Grist For The Mill

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Down by the old
(Not the new, but the old)
Mill stream,
(Not the river, but the stream)
Where I first
(Not the second, but the first)
Met you,
(Not me, but you)
With your eyes
(Not your ears, but your eyes)
So blue,
(Not green, but blue)
Dressed in gingham
(Not plaid, but gingham)
Too,
(Not three, but too)
It was then
(Not now, but then)
I knew,
(Not old, but knew)
That I loved
(Not hated, but loved)
You true,
(Not false, but true)
You were sixteen
(Not seventeen, but sixteen)
My village queen,
(Not the king, but the queen)
Down by the old
(Not the new, but the old)
Mill stream
(Not the river, but the stream).

Down By the Old Mill Stream, by Tell Taylor *

 

 

ADHD: Fact or fiction?
Fact
Ritalin and other ADHD meds: Dangerous fad or helpful tool?
Helpful tool

Good – now that we’ve gotten the drama out of the way, let’s get down to actually talking about ADD, not agonizing over how many Adderalls can dance on the head of a pin, which is what much of the ‘discussion’ about ADD has been for decades. I remember a time when I was on the phone with a consulting psychiatrist, and suggested that he evaluate our shared patient for ADD and appropriate meds. After an ominous silence, he sneered, “You change your tune right now, young man, or I’m hanging up this phone.” Change my tune? I said, “How about, Down By the Old Mill Stream?” Sure enough, he hung up. Oh well, I doubt that he could have done justice to the all-important second-lead patter that makes that song any fun at all (see above). And really, as someone wise once said (I’m pretty sure it was either Rumi or Art Linkletter), any psychiatrist who doesn’t even offer to sing second lead on Down By the Old Mill Stream is, well, not even worth the paper his prescription pad is printed on. Then again, perhaps the poor thing was just suffering from social anxiety or stage fright and needed a little encouragement to get out there and vocalize. Or maybe all that talk of ADD scared him off because he couldn’t relate to being mentally disorganized. Well, as Ned Hallowell once said at a lecture I attended, some people suffer from Attention Surplus Disorder (ASD), and that kills all the fun of being off-the-wall.

Now, where was I again? Oh yeah – ADD. Unfortunately, this is one of those disorders that carries special stigmas and complications along with it, since all kinds of mythology about it has passed into popular culture, to the misfortune of anyone who has it. It became ‘good copy’, and provocative, adorning the covers of Time, Newsweek, and any other rag that thought it could make a buck by fanning the flames of controversy and scaring the public. It was denigrated as an ‘excuse’ for students who could not do their homework, an unethical bonanza for doctors who prescribed medications for it, and a cop-out for anyone who was disorganized, scattered or had difficulty concentrating and staying on task. People were told if they just ate the right things, it would miraculously go away. They were assured, and scolded, that it was caused by food additives, too much sugar, too much TV, video games, not enough exercise, and any other handy shibboleth that hucksters of all kinds could think up.

The net result: people who have it are often ashamed and confused; they feel inferior to ‘regular’ people, and wonder:

What’s wrong with me? Why can’t I read a book like other people, or get through a movie, or pay attention in class, and why can’t I stop jumping around all the time? Why do I get so many parking tickets, and why can’t I pay them on time, pay my bills, or even find my bills? Why can’t I finish a term paper, or start studying before the last minute? Why does my room look like a federal disaster area, why am I always forgetting everything, why do I always make everyone mad, why am I always late? I don’t think I’m a bad person, but what’s wrong with me? Am I stupid, lazy, emotionally disturbed or what?

Thank goodness, in recent years ADHD (the new, ‘approved’ name, doubtless thought up by people with Attention Surplus Disorder) has become less of a religious cult and more of an actual working diagnosis. The Americans with Disabilities Act helped – now anyone with a legitimate diagnosis of ADHD can have extra time to complete tests, for example. Why? Because they’re stupid, lazy and emotionally disturbed? No, because they in fact have a brain function disorder that can actually be seen on functional brain scans (SPECT; PET). As Dr. Daniel Amen and many others have shown repeatedly for years, it can be demonstrated that, when many people with ADHD are asked for example to do math problems in their heads, activity in their frontal cortex actually can slow down, rather than speed up, as in ‘normal’ people. What does this mean? It means that when confronted with certain kinds of problems in ‘real life’, such as academic ones, many people with ADHD actually can’t “think straight”, regardless of their IQ. It means they may ‘space out’ when contemplating starting a term paper, instead of making and carrying out plans to begin the paper. I have heard this phrase countless times:

I can’t trust myself.

Imagine living with this:

Just when you need your brain to ‘ramp up’ and get going, it shuts down and you can’t think straight. You are talking to someone about something sensitive, and suddenly you blurt out something inappropriate. You are talking to someone and suddenly you notice they have a glazed look in their eyes, because (you suddenly realize) you have been rambling tangentially about everything under the sun for the last five minutes.

You are sitting in class, being quiet and facing front. Suddenly, everybody is getting out paper and pen, preparing to do something important – why? You realize you have been spacing out for the last five minutes, though you thought you were attending to the teacher’s every word.

You vow to start working on your taxes early this time, but first you’re going to allow yourself just a few minutes of watching your favorite TV program. You even set the timer on your iPhone for fifteen minutes, to make sure you don’t forget. You ‘come to’ two and a half hours later, wondering what the hell happened. You realize you set the timer for 8:00 AM instead of PM, your wife is yelling at you because you promised to put the dishes in the dishwasher and feed the dog, and when you finally do get to work on the taxes, you can’t find the paper bag where you put all the receipts for the past year.

Your life becomes a constant storm of forgetting, failures, disappointing others, embarrassment, inability to trust yourself, and wondering, “What have I done now?”

What am I supposed to do again? It’s on that list somewhere. Where is that damn list anyway – the new one, not the one that got lost somewhere in the car last week. Where’s that phone number – you know, the one of that guy I was supposed to call to explain why I was late with the information he wanted, the information about – oh, what was it again?

This – this storm of forgetfulness, this barrage of unfinished business, this litany of people mad at you, this is your life. So what do you do? You develop compensatory mechanisms to help you get through it, things most people wouldn’t understand, things that are private, alone. Most all of these mechanisms are developed ‘in house’ by people who are alone, ashamed, confused, frustrated – they are not well-known principles that are taught in school by anyone, but Rube Goldberg devices of the mind, that help you get through time, that help you survive. Things like:

Getting high on marijuana or alcohol  (“Thank god – for a few minutes or hours I can forget all my problems, slow down a little, appreciate the moment, and not feel bad about myself”.) Of course, it ends up not only worsening the problems (because, though you may feel better for the short term, you have just put off real life that much longer, making returning to real life more difficult, requiring more dope and more booze), but now you have a problem with dope and booze on top of your ADD problems. And now everyone’s mad at you for that, too, requiring more dope and booze to ‘deal’ with it all. And on and on.

Becoming adept at excuse-making. This is a whole internal subculture unto itself, including developing a persona where you laugh at yourself for others’ benefit (while hurting inside), saying things like, “There goes Old Faithful again – every hour on the hour, I have to forget something important,” or “They say I was dropped on my head a lot as a baby.” You spend inordinate amounts of time trying to think up plausible excuses for things undone, things forgotten, things you “didn’t have time for”, although secretly you know that you wasted ten times as much time avoiding the task as you would have spent actually doing it.

Lying to others about “what happened”, and what’s worse, lying to yourself. Eventually, you begin to believe your own lies and excuses and blaming, until they all run together and you can’t tell them apart anymore.

Saying to yourself, “Fuck it – I don’t care. I’ll just be a rebel and go my own way, and damn the consequences. ‘Their’ world is all fucked up anyway – I don’t want to be a part of it. Bunch of compulsive, anal, neat freaks and perfectionists anyway. Who the hell needs it?”

All around you, you see people doing well, doing what they are supposed to be doing, paying their bills on time, their taxes on time, not being terrified because they might be pulled over for an expired car registration and brake lights that don’t work. They’re getting raises, promotions, and everyone isn’t mad at them. Somehow, they seem able to do things right, do things on time, take care of business. How do they do it? Are they better than you? Smarter than you? They don’t blurt things out, or embarrass themselves, or have to lie to live, or have to remember their lies so they all match up.

What’s wrong with me, anyway?

This is when those who seek therapy, seek therapy. If they are young, it most likely involves school performance, “not working up to potential”, and comes complete with disappointed, angry, frustrated parents who also wonder what they did wrong to produce this obstinate, maddening low achiever.

If they are adults, they come in trailing a stream of sabotaged opportunities, missed deadlines, legal troubles, and wrecked relationships. Nowadays, most will add, parenthetically, after they’ve listed their ‘real’ problems, “Oh, and I’m pretty sure I have ADD, too,” as if they are reporting, for the sake of completeness, that in addition to cancer, they also have dandruff.

So, the first thing we talk about is that ADHD isn’t just something “else” you have, in addition to your real problems: it is a primary problem, that affects the entire range and scope of your life, from school, to work, to relationships, to your personality, and most importantly, your self-esteem, your dreams and your hopes. This is BIG, and it needs to be dealt with, if not first, then soon. We talk about how ADD is not a moral disorder, and not a genetic propensity to being a lazy slob, a liar and a procrastinator. It is not caused by having a deprived childhood, though of course it interacts with whatever emotional problems, and whatever other disabilities, are on board. It is not about being stupid, though high intelligence can mask it until later in school, perhaps college, grad school or beyond, or whatever point ‘real’ mental work is required, work that you can’t just toss off at the last minute.

We talk about self-image, which by this time is usually down in “Loser/Failure” territory. Most people seem to operate on the implicit assumption that they, along with everyone else, have “free choice” in what they do. Much later, after a lot of therapy, most of them look back and see that they were in fact hobbled by emotional wounds and damaging assumptions, and that they were irrationally harsh on themselves, holding themselves to standards they couldn’t possibly have reached, operating as they were with both hands tied behind their backs. But when they begin, waving the ‘free choice’ banner, they have no other option but to see themselves, personally, as the reason for their failures – what in AA they call “character defects” (much to my disagreement).

They want to know:

Why can’t I get it together, like everyone else does? Lots of people have problems, and worse backgrounds than me, but they seem to be able to function, and live up to their potential. Why not me?

Why not you? Because your brain isn’t working right. And because your brain isn’t working right, you’ve developed a chip on your shoulder, resistance to doing the things you can’t do as well as you ‘should’ (schoolwork, sitting still, paying attention, reading, being patient about anything), and the belief, on some level, that you’re some kind of a second-class citizen who’s born to fail, or at least disappoint. So we often start with education – reading (though of course reading is hard sometimes) books like Driven to Distraction, by Edward Hallowell, books by Daniel Amen, that show graphically the functional deficits in performance based on actual brain scans, and describe the subtypes of ADD that are suggested by these studies, and also books that take a creative, even refreshingly radical view of ADD, books like Attention Deficit Disorder, by Thom Hartmann (it used to be called Hunter in a Farmer’s World !), the parent of an ADD child, who developed a theory that in the early days of human existence, the ADD brain was actually MORE suited to survival in a hunter-gatherer society, when an active, ever-changing approach to interaction with the natural world was required in order to recognize possible prey and move boldly towards risk and taking chances in obtaining it.

We discuss possible medications that can help, and also the resistance to such help: “I shouldn’t need that”; “Pills are just a crutch”; “I’m not that bad”; “It’ll make me a zombie”. We talk about how the proper medications, far from making them a ‘zombie’, can make them feel like “That’s more like it – now I feel like myself; now I can use my brain, instead of fighting it all the time.”

No, “pills” are not the entire answer, and sometimes they are not part of the answer at all, but they can often provide a dramatic shift in the ability to utilize what the person has – to get the car on the road, instead of being up on blocks, which is how it feels to many ADD sufferers.

We also talk about ways to keep ‘to do’ lists that work – lately, there are several ‘apps’ for cell phones that are remarkably good at helping people organize their lives, not only keeping tasks in order, but reminding people of upcoming needs, and helping them keep track of elapsed time. A young patient of mine says his app is like having a “smart valet” – there to help him address the tasks of life, without judgment or blame.

And what is the outcome of all this? Well, I’ll just say that there is nothing more meaningful than having someone who was angry and resentful, disillusioned with the whole idea of doing anything with their life, feeling like a total failure, sit before me and say, with tears in his eyes:

I’m not stupid, after all – I’m not lazy, and I’m not a bum. I can do things. I just have to give my brain some help, and when I do, I can accomplish all kinds of things. I’m not afraid anymore of what’s going to come out of my mouth, and of what I’m going to do next. I don’t wake up in the morning dreading remembering what I did, or didn’t do, yesterday. I don’t have to make up excuses and lies to cover my screw-ups. Do you have any idea what it’s like to be able to trust yourself again?

Turns out there’s a lot more at stake in treating ADD than proper mental functioning.

The real treasure at the end of all the work?

Self-respect.

 

* Song published by Tell Taylor in 1910. He wrote it in 1908, but his friends tried to persuade him not to publish it, as they felt it had ‘no commercial value’. Whoops – it became one of the most popular songs of the early twentieth century, sold four million copies in sheet music, and is still a staple of campfires and barbershop quartets, a hundred years later. The moral? If it feels true to you, go with it. Self-respect.

 

 

 

 

 

 

 

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Be Yourself – Everyone Else Is Taken

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Welcome to your life,
There’s no turning back…

— Everybody Wants to Rule the World, Tears For Fears

We’re all on this crazy carnival ride called Life. We can dress up, we can dress badly, we can be hipsters, goths, or punks, we can make a ‘statement’ with tats, geeked-out hair, flashy rings, elbow patches, sandals, or fashionista shades. We can spruce up our little roller coaster cars with gold lame seat cushions, faux painting effects, or platinum grab bars. We can scream at the scary parts, or be impressively stoic as we plunge and climb. We can turn to our riding partners and chatter away, or stare straight ahead, contemplating the mysteries of the universe. But none of us is turning back, and none of us is escaping that last jolt at the end of the ride.

So, what can we do? One – we can pay attention, so we don’t miss the ride, and two – we can be ourselves. Sounds obvious, doesn’t it? Easy, too, no?

But what does it mean to be ourselves? Well, one part is Accessing – another part, Expressing.

Accessing:

How do you get access to your real self? How do you know what you really feel? How do you separate what is essentially ‘you’ from the million cultural influences, the social pressures, the need to be “a part of things”, the need to be like other people, to be liked by them, the need to feel normal?

I can’t say how many times patients have said,

But what if I don’t like what I find inside?

or

I already know what’s in there, and believe me, I’m not interested. I came here to become something else than who I really am.

What do these statements mean? They usually mean that something, some complex of feelings, some interaction, some response, has become impacted deep down in the psyche, and is now experienced as a fait accompli, a done deal that cannot be changed, but only avoided. These are usually expressed as an “I can’t”, or “I won’t”, or “Don’t make me.”

An example: The “nice guy” who abhors anger, or conflict, or disagreement, often becoming a situational chameleon, in order to float along with the stream, not disturbing anyone or being disturbed by anyone. Eventually, he forgets who he is. There is an expression, “Fake it till you make it,” usually used to help people ‘try on’ a behavior until it feels more natural. Well, for the nice guy, it’s “Fake it till you become fake,” as he loses touch with what he actually does think or feel about things. It’s hard to engage this type of person in therapy, because, at its best, therapy is the skillful use of conflict to encourage growth. So, when this type senses potential conflict, he will stay on “his side of the fence”, either denying it to himself, not letting it come into consciousness at all, or just remaining quiet about it, as a gulf grows between him and the other person (the therapist, in this case).

This person has no idea why other people get mad at him, when all he is trying to do is avoid anger. But you can see why other people get mad at him: he refuses to really engage, withholding his real reactions from the other (and often himself, too), and acting as if everything is alright, whether it is or not. The other person eventually feels like they are the only one showing up for the relationship or transaction, the only one ‘putting out’, and the only one taking any risks. The nice guy is like a poker player who never shows his hand, only folds his cards before the betting starts, on every deal. Eventually, the other person feels like, “Are you gonna play or not?” Then, the nice guy says, “What are you so mad about? I didn’t do anything.” The other person says, “Exactly.” The nice guys says, “Well, if you agree I didn’t do anything, what are you so mad about?”

And on and on it goes, with the nice guy wondering why people are mad at him, and also, why he doesn’t feel close to anyone, or involved in anything. As Tennyson said:

He makes no friends who never made a foe.

The nice guy serves as a great example of a major principle of human emotional life: What you’re not aware of is STILL very much in play – there is no way to make things ‘go away’ so that they’re just gone. Know this: human beings LEAK, and there’s nothing they can do about it. So, if something big is going on inside you, about yourself, about someone else, about anything – you might as well find out about it, and claim it, so that you can find another way to channel it, because it is already in the mix, all the time. Things ‘show’. In gambling, they call this unconscious self-betrayal a ‘tell’; in baseball, they call it a ‘tip’; in therapy, we call it ‘doing therapy’. A great deal of the basic working material we use in the session, comes from paying attention to tells, tips, intuitive hunches, semi-conscious awareness, and feelings.

Example:

Therapist (picking up a ‘tell’): I don’t know why, but it just feels like you’re holding me at arm’s length.
Patient: No way. Why would you say that? I came here to talk to you, didn’t I?
T: You seem mad that I just said that.
P: Are you gonna start that shit again?
T: Okay, if I’m wrong, I’m wrong.
Silence
P: Like last week – when you jumped all over me for eating in the room.
T: Hmm, I don’t remember jumping. . .
P: Yeah – all I did was pull out a banana, and you gave me the, like, death stare.
T: So, wow, after that, I guess I can understand…
P: Yeah, exactly – why I wouldn’t, you know…
T: Feel that inclined to…
P: Yeah – to be open with you, or whatever you people call it.
T: Well, I appreciate your telling me.
P: Well, we’re supposed to be honest in here, right?

So, does that mean that, every time you become aware of some inner feeling, attitude or whim, you bray it for the whole world to hear? No, of course not, but it does mean that, if it’s going on inside you, it is in play in the world already, so what you can do is practice doing what a therapist would do with it: use it for compassionate understanding of yourself, for seeing what your real motivations are (whether you like them or not), and for plotting your course forward.

After all, shouldn’t you treat yourself as well as you would a pet? Suppose you’re on a walk with your (normally) well-behaved dog. As you approach another dog and owner, he starts a low growl. Would you:
a) hit him until he cowers and stops growling

b) force him towards a confrontation with the other dog

c) give the other dog a wide berth, until your dog moves along and busies himself helpfully watering the hydrangeas in the next yard?

For the sake of your pet, I hope you chose c. Well, how about treating yourself at least as well? Instead of saying, “What’s wrong with me?”, ask yourself, “I wonder why I feel this way?”, and also, “Since I do feel this way, what can I do, going forward, to make my life work better, in the light of this new information?” Because we are going forward, not back – remember the carnival ride?

And here’s another helpful trick of the trade: the more, and the more compassionately, you pay attention to your ‘inner child’ (yes, embarrassingly, we actually do use that phrase), the more he or she will ‘come out to play’. Think of your insides as, literally, a frightened child. What would be more likely to get him/her to engage with you: yelling, judging, bullying and ignoring, or patient encouragement? This, in effect, is a lot of what a therapist does for patients: wait patiently, pay close attention, watch, encourage, make the therapy relationship a safe place to be. When that happens, ‘things’ happen. No surprise there, right?

Yes, doing therapy is being a “person whisperer”, yes, it is a lot like taming a wild animal. Same principles: observe carefully, be patient, encourage, provide structure, be kind, be safe, don’t make any sudden movements, and above all, be respectful. Once when I was still in training, I excitedly blurted out this ‘amazing’ insight to my very uptight therapy supervisor:

Wow – it’s kind of like training a dog, except there’s only one command: Stay!

Recommendation: Never say that to your supervisor. But I digress.

So, you’re working to get in touch with your real self – you’re being kind, trustworthy, not mocking, not belittling, not judging your insides (and that already puts you in the top 1% of human beings) – what, then, do you do with what you find there? That brings us to the second task of self-realization.

Expressing:

But, what if they don’t like the ‘real’ me?

I’ll just embarrass myself.

I’ll get hurt.

I’ll get fired.

I’ll get dumped.

They’ll find out I’m just an imposter.

They’ll find out I’m selfish.

They’ll find out I’m weak.

They’ll find out I’m scared.

They’ll think I’m stupid.

Well, I’m no Pollyanna – and sure, these things can conceivably happen, when you express what’s inside you. But here’s the deal:

1. Just as you developed the capacity to access your real feelings, you develop some skills to express them. You learn when, where, how, and to whom, to express what you ‘really’ feel and think.

2. You learn that there are natural ‘compensations’ at work in human life. For everything you theoretically ‘lose’ by growing, there is something you gain – something better. In this case, what you ‘lose’ (you think!) by expressing yourself is: keeping it all hidden from others, not possibly upsetting them, having them think you’re ‘like them’, not exposing yourself to negative judgments. Okay, and yes, some of these things might possibly happen.

But look at what you gain: As you begin to know yourself better, and make that knowing manifest, out in the world, you start to feel stronger inside, so that if someone does judge you harshly, it doesn’t matter as much. Since you have something inside (a self), you don’t need to get it all from outside ! As a patient once expressed it:

It’s like getting off of heroin – now, I’m not totally dependent on what everyone else thinks of me. They don’t have the ‘supplies’ I need so desperately anymore – I do! They don’t have all the power anymore – I do!

You begin to develop pride, not in being a ‘good boy’ in someone else’s eyes, but in living from the inside out, living from your own hopes, dreams, values, opinions, in your own way. And here’s yet another compensation: Lo and behold, it turns out most people don’t want everyone to be ‘like them’ anyway – they like it when others are real, solid, when there’s a “there, there”. It is attractive and appealing when other people are solidly themselves, when they are of a piece, when they are ‘put together’, when they are real. People respect someone who stands up for who he really is, his own views, his own preferences, his likes and dislikes. And, when someone embodies who he is, they allow leeway for them to be who they are. Passive, frightened, hidden people always look at others and say, “Damn – how come he gets away with that? It’s not fair!” It’s true – someone who is real, solid, self-manifesting, does ‘get away’ with a lot more than the hidden person. Why? Because, when you’re consistently yourself, the other person creates ‘space’ to allow that self.

It reminds me of two very different dates I went on, back in my single days. The first woman just sat and listened, asked me all about me and said nothing about herself, nervously offered to pay, agreed with everything I said, and generally subsumed herself to my ways. I learned, right away, that it was mostly going to be about me. The second woman, when we got to the restaurant and sat down, looked at me with an impish smile and said, “So – impress me.” What did that tell me? That I was going to have to earn it – that she wasn’t afraid to show up, that she was going to stand on her own two feet. My point is – like the animals we all are, in both cases I immediately created a “space” (psychologically) for who the other person was, and based my expectations on that, from then on. There is a wide leeway for what we’ll ‘allow’ in others, but it happens fast, and unconsciously, on the animal level. The first date had to work a lot harder, and got a lot less out of the deal.

The first woman is what I call “the universal donor” – agreeing with everything, fitting in with everyone, being all things to all people, and nothing to herself. Her unconscious game plan is that, by being all-agreeing, all-matching, she will be all-loved. But what actually happens? The other person is like a space vehicle trying to ‘dock’ onto a space station, but there is no dock, no definitive place to click into and center on. So they just continue to hover, searching for something more definitive, until they get frustrated and move on.

The social world is designed for you to “take up the space a human being takes up”.

Take it – it’s yours.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Fashion on the River

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My friend Beth once told me that her immigrant grandparents had their own cockeyed name for the great Gershwin song, Fascinatin’ Rhythm. To them it was Fashion on the River. Not bad. Topped only by my own Grandma Bernstein’s name for the great 1960 Natalie Wood, Warren Beatty movie: Splinter in the Grass (ouch!).

What’s the point? That we all freely ‘customize’ all kinds of things, constantly: if not names, then it’s ideas, expressions, gestures, intents, meanings and assumptions. We take things we hear about or experience, and we subtly shift them, internally, to fit our knowledge base and experiential data banks, but we don’t know it, and we do it all the time.

When it’s a foreign speaker, or a child, we smile and understand: after all, they just don’t ‘know’, right? My daughter for years thought – no, knew – that the word ‘tree’ was actually ‘chree’; it only came out when I corrected her spelling one day, only to be told indignantly that I was wrong, wrong, wrong. After all, to her, it was chree: she had been pronouncing it that way for years, and no one had corrected her before, so why was I suddenly changing all the rules now? It was only after I had carefully shown it to her in ‘official writing’ and gone over it with her that she was, grudgingly, willing to accept the truth.

Even word usage can be more subject to custom and setting than we realize. Years ago, I was sitting with a female patient, originally from England. As we sat there together she talked about her relationship with her mother. After a while, I casually noted, “Wow, you’re really mad.” At that, she immediately bolted upright, grabbed her purse and headed for the door. Shocked, I rose and said, “My god – what happened?” She said, “You just told me I’m crazy – what do you expect me to do?”

But how many things do we all ‘know’, that we feel are common knowledge, common sense, that are in fact highly subjective takes on reality? Everyone knows, or should know, not to talk politics or religion with others, unless they’re up for a fight. Why? Because these topics are notorious for being emotionally charged and highly personal. A comic I heard on NPR the other day said, “I came home totally exhausted. I couldn’t handle reality, so I turned on Fox News.” It’s funny because we all recognize that ‘some people’ skew reality to their liking, and only listen to, or watch, those things that confirm that reality.

What we don’t always realize is that we are part of those ‘some people’, too. Of course, what we believe, is right – right? To us, there is an important demarcation between what we are willing to fight for, even in conversation, and what they are willing to fight for. What, in us, is passion (yay!) is, in them, obsession (eeeeewww!).
A soldier falls on a grenade to save his comrades. If he’s American, he’s a hero. If he’s a Nazi, it proves they’re all fanatics.

But what about the skewing we do on a more subliminal level, below politics, religion and country? I used to work with an executive I’ll call ‘Bill’, who once told me, emphatically and angrily, that he was as good as fired. Of course I asked him how he knew this.

Bill: Easy – the Boss didn’t even bother to do it in person.
Me: Do what?
Bill: Fire me, obviously.
Me: So, you know you’re fired – how?
Bill: (Sighing impatiently) Because he actually called me, telling me we have to meet next week.
Me: I don’t get it.
Bill: Easy – when it’s just a meeting, he emails. When it’s a firing, he does it in person.
Me: How do you know that?
Bill: (More disgust) Everyone knows that.
Me: Could you be more specific?
Bill: Look – it happened to Dan that way, and Evan too – and they got the axe, so you figure it out; it’s a pattern, see?

The following week, he came in smiling.
Me: So, you seem to be in a good mood.
Bill: I oughta be – I got a promotion today.
Me: But I thought…
Bill: Yeah, well, he likes to do these things in person – you can understand that, right?

All I could do was smile. But we still had work to do: the ‘pattern’ that was actually important was Bill’s pattern of distorting, negatively, everything he wasn’t sure about. Thus, when I looked down briefly in a session, he would say, “Now, what – you got a cold?” Another time, when I mentioned that I had a short vacation coming up, it was, “Yeah – doing this stuff must really wear you out.” His family of origin had a tendency to go silent when negative feelings were happening, so he learned,

When you don’t know what’s going on, it’s bad.

Was this helpful at times? Yes, because he was always prepared for the worst. But it was also crippling to his relationship with his wife, who knew that her every gesture and sentence was subject to immediate ‘downgrading’, so that Bill could protect himself from the (supposedly) inevitable bad news. And at work, his team learned to keep anything that was unclear, away from him, so they didn’t have to ‘babysit’ him through his anxieties, which were almost always unfounded.

We finally got to the point in our work together, where I could tease him a bit about his doom-and-gloom viewpoint. One day, I had to blow my nose a couple of times early in the session. After a while, I said,

“Hey, I feel neglected.”

He gave a start and looked panicked. “Why?”

“Because here I blew my nose two times, and you didn’t even say, ‘Are you sure you should even be here today?'”

He smiled and nodded, “Okay, okay – you got me.”

We’re all doing it, all the time. When it’s me, I try to catch it if I can, and if someone else points it out to me, I try to have a sense of humor about it.

And if it’s one of my psychotherapy patients, I just smile to myself and think, “Fashion on the river”.

 

 

 

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

BK

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Today I want to talk about King Kong. No, not the Big Themes, like Beauty and the Beast, or human chauvinism, but something smaller and quieter. No, today I want to talk about BK.

As you probably remember (and I’m talking here about the recent remake, not the original film), early in the film Kong snatches Ann Darrow and, after a long and harrowing journey through the jungles of Skull Island, they finally arrive at his ‘home base’, a high, craggy cliff face. Behind it is an ancestral cave, replete with the skulls of Kong’s dead ancestors – he being the lone surviving member of his line – and in front of it is a magnificent, sweeping view of the island. Ann, recovering a bit from the horror of the abduction and the journey, sees Kong looking out over his world, and for an instant, she understands not only his loneliness in being the last of his kind, but his pride and glory in his kingdom. She touches her heart as she speaks to him: “Beautiful – it is beautiful,” and in some sense, Kong seems to understand, and to see that he is understood. She has seen, and accepted from him, perhaps the most important thing that he can offer. She has understood the magnificence of his primacy over this land, and his sadness in ruling over it alone.

Much later, when he has fled to the top of the Empire State Building, with Ann again at his side, they look down over the glittering city, for a moment safe, for a moment triumphant, and she again touches her heart and says to him, “Beautiful”, and he seems to understand, and this is their bond. He has given her something, passed on a legacy, a gift of the heart, that will live on in her, that will supersede him: his Beautiful Kingdom – BK.

At the beginning of my career, I worked for years in inpatient alcohol programs. I was the ‘hired gun’, the psychologist who came in and ran groups composed of lots of tough union guys – those who had good benefits and could afford expensive inpatient treatment. It would be thirty guys, thirty cigarettes going, in a closed room, for two hours at a time. Crazy, and fun, too – but that’s a tale for another time.

Right now, I want to talk about the wife of a particular inpatient. The program, like most, included treatment and support for the families of the inpatients, helping them come to terms with the reality of alcoholism, that it is an illness, that it can be treated but cannot just ‘go away’, that the family members need support too, to help them stop centering their entire lives around the drinker, to create meaningful lives of their own, whether they stayed or left the alcoholic.

This particular woman, I’ll call her Jackie, had the wide-eyed look of a total innocent, despite all she had been through with her husband’s drinking. There was an indomitable naivete about her, a freshness and openness to life that hadn’t been degraded by the loneliness and frustration of being the wife of a heavy drinker who was killing himself, literally (cardiomyopathy and cirrhosis), and his family, metaphorically, daily.

I ended up seeing Jackie in individual therapy some time later. Her life continued to be hard and hurtful. She eventually did work up the courage to leave her husband, but never hated him or blamed him, although this was certainly not her life plan. Conservative, sweet Jackie even had a brief get-together with a married executive in her industry, whom she still, respectfully, called “Mr. ___________”, throughout their entire relationship.

She still had to raise her children and keep a household together, on very little money. But she maintained her spirit, her joy and her spunk, regardless of the curve balls life threw at her. My ‘job’ was to teach her to be more guarded, more questioning, more realistic, more protective of her own boundaries and limits, and less susceptible to shady situations and unkept promises.

But she was doing a job, too – on me. She would spend an entire session trying to decide whether pimentos should go in her potato salad. She would ask me to explain, in detail, once again, “Why can’t people be nicer?” She would talk about a section of Berkeley where she grew up, and draw word pictures of Ozzie’s Soda Fountain, a place where all the kids hung out, that made me feel I had grown up there too, that made me agree with her that, yes, it really was a shame that the gang at Ozzie’s was not there anymore.

One Halloween, she came to therapy dressed in a witch outfit, complete with pointy hat, with orange and black cupcakes she had made, with orange and black candles in them, which she set down on my table and lit, saying, with pure joy, “Now, look how pretty these are.”

Of course, I was a young, earnest therapist, a ‘serious’ therapist, and on some level I considered all this to be humoring her until we could get to the real stuff, the deep stuff; it was all probably just resistance to the treatment, a way of roping me into her obliviousness to reality – maybe I was just colluding with her denial? How could she ever get better if she didn’t get down and muck around in the grime of reality? Of course, we talked about her past, and she came to understand some of her patterns. I once even tried to point out how the Halloween session might have been a way of avoiding reality.

She looked hurt.

I never did that again. But I did keep worrying about how she was ever going to get better if she didn’t do the ‘deep work’. But Jackie did get better. A few years later, she found and married a wonderful man who loved her a lot. She was happy – a well-deserved happiness if ever there was one. She would finally have the life she deserved.

A short while later, I got the news: Jackie had been killed in a traffic accident. A drunk driver swerved and hit her head-on.

I wondered about fate, about god, about luck, about deserving — and undeserving. I was mad, I cried and thought about the unfairness of life and all the other things that you think about when bad things happen to good people. And, in a strange, maybe selfish way, I felt cheated, too – cheated of the life she should have had because of all the work we had done together.

But as time went on, I came to realize that I still had the time we had spent together. I still had the smiling face, the courage, the unreasonable optimism, I still had Ozzie’s, and the Halloween cupcakes.

All of this was her legacy to me, her beautiful kingdom.

BK.

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.