On Mother's Day

It is like a Memorial Day, but in reverse. Rather than look down, we look up.

Many are not happy with what they see, is the problem, making a celebratory day more of a day of reflection.  It's not so easy, showing gratitude to mom, sometimes.

Much of a therapist's week is about the mothers that are difficult to see, to understand. There are the ones who are selfish (narcissistic), who think every day is supposed to be Mother's Day, and that every day their children should be gazing back at them with love, appreciation, and attention.

We speak in therapy of the mothers who are confused, too, who feel too strongly, whose emotions spill over on us, too often, for whom life is back and white, or mostly black, and their children are supposed to change that, at least understand them, think of them, consider them, respond to them right, as if there is a right way, right for everyone. It is very hard to understand these moms and their needs when our own need for a mother that cares goes wanting.

And we speak in therapy about alcoholic and drug addicted moms, many of whom have left us in the care of others, often an older sibling or to foster care, moms who are passed out somewhere, not necessarily in their own beds.

And we speak of mothers who are far away, who we left to live their lives mostly without their sons and daughters because they launched them properly. The offspring took off, married, found work, or merely . . .left, because it seemed the right thing to do at the time.  Far away. Dinner by Skype. Sure.

And then some of us have lost children. For moms with this issue, what can anyone say?

Such an easy, happy holiday, let me tell you, to discuss in the week before the dawn. The weeks before the holiday that many people actually dread. And we're not even talking about the brunches, which for many are insufferable. What are the odds that a brunch or a dinner is sufferable? Fifty percent or less? Yes, probably, depends how much champaigne is poured, and that could make it worse, not better!

SO....nothing left to do, why not celebrate Mommy Bloggers?  Because these kids, women, grandmoms, are getting it together, have found an outlet, a way to find sales and coupons, and share. They love their children and often their parents to the degree that they tell their tales to all of us.

Some are bringing up children they adopted, or have taken on foster children. Some are single and broke, or single and working, but have figured it out, how to manage a family, yes, and do it without the help of a significant other.

Let's celebrate everyone, who is a mom or who is not, because honestly, not everyone has a mother, many have lost one, and not everyone is blessed with children. A short list of bloggers who talk about their lives as mothers or almost mothers isn't a bad place to start.

I did a little cruising, searched for happy blogs and here's what I found in my first hour or two. If you think your blog should be on the list, email me or comment and we'll link over. Granted, it isn't as if I read very far, or got to know these bloggers, but I would like to get to know them, like I would like to get to know all of you.

Here we go.

What about What Not to Say, on Then I Laughed. Terrific.
:
Okay, on adoption,  It’s expensive, adopting, many future parents solicit to defray their costs, but then, boy, can they write!

Two cats and a cradel

BumbersBumblings: /

The conversation about adoption. 

Adoption advice, 

And about that long road to success, Mom At Last 

Life for mothers is a mixed bag, but when your spouse is arrested, when life changes forever, you have to write about that, too. Life Turned Upside Down. 

How about single moms? Mom Solo, for one. And Single Parent Adventure.

For a peak at women who think out of the house, yes, do it on the road, try Mommy Adventures.

First time mother? Well, First Time Mom and Dad, obviously.

Lots of babies at once. Quadruplets always thrill me.

Need more of a' tude? Or a banner with heels and those dopey balls kids love to fall into? Cloudy with a Chance of Wine.  Or better,

http://hotmessmom.com writes about menopause

Then there are honest moms. Refreshing, since most of us lie every ten minutes, according to a Ted lecture I watched. Or some statistic close to that. 

And mom’s who have an occasional special kid, women who know how to love. Dysfunctional Dose. 

Crafts and recipes? The Photographer's Wife, Mommy Katie

Baby products? No end to these, but lets end it.  Or just products: These Four No More

Kvetchers, but not really: Just a Little Nutty

Taking care of number one, One Classy Motha. on body waxing.  

What we would expect, When Crazy Meets Exhaution

 One thing we have to respect about the entrepreneurial mommy bloggers who review, sell, direct the female blogger traffic-- they are the life of the blogosphere. For an incredible list of mommy bloggers, forget about mine, go to Bloggy Moms. 

There is such a thing as influential social media mommy-ing. They usually are giving away something.

There are the creative moms that make us feel totally incompetent, like Mom Candy.
And RealHousemoms.

Or those who inspire us to take out our cameras. Mom Photographer, for example.

And Mommy reviewers, who get to wear cool shoes in exchange for a few words on the blog, and post nice pics, like SunnyDayTodayMama.  And shameless product promos, who doesn't like a good ad, as in, I Gotta Try That.


We have to include Childless Mothers Connect, although I would disagree that all women have the heart to be a mother. Not every mom has it in her, is the sad truth. But the bloggers at this website have their hearts is in the right place, and we salute you.

And why not read The Mom's Day Eve, and grocery shopping:

For women who wanted children but never had them, age forces some level of acceptance upon them. Grief and regret transition to “it is what it is.” Seriously, it’s worrisome if you’re 64 and still crying at the sight of a very pregnant woman.

Yes, dear, but some do. The Happy Mother's Day marketing everywhere, begins in early April. It gets obnoxious even for those of us with children.

Crazy thing, I couldn't find a homeless mom's blog. But there are blogs for victims of domestic violence, whose partners beat them or who are hurt and have no place to go. Joyful Heart Foundation is one.  Women Thrive is another.  Violence Unsilenced is another. Warning, this mom is really angry. It isn't a happy blog.

Hardly much of a list, considering that there are thousands of bloggers, but it is Sunday and this mother will still go to work, talk to other mothers who aren't terribly comfortable today.

So many kinds of moms, including older moms like mine who bemoan the losses of their lives, that they did so many things and just can't do a damn thing anymore. Still an inspiration. Every single day.

Happy Mother's Day Mom, and to all of you, no matter how this Hallmark holiday hits you.  It really will be over soon.

therapydoc

Teaching Them Things

(1)  Strike Two!

Spring League

It is baseball season, and my grandsons are old enough to throw a league much better than me. This hasn't always been the case. Having had two athletic brothers, when other girls played with Barbie dolls,  we played running bases. You learn to use a mitt. I never looked back.

  
Except I haven’t had my own mitt for a long, long, time. When it would have made sense to play catch with my own sons, work got in the way. If you don't work the afternoon/evening therapy shift as a young therapydoc, you don’t establish a practice, not quickly. If you do work until late evening, you won't see the afternoon sun, nor the sunset, not in the winter. Or your kids, either, you won't see them. It is a trade-off. The dues we pay. 

You hope quality trumps quantity, and that you will get by with your charm.

Wilson A300 baseball glove

But Thursday, because it is spring and because I can work as little or as much as I want, I stop at Target, pick up my mom’s meds at the pharmacy, then head for the sports section. 

I go through every single mitt before choosing a Wilson A300. The Wilson A300 is a shorter glove, has a shorter pocket than, say, the Wilson A350.  

The larger the mitt, the easier it is to catch those hard to reach flies. But for me, it doesn't matter; this one will work just fine. It is exactly the size of my childhood glove. 

That one my older brother gave to me. He was eight, I was six. Nobody else would use it, that's how used it was, probably my father gave it to him. This one is the same chocolate color, and it is new. 

There is, however, some difficulty in the decision. My two grandsons only have one mitt between them. Buying two mitts might be a more elegant idea. The three of us will play together. Except they will mostly be playing without me, because although I'm the boss of me, no workie, no foodie. So one mitt is enough to start us off. 

Other variables matter, too. I want to see how well they will take care of a mitt, even if it isn’t technically theirs, before shelling out another thirty plus bucks. Will the  glove make its way into the house after they argue and one child stomps inside for water? Or will it lie fallow overnight on the front lawn, or even for a few days, until a punk walking by considers it public domain, walks off with it.

One glove is enough to test their maturity.

So I tell the eight-year old, on the way to school, that I plan on buying myself a mitt and ask if he wants to play with me when I get home from work. Indeed he does.

Home at about six-fifteen, waving my Wilson A-300, he looks absolutely astounded. “You really bought a mitt?”

“Uh, huh. You’ll need shoes if we're going outside. Come on.”

So we go out to throw the ball around, but the sun blinds us, and his older brother pops outside to see what is going on. I throw my the new glove to him and the two boys discuss whether or not it is any good. They can't decide. Their father comes home from work, enters the mix, and I sneak back into the house to check some laundry. Upon my return they are throwing a football. My mitt is on the ground in the damp evening grass.

“I’ll keep it at my office,” I tell the younger.

“Why would you do that?”

“It will be stolen if you guys are in charge of it, for sure. This is Chicago. You heard the story about the woman who drove up to the curb and tossed a plastic Big Wheel tricycle from our front yard into her trunk. And it wasn’t even a new tricycle. I’m not over it.”

          
“Oh yeah, I heard that story. Did she go to jail?”

 “No, we didn’t press charges. She said she didn’t think anybody cared about the trike. She thought we had left it out as garbage. That’s exactly what will happen with my new baseball glove if I leave it to you guys. Except this time we won’t get a license plate on the thief. He'll be long gone when we notice the mitt is missing.”

He promises up and down he’ll take care of it, and I relent.  He has a special place in the house for bats and balls, mitts. He is confident my glove will be well-guarded.

Cool. 
Five minutes playing catch, an entire lesson—learned.

(2)  Appreciation

 It is a case of overbooking, and if you are a doctor, or maybe just a person, sometimes you pack your day too full. Or you make a mental note about time and lose it. Call it mind fatigue.

When I made a 9:00 doctor's appointment for my mother on a Friday, I forgot that I drive the boys to school in the morning. That I drive them every day is routine, a pleasure for me, and we all take it for granted. It is simply what we do.

My mother lives in a residential facility and I’m never far away if she needs me. She has some difficulty getting herself ready for early appointments, but manages independently. Still. Would she be ready in time for me to pick her up and get the guys to school on time? There's her make-up, her hair.

I decide to take the boys first and swing back for her, even though it is out of the way.

            
One of the guys gets an earlier ride, so it is only me and the eight-year old on a beautiful spring day. He seems happy that it will be just the two of us. He opens the door to the front seat and hesitates before asking, “Is it okay if I put my backpack in the front?”

This is an odd request because there’s no reason it wouldn’t be okay. What he wants to ask is, “Can I sit in the front?” But he balks.

“Sure,” I tell him.

As we drive in the opposite direction from his grandmother’s residential facility, he cries out: 

“Hey! I thought we were picking up Buba.”

I explain the new plan.  

“You sure do a lot for her!”

“Nah, not really. She takes perfectly good care of herself. All I do is drive her a few places on occasion, not all that much.”

“But you visit her when you don’t have to visit her. Like, you’re there when we’re there.”

What he’s picked up on is that a visit to an elderly person can feel like an act of kindness, but it might be an inconvenience, and if someone is already there, then the job is done. Why the overkill?

I reinforce. 

“People who can’t get out, who can’t drive over to see their friends anymore, really like company. So it is great that you and your parents walk over to see Buba on Saturday. If I’m there, too, it is because it is in my mind to go at that time, no matter what else is going on. It is a rote thing. Do you know what rote means?”

He did not.

“Automatic. Rote means automatic. Habit.”

What I don’t say is that when there is a set time to visit, I know that at least someone has visited. He is captivated, so why not roll on:

“And Buba really shows her appreciation for the things everyone does for her. She’s very appreciative.”

 There is a pause as this sinks in. In case it hasn’t sunk, I deliver the blow with more impact.

“It’s a really important thing, showing appreciation. When people go out of their way and do things for you, they expect a thank you, even if was their idea to do it. Even if they love doing it, a thank you makes every effort worth the effort. It makes the good deed even better.

When you do something for Mommy or Daddy and they say Thank you, you like it. A silly, small thing like a thank you and the day is a happier day. It's so weird.”

 He thinks a moment, then says, 

“Well, I appreciate you!”

“You do?!” I exclaim. “How nice! For what?”

“Well, for playing catch with me yesterday. I appreciated that a lot!”

We get to school and as he takes his backpack from the front seat, he looks up and asks, 

“Do you think sometime I could sit in the front seat?”

“Sure. Why not?”

“In California it is against the law for kids to sit in the front seat."

He has recently migrated to the less enlightened Midwest. We are in the new social experiment, three generations under one roof for about a year now. He is still making comparisons. My job is to clarify. 

“But here it isn’t against the law," I say. "I don't think. In Chicago, kids can sit in front. Ask your mom.”

“I will!” He smiles an empowered, satisfied smile before slamming the door.

No Thanks for the ride! that day, but he hit a home run the following.

therapydoc

  

Practice Snaps

Oh, I will ramble a bit. Take it in pieces or go get a sandwich.

DBT Made Simple Worksheet

(1) The Perfect Patient Mix

Everyone knows who the worst patients are. But one man’s silver is another man’s gold. Meaning my  nemesis isn't yours, my ideal patient, not your ideal patient.

By best and worst we mean type of personality, type of disorder, type of patient who jolts us out of our hum drum, our oh bla di, those who grab our attention whether we like it or not.

What makes for the best or the worst? Too many things. But if my father had borderline personality disorder, then it might mean that I’m pretty comfortable with people who have it. Or, it might mean that someone with that disorder makes me extremely uncomfortable. Therapists all have interface of some sort or another. We have our triggers.

Before we're let loose on the therapy-seeking public (a clinical population, as opposed to our friends and fellow students, unless they, too, are in therapy), those of us trained to be therapists usually have identified our comfort and discomfort zones. But these zones are squirrely, they can change, especially as we absorb new knowledge and want to try out new skills.Meaning, the zones change.

At a great continuing education workshop, for example, we might have learned volumes about dom-subdom relationships. We might want to work with this population, understanding that their issues are varied like all of ours. Feeling confident, we advertise as an expert and begin to get referrals. Things are going well.

Then one day a dom tells a what happened to me on the way to therapy story that changes things. Perhaps he stopped for gas. While waiting for a teenager to finish at the pump, he fantasized about taking out a tire iron and killing the teen for being so slow. The patient is a Vet, has killed before.

"Would you really do that? Beat a kid with a tire iron?"  We have to ask.
"Yes, if the moon is high."

Still comfortable with the dom-subdom patient mix? Nothing to do with interface, either, or an average dom. This one probably came for his four-year old's toilet training issues. It happens all the time that things aren't the way they seem. A presenting problem may not be the problem. One homicidal patient and you question what you're doing, are much less comfortable around people who are comfortable delivering pain.

You might be wondering, how to respond to Yes, if the moon is high.
Best to keep the conversation going, not judge, follow through. Ask: "How do you feel about being a man who would do that, beat someone up because he's making someone wait?"

(2) Absorption

Some therapists watch their patient mix, so as not to absorb too much emotion.  Emotion gets all over us.

A mentor of mine told me that if I found myself getting too depressed because my patient mix tipped toward depression, then I had to put a limit on how many depressed people I treated.

That makes sense. But if 90% of the human race suffers a major depression at some point in a lifetime, then it is likely that a good chunk of new referrals are in the throes, first call. And let's not forget that angry people are usually frustrated, but sad is the true emotion deep down. And our anxiety sufferers cry, the anxiety can be so debilitating. It is exhausting, so much sadness, so many tears. We may as well stop working if we're going to limit depression.

On the other hand, there's depression, and there's depression. Not everyone rates an Axis I.

(3) Punting

No matter what we might hope for, no matter how we try to watch our personal discomfort barometer, we can’t merely reject someone who comes for help, not in good conscience, once he is there in the room. We might say, as the patient tells his story, that we have a colleague who would be a better fit. If we have that colleague.

Using our best self-relaxation, anxiety reduction skills, listening for the patient's real needs, we find that we can handle it, whatever it is, all of the time. It is true, what they tell you when you graduate, that having a master's makes you a thousand times more capable at this job than the average ear. The trick is to sit tight and trust yourself.

We dig in and treat, do the job. But it ain't easy.

Perspective: A consultant, a psychiatrist and I work as a team. We have a running gag. We’re not supposed to send one another sick patients. What we mean is no really sick people. We joke that we’re too old for it, too burnt out to treat those with demands that run too high. Or so we say.  Of course this is a joke. The only reason it is funny is that grain of truth we both know is there.

Finding the network isn't easy, but there are new docs graduating every day, ready and willing to take on what could be our worst when we aren't up to taking it on. Maybe we can even find an entire team of  DBT specialists. 

(4) DBT

Oh, but what is DBT?  It is not the pesticide that the Americans used in Viet Nam in the sixties and seventies.

Sheri Van Dijk's DBT Made Simple

Dialectical Behavioral Therapy is a therapeutic model for the self-injurious population, the brain child of prodigious research psychologist, Marsha Linehan. Dr. Linehan has authored seminal books and manuals and has thousands of protegees, therapists who follow her religiously. She understood, well before anyone else could put it into words, why the cognitive behavioral strategies that work with most everyone else, don’t always work with those who have the most severe pathology-- the suicidal, borderline population.

Cognitive Behavioral Therapy (CBT), an older school, is about behavioral change, first and foremost, whereas Dialectical Behavioral Therapy (DBT) is about accepting reality first. Yet another acceptance therapy, Acceptance Commitment Therapy (ACT) is close to both ideologically. The therapist works with the patient to develop a new narrative, very much in sync with the patient's world view. DBT might incorporate the narrative, but offers much more than a better story.

The basics include a range of emotional management/distress tolerance skills and group therapy. Individual therapists have support or they would go sleepless otherwise, and oh, a 24-hour hotline.

The founder, Dr. Linehan recognized that the very sick are often an abused and neglected population. They experienced life at its worst. For them, countering negative thoughts can be waste of time. Life's evidence is to the contrary, damning. They have witnessed trauma to the degree that they believe themselves culpable, deserving. As you sow, so shall you reap. The sentence is issued, judgment must be served. The abused adult bought into her guilt years ago, like the foster child in  The Language of Flowers, a novel, about a child punted from one group home to another. (That one should be required reading for graduate students. A nurse recommended it to me.) They are full of anger and confusion.

The behavioral therapeutic schools have shifted the blame away from parents in the past forty years, but when we talk about causality, the environmental approach to mental illness wasn't so far off the mark. Parents have the power to construct realities, to make the world heavy or light. Some literally choose to make it heavy, don't know any other way. So while blaming, judging isn't fair,  saying they had no hand in the outcome isn't true, either. We can make the connection without judging.

Remember that Holocaust movie, Life is Beautiful? There, in the horror of a concentration camp, a father, by force of his positive personality, makes avoiding Nazi barbarism a game with his young son. The game is to spare the boy's optimism, to hide the truth of his experience. The two laugh throughout the movie. Most abusive contexts aren't this way, aren't fun or funny, and parents don't have this parenting skill, the skill of finding humor, creativity and laughter. Their children can't merely wish away negative thoughts, not even with the best rationalizations to counter them, not with our best hypnotic suggestions.

Therapists, then, need to accept the patient where she is, not a terribly novel idea, and introduce the irreverence, the humor in what is real, only possible if we stop fighting it, accept that some lives are more difficult than others. We old Jews, when we speak of some things that are anything but clean, we refer to them as holy, rather than profane, switch up the words. In this way, I refer to the difficult life as a beautiful life. Abused people get it right away.

(5) Beyond Acceptance

Linehan knew what she was talking about. She experienced the worst of depression, made serious suicide attempts. I read somewhere that she had an epiphany moment, one in which she decided that it was okay that she wanted to die, but she had to love herself, it was her job. No one else had that obligation in reality. If she loved herself then she wouldn't kill herself, killing isn't loving. She had to move on and teach others how to do it, too. Accept the raunchy feelings, then have a good life. Why the hell not.

So how do we do that, exactly, accept the raunchy feelings, then have a good life?

Lucky for us, Sheri Van Dijk simplified Marsha Linehan’s work, cleared the smoke of Dialectical Behavioral Therapy with DBT Made Simple.

This manual is fresh, refreshes, and if you buy it (not cheap at $27.96 on Amazon) the patient handouts between the covers are free to use. No more dividing your college rule paper into columns and scribbling homework assignments. They are all here. And the good doctor, Ms. Van Dijk, gives us permission to copy and use them at will. Who does that? Sheri, I love you.

Among the pages of patient information are ways to act differently, and pages of columns with dozens of words to describe every emotion. Who doesn't need more words?  It feels so good to describe our angst, our happiness. So yes, it is recommended reading. Required.

The Language of Flowers, a novel

To be fair, I don't like that shade of green on the DBT book cover (above). Compare it to the cover to the right for The Language of Flowers.

There, the review is balanced.

Ms. Van Dijk reinforces acceptance and teaches self-validation to reverse the self-castigation game. She teaches emotional reactivity reduction and distress tolerance skills, even mindfulness. Support for the therapists is a part of the plan. Therapy for therapists. Like having a suite mate who reads it in your eyes and takes five minutes to let you debrief.

Yes, that is why some of you wait a bit in the waiting room. Not complaining, just saying.

(6) What if there isn't a DBT therapist anywhere to be found?

My suggestion, assuming there is no DBT therapist at a local mental health center near you, is to take the time to learn the skills we've been talking about, reducing painful emotion, increasing the positive. (These are cognitive behavioral therapies, by the way.) Watch the basics of mindfulness (see video links below). Work with a psychiatrist, a therapist, and a primary care physician. Have a suicide contract in place, and the option of insisting upon a hospitalization. If the patient is in an Outpatient Day Program, stay in touch with staff. They need your input.

One on one, no team around, the job is to help people accept and love themselves. You’re fine exactly as you are, not that we all couldn't be better people. You are entitled to your anger. You are entitled to your sadness. Why wouldn’t you be angry? Why wouldn’t you be sad? Why wouldn’t you want me to feel your pain, manipulate your therapy so that I do, so that I know what it's like?

You see, misery loves company. If you don't want the  patient to turn on you, because some do, increase her demands, to try to make you miserable, then the heart of your work must be to join her, make that joining obvious, discuss the ugliest of her truths. Much more powerful than—Let’s try this!

(7) And If You are the Patient? How Do You Help Yourself?

You help yourself by being honest in therapy, for sure, and by having compassion, patience with a sometimes deficient therapeutic system, patience with loved ones, patience with yourself, if you are your only loved one. Then add patience to that patience, compassion on top of compassion. (I'll review Jonah the Woodcutter one day. In that book by Joshua Rubin, Jonah tells the shoemaker that if we have compassion, we don't need patience.)

Read the Ten Reasons Not to Kill Yourself, while you're at it, and buy Sheri Van Dijk's book, or Marsha Linehan's about how you really have a wise self. Begin to use it, that wise self. Start working your own program.

They say Linehan suffered schizophrenia, BPD, and depression. She has at least five videos on Youtube. Watch her teach.  Try her  breathing techniques, watching the breath as opposed to controlling it. Many of us teach diaphramatic breathing  for stress management, much harder, no need. Click on the mindfulness videos at  DBTselfhelp.com fall asleep to them.

Don't do anything to harm yourself. You only have one ultimate mother, one father, and that mother, father, is you.

(8) Politics

We can only hope that with changes in health care, money will be earmarked for the vulnerable, will move Marsha Linehan's epiphanies right along, train more teams of DBT therapists for the trenches, make mental health something we can buy at the local intermediate care center. It is a war, I tell you, that war against self-hate.

Next time I post, it will be on something light, maybe the Dove Real Beauty videos, or maybe whether or not having a mother who shoplifts expensive dresses from Lord and Taylor is likely to have a terrorist for a son.

Maybe why I just want to shake Don Draper and say, "Don, you are like your father, a terrible father, because, like him, you are an alcoholic. Kids are a real inconvenience to you."

therapydoc

Ten Reasons Not to Kill Yourself

Suzie Gonzalez

I read the news today, oh, boy, 
About a lucky man who made the grade, \
And though the news was rather sad
Well I just had to laugh
I saw the photograph
He blew his mind out in a car, 
He didn't notice that the lights had changed
A crowd of people stood and stared
They'd seen his face before
Nobody was really sure if he was from the House of Lords

Beatles, A Day in the Life

For some reason, I always heard those lyrics as describing a suicide.

Not a pet cemetery

About the picture to your right. They try to make them look like parks, but these are really dreary places to visit. 

Matthew Warren, son of Pastor Rick Warren of the Saddleback Church in California, dead. Matthew's famous father spoke at President Obama's first inauguration. He wrote a letter to his congregants to tell them that Matthew had taken his own life, had lost his battle against depression. It was a self-inflicted gunshot that killed the 27-year old.  

Huff Post quotes the father:   “No words can express the anguished grief we feel right now,” Warren wrote. “He had a brilliant intellect and a gift for sensing who was most in pain or most uncomfortable in a room. He’d then make a bee-line to that person to engage and encourage them."

“In spite of America’s best doctors, meds, counselors, and prayers for healing, the torture of mental illness never subsided."

We would say that Matthew had bad disease. What we lost, a picture of Matthew Warren.

THE STORY
I need to remind the reader at this point that the caveat at the top declaring much of what you read here as fiction is there for stories like these. 

A few years back I’m sitting across from an extraordinarily handsome young man in his early thirties. He has an excellent vocabulary and an eastern seaboard accent. He narrates about the mental illness in his family—schizophrenia, the schizo-affective disorders, bi-polar disease. He's been on his roller coaster of disorder and chronic drug and alcohol abuse, with multiple physical problems (as if these can be separate), too, all his life. 

He is talking and I am thinking, Oh My.

There is a feeling the therapist gets and I have it, a worried feeling that her patient will not make it, will kill himself, and it will be on her watch, and she will be held responsible for not getting him to the hospital in time, and even if she isn’t responsible, she will feel she could have intervened somehow.

He tells me that he knows he will kill himself one day, as sure as the sky is blue.

I tell him: Not on my watch.

He laughs and thanks me for that. He needs a great deal of direction in general.

Time passes, my friend leaves the city. We speak about continuing our work on the phone but I am reluctant. I want someone to lay eyes on him, as I like to put it, to feel him.  When we're with the patient we can get that feeling, some of us, that things aren't right, that the psychotic part of the depressive continuum is ascendant. The patient has checked out, wants no help, intends to finally carry through a plan that is always on his radar. He won’t tell any of us this. No, we won’t hear about it from his lips. In fact, when we try to get near to it we hear a resonant objection and a defense of his mental health. “I’m fine! Go back to your nap.” This I do hear, for he knows full well that a good nap does a body good.

He leaves, has a new team in another state, miles and miles away, people to keep him alive. Somehow. 
Six months later I get a call from his wife that he has finished the job. I am startled, surprised, upset, and very, very sad.  This was a pleasant man, a likable person. Surely he could have done something wonderful with his time on this planet, even if was some kind of volunteer work. But he is out of his pain, finally, is what everyone will say.

His wife, on the other hand, is furious at him. Selfish bastard! How dare he do this?  Why in the world would he do this to her? She would have stayed with him, headaches and all, no matter how difficult, no matter the drama! He was in total sobriety and on the right meds, in stable condition, as stable as he had ever been. He should have loved her more than to leave her like he did.

She hates him for this. She will never love anyone as much, or hate anyone so much, all in the same moment. We hold hands over the phone as she cries.

There are others he has left in his wake, parents, siblings, therapists, doctors, people kicking themselves, wishing they could have done more. Even I am thinking, Should I have called him once in awhile? No, he wasn’t my patient. But could I not have just checked in? Is that such a crazy thought?

Oh, it is water under the bridge. Sometimes there is nothing we can do. People leave clues, they tell us as much, that this is the plan, this is as it should be. We can call the police and the patient will charm her way out of an admission. Shlep a man squawking to the hospital, and if he is admitted, he is eventually released, and when he is, if he can get his hands on a gun, he’ll shoot himself. Or use a rope. A woman will ingest all of those meds she’s been hoarding for just the right moment. 

Sometimes we just have to face it. People are hell bent on suicide, either need a release from their pain or want to take others down with them as they go, make sure they are missed. We may not be able to stop it but we can try. 

We can say, "Not on my watch." 
And they can say, "Why not?"
And we have to find reasons why.

Maybe there is something we can do about it to slow it down, for this wave of youth killing themselves does seem to be an epidemic. We need to call it what it is, let’s talk, self-inflicted murder, no different from homicide except that the one pulling the trigger is the most obvious victim. 

To call attention to the problem we should support suicide awareness, visit AFSP's website. We can join in on their walk, donate. AFSP, the American Federation of Suicide Prevention, could use money to promote their anti-suicide campaign. We should make it our anti-suicide campaign. 

Taking a walk to draw attention to a cause is a nice idea. Good people do this. 

There's something else we must do. We have to counter the forces of death on the Internet. I feel it is a Star Wars mission we're talking about. We are the Jedi. 

If you aren't aware of this, you should know that there are websites that feed vulnerable, depressed kids step by step instructions on how to kill themselves. Here, where we are at this moment, people give advice on how to die. Go ahead. Open a new browser and Google: How can I kill myself? You'll fall off your chair there's so much advice out there. Sites share specs on lethal doses of poisons with anyone who asks for information. I imagine they teach rope knots, too.

This upsets me, that the Internet has become the Wild West, a dangerous place, because I like to shop here. There is nothing quite as amazing as Amazon, or useful as a university database, or Hulu. This is a wonderful place, cyberspace. A few rotten apples. Right? No. The tip of the iceberg.

They have to be shut down.

 Suzy Gonzalez was a child. 

Hear her story.

(CNN) -- Suzanne Gonzales seemed to have everything going for her.

A bubbly 19-year-old with loving parents and good friends, she was also a strong student and earned a science scholarship for college. But everything changed one spring day two years ago, when Suzanne's parents, Mike and Mary Gonzales, received the following e-mail.

"Dear Mom, Dad, and Jennifer, I will make this short as I know. It will be hard to deal with. If you haven't heard by now, I've passed away," the e-mail read 

Suzanne's case has an unusual twist. She frequented an Internet newsgroup called called ASH, short for Alt.Suicide.Holiday.  Members of this news group trade advice on how to commit suicide, using code words like 'transitioning' and 'exiting' and 'catching the bus.' Suzanne found this group nine weeks before she died, posting nearly one hundred messages detailing her plans.

Her parents are grieving, her friends and teachers are, too. And it is clear that Suzy had much to offer. People who are very much still alive who say they've been there and respected her wishes to end her pain, persuaded her to hide away in a Florida hotel room and take cyanide.

They told her exactly how to do it so she would make no mistake. Hers was a copycat suicide. They coached her, told her over recipes to die.

Recipes for suicide.

So yes, THIS has to stop. These websites are taking free speech too far. Throw the perpetrators in jail. Pass stiffer laws. I plan to email my congressman. He writes me to say Mazal Tov! whenever something nice happens in my family. Time he did something more.

Is it possible that bloggers like me, bloggers like you, or just readers with Google circles or Facebook pages, Tweeters, any one of us, might participate or better, start a chain, post the reasons that suicide is a very bad option, all things considered?  I'm not technologically savvy enough to know how to do that, but some of you are.

 Feel free to cut and paste. 

         Why suicide is a bad idea. 
(1) There's an agent for everyone. We have new and better medications. Be patient. There's one coming out at a pharmacy near you soon.

(2) Brain research and the fields of psychology and neurobiology are exploding. There may be a cure for depression, a laser, a surgery, who knows? Think about it. One day, zap. You're better. Things are likely to get sunnier if you wait it out. Study up on these things. Learning anything makes you feel life is worth living, too.

(3) You are not bad, not evil, not the source of all that is wrong in your life, your world, the universe. The world will not be a better place without you, no matter what the relentless, unceasing voices in your head are telling you. This is as wrong as 2 plus 2 equals 1 to think that you MUST do this, totally irrational, the thinking of a sick mind, a mind on psychosis  It's not about you, frankly.

(4) People love you, so you can't do it. You don't have this right, no matter what anyone tells you. People love you and if you believe in God, that Higher Power does, too. She has declared all forms of murder out of bounds, even yours. We don't mess with God, but it's not just God. The people who love you will really, really hurt if you kill yourself. It is one thing to feel pain, quite another to give it to others. Wait because you  probably do have love inside, although it is surely fogged over by disease. But you loved and you will continue to love at least someone, or something, and others love you. Love is ephemeral, holy, and all that is good.. Why lose that?

(5) Tough it out because you are already in the process of change, you can't not change. Our cells change over every day. Our moods can, too. We have so many ways in therapy to accomplish this thing we call affective change. Pay attention. 

(6) Change your therapist if therapy isn't working. This should be obvious, but it isn't. A new set of eyes on you is refreshing. Therapists all get a little boring after awhile.

(7) You haven't even tried aging yet. It's not so bad. Age a little, give life a chance. See what is in your future. It will be better, you'll see. And how can you not want to know the future? Seriously.

(8) There are things that only you can do, no one else can do them, and these things have to be done.

(9) There are things that only you are. Nobody else will be the uncle that you will be, or the aunt, or the mother, the father, the daughter, the son. These are unique jobs, very, very important ones.

(10) We need you. We need a new poster child every year, at least one every year, someone who comes out to the world and tells young people: Wait! It really is a permanent solution to a temporary problem. They weren't kidding! I waited and look at me! My picture is on a bus!

We can't judge people like my friend who moved away and did what he said he would do, as sure as the sky is blue, although his wife always will, or the Matthews, the Suzy Gonzalez's. They really didn't know they had a future.They were convinced, in fact, to the contrary, that life would not get better. But  Suzy scooted around her neighborhood in a plaid skirt and green tennis shoes. And Matthew helped others as soon as he sensed their discomfort. A girl like that, a boy like that, knew how to make others happy. We can't afford to lose kids who suffer from depression. They get happiness on a level that no one else ever will. 

So why then? Why do they do it? Sure there's pain. But I propose that they lost that tiny sliver of affect that kept them alive, the one we think of as love, that very positive emotion. We need it to stay alive, need to love something, someone, and we're not talking romantic love, here, rather a sense of connectedness. Friendship will do. For some, a hobby.

On Suzy's website the people who loved her wrote:

Suzy Gonzales was a bright girl who needed to be reminded of the good things
in life, not encouraged to end it. At the time of her death, Suzy was the 14th confirmed
suicide associated with this particular site, they claim 24 "successes" today.

I'm so sorry for her family, and for Matthew's, and for all of you who have lost someone to suicide.

therapydoc

Anger and Abandonment

It has been blustery in Chicago, the reputation as the Windy City well deserved. So blustery that at the end of March, when the weather is supposed to be mild (March comes in like a lion, out like a lamb, every second grader knows this) that we tell frail little people like mother, "Don't go out for lunch. You'll be grabbing onto your walker as the wind carries the both of you away." She goes to lunch anyway.

FD tells the story. He's in a parking lot at Home Depot, returning the cart. A bundled-up middle-aged man with a white beard is holding on tightly to a cart. If we don't hold them tightly, carts will take charge, fly off and hit parked cars. Chicagoans know this.

The man begins to curse as his hat flies off his head and hits the ground. FD, retrieving it, is rightly impressed by the long string of expletives, ef__, es___, d__, ef'in___b, b___, ef___, ef'n___, es-ef___, spewing from the man's mouth. Listening to this, he doesn't say it, but is thinking, Save your expletives for when you break a leg, or lose a house, maybe. Why waste them here?

A few years ago, two men with romantic accents came to see me in one week for anger management. It sometimes happens that two or even three new patients with similar problems come to therapy in the same week. It is as if there is something in the air or the stars are aligned in some special way. This affords the therapist the opportunity to experiment, to do her own little research study, assign homework and see what works and why, and see what doesn't and why not, because there is something of a control, having that second patient with comparable symptoms, comparable objectives.

It gets better. Both tell their narratives fluently, and both are from that continent hailing the new pope, South America. Both are reflecting upon a childhood living with extended family, not their moms or dads. Their parents left southern climes to establish themselves in this country, the United States, a land of opportunity, and called the sons to join them years later.

Years. Later. A long time to miss a parent. Without means, long distance phone service was prohibitive back then, and letter writing, well, there wasn't money for computers and email, and who had time for it anyway?

The child left behind, defenseless, odd-man out among the cousins, abused by drunk uncles and bullied at school, learned to be a very tough human being, so tough that peers eventually realized that to mess with him meant a fist fight that he relished. To beat another human being with his fists felt fantastic. This is where the phrases  sees red, has a hair-pin trigger, and Intermittent Explosive Disorder can meet as one.

Left behind.

Therapists hear about domestic violence, but usually not from the perpetrator, but the victim. The spouse or child tells the story. Here the patient is both victim and perpetrator. As an angry man, however, he doesn't hit his children or his partner, and has learned, as an adult, not to beat other adults, either, unless the circumstances clearly warrant physical violence. To him, they occasionally do, certainly if he hasn't stopped drinking yet.

We don't need advanced degrees to see where it comes from, the anger, and why the expletives become something that will need work, and surely the physical pounding, the rage, the immediate need to redistribute justice and turn things around, has to be channeled productively. One of the interventions I love, one that started with those two-in-a-week, works as follows.

The patient is told that he has to deliberately lose every argument. Every disagreement, every difference of opinion, my bad. He is to tell his partner, dispassionately, "Fine, I'm driving poorly?  I'll work on it." That kind of thing.

"Two weeks, you're an idiot for two weeks. She's the smart one. It's okay. You're really not an idiot. In your heart, in your head, you know that. You do know that, right?!" The therapist asks this in all sincerity. "Keep that in mind at all times. Nobody left because of you. Nothing to prove. Nobody thinks less of you if you are wrong. Your partner will value you more for being human."

It helps to have a partner or spouse in the therapy to reinforce the intervention, someone to look into his eyes, to tell him, "You're the smartest guy I've ever known. I love you. Love me."

And if he can't, there is that possibility, she might leave. Been there, done that.

therapydoc

Gaining Perspective

A dreary place at 7:00 a.m. Lincoln Towing

There's this ridiculous situation where I live.

The condo association offers guests parking in the Circle Drive close to the front door of the building. But not to residents, who presumably have their coveted spot in the garage.

That's not so bad. But if you do dare to park in the Circle Drive in the evening, if for some reason you take this risk, maybe you think you'll be right back, or maybe someone calls you and you get involved in a conversation, or you put a soup on and have to watch it and forget about the car--

if the car is still there between 2-6 a. m., a tow truck will certainly hook it up and tow it away in those wee hours.

There are signs in the driveway that communicate this; it isn't exactly rocket science. People have to move their cars from the Circle Drive.

Why? The rule is so old nobody remembers why anymore. It doesn't matter, but last night I forgot to move my car and this morning, thinking he would find it in our usual spot in the garage, FD returned to the condo, confused.

I'm pouring the coffee he has made.

"Car isn't in the usual spot," he informs me, unemotionally. "I'm walking to shul (the synagogue). See if you can track it down. Stay in touch." And he's gone.

My immediate response is an expletive, only one expletive, just so you should know, one that is preceded by a loud

OH! as in,  OH, ___!

It's the kind of thing that doesn't come out of my mouth very often, so when it does, I know I'm upset. This happened once before, this rendezvous bit with Lincoln Towing. It had been pouring that night, deafening lightening and thunder, and being terrified, I hid under the covers and fell asleep. Never did move the car. Surely innocent to a jury of my peers.

But no. To get it out of the auto pound a crummy $198.00 is required. And they don't have change.

I dig out the cash, throw on a coat, and trudge downstairs to wait for the bus. At the stop I text my kids to see if anyone is around to pick up their father. Everyone is willing, but FD is fine. He'll wait to see how things play out. His early meeting at the hospital is optional.

Chicago CTA bus

My bus comes right away and the driver is garrulousness, in a fabulous mood (this is the end of his shift, we'll see). No, he can't change a twenty, and no, this bus will not get me anywhere near 4882 Clark Street. I'll need to transfer at Lawrence. He lets me on for free and offers an "emergency" transfer.

I am tickled. It isn't as if I don't pay lots of taxes for this sort of bail out, but still. Perhaps when your car is towed it is considered an emergency to the CTA. If so, What a wonnerful city, as the late Mayor Richard J. Daley would have said. And it is, truly.

The bus is getting more and more crowded, but I have a good seat. About a half-mile before my stop I see that my driver is getting up to leave, has pulled over to the curb at the light. He's switching with another driver at Foster. I sprint to the front to thank him again and ask if I can take his picture.

I have this blog, I say, it's a therapy blog, Everyone Needs Therapy, and if he wouldn't mind, I could post his picture, tell the world what a great city this is, how a kindness like his, just being really nice at 6:30 in the morning, changes everything for the low-lifes in the world like myself, those who leave their cars overnight in the Circle Drive.

He laughs, "This isn't going up on YouTube right?  I don't want that!"

"Oh, I won't even put up the picture," I tell him, "It didn't come out very well. Don't worry."

He seems disappointed.

Now. The new driver has heard this conversation. "Yes," he nods, "Therapy. People do need therapy.  I swear, the people who ride the bus, man, do they need therapy some of them." He is whispering so that if what he's saying is inappropriate, maybe I won't hear. This man has a true conscience, it is refreshing.

"Uh, huh," I agree, "tell me about it."

He proceeds to tell me quite a bit about himself, how his Mom raised him right, and how she and his father paid attention to him and watched who he hung out with, and made sure he did well in school, and parents today don't do that, and so many of them are on drugs, what is a child to do? Mom made sure he knew that there was a God, too, and he is forever grateful for that, too.

"The most important thing," he tells me, "is kindness.  If you're nice to people they'll be nice to other people. It's a pay it forward thing, like in that movie, Pay it Forward. That's absolutely the most important thing we can do is just be nice. That's all," he says. "That's all."

And I'm thinking, that $198.00 I'm going to spend is a drop in the bucket compared to what people spend on drugs, those who spend money on cocaine, maybe heroin, and probably isn't that much to some who spend their money on lottery tickets or beer and marijuana, either.

And if I only do this, fail at moving my car, lose that gamble, say, every six months, that gamble on  parking in the Circle Drive, the one for guests only, not even a gamble if it is there between 2-6 a.m., a surety, then maybe that isn't so bad either.

Could be worth it to hang out with these guys turning the corners on the CTA in the very early morning rush hour.


therapydoc

PS: The late folk song writer/performer Steve Goodman did a wonderful spoof on a car towing company in Chicago, The Lincoln Park Pirates.  Totally worth a listen. Back then I think it was only $135 to redeem your automobile, but how would I know?

When Mindfulness Isn't Helpful

Meditation:  Yes. Wonderful.
Hatha Yoga:  For sure, who can live without it?
Controlled breathing: A life saver.
Guided body focus: Best thing for you.
Containing, holding, focusing only upon depression, anxiety, or anger: Maybe think about drawing the line when this particular intervention is making you sick.

At least don't feel badly that you have failed the class, can't get all cozy with your negative emotions. Because that's the goal, understand, oneness, full acceptance. Mindfulness.

Tell yourself that it isn't your fault if you can't befriend your sadness, if you hate the training, if you aren't getting any better and want to run away, to be anywhere else than in that room full of mindful people.

Who could blame you?  Attending to pain won't  magically bring on peace, certainly isn't nirvana, not for every deep sufferer. It just isn't.  Fine, let's qualify. It works for some, certainly not all of us.

There, I've gone public about something that has bothered me for a long time. I held them in, my mixed feelings about this part of mindfulness, getting close to the pain, because I like the rest of the therapy, and I know that pain does lift and when it does, nobody tends to notice.  So say hello to unhappy moods because they have a shelf life. They also spontaneously regenerate, which is a shame, but it''s called being alive.

The mindfulness therapists will surely tell me I have it wrong, will spleen me for what is to come, but it is worth the risk, shouting to the blogosphere, reaching out and yes, relating to the confused and the angry, the still depressed and even more anxious, those who have plunked down their five hundred dollars to take the 8-session class, if not go on a weekend retreat.

But I'm giving you permission to Just Say No, to say I'm Not Doing This. To say, This Was Okay Until Now, But You've Crossed the Line asking me to lean into my bad feelings.

Lean into the pain?  You want to know who else leaned into the pain?  Aaron Swartz. He killed himself a little over a month ago.

Saying No! when told to embrace depression, anxiety, etc., should empower more than one somebody, and that process, asserting feels good.  Assertiveness is one of our more successful emotional management strategies, tried and true.

No question, each of us gives negative emotions their due in our lifetime. There is no escaping or denying, and those who battle their feelings regularly have spent countless hours in their presence, mostly fighting them, wishing they would go away. It makes a certain amount of sense, therefore, that changing one's attitude, which is what mindfulness is really all about, is worth a try. This is like any other behavioral technique or strategy, in that it deserves a try.

Rather than run, rather than medicate, if we get into it a little, feel the sadness, the anxiety, the anger, it will lose its power. Stop fighting it, it can't kill you unless you let it. Ironically, we tell alcoholics and drug addicts to do this all the time because using is truly hiding, avoiding emotion. So for them feeling is educational.  We tell addicts, Stay with it, feel badly for a change. It won't kill you and it won't mess up your life like substances does.

Staying with a bad emotion might not kill you, but staying in a bad marriage probably won't, either. That doesn't mean you should.

And then there's Aaron.

It is very unlikely, working with a professional mindfulness therapist, that you would do anything self-destructive in the process of getting well. Aaron had severe mental illness; he needed more help than he had, or he simply couldn't take it any more, that spontaneous regeneration. The mindfulness trainers who have trained with the best, and who hasn't, are setting themselves up if they know how seriously mentally ill their trainees are and still pretend it will all be okay. Close your eyes.

No matter, for those who are not severely distressed, it is still possible to feel like a big loser, a huge loser when making the mark feels impossible. If the sadness, anxiety, the anger is no better when you embrace it. If you feel like exploding or imploding while focusing on the pain and don't feel a whit better when it is all over, it is likely that you will feel worse.

Are you not embracing it enough?  Are you a poor embracer? If it feels worse because you are giving it your undivided, your full attention, worse isn't what you are looking for; it's not the goal. Less is.

Theoretically, the major disorders are compounds of negative thoughts and feelings. That's all. Sadness is just a feeling, no more no less, anxiety and anger, too. Emotions are realities like every other reality, anything else that grabs our attention. Hanging out with them should be seen in that light, a fleeting reality. One long moment.

Except that hanging out in this reality, watching pain, hurts a little more than say, watching a sunset or maybe visiting someone, holding someone's baby.

I prefer the sunset. The baby.

You could say that cognitive behavioral therapists who recommend distraction, the sunset, Modern Family (television), taking a walk around the block, or doing a crossword puzzle over embracing the pain are chicken. We also like anesthesia for surgery.

A patient says to me:

 Like I don't know what it is like to be consumed with anxiety?  Every day of my life I suffer from anxiety. And they want me to invite it in?  Makes no sense. I tried and it made me feel even crazier than usual.

Nice.

I recall being a young therapist, a hundred years ago. The patient is crying and I am saying, "It's okay, cry. Crying is good. You have a lot to cry about." And the patient continues, throughout the visit, weeping, and it won't let up, and she won't get up off the floor at the end of the visit, won't leave, continues to sob, and I have to call an ambulance to take her to the hospital.

Wouldn't it have been better if I would have taught her to manage her sadness? Would it have mattered? I think so. I'm pretty sure it would have been better if I had guided her to disengage from the pain, not embrace it.

Of course, I'm not a mindfulness teacher and hope to hear from someone who can clarify for me. But one thing I know. Give me a good distraction, a good procrastination, a good rewrite or a new script, a napkin full of obsessive thoughts, a hand on the heart, a phone-a-friend or any one of the hundreds of emotional management strategies we can all think up with only a little imagination, any day.

therapydoc