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Wednesday, May 20, 2015

Child Sexual Assault: A Different Paradigm

May is Mental Health Awareness Month, and what better way to promote that than to discuss a successful therapy. Thanks to the American Psychological Association's Annual Mental Health Blog Day (today, May 20) for keeping us current.
APA Mental Health Day

APA Mental Health Day








Onto the case study.

This is about Ziv Koren, who at the age of six became the sexual obsession and conquest of her uncle, remained an extension of him for ten years. As in the case of many pedofiles, entirely possessive, the abuse blocked Ziv's social and psychological development. Her identity remained in no-man's land as did her sense of self, even after the abuse had stopped.

She had six years of unsuccessful therapy (Ziv suffered addictions and a plethora of disorders), until she met Dr. Rachel Lev-Wiesel, a professor and childhood sexual assault specialist at the University of Haifa, in Israel. Dr. Lev-Wiesel is director of the Graduate School of Creative Arts Therapies. (For another synopsis of their work together, click here).

Rachel asked Ziv to draw her feelings, her experiences, and this became the vehicle for communication, a process of externalizing pain and telling the story. The doctor and patient published a book together, a near complete transcript of what happens, psychologically, when a perpetrator steals a child's body and mind. It is a picture book. Ziv's art tells the story. When when it is finished, we are treated to the therapist's contribution to mental health, a gift that will change the way many will perceive and approach the treatment of child sexual abuse for years to come, a new paradigm, new ways of seeing this inhumanity. She refines her research in a mere twenty pages.
When Time Stood Still by Rachel Lev-Wiesel and Ziv Koren


Nowhere, not in any of the data bases I've scoured for the latest treatments of sexual assault and pedophilia, have I read the word, "soul". If I did, it was in passing, perhaps soul-less behavior, assault; not a core construct for therapeutic intervention.

But of course this is about stealing a soul.

Rachel Lev-Wiesel, has no issue using the word and discussing the existential experience of assault victims who lose their identity to their perpetrators, and dissociate from their bodies, the bodies that betrayed them. Citing numerous studies on dissociation, she reiterates what most therapists already know. Dissociation is a process that enables sexually abused children to survive abuse. The conscious mind detaches, disconnects from reality, the thoughts, memories, feelings, and acts in the here and now. The onslaught of pain is avoided as reality is put in its place, far away. The soul, or self, or mind, consciousness, whatever you want to call it, is entirely separate from the body, from the event. Identity confusion has to follow, will take years to coalesce, healthy relationships difficult to maintain.

Paradigms about what happens to us during any emotionally upsetting, memorable, traumatic event are referred to traumagenic, and they are not new. At the core of psychological injury, Finkelhor and Brown (1985) categorized four dynamics: traumatic sexualization, betrayal, stigmatization and powerlessness, all associated with victimization, characterizations that have helped those of us in the helping professions to work successfully with survivors. Dr. Lev-Wiesel builds on this theoretical framework, and mental health professionals should be listening.

We need more words, easier words, to work with in treatment.

Those last twenty pages of When Time Stood Still deliver, and the first 147, Ziv's story and art, move us as if we are there, doing the treatment, feeling the pain and the progress. It is an art therapy, and for those of us who haven't ever tried this treatment modality, certainly worthy of considering when words simply don't mean enough. Ziv Koren's drawings are the heart of the book. The pictures aren't pretty, but the art is what art should be, the great communicator. The verbal therapy is via email, a discussion of pictures, and we have the transcription.

Dr. Lev-Wiesel's theoretical framework, however, tells it all. Here is where the concept of a soul's homelessness resides. She explains that most of us see our homes as shelter, safe, predictable places, points of departure and return. The body is similar in that it is the shelter of the soul. The soul is loosely defined, and we might substitute sense of self, other words, but if the body is the soul's private space, and it is invaded, unprotected, that sense of safety is corrupted, ruined.

We all have strong reactions to breaches in personal space. In the case of sexual assault, especially chronic, prolonged sexual assault like incest, the body is no longer safe. It becomes a prison.

What's a soul to do? There are options, Dr. Lev-Wiesel teaches us. (1) Identify with the aggressor (take his identity), (2) split off with dissociation, become oblivious to the body and its needs, and (3) retaliate with punishment for betrayal. This we're all familiar with, self-injurious behavior, substance abuse, eating disorders, promiscuity, addiction to sadomasochism, neglect of hygiene, depression, etc.

No, not new to those of us who work with victims. When the body fails to protect, when it has caved to coercion, an act of self-preservation, it becomes repulsive, contaminated, worthy of self-abuse, self-punishment.

And soul's homelessness is only the first of five exquisitely conceived traumagenic constructs.  Over time we will revisit the others, captured in time, the present and future become reflections of the past; re-enactment of abuse, or time cycling; the betrayal entrapment; and entrapped in a distorted intimacy.

Valuable stuff for not only therapists, but victims and survivors as well. A new appreciation of art, one we won't get in Art History 101.

I'm Blogging for Mental Health 2015.There is much to be positive about this May, Mental Health Month.

therapydoc

More on Ziv Koren's art and her therapy, click here.

Ziv Koren's art

Ziv Koren's art







Monday, May 18, 2015

Mad Men Series Finale

Light spoilers, sorry. But as we like to say around here,
Never lose an opportunity for a teaching moment.
If you haven't seen it, have no intention to see it, assume you'll never see it, reconsider.

To enjoy this last of the Mad Men season, the AMC Mad Men Series Finaleyou really don't need to know very much about what happened previously.

You probably should know that Don Draper (Jon Hamm) is the mind behind several brilliant television ad campaigns in the sixties and seventies, that he does it all effortlessly, usually under the influence of bottle after bottle of Scotch, and yes, he suffered a dysfunctional upbringing and has secrets, other identities.

You might need to know that his ex-wife Betty (January Jones) is a survivor of an era that objectified women and defined the parameters of their success. Not that this era is over, or that she has ever been a warm and fuzzy stereotypic mother. All of the women in this show, for all seven seasons, are the second-class citizens that feminism seeks to graduate, the heart and soul of the equal rights and women's liberation movement.

You might need to know that Peggy Olson (Elisabeth Moss) has been raised Catholic and that she steps out of her family script to express herself in advertizing, and that she's never been lucky in love.
Mad Men

And that Joan Harris (Christina Hendricks) has always been the subject of sexual harassment in advertising, for she is stunning, an iconic female, but she will persevere, become a partner in the firm.

 It is the Don Draper story, one that surely can be found on a summary at AMC, that captivates us. We find him in California in this last show, having walked away from his success in New York, disliking the powers and politic of the company buy-out. He has hit the road, in search of what, we're not sure and neither is he. The walking away, the dropping out, searching, is so symbolic of that era, the late sixties and early seventies, and the costumes, the execution of the plot, bring me back, nostalgically, to a time when it was all up for grabs. Everyone could be an adolescent. A pox on your stage theories.

Even the group therapy of the times, we see much of it in this episode, is perfectly rendered as both impossibly ineffectual, and then. . . a work of beauty.  The stories they must have told on that set at lunchtime.

I can't do it, won't give away the ending, or even much of the middle, but suffice it to say that this one show will be, should be required watching, on the syllabus, for those who like the idea of art therapy, of art as therapy. Out of existential conflict, creativity is born, assuming one thinks this way, is trained to think this way. And from creativity, happiness, serotonin surging, surely, and what feels like psychological growth, resolution, not necessarily all in that order.

But because it is so hard to train people to think creatively, this particular season finale of a popular television show is serious business, a commodity, valuable art, a teaching moment, make that hour and fifteen minutes.

Think creatively, or learn to do so, and no matter what happens, we can make something new out of something that is wearing us down, make it better. We are, basically, in charge of that, making it, as the Beatles sing in Hey Jude, Better, Better, Better. Good therapy, can bring us close, but we have to add that final dab of paint ourselves.

therapydoc


Friday, May 08, 2015

Snapshots: Baseball, Fishing and Mothers Day

Over St. Louis
1. Mother's Day

This will be a big weekend for many of us. I'm invited to a picnic for Mother's Day, and since it is likely to rain in Chicago, it will probably be take-out indoors.

I'm not working, have always loved this particular excuse to take off the whole weekend. But let's move on, take a look at a water snake at Lake Kinkaid. It doesn't get any more interesting than that.

No, I didn't take the picture.
Water snake

2. Vulnerability  

FD took off earlier in the week to go fishing in southern Illinois with his brother and a couple of his brother's friends. As a pri-care, he really needed it, needed to be out of cell phone range.

The first night he was gone I had a home invader dream, haven't had one in ages. So disturbing. But the dream clarified my subconscious appreciation that he's around most of the time, reinforcing my belief that we don't consciously know what people really mean to us.

3. Men Pack, Women Pack

When he did have cellular service he called, heard the story, and thinking he could take advantage asked, "Any chance we could put my tackle box in your carry-on for the trip home?" Perfectly serious. (The plan, meet him mid-week in St. Louis, after the fishing trip.)
tackle box


Was he kidding?

4. Hope

His brother caught fish, made it look easy, but the rest of the crew only managed one catch apiece. It is a competition with men, although nobody really begrudges a good fisherman, and everyone had their role to play. FD fried up the bluegill. It tasted amazing, they say.

Great seats to the Cardinals-Cubs game Wednesday served as the seduction to get me to St. Louis. And I was fairly certain they would all have showered by then.

The Cardinals are a Cubs fan's arch-enemy, but Chicago has a new manager, and some new sluggers, and they have won more games than lost this season. So I've been watching the highlights of most games.  Because you know, hope springs eternal, especially if you're a Cubs fan.

5. The Worse Loss of the Two

There will be no one else to blame if I miss the early afternoon flight. An evening game, but the pressure is on.

Reasons to miss it included a trip to the orthodontist for one of the kids, and ice cream, naturally, and picking up a last minute gift for my host and hostess, then little things, like going to the bank.

But even at the bank, which can be really slow, it is like butter. I know the woman in front of me, the one with five business deposits all lined up on the counter. She turns, surprised, and suggests I go first.

And then we commiserate about it being Mothers Day this Sunday, as only women will do in a familiar bank in a random line, she for her son, me for my mom, four eyes with tears. And I show her a picture that I carry with me, but tell her that her loss is worse, because we both knew that to be true.

6. The Flight

All amazingly chic-chak at remote parking and security (Pre-TSA helps), except that at the gate the attendant announces that our plane is unflyable and they are looking for a new one. It will be about an hour, he thinks, but it isn't. It takes three hours to find a new plane.

And all I have with me is a thin paperback and my phone, so there's no writing, either, not with a computer. Paper and pen will have to do.

And there's nobody to talk to in the middle of the day, nobody to call, because everyone is at work, and American has no electrical outlets at the "K" terminal to charge your phone, so even reading the dozen samples you've downloaded on Amazon feels dangerous.

Once on the plane, however, the flight crew is jovial. Perhaps they have had time to commiserate with one another at a bar. A flight attendant offers me a full can of Coke Zero, always a good thing, then she leans over and whispers, "You know, you better be careful wearing that hat where you're going. Kinda' like enemy territory, you know?"

And I nod. "They'd best not mess with me. You do know, don't you, that the Cards are going to lose tonight, right?"
therapydoc in a Cubs hat

She smiles sympathetically.

7. The Game


Lambert airport in St Louis
FD never looked better as he approached me on foot at Passenger Pick Up at Lambert International. Sporting his Cardinals jersey and Cardinals hat, he looked like he hadn't shaven in weeks, but he tans easily, to make up for that, and three days fishing, well, there's no amount of sunscreen to save him.

We had to rush to the game because of my lateness (American finally found a plane). It was a challenge getting photos of downtown St Louis at stoplights but I jumped out and got one.
The St Louis Arch


Busch Stadium
Finding our seats at the ballpark the sea of red is intimidating. This picture doesn't do it justice, but 50,000 Cardinals fans, all in red jerseys swarming into the stadium is stupefying.

Every time the Cubs do anything remotely wonderful I am shouting Hey, hey, hey, stuff like that, and nobody really pays any attention because they all assume it is a done deal, the Cardinals will win this like they always do.

But they don't! Cubs win, 6-5!

Cubs Cards scoreboard

Happy Mothers Day, friends.

therapydoc


Sunday, May 03, 2015

New Ways of Seeing: The Art of Therapeutic Reframing

Monopoly
We've talked about looking for the big personal or family theme, a generalization that feeds a person's history and worldview, a belief that might hold the patient, maybe the whole family, back.  A well-placed reframe, usually with a metaphor, teases away the old way of thinking. No turning back. 

Board games are making a comeback, but Monopoly never did go away.

I stopped playing for a third of a century, but on a visit to hang out with my grandkids (their parents trusted us to take care of them while they took a work vacation) revisited the game again.

Is there anything worse than losing at this?  Losing fair and square? To a six-year old? Early in the game there is a sinking feeling that the outcome is obvious, the game is over. For the very first time you learn the true meaning of Connecticut Avenue. You never valued it before. Now, landing on a hotel, you are shelling out six hundred Monopoly dollars. He has shattered your world view about how to win (buy everything). Three out of four railroads is meaningless in the big picture when you keep landing on his stinking hotels.

How do play therapists do it? They must not play Monopoly.

This is a metaphor, you tell yourself, for losing in life. Over half your patients think they are losers. Although you think you are, too, in random moments, now you relate in a different way. Being a loser is a hopeless place to be, a self-loathing, self-blaming place, and when we lose at a game it is so obvious. We have been outplayed. This time.

Losing at a game we have a sinking, negative feeling of inevitability. But the good news is that you have a new metaphor, and the metaphor by its very nature has the power to paradox, to tweak thinking in a direction that is not hopeless. Laughing at ourselves, it turns out, is the best medicine.

You think you're a loser? Have you ever lost at Monopoly, lost to a person who has yet to graduate kindergarten? Huh?

It has to make a person laugh, which is one of the more curative features of good therapy.

Mark Tyrrell would second that opinion. I had the pleasure of meeting him (via Skype, which is aggravating but does the job, unless you keep trying to move the tablet as far away as possible to look better but your arms don't stretch that far).

By Mark Tyrrell, MD
New Ways of Seeing




Mark is shirt-sleeved, and from the accent, British. His publicist sent me the book and it cost ten pounds to mail it from the United Kingdom, so I'm especially flattered. I had automatically assumed him to be older, because his book has so much wisdom packed into these short blurbs of hypnotic suggestion.

That is what a metaphor really is, a hypnotic suggestion. It reaches into our head and we find it either funny, or calming, or more sensible than the negative ideas we've had about things that are sometimes remotely related.

Many of us understand, for example, the idea of learned helplessness. A woman endures various hardships in life, foster homes, abusive relationships, and is wired to be anxious all the time, unhappy. She finally meets a kind, gentle man and knows he will be good to her, but she is terrified that the future will surely end up wrong, as if she doesn't deserve to be happy.

Her therapist has her imagine a young bird, set free for the first few days of life, then captured and locked up in a cage. The bird is beautiful and has a wonderful song but cannot sing or fly free. Then one day, through sheer hard work and some luck, the cage door is open. At last she can fly and sing as much as she wishes. But she won't. She just stays in the cage.

The doctor then asks the patient: If you could speak to the bird, what would you say?"

The patient answers: "Well, I would tell it to fly free, of course. . .because now it can, only it just doesn't know it."

Dozens of gems like this in New Ways of Seeing.

"Must one study hypnosis to do this?" I ask Mark, knowing full well that at the Chicago Family Institute we learned about the metaphor and that have been using it for thirty years, but most of us don't consider ourselves hypnotists.

"No, but it helps.  It is really the relationship that makes the difference, the trust in the doctor is key. We relax automatically when we are in a trusting relationship, and what is hypnosis if not deep relaxation?"

Thanks Mark.

The Amazon link to New Ways of Seeing: The Art of Therapeutic Reframe

To read other things about this prolific therapydoc check out his website.

therapydoc





Wednesday, April 01, 2015

Co-Pilot's Troubled Past Was Known

We'll get to co-pilot Andreas Lubitz, who crashed Deutsch Lufthansa AG Germanwings Flight 9525 during a depressive episode. But first, when therapists become aware of dangerous situations, our responsibilities right here in the USA.

(1) Firearm Owner's Identification (FOID) and the Mental Health Reporting System

 I'm not sure when it happened, whether it was after a shooting at a school or maybe the Batman massacre in the movie theater in Colorado, but soon after I opened my office slowmail to find a pamphlet from the State of Illinois that disclosed a mandate for mental health professionals. We are to report individuals who have firearms if they have suicidal or homicidal ideation.

The exact statutes vary, but states regulate the sale and possession of firearms to the mentally ill and developmentally disabled, along with federal regulations, too. The Law Center for Prevention of Gun Violence provides us a map of the United States. We can click on a state before deciding if we want to move there.

In Illinois, for example, the state:

  • Requires that any person obtain a ten-year license (a Firearm Owner’s Identification, or FOID, card) to purchase or possess firearms and ammunition. The licensing process requires a detailed background check on the prospective FOID cardholder;
  • Imposes waiting periods between the purchase and actual transfer of a firearm to a purchaser – 24 hours for long guns and 72 hours for handguns;
  • Has implemented some design safety standards for handguns and has equipped the state attorney general with the authority to adopt detailed standards for handguns;
  • Has a Child Access Prevention law, which prohibits leaving a firearm unlocked and accessible to a minor under the age of 14;  and
  • Requires firearms owners to report lost or stolen firearms to law enforcement.
Caveat: The case descriptions in these blog posts are composites of different cases and different individuals and my imagination.

While I read the pamphlet about FOID regulations, I realized that I was to see a gentleman who had suffered from serious depressive bouts in a few hours, and he probably had a gun. He had a military background and worked security.

We had been working together on his depression for about a year, on and off, and he had made significant progress, was back to work, enjoyed his usual activities. But we still got together about once a month, and neither of us trusted that he wouldn't suffer new episodes. If that were to happen, he would be a clear and present danger unto himself. We both knew that. He also had a psychiatrist and a very involved medical team working with him on this and other medical issues.

So about midway through our session I asked if he had ever seen the FOID pamphlet, and showed it to him. He raised his eyebrows, looked at me carefully. "What does this mean?" he asked.

"Do you have a gun?" I asked gently. "Because I think if you get into serious trouble again, I'll have to report you. I could be wrong, have to look into it. Just saying, it's possible I have to do it even now."

He didn't answer, skipped over the subject to something else, and I let him. We finished up and rescheduled. The next day he called to cancel the next appointment, said he'd call me when he needed me. We had been operating like that for a year, a few months weekly, then a few months off. But he never did call, and I didn't follow up.

(2) Aviation as a Mental Health Specialty

It is likely that Andreas Lubitz saw an aviation mental health specialist. This young pilot suffered suicidal ideation and was told not to fly Tuesday. He somehow circumvented the direction and took down an airliner and 149 people with him.

If you have an insurance based practice it is likely that at some point you will work with flight attendants and pilots, even aviation engineers and the blue-shirts behind the counter who help you when your flight is cancelled. And TSA folk.

It is very stressful, flying for a living, or working in an airport. Having treated a few handfuls, at some point, while filling out a profile on the Psychology Today provider site, I checked aviation specialist. Now I'm thinking of editing that.

Not that the stressors are so unusual or different. But many people who work for an airline have commuter marriages and relationships. They sometimes feel homeless, adrift, sleep deprived. There's guilt not being around to go to normal life events, birthday parties. The kids miss you, you miss the kids. Your spouse or partner bears the brunt of the second shifting.

Relationships are intimate among the crew, or certainly there is plenty of opportunity for that, and that can be stressful, too. It is too intimate in those hotel bars, drugging yourself to sleep with alcohol deciding on the cocaine. That movie Flight, highly recommended, is not off base, scarily enough.

Did you know that one of the airlines is known as the love airline? No, not for me to tell, which one.

And naturally, pilots and flight crew don't have it easy. Passengers can be difficult, unpredictable, demanding. On The Moth, a podcast, a flight attendant tells the story of an older gentleman who passed away mid-flight. What do you do? Where do you put him? It is surreal, but real crises happen thousands of miles above us, on those airplanes we take for granted, those dots of white in the sky.

Flight crew persons are not exempt from run of the mill mental health issues and addictions. Depression is the diagnosis of the century, even for them. Those who are impaired, when they come to therapy, beg us not to use that diagnosis: Major Depression.

"Isn't there a V-code you can use?"

A V-code is about life circumstances, marriage problems, social issues. Most people who go to therapy can easily find one that applies, and it is less stigmatizing than an illness that might sneak up, compromise one's ability to do the job.

So often, yes, we do that, because they are true. We use a V-code. But if it is serious, no, you bet, we can't, even if that pilot will be grounded. He might have issues, and may not necessarily a diagnosis other than a V-code. We really have to be careful, though, examine our motives when we ignore a major threat.

The latest on Andreas Lubitz is that he didn't want anyone to know about his depression because he was afraid he would lose his license if the diagnosis became known. He deliberately put himself in a position in which he might kill himself and many others, rather than be tagged as mentally ill, and lose his license.

To him, losing his license was the big thing, totally irrational.

What should have been discussed in his therapy? Surely the potential for harm, should he keep his license, and how that feels, how thousands are affected, when 150 people die. Witness to excessively irrational thinking is one way we know someone is really sick. When thoughts are far removed from reality, we call it psychotic thinking. In a good therapy, the discussion about his thoughts is the discussion to have. The conversation that has to happen really is about keeping the license, losing the license, staying alive, keeping others alive, the risks in all of that and why he can't take them.

Like my discussion with that security guard, somehow it didn't.

therapydoc 



Tuesday, March 24, 2015

But You Never Said: Why Couples Remember Things Differently

We couples therapists, if we want to stay in business, try not to take sides. To be effective (and keep a couple in therapy) we have to be on everybody's team. Some of us will push it. We'll say, with total confidence:
There are three patients in the room, both of you, and your relationship. We have to treat all three or there's a good chance of relapse.
And inevitably, when we get to the gory details, the hurts, the nursed grudges, recollections, both partners, two of the three patients, remember things differently. Only the relationship gets it right.

My approach, when this happens, is to say,

You see? Your relationship suffered way back when! This hadn't been discussed well enough, not to the degree that you would agree, in the future, as to how it would go down in history, when you might tell it over to a grandchild, or to your family, drunk on a holiday, or to a therapist.

We tend to remember things from our own perspectives, forgetting, or never understanding, that of our partners.

This buys me time.

WSJ psychology reporter Elizabeth Bernstein fills in the blanks. Her example, one partner buying two arcade games on Ebay, the other remembers barely conceding to one monstrosity. Substitute your own relationship quagmire if you can, some disagreement or another. (We tend to remember large purchases).

The reason there is so much contention about how things happened, is that from the very beginning couples perceive and record events differently. There are two people receiving information and recording, after all, and they don't have the same video-recorder. These recordings will effect that third patient, the relationship.

That we record memories, by the way, totally off-topic, is why EMDR works. Memory desensitization files disturbing "recordings" so they lose their power to disturb us.  Here, years after the issue transpired, those less than integrated recordings are still readily available, nagging at one of the partners, for sure.

So we begin with two versions of an event existing in the minds of two different people. The event is upsetting to at least one of the two, which is why it comes up in the therapy.  Add to this that negative emotions are likely not to be integrated, are not let go

Then add to this that women are prone to remembering more details about issues having to do with the relationship (that third patient), and reminisce more.

Pile on the research that we all remember our own behavior much better than that of others, the irrefutable egocentric bias. Egocentric bias explains why, when a therapist asks, Who does more of the second shifting, both partners raise their hands.

Finally, there's that negative mood. Anger, sadness, anxiety, all contribute to memory, increase the likelihood that something will be remembered, and how. This is why problem-resolution is so important. Buried problems are likely to resurrect at inopportune moment, come back to haunt. When one partner hasn't let a slight go, it is likely to come out of his or her pocket later, even stickier, messier.

Why should that be? When we hold onto a memory, on each recall something is added or changes. Our memories are fallible, morph incrementally into entirely different recollections. In that process, a partner is devalued, loses his or her glitter.We like glitter, prefer to think of our partners in a positive light.

That the truth lies somewhere in the middle is hard to grasp, a difficult concept to get across in therapy. Couples receive somewhere in the middle as, "You are both wrong." What we should be telling them, in our best psycho-educational tone, is: 
Your recollection is valuable information. We need to accept all of the information, go over it, and discover how the data changed over time, and why. You're both right.
Andrew Christensen, professor of psychology at UCLA, in his book, Reconcilable Differences, agrees with that approach, the politically correct, You're both right. It is the emotions that matter.

Because it is the emotion attached to what happened, way back when, or even now, that will determine how that third patient, the relationship, is going to fare.

therapydoc




Thursday, March 12, 2015

Snapshots: Late for the Plane

(1) Ducks in a Row

Families fall into three camps, usually. We're either: (a) anxious, (b) depressed, or (c) both. Not a scientific fact, just my humble opinion. My fam, depending upon the weather, runs on high anxiety. Discussing it at a recent wedding, obsessed with shooting photos and getting them right before stuffing our mouths, even the younger cousins agreed that yep, most of us run scared.

For those who worry and over-think situations, not dinged with technical OCD (obsessive compulsive disorder) or GAD (generalized anxiety disorder), but symptomatic enough to get sick with worry, the thought of leaving on a jet-plane is exactly as Peter, Paul and Mary sing in that l969 song about leaving on a jet plane; don't know if I'll be back again. Leaving on a jet plane is loaded with meaning.

Rationally you know you have a round trip ticket. But emotionally, you're not sure. It is that return trip in the back of the brain, talking trash. Will you make it home?

So you make sure the flash drive with all your tax information from 2014 is updated and in the clear plastic box clearly marked 2014 Tax Information, and that your sweaters are folded in your drawers, your kitchen counter swept for crumbs, refrigerator clean. It could take days to prepare to leave for a one-day vacay. Because you know, anything can happen.

The wedding is on a Sunday, so Saturday night I'm engaged in all of the above and notice my AmEx card is missing. Not like there's no back-up credit card, but it bothers me. It is a credit card, after all. So while straightening up, watering plants, putting away dishes, etc., even though we leave in the morning, get back in the evening, I am obsessed with finding it. I remember taking it out of a wallet, stuffing it into a drawer, but it isn't there. The online balance checked out so it isn't stolen, has to be here. Somewhere.

The rational brain tells you, don't worry. It will show up. Go to sleep and be fresh for the early morning flight. But it is Daylight Savings Time and sleep will be difficult under any circumstances. Flying, you know, on a jet plane. And FD has gone to the office to tie up his own loose ends, hoping this way nobody will need him while we're gone. He has asked for a 5:00 am wake up call at the office to make sure he gets home for the flight.

Forget that. He wakes me before my alarm. He's ready to go, hyped up, hyper for him. I leisurely dress. We're on time.

But in the car, he's kind of worried we're late. This is odd because usually it is me, not him, worried about missing the plane.

There are some things that really are binomial, and opinions about the right time to get to the airport are like this, one or the other. Some prefer to be at the gate at the very minimum, a half an hour before boarding, preferably an hour. The rest of us love the game, the excitement, the challenge of getting to the gate at boarding, as the groups are called, when everyone is lining up. Many marriages have their best fights about this one. Many times I have threatened divorce.

So he turns to me, even though he is making insanely good time on the road, we have not even had to stop for a Metra passenger train, and asks, "Why are you not nervous? Why am I the one who is anxious here?" (This is a process question, for those of you who look for such things in couple dynamics).

This has to be worked out, why the low anxiety. It is a game changer. We could say, for sure, that I burned it all last night, but that doesn't feel true. The credit card is still missing, that program still running, but I have let it go. I am not anxious. The question is legit.

We answer questions with a questions. "The real question is, what's going on with you?  Because you usually are into this, getting to the gate without wasting any time waiting there for the plane. You never worry about missing planes."

We brainstorm, determine that it is a combination of things, usually the case. (a) He had no sleep the night before, feels out of control. (b) It is Daylight Savings Time, and DST always plays with a doctor's head, patients not showing up, showing up too early or late. And it is likely to mess with flight times. The time zones are all different. Does anybody really know what time it is?

Whereas I always let it go, DST. My patients traditionally do show up on time, and because I'll only see five, maximum, at a shot, they get a call to remind them on Friday.

But here, face it, we can't exactly call and remind the flight crew and the pilot to say, "Stay sober Saturday night! There's this family wedding in New Jersey Sunday and these people start on time, so do me a favor and don't oversleep. Remember, spring forward!"

We park, rush to the gate, our phones buzz. The plane is delayed, naturally.  The flight crew is late.

(2) Straws
Biodegradable straws

I buy a bottle of water at a concessions counter, the adult alternative to Starbucks, but forget to get a straw. Tempted to take one from Starbucks, I hesitate. That's stealing. But I need a straw. Straws make me happy. The woman manning the straws laughs at me, asking her for permission. Of course, take two.

The straw falls into the bottle, irretrievable. FD offers to fish it out and I push his hand away, this is just weird. People stare.

We board uneventfully, and having thought it through, I tell him the real reason I didn't worry about being late this time. CBT works. The drive to the airport, typically high anxiety, didn't faze me because of repeated reminders, little messages to myself, the night before while packing, and then again in the morning, brushing my teeth:

(1) We had Pre-TSA, a perk of  frequent flying, being not-so-young anymore, so the line is short at security.
(2) United is notoriously late flying east, probably would not fly on time. If we were late, they would be later still.
And (3) No luggage, not even carry-ons. Nothing to shlep. We could run to the gate if we had to, and we wouldn't have to, haven't in ages.

So although my bag brimmed with many unnecessary objects, a second pair of shoes, nylons, etc., and now the straw, there really seemed to be every indication that things would work out fine. Just chilling, exhausted from the night before, eye-shades in place, FD to my right, flight magazine in hand, my mind scans the house. Still looking for that AmEx card.

(3) The Return: Uber and airport golf carts

We're in pretty good physical condition, but the days of running through the airport to make a plane, having dawdled too long at a wedding, are over. Never again.

He's lost in the dancing so at 6:10 I leave the party to get our coats, shoot him the following text:
Come on! We gotta go.
In good fashion, he tells me: 
Too early. Flight leaves 8:15, 30 min to airport.
He wants to have dinner, and they are serving.

Rationally, it is true. We have two hours, and we are Pre-TSA again, should buzz through security. The airport is 15 minutes away in decent traffic. So I take a deep breath or three, have dinner, and we say our goodbyes for the last time.

Uber replies right away, at 7:00, but then the driver's pic and plate disappear, so I try again. This time they want more money. Traffic is horrible, you can see it from the hotel and there is a line of limos and cars leaving that can't even get on the service drive to the highway. Uber offers me the chance to double my money and get a car, so sure, what other alternative is there. A driver responds. He calls, we talk. We tell him we'll meet him on the service drive, hoof it past the limos in line. Our driver flashes his lights when he sees two anxious people in black raincoats waving.

Except only one of us is anxious. We will miss the plane, of this I am sure. We will have to pay for another flight in the morning and a hotel, and I will have to call to tell people, "Um, I may not make it in time for our appointment. I'll call you as soon as I know." We have, at this point, 35 minutes to get to the gate. Traffic is crawling.

But he is skilled. We are there in 20 minutes.

At security we are told that the Pre-TSA line is closed. But they hand us a card and we are able to skip over the line. FD gets through, starts to run. It is 8:05.

I am stopped. An officer is checking my bag. Apparently that bottle of water is still in my purse. I bite my lip, wait. He hands the bag back with a smile. It is my turn to sprint, which feels good, but in 200 yards, that's it. Walk, run. Walk, run.

And then. The guy in an airport trolley pulls up next to me from nowhere and says, "Hop in."

"Who, me?"

"Yes, I'll take you to your gate."

There is a god.

He zooms through the terminal. We see FD and I tell the driver, "That old guy in the grey hat! Pick him up!"

FD is stunned. His machismo speaks to us, "No,go without me. I'll make it." I growl/shout. "Get in!!*!"

He obeys.

We make the flight.

When we land, walking through a dark, nearly deserted Ohare, shop-keepers closing up shop, we begin to process the whole thing, how he chatted for 18 minutes about sports with the Uber guy while the man gunned it through traffic, my nails digging into my skin; how we never dreamed of flying through the airport on a golf cart; how the other passengers looked at us when we got there and the woman in front of us in line somberly confides, knowing. "You didn't have to rush, they never fly on time at Newark." We laughed and laughed until it hurt, and he told me that yes, he loves that challenge, the test, eeking out those last moments to the gate, he hadn't worried, not for a single minute. And I told him that I hate it, truly do, and we can't do this again, we just can't, and he will have to get his own ride to the airport the next time.

Just like I have told him, so many, many times before.

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