Author Archives: jwlef1

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Memory is still a very important topic for people in my age group. Every Tuesday I have breakfast with a group ranging in age from 68 to 78. Sooner or later one of us will talk about problems remembering words, events, appointments, history, etc. A neurologist has said that this is a normal function of aging. The time to become concerned is when you forget the function of certain objects i.e. you don’t know what a stove is. I had a patient many years ago that had severe organic brain damage. Her family was still letting her drive. When I began questioning her about this, she admitted she didn’t know what a stoplight was and thought that it was a clock. Thankfully her family removed her car keys.

The thing about memory is that everything we have seen or done is stored somewhere in our brain. Sometimes a word, a song, a smell can bring back very vivid memories of the past. Imagine walking into a house where someone has just baked Chocolate Chip cookies. What would that smell do for you? Would it bring back memories of your childhood? For many people it does.

I had another patient who began to have extreme panic attacks in the summer when road construction was happening. The smell of fresh asphalt reminded him of the smell of helicopter fuel in Vietnam. He would often stay in his house all summer long and not want to come outside because of it.

I am thinking of this because my sister and her family are going to spend a week at a lake in Michigan that we went to as children. My uncle owned a small cottage there. His son and I were the same age and we would often spend the entire summer. The more my sister talked the more memories came back. It was a very small and primitive place, but we thought it was the grandest place in the entire world. We had a very small boat with an outboard motor. My uncle would let us take the boat and go out on the lake. We would swim all day and then collapse at night. One of the highlights of the summer was when would go to a small restaurant/store near the cottage. They had some small arcade and pinball machines. We would save our pennies and small change and look forward to playing them. It was a very innocent time. The more my sister talked, the more memories of that time came back.

I once heard Carl Whitaker say that he never really thought you lost anyone. He said that if he tried, he could bring back all the sounds and smells of the room his father died in almost 60 years ago. As long as you have those memories you are never really alone. The more I thought about it, the more I agreed. When someone close dies or leaves, the pain is very sharp. It feels like it will never end. As time goes by the pain is still there but some of the sharpness goes and you get on with life. Some people never get thru it. My grandmother would say two rosaries a day for my grandfather after he died until her own death. My mother would break down in tears years after my father died. Other people have told me they can go for weeks, months, years without thinking of a deceased love one, and then suddenly something will trigger them. The memories, both good and bad, burst thru. I have had many people say things like: “ I haven’t thought of my mother, father brother, sister, etc—in years. Why am I thinking of them now? “

Sometimes it seems like we all have these hidden passwords to our own past. We don’t know what the passwords are. We don’t know where they are or what they will unlock, but when they appear we are amazed at the result. Sometimes this can leave us laughing. Sometimes it can leave us in tears. Sometimes it can terrify us. I had a patient who suddenly remembered severe episodes of abuse that happened when she was 5 or 6 years old. She remembered when she was 25 because of seeing something on TV. The memories literally overwhelmed her. Our mind really does try and protect us, but sometimes that can also be a problem. Those who suffer from PTSD would like to find a way to safely deal with their memories. Their memories are not the happy ones, but the terrifying ones. They creep in and seem like they will never leave. I know that there is now an experimental drug that produces a sort of amnesia so these poor souls can let go of the trauma of their past.

For the rest of us we just have to deal with this enigma of our own memory. We all have so many memories and our individual filing system remains very mysterious. It would be great if we had a magic key to enter and file clearly and really discard the unpleasant ones. However that is not the way our minds work. So I will try and be thankful for the memories I have—both the ones that make me laugh and the ones that make me cry.

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April is again the cruelest month. The weather is unpredictable and we all wait for Spring to appear. It’s a busy family month with birthdays for my two sons and my wife. It is amazing to think that both my sons have grown into adults with adult responsibilities. I still think of them as children and have to continue to remind myself not to give them advice and just to offer them my love.

I still think this aging thing is difficult to accept. I know I cant do many of the things I used to- or if I do, it does take longer to recover. The memory lapses don’t bother me that much. It doesn’t seem that different from when I was younger. I don’t think even death concerns me right now. I know it will happen and it is certainly a reality I have to face every day. I see the music, film and sports stars of my youth all fading away. I can even criticize their appearance and think that I don’t look as bad as they do.

What has been bothering me is thought of lack of function. The television show “60 Minutes” had an episode this week about Alzheimer’s. They presented an actual couple they had been following for 10 years. The wife was diagnosed in her mid 60s. Her deterioration over the ten-year period was graphic and tragic not only for her, but also for her caretaker husband. Fortunately this is not a common condition in either of our families, but both my parents and my wife’s mother died fairly young. I hope if this does happen, my sons will convince which ever one of us is the caretaker to make a decision to let go.

I saw a lot of families struggling with addiction and mental illness. The addict or person with mental illness certainly had their own struggles, but what always struck me was the impact on the family. I would spend a lot of therapy on the importance of setting limits and encouraging families to realize the effect this was having on their own lives. One family struggled with the husband’s heroin addiction for over 40 years. I remember a family conference after another period of relapse with the wife and adult children trying an intervention. Despite all their pleading and tears, the addict continued to say “I just like the high”. He had been using since he was 16 and had two lengthy prison terms on his resume. His wife just would not let go and it adversely affected her own health and her relationship with her children. I would see parents of rebellious adolescents trying everything to help their children only to begin blaming each other for what was happening. The whole concept of enabling and contributing to someone’s illness came out of studying alcoholic and addicted families. The idea of giving someone “just one more chance” is often just a way for the problem to continue. One husband spent over a million dollars on his wife’s treatment. She never got better until after they divorced. Another father would send his son thru endless treatments and hospitalizations. He would always blame the therapists when his son relapsed. He could never understand how his constant rescuing and helping his son avoid consequences was one of the real reasons therapy was not working. He also had difficulty seeing what was happening in his own life. His marriage was failing, his weight was out of control, and he had developed diabetes.

The 60 Minutes episode showed the progression of the illness in just not the wife, but also the real deterioration of the husband. He talked about his own depression and thoughts of suicide. He was committed to caring for her, but finally after 10 years, he could not do it anymore and agreed to place her in a nursing facility. I’m sure he had very mixed feelings about this- both of guilt and relief. However he really had no other choice.

I think it’s this choice that I am thinking about. Our decision to move seemed somewhat impulsive, but it had been simmering away for a long time. I really did not want to move. I don’t like change. Maybe that is a real sign of ageing. However I finally realized that if something happened to me, my wife could not physically manage the home we lived in. Both of our sons were over an hour away and would have difficulty getting to us in an emergency. Now we are closer to our sons and this house is more manageable for my wife.

So what I simmer about now are all the senior concerns about illness and loss of ability to function. I certainly don’t want to be a burden on my family. I also would not want to get to the point of suicide or mercy killing. Right now I don’t really know what the answer is. This, like much of this stage of life, is just one more important thing to think and talk about.

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I still have difficulty letting go. I hold on to old clothes. I still have most of the shirts, pants, and ties I wore to work even though I have now been retired for almost five years. Now the only time I wear a tie is when I have to attend a wedding or a funeral. I still have textbooks from college and the thought of even giving them away once caused a serious argument with my wife.

I know that George Carlin has a famous routine about “stuff”. I laughed when I heard it the first time, but it’s true. Your “stuff “ is what helps define you. When we moved from our home of 36 years there were almost monumental decisions of what to let go of. I would make almost daily trips to Good Will with boxes of our “stuff ”.

I still have boxes of old hard drives that I am somehow, someday, going to catalog. I have boxes of family pictures that I need to organize even though I haven’t looked at them in years. I have a 2006 Ford Explorer with 112,000 miles on it. The windows don’t work, the rear windshield wiper doesn’t work, the heater fan only works on level three or four. It usually gets all of fourteen miles per gallon, but I am comfortable driving it. My wife is not. I have had the car since about 2008. She has never driven it. She says it’s because she is too short and can’t reach the controls comfortably. I am still comfortable driving the car, but a decision had to be made.

This new life we have doesn’t really fit this old car. It is almost too big for our garage and the mileage is getting to be a burden. I just had to replace the battery and I know I will have to replace the tires soon.

So we have to get a new car and let go of my old friend. The whole process of researching cars, test-driving, talking to salesmen is one of my least favorite activities. One of the guys I know loves this. He always tries to work the deal in his favor. I suppose I could do that, but I just don’t trust the salesmen. I had a number of car salesmen as patients and the more they described their jobs, the worse it sounded. I tried to do it online, but that almost became too complicated. There were no humans involved. One service was based in Texas and if I liked a car they would transport it up here. I could drive it for three days. If I decided to buy it I would just have to do a wire transfer of money to their bank. I was uncomfortable with that process. I did more research online. I ended up giving my name to a car research site called Edmonds. Big mistake. Phone and Internet for then contacted me over a week by various dealerships. I thought I had found a car so I called a dealership. They said “Come on down—we have this car for you”. We got there and after much delay they said that car was gone, but they had many more just right for us. We walked out. The next day we did go to a dealership and ended up buying a new car. My wife likes it because she can drive it. She also likes all the new safety features. It beeps warning noises if you drift over the lanes. She says she now wont have to tell me when I do this, the car will. I like the car, but I also liked the Explorer. I think change is harder as you age—at least it is for me. I get used to things being a certain way, get comfortable with certain routines and then everything changes. I still have difficulty accepting that I am no longer an active therapist. I consciously let go of all my old patients and resisted all of their attempts to maintain contact. I did maintain contact with one. I would see or text her intermittently over the years. She has gone thru a lot and I just couldn’t see leaving her. However she is now in a new relationship and seems to be in a good place. She hasn’t contacted me for a while now and maybe even this is ending.

I think what I liked about being a therapist was meeting people at times of crisis in their lives and actively entering into their process. At times it was almost like being swallowed up into a whole new universe. I liked the acceptance and even the power of being listened too. Yet after almost forty plus years I really had to realize that it was time to let go. I have had to start thinking about what it is that I want at this last quarter of my life. I have a wonderful wife, grown married sons, and grandchildren. I really want to be able to focus on this. I still ask myself almost every day, “Is this enough? “ Sometimes it is and sometimes it isn’t. I still think I am in process of deciding what I want to do. Eric Erickson called this stage Ego Integrity vs. Despair. I would like to continue to develop and someday it is really possible. I keep telling myself that I need to be grateful for those days and what I have. The 12 Step programs focus on “One Day at a Time”. All of the 12 Step mantras sound so simple, but they are really difficult. The key is the ability to let go—but that’s my problem. I just have to accept that I am still a work in progress. Maybe I need to keep focusing on my favorite 12 Step mantra “Progress not Perfection”. We are all just fallible organisms. The more I focus on the positive aspects of my life the more acceptable this progress will be.

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Another tragedy, more spinning, and more thoughts and prayers. I keep going back to the quote “Who knew Healthcare was so complicated?” Life is complicated and there is no easy answer to this. There was an interesting juxtaposition of stories on PBS on Tuesday and Wednesday. On Wednesday the coverage was all about the shooting in Florida and the evil of guns and mental illness. However on Tuesday there was a very interesting piece on the benefit of deer hunting in Iowa. The deer have no natural enemy and can over run some of the corn and other crops. The herds need to be culled and harvested to reduce the damage they do. The interesting part was the number of deer and amount of venison that is donated to food pantries and to homeless shelters. This is a real benefit to those programs in their attempts to feed the hungry, especially with the planned reductions in funding.

The “solutions” to our mass shootings always comes back to reductions in the type of firearms available or increased mental health awareness. This doesn’t necessarily mean treatment since those resources are also being reduced. I keep thinking that it’s not the guns. The availability of automatic recoil weapons does appear to make mass killing easier, but shotguns, hunting rifles, handguns can also accomplish this. I had a patient who tried to kill someone with a metal can of tomatoes. Should all metal cans be registered?

In some parts of the country there is a strong family tradition of hunting. Firearms are considered tools and are often passed down from generation to generation. If we begin to think that you have to be a certain age to own a gun, or hunt, or shoot in competition, this would seem to only complicate this issue even more.

I also have concerns with putting the responsibility for identifying mass shooters on the public. Of course if someone is walking around with a machine gun or a machete covered in blood I hope someone reports him. However most of these shooters are somewhat isolated. They may make comments on social media, but if questioned they will deny any intent to harm.

I keep thinking of some of the patients I sent to the emergency room because of my fear that they were going to hurt themselves. I would have to fill out a long form specifying my concerns and their comments and actions. They would then be interviewed by another therapist, MD, counselor and then either released or hospitalized for a day or two. Then they would be back on the street. A friend of mine had a patient released from our treatment program with a very solid aftercare and outpatient plan. We thought he was ready to be discharged. He left the hospital went home and killed his wife, child, baby sitter and himself. It is very hard to read someone’s mind and identify those who are a real danger when they have no real history of violence.

This is especially true with adolescents. One of my old supervisors used to say “Adolescence is a disease”. The teen years are very turbulent. Hormones, school, peer, parental pressures can often be overwhelming. Every day can bring a new challenge. Unfortunately almost every teen will admit to considering suicide at some point. For some it is just a passing thought, for others it is a recurring nightmare. One of the other things we would see is that after a teen succeeded in suicide, there would often be others at the same school that would at least attempt or threaten to do the same thing. The fascination with the attention these children got overcame any fear of consequences. There is some speculation that their brains really cannot conceive of consequences because they are still developing.

After this latest episode, I’m sure there will be someone who wants the “fame” and notoriety of being another school shooter. There will continue to be loud accusations on both sides and the usual solutions proffered. This will probably mean that nothing will be done until the next time this happens.

Many people long for the good old days when nothing like this was going on. I recently read a column that blamed everything on loss of respect for life from abortion, violent video games, and the escalating sexual culture. I keep think that the good old days had wars and an enormous amount of violence. If anyone disagrees, I would suggest they go and look at a certain wall in Washington where an enormous amount of violence and loss is documented.

Over the next few days we will all be overwhelmed with the sadness of all this. Young lives lost for no real reason except to satisfy some poor deluded soul’s need for attention. So what is the solution? I really don’t know, but I hope that mental health resources and treatment are increased not just in schools, but also in all our communities. I hope that something as simple as a universal background check could be established. I would like to limit the ability of people with severe mental illness from being able to access firearms. I don’t want anyone to lose his or her rights, but I would like some common sense to arise in our culture. As complicated as this is, we can do something!