Monday, July 18, 2016

Snapshots: Baton Rouge, Nice

First, Baton Rouge.

Three police officers, shot down. One, just vacuuming his car. I saw the video, the reenactment. The shooter, an ex-Marine, hides behind the corner of a convenience store at a gas station, peeks out, eyes his target, an expert marksman, takes them down.

What is this?

At first you think, Oh, another reverse racism thing, Race in America, the unsolved puzzle, the ultimate in displacement, the psychological defense, placing one's negativity, anger, on someone, something else. If I come home angry and slam a door, or kick the dog, my anger is now in the door, it is the dog's problem. I feel better, momentarily

An immature defense, and too simple an explanation for recent murders in Dallas, five policemen were killed, nine injured, and now . . . more dead in Baton Rouge.

But this massacre is different; one of the policemen, one of the victims is not white, his skin tone is closer to black, so there must be some mistake.

The perpetrator, Gavin Eugene Long, reached 29 short years of age yesterday, the day of the shooting, a birthday, death-day celebration. He self-identifies as Cosmo Setepenra on YouTube, an author of three self-published books, a life coach, and the leader of an extremist group, the Sovereign Citizens.

Protests are not enough, preached Cosmo. Violence is what is called for in the struggle against the government of these United States, a war against the police. He thought the violence in Dallas a good first step.

To me, first glance, this is a man in a florid manic episode, full-blown, psychotic and narcissistic, a person whose reality testing has likely been compromised by mental illness. His words:

If anything happens to me is a reference to his suicide-homicide. Youtube took down his videos, but they're nested in the link above.

An ex-Marine, he had military training. This would be an asset, should one become paranoid, want to take a society, even one with democratic ideals, down.

A therapist would maybe say, "They are only ideals, the government is the means to realize them. It may another two hundred twenty years to create a perfect society. Let's strive for better. How can you make it better? Let's talk about your ideals."

But most probably Cosmo needed another kind of doctor, too, one to give him something that would help him sleep a little, take off that trigger-happy edge.

Nice, France     
Fire Works, Evanston, IL


But first, a story.

Always a fireworks fan, the Fourth of July has become a bit much the past few years. Alley displays are out of control, fire crackers and rockets explode throughout the night, usually a lovely summer night in Chicago.

You want to keep the windows open. The dog covers his ears with his paws and moans.

But watching the faces of the children at an authorized beachfront festival is irresistible, and the music, so,patriotic, upbeat. This year my grandson invited us to join him and his parents to see fireworks. FD suggested we skip the crowd, watch from the top level of the hospital garage near the lake. Perfect for me.

We hadn't counted on security chasing us away.

As an alternative, FD drove us as close as he could to the beachfront, dropped us off a few blocks from the action. We would be in the thick of things (the child among us wanted to do this, anyway, hadn't particularly liked the garage rooftop).

Every street to the Evanston, Illinois beach cordoned off, saw-horses blocking traffic, blinking red, pink beams flashing from flashlights. No vehicle entry to the lake.

You don't think, Well, a truck could plow through that.

But now you do.

When I told a friend that it hadn't been my first choice, going to see fireworks where hundreds of people would be gathering, a jihadist's dream location, and a symbolic gesture, too, this being a national holiday, she told me,
"You can't stop living. That means they won!"
I thought that ironic. They stop others from living.
He had a history of mental illness, according to his father, two nervous breakdowns in Tunisia. Neighbors said he often acted nervous and angry.

Mohammed Lahouaiej Bouhlel murdered people enjoying their holiday, punished others for being happy, for having something he didn't have, maybe. Happiness.
Oddly enough, he flaunted the Koran, scoffing Islamic law, beat his wife, took drugs, drank alcohol and ate pork, according to his cousin. He did not, as far as anyone knows, act as an ISIS puppet.

What could have been done to stop this? He told police that he was delivering ice cream to the beach, so they let him park the refrigerated vehicle over night. They didn't bother to ask for a sample, we suppose. That might have changed everything.

Authorities had him days before that. French police intervened as he threw a heavy board at a motorist during a traffic altercation. He had priors for theft and violence.

Mental health professionals had him, too, the ones treating those nervous breakdowns, and his family knew he could be violent, the potential was there.

Nobody reeled him in, however, when it mattered, when that divorce went through.

Sometimes these things aren't as complicated as they seem.

Great, but what's a professional to do? And law enforcement can't deprive citizens of their rights. We've all watched Law and Order. 

It becomes what might each contact have done, each person who comes into contact with a Mohammed Bouhliel, or a Gavin Long.

What would I have done, had the Bastille Day terrorist in Nice come to see me?  We'd have talked about that marriage, and his anger.

Gavin Eugene Long wouldn't see a mental health professional. He would be the problem of his commanding officer, and likely a military wildcard. But he had a commander, once, who might have picked up on that mania, had he a bit more training.

And we haven't even talked about Bowe Bergdahl, a very different story, an American soldier who walked off his post in Afghanistan, only to be captured by the Taliban and released in exchange for five Taliban leaders in Guantanamo Bay.

(Spoiler alert, if you haven't listened to the podcast, Serial).

What possessed Bowe to walk off, we want to know, ultimately costing the world, not only the US, perhaps hundreds of lives in the future? Do Taliban leaders return home and take up knitting?

Bowe had schizotypal disorder, we learn on that second season of Serial, and should never have been in combat. He had been diagnosed, then sent off to war, couldn't take camp, and the hypocrisy of command. Took off.

O're the rockets red glare, the bombs bursting in air, gave proof, through the night, that our flag was still there.

I don't care what anyone says. Next year, I'm staying home.

therapydoc



Friday, July 08, 2016

Taking Notes

When I told one of my friends that there's no way I would remember the most important, the most salient details of a therapy visit if I didn't take notes right then and there, she said, "Well, you wouldn't be my therapist. I need someone totally looking me in the eye."

I didn't tell her that I could type ninety words a minute and never have to look at the screen.

I'm not exactly sure how they teach note-taking in graduate schools anymore, hopefully the importance of a good genogram (family tree diagram that indicates alliances), among other things. In some Masters programs, surely, the old process recording is still taught.

A process recording is what is done in the courtroom. You write down, verbatim, word for word, what the client said, although he's not on the stand. It is useful in many ways, not the least of which is that when there's a need for clarification, nothing's more powerful than telling the patient, "Let me see what we talked about last time. Oh. Here it says, in your words. . . ."

People forget.

I've been deposed a few times, and in that process the lawyers on both sides of a case review your notes before the interview. They always joke about mind, tell me my notes are illegible, ask me to read back what I wrote. My response would be, Why do you think they're illegible? No one is supposed to read them but me. The writing would be difficult to discern, even for me, reinforcing the myth (maybe) about doctors and penmanship.

But that was back then, in the day, pre-electronic everything.

Shredding charts every seven years, over time, became quite the chore, and being more ecologically green, the whole thought of paper, paper, everywhere, just felt wrong. So, for a few years now, the typing began, and it is more elegant, and easier on the eyes, having the luxury of seeing words on paper and not having to wonder, What does that say?

Oh, but how to keep them safe from hacking.

Here's my system, feel free to try it. Each patient has a flash drive, their very own, that lives in the paper chart with a full name and account number, housed in a locked file drawer. Each visit, the record is typed, signed with my initials, encrypted with a password, and saved on two master flashdrives that are inserted into a USB hub that can hold several flash drives. Then, every month or so, the patient's own flash drive is inserted into that and the notes are copied to it.

This may seem tedious, but it avoids wear and tear on the flashdrives. They aren't inserted in and out so often that they lose their integrity.

Word 365 allows password encryption by going to "Review" on the menu and following instructions. Using a Mac, with "Pages," it is even easier. Go to File, set a password.

Once that note is complete, saved to the master flash drives, it is never changed, so the date never changes.

No names on any notes, no birthdays, nothing but a variation of the patient's true account number that I take off my billing program, also password encrypted on a old PC that is disconnected from the web.

Like paper charts, the master drives are locked in a file cabinet, still attached to the hub that I attach to my laptop the next time I return to the office to take notes. I turn off the Internet on my laptop while the hub with the masters is attached. Macs are supposed to be more secure, but still.

Nothing's saved on my computer. After the visit is copied to the flash drive, it is deleted.
But it is also saved on a cloud, later in the day, with visit information added to one long file, also password protected. That's done at the end of each day, when the Internet is turned on, briefly. Not that my service provider isn't safe, but it makes me uncomfortable working with patient charts.
Once the visit has been uploaded to the cloud to become a part of the patient's chart, when I need to review it, there's no waiting, no wear and tear on a flash drive. These won't last forever if they're swiped in and out regularly.

So when I need to refer to what was said last week, that's where I go, the cloud, where the entire chart is there for me to access, typed, not handwritten.

Lots and lots of passwords, but they are easy to remember because of an algorithm I made up with patient initials and two of the numbers in the account.

Here's a sample patient visit.

Pt Code and Date of Visit
Current Primary DX:
Process recording
Current Symptoms:
Plan for the week:
Long term Goals:   same  ___  new____
New Goals:
So let's say the patient's name is Jennifer McGooglestein Romiretsky. One could conceivably code her as JMR289703 if 289703. The 289703 would be the account number provided by the billing program. Or you could cut it back to JMR03-1. The 03 is the end of her account number, and the -1 means she's the first JMR03.  You might, for example, also be seeing John Miguel Robertsonsteinenvasser, who has the chart number 297403. He would be JMR03-2.

See how easy this is? And you thought therapists mostly think about despair, panic and suicide. Not so.

Now let's make up the rest of the visit note. Anything in parentheses wouldn't be in the note)
Visit Specs: Pt Code, Date of Visit, and Procedure Code : JMR03-1   6-30-16   90837
Current Primary DX:  F33.1  (Major affective disorder, depression, severe)
Process recording: OMG! I hate my life! Yesterday I slept too late, walked into the elevator with my boss. He said, "You look like ___. Why do you even bother coming to work?" And truthfully, I couldn't make it through the day, not sure how I did, and on the train home I fell asleep, realized I'd left my phone at work. I don't even know if I can stay awake for this visit.
(etc. only write what feels important)
Current Symptoms: fatigue, hopelessness, hypersomnia, 
Plan for the week: See Dr. Promtigyoplicweiner for medication re-evaluation, use imagination exercises discussed last week
Long term Goals:   same  _x__  new____
New Goals: none
           TD   (your initials)

How easy is all of that? Feel free to ask questions.

therapydoc



Monday, June 27, 2016

Snapshots: NASW16 and Transformations

When I told FD that I wanted to go to Washington DC for the annual National Association of Social Workers (NASW) conference, he surprised me and said, "I haven't been to DC."

So let's go.
NASW annual conference 2016 in DC


(1)  Going it Alone 

Many of us don't like attending conferences by ourselves, and being one of this population, I dreaded walking into the enormous conference auditorium (the Marriott Wardman Park ballroom) alone. FD, a medical doctor, not a social worker, would be roaming the Holocaust Museum by now, fearless, yet shaken. 

Considering the space between workshop participants in the auditorium, three to four seats apart, it seemed that hundreds attended alone, like me. 

And we have to do what we have to do, most of us armed with a truckload of CBT exercises to power through that test.  

A few deep breaths, a critical eye at faces for signs of friendliness, and one can and will survive.

(2) Opening Remarks

Darrell Wheeler, the president of NASW, tall, relaxed and polished, opened the keynote session with questions to a few seasoned academics about the future of social work . He's younger than me (not by so much), but has done a whole lot more. 

Here's the best answer to what social work academics would hope to see by 2020.

"I would hope," a professor smiles, "that by the year 2020, when I tell people I'm a social worker, that I don't get that blank look, the one that says, Say what? That No, you're not, impossible, look."
Darrell Wheeler, PhD, president of NASW

Kudos to her on that one. 

Another professor suggested an answer to What are the big questions that contemporary research professionals needs to answer? Dr. Richard Hart said we should investigate the efficacy of how well cognitive behavioral interventions work with various populations. The people we see in our practices are so diverse. 

So true. But I would hypothesize, based upon (a) the National Institute of Mental Health's strong insistence that CBT has already been empirically validated; and (b) most trained clinicians are well-trained in it, if not in graduate school, then in continuing education; and (c) that we use it already without regard to race, color, nationality, etc., that all of these techniques work just fine (they do in my practice, which is diverse, and surely for my tribe), and if we try something and it doesn't work, we'll look into the war chest to try something else. 

Meanwhile, it took me three tries to find someone who smiled when I raised my eyebrows as if to say, Anyone sitting here? Three's a charm.

This young man followed Dr. Wheeler's beginning. I sensed he was a musician when the notes wafted into the room, no violin in sight. 

Young Kai, an innovative, original, yet classical artist walked gently into the room, his violin crooked under his neck, sawing away with the bow. He stopped right in front of my row to finish the piece but naturally, I couldn't get my phone out quickly enough to get a picture. But he punctuated his narrative with his music and many of us recorded him. Not sure it is kosher to post my video, so if it interests you, look for a YouTube video. I think there are recordings on his website. His CD's must be wonderful.
Kai Kight

Kai reminded me of Giacometti bronze, something I'd see later in the sculpture gardens at the Smithsonian, studied many years ago in an art history class.. 

He performed his many notes and what he calls air violin, and spoke about his life, told us that about training in Beethoven and Mozart, the expectation, when you train as a classical musician, that you will execute each note to perfection. 

This changed, the need to do it their way, the classical way, when one afternoon Kai's mother told him that she had cancer, would be undergoing chemo. 

He speaks in metaphors, and seemed to be saying that his emotion changed how he played, that he evolved into this extremely powerful, angry (that's what at least one of us detected) performer who did whatever the hell he wanted to do, when he took a bow into his hand.

Then, at a contest, he froze, could see nothing, hear nothing, couldn't play, certainly could't play what was expected. But what came out was pure, and real, and good, and from here a new talent and message evolved. 

The lesson, according to Kai, is that There's beauty in beginnings, for he had to start over, become a new type of musician to fit into his new emotional world.  

Therapists know the lesson well, that rationally, change, transformation, shouldn't be scary, it is what we want, as therapists, what we are reaching for. New beginnings, the start of transformations, can be beautiful indeed. And they feel good, as soon as we lose the fear. 

And yes, his mom is fine. When we heard that, the applause, the foot stomping made another kind of music.

(5) Soledad O'brien and Uncovering

If you're unfamiliar with the work of Soledad O'brien, that should change. As much social worker as journalist, Soledad is the voice behind Black in America and Latino in America, CNN award winning productions, now under the wing of Starfish Media. 


All mental health professionals, including clinical social workers, uncover stories, encourage personal narratives. That is half the incentive for joining the club. But we don't produce them, and we can't tell them over, not the way journalists do. No amount of release of information takes away that element of potential coercion. We can't encourage patients to let us tell their story. We can't evoke a Yes, you can tell my story. It is their story to tell, first of all. And for sure, most will say yes to please the therapist. That is the nature of therapeutic relationships. Gratitude- authority. Despite every attempt at egalitarianism.

So it is good that Ms. O'brien is doing the job.

And she established a scholarship fund for disadvantaged young women who want to go to college. 

Worth the price of my ticket to DC is her own story, alone. Soledad tells of being the child of a Black Cuban mom and a White Australian dad, and how her mother, launching her into 99.6666666% white populated schools, merely suggests that she and her siblings, blend in. How hard could that be? 

Soledad O'Brien #NASW16
One of the journalist's more interesting spins on what we do:
Social workers trade in hope. 
Yes, we do. It is one of our defining attributes. There's something ridiculously positive about social workers. 

4. The War Memorial and The Smithsonian
DC war memorials

It was impossible to stay in and attend CEU workshops on a beautiful day, considering I had never been inside the Smithsonian, and hadn't seen the Viet Nam War Memorial. The only time I'd visited DC was on a stop to Baltimore for a wedding. I snuck away from the conference. FD had been in the Holocaust Museum while I attended the conference. Admission is free for the Holocaust Museum, as it is for all of them, but you need to get tickets in advance between March and August.

We rented bikes the first day and cried at the memorials. Both our fathers served in the Pacific. It is by the grace of the Old Mighty that we are even here.

The sheer emotion. . .

WWII, only one front

Viet Nam War Memorial, even more astounding
Inside, the paintings at the Smithsonian overpowered me, the Paul Mellon collection at the National Gallery of Art, in particular, and the Robert Irwin at the Hirshhorn, All the Rules Will Change. Of course I liked that.
All the Rules Will Change-Robert Irwin

 So that's the kind of stuff you're treated to, if you pop for the conference fee and airfare to a place like Washington DC. Our nation's capital. The workshops will inspire, too, in different ways.

I saw Dr. Wheeler at the hotel that first night of the conference, complimented him on an entertaining, emotional first day. I also told him it was nice that he was footing the bill, since he was signing a credit card receipt. He laughed, but he got it, my reference to his remarks about being president of NASW, a job that can be hours of work on a given day or three for no pay.

He's got an expense account, FD assured me. 

Well, I'm deducting every penny, too.

therapydoc

Sunday, June 19, 2016

The Dad That Got Away

Last week TCM, Turner Classic Movies, showed Funny Girl, a sixties throwback musical. (There will be spoilers.) The Broadway smash/film is a  fictional take on the life of Fanny Brice, the Ziegfield Follies star.

The film and Broadway musical are highly romanticized. In reality, the Brice (Borach) family owned a string of saloons in Newark, NJ, and lived in Manhattan. They did okay. They didn't buy fruit at the stands in crowded Brooklyn, weren't a part of the lower class, colorful Jewish neighborhood on Henry Street.

Also, in real life, Nicky Arnstein, Fanny's true love, courted her for her money and cheated on her. He was a far cry from the handsome, proud, and elegant man in a tux, played by Omar Sharif, who would rather divorce Fanny than depend financially upon her.
Barbra Streisand, the ultimate funny girl

Who cares? Funny Girl, is so politically incorrect by now. Zeigfield, the man Ms. Brice most admires and wants as her boss, is the ultimate theatrical female objectifier, not that anyone would dare call him on it, turn of the twentieth century. 

And the plot is predictable. We know how it will end as soon as Nick confesses to Fanny that he is a gambler by profession. Fanny will be heartbroken, we're quite sure. Gambling stories don't end well. Nick will lose his money, go to prison, and feeling unworthy of her love, powerless to take care of her, not that she needs him as a provider, insist they divorce. 

When it happens at the end, she's devastated, sings the love song of undying love.

Oh my man, I love him so, he’ll never know . . . what’s the difference if I say, I’ll go away, when I know I’ll come back on my knees someday. For whatever my man is, I am his, forever. . . more.



At Intermission, a confusing film technique, but there nevertheless, well before that show stopper song and end of the movie, I found myself asking FD:
Where was Fanny's father? 
Abandonment is a huge theme in therapy, so many problems come down to it, and he's nowhere to be seen. Later, reading the story of the real Fanny Brice, I learned that papa was a gambler with a drinking problem, and he left the family. Took off.  

That implies not only physical, but emotional abandonment. It happens, though, fathers, even mothers leave, not only to shack up with other partners. But Dads in particular pick up and leave when they can't support their families. They just give up and assume, erroneously, that their families couldn't possibly want them around, that everyone would be better off without them.

And when they leave, they suck the air out of the room, leave a vacuum.

Fathers are irreplaceable. It hurts consciously for awhile, when they go, then less so, sinks beneath our consciousness, that need for a father, someone who takes us in his arms and tells us, It is all right, don't cry, and we try to replace him, even in adolescence, with other male figures, then significant others, often people who remind us of him.

Therapists are trained to look for it, that unconscious need, the reasons people make the choices that they do. We're trained with abandonment vision, seek out losses and how they affect personality, the ways we replace or cope with loss. Looking at it this way is looking at humans needing other humans, people needing people, as Barbra sings so beautifully in the movie.



When Nick gets out of jail, when he returns to her, having served his sentence, they both know that it is over. His pride can't handle her supporting him. They will have to end their marriage. They had a child, too. 

Father’s Day there will be people needing fathers who left, who didn't come back, and people who lost their fathers too young. We lose a big part of ourselves when that happens, too, when a father dies. 

FD turns to me after the movie and says,
"I just want you to know. I'll be just fine if it ever works out that you have to support me. I won't leave you."
So reassuring, dear.

Happy Father’s Day friends.

therapydoc

Wednesday, June 15, 2016

Orlando Terror and the Self-hate Crime

The following prayer is recited by many observant Jews, soon after waking.

May it be Your will, Hashem, my God and the God of my forefathers, that You rescue me today and every day from brazen men and from brazenness, from an evil man, a bad companion, an evil neighbor or event. . . whether he is a member of the covenant (a Jew) or someone who is not a member of the covenant.

Maybe it could become a national, no better, a universal prayer. Maybe we should all start saying it. Leave out all the Jewish stuff, assuming that doesn't apply. Choose your own higher power.

Here we go.
Sitora Yusufia, Omar Mateen's ex-wife
The gunman authorities say massacred 49 people at an Orlando nightclub had proclaimed he wanted to be a martyr, traveled to Saudi Arabia and alarmed co-workers with claims of links to extremists. . .
analysis of Mateen's electronic devices showed searches for jihadist propaganda, including ISIS beheading videos."He consumed a hell of a lot of jihadist propaganda" online, the source said 
Mr. Mateen had a chilling history that included talking about killing people, beating his former wife and voicing hatred of minorities, gays and Jews; most of his victims were gay, Latino, or both. His father, Seddique Mir Mateen, an Afghan immigrant, has said that he was particularly enraged by seeing a same-sex couple kiss
Nothing, FD would say, that we haven't heard before, except, perhaps, the pronounced homophobia. 

Targeting the lesbian, gay, bi-sexual, transgendered and queer community (LGBTQ), this is likely to be a hate crime. How could it be otherwise?  Yet Omar Mateen, the assassin, frequented gay bars and gay chatrooms. He visited PULSE, the club he chose for the massacre previously. Maybe the purpose of the visits, research the crime. Or maybe it is as it seems, he was a member of the LGBTQ community.

His ex-wife, Sitora Yusufia, in a CNN exclusive last night, said that she believed something was wrong with him, that maybe he was gay. He couldn't confide in his father, certainly wouldn't come out, if that were the case, or divulge that he liked to drink, and liked to frequent clubs. Omar had a side he couldn't talk about with the authority figure, a prominent man in the Muslim community.

Ms. Yusufia, now divorced from Mateen, told CNN that she thought Omar suffered severe sexual and emotional conflicts. He changed soon after they married, turned from a fun, sweet guy, to a controlling, abusive husband.

She didn't say it, but I will, being gay and married to a beautiful woman can exacerbated internal sexual conflict. She represented what he was not, a heterosexual partner, and her attempts to seduce her love might only anger him.

And anger can lead to battering, not only to those who have been battered as children (we have no childhood history to work with).  Ms. Yusufia said that Omar tortured her. He hurt her as she talked on the phone to her parents, and once, in a grocery store, when he noticed that she wasn't at his side, screamed for her, loudly. She was in the next aisle and came running. He dug his nails deeply into her wrist, brought her to her knees in pain, and told her never to do that again.

You can't make this up. Her parents had to rescue her from the marriage. The young couple divorced.

Domestic violence is usually learned, as is controlling behavior, but not always. If his wife found him attractive, not only might her youthful sexuality have felt threatening, but he may have only married her to prove to himself that he wasn't gay, or to prove it to others, particularly his father. He preened in front of the mirror, his ex-wife said. He behaved in ways that gay men do.

So it is possible that merely being with her tweaked his sexual conflict, aroused only his internal homophobia. Annoyed to the point of infuriated, he might have attempted to extinguish loving behaviors in her. He might have deliberately punished her for fanning his own self-hate, intentionally making himself unattractive to her by beating her.

Omar Mateen, as a murderer in the name of ISIS,  did not have to target the LGBTQ community. Everyone knows that Disney World is also in Orlando and there are crowds, long lines of tourists who visit the amusement park. Thus the question, the suspicion about his sexuality. Why the choice of a gay club and not the Harry Potter exhibit? And why, if he did have same-sex attraction, did he murder the objects of his love? That isn't logical, supports the theory that he only visited the bar to case out his crime.

He had visited Saudi Arabia, networked, presumably, with other jihadists. Knowing that ISIS throws homosexuals off the highest of buildings, if he were gay, he might have preferred a different type of death, a closeted, heroic death, the kind we're seeing now, as young men declare their allegiance to the terrorist nation. He found an outlet for his anger, the anger associated, too, with domestic violence. He likely hated himself, and craving acceptance from authority figures, the chieftains of ISIS, showered his hate upon the LGBTQ community.

In this way he could choose martyrdom over shame.

Following the Yusufia interview, a forensic psychologist and a psychiatrist had airtime on the show. The psychiatrist said that had Mateen suffered an affective disorder, the depression or mania might have popped the lid off his sexual confusion. The forensic psychologist concurred. One of them mentioned that narcissistic injuries also trigger violence.

FD, watching the interviews with me asked, "What do you think?"

"I agree with all of it, especially the narcissistic injury hypothesis.  Perhaps he was dumped by a lover, suffered a severe ego hit. But worse is this inability to accept himself if he were gay, internal homophobia, a negative emotion. It isn't confusion at all, it is fear of oneself, capped off with self-loathing. A person raised religiously, especially, who has been socialized to hate homosexuality, will have a very hard time not fearing, not hating himself. That's assuming he was gay, or bi, or trans, or queer."

I couldn't stop. "The hatred fostered by ISIS is fuel to the fire. He suffers irrepressible self-disgust., thus to redeem himself in his own eyes, and the eyes of the terrorist world, he has to prove he isn't a homosexual. Add to this the marked mood shift described by his ex-wife, and the knowledge that he couldn't change his sexual orientation, and it is possible that he saw himself as better off dead, death a just punishment for gays. Martyrdom, jihad, accomplish each of these goals."

Just an opinion, pure conjecture, never having met Omar Mateen. But the opinion is likely shared by the GLBTQ community, one that is grieving now on so many levels, as we all are.

"Anger," I told FD, "is dangerous and it is woven into all of us."

We have good reason to pray.

therapydoc





Sunday, June 05, 2016

A Modest Public Bathroom Proposal

Three stories

1. Modest Clothing

A Jewish woman wearing a stylish wig, long sleeves, and a long skirt, stands in line at the Department of Motor Vehicles. She is behind of a group of Muslim women who are also wearing long skirts and long-sleeved blouses. But their hair is hidden in headscarves.

Farther back in line are two nuns in habits.

We're used to all of types of dress, different costumes serving similar functions. The skin, the hair, exude female sexuality. Covering it is modesty personified.

I had to wonder. Might any of these women really care, at a pit stop, would they be truly offended and upset, if a trans woman, a biological male in female clothing, walked in? My guess is the cross-dresser would attract attention and curiosity from this crowd, but probably not fear.

Because they're all, almost always, fully dressed.

2.  Caitlyn Jenner  
Caitlyn Jenner Time Magazine's 2nd Runner Up Person of the Year


In April, 2015, Bruce Jenner, 65 years old, an Olympic gold medal decathlete,* crossed over to become Caitlyn Jenner, a trans woman.

Caitlyn's revelation made a tremendous splash in print and on the internet. She publicly revealed her new name in a Vanity Fair cover story. Time Magazine featured her in second place as Person of the Year. A television personality never looking for work, some consider Caitlyn a poster child, the person to validate being trans. 

We would say, she normalized it.

If the spokesperson/super athlete on the front of the Wheaties cereal box can be a woman, anyone can.

Jenner, not exactly new to publicity, still had her difficulties coming out, particularly in interviews. She had been quoted as saying that the hardest part about being a woman is figuring out what to wear.

. . . actress Rose McGowan . .  (in a Buzzfeed interview[145]) . . . argued: "We are more than deciding what to wear. We are more than the stereotypes foisted upon us by people like you. . .(during) your life of male privilege.

Despite the Rose rant, being a female in a male's body isn't easy for anyone. The struggle is hardly a privilege. Caitlyn wasn't joking or making light of the situation when she bemoaned what to wear. It can be hard, finally having a wardrobe, no longer having to worry about where and how to change clothes. It is a relief to stop hiding; the anxiety abates. You feel almost giddy, like a school girl. Before it had been hiding and sneaking around, dressing in the dark, often in a closet in the basement.

Caitlyn tells us that for most of her youth she suffered gender dysphoria, that she cross dressed for many years and tried hormone replacement therapy. She's had cosmetic, but not sex reassignment surgery.

Her sexual attraction? Only women. She's not interested in men, and certainly not children.

 3.  My Transgender Transition: When Donald Became Deirdre

Once Donald, no longer. Deirdre N. McClosky served as a distinguished professor emeritus of economics, history, English and communications at the University of Illinois, Chicago. Professor McClosky is a scholar.

Her experience as a trans woman is different, much less publicized, than that of Caitlyn Jenner. She doesn't have her own television shows, rather she has authored 17 books and 400 scholarly articles. A hot intellectual right now, the Chronicle of Higher Education and the Wall Street Journal both recently featured her. A scroll-through on her website hints at her sheer prolific intellectual productivity.

Like you, I'd never heard of her. But the WSJ essay, My Transgender Transition: When Donald Became Deirdre moved me, inspired today's post. 

Here's one clip, about driving, presumably on the highway in Iowa, and stopping for gasoline. She needed the restroom.

She writes that she had to go.

Really. No bushes were at hand, only soybeans plowed under. As I drove into a rest area on Route 80, I noted that a policeman had “read” me. I was not then passable as a woman, and heads turned if I walked down the street. 

I went in and came out, and he rushed over. It being gentle Iowa, he didn’t do anything but shout at me. 
Deirdre N. McCloskey

That's her way of saying he didn't beat on her, or haul her off to the station, even give her a ticket. He just shouted.

So, a couple of thoughts.

This bathroom dilemma isn't going away, primarily due to Main Street homophobia, still. Homophobia is always more pronounced when it is professed in "defense of the children."

Those uncomfortable with trans men and women have expressed fears for children, theirs and others. The thinking is that pedophiles will dress up as women and use their alleged female identification as an excuse to gain restroom entry. The purpose? Molest children.

Well, that would be bad. Even if it is irrational and no correlation has ever been found between pedophilia and transgender. So there needs to be a solution, a way to alleviate the fear other than sending everyone to therapy.

Thus: A Modest Proposal for Public Bathrooms or Restrooms, Either in Service Stations, Airports, Restaurants, Hotels, Health clubs, Libraries, Nail Salons, Ball Parks, Museums, or Anywhere Else:

(1) Tax credits should be voted upon to reward proprietors who install enclosed urinals in bathrooms. Nobody needs to watch anyone tinkle.

(2) Parents who fear for their children should supervise restroom visits, go in with them. If this proves uncomfortable for some reason, they should stand outside, be in earshot. Children should be taught to shout if anyone bothers them. Most of us do this already.

(3) Signs in restrooms should discourage undressing in front of others. Another tax break to business owners who add curtained off, private dressing areas.

(4) This one, surely, will not go over well, the author is prepared. But it ties in with the DMV story, so so why not give it a whirl?

There is yet another way to feel less vulnerable, if vulnerable and afraid is how you will feel if a transgendered individual makes an appearance in what you think is your personal space. When you dress in the morning, or whenever, throw on clothes that show less skin.

Nobody's asking you to wear a wig, a burka, or a habit. But clothing is power, you know, makes us feel good, less vulnerable.

Again. What to wear, what to wear.

therapydoc

P.S.  THIS POST IS NOT TO IMPLY, INSINUATE OR REMOTELY SUGGEST THAT THE VICTIMS OF SEXUAL ASSAULT ARE VICTIMS/SURVIVORS DUE IN ANY WAY TO THEIR APPEARANCE OR STATE OF DRESS OR UNDRESS. SUCH CRIMES ARE ALWAY ABOUT THE CRIMINAL, NEVER THE VICTIM.



*The winner of the decathlon is thought to be the greatest athlete in the world.

therapydoc

Sunday, May 29, 2016

Interventions: The Screenshot

Before intervention became a household word, disseminated via television as a strategy to sober people up, therapists used it universally as any strategy designed for change.
An intervention is something a therapist uses to change behavior that doesn't work for the client. Or it might add a behavior that works much better. 
Much of therapy is about finding ways to stop something or to start something.
Here's an example, an intervention I thought up working with a client who wanted to lose weight. But  the intervention can be altered to fit any behavioral or emotional issue, too. Anything that needs reinforcement, reminders. A pretty big set. 
Just a reminder that the example below is fictitious, a variant of what really happened.

We're bemoaning the fact that at a hundred pounds overweight, the patient needs to use multiple behavioral strategies to cut down her calories, and she needs to walk every day. She does nothing but eat and sleep. The emotional reasons, the psychology, has all been discussed, purged, but the numbers on the scales still go up. Sometimes down, then up again.

Like most of us, she has a cell phone. Hers tells her when she has email.
"Can you just send me an email everyday?" she asks.
If I can't remember to call a sick friend once a month, do you really think I'll manage to do that, email you? No, this is your program, not mine.

But we come up with another idea. I print out the following, her reminder.
STOP EATING!
You want to be here to see grandchildren.
You don't want your kids to bury you in your forties. 

Print-out obesity intervention

Screenshot-obesity intervention

Then she takes a picture of the printout, and with a little effort, tries to make it a screensaver.

The Home Screen Intervention


We had to reprint it again, condense the text, make it single spaced and compact, but eventually it worked and we made it into her home screen.

Now, every time she uses her phone, the message confronts her. We're chipping away at her denial.

Time will tell, certainly, if this is going to work.

Now you have the intervention. I'm still working on what mine should say.

One thing's sure. It is cheaper than buying the many apps on the market today, and if we keep changing the words to deliberately avoid desensitization, it can't hurt, might even be, effective.

therapydoc