Monday, August 18, 2014

The Year of Mourning

We've talked about it before, ritualized grief. It is healing, if executed well, and at the end of an official year (especially if you do it the Jewish way) one feels different, as if a millennium has passed.

We're on the return leg of a road trip to Ruby Falls, a tourist trap in Tennessee. I had the front seat of the van on the way out, but am in the back for the return trip, with three very dirty and exhausted children. They are engrossed in movies. I can stretch out my legs. Not a bad way to travel. Gazing out the window, the lyrics come to mind:
Let us be lovers,
We'll marry our fortunes together.
I've got some real estate here in my bag.
So we bought a pack of cigarets.
And Mrs. Wagner pies,
And we walked off to look for America.
America, the Bookends Album
Hard to get the song out of my head. Simon and Garfunkel Bookends album. Now you've got it. That's what we do in my family, pass off songs.

My son asked if we could take a short vacation, come for a visit this summer. So just before the year ended, FD and I got on an American Eagle jet and took photos of clouds, seeing clouds from both sides now, obviously. Changing the song works, too.

But only one  emotional snapshot stands out from that vacation.

The children have personal entertainment consoles;  The Lego Movie and Lilo and Stitch play on and on. I look out the window and watch the landscape, hoping for an occasional rooster or horse. The Paul Simon song attacks and I want to sing but can't remember the words, immediately Google them on my phone.

A patient had just complained about her niece and an internet addiction. More accurately, a media addiction. And I think: My grandchildren will have to wait until they have children of their own to even  begin to look for America, feel the sensory joy of looking beyond their phones, their tablets. They will have to take their kids on road trips. Drive.

But maybe not. My kids are pretty conservative, don't even let the little ones have email accounts. I understand you get one now at your bris.

So I sing softly to myself, thinking it odd that during the first year of mourning, if you observe those Jewish rituals, singing is permitted, but not listening to music. Certainly not live music. Recorded music is discouraged, too, really. Paul Simon whispers in my brain and there's no need to adjust the volume, no headset.

So I looked at the scenery, she read her magazine, and the moon rose over an open field.

Ruby Falls at Lookout Mountain
Why forbid music during a year of mourning?

Too happy, maybe. But until it ends we don't understand the real reason. After a year of sensory deprivation, at the end of that season of grief, the anticipation, the desire, the need to live is indescribable. And when you finally hear the sound of music, you cry.  It is as if life begins again.

As it should. That is the point. (We only grieve this long for parents, by the way).

So picture me the last evening of that season, a Thursday night. I have invited guests for a Friday night dinner, cooked a few hours. It is finally dark. Pitch black. FD comes home, has a quick bite to eat. I am in a chair, exhausted, feet up, watching my fish swim in the aquarium. He asks me if I want to hear what he's been working on. (He is a classical pianist). I thought you would never ask.

For a year he practiced on a keyboard, headphones on, and all I heard was the banging of keys, no notes. So now he plays the scherzos so that I can hear them loud and clear, explains each one. Then we listen to yet another on YouTube, one that he hasn't learned because it hasn't been transcribed for piano. He's working on the transcription. He tells me that a scherzo is a musical joke. The thought makes me smile. Weird Al has nothing on a scherzo.

The next day I am texting the kids, asking them for the names of popular songs that I missed during the year. I use itunes (forgetting all about Pandora) and listen, wondering if I even like the choices. As I dice onions, the enormity of it all, the trance-like feel of transition, works its effect. Guests! Fun! Friends. For a year socializing has been limited to family, primarily, and a few couples, one at a time, let's not over do it, very few. Certainly nothing remotely like a party. Tears applaud this moment, make it memorable.

My grandson would videotape the scene: An aging female seeking show tunes on her iphone, crying as she dices onions. Funny, no?

But it is sad. Setting the table, it is clear to me that my mother would love the china, the silver, the royalty of this Sabbath meal especially, for her touches are on everything. She is everywhere.
Waterford rose bowl


Then at night, after the dinner, a dream, a disturbing dream. She is alive, but not really alive, wearing a pale green dress that I don't remember, but her style (and green is a good color on her, but not this time). She is thin and disabled, and it is my son's wedding, which she missed due to her illness. But she's there now, and I have lost her and am in a panic trying to reconnect. She is in a carriage, or a rickshaw, on her way to the synagogue where we are hosting a huge celebration after services, the occasion of the day. I miss the whole thing trying to find her a lemonade.

Not a good dream, and it cast a pall over the weekend. We don't lose bad dreams easily, and even though it was nice to see her, it wasn't a picnic. I blame the short glass of excellent red wine, a Gallil Mountain, Yiron 2010. My guests chose well, but wine can be dangerous, even in small quantities.

The next night we dress up again. FD has tickets for Brigadoon at the Goodman Theater downtown, and from the very first note, the voices so clear and high, so strong and powerful; the scenery, brilliant; the story, fanciful, I am lifted there, to Brigadoon. A musical is surreal under any circumstances, which is why we love them, but to hear the songs that Andrew Lloyd Webber pirated (you're undoubtedly familiar with Phantom), and gaze closely at classically trained dancers up on their toes, stepping, twirling, skirts flowing, everyone smiling on stage, in the audience, everywhere.

Quite a sensory whirl.

We meet a few friends at the theater, too, also odd, because who goes to see Brigadoon? (People a bit older, that's who). Our friends go to the theater often and suggest we try the Lincolnshire if we haven't already. Very reasonable, wonderful productions. My parents had season tickets, I say, but we never took them up on their offer to go; the drive is a little far. Now I want to go. I am becoming my mother, I laugh.

Brigadoon-Goodman Theater
One of the women notices and compliments my beaded bag.  She has one like it, her grandmother's. She is nostalgic, her eyes look up and to the left, remembering.

My bag was my mothers, naturally.

therapydoc


Tuesday, August 12, 2014

Robin Williams and Bipolar Disorder

Robin Williams
I know he denied it, but it does seem that Robin Williams had bipolar disorder. So based upon the presentation, at the very least I'm going with a Bipolar II. You only need one manic episode for that one.  A depressive episode took his life.

I get my first world news updates from Robin Meade's early morning show. Her voice is calming. In therapy, people who work on a morning news show are at work at one a.m. They will tell you that to get through that shift: You drink a lot of caffeine.

Many of us do, too, drink a lot of caffeine, if only in the morning, and it makes us a little  manic (I am typing fast) and we wouldn't trade the feeling. Half-caf is a suitable alternative. 

There is a world of difference, however, between the manic feeling associated with two cups of coffee and the "manic" in manic-depressive, or bipolar disorder. We now really only use the term, bipolar disorder. I don't know why.

One of my first posts on this blog, back in June, 2006, hosts a long list of celebrity sufferers, including Mark Twain, Agatha Christie, Abraham Lincoln, Plato, Graham Greene, and Sir Isaac Newton. Dozens of Hollywood stars rate inclusion, celebrities gone public about their disease.

We have to add Robin Williams, now. He killed himself to escape the disease. He was in Hazeldon for rehab only last month and had treatment for depression, too, fairly recently. His daughter Zelda just turned twenty-five. Susan Schneider, his loving wife, is "utterly heartbroken." Millions of fans, everyone, mourns with the family. It is a dark day, and it isn't just the weather.

When I see the montage of photographs it seems as if the actor is crying in most of them. The editors on television shows know how to relate, convey empathy. There is a sadness in Mr. Williams, a sadness in his eyes.

It is not the sadness of Lesley McSpadden who lost her son, Michael Brown, on the same day, although her eyes are sad, too. A policeman in Ferguson, Missouri shot the boy down; Michael's hands up in surrender. A riot ensued, teargas to contain the mob. Ms. McSpadden shouts to police:
"You took my son away from me."
The shooting, racially motivated. Had it been a white teen on the street, it is unlikely this would have happened. So Ms. McSpadden has fellow mourners, millions, too.

It is not the sadness of the family and friends of Rabbi Joseph Raksin:
Rabbi Raksin: Victim of hate crime
In cold blood.

Homicide victims, symbolic of the racial tensions of the day, are now common. And we haven't even discussed Knockout, a video game encouraging players to take to the sidewalks. One rolls the camera while the other casually knocks out an innocent pedestrian. Victims happen to be Jewish in New York. It is rumored to have happened a few weeks ago in Chicago, and the victim died. So scary that some of us think, "I should buy a gun and learn how to use it."

Then there is Robin Williams, who died with a belt around his neck, a man who brought the world happiness and tears, the tears we love to cry at the movies. It feels like a crime, too, his suicide. He describes his quiet childhood, and tells NPR that he certainly suffered sadness, but everyone does. Yet others speak of disabling depression. A person can take only so much. He probably thought he had tried everything. 

But he hadn't. We know that because he's gone.

To "treat" his disease, among other interventions, he used alcohol and drugs as "controllers." He suffered a dual-diagnosis, most likely: bipolar disease and poly-drug dependence, hence the stay in Hazeldon, a popular, effective, addiction treatment center. Following his release, clearly, he should have been evaluated to be sure he didn't kill himself, to see exactly where he might be falling, alcohol-free, on the depressive continuum. For those with dual-diagnoses, treating one and not the other is futile. Easy to see this with hindsight, but Mr. Williams should have been admitted for a long stay in a psychiatric facility, a nice one, of course, for observation. He could afford it.

We can assume he had been there and done that in the past, probably plenty of it. It is a cyclical disease, however, and a cycle can last. A depressive cycle can be so painful that the patient wants to make it stop lasting. We might say Mr. Williams needed a much longer inpatient stay, longer than he had ever had before. Again, twenty-twenty hindsight, but we're talking about a legendary actor, and there are other legendary actors who suffer, much like Abraham Lincoln, Sir Isaac Newton, Mark Twain. . . Not that they all killed themselves, maybe none of them did, but one in ten with bipolar disorder do. We have to learn from these suicides, don't we?

therapydoc

Wednesday, August 06, 2014

Enmeshment and a Proper Ending

We haven't talked about family of origin in awhile, so why not get back to it. I was going to write about guilt, anyway.

I have an optometrist who made me a pair of rimless glasses about fifteen years ago, glass.  "Treat these like jewelry," he warned. "They are very fragile."


Random building, random car, not the car
or building in the story
.
The Story:
Five or six days out of the week I swim. At the same time, as I walk into the looming multi-unit building, a frail older man in a white shirt and tie, black suit and hat, is leaving. A large SUV waits at the curb. The gentleman struggles with the passenger front door, steps up carefully into the car. He and his driver are likely off to morning prayers.

The windows are dark, but I assume the driver is his son. I can picture the older man tossing the cane into the back seat.

Hating myself for judging, it bothers me that whoever it is picking him up, for whatever reason, hasn't popped out of the car to help. It is what I did for my mother at any opportunity, pop out, although she complained.
"I can do it."
She couldn't.

My bad for that? Should I have respected her need, her desire for independence, the very thing we crave most of our lives, especially in the more traditional marriages, marriages like hers, as in, serving-is-just-what-we-do? But I wouldn't have dreamed of letting her risk a fall while struggling with a car door. Any fall at that age is critical. The recollection of her broken pelvis as a younger woman is enough.

But giving the benefit of the doubt, the resident is a man, after all, if an older man, less brittle perhaps. Maybe the passenger sternly warned the driver:
 "I am not an invalid. Do not insult me. I can get into an automobile." 
Said with feeling, spoken with intensity, the lasting affect of a more youthful personality. And obviously, he can. The son shows respect. The father, surely at one time a person who drove his own automobile, has his autonomy. What choice is there?

And inside the car it feels intimate, it has to. Because as we lose height and balance, we suffer fewer niceties, fewer formalities. Less tip-toeing around feelings because there's no denying the need for doctors, medicines, help. Aging, accompanied by aches and pains as a rule, begs to be expressed. "How do you feel?" and the cork is popped. The answer, in a whisper or a roar, will be better in Yiddish.
Elaine Stritch on NPR's Song Travels

Elaine Stritch recently died, but worked well into her last years. Even before reaching a certain age her style was direct, honest. Comedians get their laughs precisely for that, their honesty and self-disclosure. Even their memoirs are intimate. Watch famous younger actors fawn over Ms. Stritch in Shoot Me. The actors want a relationship with her, want her time. It is more meaningful than a random act of kindness to a stranger, not that helping someone across the street feels bad.

So fellow actors, make-up artists, coffee fetchers and valets will grieve an actress like that.

Of course, they aren't family.And let's not forget, there are old people, and there are old people. Generalizations about intimacy are meaningless when people age mean and difficult.

Which brings us to a few dissertation questions for the graduate student's consideration.

Long-term outcomes of childhood enmeshment

(1) Does childhood enmeshment predict a good result for the aging parent?

We assume it is bad for the child, especially toxic for a teenager who is denied a life, who cannot run with friends, socialize or leave home for college,individuate, become his own person. And it is bad for younger children, too, never having play-dates, missing school to stay home with a needy parent. All because of a psychological (and sometimes physical) need for control and attention.

But does it work for that parent during those senior years? Or is it payback time.

(2) Does childhood enmeshment predict depression, anxiety, substance abuse, etc.? Fill in the blank.

Does an enmeshed child's mental health fare that badly over the course of a lifetime?

Studies would have to control for confounding variables, like the degree of enmeshment, degree of psychopathology, characteristics of the adult child, the parent. Keep it simple for a dissertation.

In some cultures enmeshment is an emotional death sentence for the oldest or youngest daughter, destined to care for her parents, not to marry and move on. But usually enmeshment is less formal, isn't reserved by birth order. It is the coddled son who never marries, who is still living with his parents well into middle-age and is drinking with them on the couch in front of Dancing With the Stars.Or a family like we see on Everyone Loves Raymond. 

Logically, over-involvement, interference, should predict anger, but it might not. (Alcohol keeps it in check, and humor can, too). But the guilt associated with the very thought of leaving home has its own sedating effect, is my thinking.

For those of us who treat family problems, who see the way the family operates as a having an impact upon mental health, another question is relevant. What can we do? There is a field of outcome research that evaluates the efficacy of our interventions. I'm proposing one here. Call it, the future tripping intervention. A more professional term would be
  projecting into the future  
A final research question then,

3) Does projecting into the future function to dis-enmesh families that have problems with one generation respecting the physical and psychological boundaries of another? Narrow this down, of course, focus and study in-laws and their adult children.

It is the adult child who comes to therapy, generally, alone or with a partner, and many therapists leave the invasive in-laws out of the treatment intentionally, assume that it is healing for the patient to buck up, assert. The asserting is scripted, sometimes as an unimaginative ultimatum to the parent:
"If you can't stop . . . then. . . we'll move away." Or more typically, "won't answer your calls."  Fill in the blank.
The famous moratorium. Sometimes it works, but it is painful for everyone, and feels like over-kill. Parents with personality disorders will find ways to make the child feel even worse, will sabotage or retaliate. Parents who are less disordered might miss the entire part about the family's overall mental health.

Include them in therapy and it is another situation entirely. The therapist is a witness, one that will validate, certainly to a degree, rather than an attack the older generation, the one that ostensibly is responsible for the enmeshment. They need help, after all, do they not? Therapy should feel like an unanticipated benefit, enacted well. Add the projecting into the future, what it will be like when these people will really need attention, and the thought that by that time their children may resent the inconvenience (not that they do now, but in the future. . .) and you have a winning hand.

Nobody wants their children to have a mid-life crisis and abandon them at the worst possible time, about the time they can't find their reading eye-glasses.

Always use abandonment fears in therapy when you can.

Projecting into the future isn't an intervention only for enmeshment, but a natural technique in any type of multi-generational family therapy. Any family-inspired mental distress will do. It is useful, especially, when the parents have been abusive. Abused adult children often still seek the love, want it, which explains why many take care of their parents at the end, no family therapist need apply. But it is a gamble for the abuser to depend upon that.

So to me, seeing that SUV, the father-son relationship played out in the early morning, is a snapshot full of possibilities. I want to know how they got there, how he got to be the good son. Or was he always that way.

therapydoc


Tuesday, July 22, 2014

More Snapshots

We are deep into summer and the activity level rises. Consequently, it's getting harder to function in the morning. I feel like a drunk, but grind the coffee beans, add water from the Ice Mountain water cooler, and pretty soon, can bless G-d, check my messages, and write a little. Always in that order, naturally. (No Keurig, although I understand there's a small one for $52.00. A thought.)
Bike Selfie, therapydoc

(1) FD and I try to take a bike trip on our anniversary. The day we met he won a Raleigh 10-speed in a raffle for Native Americans. He still rides it. We keep our bikes inside, no rust. And no home-invader would want them.

Frankly, fixing a bicycle, to me, has always meant filling tires with air, or perhaps grabbing a stick when the chain falls off to slip it back on. That's as far as my skill goes, and it doesn't matter because FD is a good bicycle mechanic, and Bob, who I think of as an authentic bike guy, is a bicycle savant.

One night, heading home from the office, my pedal fell off, or was that the derailleur. You can't ride very far without these things, but a bike shop loomed ahead, lucky for me, so I gathered the pieces and walked over.

Bob, working late, suggested that I leave it with him, he would work on it that night, have it for me the next day. I whined, "Then how would I get home?"

He agreed. Neither of us even considered the bus or a taxi, and Uber didn't exist. So Bob, who channels Haight-Ashbury, rewired the whole bicycle, charged me almost nothing. Now, whenever something goes wrong, he's my go-to guy. FD might be jealous, not sure.

Anyway, we're about to launch our annual anniversary trip, only a day trip, no plans to stay anywhere over night. FD has found us new bike paths north of Chicago, trails we've never seen before. Aside from the nuclear reactor a few yards away, and the black sand on the beach, it looks really great. But my bike gears don't work and FD is really busy. I am, too. Things are getting tense, as tense as if we were off to another country and hadn't packed.

My only hope, Bob. So I stop in after work, but he's not there. Two other guys are lolling around the shop (this place is like a barbershop, honestly). One takes my bike for a spin, comes back and pronounces, "It's frozen. The gears,or whatever, frozen. No clicks at all."

This I knew.

"So fix it, no?"

"You can't fix that."

"Bob has done it many times. Maybe I need a new whatchamacallit.  Can you do that, replace it?"

No, that's an old bike, and finding the whatchamacallit will take time. It so happens that this bike shop is a museum of bikes, and Bob can do this in five minutes, either repair it or replace the shifter. He would have known which bike to pirate it from.

"Where's Bob? Can't you call him?" I ask desperately. "I know he'll come in for me. He made me a bike once (He did). He knows this bike."

Oh, Bob doesn't have a phone. "You can leave the bike if you want. Maybe he'll be in later. Maybe not."

"Thanks anyway."

The bike gets me home with two working gears, but riding 10 miles the next day is going to be a drag.

In the morning FD is fiddling with his bicycle. He will get to mine, surely, but I take out a screwdriver and a wrench, pry open the clicker. I pull on a cable, tighten a bolt, squirt in a little WD-40, then climb on to try it out. It works! (A reader tells me that Finish Line is better for bike chains, already on order.)

You would think I have discovered a cure for cancer, maybe one for mental illness, fixing my own bike.

That's how self-esteem works. Too bad it is so easy to undo. That clicker has a short life, too, I imagine.

(2) Funding for mental illness

The US government has cut back on biomedical research, so when two of my sons went into bench science, my hopes for a comfortable retirement based upon their wildly important discoveries flitted away. I have an almost daughter-in-law, also in a bench scientist at Harvard. She toyed with real estate before a fellowship made that a less-than choice. What is with this attraction to selling buildings?

But thankfully, the Broad Institute in Cambridge will a receive $650,000,000 gift, the biggest gift worldwide for psychiatric research, ever. Ted Stanley's son Jonathan had a psychotic bipolar episode in college at the age of 18. The Stanleys decided that the best use of Ted's hard earned money is to find cures for these troubling life-breakers. He made his money marketing and selling collectibles.

Good for the bench scientists, and wonderful news for everyone else, too. Because although we're affected by everything from the air we breathe and our experience coming out of the womb, to the way our parents and everyone else treated us since then, it is biology that holds immediate power for the fastest cures. No worries. Therapists will always find work.

(3) And in Antisemitism news
Jewish owned pharmacy in Paris  Http://tinyurl.com/m2mldag
Technically, antisemitism should also refer to being anti-Arab, too. But it doesn't.

Due to the war in Gaza, at least one mob is breaking down doors to Jewish businesses, ransacking Jewish lives, burning stores to the ground.

Shades of the late 30's, early 40's, Hitler. Skin-heads. In Berlin the call for an end to it goes unnoticed. Politicians try, but the taste of violence is irresistible.

In my own neighborhood, Chicago, Illinois, death threats: We know where you live.

No, we don't have the right to be happy, not when people are dying, when stores are burning, people dying. Palestinians need to get out of their homes, let the Israelis find the tunnels, the rockets, disarm them, stop being human shields. It should be a war of words.

Easy for us to say. But if Canadians tunneled into Minnesota armed with grenades and explosives, ready to blow up the Mall of America, taking down hundreds of Americans in one blow, Americans would stop them. This is insanity, waiting for terrorism in Israel. So innocents die in Gaza, told they have a straight shot to Heaven. My guess is that they will.

There is a pro-Israeli rally in downtown Chicago today. My colleague, the woman who shares a suite with me, asked if I would go with her. She'll drive.

Someone guilts her into going, she guilts me. Despite FD's warnings to consider other ways to show support (worried about rocks and other projectiles), it seems like the right thing to do. It is too hard watching the war online. Even Palestinians want an end to Hamas terrorism even if they lie down and die for them.

At the rally, about fifty Palestinians, held back by police, shout at Jews and wave their own flags. We make eye contact, although I keep walking, don't stop. But I can see that these people are not violent, they have fears, concerns, likely relatives back home under fire. They plead, heart-felt, need to express their own angst, be understood. I don't take a picture of them, feel it is an invasion of privacy. Whereas the Jews at the rally are landtsmen. Wouldn't it be something if we took 5 Palestinians at random, and 5 Jews, and sat down for a conversation?

The rally was over in 30 minutes. As my ride told me, "Jews aren't going to miss lunch."
Rally in Chicago-pro-Israel




therapydoc



Pro-Israel rally Chicago





Thursday, July 17, 2014

Sugar Daddy

A screenshot of Alix Tichelman's Facebook page
KSBW News http://tinyurl.com/nxvkxjd
All set, once again, to write about guilt and psychopathy, when Alix Tichelman's court appearance pops up in the news. Feast or famine. 

On November 13, 2013, Alix Tichelman became famous as the prostitute suspected of murdering Forrest Timothy Hayes, a Google exec who worked on Google Glass.

Alix is the one on the right. Who is she? A 26-year-old woman from an upper class Georgia family, her dad a CEO. She left home and lived on her own awhile, ran out of money and became a call girl, a prostitute with a heroin addiction. Not so unusual, that association, heroin and prostitution.

We don't know if her addiction to drugs came before or after her decision to make large sums in the sex trade, but it would seem that heroin came first. Hayes, owner of a yacht (The Escape) lived in a 4 million dollar home with his wife and 5 children. He found Alix, or she found him, on a sugar daddy website, Seeking Arrangement. Tichelman injected Hayes with heroin, his last dose ever, and watched callously as he fell into a stupor and died. Security tapes tell all. You would think people would know that they are everywhere, certainly on a Google exec's yacht.

The first thing a sugar daddy should know, obviously, is that you can't go sleeping around with just anyone. Get references. I'm sure there's a reference website for that. Coming soon.

Ms. Tichelman's previous boyfriend, Dean Riopelle, owned an upscale nightclub in Atlanta. Her Facebook posts express love and passion for him, they lived together. When he, too, died of a heroin overdose, it was ruled as an accident. But someone put two and two together, the common denominator in the deaths, aside from heroin, is the call girl.

Riopelle, who died two months prior to Hayes,  played in a band.

"There is no way that guy did heroin, no freaking way," bandmate Allen Vine told CNN.
Well, he did at least once. 

On Facebook Alix writes dark poetry about heroin addiction and how she admires serial killers. She has tattoos, Hell is Love and Kiss or Kill. Her favorite book: The Satanic Bible.

She also posts her poetry, and some of it is really good

"this private downward spiral-this suffocating blackhole
makes you feel so warm inside,
yet makes your heart so cold.
each day takes it's toll,
your thoughts become emotionless
your soul feels too old.
the demons whispers to me ever so lightly,
he never let's go of his hold,
taking everything from me, I'll end up dying alone.

and some of it is gruesome.

"Sick of the lies and all the pain you have given me,
Wrapped up in a bow like I thought it was supposed to be
But now you're laying in a box, waiting to suffocate,
Saving your last breath as you scratch at your coffin case.
I know I'm crazy, but vengeance is mine,
The dirt that pours in your mouth into your eyes,
Never thought I would see you so surprised
Cause im watching up above as you choke on the dirt, 
Bury th elies and the memories cause all you've done is hurt.

Can we diagnose from poetry?


So Yes, drug addiction is really bad for the personality. In fact, when we diagnose, we have to add information about organic causes, medication. Even prescribed medications can cause psychosis.

So what have we here? A personality ruined by heroin? A woman with an antisocial personality disorder who has no guilt (is that so enviable?), no regard for others? Does she have a mostly borderline personality,  Abandon me and I'll kill you; or a narcissistic personality, Fail to admire me and likewise?

And who is Dexter, anyway, that she should find the show so amazing? She loved a good serial killer. So perhaps it is a case of transference.

We don't know. I'd love to hear about her childhood. My guess is that there is childhood sexual abuse of some kind. Often, with prostitutes, that is the case.

I remember speaking with one who had no feelings for her clients. None. They were a means to an end. She told me that's common.

And I remember speaking to someone who had no interest in prostitution but wanted the benefits of offering himself/herself to a rich man/woman. Wanting to leave a 9-5 corporate job to marry a sugar daddy/mommy isn't uncommon. My patient's thinking? He/she could provide for his/her lover, and the lover could reciprocate. Age no object. Nobody cares.

But what if this person is married, I asked.
"Oh, in that case, forget it."

One day my friend found the right one, felt great, stopped therapy. I never saw the patient again.

But there have been other cases, too, of high class women, mostly, seeking rich men, women paid for their services, tipped in lavish ways, who are delightful and wonderful and have had several proposals for marriage. But they turn them down, won't settle down, not with any one of them. Why? Missing self-esteem. Instead, a sense of unworthiness, and the fear, unwillingness to bring a lover down.

Alix Tichelman apparently isn't like that.

therapydoc


Monday, July 14, 2014

Today's Snapshots


The look of fallen rockets in Israel

I had a perfectly good post ready for you on guilt, but decided against it. That can wait. Today's stories are just too rich. 

(1) Comcast Belligerency Gone Viral

I'm working my remote control, looking for something to watch in the bewitching hour, dinnertime. Before the dishes are done I'm scrounging around in the freezer for something, anything, truly bad for me (we call this dessert). Success, I take a sliver of cheesecake to my nest and flip channels only to find a new one: Can Israel Win the PR War?

This looks good, but of course, when something looks good, I am not a subscriber. I determine to call RCN tomorrow, won't make financial decisions under the influence of milk products.

Wait a minute?  Why RCN?  Doesn't everyone subscribe to Comcast? Crazy coincidence, but I had recently cancelled Comcast, made the switch only a few weeks ago. Comcast seemed to be bleeding me. But the real reason for the switch? The customer service person at RCN seemed so nice.

Interrupting my search for something mine-numbing, the concerned folks at Comcast happen to call me just then. "But why did you really switch? We really want to know. Why?" I hang up at the second question,  I get it. My Spidey sense smells a predator. I find Jane Eyre on Netflix (perfect), a service RCN includes with the package.

Then this morning, on HLN's Morning Express with Robin MeadeI hear that a phone call gone viral from a Comcast representative to customers who happened to work for AOL. The customers taped the ten minute conversation which sounded suspiciously like the one I could have been stuck in last night. Having conversed most of the day at the office, that wouldn't have been fun.  (Just an aside, 20 minutes of HLN morning news is all anyone needs, but it does fill a gap in one's life and I know someone who works for the network, so show my support. And if you're interested in hot car incidents (child neglect), there's one a day. HLN will cost you on Comcast, naturally.)

Here's a link to that viral video. We hear: "If we don't know why our customers are leaving, how are we supposed to make it a better experience for you next time?" Not our problem, Comcast.

So it is likely, since others are experiencing the same telephone harassment, that Comcast reps are trained to push the product hard, that this is a systemic sales approach, no different from any retailer offering you a dozen incentives to buy a product. The guilting the hard sell, could be on its way out.

The question for me becomes: How does the rep feel, pushing the product to the degree that he is harassing the customer? Will I be seeing him in therapy?

Yes, as a matter of fact, yes. Thanks so much, Comcast.

(2) Joshua Corbett and Sandra Bullock

As a marvelous actress and movie icon, Sandra Bullock has many fans, yours truly among them (nothing like 28 Days for those of you trying to stay sober).

So it is no surprise that she has her stalkers, what Dr. Phil calls erotophiles (or did I hear that wrong), people who fantasize about stars and become delusional, come to believe they have a relationship with them and the right to violate social boundaries, like doors and windows.

Joshua Corbett did that, broke into Ms. Bullock's home to continue an imaginary relationship. He apologized, but as Dr. Phil suggests, it is likely he won't stop, hat he is incurable. He could be a psychopath, in that case, and we're going to be discussing being a psychopath in the next post, the one on guilt. Because psychopaths don't suffer guilt like the rest of humanity, neurotic humanity.  Just one theory why.

(3) That PR War between Israel and Hamas

Is every war really a battle of the media, all about image, public relations? This one is, above all. It is not about children being kidnapped and killed, or some wise politician, someone like Solomon the Wise, the Jewish king of Israel, no, make that Palestine, over two thousand years ago, would offer a a better solution.

Solomon, if you recall, when two women came to him arguing about possession of the one surviving infant (the other had died during the night), suggested that they cut the surviving baby in half. The true mother cried, "No! Don't! She can have it!" Solomon gave the baby to the one who cared, the proper mother.

Were he here today, Solomon might have suggested an alternative to missile launches (the Hamas response to the death of a Palestinian child) or an invasion in Gaza, the Israeli response to the missiles. The order of events: Hamas operatives in Hebron, near a Jewish school, kill three Jewish teens. Jewish renegades retaliate, kill one Palestinian youth. Solomon might say that to make it square, Hamas should kill three Arab kids, Israel should kill another Jewish child. The score, four to four.  Even.

No? A bad idea? Surely it is, because this isn't about children. It is about making Israel look aggressive and evil to the International community. The war is for sympathy. Having an excuse to power off more Syrian, Russian, or Iranian missiles, Hamas pounds Israel hoping for a response in order to accuse Israel of genocide, another Holocaust.

The international community doesn't know who to believe, for calls of genocide are to be taken seriously. It sounds strange, Israelis shouting to Palestinians to leave their homes, they must be bombed to destroy arms and missiles, route out Hamas. Homeless, they are hapless victims. It is a terrible situation and it looks, on the surface, as if Israel is made of heartless leadership, oppressors beating on a defenseless people.

The prime minister of Israel, Benjamin Netanyahu (I think Harvard educated, not that it matters, but his English is impeccable) explains the problem. Hamas, a terrorist organization,  hides in Palestinian homes. Missiles are stored in tunnels that ordinarily would be used as bomb shelters for people in times of war.

Netanyahu eloquently describes the situation: Israel uses missiles to defend civilians, Hamas uses civilians to defend missiles It has gone viral.

The story is worth reading in its entirety. 

My experience with social media (and I have about ten FaceBook friends, so you know I'm well-versed), is that Israel is doing a nice PR job, although losing, as usual. Groups such as United with Israel, Stand with Us, the IDF blog (Israel Defense Force) and the World Zionist Organization help people like me feel connected with what goes on behind the scenes. The Jerusalem Post, the Anglo newspaper, is up to date, and we have eloquent Arab Zionists like Mohammad Zoabi, shatters myths with his public FaceBook page.

(Friend me! I have no friends! Therapydoc Doc), but first check out Zoabi.)

What has this to do with therapy? Well, those of us American Jews who wish we lived in Israel, who feel emotionally, spiritually, nationally, genetically, phenotypically, archaeologically, and all kinds of other ally-connected words that connect us to the holy land, feel guilty that there isn't much we can do from afar, aside from sending money for bomb shelters for either side. We would like to support the country, Jew and Arab alike, and we certainly don't like that the Arabs who are called Palestinians are victims of terrorist organizations. But we hear stories that they teach their children to hate Jews, any Jews, and this is upsetting, too, tickles our catastrophic fears of gang warfare, many Arab countries coming down upon Israel, and nukes from Iran.

So an Israeli public relations success essentially means, work the guilt. Disseminate the other side. Write. Post on FaceBook. Tweet. We're good at all that.

Oh, let me ramble on just a little more. Some people don't even know where Gaza is, what it means, why the Palestinians are even there!  Israel traded this fertile coastal territory, Gaza, ten years ago, for peace. Land for peace was a political solution to the terrorist problem. Jews left their homes, synagogues, their irrigated fields and farms, profitable kibbutzim, handed it all off to the Palestinians relocated to tents in Israel proper.

I have pictures of my cousins, prior to what was called disengagement, smiling teenagers working in Gush Katif, a kibbutz. I remember touring the Gush proudly, before Ariel Sharon handed it off, determined it a good trade. Don't let it die, the Jewish farmers begged the Palestinians in 2004. Land for Peace. You take the land, we'll take the peace.

So in return, ten years later, from their new homes, these residents are subdued or influenced, perhaps even side with Hamas, the bully in their midst, and send rockets as thanks.

No pity from the Western press for Israeli farmers, their fields blown to bits by these missiles, their children running for shelter. Loss of Jewish life has begun. A man bringing sweets to soldiers fell this week. And all the while, as the anti-Israel press speaks of a holocaust.

There are more good links, good videos. Try Israel in My Heart, or  Dennis Prager's  easy on the eyes Middle East Problem. Detractors call Prager's propaganda, but it is all true if you know Jewish history. And here's a nice one about bringing comedy to the troops. Because war isn't supposed to be a drag, constantly.

Prefer a good book? I look to Berel Wein, when it comes to Jewish history. He writes clearly, has great wit, a very wide lens. Try his crash course, 5000 years in 5 hours,  or the Miracle of IsraelPaul Johnson's History of the Jews is excellent, too..   

The Western media doesn't tell you much about a 5000 year Jewish presence in Israel, three Jewish states, the many kingdoms, the constant battle against extinction. Nothing about the constant presence of Jews in a land they irrigated, farmed, and modernized, on their own. Nothing about the Palestinian Liberation Organization's constitution that vows to send their cousins packing, driven to the sea, sans boats. The Palestinians are the vulnerable population in Gaza. But the Jews are vulnerable, too. Always have been, although we like to think less so.

The Israeli offensive to rockets in the backyard

Young men with small children, like my nephews, will be called up for service to put an end to the missile launches. And yes, people will die, will lose homes, are losing them as you read this. And for what? Because there is no amount of land that will buy peace in Israel, unless it is all of the land. Not happening.

I have a ticket. Just a visit to see family, to recharge my battery, and no, have no intention of not getting on that plane.

I watched as neighbors packed boxes into a huge van, dozens of boxes, their entire lives lifted by skinny muscular guys into a truck. They are moving to Israel this week.

There will be, contrary to the news you hear on the radio, an airport, a place to land, when they get there.

therapydoc




Wednesday, July 09, 2014

Hi Ho, Hi Ho, It's Off to Camp We Go



Some kids take off to catch that bus with barely a good bye, letting their parents shlep their trunk. No big hug or kiss, no "I'll miss you!  Love you!"  The words, Don't forget to write, fall on deaf ears. Gone and good riddance. I finally get to be me.

Then there's the opposite extreme, the kid who has panic attacks that begin as the bus begins to pull off the lot, or perhaps they are delayed, he holds them in until the second day of oatmeal that just doesn't taste right. Food issues never thought possible rise from the cafeteria. Some forget to eat out of excitement, some refuse to eat, too anxious.

And there's always the one with anorexia.

One kid is on too much psychotropic medication, newly prescribed, and feels dizzy. Another isn't on enough. Upon examination the camp nurse hears that his family is in the process of a big move, or his parents are fighting, one is threatening divorce. "Have fun, sweetheart, we'll miss you."

So many issues, so many kids. What to do?

And there's the kid who sewed pot into the lining of his jacket, another who cuts herself. There's always one so depressed that everyone knows it. The others don't know what to do. The counselor is beside herself, worries about a possible suicide.

Three to eight weeks, depending upon the sentence. Parents searching camp websites for pics of smiling kids, many rightly rewarded.

I remember my daughter, probably all of fifteen, working as a camp counselor, calling me every night to consult about one kid! Just one with a diagnosis can deter a teenager from a career in mental health. What do I do when. . . .  I still hear her voice, the fear. So over her head.

FD is the doctor for an in town summer sleep-away camp. He has hours, sees kids a few times a week. Already . . .  one week into the session, the counselors are calling him for emergencies. Some need attention, if not emergency attention. Some kids need therapy, right away. No surprise, but what camp has a therapist on call? He's looking into it. Perhaps there is one.

It isn't that the children who need a little support (or a lot) shouldn't go to camp. Sometimes there's nothing better than camp. I have a patient with a kid who is only good (mentally) at camp. For me, there was nothing better, but that letter from my mom (why do I think daily?) iced the cake.

Counselors really need a mental health in-service before the summer begins, what to expect, how to handle the expected disasters. Most summer camps are born of some type of a community, and that community really should sponsor a therapist, a young person who, although new to the trade, has expertise, at least a master's, and wouldn't mind a few weeks on-site, roasting marshmallows on green sticks, plying away at the trade a few hours a day. I'll bet she would be busy.

The best sum up, of course, for most kids at sleep-way, is the Alan Sherman song, Hello Mudda, Hello Faddu- a Letter from Camp Granada.  The abridged lyrics below are from memory, although the best experience, surely, is to get the album and listen to the song on a turn table, mono, preferably.

Hello Mudda, Hello Faddu,
Here I am at Camp Granada
Camp is very entertaining
And they say we'll have some fun if it stops raining.

I went hiking with Joey Spivey
He developed poison ivy.
You remember Lynnard Skinner
He got ptomaine poisoning last night after dinner.

Etc. etc. until the refrain

Take me home oh muddah faddu
Take me home, I hate Granada
Don't leave me out in the forest where
I might get eaten by a bear.

Take me home I promise I will not make noise
Or mess the house with other boys
Oh please don't make me stay. I've been here
One whole day.

Wait a minute
It's stopped hailing.
Guys are swimming
Guys are sailing.
Playing baseball
Gee that's better
Mudda faddu kindly disregard this letter.



How I wish I could say, just let them go. Don't worry about them.

therapydoc