Category Archives: psychotherapy

Not Signing On

My professional associations fought for years to become approved Medicare providers, and, in January 2024, this will come to pass.

I won’t be signing on.

The primary reason, and one that is sufficient unto itself, is that I do not work with any insurance. Having a vast bureaucracy wedge itself between my clients and me, forcing me to diagnose grief as a mental disorder (for example), and to pathologize the search for meaning as life takes its confusing twists and turns, is against the principles under which I trained for this profession. To be alive entails suffering; to help those who suffer is not necessarily something that can be reduced to diagnostic and intervention codes. I can do cognitive-behavioral therapy and other science-based work without reducing the client and the heartache to a series of codes.

There are other reasons, which, if the simple fact of not working with insurance were not sufficient, would add weight to the argument.

It would limit my clients’ options. Some people want to self-pay for services, and if they have Medicare, and I have contracted with Medicare, I can no longer offer them that option. The rules would impose limits around what I can and cannot do, even when it does not cost Medicare anything.

Second, it would complicate my practice. As with all insurance companies, an online billing process for electronic submission would be necessary. My simple process of recording of payment and making a bank deposit would be replaced by electronically keeping track of what was paid, what is outstanding, what requires additional documentation or some other time-consuming and frustrating process, copays and coinsurance and deductibles.  A conservative guess would be an additional five hours a week spent in this process, five hours that I believe would be better spent with a client or two, a professional training, a walk in the park.

Finally, there is the issue of insult. I am presuming that the Medicare per-session reimbursement for either of my professions, Mental Health Counseling and Marriage & Family Therapy, will be the same as Clinical Social Workers. It is my understanding this is the case with third party payors. With this as the expectation, then, by accepting the terms of Medicare, I would be acquiescing to the bizarre notion that my work as a psychotherapist is only about three-quarters the value of a clinical psychologist’s work. Of course, there are many clinical psychologists far more skilled than I; on the other hand, after many years in the field, I do not agree that any randomly selected clinical psychologist is necessarily my superior as a psychotherapist.

It is not the money; I work on a sliding scale, based on household income, and, as you might imagine, a number of my clients pay considerably less than Medicare would.  However, the arrangements I have with God give me a sense of peace, not injustice.  A client who pays me less because she is in poverty is part of my relationship with the Lord; an insurance company that pays me less because people who do not understand my profession have, via a dart board or an indolent board room debate or perhaps a roll of the die, have decided thus is tyrannical injustice; “Because we said so.”

So, while many in my profession are exuberant, feeling validated that our profession has achieved recognition on par with other mental health professionals, I shrug. If this makes them happy, I am glad for them. I hope that the process is fair and that my misgivings will turn out to be unwarranted.

But I won’t be signing on.

Take a Break: A Shabbat Habit

I was asked to give a talk to a women’s faith group about finding peace in this busy, stressful world. The direction I chose was to invite each person to consider how they keep Sabbath. Beyond attending worship, Sabbath includes truly connecting with God, with family and friends, with creation, and a deliberate disconnection from the usual routine of life. Perhaps you don’t practice a religion and feel that some sort of mandatory day of sitting around doing nothing sounds boring and stupid.  “Sitting around doing nothing” is a corruption of what the day of rest was meant to be; think of it as a day to step away from your usual routine and focus on what is most important. If you’re having trouble figuring out what that might be, think about the people you’ve known who were dying, or what you focused on most when you lost someone you love.  The great existential crises of life tend to make some things stunningly clear.

There are entire books written about the importance of Sabbath time, of that weekly stepping back from rushing, overstimulation and noisiness.  This short column is just a little memo, to me as much as to anyone who might happen to read it and could use the reminder.

So why should anyone consistently and deliberately take a break from the routine? Here are a handful of the many reasons.

It gives you time to recuperate from overdoing. My car’s tachometer goes much higher than the engine is meant to run to function well.  It’s the same for us. We are not meant to run at “100%” 24/7.  Taking a step back from overdoing gives your body a chance to begin to recuperate from an overstressed state. A lot of people like to think they do their best work under pressure, but at a certain point, the nervous and endocrine systems will conspire to have you functioning in a way that reduces your access to your logical, analytic brain.  You probably won’t notice it’s happening, but other people will.

It gives you time to begin to take a different perspective.  Much of modern life is designed to keep us distracted and in an artificial sense of urgency.  This interferes with reflection, the deeper thinking about what is going on, where our actions are taking us, and what does and does not really matter. Put another way, it can help you figure out what is important, versus what feels urgent but is not as important.

It gives you time to focus on relationships. Whether it’s online contact with family far away, time for a walk with your loved one, a meal with family or friends, or a ruthless, hours-long game of Monopoly, a Sabbath mindset puts aside clocks and schedules and savors the time with the people we love.

It provides time for play, rest, and creative pursuits. These are all important. They are not accessories, nor does their value derive from their contributions to work performance the rest of the week.  They are part of being human and have inherent value without having to be subordinate to our work roles.

…and I, definitely, and you too, perhaps, are far nicer to be around when there’s been enough rest, fresh air, laughter, and time with people who love us.  Sabbath time helps make us whole.

That wholeness is part of holiness.  People who are too rushed and focused on work, on the “next thing,” on the next ping of an electronic device, are not able to tune into other people, to themselves, or to God.  Doing what people most associate with Sabbath – going to worship services – loses something if I show up with a rushed, preoccupied, “Yeah, okay, but what’s next?” mindset.  We need a break, a prolonged pause that lets what is important float to the surface of our attention.

If you think this sounds crazy…try it anyway.  Try to take one day a week and carve it out as a day set apart. Spend time with the people you love.  Read a book; take a nap, play games or work on a puzzle. Savor the music you’ve diligently collected. Make art. Write a poem. Go for a nature walk. Cook and enjoy a meal together.  Put your devices away except for purposeful connection with people not physically present.  Then try it the next week. Try it for four or five weeks, and see what you find.

Shalom. Peace.

Prodigal and in your face

The holy days of fall and winter have begun, with Rosh Hashanah and Yom Kippur behind us and Thanksgiving, Hannukah, Advent and the Christmas holidays closing in fast. The stores overflow with all things green, red and peppermint. This means that one of the dreaded markers of the season is also upon us. You might be thinking about the price of turkeys, or heating bills, or navigating the dynamics of family and politics, but I am thinking in particular of the seasonal outbreak of atheism and related forms of cynicism among adolescents and young adults. Except for the power to disrupt other people’s good times, I’m not sure why so many families experience the angry outburst, arrogant smirks or sullen refusal to participate in the traditional prayers and rituals of life just when it is most likely to hurt.  Other than the week of Passover and Easter, there is no time more likely to cause suffering, than the fall and winter holidays: the season seems to be a favorite target for unleashing pent-up bitterness over having been raised in a tradition of faith and culture.

So, if this has happened to your family, you’re not alone.  Over a quarter-century in the mental health field, I have had to see many families distressed at the verbal attacks, the rebellion, and the apparent determination to be hurtful. Fighting with the young person about it is, of course, useless.  Trying to listen calmly, refusing to participate in conversations that are disrespectful, and suggesting the conversation continue later (and then following up to be sure “later” can happen) are potentially helpful.  Give yourself time to calm down, seek guidance from other people, consider the direction being taken.  If the young person has decided that belief in God is a superstition, something incompatible with science, perhaps they are willing to explore this, including the substantial number of scientists who are convinced that there is a God. Perhaps they are willing to learn about intelligent design from non-biased sources.   When the attitude is not mere cynicism but actual anger, it is very painful. Sometimes the rage is about the perceived lack of choice, the complaint is that they didn’t want to participate in the faith from childhood and that the introduction into the faith, whether bris or baptism, was abusive and unfair.

A rabbi whom I consulted echoed the mental health professional’s perspective: look at what else is going on, what other issues are at hand.  Someone who has found clarity (as they see it) should be more peaceful, not angry. An adolescent or young adult who has decided that religion is just superstition might be annoyed at being expected to participate, but will not be enraged. Anger is the sign that the presenting assertion is merely the top layer. What else is going on? Why the sudden rage?  Is someone smart enough – smarter than Fr. Georges le Maitre, the Jesuit priest and physicist who developed the theory now called the “big bang theory,” apparently, by their own reckoning – simultaneously naïve enough to believe something just because some people who sound convincing said so on some internet platform? What other indoctrination have they absorbed with unquestioning readiness?

Of course, you won’t have this conversation at Thanksgiving, right after the young person drops the bomb of their atheism, or rejection of religion, or rage at you about their Baptism, Bar or Bat Mitzvah, or Confirmation. That’s the time to somehow find the patience to be, or pretend to be, calm, politely curious and willing to discuss this later.  The conversation may happen over weeks, months, or years; it may involve some third party – a religious advisor, a therapist, a wise friend who has been on the same road.

It won’t be a fun conversation, and we can’t control the outcome. By being calm, listening carefully, asking sincere questions and verifying that you understand, you leave the door open for further dialogue as well as for the possibility of a change of heart.

Changes of heart are hard to admit, and even more so in the world of social media.  If a young person adopts a position, there will be a host of online encouragers.  If the young person reports pushback from adults, there will be more voices, criticizing the adults, urging cutting off the relationship, etc.  But, if the young person announces a change of heart, some of these voices of encouragement can become accusing, vindictive, cruel. Backing out of a decision can always be hard; imagine telling your parents you’ve decided to drop out of med school to be a professional surfer.  Consider the people who go through with weddings because they don’t want to disappoint people. Even smart, competent adults foolishly move forward into situations they know are wrong because they don’t want the transient embarrassment and miserable, but also transient, short-term effects. How much harder it is for young people who haven’t finished developing a mature brain.

This means our first job, as adults, is to listen with compassion and find a way to keep the door of communication open.  This way, when the young person is ready to reconsider, or be less vitriolic, or simply have a real dialogue, it will not require they have the desperation of the Prodigal Son to take the first steps. Whenever the child takes those first steps towards dialogue and reconciliation, remember the father in the parable, who ran to meet the returning child.

The Serotonin Story

Unless your newsfeed features obscure psychiatry and psychology news, UK news, or the very limited US news coverage of the July 2022 publication of “The serotonin theory of depression: A systemic umbrella review of the evidence,” in the Journal of Molecular Psychiatry, you might not have heard this news. In a sweeping meta-analysis addressing six serotonin-based hypotheses and multiple studies, one of over 150,000 people, the conclusion has been drawn that, verifying what the senior author of the article, Dr. Mark Horowitz, noted is “known in academic circles, that no good evidence has ever been found of low serotonin in depression (Medscape, July 22, 2022).”  The evidence does indicate, in some studies, that long-term use of some antidepressants can lead to lower serotonin levels, just as long-term use of drugs that boost dopamine (amphetamines, for example) can ultimately lead to depletion and insufficiency of that neurotransmitter.

To repeat, in the academic world, it has long known there is really no substantive evidence linking low serotonin levels to depression. This is similar to the academic knowledge that marijuana, especially in its modern, heightened THC formulas, is a dangerous road to sometimes unrelenting anxiety or even psychosis.  However, since science is hard and so often inconvenient, these particular unpopular truths have usually been ignored. About one in six Americans, and about one in six English adults, are on antidepressants.  Yet the science says the rationale for these drugs – that they will fix a chemical imbalance in the brain – does not stand.  The science does seem to indicate a placebo effect, as well as some people experiencing a numbing of emotional pain, which might be sufficient to begin the work of the changes necessary to heal from depression. The researchers are quick to note that no one should stop these medications quickly; cessation ought to be done slowly, with medical supervision, because of the risk of physical and psychological ill effects during withdrawal.

Depression, as Dr. Horowitz’ team and countless other researchers and clinicians have long asserted, is a complex experience of physical, emotional, cognitive and social aspects.  It is also a rather fluid diagnosis, encompassing, as it does now in the current diagnostic manual, almost any two-week period in which sufficient symptoms are met, even when life’s events make it a completely normal response.  As I have noted in other articles, the grief exclusion for depression has been eliminated, for example. Are we, therefore, to believe that, once someone you love dies, you develop a potentially lifelong brain disease in which one neurotransmitter (among many) suddenly goes haywire?  Or is it feasible that death, or profound injury, or the loss of a job or home or friendship, etc., could cause sadness, physical pain and fatigue, and a tendency to withdraw from the very activities and relationships that could bolster recovery?

One of the interesting aspects of this study was its analysis of the very popular genetic explanation, a sort of, “It runs in my family,” explanation for depression.  Besides the scientific analysis of the large body of research indicating that that while a very small, initial study hinted this may be the case, the much larger research studies indicate it is not.  Of course, there is more to “running in the family” than genes. Some of this may be impacted prenatally via epigenetics, which helps tell which genes to turn “up” or “down” (a grotesque oversimplification; sorry) depending on environmental stressors such as severe poverty and want of food.  Then our families teach us whether the world is a safe place or not, and whether to take risks or not. Optimally, families teach us we are worthwhile, and how to make connections and corrections in relationships.  They set a life pattern in place that may ses us up for long-term healthy habits, or inflict a neglected or violent childhood that results in shortened telomeres and the prospect of an unhealthy and too-short adulthood. If the family fights dirty, abuses substances and one another, is rejected by the community via being fired repeatedly from jobs, ostracized by neighbors, and disliked by peers, the children will grow up to be unlikeable, rejected, angry and depressed adults.  There need not be any genetic component for this to be the case.

This type of adult will need to learn to heal wounds, how to develop a sense of purpose and meaning, and the cognitive skills to overcome depression. The latter includes developing the skill of interrupting and redirecting rumination, challenging and changing unhealthy thought and behavior patterns and thus changing emotions, and improving the skill of being in the moment, or, as Dr. Stephen Hayes has written, “Get out of your head and into your life.”

There are biological factors at play; anyone who believes they are suffering from depression ought to have a full physical exam, including bloodwork, to rule out medical causes for many of the symptoms of depression.  Good guidance on nutrition, sleep, exercise and natural light exposure are all in the physical realm of helping, and deficiencies in any of these areas may be sufficient to trigger the low mood, lack of energy, erratic eating and sleeping identified with depression.

There is, as can be seen, nothing here that is so complex that it is beyond the average person’s ability to understand and do.  For most of human history, the rhythm of sleep, hard work, natural light, meaningful connections with others and a strong accession to the transcendent provided a milieu in which profound suffering had both meaning and support. Our lives were designed for mental health.  This, alone, is so reassuring and empowering that one would think that this simple, ancient recipe for mental health would have never been relegated to a supporting role. Unlike the message that your brain is broken and there is nothing to be done except take this pill – which may make you suicidal, or homicidal, or cause tremendous weight gain, sexual difficulties, apathy, or moments of mania – the message of the Horowitz et al research is a hopeful and inspiring one: that it is possible to overcome the depression that threatens to crush your spirit.

Gorillas in the Mix

People who do not believe in God, or are afraid to believe in God, often make predictable assertions to support their position.  They will often start with a mocking supposition about an old wizard or some such image who sits on a throne in the sky.  Well, duh.  No mature believer takes those images literally any more than they still believe that their doll’s hair will grow back overnight, or that wishing their stuffed bunny is real will make it so.  No, we have outgrown childish things, thank you very much.

Another argument points to how badly people behave who claim to believe in God.  Well, again, no surprise.  Of course, humans behave badly; that is a big part of the whole story. Have you read our sacred books? Good grief, it’s nothing but lying and murder, greed and adultery and every sort of mischief, about from the beginning.  Adam screws up and blames both Eve and God! Before long, our partner in conversation points to the sexual abuse horrors of the modern age. There are no excuses for this. Religion, of course, isn’t the only arena with a flawed priestly class. The fact that scientific experiments often lead to no useful knowledge doesn’t keep people from vigorously asserting we must follow the science.  Some scientists torture beagle puppies and other ones discover how to vaccinate against polio and rubella.  We do not throw out the world of “science” because some of its clergy are pretty terrible.

Doesn’t all this magical God stuff just give us an excuse to not learn things? This intriguing question seems rooted in the confusion between parable, history, poetry, wisdom texts, and other types of books in the Bible.  Nowhere in Scripture are people charged with staying as dumb as possible, and many scientists will admit that the more they learn, the more apparent it is that what comprises the material world does not seem to be mathematically possible as a random series of events.  What is obvious, perhaps, to a physicist like the late Father le Maitre, the Belgium priest who first came up with what is now known as the Big Bang Theory, is a bit harder sell to regular people.

This leads to a particularly interesting argument: if God really exists, it would be obvious, and not just to Jesuit scientists.  How obvious, you might ask, and so would I.  As obvious as a Marvel Comics super hero?  Would God look like a Durer woodcut, wearing what were called JC leather sandals, and making a peace sign? Would the bad people be punished, instantly and with schadenfreude-gratifying anguish by a lightning-wielding Viking in the sky?  Despite the childish imagery, our non-believer wants to pin believers down on the issue of God’s supposed invisibility.  To believers, though, God’s existence is clear as day, although sometimes it is recognized on reflection and not in the moment. Still, God is obvious, as obvious as a gorilla in the middle of a basketball game. 

Of course, I am referring to the famous and oft-replicated experiment designed by Chabris and Simons in 1999.  Given the task of counting how often the basketball was passed between one team’s players, almost 60% of the subjects failed to see the person in a gorilla suit walk through the basketball court.

Yes, perfectly bright people stared at a short film clip, diligently counting basketball passes and bounces, and failed to see the obvious. Other scientists, around the world, have replicated this experiment with much the same outcome.  People focused on a task will ignore the obvious, even a person in a gorilla suit strolling through a basketball game. How much of a stretch is it that we miss other remarkably obvious things in our environments?

I imagine most people think they would be in the 40% or so that would notice the gorilla, but statistically, that’s unlikely.  We can’t all be above average.  More likely we all ignore, or fail to attend to, amazing things every day, selectively riveting our attention and discounting other stimuli as irrelevant or interference.  One listener’s static is another’s radio transmission.

The non-believer, and perhaps, at times, almost all believers, have some confusion about what is, and is not, God’s job.  I know I suffer with this one, too: don’t we all ask for things and view the apparent “no” or “not yet” as rejection, like when Mom or Dad once again says “no” to ice cream for dessert? Sometimes it takes a long time to see the utility of experiences, because a believer has to learn to see things, to the extent possible, through a different perspective – a God perspective. 

We will die.  That’s inevitable, and death seems to be easier for people who have made peace with the people in their lives, with God, and with at least most of the processes of aging.  It must be easier to let go of this life without too much reservation, when one has, often slowly and painfully, surrendered so much: health, beauty, quickness of body and mind, social power, loved ones, valued roles in our relationships.  Every loving mother (I am not a father and cannot speak to this) knows that our children move on from each level of parenting before we are ready to let go, and those practices of having part of life that is important to us peeled away is preparation for eternal life. Imagine how painful it must be for young people who are terminally ill or terribly injured and facing mortality, who have not had the practice of surrendering, over and over, to the losses of life.  A believer looks back over this pattern and can see, very clearly, where God was present (all through it) and how the love and compassion of God was extant in some people around them, the coincidences that were not coincidences at all, the seemingly random moments of pure, abandoned joy.

If you are preoccupied with the tasks of the day, riveted on a to-do list and the self-created commands of your bullet journal, do not be surprised if you miss the obvious, even something as obvious as a gorilla in the mix.

If this were my kid…

Advice-giving:  some therapists claim it should never be done; therapists-in-training are eager to leap in with advice before they know enough about a situation to offer it.  The stance on advice-giving has its roots in various philosophical approaches to therapy.

For those of a more psychoanalytic bent, it is the role of the therapist to push for deeper self-exploration and understanding, with that “a-ha!” process leading to more responsible, better-informed decision making.  Insight leading to action is a vital part of maturation; the alternative is an adulthood of adolescent reactivity and self-absorption.

Psychoanalytic insight may not do a frustrated parent any good at the moment they are figuring out how to handle the upside-bowl of cranberry sauce on the floor. Again.

In solution-focused brief therapy, the emphasis is on searching for times when a problem is absent or much reduced and breaking down the details of those situations, especially in regard to clients’ behaviors. This process empowers the client to realize that s/he is already equipped to deal with much of the situation(s) at hand and develop plans to do more of what already works.

This is a very helpful process, but sometimes people want a little more guidance.

Psychoeducation – teaching, basically – is different than telling a client specifically what to do. It provides information, refers to scientific data, often linking particular actions to help with problems.  Education is part of holistic counseling approaches to many concerns, including depression, anxiety, eating disorders, and problematic insomnia.

All of which brings us back to the question of advice.  I am not a new therapist, and people are not coming to see a therapist with 25+ years’ experience and some white hair so I can look vaguely concerned and steeple my fingers and murmur, “Hmmm, how do you feel about that?” when they express anger and shame over their inability to get a five year old to comply with bath and bed routines.

So, I am, at least for the moment, breaking the invisible fourth wall – the wall first broken in literature by Charlotte Bronte in the final chapter of Jane Eyre – and say, straight out, “If this were my kid…

“I would take away all electronics for at least six weeks.  Maybe longer.  Not even any television/movies unless a responsible adult is with them.”

Yes, they are going to be bored. They will be angry. If they have been playing video games, they may become aggressive and destructive – be prepared for this.  If they have been using pornography, it could be even worse. Fists and feet have gone through drywall over losing access to video games and phones.  If your child becomes hostile and aggressive (not just normally angry), it is evidence you are doing this late in a problematic process.  What are they going to do?  Play other games. Make art. Play the instrument that is gathering dust. Exercise. Do chores.  Read.  Libraries offer books, puzzles and games to borrow: no cost, little effort.  Try a family book club to introduce them to a broader range of reading.  Help them learn how to have a conversation in full sentences, complete with eye contact. The possibilities are boundless.

If they need a device for school, it can be carefully monitored and programs to limit access (such as Covenant Eyes) are available to try to control what is going on. 

“I would have them do chores.  No, ‘school is their job’ is not a good idea.  Do you want to be married to someone who goes to work, comes home, and expects to be waited on, because they did their job?”

By 13, an average, healthy child should be competent at all the basic skills of housekeeping. That means, able to clean any room without having to call in HazMat; sorting, washing, appropriately drying (read the tags), folding and putting away laundry (I give everyone a pass on fitted sheets, and yes, that reflects on my clumsiness); plan, execute, cheerfully serve and thoroughly clean up simple and nutritious meals; do most of the tasks of pet care; be able to handle trash, recycling and compost duties.  Would you want to be roommates or married to someone who can’t do these things as a young adult?  Your future daughter- or son-in-law will appreciate it.

“I would have them get an hour or two more of sleep, every night.”

According to the CDC, children age 6 to 12 need 9 to 12 hours of sleep per night. Teens need 8 to 10.  Odds are, your child is not getting enough sleep and you are already saying this is ridiculous and impossible; how are you supposed to do this?

Insufficient sleep has an almost immediate detrimental effect on brain structures and functions critical for focus, memory and mood:  factors that teachers and parents spend a lot of time complaining are deficient in children.  You know what you’re like when you don’t get enough sleep; foggy-brained, irritable and looking around for caffeine and sugar.  Your children are like that, too, except you are probably keeping the little ones away from triple-shot lattes.  If your teen has to be up for school by 6 AM, then they have to be in their room without electronics sometime between 8 and 10 pm.  The math is easy; accepting that something has to give is the hard part.  Make it an experiment to accompany the electronics question and see what child you meet after a few weeks.

“I would have them learn to use a planner.”

Unlike the early years of school, and even a lot of secondary classes, real life – adult life – requires strategic planning.  By middle school, students should be learning how to break down tasks into manageable, realistic chunks and follow those plans, adjusting as necessary.  That means writing down “Social studies test tomorrow” Thursday night is not good enough.  It means figuring out how much review needs to be done each night of the week to be adequately prepared, and adding that to Monday through Wednesday’s plans.  Even outside of school, the skill of planning is useful.

For example, many people get into power struggles/arguments/endless debates over dinner. The frequency with which this particular power struggle erupts in therapy would astound non-therapists.  I do not understand the surprise that dinner must be had.  Name a date in the future – any date – and if I am not deceased, unconscious or doing colonoscopy prep, I will expect to eat.  The need for a meal at night will never catch me by surprise.  Yet this recurring surprise is apparently part of the annoying texture of life for many families. Model the benefits of planning.  Get the week’s meals worked out, and streamline evenings.  There is an immediate benefit: instead of arguing about “what to do” and wasting two hours around it, have a quick, planned meal and then have time to do something fun, like watch a parent-approved movie together, fold that pesky laundry, and push around more pieces on the 2000-piece puzzle of a Tiffany window that seemed like such a great idea at the time.

I’d make some good memories, I’d say, if this were my kid.

That’s Confabulous!

That’s Confabulous!

Your favorite uncle entertains every family gathering with the same stories.
His listeners realize they are not the same stories. The tales shift…small flourishes are added, details are lost and later denied (“Uncle, what about the cow? You mentioned the cow in the marsh last time.” “No, no – there wasn’t a cow. It was a goat. It’s always been a goat. Why would there be a cow in the marsh?”) Emotions intensify, diminish, and intensify again; the who, when and even the where are wobbly.
Is your uncle a pathological liar?
Well, he might be.
More likely, he’s a normal human being.
Memory is not a video recorder from an omniscient position. Our memories are constructed. Because it’s imperfect – and our brains want things to make sense – we fill in the blanks. There’s a little of filling-in-the-blanks in almost every memory, and in extreme cases, it is called confabulation.
Karl Bonhoeffer, German psychiatrist and father of martyred pastor Dietrich Bonhoeffer, coined the term. Confabulation, properly used, is the unconscious attempt to fill in the blanks in memory with made-up details, identified most with alcohol-related forms of dementia. The speaker believes it’s all true – but it’s not. Brain damage causes inevitable errors in processing and storing memories, and the brain valiantly attempts to weave a story out of scraps.
Related to confabulation is the tendency to “fill in the blanks” where there is no dementia and no logical reason to do so. People make up stories about other people, ruminate on them, discuss them with their companions. Later, when the subject comes up, the remembered imaginings are woven into whatever sparse facts were originally available. Electronic media has speeded up a process that used to require substantially more time and effort. The possibility of interrupting the downward spiral is much diminished.
A nearly harmless example: last year I moved my office from the high rise where I’d been for 19 years to two parish-based offices. My old office furniture was not needed in either location, so I gave it away to my parish, where it is apparently very popular with the youth group at their Sunday night meetings. Imagine my surprise when I heard from various sources that I had closed my practice, semi-retired, stopped working…you see the drift. People took one fact (she gave away her old couches and tables) and built a story around it (she retired). I have no idea how many referrals have not come my way due to someone’s – or several someones’ – confabulous storytelling regarding my work.
Less benign are the tendencies of unhappy people to ruminate and stir in speculations, scraps of other unhappy memories, fears and grudges, creating a new and often sinister narrative about a situation or people. This seems to be most effective when done in dyads or slightly larger groups. My observation, at least, is that the more shared memories, the more believable the confabulous concoction of “truth” that emerges from the co-rumination. Motivations are attributed with no evidence; “facts” are mutually invented and, since someone else believes or remembers the same exact thing – why, clearly, it must be true.
If this has ever happened to you, often in the context of perpetually unhappy coworkers, family members or friends, you know how useless it is to fight against the creative power of two or more brains that have mind-melded a mutual mural about…you. The only useful thing one can extract from the misery is a warning against being part of that type of dismal discussion.
Even with honorable intentions, memories shape-shift over time.
Emotion tints memories. Next time you are in a generally happy mood, pull up an old memory, perhaps a time shared with a loved one who has passed. In contentment, reflect on the events of the day and the joy you felt with that loved one. Really sink into the memory. Next time you evoke that memory, it will have shifted a bit to emphasize the joyful aspects – the smile, the warmth of heart – whereas if the same memory came up when you were sad, somehow it would be tinted. You might notice that other memories that feel the same way easily come to the surface: that’s another aspect of memory. Our memories are linked by emotional flavor, not just content. That’s why someone who is angry at you seems to have a boundless recall for every stupid and disappointing thing you have ever done.
Words also shape how memories are shaped and stored. A car comes up from behind, passes you, enters your lane and, a half-mile later, ends up in the ditch. You pull over to call 911 and see if you can be of assistance. Later you are questioned about your observations. How much did the car swerve? If asked, how much did the car fishtail…your memory will subtly adjust. The next time you recall it, the film may contain a touch more veering about.
Personal beliefs and biases enter the picture, too, and help form “memories” that are less than precise. It might be as subtle as “assuming” that someone meant something and then sliding into believing that they implied it, and subsequently taking offense by something that was unsaid as if it had been a slap. It could take the form of filling in the blank in someone’s appearance or comportment based on biases. Alternately, beliefs or entire cosmologies are attributed to someone based on scraps of “evidence” and then merrily embraced as “truth.”
It’s an interesting dilemma, encompassing the Commandments (Thou shalt not bear false witness) and Pilate’s coyly avoidant, “What is truth?” False witness, after all, is not just perjury. It comprises gossip and unnecessary tale-telling, both inevitably not the whole truth, as any elementary school teacher can attest. It’s all the ways in which we might fill in the blanks, perhaps consciously but, I suspect, as often reflexively, justifying our own emotional wallow with imagined and projected details.
Isn’t that confabulous?

Every parent’s nightmare

All good parents – and most not-very-good-at-it parents – want what is good for their children. They would like them to grow up happy and healthy, to have a comfortable life, stay out of jail, etc. A few grandchildren and regular calls and visits would be nice.
Often unspoken, but definitely there, is the desire that their child not be what they might call “crazy.” It’s not my word – I’d use depressed or anxious, or having a psychotic episode – but for parents, one of the greatest fears of all is that their child grows up to be mentally ill, with hallucinations and delusional beliefs – to be out of touch with reality, to be, in short, psychotic.
Psychotic doesn’t mean “violent and crazy,” as it is so often misused. It means to be out of touch with reality, often with some sort of hallucination (hearing voices, seeing things that aren’t there, or some other sensory misinformation) and/or delusional beliefs (paranoia, which may mean being persecuted or it may mean an unrealistic arrogance, belief in one’s special powers, or that one is in fact someone of great power and importance).
And, it turns out, psychotic symptoms are a risk factor for two common substances in the lives of young people: methylphenidate, a commonly prescribed drug for ADD/ADHD, and cannabis.
The research on methylphenidate has been ongoing, in some cases for decades, and while you cannot do experiments to “prove it” (who would volunteer to try to have their child rendered psychotic just to see about a drug’s effects?), researchers scour multiple studies following up on children and teens prescribed methylphenidate, and find that 1 to 2.5% develop psychotic symptoms. That’s up to more than one in 50. The latest meta-analysis was published this summer in the Scandinavian Journal of Child Psychiatry and Psychology, using multiple studies with over 77,000 young people in all.
The link between cannabis and later psychotic symptoms, as well as anxiety, for young people has been known for years, but often studies began in the mid- to late-teen years and it was difficult to determine if those who were prone to mental disturbances were more attracted to cannabis than healthy teens, or if otherwise healthy teens were developing psychosis as a result of cannabis use. With studies beginning earlier – in 7th grade – researchers feel confident asserting there is an increased risk for psychotic symptoms within a year after a teen begins using cannabis. This is for all teens, not just those with family histories of psychotic illnesses such as schizophrenia.
What should parents and other caregivers do?
If your child is being treated with methylphenidate, work closely with the prescribing physician to monitor side effects, be honest about what you observe, and do not panic. Remember that counseling and neurofeedback, provided by experts, can help someone diagnosed with attention deficits develop skills and neurological adaptations to reduce symptoms. Seek a referral from your child’s physician.
In terms of illegal drug use…assume no “safe” amount of an illegal substance. The fact that many states have legalized or decriminalized marijuana has misled many people to believe it is “safe.” It is not. The American Medical Association and the American Psychiatric Association both have published strong positions warning about the use of marijuana.
Parents and caregivers also need to be mindful that the drugs used for ADD/ADHD, and methylphenidate as an illegal substance, are popularly misused, sold, or shared among young people. According to studies published as recently as last autumn, 5 to 10% of high school students and 5 to 35% of college students use, or have used, prescriptions for ADD/ADHD illegally as “smart” or “study” drugs. This may be regular use, or may be occasional to get through end-of-term crunches with minimal sleep. Side effects include sleeplessness, agitation, anxiety, dizziness, headache, sweating, appetite loss, elevated blood pressure, and psychosis.
Be alert for subtle changes in behavior and do not be afraid to be assertive about this. Your child’s physical and mental health may depend upon it.

To Live Long, To Live Well: The Ongoing Research

Cognitive decline – dementia – Alzheimer’s disease – senility – to lose our independence, our memories, our minds – our “selves.” This is one of our greatest nightmares. But, what if this precipice – the thing people seem to fear worse than death – is almost entirely avoidable by changing how we live?

The Alzheimer’s Solution: by Dean Sherzai, MD, PhD and Ayesha Sherzai, MD (2017) asserts that this is indeed the case. You won’t find wishes, a few convenient anecdotes and flimsy, recent research. The doctors Sherzai tie together decades of substantive research from multiple, credible sources (including ongoing Blue Zones research) and their own research and medical practice. The result of this work: a straightforward and remarkably simple (albeit not easy) recipe for long, healthy mental functioning.

Unfortunately, it requires that we do stuff. Differently. In a lot of cases, way, way differently.

Here’s a synopsis:

They use the helpful and appropriate acronym NEURO: Nutrition, Exercise, Unwind, Restore, Optimize

Nutrition: quite specific nutritional guidance – recommending a largely vegetarian diet high in specific types of nutrients.

Exercise: not just a regular appointment at the running path or the gym, the research emphasizes activity throughout the day on a frequent basis.

Unwind: Managing stress healthfully and living with purpose.

Restore: Enough good quality sleep (this is a tough one for me). There is no substitute for sufficient sleep in terms of long-term brain health

Optimize: a lifetime process, and never too late to start: complex, creative, learning and doing. While the puzzles we encourage elders to do to keep their minds nimble are a small part, greater benefit comes from ongoing learning, complex tasks, mentoring/teaching and other activities that use multiple skills.

The book, published this past summer, includes interesting case studies, questionnaires and specific recommendations to make changes as needed on a case-by-case study. It’s helpful to remember that, all over the world, there are “Blue Zone” communities – places where most people live long, robust lives free of chronic diseases and dementia – where these lifestyle choices are just “normal,” not sacrifices. At least, I tell myself it’s helpful.

My challenge, which I share and dare towards you: do some investigating on this. If you’re intrepid – seek your physician’s guidance and take it from there. If you’re a little timid, hesitant or just plain skeptical, pick one piece that’s easy to do, get the medical OK, and go for it.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

 

Posts are for entertainment and not meant to be construed as treatment or professional recommendations. If you need mental health assistance, please contact a licensed professional in your area.

Duck, Duck, Goose

Muscovy ducks are ugly.

There’s simply no getting around it. Perhaps some find them in the category of, “So ugly, they’re cute,” the befuddling phrase used to describe certain regrettable-looking breeds of dog with what seems to be a permanent, long drip of slime on their maws. I don’t see it, in either the dog or the duck.

Muscovy are also an invasive species here in west-central Florida, driving out our adorable and good-natured native ducks. Thus, they are unwelcome both in, and by, appearance.

During an Emmaus retreat at the Franciscan Center in Tampa, I was able to observe a female Muscovy along the river last weekend. She was waddling along, looking into the river on her right and then to the ground on her left, seeking food. She was followed closely by one, then two, then four, large, ugly and showy Muscovy males. She seemed oblivious. They were posturing: just short of chest-bumping one another, fluffing up their feathers, strutting in circles and then, realizing she had waddled on further ahead, scuttling up closer to the object of their desire before devolving into posturing observed only by one another, and me.

Ms. Muscovy did not feel obliged to wear shorter feathers in her nether region or walk on her webbed toes to gain their attention, and indeed, it was apparently unnecessary. She had the power of her femininity, and that was sufficient. God knows how large the flock of males out-strutting each other got before she made her selection; the bells rang and I hurried off to join my fellow retreatants for Morning Prayer.

Flash back to the 1980s, when wearing brassieres over one’s clothing, instead of under, was all the rage for a few unfortunate years. During a lunch conversation, a male colleague (middle-aged, recently divorced and apparently adjusting with difficulty) mentioned his amazement at seeing this while out in a nightclub. A few of the females opined we would never do such a thing. If we weren’t married, he said, and had to be out there, competing for male attention…whoa, whoa, WHOA. A man, I said, for whom I was to “compete” by wearing my underwear over my clothes would not be the man for me. My female cohorts agreed. Divorced-dude was amazed.

Alas, times have, apparently, changed. Somehow the power to vote, own property, and be paid the same for the same work (let’s not go to where we compare part-time clerical staff with chemical engineers and whine about salary differences, okay?) seems cast aside for the “power” to wear vagina-hats in public, insist that tights are business trousers, and gain fame by posting indecent pictures of oneself to (anti)social media.

In our little yard, I cannot, from a respectful distance, tell Mrs. Bunny from Mr. Bunny, but apparently they can, and so things work just fine. Mrs. Cardinal is subtle compared to her (to human eyes) flashy husband, but trust me, when the six or seven species of birds – almost all larger – are sharing the seeds I have flung onto the front yard, it’s little, softly hued Mrs. Cardinal who commands attention and sets the rules. Mr. Cardinal does not seem to have any objections about being partnered up with his gently-toned, energetic little mate. Likewise the pair of black snakes, the ever-expanding clan of blue jays, or our resident crows, Poe and Annabelle Lee, and their hapless but fun-to-watch adolescent offspring: all seem content without the females doing strange and torturous things in a craven attempt for male attention.

Why are humans so singularly dysfunctional when it comes to male-female relationships? Can we blame it simply on the Fall and the impact of a long history of bad choices that have turned us slowly away from what we could have, and might still be, towards this strange situation in which much of our culture finds itself?

For almost three decades now, mental health professionals have dealt with body-image and sexuality issues created by a pornographic culture so pervasive that too many young women believe they should engage in sexual activity whether they feel like it or not, and many young males have incurred physical damage on themselves due to excessive masturbation with porn as the stimulant. Conditioned to images on electronic devices, a normal, living female is just not as attractive and too much trouble. We’ve all, no doubt, heard of the teen magazine that explained sodomy in how-to terms. In my work, this isn’t some abstract issue; I listen to young women wrestle with their discomfort and shame over what they feel obliged to do and the fear that their hesitancy to engage in impersonal sexual acts means there is something “wrong” with them. I help couples whose relationship has been torn apart by the husband’s pornography addiction and disengagement from his wife.

I used to pity my male college students, assuming the heterosexuals had their ability to focus on psychology (endlessly interesting to me but, I realize, not to all) cruelly challenged because, for a healthy straight young male, the proximity of female peers would normally be distracting. Now the female peers are often dressed in revealing clothing. I assumed (naively) that this placed an unfair, even uncharitable, if you will, burden on the males. Now I wonder. I wonder if, drowned since childhood in a flood of hypersexualized images, the presence in the next seat of a young woman with her breasts pushed up to her collar bone is…nothing. Now I feel sad about that; they are both missing something about the joy of being human: they have lost the capacity to appreciate one another.

He may be sentenced, until he works to change it, to a life of seeking ever-more extreme forms of sexual stimulation, and she will be reduced to claiming that her power comes from the right to have sex indiscriminately and wear unflattering pink hats in parades.

Meanwhile, Ms. Muscovy is enjoying the riverbank and may eventually pick some posturing, squawking, ugly drake from among her admirers.

The ducks have it figured out. Guess who gets to be the silly, sad goose?

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2017

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.