Monthly Archives: May 2015

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

Posted on May 29, 2015 | Comments Off on “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.

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Posted in Meandering, Stories

“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