxiety, one that therapists refer to when talking of any loss, especially death. 

The new status marks the death of the relationship. Thoughts escalate, become irrational. A person begins to think that she is the oldest person on earth not attached legally to another, not in an intimate way, one that scores showers and parties, insurance. We begin to think we really are old, in our 30's or 40's, which is not old. We'll let you know when you're old.

You begin to think that you were at fault for the break up. It must have been your fault, because she has found someone who clearly finds her wonderful. Why couldn't you do that, find her wonderful?  She went ahead and took the advice of a rock star.  She made him put a ring on it. She couldn't make you. Yeah, you had issues.


This self-castigation gets worse, becomes an obsession. One begins to self-blame constantly, for what went wrong in the relationship, well beyond not having committed to it. For the first time, perhaps, there is a serious look deep down, not at her, where the blame once rested. And when we look at ourselves, our faults, our personality, our petty ways, for we all have them, we come up short.

You go to therapy and ask, "What is wrong with me?  Why couldn't I commit?  Or in the case of a previous self-initiated divorce, Why couldn't I stay?! Why couldn't I be that guy, or that girl, the one who gives, the one who gets the ring."  And you discuss fears of intimacy ad nauseum perhaps stretched out on one of those safe pieces of furniture, the therapist's sofa, a box of Kleenex to your left or right (we buy in bulk), discuss the fears of exposure, merger, suffocation,and yes, abandonment,all those fears brought to the dim light of day in that office. You don't leave out how badly your parents got along, how much trauma you yourself suffered in relationships in those short thirty or forty years that make you feel so old.

And the rational side comes out and you get your act together to defend yourself and ask the doc: "Why would I risk spending the rest of my life with someone who made me miserable and threatened to do so for the next fifty years? I am perfectly fine as is, now that you mention it, and did I tell you?  I like my space." Amen.

The therapist confirms, probably, and brings things back to affirming that you are on track, thinking systems, staying rational, remembering the times she was so mean. Or the time she ignored what you had agreed upon, or so you thought. . .that was truly horrible. Yet you forgave, swept it to the pile with the rest of the disappointments, until it all got too difficult, too many tears, too little laughter, and you simply had to say: Enough is enough. We're over.

So why be upset when she moves on, right? Because it really is over now, no turning back. And although it feels like rejection, an in your face, and it feels like you'll never find someone now, for sure not, you can bet on it, you really don't wear a sign that shouts out: Damaged. You don't.

She wasn't the first, although now she might be the last to refuse to give you the job, and you are, now, an amazing candidate, better off without her. You knew that in your gut, you know.

So don't say, although you could, that she will probably never stay married, and that this guy is in for more than he bargained for. No sour grapes.

Be happy for her.

therapydoc







Gilbert O'Sullivan - Alone Again (original version)



We talk about this one all the time.

Wednesday, October 01, 2014

Snapshots:September, 2014

With so many horrible things in the news, I say we take a vacation from it all.

(1)  With Feeling
Dunkin Donuts, Kosher in Chicago on Devon

A grandson has a 10:30 orthodontist appointment on a school day, and I have the honors. The rain is coming down hard and he holds the umbrella over me while I unlock the car. Once inside, the fellow shoots me a sideways glance. I turn my head, raise an eyebrow, speak our first words since leaving school.  

“I’m starving.”

“Me, too!” he exclaims.

We work out the details of taking out from Dunkin Donuts. He will sit and get his braces tightened, change hues, and I'll run in. There isn’t a minute to lose because office hours begin in the early afternoon and I can’t be late. 

Our timing executed perfectly, he is at the curb, ready for me after the procedure. Overjoyed with the egg-and-cheese croissant (with fake bacon bits), hash browns, and a blue berry muffin, he eats faster than my Airedale. He can’t thank me enough.

Three years ago, at 9 years old, a Thanks! might have stuck in his throat. But he has it down now, smiles with gratitude and the words gush out uncontrollably. Thanks SO much!!!

For this reason alone, and there are many others, parents have to think: There's no hurrying psychological development.

The tests of our children are really our own.

(2) Our Unfamiliarity with War (Details about patients in this story, and all of them on this blog, are pure fiction.)
Montfort Castle in Israel


This profession can be quite intimate, and although most therapists share about themselves, we don’t share all that much. We may share more, even share less if we have been seeing the patient for several years. I know I do.

It all depends upon the person getting the therapy. But over the years there is more depth to a relationship, and confidence that what we do share will be absorbed for the good. Otherwise why say anything at all? It is not a friendship, not by any stretch of the imagination, but both the therapeutic relationship and friendship are defined by mutual trust emotional safety.

Still, whereas the patient can never say too much, for what he says is all relevant and diagnostic data, we can.
   
Just prior to leaving for this vacation, the first real time away from work for longer than a few days-- in years, I let the destination slip a few times. It happened when rescheduling proved challenging. Frustrated with the perceived long wait, the patient would ask:
 “Going on vacation, are you?” 
”Well, yes, actually. Kind of far away, too. A small middle-eastern country.”

Subtext:
Don't call me. I expect we worked hard enough on your independence in the past few weeks. You can do this.
Text: 
Let's talk about this, how you really feel, and how it will go in my absence.
The Western Wall, or "kotel"
The last time I left for that small middle-eastern country, a patient knew about it and attempted suicide in my absence. He showed me. But we had expected it and the family and covering psychiatrist knew what to do. We could say, even, that the patient ended up better for it, that extra special treatment a person merits in the hospital if the presentation is that severe.

People are okay, at least it seems within my practice, if a therapist is off to a conference or a presentation. But no such thing now, and a fib felt bad. I liked the idea of promoting tourism, maybe. “Everyone should visit Israel at least once in a lifetime. It is an amazing country, nowhere in the world quite like it.

Blank stares.

Immediate regrets for the blurt. And worse, once I let down my usual guard and added,
 "And for the first time I'm a little scared."
Israel felt scary to me, from Chicago. Despite the peace treaty, the country is always at war, and although the war is now more about rocks and fears of suicide bombers in pizza shops, the missiles were glaring. In fact, those launches Hamas supposedly had stopped did start up, if only once, during my tour, although Hamas apologized. A mistake.
Shraga's. The gourmet food is on every corner.
Was my fear rational? Not really. Nevertheless, you don't lay that trip on a patient.

He didn't bat an eye, is the truth. Maybe didn't hear, worried mostly about his own troubles. More likely, too surprised to respond.

Predictably, when I got back, there was rarely even a reference to my glorious vacation. Maybe a single question, "How was your trip?" to be polite.

The redirect, when that happens, takes seconds.

(3). Flying 
Austrian Airlines, not cheap on beverages.
So here, 34,700 feet above sea level on Austria Airlines, a flight attendant pours FD a half glass of Chivas. He had asked for a thimble-full. But they probably speak German, and perhaps a thimble is a glass in Austria.  Whatever the case, FD wants to sleep so he drinks half of it, asks me to hold the rest, return it to the attendant or drink it myself.

(Just flying European felt strange, but the new experience, like most new things, awesome, highly recommended. Plus it is really cheap). 

Knowing sleep rules jet lag, I sip at the Chivas, hope it will shut me down. But it doesn't.  Even in a dark cabin wearing eye-shades, and a decent yogi posture going, my head is stuck on the fact that this is what they call a vacation. That and it is only 8 PM, Chicago time. And I’m a little high, the scotch has nothing to do with it. I’m on vacation.

Mind you, this feeling is not only weird, but it is incongruous. Today is my mother’s first yahrtzeit, (a Yiddish or Hebrew word, rhymes with door-site), the first anniversary of her death, and rather than see that candle burn out (we light a 24-hour candle, give to charity), FD and I are on a plane, a little closer to heaven. Up in the air, at 37,700 feet, we assume we’re a little closer, that prayers are local calls. We have no evidence to the contrary.

At the terminal in Vienna we expect to have to run like hell (as is always the case) to make the connecting flight to Tel Aviv.  Our flight from Chicago had left two hours late. But the good people of Austrian Airlines have hustled. We made up the time.
Still I wonder if discussing the problem with my mother, asking for a little help to move us along, make time, helped. Do they have clout up there? No evidence to the contrary.

(4) The King of Morocco

It is the Jewish New Year season, and we think the whole world is judged this month. So it is kind of scary and people who aren't remotely religious come out of the closet and go to the synagogue, or merely hope their thoughts and prayer will be heard wherever they might be.

Anyway, my rabbi told over this story the week before to get us in the mood. He thinks it is true but isn't sure if the king is really the king of Morocco. 

The king of Morocco is visiting London to meet with a particular businessman, who happens to be Jewish. The man is expected to attend the Bar Mitzvah of the son of a close friend on Saturday. He asks the father of the boy if he can bring a guest, an important person. Of course, why not? The king is delighted.

At the party the king is introduced to the father of the boy. He takes out his checkbook and writes a check for $250,000. The boy’s father is shocked and upset. He tells the king that the gift is over the top, he need not do this. Most people give much, much less, he says, they knock off three or four zeroes. The man is honored by the royal's presence alone.

The king replies that it is not fitting for a king to bother with an insignificant amount. He doesn't write small checks. And there's no way he won't give a gift.

So it is with our King, concludes the rabbi.  He doesn't write small checks. We should think big when we are asking for things.Money, health, go for it.

Not hard, right?

May there be no more hate, selfishness, or illness in our world (and we in the northern climes could use better weather this winter). May we include one another, when we obsess about what we should have said, should have done, should do, for happiness and health, success, and good will, and work towards that.

A happy new year to all of you, friends.

therapydoc


This is a lichi. I had never seen one before visiting Israel. We eat new fruits on this holiday. My Israeli brother-in-law is always eating new fruits.

I liked Brussels airport. Also, they have cots for napping, enough said.
Brussels airport synogogue

Brussels airport mosque

Brussels airport humanist consultant

Brussels airport chapel

A beach in Natanya.



therapydoc

Tuesday, September 09, 2014

Ray Rice, Power, and Domestic Violence in the NFL


Rape, now more commonly called sexual assault, is the end and the beginning of many things. It can be the end of innocence and trust, for as long as it takes to recapture that, and the beginning of guilt, shame, fear, sexual problems, infertility, mental and physical illnesses, isolation, and more.

Tearing it apart, the perpetrator overpowers a victim, a person who protests, and having more power over this person, commits a crime of passion, of sorts, Those cries of "No, I don't want you to . . ."  (do whatever it is that is objectionable at the time) are overruled by brute force.

We tend to think of a sexual assault perpetrator as larger-than-life, stronger than your average Joe, but more often than not, he's not. Sometimes he's the person you would never suspect, might even respect (think of teachers). When the suspect is a professional football player he is stronger, indomitable.

Six years ago sexual violence was outed in the NFL.  Ben Roethlisberger, accused of numerous sexual assaults settled one of them, a casino incident. Stories like this are buried, no surprise.  If you want access to our locker rooms for your sports column, you had better make this one die of natural causes.

Now we have Ray Rice beating his wife to unconsciousness. And nobody is burying anything.

Strangely enough, before I saw the infamous clip, public since February (!), I was watching highlights of Monday night football and came to a crazy conclusion.  That athletes brush off tackles and crashes to the head is astounding. These people are stupefying, superhuman. Inhuman, brushing off falls that would put most of us out of commission for weeks. How does a person endure so much physical abuse and still pop back up and play ball?* Players learn to endure pain, is the answer, and it is admirable.

But here's the point:  Maybe they project that invulnerability onto others, assume we ordinary mortals can take physical abuse, too. There are other explanations, from poor family and peer role models to the narcissism learned as a child, treated special, always, as a potential star. Groomed for college ball and maybe the NFL, women and cars, hotels and alcohol, are assumed. Those courses on ethics are skipped, too boring.  And maybe men like Ray Rice actually are fooled into thinking that women like his fiance can take a wallop on the head, like he can.

Ray Rice needs to know what it is that happened there in the elevator, decking his wife with one blow, dragging her seemingly lifeless body from the elevator floor to the corridor. He is probably as surprised as any of us, and yet, it is unlikely this is his first physical altercation. His father died when he was one year old, shot dead. John Clayton:

"I faced a lot of adversity," Rice (told me once by phone), "and I had to be a man real young.".

The NFL response? New policies are in the works that will (surely) reduce violence perpetrated by players. That is the intent.

Not everyone agrees that the new policies will be enough. Certainly not those of us who work with victims and perpetrators. It is changing personality we are talking about: impulse control, narcissism, and empathy, and a different defiintion of manhood. A year in therapy is a start, but education, workshops, testimonies from survivors of assault, so many that the words of survivors are predictable, this type of exposure is what these very large men, players like Ray Rice need. Even with those workshops there will be sociopathic players who feel they are above being told what to do and what not to do, what is expected of them as human beings, members of the human race.

Social workers approached Roger Goodell, the commissioner of the NFL, with assault prevention workshops years ago. As anti-violence experts, we received polite applications. Fill these out. Let us know your plan. We'll get back to you. Don't call us. . .We'll call you.

Something tells me the applications hit the waste basket pretty quick.

therapydoc

 *Players aren't actually superhuman, and they know it. Concussions, many of them, are an occupational hazard. The self-abuse of a life-time in sports is future-changing, predicts a difficult retirement. Cognitive functioning, you know, is a terrible thing to waste.  I hope Janay Palmer is okay.


Thursday, September 04, 2014

When the Diagnosis is : All of the Above

Most of us aren't Diagnostic and Statistical Manual (DSM) experts, but are aware of this thing we call the DSM-5, or Diagnostic and Statistical Manual of Mental Disorders that therapists memorize. The bullet-point system of features at the corner of the desk is likely a well ear-marked spiral-bound copy of the bible. Docs flip easily to a suspected disorder.

"See?" we declare knowingly. "That's you."  Or more likely, "That's her."

Some of us read the patient right away. He belongs to either the anxiety disorder family, or the affective (depressive-manic) disorder tree, because so many of us do. The lucky belong to both. The experienced professional also recognizes substance abuse, eating and gambling disorders, personality disorders, everything.

Still, we work at that differential diagnosis, want to narrow the problem down, if there even is a real disorder, one that has met the full DSM criterion. Not everyone has a particular disorder, but we live in a world replete with mental and behavioral messiness, so a typical therapy visit also means someone else, someone who is not in the room, is the subject of that "See? That's her." Yes, you should worry when your partner gets a therapist.

All well and good. But what's a therapist to do when the patient begins by saying, for example, that as a kid he had an addiction to pot, and can't remember being depressed as it presents in the books, but knows he had suicidal thoughts. He will continue to say that he treated teachers as inferior beings and passive-aggressively refused to answer questions, yet never scored lower than an 90 on a test without studying. She'll tell you, too, change the gender, that she binged and purged before even knowing it would be popular in college, and that by the age of twenty started having obsessive thoughts when she saw a knife, visualizing the knife slashing her of its own accord. Or she might irrepressibly slash herself. Add to this a social network disorder that culminated in job loss, and compulsive sexual relationships on the internet. Oh, and she has a new job and she hates it.

All this without any family history, as if to say, It is my genetics that made me do it. I have a mental disorder and none of the doctors in the past have managed to narrow it down. Would you do that for me please? I'm under a lot of stress.

I look at you, do my best to read you. You return the favor, read me. I ask, How did you find me? Why me? This yields wonderful diagnostic information. Another question: What does your primary care doctor think?

Inevitably, assuming the pri-care is a family physician, the answer is: That I need counseling. I need to talk to someone like you.

Those of us who have helped people in one or two visits, who specialize in "only evaluations" or are in a hurry or don't have evening appointments might want to pass him on to another therapist. Our patient with a million symptoms and as many diagnoses and problems likely had a very messy childhood. One of my mentors once told me that if a person has been incested, that means twice a week for years.

Makes sense, right?  There are so many forms of incest, is the thing, and indeed, twice a week on the couch for years is an incredible luxury. And it usually isn't necessary, all due respect. Who has that kind of time? Job stress is at the top of the list. There is a V-code, I think, for that.

Upshot: If the patient with All of the Above* is your new patient, then settle back and relax. Feet up on the ottoman. Do the therapy that the primary care doctor has asked you to do. And don't worry about the diagnosis, the medication, or even who else you think should be in therapy. This one's yours. Embrace it.


therapydoc

All of the Above*: Not to say that there aren't a few diagnoses, but usually there are a few features of several diagnoses. One does have to go through that process, vetting those features, finding illness. All I'm saying is, don't let the diagnostic process get in the way of the therapy. Because it really can, seductive monster that it is.