“I’ve Fallen And I Cant Get Up”

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Dealing with memory issues is such a strange part of growing older. The smallest thing can trigger a memory of an event that happened 20 years ago. Other things just seem to fade away. Lately there has been a TV commercial about early signs of Alzheimer’s. It shows a woman who can’t find her keys and her husband tries to help her find them. The commercial ends with warnings that this could be an early sign of the disorder. So imagine how I felt this week when I lost a set of keys. I had just walked into the house with them and they “disappeared ”. I looked everywhere for them. I do mean everywhere—including the freezer, the bathrooms, under the furniture and the garbage. I was beginning to have paranoid fantasies of someone breaking into the home and stealing them. After two days I gave up and had another set of keys made.

This morning I found the keys. They were bunched up in the workout shorts I had been wearing. I had taken the shorts off and forgotten the keys were in them. They were not evident at first because of the material of the shorts. The more I think about this, the less concerned I get. I have always had things “disappear”. I once lost another set of keys for over a year and a half. I think this happened in my mid 40s. I have no idea what will disappear next. I just have to accept that this has always been an issue. My wife is trying to come up with some increased structure so it doesn’t happen as much, but I’m sure I will find a way to overcome any effort she makes.

Names, titles, events just seem to slip in and out. I can be talking and all of a sudden not remember the title of a book or an author’s name. It will come back to me later almost like the keys that magically reappeared. Last week I was with a friend and we both began to laugh about how frustrated he became one time with how slow a driver I am. He was sitting next to me and put his foot on the accelerator. I just had to steer and swear loudly. The more we talked the more it seemed that this had just happened. I think that’s the thing about getting older. I have this gigantic hard drive inside my head that is packed with material and images of the past. Lately I have been going thru old pictures for a project for my son’s wedding. I look at pictures of him as a child and have trouble accepting that he is a man in his 30s. I also look at pictures of my wife and I back then. We were so young. Our children were so young. It just doesn’t seem that long ago.

Every age has its challenges and it’s benefits. One of the benefits of getting older is all of the memories—especially the happy ones. I suppose I could focus on the sad ones too, because they are also a part of who I am. I once heard Carl Whitaker, one of the icons of family therapy, talk about this. He was then in his mid 70s. He told us that if he tried hard enough he could bring back all the memories, the sounds, the smells, the places, the words and the people that were present when his father had died more than sixty years ago. He used this to tell us that this meant relationships never die. People in our lives live on in one way or another. One of my colleagues used to ask how often you hear your parent’s words coming out of your mouth. This surprised me because of how true it was.

What are the important memories – the ones you really don’t want to lose? That is a really difficult question. I suppose we could all say weddings, births, graduations, vacations, etc. However the mind stores everything. Sometimes the memories we don’t want can come flooding back. I had a number of patients with PTSD from Vietnam. They were symptom free for years, until random sights, smells, people would start something. One man was walking in the city and he suddenly found himself next to a family group from someplace in Asia. He heard them talking in their language and immediately had a severe panic attack. Another man was locked in his basement for two days because of fireworks on the 4rth of July. They wanted to never think of their time in VietNam again.

I think the challenge to accept everything and work thru it is what makes us who we are. I keep thinking of how diamonds are made. Before they become diamonds they are lumps of coal and have to be subjected to immense pressures for thousands of years.

Sometimes I still feel like a lump of coal, but sometimes I do feel like I’m beginning to shine. I think it depends on just continuing to accept every part of where I’ve been, whom I’ve known, and what I’ve done. I know that there are people, places, and things that will continue to disappear. I just have to not get upset and be ready when they come back.

She Walks These Hills—-

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Lately I have been thinking about death, The recent deaths of a relative and the son of a co-worker who was only in his early thirties have probably brought this on. The death of any young person is very hard to understand. There is so much left unsaid and undone .My cousin’s husband died last fall. He was eighty and had lived a very full life. His funeral was full of children, grandchildren and great grandchildren. The difference in wakes was more than age. There was a different mood. The only thing they had in common was death.

My grandfather died in October 1950 when I was five years old. There was a three-day Irish wake at a funeral home. My cousin and I were brought in for two of the nights. My cousin has memories of us wandering thru the funeral home. I just remember it being very warm. After the funeral my grandmother went into a perpetual state of mourning. She always wanted my mother or one of her other children to take her to the cemetery. She lived with us off and on until her death eleven years later. She often wore black or dark clothes when she went out and would pray at least two rosaries a day for my grandfather until she herself died.

Another clear memory I have is when I was in grade school and the father of a classmate died. We all went to the funeral mass. The wife of the man who had died began screaming and threw herself on the casket. I remember that this frightened me because I had never seen this type of emotional response. When I think of it now I realize that the man who died was probably a young man who left this poor woman alone with a very young family. No wonder she was so upset.

Death is going to happen. Nobody knows when and most of us dont want to think about it.. Whenever I had a suicidal patient I would work hard to have them think of the others in their life. I would try and get some type of contract with them so they wouldn’t do it. . This is standard practice, but if someone is really serious, it is very hard to stop. There was a young man in the hospital that hung himself with his own pajamas. My wife told me a story about a patient at Rush who killed himself with his hospital bed, , Then there are the sudden unexpected deaths from accidents/heart attacks/aneurisms, and whatever. These are usually very hard on the family because there is no real closure. It is most hard when there are many ambivalent feelings about the person who died.

There was a woman who was in a terrible marriage with long history of verbal and physical abuse towards her and possible sexual abuse towards her daughter. She had finally decided after almost fifty years of marriage to divorce. On the day she was going to tell her husband, he died while driving in a car with her and two of their friends. The friends and the woman suffered minor injuries, but the husband had a major heart attack and died on the scene. This woman who had bemoaned her fate for years was now not sure how to behave. The marriage was over, just not the way she wanted.

Another man told his wife in my office- “One of us is going to die and then the survivor will finally have a chance to be happy”. He ended up drinking himself to death, but she had developed Parkinson’s and is now in a nursing home. I doubt if she is happy.

Later this summer I will be 70 years old. I can’t even begin to accept that. My denial system is extremely strong and every time I am confronted with the reality of my age , I turn the music up louder. I like it when people say, “I can’t believe it—you don’t look that old!” However the reality is I am. I wonder what my wake will be like. I told my wife jokingly many years ago that I wanted a Rolling Stones song played as they were carrying me out. Now I am not so sure. Perhaps some bagpipers? I can picture people coming up to my casket and saying “Doesn’t he look good?? They did a great job on him!!” The thing about any wake or funeral is that it is a reminder of mortality—and that is still something I am working on.

We recently spent a week in Door County Wisconsin. I am an early riser and would usually go for a morning swim. One morning after the swim, I went for a walk with a cup of coffee and came upon two deer. They were only a few feet from me. They looked at me and then continued to graze until they slowly walked away. It was a moment of wonder. These moments are few and far between, but they still exist and continue to make me glad to be alive. Maybe I need to focus more on the wonder of now and not so much on the end. There is still a lot to see.

“Come Holy Ghost”

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I was raised a Roman Catholic and that really has influenced much of my life. Thoughts of right and wrong don’t just appear in a humanistic form in my head. I think the good nuns and priests that have taught me over the years are still there whispering in my ears. I do have my own doubts about the Church and right now I am probably still a cafeteria Catholic in that I can take most of their teachings, but let some of the others go.

I think I am writing this because of some thoughts about our new pastor. He is somewhat more conservative and formal than the previous pastor. He reminds me of some negative contacts with religious that I have had over the years. Due to this I am thinking of joining a new parish. He probably is a very good man, but my own stuff is getting in the way.

To understand this you really would have had to grow up in the 1940s and 1950s. My wife doesn’t understand some of this. I remember being taught by nuns all thru grade school and priests all thru high school. We looked down on the kids that went to public schools. We used to classify kids as Catholic or Public. I remember the “Marian Year” in Chicago and tens of thousands of people marching to Soldiers Field. I remember in grade school how the statue of Mary would be passed from house to house so families of the school children could say the rosary. I remember how priests were treated as royalty and their words as almost commands. Divorce was unheard of and birth control was never talked about. My mother was once criticized for only having three children when families with ten or more were praised.

This whole thing begins to make me think about the nature of power. In my childhood and adolescence the clergy and religious were the ultimate rulers of right and wrong. There was even a Legion of Decency that listed what movies a good Catholic could watch. The Church infiltrated every area of life.

Things are obviously somewhat different now. Divorce is part of the norm in the 21st century and families are more complex than ever. Birth control is never talked about because it is assumed that every couple practices it. I am writing this about two weeks after Ireland passed a law making same sex marriage legal. This was totally against what the Church wanted. People who were interviewed about this basically said that the Irish had grown disillusioned with the Church and were not listening to them as they had in the past. The scandal of clergy abuse has turned many away.

Pedestals are difficult to stand on. It’s very easy to fall off and very difficult to get back on. Right now there is also an ongoing scandal with a former Speaker of the House of Representatives. I think it was Warren Buffet who said, “It takes 20 years to build a reputation and five minutes to ruin it”. The Church has lost much of it’s splendor because of the scandals and also because the world has changed. The clergy used to be the most highly educated members of the community. This is no certainly no longer true. It was easy to do what “Father, Sister says” because of what they represented, but now that has been tainted. Perhaps that is not all bad.

As a therapist I often had to deal with the tendency of my patients to put me on a pedestal. I would continually try and climb down because I really didn’t want to be put in that position. I never wanted to make decisions about other people’s lives. That is up to them. I think that one of the goals of all therapy is to help people take responsibility for their own lives. It may seem easier to have someone else take over, but that is usually the way to disaster.

One therapist used to tell a story that he felt like someone on a hill watching two trains rushing toward each other. He would jump and shout and wave his arms, but it was up to the trains to stop. He couldn’t make them. This again brings up the difficulty in letting go and trusting people to make their own choices. Sometime this is easier said than done. I am still struggling with this and when I have someone telling me what to do, I have a very difficult time. I can respect what the Church is saying, but I still have to make up my own mind. I have to work on doing this without being a rebellious teenager or a stubborn child. I still feel the need for what the Church offers. I am still working on how to accept it.

“Well, my mind is goin’ through them changes”

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“For there’s a change in the weather. There’s a change in the sea. So from now on there’ll be in change in me”. This the time of year when there are quick increases and decreases in temperature. It can be sunny and eighty degrees and then rainy and forty. Weathermen talk about high and low pressure fronts moving in. Huge rainstorms related to El Nino and man made climate change are shown on very detailed TV screens. It all sounds very scientific until you have to experience it. Changes in our own moods can be like that and can be very difficult to deal with for all of us. Why is it that one day you can be happy and everything looks wonderful and the next you feel as if you are in Death Valley ? Bi-Polar Illness ,or Manic-Depressive disorder as it used to be called, is a very popular illness. Countless celebrities claim to have it. It is constantly used as a defense in criminal cases ,but how much of it is real. It used to be that all it took was one “manic” episode over a lifetime to be diagnosed with it. Now there are various gradations of the condition.

I remember the extremes. There was a man trying to row his small fishing boat across his grass-covered lawn; another man tried to convince the psychiatric unit that he had discovered a new theory of relativity. There was a man who was a top advertising executive. He refused to take any medications because he was most successful when he was in a manic phase. Then there are the cases where people really do get into trouble. There were suicides from people in extreme depressive states. There was a nurse who had literally crawled out of her illness and was managed quite well on meds. She became a top flight psych nurse and was the head nurse at her hospital. She had been managed on lithium for years, but then the lithium began to attack her kidneys. Other meds were tried, but none of them worked as well . She had a series of severe manic episodes and lost everything. She has now been on psychiatric disability for years.

One man came into my office extremely upset because the FBI and CIA had targeted him and were eavesdropping on his phone calls and all of his conversations. He was convinced that there were even listening in on our conversation. He was thankful that he always carried a gun to protect himself. After much maneuvering and convincing, he finally agreed to go into the hospital. He improved and stabilized, but he was furious when he found out that his hospitalization had cost him the ability to own firearms. After a few years he was able to get that privilege back, but he continued to bring it up in therapy and still had a real distrust of the government and all health care providers.

I think it’s the loss of ability to reality test that is the concern. The extremes that end up as psychoses can be pretty obvious. When you talk to someone in the middle of a cycle, they really don’t want to accept that there is anything wrong with them. Everything seems logical and they cannot understand why you don’t “get it”. Some people have milder forms of the illness. They can either go on meds or not. They seem able to deal with the sudden mood swings. One woman said that for her it was seasonal. Every spring and in late fall she would experience this. Another person had a bad experience with a recreational drug that triggered his manic episode. For him it was inability to sleep, heightened irritability. For some people it is compulsive shopping, gambling , promiscuity, poor judgment. These episodes can often lead to comments like “What the hell is wrong with you ?” No incident of the illness is exactly the same. I think that is why mental illness is so poorly judged.

Measles, Chicken Pox, Intestinal Flu all have symptoms that can be seen and measured. This doesn’t happen so much with mental illness. It is hard to measure someone’s internal state. Years ago there was a patient who tried to explain this to some of his friends. They couldn’t understand why he couldn’t drink. He tried to tell his friends that when he drank he “broke out”. When they asked his what kind of break out, he told them “I break out windows ,doors and peoples teeth!”  His friends suddenly were not quite so enthusiastic in pushing him to drink.

Unfortunately most mental illness cant be explained like that. There is no one answer. If you are going thru it, don’t give up, there is help. Just try and be open to the possibility of things getting better. Hope and support are probably the best medicines we have. Just keep trying.

“Just a Castaway”

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How do you start again ? Over the years many patients came to see me dealing with break-ups , divorces, deaths of a spouse. I also had many people laid off from work , or on long strikes. One of the large corporations in the area had a number of long strikes that caused much conflict. Workers who had been at this company for over 20 years suddenly had to make a decision to go without a paycheck or to “cross” union lines. If they stayed out their families were at risk because of loss of financial support.. If they crossed they were immediately at risk of losing support of their friends of many years. Even after the strikes were over, the workers who crossed were not accepted back. They were ignored, insulted and some were even attacked. There were family members who stopped speaking to them. There were two brothers who had worked at the same company for many years. During the strike ,one of the brothers crossed and returned to work. His brother stopped speaking to him and told him he was no longer a member of the family. This has now lasted almost 15 years.

When someone does suffer such a loss of relationship ,or support ,they often feel totally overwhelmed . They can think of no way thru their loss. I saw people who totally withdrew and would avoid all human contact except for work or family obligations. One man, after his second divorce , literally had no contact with anyone outside of his work for over 20 years. He would go to work—to a job he hated- work his shift, come home, eat go to sleep, get up and do it again. On weekends he wouldn’t leave his house. He wouldn’t be able to sleep on Sunday nights knowing he would have to get up and go to work. His company began to have financial problems and laid off most of their workers. When he was laid off he became suicidal because he had lost the one social support that he had. He tried to get other jobs, but he would only be able to work for brief periods of time before breaking down again. Medication and therapy did help by assisting him to develop a minimal schedule for his life, but he is still extremely withdrawn. It might sound easy to get over it and start again, but it’s really not.

Another woman began a series of one-night stands after the break-up from her boyfriend. This boyfriend had been violent and manipulative. She had stayed and put up with him hoping he would change. He finally left and blamed her. She was devastated and the only solution she could think of was to find someone else quickly to ease her pain. She went thru many men until she hit her own wall and began therapy to find another way. Often these people would talk about no one being able to understand. One woman talked about this gigantic hole in the middle of her heart. She tried to fill it with men, with alcohol, and with drugs, but nothing worked .

I don’t know if there is a good way to start again. Maybe the best way is not to. I would always tell people after a divorce to not date for a while. I wanted them to work thru the pain and the loss. There was a very wise nurse at the hospital who would tell our patients that after a loss you had to go thru a year of holidays, birthdays, anniversaries. This was specifically about death of a loved one. We began to use it around loss of relationship issues and found that it seemed to fit. Divorce is often like a death. I had one woman tell our group in a joking way “It would have been better if he had died”. When no one laughed she was able to process that she really did mean this.

Loss is hard and pain is not fun. Nietzsche’s famous quote about what doesn’t kill you makes you strong does have some validity, but not at the beginning. In the beginning you need support. Often when an animal is hurt it tries to hide. When a person is hurt that may be the first response, but it is usually wrong. You want to get rid of the hurt as soon as you can, but it takes time. Try and find someone safe to talk to. You don’t need just another shoulder to cry on, you need people who can listen and offer support and sometimes give a shove in the right direction. Most of us have gone thru this in one way or another. No one can say they experienced your specific loss, but we all know what pain is like. There are a “hundred billion bottles washed up on the shore”. It’s not that “misery loves company” as much as we each need to find a way to get the support and find the right path thru the loss.