Friday, February 05, 2016

Do Therapists Age Out?

I admit to sometimes Googling people, if not after they make an appointment, then before. It helps knowing the public profile, what people are trying to present to the world, as themselves.
Nancy Slagg's profile on Yelp


Working downtown, some prefer to go to therapy on their lunch hour, then go directly home. Because seriously: Can you simply change the channel, switch from sharing things so personal, to attending to what matters most to your boss?

It is an art, switching channels, one honed with time and experience. Rabbis and other men and women of the cloth do it when they run from a funeral to a wedding. Therapists do it when they're seeing eight patients in a row to make some money. We get good at disengaging from the last patient to focus on the next. In a matter of minutes, maybe seconds.

The story:

A friend asked me for a recommendation, a therapist he could see downtown, maybe on his lunch hour. I remembered a short list buried in my email and forwarded him the names.

But we were together at a kids' basketball game, watching the home team get clobbered. So I Googled a few of the referrals. One therapist seemed to be about my age, and I marveled at her accomplishments. She is on the faculty of a prestigious university, does research with the homeless, and has a private practice. She's also a bit expensive. When I showed my friend the bio with photo, he balked.

He says it is possibly ageism, but he wants someone younger, more likely to relate to the issues of his generation.

This gives me pause. Do we really age out? I'm quiet.

The incident gives me a reason to Google myself, something we're told we should do every few weeks, but only true narcissists do. But who knows what kind of negative stuff is on Yelp? My search finds an interview foreign to me. The printed words are definitely mine. It is an online issue of a major newspaper. The final cut has never come to my attention. Or have I just forgotten?

Random people call you up, ask if you will take 15 minutes to chat about a particular subject, and you say, Sure, sure, why not, and before you blink it is over and that's the last you hear from them, no matter how intricate the questions, or how thoughtful the answers.

It graduates to an out of sight, out of mind, thing. You just forget. In this case we had discussed romance and intimacy, getting the most out of a loving relationship, this being that time of year, February, Valentine's Day.

It is worrisome, the thought that I might have seen the interview, read it online, and yet it is totally gone from my long-term memory. Maybe my basketball loving friend is right about aging. Or maybe it isn't aging so much as very full days. When I go on vacation it is all about not returning calls.

The whole interview business reminds me that putting one's self in the public eye, whether on a blog or talking to a reporter between patients, makes you ripe for abuse, thought snatching and misinterpretation. Students plagiarize. They're karma, you used to say. Why care?

And there are apps that help you find where your words have gone. I discovered Dupli-Checker. You don't have to download anything. But now it bothers me, the paranoia. Old people get that, not me.

So people my age not only aren't in touch with young people, but we're likely to get paranoid, too.

Wait a sec. Do therapists get too old to relate to younger people? We have to address this, argue the assumption.

And it is easy, too, because in the big picture, therapy is like this:
Each of us lives in a dense forest. And in this forest are multiple, mostly hidden reasons for our pain and suffering. The answers are there, too, the better responses to situations, challenges, solutions we have yet to consider, wouldn't even think to consider. The forest contains every variable necessary for a good, no, a great therapy. Yet almost all of them are camouflaged, like the spiders, rabbits and other small animals in the forest, the birds in the trees. The older we get, as therapists, the quicker we see the spiders, the webs, the rest of what is hidden. The older we get, as therapists, the better we see what other people, even younger therapists, can't see. 
We'll take notes, naturally, to remember.

therapydoc

Tuesday, January 19, 2016

Schizoaffective Disorder, Ethics, and Brian Wilson of the Beach Boys

Love and Mercy
We’re in Miami, FD has a cardiology conference. 
Miami Beach is nice but it's not 
Bermuda, Jamaica, gee I wanna take ya’ to Key Largo, Montego, honey why don't we go.  .   .  to the Kokomo
It gets in my head (you're it) and wanting to know where exactly Kokomo might be, a little research yields the following.  


So we’re not that far away. 

We saw the Brian Wilson- Beach Boys movie last week, Love and Mercy. If you haven't seen it, there will be spoilers. But most of today's story is from YouTube interviews and Rolling Stone.

There was a time when a certain brand of music summoned up barefoot on the beach, surfing, fast cars, and a paycheck lost to buying records at K-Mart; 45's or the long-playing 33’s. Some of us bought albums by the Beatles, but there was always a kid who loved the Beach Boys. Paul McCartney is quoted as saying that Pet Sounds, an innovative Beach Boy album, is his favorite of all time.* But the Beach Boys had so many hits.

Surfin', California Girls, Surfer Girl, Don't Worry Baby, Do You Wanna' Dance, Good Vibrations, Fun, Fun, Fun; God Only Knows, Caroline No; Help Me Rhonda, I Get Around, Wouldn't It Be Nice, Kokomo. To name a few.

Surfin' USA
And In My Room, a slow dance song that Brian Wilson, now 73, the primary writer, composer and musical director of the group, says expressed his inner feelings and thoughts. In My Room makes Brian's private world public, invites you inside, universalizes the need for safety. So many of us still do this, retreat to our rooms, or would if we had one, for personal space.

Mr. Wilson has an amazing recovery story, beginning with the decline to severe mental illness, a "nervous breakdown" in his twenties. He hears voices telling him he isn't as good as the public says he is, that he ruined the band; his orchestrations, far from brilliant. He rationalizes, in a psychotic but sensible way, that the voices aren't able to keep up with his success, that they are jealous, want him out of the way. It is likely they told him to self-harm.

After dropping out of sight in the seventies, a hermit due to mental illness and drug addiction, Mr. Wilson is in recovery by 1999, twenty years later, working again, producing records, even Smile, the long awaited unfinished album of 1965. "I'm anxious, depressed, I get scared a lot,"  he tells his fans. But he's out there, brilliant as ever.

In 2006 he tells a reporter that he still hears voices, every single day, that he has most of his life. A community of angry, critical people in his head.

His whole adult life he's been begging them to shut it up.

How does it present, an illness like this, Schizoaffective Disorder? There are two types, F25.0 bipolar, and F25.1 depressive. Voices in the head, delusions, can be features of either.

The DSM 5:
 In schizoaffective disorder, a mood episode and the active-phase symptoms of schizophrenia occur together and are preceded or are followed by at least 2 weeks of delusions or hallucinations without prominent mood symptoms.
According to Mr. Wilson the voices started soon after his first LSD trip as a very young star.

This changes everything, as far as diagnosis goes, foils schizoaffective as the obvious choice, because if you read the criterion, you find the all important D.
D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
Technically he couldn't have schizoaffective order because the effects of a substance triggered the illness. That being the case, the diagnosis has to be:
 Substance/Medication-Induced Psychotic Disorder (F16.959), without use
Without use means that he doesn't have to be using anymore to suffer the delusions, hear the voices of psychosis. He stops abusing drugs in treatment, but his disorder has its hold. Without use, still delusional, it is an F16.959.

Your mom was right when she said that drugs are dangerous. During the frolics of the sixties, the more anxious worried about friends who took LSD. We heard stories of people flying off rooftops. They needed designated watchers, really.

The most famous of the Beach Boys might not have suffered Schizoaffective Disorder, a combination of symptoms that present in both Major Affective Disorder and Schizophrenia. Had he not used LSD his bout with mental illness might have been much less horrific. But we really don't know.

And there is another theory, that children with a predisposition to major affective disorder or schizophrenia manifest their symptoms under stress. Brian undoubtedly had stress, beginning with a family group that depended upon him and a rabid desire to succeed, and a father who physically and mentally abused him, deliberately made him feel badly about himself, fed his self-doubt with critical, harsh words, and the fist. Wilson boxed Brian in the head, permanently knocked out the boy's hearing in one ear when Brian was little.

Murry is the voice behind the voices, cold and withholding, jealous, a spare the rod, spoil the child kind of father who strips a kid of his confidence.

The son still wants the father’s approval, plays down the abuse in interviews, although in the film it is the first thing he talks about with Melinda, the woman who tries to save him from an exploitative psychologist, Eugene Landy. He won't demonize Murry for traumatizing him, triggering his illness. He can't embarrass his father. It was the drugs, Brian insists.

He even credits his Murry with the success of the band. Murry is the one with connections, the one who arranges the initial recording contracts. When things sour financially and the band doesn't like his decisions, they fire him. Vengeful, he sells their songs for a fraction of their worth, keeps the whopping $700,000 for himself. Bermuda, Jamica, come on let me take ya'.

No picnic for our hero, the path to superstardom is disrupted, spotty, an illicit drug marathon. He hides in his room for two to three years (!), fears the shower (the shower-head is a spy), eats constantly (weighs over 300 pounds), and stays stoned 24-7. Tired of it, the family hires a psychologist to bring Brian back. 

Eugene Landy claims to have done it, but his methods? Full of textbook professional ethics violations. 

Landy marginalizes his patient, squirrels him away in a rented beach house, taking Brian’s home from him for himself, a house that is also on the beach. He renovates it on Brian’s nickel. We might call it messed up milieu therapy, Landy protecting the patient from family, denying all visitors. He snows Brian with psychotherapeutic drugs that he has no license to prescribe, and beats on him emotionally about his weight. All the while, Brian takes it on the chin, follows the doctor's orders, alternatively idolizes but fears him.

You don't have to be a professional to connect the dots when it comes to father figures.

The family has always known Brian to be fragile and afraid, but that the young man has plenty of confidence when the band is recording. He's on them for every sound, controls exactly what each musician plays, every note, each harmony. He arranges meetings in swimming pools, probably assuming that the voices can't spy on him there. Manic? Certainly, which is why the schizoaffective disorder, F25.0 bipolar is everyone’s first choice, as if it really matters, the diagnosis. 

But it does matter, at least for us mental health professionals. We have to get it right, think about what is really going on, assume nothing. If we think about the history we find that the triggers for schizoaffective disorder are rife in Brian’s world before the LSD.  
1.  He had a difficult young adulthood. Psychoses often present in the twenties or late teens
2.  He suffered extreme stress, had to produce the perfect record, face audiences of thousands.  
3. He surely suffered post traumatic stress, the negative, or “expressed emotion” inherent in child abuse. 
So maybe he had schizoaffective after all.

Looking back on how he cut off his wife Marilyn and his two daughters, Carlie and Wendy, in that stoned, depressed, psychotic two-year episode in his room, he regrets his decisions, his decent, especially listening to Eugene (Gene) Landy for prolonging the family abandonment another five years. He doesn't seem to care that Landy made millions off of him, but it infuriates the mental health community.  

See, most of us want a few well-off patients.  But we would never consider this kind of thing. 

Landy persuaded Brian (coerced, because Brian suffered a disorder) to become partners, a business collaboration, Brains and Genius (Brian and Gene). Landy takes half of Brian's earnings from investments contracts, books, and records in this great deal. If a sponsor gives Brian a sports car, Gene gets one. If Brian lands an upright piano in a deal, Gene gets a baby grand.

Sickening, taking advantage of a patient like that.

Marilyn Wilson ends the marriage, and his daughters grow up missing him, yearning for him. They team up with Chynna Phillips, daughter of John Phillips, another addicted, dysfunctional father (Mamas and the Papas). Wilson-Phillips will successfully produce and perform their own songs. You know the songs, they're that popular. Hold On, for example.

We want to give the father, the genius a big hug and say, It's not your fault.

As therapists, of course, we can’t hug him. We have our ethics and touching is touchy.  (See the new page on ethics on this blog).

Eugene Landy will lose his California license.

Later in life Brian will produce more records, and children all over the world will perform his songs in choirs. He and his wife Melinda establish a foundation for mental health awareness.

Watching the film isn't easy, but it is so well done. And hearing the rest of the story cleared my head, for I could hear Eugene Landy telling Brian Wilson, “They (his family) don't love you.  I do.“ This is what cult leaders tell their followers, young and old, who also pledge their allegiance and all of their money to an idealized father figure.

Ultimately Eugene Landy is listed as the sole beneficiary of Brian's will. You'll have to watch the movie to find out what happens with that, or read the biographies.  The Rolling Stone article is wonderful, too. 

Not surprisingly, Landy has other ethics violation accusations: one for rape, another for free-basing cocaine. We can diagnose him with an Antisocial Personality Disorder.

Because that's what he has.

therapydoc





*Brian refers to George Gershwin's Rhapsody in Blue, a masterpiece in his opinion, the great musical influence in his life. The seventeen minute composition is just shy of one side of a microgroove vinyl record album (bigger even than CD's) back in Wilson's day. Gershwin inspired Wilson, and Wilson inspired the Beatles.





 



Friday, December 25, 2015

Nittel Nacht

Translate that, Nittel Nacht, it would be . . .  well, I don't know.  I know that Kristallnacht is the night that the Nazi's broke every Jewish storefront in Germany. 

But on
Nittelnacht Jews play cards and watch Elf. Or maybe Titanic. Or Meet Me in St.Louis

The rabbis forbid learning Torah on Christmas Eve. Except to learn about why it is forbidden to learn Torah on Christmas Eve. Learning is what observant Jews do, or wish they did, most nights, most days, in their discretionary time. It is one of those pastimes that keeps on giving.

So you would think that learning is definitely something Jews should do on Xmas eve. But no. We'll get to the reasons.

Last night FD finishes the last slice of pizza, 47th Street (New York) pizza, but made in Iowa, sold in Chicago. He asks me if I want to join him, walk over to the synagogue to hear a shiur (she-your, Hebrew for class) about the origins of nittel nacht.
Nittel Nacht 47th St Pizza

Nittel Nacht Movie teev
This is enticing, but no thanks. "You go. Take notes.*"

Nittel nacht (pronounced knit-tell nah-cht.) is hard to translate, but it amounts to goofing around, playing chess or poker, eating Chinese food. Why would I go to a class?

This is an underground holiday, isn't even on the Jewish calendar. The reason for the camouflage is that Jews, historically, needed to be hidden, needed to avoid attention. In Europe, if caught learning Torah, they were likely to be victims of violent crimes. On Xmas Eve, especially.

We're still thinking about old history, movements like the Crusades (Kill the Jews!) and the Spanish Inquisition, (Chop off their heads!). Whose heads?  Guess. Theology as an excuse to murder is something of a trigger to our collective annihilation anxiety and PTSD.

Because we're a tiny minority, perhaps there are 13 to 16 million people who identify as Jewish in the world today, compared to 2.5 billion Christians,  1.5 billion Muslims, we're hardly a threat to anyone.

But I worry. Do people still believe in blood libels? Can such rumors, excuses to kill, still make press? There are so many ways to propagate misinformation.

For most us (I'm always asked) Christmas is pretty much just another day. But the true sentiments of the holiday, the whole idea of giving, selflessness, makes me happy. And patients want to give me gifts, but I have to say No, warn them in November.
No gifts, please, it is unethical (see this version of professional ethics) for therapists to take stuff from patients. You pay us, it's enough. And please, no cookies.
I used to be tempted to say, Merry Christmas to patients who told me they celebrated the holiday. But now, that is just wrong. We're completely bamboozled, paralyzed by political correctness, so we don't know what to say. Chanukah is over, so Happy Chanukah makes no sense, even when the patient is Jewish, and Happy Holidays seems so lame. But that is the preferred, politically correct, substitution.

There's a story in yesterday's Wall Street Journal, The Year Christmas Died, about Fifth Avenue. The high end retail stores in New York no longer let Santa and the elves into their windows. We've seen the last of the red and white, all is now white and electric blue. The only references to holidays are seasonal snowflakes, windows that aim to evoke a winter wonderland.

As if any of us really want to see snowflakes, seriously.

Although I grew up in a Jewish neighborhood, Christmas was a seasonal part of my childhood, window shopping downtown, driving out to the suburbs to see the lights and decorations. Cars lined up for blocks in the better neighborhoods.

A father like mine, at the end of the season (the retail season), after he passed out the last of the end-of-year bonuses, wanted to kick back and relax. We had a big dinner, a turkey or a roast on Christmas Eve. Why not? They give gifts, we sell them. It's is a win-win!  Kind of like the celebration of Chanukah. They tried to kill us. We won. Let's eat.

Then, after dinner, we settled in and watched Its a Wonderful Life.

Because it is, you know.

Here in the United States, gratefully, we have the freedom to worship however we choose, we celebrate that we have the option, that our country is diverse and everyone is different and we can all learn from one another, the original melting pot. Which is exactly why the stores are methodically eliminating Christmas. It is a retail nod to the new paradigm: Christmas is no longer assumed, and we don't have to listen to that music for months and months and months anymore. We're not bombarded with reindeer, either, although I miss them.

And yet, last I looked, Christmas is still a national holiday, a bank and U.S. mail holiday. Most of us aren't going to school, or to work, except maybe to keep the hospitals going, make sure people on the street are safe, not so easy anymore, but it never was.

Maybe to balance it out, other religious holidays should become national holidays. Let's take off for Kwanza, Chanukah, Ramadan (that's a lot of days), all of them!

Or maybe they should just call December 25 something else, something we all can join in on.

Nittel Nacht?

Happy holidays, friends.

therapydoc

*FD told it over, the shiur, but the only thing I remember is that Jesus studied under Rabbi Yehoshua ben Perachia, best known for the idea that we should all give one another the benefit of the doubt (1st perek of Mishna, Ethics of the Fathers).

Thursday, December 03, 2015

Because it is getting all too crazy

That's what everyone is saying, the world is not what we thought it would be, or could be, or should be. It is crazy. People are crazy.

We're using the word crazy, even therapists are using the word crazy, which is a word that we frown upon. But to kick it up a notch, nobody is technically crazy in our world. If a description isn't in the DSM 5, and crazy is not, then it isn't a label. End of story.

What we're seeing is sociopathic, certainly, signs that people we call human are lacking in empathy, kindness, compassion, and, well, humanity.

The world feels unsafe. If a married couple take it upon themselves to kill the most vulnerable of our society, can't see that we're supposed to protect and find ways to care for the most vulnerable, those born with developmental disorders that make making it hard, then the world is not a safe place.

We have lost our innocence and our basic trust. It's gone. The world, the people in it, don't feel natural. What is happening is unnatural.

Many of you readers get this blog by email, and I don't want to glut up your email boxes whenever I have to write to get this madness out of my system. But I'm going to start writing, a lot more.

Just not here. And I'm not going to spend hours editing. It will be short and sweet.

The words, unfortunately, will include words like slaughter, massacre, gun down, bomb, stab, maul (reserved for tigers and other large cats), slay, murder. rape. There will be some hard words. We're living in hard times.

So we're going to try an experiment. I found another blog, one totally under the radar. I didn't even realize it is mine when someone linked over there and that caught my attention. It dates back to 2006, looks like I put it up as a shameless way to direct people here to Everyone Needs Therapy. When that was no longer necessary, I chucked the whole thing.

It is called When Therapists Blog.

The most recent post is about the San Bernardino shootings, and the one before that, the loss of Laquan McDonald and how the response to his slaying (murder) by police officer Jason Van Dyke is a problem, one that mental health professionals have to keep an eye on.

I'll surely write over here, but the topical stuff will go over there.  

Have a wonderful holiday, whichever you celebrate. And may there be no crazy in the news for the next four weeks, or ever again.

therapydoc

Tuesday, November 24, 2015

Pre-Thanksgiving Snapshots

(1) LOSING PETS, BEING LIKE PETS

Once in a while you'll see a sign on a tree, Have you seen Fluffy

Somebody in my neighborhood keeps losing his iguana and posts pictures in the summer. I always wonder, if I found him, what would I do?

But this isn't about that.

Therapists hear many pet stories. People are crazy about their animals, marvel at their better qualities, worry when they are ill, and grieve their loss. When a favorite pet moves onto the next world, it is as if a person in the family has died.

Because pets are family. They live with us, we feed them; they reciprocate with unconditional love. It is a fair deal.

My brother and I have the same memory. You tell me how this happens. He tells the story exactly the same way:
One chilly autumn morning, the dog scratched at the back door to go out to the yard. About to leave for school, I saw an accident on the kitchen floor, wiped it up quickly, then let him out. He'd been sick for months, but he was a very old dog.
My father walked in, saw me watching the dog from the window.
He looked at me, I looked at him. "We should. . ." 
We both said it at the same time. . . put an end to this. Then we carried the dog into the car and took him downtown to the Anti-cruelty Society.
Maybe both of us were there, my brother and I. Or maybe one of us told the story and the other snagged it. But that we each own it tells me we both wanted to be there.

You want to have every last minute with your pet, especially if it is a dog. Because no one else will wag a their tail at you, not like a dog, and you can't buy that loving gaze, the nonjudgemental innocence. (Well you can if you buy a dog).  We count on our dogs, we count on all of our pets, for venting, to comfort and hear our woes, listen, without interrupting.
Still a puppy, thankfully
We could learn from them.

(2) FRIENDSGIVING

Like a good pet, there are people who are always there, assuming we have cultivated friendship, not an easy thing. When the family is far away, or the thought of being with family has lost its glitter, the alternative is Friendsgiving.

If you get an invitation for one of these dinner parties, just go. The food will be amazing, everyone can cook these days, and there will likely be a break in the conversation for guests to toast the hosts and one another. Maybe you'll go around the table. The praise and thanks will be about the importance of being there for one another, providing consistency, support, help when it is most needed. Some will be singled out as endless givers in relationships.

On other days our egos are in the way. We are too busy wondering why nobody has done anything for us lately. So it is good to get outside of that, thank our friends for what they do.

The whole business, however, can get stressful, especially for the hosts. The problem is the association between hosting and physiological arousal, and two little discussed DSM 5 disorders, specifiers of generalized anxiety disorder, related to performance and anticipatory anxiety.

(1) There Will Not Be Enough Food Disorder,  and
(2) The Food Will Either Burn or Be Undercooked Disorder.

Luckily, other bloggers have addressed this problem and many other problems, so I defer to Emily Fleischaker, the food editor on BuzzFeed (the post is clean, nary a 4-letter word):
17 Rules of Friendsgiving
The best, for sure, is number 17, Don't Tell Mom if You Like It Better than Regular Thanksgiving.

(3) SUPERGIRL
CBS new SUPERGIRL


Spoiler: She zaps the turkey because her mother worries it might be undercooked.

Everyone is afraid to tell everyone else that they watch SUPERGIRL. But they do. Test this theory this Thanksgiving, or Friendsgiving, whatever. Nobody will mention SUPERGIRL outright when the conversation turns to TV talk. But when you bring it up, just wait and see. You are not alone.

Maybe we don't want to appear too geeky. Liking a show that is campy, soppy relationship-wise, female-centric, has special effects and a drag down, knock 'em dead, but don't necessarily kill the bad guy scene in every show, plus throw-back costumes out of a comic book, maybe isn't cool. Who reads comic books?

Um.

Geeks know that fantasizing, and watching or playing fantasy games, can be a healthy coping strategy. (Until it isn't).

But assuming you're not the addictive type, if you can't wait for the new  Star Wars movie, catch an episode of SUPERGIRL on CBS. The first minute of each show will fill you in on the backstory.
DC comics Supergirl
As if you didn't already know it.

(4) WHEN THE NEWS IS SAD AND BAD

The news, unfortunately, is hardly ever good and it is often sad. Therapists warn against too much of it, too many headlines.

We didn't need Paris to know that terrorism is bad news, and that it is closer than we think, a real international threat.

Years ago, after one of the college massacres here in the US, some of us blogged about the way that Israelis handle security. They have had more than their share of suicide bombings on busses, in malls, pizza shops downtown. For years no one has walked into a school, an auditorium, stadium, shopping center, even coffee shop in Israel without first having their bags checked and bodies scanned with a wand.  If you live there you don't complain about these measures, not at the airport, not anywhere else. Soldiers are usually posted everywhere, and they are awake and armed with rifles, anywhere people might congregate.

Do we need that? Yes, we do.

I think that it will be hard to be happy this Thanksgiving.  I think we will all be wondering when and where the next ISIL attack will be, how many will be killed. Will we know a victim? The moment will pass, of course, the discussion will be over, and we'll get back to dinner and talking about shopping, movies, and of course, TV.

In Israel the war on terror is becoming more personal, more challenging. The Palestinians, despite grabbing attention for not having a country, live there, in Israel proper, not just in Gaza. And now anyone can be a terrorist, no professional training or expensive equipment is necessary. All you need is a car and a knife. Not even a car. Just a knife. Everyone has knives, our most primitive tools.

Ezra Schwartz, stabbed by a terrorist in Israel
Ezra Schwartz, a United States citizen from Boston studying in a yeshiva, was stabbed to death last Thursday. He was  delivering food to Israeli soldiers. Young Ezra is describe with
boundless energy,” capable of “making friends with anyone.” From mentoring his siblings to spending quality time with his grandparents,Schwartz was remembered for earning the respect and love of all kinds of people — “kids with little quirks and idiosyncrasies were his specialty,” according to Schwartz’s grandfather.
He was eighteen.

Hadar Buchris, stabbed by a terrorist in Israel

Yesterday Hadar Buchris, a female Israeli seminary student, also a child, 21, suffered multiple stab wounds to her head and chest while at a junction in the West Bank. She died in Shaare Tzedek hospital, a victim of this new knife intifada.
"She was a very talented theater student and a successful comic who always created positive vibes around her friends, . .. She was also a kind of 'psychologist' who would lend a sympathetic ear to whoever needed it.
This has been going on for a few months. It started with Palestinian drivers ramming cars into crowds of people at bus stops, or in train stations, hoping to kill pedestrians. They are succeeding. The drill works like this. After the car hits the targeted group of innocent civilians, the driver gets out, grabs his knife from the front seat and runs off, stabbing and slashing as many people as he can on his way to escape. Attackers are usually shot by soldiers or police, so it is really a variation of a suicide-homicide attack on Jewish citizens.

There used to be rules about war. You didn't go after civilians, the elderly. Children.

The Israel Defense Force posted on November 18:
A year ago today, terrorists entered a Jerusalem synagogue during morning prayers. Armed with axes, meat cleavers and a gun, the terrorists murdered 5 worshippers and a policeman.
That happened again, as men left afternoon prayers in Tel Aviv last week, praying for an end to sickness and war. 

Lital Shemesh (below, or watch her video on FaceBook) tells us:
In just two months: 7 shootings attacks in Israel, 51 stabbing attacks, 13 car ramming attacks, 51 rock throwing attacks. It's time to speak up against terror.
Nobody knows what to do with this kind of terrorist, the one that appears out of nowhere, sometimes a he, sometimes a she. The hatred is the same hatred that drives young men in Brussels to step out of taxis in Paris with loaded guns wearing suicide vests. It is the same kind of hate.

Meanwhile, the FBI reports that the majority of the hate crimes in the United States are against Jews.

How can we stay happy? Should anyone be happy when there is so much anger and hatred in the world?

Of course we should! We have to try. I went to a funeral today for a Holocaust survivor. People in the camps tried to stay happy and they were literally starving. We are most alive, you know, when we are happy.

Happy Thanksgiving friends. Try not to let it get you down. Don't let the news ruin your holidays. Don't cancel your plans to visit Israel, if you have them, for there is much to learn there. Don't let them terrorize you, not here, not there, not in the USA or England, France, Turkey, Argentina, Canada, Japan, Malaysia, or wherever you are. It really is what they want.

Escape it with the likes of SUPERGIRL. Or quality time with the people you love. Take the dog for a long walk, good for you, good for him. Or sit down and write to your congress-person about more security. We're going to need funding for guards in public places.

therapydoc




Friday, November 13, 2015

Hoarding, Mess, and Barry Yourgrau

I want to think that everyone has a closetful of plastic bags.
Barry Yourgrau's MESS, required hoarder reading


The city of Evanston banned plastic grocery bags, the ones we see caught in the branches of trees, if we look up. The good news is that we can now choose between a bag made out of tougher paper (they still break) or new sturdy, shiny plastic bags that talk.
Recycle!

We're supposed to bring them back to the store to use them next time.

This never happens. They remain in the trunks of our cars because who can remember to shlep something out of the trunk of the car to shop? But the thought of reusing things is nice.

Chinese gift bags

The cynic in me thinks of an Iranian relative somewhere on the family tree who made his fortune many years ago in the shopping bag business. Smart guy.

On a recent vacation, I found the shopping bags in China so crisp, new, and easy on the eye that throwing them away proved challenging. I paused before giving gifts to relatives. A voice inside whispering,  
Keep the bag.
It shouldn't hurt to throw things away, but the illustrated panda and the fortune-cookie script in Chinese-- priceless. Such things keep memories fresh, like photographs, but not being much of a pack rat, seeing the bag is wrinkled, it is history.

Similarly, had there been two panda bags, only one would have made it to  the closet with the good bags in the first place. (closet not shown).

Let's get serious and take a look at the features of Hoarding Disorder to determine what is pathological, what is not. Because lately, a lot of people are nagging other people to get rid of perfectly good stuff. 

Hoarding Disorder (F42) DSM 5 (not word for word but close, page 247)

A) Persistent difficulty discarding or parting with possessions, regardless of their actual value.
B) The difficulty is due  to a perceived need to save the items and to distress associated with discarding them. 
C) The difficulty discarding possessions results in an accumulation that congests and clutters living areas and substantially compromises their intended use. 
D) The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment).
E) The hoarding is not caused by another medical condition, such as a brain injury, or cerebrovascular disease)
F) The hoarding is not better explained by the symptoms of another mental disorder.
We're to specify if there is excessive acquisition, and if insight into the condition is either good, fair, poor, or delusional. 80-90 percent of this clinical population fit excessive, most with hoarding spending habits. But many of us hoard freebies, like gift bags. Few steal. 

The word persistent refers to a life long condition, not having acquired an inheritance (a garage full of incredible stuff). Most hoarders believe in the value of their possessions. Many are simply sentimental fools. There are combinations.

Also a feature of Obsessive Compulsive Disorder, holding onto possessions is a way to defend against intense contagion fear. Keeping something serves to protect others from the perceived biological contagious quality of the item. Hence there might be rancid, putrid, moldy things among the possessions of those worst afflicted.

Animal hoarders probably fit in there with obsessive compulsive personalities.

Someone with this disorder might feel defective, incomplete. Surrounded by things fills us up.

It is also a familial disorder, fifty percent see it in other family members. That said, a traumatic event might precipitate safety in hoarding.

It is not an easy problem, not for the person who has it, not for family members.

We think that because the thought of discarding acquisitions causes distress, that hoarding behavior is intentional, even when it is dysfunctional to the degree that there is no room to move, a narrow snake path left, maybe, for a visitor to find the bathroom (although visitors tend not to be welcome). Piles of newspapers or National Geographics decorate beds, take the place of mattresses. This would be where back issues of Psychology Today, the ones we'll never get around to reading, might go. A hoarder will frequently sleep in a chair rather than chuck items on the bed.

It could be because as humans we're members of the animal kingdom. Take hamsters. Once while house-sitting the dog and a family hamster, the hamster escaped! He had been planning it for weeks, for sure, but when we found him, had an excellent stash of candy and dog hair that he couldn't possibly have acquired on such a short vacation. He had priors.

This nest could have meaning, could be what hoarders are up to.

Barry Yourgrau, in his beautiful memoir, MESS, describes his struggle to get rid of his clutter. The fear of losing the love of his life, who insists he make her dinner in his apartment, motivates him to change.

Forget that the writing is so strong, which it is, and that you will learn new words, like flaneur. In an effort to clean up his act, Mr. Yourgrau tries different methodologies,a multivariate approach. Family therapists don't believe in any one size fits all cures to life's obstacles, and because people with hoarding disorder in particular tend to be indecisive, trying everything is the way to go.

Barry's scientific approach:

(1) He studies up on famous hoarders and visits them to learn more about himself, You don't have to be a journalist or hunt any of these people down, it is all in his book, makes for an interesting who-done-it. People with this diagnosis can be exceedingly private.

(2) He attends Clutterers Anonymous meetings, reinforcing the therapy adage that we are only as sick as our secrets. Hearing what other people are doing, feeling, hating about themselves is the great normalizer. Plus the stories are compelling and true.

(3) He hires professional declutterers to help him get rid of things, a very brave and painful process. But love is a great motivator, and losing the love of your life, a person who will take you to far away places to buy shiny new things and an endless buffet of bags, is not something you want to do. Lose your clutter, find yourself.

(4) Which is the process of therapy, too. Barry goes through a few therapists before finding the right one. Finding a therapist is like finding a 12-Step meeting you like; try six before you give up. He shares the experience, the ah ha moments, only briefly touching upon being a twin. Being a twin, imho, can account for much of the psychodynamics of the disorder.
Maybe Barry Yourgrau was blue. MESS




Twins tell me that they are particularly cautious, even zealous about their belongings. They are forced, even in utero, to share! The competition for resources never really stops, either. Whatever the other has, even as an adult, can seem better than what you have. And nobody talks about it because it is like talking trash (no hoarding pun intended) about yourself. Even arguing with one's twin can be like arguing with oneself. What you do get is a color, and you are glad for that. You are the one in the orange.

So the author has that going for him, along with the fact that he moved so much during childhood, and moving is associated with hoarding, so much interruption, so much down-sizing. A person wants to hang onto their things, especially if they seem ephemeral, which goes along with never throwing anything away, even when you can replace them at will, as an adult.

The excuse, one of the many, is that everything might be useful one day. We have our comfort stashes, old medications,paint cans with an inch of paint or less. Add your example here.

Well maybe not all of us. The spouse of a Marine, a career service guy, once told me that she couldn't bring home a new blouse unless she gave away an old one. A Marine might have a watch collection, however.

What is the difference then, between a hoarder and a collector? If Mr. Yourgrau acquired only specific things and organized them systematically, even if there were a lot of them, he would be a collector. So there is that out.

But if your basement is really one big train set, you might reconsider the whole idea, make room for a ping pong table, just to stretch your identity.

And if the plastic bags are everywhere, just toss them.

therapydoc.




Thursday, November 05, 2015

A little more about that dirtyword: Blame

Should I sue the hotel?
Not saying there's anything new, here. But is is a practical application, something to keep in mind when someone is busy blaming you for God knows what. 
When we think back later, we say, What a silly argument!
This morning FD left without his keys. He returned right away and knocked on the door. It took me awhile to open up and he was angry--at me-- for taking so long, making him late. The best possible spin on this is to assume that sharing emotions is a good thing, better out than in. Permission to let off steam is what healthy couples do.

So why does it feel so bad?

A few months ago, after stubbing my toe on the metal frame of a hotel bed, I cried out. Maybe I even cursed the hotel. It hurt a lot, warranted expletives, facial grimaces. The object of the anger, unclear. A person can't exactly rant at a bed frame, it is inanimate, doesn't care. Hotel management might care, but it is inconvenient to go to the front desk, ask for the manager, complain about a bed frame. So I let it go. Somehow we survive such things.

The mystery is when something happens and someone could be blameworthy, just a little, but still. Perhaps a child leaves a tricycle on the walk and someone trips. Or, looking around to answer a Where Question, we bang our shin on a coffee table. Or a document is missing, a bill, a check. If a housekeeper has been around in recent history, she's the first scapegoat. If not, anyone will do.

What could have been bad luck, clumsiness, or simple short-sightedness, becomes a gotcha' moment when someone's around. We assign blame. The front desk is in the room.

I've thought of a few reasons that people lose it, act either as little children or very scary adults when something goes wrong. We've all got at least of few of these working for and against us.

(1) Social Needs

We're born social  animals, and as infants can't get very far in life unless somebody takes us there, cleans us up, too, feeds us, etc. That first social experience, a mixture of biological and learned dependency, is never erased entirely. Our memories packs primitive, but powerful social expectations, Someone else should protect us, anticipate our needs, prevent us from harm, The best parenting, the most charmed childhood, won't erase the imprint. But it might make us less reactive to the thought of abandonment, more independent.

That primitive memory, our infant ego, unfortunately, is fed with wedding vows. (Not that you shouldn't get married, but it is a good thing to discuss).

(2) Generalization

Spouses or intimate partners become our mothers, fathers, sisters, brothers, aunts and uncles, friends and lovers, all in one. They represent any and all of our people in the here and now and the past, too. Those who have systematically disappointed or hurt us get top billing. We might not have been able to punch back as kids, but maybe we acted out. As adults, the force is with us--displacing anger on a loved ones just feels right.

(3) Stress

Stress, perhaps from hunger or lack of sleep (new parents are particularly susceptible), often makes us testy. Add to that testiness a sense of hopeless over life's inevitable dilemmas and one more potch (rhymes with watch, means slap in Yiddish) becomes the proverbial straw that breaks the camel's back. A decent crisis, post-potch, even over something that will seem silly later, evokes a  rise in adrenaline. Then the fight or flight relief response kicks in.

Except there's no place to go, because the problem, the crisis, has to be solved, the key found, the broken glass swept up. So flight isn't an option.

But fight is.
You're going to say, but not everyone does this, displaces anger, goes on the offensive when things go wrong. Some of us prefer to mutter to ourselves, shake our heads back and forth, occasionally pound a pillow, even when someone is home to take the blame.
So maybe something else is at work, perhaps annihilation anxiety is the answer. That might explain both the aggression for some people, and self-control for others.
(4) Annihilation anxiety.

If you have ever held an infant, you might be familiar with what is called the startle response, a noticeable shiver that disappears as an infant develops. But some of us know it is still there. We feel it when we're afraid. When we are small we are afraid quite often, everything feels dangerous, a bee buzzing around us, a parent with a frown. This feeling has been described as fear of annihilation, which might sound extreme, but if you're little you just don't know, especially if you've been subjected to child abuse,

Abused kids get negative messages about who they are. They are told that they are deficient, blameworthy, to explain frequent punishments, displacement of a parent's negative emotions about God knows what.

So when things go wrong, an abused person, to avoid more abuse, might jump to apologizing even if they have nothing to do with anything. This averts a crisis, owning responsibility,and functions to avoid annihilation. If they don't apologize, they keep it quiet, have learned that passivity is better than saying more, getting into more trouble.

Alternatively, abused kids identify with the aggressor, learn that the best defense is a good offense.

But not only abused kids learn that. It is a social response to stress that just works. Anger puts everyone off. So use it to your advantage, is the thinking.

The rest of us learn variations of the above, probably much less extreme.

So in the end there are no easy answers, no one size fits all.
But at least I know, when I stub my toe, that I have only myself to blame. And FD? Just a guy with too little sleep, maybe not enough food, and too much stress. That's all.

therapydoc