“Just a Castaway”

Posted on May 21, 2015 | Comments Off on “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Medication and therapy did help by assisting him to develop a minimal schedule for his life, but he is still extremely withdrawn.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.

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Posted in Meandering

“What’s The Matter With Kids Today ?”

Posted on May 14, 2015 | Comments Off on “What’s The Matter With Kids Today ?”

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Why is it so hard to let go? No matter the age of your children, they are always YOUR children. They can be in their 40s, but you still see the cute toddler learning to walk. I think this is true for all parents. I remember two cases where this became very evident to me. One family had a very gifted son who had done well in grammar school and went to a very well known prep school. He went to a Big 10 University on an athletic scholarship. He appeared to be on the road to a successful life, but then problems began. He had a psychotic episode from which he never fully recovered. His family was fairly well off and they spared no expense in sending him to the best psychiatrists, the best hospitals and the best long-term treatments. This all happened in the early 1960s. At that time there was a general belief in long term residential care for young men like this. Medication was available, but was very unpleasant with some risky side effects. He did not do well with any treatment regimen. He left treatment and left home. He would disappear for long periods and then resurface. His parents are now in their mid 80s and still worry about him. They both have been in therapy for years trying to work thru this. They blame themselves despite everything they did for their son. They have two other children who have had fairly successful lives, but the son with the problems got most of their attention. The last I heard he was living in a special housing project out of state. He was able to support himself with social security and special work programs. He didn’t want an allowance from his parents, but they kept trying to help him. They were both concerned that because of their age and frailty they would not be able to visit him again. They were also concerned what would happen when they died. They have set up a trust fund and one of their healthy children will control it, but they still aren’t sure if this will be enough. Their son is now 65, but to them he is still their child who needs protection.

Another family had a son who had problems from kindergarten on. He was the oldest and had a younger bother. The younger brother was good in school, sports and socially. The oldest had problems with everything. He would steal from his parents and lie about it. He would lie about school, friends, and jobs. The parents kept making excuses for him and kept “enabling” him. Enable is a difficult word. It basically means protecting someone from consequences. The whole idea of “tough love” meant that all enabling stops and consequences have to occur. This family couldn’t do that because every time they tried, their son would end up hospitalized. He would claim to have heard command hallucinations to kill or he would “see “ devils. In retrospect these “hallucinations” are certainly suspect, but we had to respond. He had many hospitalizations and would seem to do well. He then was discharged and would soon go back to his problematic behavior. His parents didn’t know what to do. He stole a large amount of money from them and they were quite angry, but when they confronted him, he threatened suicide. This was overwhelming. Finally he went to far and threatened them. They did kick him out, but continued to support him financially for years. The father then had some health problems of his own and could no longer work. The money stopped. The son is now living a very risky life and may in fact be homeless. His parents have been able to set a limit that he cant live with them any longer because of their own health issues. He has a hard time with that and keeps trying to get them to let him come home. The father is still holding firm, but he is unsure if his wife will be able to continue to hold this limit.

As a therapist sometimes you can see with crystal clarity what should be done. You sometimes want to just begin yelling –“Kick him out!! Don’t give him any more money!! Call the police!!” However that usually doesn’t work. Once a parent, always a parent. There has to be some final bottom for parents to act.

Another family had a 19-year-old girl who ended up hospitalized. She was an honor student in high school and seemed to do well in college, but then broke down due to alcohol. She went thru treatment, but didn’t go back to school and seemed to lose her way. Her parents tried to help, but the she ended up in a state hospital. They held firm and set limits when she came home. She left home and something seemed to click. She has been sober for many years and is able to live independently. Her parents are still supportive, but she seemed to grow best when they stopped enabling.

Before we had children I thought I knew everything. After all I had graduate degrees and special training in family therapy. I could criticize other family members for their children’s behavior. Then we had our sons. Even to this day if they call with a problem we both begin to worry. Thankfully their problems have all been manageable and even the difficult ones have all been dealt with. They no longer call for answers, just for advice and sometimes they take it and sometimes they don’t. They are adults, but sometimes I still have trouble letting go of the little boys I love so much.

 

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Posted in Family Story, Stories

Silver Threads

Posted on May 5, 2015 | Comments Off on Silver Threads

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I suppose this is the time for me to begin thinking about this, but I just don’t picture myself as old yet. Some days it is more difficult to get moving and some days my aches and pains are more evident. Some days it is harder to remember even the simplest things, but my wife says I have always been like that. I don’t think of myself as almost 70. I don’t know what age I am. I am certainly not 21 or 31. Maybe I’m still really only in my 50s. Some days it feels like that and on my good days maybe only in my 40s.However when I look in the mirror I now see some hairs that are no longer just grey. They are white. I have thought about the beard darkener that is advertised on TV, but I would probably end up with a green beard or one that glows in the dark. This adjustment to ageing is still a challenge. I am still fascinated by how others work thru this. Maybe the real secret is not to think about it, but then I think I would be missing something important.

Erick Erickson’s last stage of development is Ego Integrity vs. Despair. Hopefully this is where you can contemplate a positive summation of life. I remember many patients who had difficulty with this and many who were able to achieve it. There was a woman in her mid 70s trying to work thru the death of her husband. He had been a very successful businessman and had died of progressive heart disease at 76. She had a very difficult time with this and began to use alcohol to cope. Her children were very concerned and sent her to us. She was able to stop drinking and maintain sobriety. She was also able to work thru some of her grief. The more she talked about her husband the more she laughed. One day she came in and told me it had been a difficult week. She told me “yesterday would have been our 52nd anniversary”. She also told me that their wedding picture was on the fireplace mantle in her home. “I still talk to him every day— I met him when I was 15 and was never with another man—do you think I’m crazy?” I offered her much support and as the therapy continued, she continued to talk to her late husband. She still felt the tremendous loss but was able to focus on the many positives of their life together.

During that same week the clinic received an emergency call re an 81 y/o man. His son was quite concerned and asked for a work in appointment for his father. The son said that both his mother and father were no longer able to live independently. The mother had just had a small stroke. He had found an assisted living facility that would take both of them, but his father didn’t want to go and had even hinted at suicide. The assisted living facility did not want to take the father until he had been assessed. When I talked to the father I told him we could help him with his depression and arrange for the transfer. He said, “You don’t understand—we have had a terrible marriage. My wife is an awful person and has made my life a living hell. Now they want to put us in a place where we can die together!!” His son agreed that his parent’s marriage had not been good. The mother was transferred, but the father continued to live in the family home. According to the son he seemed much happier.

Relationships can obviously have much to do with general life satisfaction. One of the most important decisions we can make is about our life partner. There are many stories of people in long marriages dying within a year of each other. Yet it still depends on how you define yourself and where meaning in life comes from. Relationships are not the only way to judge a positive life. There was another patient who was a very successful chemical engineer. He had developed many products and even had his own specific patents. When he retired he was overcome with depression. Due to his commitment to his work, his marriage was in second place and after the birth of their two children it fell even further down his list of priorities. When he retired he realized that his wife had developed her own separate life. His adult children had moved away and he had nothing. He began his own consulting firm and this helped. He also developed a real interest in bridge and joined some of the bridge groups in his area. He continued in therapy for many years. He finally accepted his responsibility in what had happened in his marriage, but neither he nor his wife really wanted to change. They were content in the way their lives had developed.

My brothers-in-law and I have an acquaintance that can’t understand how we all decided to retire. He even suggested that we start another business “just to keep you all busy”. He has his own business and has had for over sixty years. He has told us all that he has no plans to retire. He appears to be very happy and will keep working until he falls over. He loves his work and his devotion to it shows.

As I sit here and begin thinking of all of these things, I am grateful for what I have and what I had. I had an opportunity to talk to some of the most interesting people in the world. I have a wife who is still the one person who can consistently make me laugh and who continues to surprise me on almost a daily basis. I know that there is still a ways to go and much work to do. Hopefully I’ll continue to try without using any special hair products.

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Posted in Meandering, Stories

“Hey Nineteen”

Posted on April 27, 2015 | Comments Off on “Hey Nineteen”

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“April is the cruelest month, breeding lilacs out of the dead land, mixing memory and desire, stirring dull roots with spring rain.”(T.S.Elliot). It is also the month of birthdays. My wife, two sons and two friends all have April birthdays. There is something about celebrating the day you are born. I still want to celebrate with all my loved ones, but there is something about my own that has lost much appeal. I remember as a child not being able to sleep because I was so excited about the gifts I was going to get. As I have gotten older my own birthday doesn’t mean as much. In fact I would like to forget this annual reminder of how old I am. There was recently a news story that 60 was the new 40. No it’s not, or at least there is a lot of deterioration between 60 and 70. Aging is highly over rated. Strange things begin to happen. Bodies and reflexes are not the same. It takes longer to recover. Memories come and go. All of a sudden a word, a picture, a fragment of a song brings back events of long ago.

I was talking to someone last week and all of a sudden I remembered a patient who came into our office building and lay down in front of the stairs to the second floor. She began weeping and calling my name. I had to be called out of my office to come and deal with her. I don’t remember much else about her except she was a difficult patient. In the same building we had just finished a group with some problematic adolescents. My colleague and I were called out into the hallway because they had started wheelchair races down the stairs. Another time a different group pushed a wheel chair with a smaller kid into the middle of an ice covered pond outside our building. Another time someone started a fire. I do not ever want to work with teen-agers again. I no longer have the patience.

This thing about memory is so strange. I can’t remember what I had for dinner, but events from years ago come flashing back. When my wife went into labor with our first son I was doing a staffing at the hospital. She called and said it was starting. I came home. We went to the hospital and they sent us home. We did this two more times before they admitted her. She had an emergency C-section. I remember hugging this rather distant female OB when she came out and told me that our son was born. It is so strange to think that he is now 38. Our second son was also a C-section. He was a scheduled delivery. When my wife was admitted to her room, the first phone call she received was from some guy trying to find out what birth control we used. He apparently was some type of deviate who had gotten the number for all the OB rooms. Thank God she hung up quickly. At that time there was a big effort to get fathers more involved in the birthing process. Since I was not allowed in surgery at that time for C-sections, the child was brought out and was to be given his first bath by me. The hospital hadn’t quite gotten this down so they brought out a trashcan filled it with water and gave me my second son. I put him in the water and he began screaming. I think he hated baths until he was 11 all because of that. He is now 34. How did both of them get so old so quick?

Memories of my own childhood come and go. I’m still surprised at some things my own cousins say and then it comes back to me. My father had his first heart attack in his 30s. Now we are not sure if it even was a heart attack and not something else connected with his poor health habits. He was a great guy but he was a chain smoker and drank too much. He really could never stop either one. I think a lot of guys from his generation grew up going to taverns and saloons. They were the social centers of the neighborhood. The smoking was what everyone did. His generation got really hooked while in service. My generation smoked because it was “cool” and almost expected. Everybody smoked. I stopped when my oldest son was in first grade. He asked me to stop because he learned in first grade it wasn’t healthy. I’ll always be grateful to him for that.

As I said memories keep flashing back. I know that even a smell can bring back memory of an event positive or negative. I have heard a lot of people have positive memories of cookies or bread baking. They talk about childhood and family events associated with those smells. I remember a patient who always had trouble in the summer during road construction season. The smell of asphalt reminded him of Vietnam and fuel for Helicopters. He would be fine all year until that season and then would begin showing up again with troubling dreams and increased anxiety attacks.

Music can do it too. Every generation has their own music. My Dad loved the big bands, especially Glen Miller. I think he always wanted to be a singer. “Stardust” was his favorite song. I have had patients tell me of breaking into tears hearing an old song and the memories it invoked. We had the Beatles, Stones, etc. In high school it was the Four Seasons and the Beach Boys. There really were two groups-the “Greasers” and the “Dupers”. I still think of “Help Me Rhonda” as one of my favorite songs. When we were dating there was a Rod Stewart song that played a lot -“Maggie May” -and we always thought of that as one of “our” songs. Whenever I hear it on one of the oldie stations it brings back memories of when we met—on a camping trip with a large group of our friends.

I think of all the stories I’ve heard over the last 40-60 years. I’m sure my family and friends get tired of hearing them, but as I have said , sometimes they just emerge. I don’t know when this is going to happen or what is going to come out. It’s like I have this huge hard drive inside my head just waiting to remind me of the past. I always heard about how for many seniors the past was more present than the actual present. Thankfully that’s not quite true for me yet, but I know all those stories are just lying in wait. This is still an unknown journey for me. I just hope my family can put up with me while I am going thru it. I think of the line from a Steely Dan song “She thinks I’m crazy, I’m just growing old”.

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How Dumbo Left The Hotel California

Posted on April 20, 2015 | Comments Off on How Dumbo Left The Hotel California

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Do you remember the first movie you ever saw? I remember taking my 6 y/o and 2 y/o sons to see a Star Wars movie. My youngest son napped thru the first part and then woke up when the Ewoks appeared. He began talking loudly and stayed awake the rest of the movie.

I think the first movie I saw was Pinocchio. I still remember the start of the film. All of the old Disney films were hand drawn and were beautiful. They all had happy endings and promoted positive values. Cinderella, Sleeping Beauty, etc, all taught a lot about kindness and inner goodness. My favorite was Dumbo. The little elephant with big ears that everyone rejected. He finally was able to discover his talent and fly with help of a “magic feather”. I’ve often thought about that as a therapist. The “feather” obviously wasn’t what made Dumbo able to fly, but because he believed in it, he was able to. When he finally let it go he found that he had the ability to fly all along. I think that a lot of therapy is about giving someone a “magic feather”. If they believe in it strongly enough, change can happen. There are lots of techniques to do this from cognitive behavioral therapy to mindfulness, meditation and even anti-depressant medication. Some people report almost immediate results from the meds when we know most medication take from 3-12 weeks to achieve results. It’s the individual’s own belief in the ‘cure’ that is important.

There is a very old study about troubled couples deciding to enter therapy. The results of the study were that the decision to enter therapy often was at least as helpful as the therapy itself. Couples who were on long waiting lists often showed as much improvement as couples actually in therapy. The authors hypothesized that this didn’t show the uselessness of therapy, as much as it showed the decision to enter therapy was the key factor in achieving change—the “magic feather”.

There is still so much stigma attached to seeking counseling/therapy. It is still looked on a sign of weakness. We often had people trying to hide if from their insurance companies. I had people who didn’t want their spouses, parents, or children to know that they had made the decision to ask for help.

A lot of people would come in for their first session and be surprised that there wasn’t a couch in my office because that’s what they imagined therapy was about. The importance of helping people relax and begin to trust was essential. I would try to be as supportive as possible to help achieve this. The importance of developing trust and a developing a therapeutic alliance is what the beginning of therapy is all about.

The “magic feather” part comes later when the therapy is progressing. You get to know each other and talk about what is really possible. Not everyone can fly, but everyone has the ability to change. It just depends on how change is defined. In the hospital many years ago, a 16 y/o girl was admitted. Her parents didn’t know how to handle her and told us she was out of control. She was doing drugs, flunking school, and staying out all night. She was the youngest of four girls. Her sisters had all run away from home at 17 by leaving out a rear window. They would come home a year or so later with a husband, a baby, or both. The parents wanted their youngest to not make that same mistake. After she left the hospital she did well for a while, but then began to slip. Her parents were able to set some clear limits. When she left at 17, she left through the front door after saying goodbye to her parents. She had some additional struggles, but then settled down and has had a fairly successful life. Now this might not seem like an important change, but it was to her parents. They thanked the whole hospital staff for the change in their daughter when it was probably them that changed the most. It’s important to help people accept that they are the ones who are doing the work.

It’s very common for people to put their therapists up on a pedestal and give them all the credit for any positive change. I would always resist this. I had no need to be anyone’s false idol. We are all responsible for our own lives. Some patients don’t want to accept this. They want their therapists to “fix them”. The problem with taking credit for anyone’s success is you also make yourself liable for their failure. I didn’t want anyone to be that dependent on me. The decision to enter therapy is hard enough; the decision to stop can be even harder. In the old days therapists would see their patients weekly to semi-weekly (2x per week) for 90 minutes or longer. This could go on for years with patients making very small incremental changes. Now it is a lot different. Insurance companies and the real business of everyone’s lives wont allow that. I did have patients that came to see me for years and some patients only for months. I would tell them all about the Hotel California. “You can check out any time you like, But you just can never leave!” Therapy shouldn’t be like that.   Dumbo didn’t have to hold on to his magic feather forever. He was able to let it go and get on with his life. Therapy should be about supporting and encouraging you to realize your own strengths and abilities. You should always be able to leave when you get what you want. This doesn’t mean you can’t come back if something else happens. Just remember the address and phone number.

 

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Posted in Meandering, Stories