Project Awareness (Our Effort-Filled Existence with thoughts for the New Year)

Given the innumerable factors that we can’t control in life, it behooves us to make our lives easier,

more enjoyable and healthier in the New Year. A small adjustment can make a huge difference.

To change and simplify our lives, we can think in terms of increasing awareness on the level of body, mind, and feelings or spirit. A change for the body impacts the mind too.

As the song says, “Little things mean a lot.”

 Here are some examples of simple changes on the physical level:

Ms. H. lugs heavy packages and groceries. Once she becomes aware of the unpleasantness of this self-imposed chore, she shops more often or pushes a cart. The change lessens the stress on her body, and she notices her mood lifts too.

A compulsive gymgoer, Mr. C. discovers ways to exercise at home on freezing days when ice covers the ground. He learns stretching exercises he can do at home.

He also focuses on the muscles used in performing the activities of daily living.  The simple act of walking involves attention to the entire body: 

*He concentrates on keeping his shoulders back and down.

*Standing straight involves holding in the stomach to engage the core muscles.

*Paying attention to the leg muscles, he stretches the Achilles tendon.

*He focuses on the foot muscles, making sure the heel strikes the pavement and the movement rolls through the foot to the toes,

*He decides to climb the stairs at every opportunity, which is, in itself, an aerobic exercise.

Confined to a wheelchair, Ms. K becomes aware that rotating her head and the joints of the wrists and the ankles,  lifts her mood.

Isotonic exercises-- that is, tensing muscles without applying weight-- can be performed many times a day.

Regarding diet, Ms. M. focuses on becoming aware of the sugar in her food. She realizes the less sugar she eats, the sweeter vegetables taste. For the “empty” calories of a breakfast of toast and jam, she decides to substitute oatmeal (to lower cholesterol) and fruit (to add fiber) and nuts (for energy).

On the mental level, a single thought can obstruct daily progress, even to the point of destroying a life. For example, blaming oneself for the loss of a job instead of recognizing the external, economic factors involved.

Along this line, Mr. P. discovers that he has the power to re-frame and replace any negative thought with a positive one and this in turn, lifts his mood.  One thought makes a huge difference on his world outlook.

Mr. L. resolves to lessen stress by not overbooking his schedule this year. He decides to reward himself with a movie after he performs an onerous task, like cleaning up his cluttered apartment,

Conclusion: Each of us can examine our lives to find ways to increase comfort in the New Year. Resolving to become more aware of our body, our thoughts and our feelings offers the opportunity for great change.

Dear Reader: Please share your thoughts and experiences. jsimon145@gmail.com

These Angels Don’t Descend from Heaven

Two disparate events inspire this week’s post: First, the news that the sign language interpreter at Nelson Mandela’s state funeral was discovered to be a “phony.”

The New York Times reports that Mr. Jantjie, who stood beside President Obama and other global dignitaries and gesticulated in gibberish, “told interviewers that he was a violence-prone schizophrenic and had seen angels descending in the stadium where the event was held.”

What purpose could this man’s actions serve? His behavior resulted in confusion and embarrassment with little benefit to him. He probably is, as he said, schizophrenic and hallucinated the “angels.” 

The second event was a recent personal experience while riding the subway. A man wondered through the car, dressed scantily--given the frigid weather--in a grungy t-shirt and low-slung jeans that exposed a triangle of bare skin on his lower back.

“I’m hungry. Give me money to get something to eat,” he said in a monotonous tone over and over again as he perambulated down the aisle. In spite of his words, his efforts seemed undirected; he stared into the air, avoiding eye contact with us passengers. As a result, no one reached into their pocket for money. Furthermore, he didn’t seem to care. I realized that he was constrained by the invisible chains of schizophrenia.

(Of course our society attempts to care for these persons. Presumably, they don’t have to pursue us subway riders. Perhaps this man’s behavior was an attempt to make contact.)

In psychiatric terms, schizophrenia is designated as a thought disorder; thinking in terms of cause and effect doesn’t come naturally. Instead, thoughts are derailed and don’t achieve a goal or reach a conclusion. These sufferers may or may not “hear voices” within their heads  (perceived as emanating from the environment). But they may not be able to join our world and, as a result, suffer isolation because of the differences in their brain and neurotransmitters, the chemicals that transport messages between brain cells.

At rare times, we need to protect ourselves from their violent behavior, but generally they are harmless.  Most violent crimes are not committed by schizophrenics, and our fear of them is typically unfounded.  In the event a schizophrenic does become violent (because of hallucinations), the harmful behavior is usually directed toward a family member.

Conclusion: An individual who suffers from schizophrenia is best regarded with understanding and empathy. We can be grateful for the ability to think and direct our (purposeful) action to serve society.

Dear Reader, I welcome your comments. jsimon145@gmail.com

The Albatross of Embarrassment

The albatross has come to stand for a psychological burden that feels like a curse, probably dating from the publication of Samuel Taylor Coleridge’s classic poem “The Rime of the Ancient Mariner” (c. 1797-98). Embarrassment can be a kind of albatross, a curse that keeps us isolated, first from ourselves and secondarily from others.

Most of us have areas of our lives of which we are less than proud. Of course, we don’t have to share every detail of our past. But placing embarrassing facts in context nurtures self-acceptance and diminishes the obstacle of self-hate.

The degree of embarrassment or feeling ashamed does not necessarily reflect responsibility for the underlying event. A victim of abuse, for instance, may hesitate to identify the perpetrator because she feels embarrassed.

In a  New York Times article titled “Great Betrayals” (October 6), the psychiatrist Anna Fels writes about people who have been deluded by others;  they discover that  they have been lied to, and in a sense, regard their lives as a lie. “The betrayal leaves them feeling “embarrassment, a sense of having been naïve or blind, alienation from those who knew the truth all along.” “Like a computer file corrupted by a virus,” Fels writes, “their life narrative has been invaded.”

A story corrupted coupled with embarrassment isolates them from themselves and others. They have to review the past to understand and accept what happened  and put the story in its proper context. Moving forward in life is hard- at times even impossible-without owning a narrative of one’s past. Isak Dinesen has been quoted as saying “All sorrows can be borne if you put them in a story or tell a story about them.”

What seems inconsequential objectively may cause a person shame.  For example, an accomplished man in his seventies felt ashamed that he did not choose his profession but was instead coerced into a vocation by his parents. He actually led a productive life and had little reason to apologize for himself.

Doris Lessing  provides a counterexample. The prize-winning author, who recently died at age 94 (“Author who Swept Aside Convention,” The New York Times, November 18, 2013) bore two children and abandoned them. While many of us would be embarrassed by this behavior, Lessing neither dwelled on this detail nor suffered shame. Instead, she connected her behavior to her early history: she had disappointed her parents who wanted a son and her mother reiterated that she had sacrificed a great deal to raise her.  Her father recounted stories of WWI, which imbued her with a sense of fatalism. She recognized that she carried within her the sense of doom “like a defective gene” and she believed that she would do her children more damage by staying with them.

In addition to understanding and placing an event in its proper context, embarrassment may be alleviated through the natural acts of aging. If we’ve allowed ourselves to be out in the world, we realize other people have their foibles, too, and we learn that we’re more alike than different in our human flaws.

Conclusion:  Embarrassment is like an albatross around our necks when it alienates us from our own story/history and in turn, isolates and alienates us from others.

Dear Reader,  Please add your comments. jsimon145@gmail.com.

Hydrotherapy: The Healing Power of Water

Over the years, several patients have related that their mood improves after a bath or shower. They may spontaneously indulge in extra ablutions after a stressful day or traumatic event.

For some of us, then, it appears that water offers a fresh outlook, serving as a natural healing technique. The universal solvent, penetrating and cleansing our bodies, minds and spirits may even substitute at times for a pill.

In the 1930’s, before the advent of effective psychotropic medications, hydrotherapy was a popular method of treatment.  Although water was observed to have a calming effect, the treatment was replaced by psychotherapy in the 1940’s and ECT in the 1950’s. 

However, it is still recognized and utilized in occupational therapy and physiotherapy as a method to relieve discomfort and pain and to promote a physical sense of well-being.

An excess in either direction, over-indulgence or avoidance of water, may indicate a disturbance with rich potential for psychological exploration.

A few patients have described showering for hours at a time. They experience therapeutic benefits and seem to feel entitled and unperturbed about the environmental impact of their ritual. Perhaps their behavior indicates (a kind of) isolation. (For more thoughts about isolation, please refer to the post of November 13, 2013).

What about the occasional person who doesn’t bathe? Clearly, we’re not usually enticed to get closer to them physically or emotionally. Assuming water is readily available, their reluctance to bathe may be a resistance to moving forward in their lives; or perhaps a feeling that they don’t deserve more than life’s grunginess. Choosing to practice habits of poor hygiene may also be a way of keeping a distance, physical and psychological, from others.

On a broader scale, the arts can offer insights about the implications of water.

The Italian movie, The Great Beauty (now playing at limited theatres in Manhattan) includes a scene in which the protagonist, Jep, a 65 year old writer, excoriates a woman braggart. She responds by absconding from the social gathering, and leaping into the swimming pool, as if to wash away the wounding insults. She emerges from the water, appearing soothed and refreshed.

Some actions cannot be washed away. In Shakespeare’s play Macbeth (c. 1603-1607), Lady Macbeth goads her husband into regicide, killing Duncan in order to seize the Scottish crown. In spite of incessant hand-washing, she can’t purge herself of guilt.

Conclusion: Although dropped from the psychiatric armamentarium, hydrotherapy remains a free and available method to calm our bodies, minds, and spirits.

Dear Reader, I welcome your thoughts. Jsimon145@gmail.com

Nurturing our Stick-to-itiveness

 “Endurance and to be able to endure is the first lesson a child should learn because it’s the one they will most need to know,” said the philosopher, educator and essayist, Jean-Jacques Rousseau, author of The Social Contract  (1762).

Endurance or stick-to-itiveness and is the quality that allows us to persist in spite of the difficulty or unpleasantness involved. Without a doubt it is a valuable characteristic. In its absence, much talent is squandered. Therefore it is important to investigate the factors that nurture, and alternatively, interfere with its development.

Ideally, the ability to tolerate frustration underlies stick-to-itiveness and is a quality we learn from our parents/caretakers, who endured the ordeal of rearing us and manifested patience in the process. In the psychotherapeutic relationship, we aim to identify the obstacles that disrupt stick-to-itiveness, but the psychotherapeutic process itself requires endurance.

For example, Mr. C. had experienced his father as supportive, but as he continued in psychotherapy, he was becoming aware that his father’s words sometimes undermined him and contributed to his self- doubt and anxiety. The change in his perception increased the difficulty of staying with the therapeutic process, but he had stick-to-itiveness and navigated this tough spot.

 Mixed messages from an overly critical father and an overly praising mother confused Ms. W. and disrupted her stick-to-itiveness. In spite of positive feedback from the outside world for her art, she struggles with warring psychological forces to consistently  pursue her career.

Factors that support stick-to-itiveness include:

1. The ability to face ourselves honestly and confront our internal saboteurs. A harsh or overly critical judge, and/or the tendency to turn to addictive behavior both interfere. 

2. Seek out people who support your goals. Conversely, avoid those who disparage and discourage.

3. Read stories about people who have shown stick-to-itiveness.

  A recent example is the American cartoonist, Art Spiegelman, best known for his graphic novel, prize-winning cartoon book, Maus.  (An exhibit of the artist’s work is currently on view at the Jewish Museum in  New York City). This story (of his father, his life in the concentration camp, and thereafter) took Spiegelman 13 years to complete, but he did not give up and trusted the fertile seeds within himself.

4.  Remember the little word “yet,” which hints of the trial and error method involved in the process. The concept of “yet” reminds us that a nascent thought may, with the passage of time and effort,  blossom into a substantial product. (For more information, please refer  to my Jan. 21, 2013 post).

We often imagine others have it easier. True or not, we have to endure our own step-by-step attempts.

5. Consider the animals. Lacking our powerful brains, they are regarded as beneath us on the evolutionary scale but they do not sabotage themselves. Hence with our “superior” intellect we have the capacity to recognize when and how we work against ourselves.

Conclusion: Stick-to-itiveness is a valuable trait that requires nurturing. Identifying factors that support endurance, including those rooted in childhood, will benefit us all.

Dear Reader, I welcome your thoughts. Jsimon145@gmail.com

(Re)Positioning the Past

We’ve all heard it many times: “You can’t change the past.” History happens once...but we do revisit it and our minds reframe significant events.    Time changes  our view of the past, and it in turn, alters and illuminates the present.

At times, a person may cling to the past as a defense to insulate against change and risk-taking. Reviewing and reframing the past may be essential when a person feels victimized by it.  A traumatic experience can act like an indigestible particle of food that requires something extra to metabolize it, like a pill or, in the following example, a course of psychotherapy.

Mr. W. was traumatized by an involuntary hospitalization and as a result, felt fearful of interacting with people.  He did not understand that he may have (unwittingly) played a role in causing this traumatic event. After several months of reviewing the circumstances, he recognized that his behavior had contributed to a misunderstanding.  (He had been lurking in the hospital corridors and refused to reveal the contents of his pockets, causing the authorities to suspect malevolence.)  Acknowledging that his actions had an impact on the outcome freed him from fear of living in the present.

Ms. K. ‘s father suffered from Alzheimer’s disease. She assumed that she would suffer the same fate. “Why bother to engage in life? Look how I’ll end up,” she said.

An article in The New York Times (November 17, 2013) suggests that we don’t need a test to see if we’ll be afflicted with this disease. Instead, we need to invest in the present and plan for the possibility by staying socially active, exercising, and purchasing long-term care insurance.

Conclusion: (Re)Positioning the past may be essential in order to engage productively in the present.

Dear Reader, I welcome your thoughts. Jsimon145@gmail.com

We’re All Diplomats

The task of a diplomat is to further relationships between nations. Each of us is like a small-scale diplomat who derives benefit from furthering relationships with people in our lives. Everyday diplomatic acts involve communication skills that are vital to determining  personal and professional success.

We walk a tightrope between expressing our thoughts accurately and taking into account the impact of our words on the recipient. If we’re too blunt, we risk alienating the other person and harming a relationship. At the opposite extreme, we may withhold our thoughts and add (the element of) inauthenticity, which leads to dissatisfaction for both the speaker and the listener.  Like a house built on a faulty foundation, the inauthentic relationship is in danger of collapse.

The case of Dr. K. exemplifies what can happen if a person is insensitive to others. He  was excluded from our social circle because he didn’t care about criticizing or hurting other people’s feelings. “He simply doesn’t play well with others,” a colleague said, explaining his disappearance from our discussion group.

At the opposite pole is Ms. Y. age 85, who lived much of her life fearing and avoiding self-expression. (Please see blog post of July 16, 2012 for more about her life). Raised by parents who spoke little and avoided confrontation, she followed their pattern. After withdrawing for years from one relationship after another, she began psychotherapy because she felt isolated. Today, she continues to hone the skill of direct communication.  As proof of her progress, when I changed her appointment time last week, she tactfully expressed her dissatisfaction and asked me to honor the original time.

However well-meaning, parents can be poor diplomats when they fail to  realize the impact of their words when they criticize their children.  Although they want the best for their offspring, they inadvertently add the elements of doubt and low self- esteem to a child’s psyche, increasing the burden of his learning difficulties and problems in the world.

Conclusion: Thinking of ourselves as diplomats involved in daily negotiating, capable of tact to further relationships, can be rewarding and productive.  Communication is  ( an underappreciated) skill that determines our success in personal and professional relationships.

Dear Reader, I look forward to your comments. Jsimon145@gmail.com

Isolation is a Real Enemy

The state of isolation, in which a person experiences alienation from his fellow humans (often accompanied by hopelessness), is a major cause of suffering. The condition may contribute greater distress than underlying factor(s) like joblessness, poverty, old age, and/or illness.

Factors origiinating from an individual's upbringing, the school system, or our society contribute. And competition, an undeniable aspect of daily life, can further work against our affiliating with others.

In addition to everday causes, any kind of trauma, including divorce, death of a loved one, loss of a job, a move to a new neighborhood, PTSD, can lead to feeling "cut-off."

Any time we don't feel “okay” within ourselves, we are in some sense experiencing isolation, which can lead to feeling detached from others.  Negative emotions of anger, envy, blame, and hate leave us feeling disconnected, while positive feelings like gratitude, hope, love, forgiveness, understanding, compassion and empathy connect us.  

Isolation is worsened by a lack of awareness, which, in the most extreme cases, can lead to acts of violence against self and others.

In late October, Mingdong Chen admitted to killing his cousin’s wife and four children. He said, “Everyone is doing better than me.” Beyond joblessness, his feelings  of isolation from humanity motivated the gruesome killings.

Each person experiences isolation in a unique way, and each of us can find different ways to emerge from our suffering and (re)connect.  A story in The New York Times (November 5, 2013) about "a woman who hears voices" relates the positive outcome.  Gratitude for the treatment she received, the ongoing relationship with her therapist, and her ambition to become a hairdresser brought her out of isolation. 

Nature and artistic activities connect us and mitigate against companionlessness. In The Nuthatch (used online in The Writer's Almanac (November 6) poet  Kirsten Dierking imagines a bird on her shoulder, a most pleasant connection that keeps her from feeling isolated and demands little in return.

“What if a sleek, grey-feathered nuthatch flew from a tree and offered to perch on your left shoulder, accompany you on all your journeys?,,,,Wouldn’t that be so much nicer than being alone? So much easier than trying to think of something to say?”

Conclusion: Feelings of isolation cause great suffering and lurk behind much human destructiveness. Connecting to a discipline, whether professional or artistic, can help when human relationships disappoint.

Dear Reader, I welcome your opinions.
Jsimon145@gmail.com

Abandoning Personal Power

My baby brother (ten years my junior) is an expert on many things, so I ask his advice on occasion. His outlook on the world differs from mine; he possesses bravado and the self-confidence to walk into any social situation.

Nevertheless, regarding a recent dilemma, I was surprised by his aggressive approach that had the potential to exacerbate the conflict.  By contrast, I hoped to solve the problem without ruffling feathers.

As I mulled over the matter, I realized that I almost yielded my sense of autonomy to my brother’s modus operandi.

How often we (especially women) accept another person’s opinion over our own (perhaps “good-enough”) judgment,  resulting in an abandonment of our personal power, I thought.

Ms. D. is an example.  An intelligent, middle-aged woman with years of experience living with a husband who lacked a good business sense, she participated in their last business venture that resulted in bankruptcy. She acknowledged that she had yielded to him knowingly and committed the same mistake again and again.

What factor (s) lie behind the surrender of our better judgment is worth asking ourselves. We could be governed by self-hate, a lack of trust in ourselves, or the simple preference to be a backseat driver.

Conclusion: Many factors may underpin sacrificing our personal power to others.  Regardless of the cause, becoming aware of this tendency gives us the choice to change the pattern. We can diminish life’s frustrations and improve relationships with others (whom we might otherwise blame).

Dear Reader, I welcome your thoughts. Jsimon145@gmail.com

The Disillusioning Process is Positive

Most of us assume other people are similar to ourselves. This is a tough trap to avoid because we can only know others through our own experience, feelings and thoughts. But to grasp the essence of another person, we may extend beyond our own (past)  experience.

Gradually, by listening and observing actions, from (hard knocks of) disappointment and dashed expectations, we’re disillusioned as we learn that the other is indeed “the other.”

The pediatrician and child psychiatrist, D.W. Winnicott addressed the challenge of the “good-enough,” mother tasked with disillusioning her child. An infant naturally assumes he is the center of the world. He must learn about other people and their needs, separate and apart from his own. (Failure to disillusion her child, can result in dire consequences like the development of an anti-social person who lacks empathy and organizes his life around fulfilling his own needs, often at the expense of others.

This process of differentiation, especially from those closest to us, continues throughout a lifetime. For example, Ms. H., a middle-aged woman, married for many years, suffered from depression. Gradually, she realized her dysphoria was rooted in anger toward her husband. She had assumed he shared her goal to pay down their credit card bill quickly, and that he’d work extra hours to do so. When he planned an expensive vacation, she realized his value system differed from hers. Her awareness of his “otherness” helped to resolve her depression and confront the matter. The couple devised a mutually acceptable repayment schedule and compromised on a less expensive vacation.

Conclusion: The disillusioning process that begins between a mother and her child early in development, continues through adulthood as we distinguish ourselves from others.  As we differentiate and  negotiate, we learn about ourselves, too.

Dear Reader: I welcome your thoughts.

jsimon145@gmail.com.

The Power of Listening

Most of us underestimate  the significance of listening. To listen is to offer a great gift. The good news: it doesn’t cost anything in terms of dollars and cents. The bad news: It isn’t easy, nor without risk.

We assume the act of listening is simple; we have ears and a nervous system capable of performing the task. But we fail to appreciate  the complexity and effort involved. Most often, we’re wrapped up in our own thoughts, and setting them aside to truly grasp the essence of another’s words rarely happens.

Early in their training, young psychiatrists are surprised to learn the power of listening. Because our culture gears us to be “active” versus “passive,” the receptive act of listening proves more difficult than offering an interpretation.

To listen differs from hearing and is more involved than perceiving sounds with our ears. Hearing happens, but listening requires concentration. The brain makes sense of the words and sentences. Listening is a learned, acquired ability that often leads to more learning.

One reason we love our dogs is that they appear to be among the best listeners. Without uttering a single word, they convey understanding and seem to be interested  Paradoxically, they can’t understand the words well enough to fit the definition of “listening.” Nevertheless, they often seem to do a better job, presumably by paying attention to the tone of our voice, our body language, and our scents.

Certainly inherent in the art of medicine is the ability to be a “good enough” listener. And we need to be aware of the fact that listening comes at an emotional cost.

My internist shared his observations. People unburden themselves to him, telling him their troubles. He notices they seem happier when they leave his office, relieved to have shared their stories. On the other hand, his mood has taken a turn to the downside because at times, he feels the weight of their worries.

What can he do?  He can realize that he has given a gift and need not feel he has to do more. It’s best not to offer advice. Since he hasn’t spent much time with them, he hasn’t collected enough details to make suggestions. In fact,  to give advice could be taken as a sign that he hasn’t adequately listened to them.

Sometimes people set us up to offer suggestions they can refuse. Or they can externalize their power on us and hold us responsible for their mistake. For example, Ms. J asked me to make a decision about where she should live. I could repeat her words, reflect back to her, or mirror, her views. But for me to make a decision would usurp the power that lies in her hands. “You’re in the driver’s seat of your own life,” I told her,  “and I trust you’ll make the best decision.”

If  Aaron Alexis, the military contractor, had been listened to and heard, he and 12 others in the Washington Navy Yard might still be alive today. (Please see my post of October 14,)

A new website www.listen.org sets a sanguine tone. The website is available free of charge to guide the listeners and those who need to be listened to. It is a valuable online resource for anyone having questions about how to help themselves as well as those to whom they’re listening.

Conclusion: Listening is an art and skill that is underestimated in value and complexity.  The website, www.listen.org. offers advice to listeners and those in need of being heard.

Dear Reader, I welcome your thoughts on this important topic. jsimon145@gmail.com.

Illnesses, Images and Insights

People who suffer with mental illness have been attracting especially negative press recently.

Let’s look at the case of Mr. Alexis, the military contractor who killed 12 people at the Washington Navy Yard last month. According to The New York Times (October 5), his mother told his bosses one month before the shootings that her son had a history of paranoid episodes and most likely needed therapy. But Mr. Alexis’ managers at the Experts Inc., an information technology firm, decided to keep him on the job. An internal company investigation has found that they did not require him to seek treatment and concluded that the “Experts” mishandled Alexis and knew more about his mental problems than it disclosed.

(Alexis had been arrested three times in three states, including once after shooting out the tires of a car in what he told the police was an anger-induced “blackout.”)

In this case (and in others) signs and symptoms exist and are ignored; what appears  “out of the blue” and unpredictable is often not so.

Another kind of mismanagement (The New York Times, September 29) is the case of Melissa Morelli, whose treating physicians said “it was not safe for Melissa to go home” from the psychiatric hospital but whose family’s health insurance carrier would not continue to pay for her to stay. ”Over the course of five months, Melissa’s mother took her to the hospital roughly a dozen times, and each time the insurance company Anthem-Blue Cross, refused to pay for hospital care.”

Melissa’s mother sought the assistance of Connecticut state officials and an outside reviewer. She eventually won all her appeals, and Anthem was forced to pay for the care it initially denied. (“Anthem, which would not comment on Melissa’s case, says its coverage decisions are based on medical evidence.”)

Few people have the tenacity demonstrated by Melissa’s mother.  By implication, many people fall through the cracks. They may not receive the necessary treatment (in spite of paying the premiums) prescribed by the practitioners!

“Patients often find themselves at odds with health insurers, but the battles are perhaps nowhere so heated as with the treatment of serious mental illness,” according to another article in The New York Times (September 29).

A federal law, the Mental Health Parity and Addiction Equity Act of 2008, was aimed at avoiding fights like this by requiring insurers to cover mental illnesses just as they cover treatment for diseases like cancer or multiple sclerosis. The federal government has not yet written the mental health act’s final regulations for insurance companies, and a crucial gap remains between the act’s intention and application.

Many agree that, five years after President Obama signed it, the law has fallen short of its goal to create parity for mental health.

Mr. K. is a former patient from my practice. He was about forty years old when he reported to the Blanton-Peale clinic for counseling. He worked for a large corporation and reported abuses that he’d observed at work. He told me, “I am so angry that if I go back to work, I will shoot up the place.”

Mr. K. gave me permission to send the evaluation to his company. Within a year, I was called to court to deliver my findings. Of course I took his threats seriously and testified that he could not return to work.  Mr. K. was placed on full disability (worker’s compensation) which paid for weekly treatment and medication. Over many years, Mr. K. continued to rage about the company and express enormous gratitude to me, although I had done nothing more than acted in the line of duty. After more than ten years, he moved to another state where he presumably continued treatment.

When I read about the above cases in which appropriate treatment was denied, I realize the impact of Mr. K’s  treatment and his gratitude: It saved his life and perhaps those of several others.

I don’t like to think we have gone backward in our psychiatric care; but the confusion of our governmental policies and the failure to reel in the abuses of the health insurance companies have led (and, sadly, may lead to more) cases of violence.

Both Mr. Alexis and Melissa are like canaries in the coal mine. Their cases point to the noxious fumes (of system failure) penetrating and polluting our environment.

Conclusion: A dire situation exists in our health care system; mental health care does not have parity with physical illness for receiving care and reimbursement. Mental health practitioners, trained to determine the appropriate treatment, have lost power (to big business including insurance companies) to deliver the appropriate care.

Dear Reader, I welcome your response to this dire situation. jsimon145@gmail.com.

Acceptance and Authenticity, a tenuous balance

The struggle to become our true/real selves is, for the most part, an unconscious effort. Early in life, we learn to curb our aggressive tendencies and refrain from hitting our classmates in school in order to gain acceptance. However, balancing acceptance with our authentic being is often a subtle and life-long journey.

To a greater or lesser degree, we conform to expectations in order to be loved and accepted by our family and our world.

If we don’t receive “good enough” acceptance in our developmental years, we’re more likely to abandon the core of our “real” being, in order to receive acceptance and/or love.

The factors that determine our courage and honesty are complex and most likely involve environmental as well as genetic factors. However the following two examples illustrate the power of the environment.

Ms. L. a married woman, felt trapped in her relationship. In order to be true to herself, she divorced. She had the courage to trust herself enough to leave her husband in spite of her family’s disapproval. Her self-confidence, in this regard, may have been related to the acceptance she knew (from her family) early in her life.

A more extreme lack of acceptance from parents and his environment left Mr. M. confused about a real sense of himself, his sexuality and his talents, in spite of the positive feedback that he received from friends and colleagues later in life.

Fortunately, our society has become more open-minded regarding sexual preference. In an earlier post  (July 29, “Life Scripts”), I discussed the writer, James Morris, who after years of marriage, realized that becoming his authentic self involved a sex change operation. (He was fortunate to be accepted as a woman by his wife with whom he continues to live.)

Beyond everyday life, the theme of many plays and movies focuses on the dilemma of authenticity vs. acceptance. 

In Tennessee Williams’s play The Glass Menagerie (please refer to the post of September 30, “Consider the Chaos”), the disapproving mother, Mrs. Wingfield,  criticizes her children incessantly and drives them to escape into worlds of fantasy. Tragically, they do not experience the (relative) contentment that results from living an authentic existence in the “real” world.

Conclusion: The psychotherapeutic relationship and the arts examine the rich and fluid space/land between authenticity and acceptance.

Dear Reader: I welcome your comments regarding this human conundrum. Jsimon145@gmail.com

Consider the Chaos (in Ourselves and our World)

David Foster Wallace, the brilliant writer who died in 2008, wrote an essay titled  “Consider the Lobster.” I say let us consider the Chaos. which is actually related to D.F. Wallace.  (His suicide resulted from his internal mental state of Chaos-depression and self-hate.)

Inadvertently, our actions lead to Chaos in many small ways everyday- accidentally taking an extra playbill at the theatre, allowing the faucet to run too long. For the most part, these instances are unavoidable and need not overwhelm us.

But I’d like to pose the question, Would our world be different if we purposefully aim to diminish the Chaos and, in its place, substitute  order?

Let us start with our intra-psychic self (of which D.F. Wallace was a victim).

Our relationship with our own psyche has the potential to add order or the opposite, Chaos, to our lives. If we accept our efforts, we add order and energy as we plug away at our daily tasks. If we declare our efforts insufficient or “never enough,” we actually may work against ourselves and become our own worst enemy.

For example, Ms. C., an artist, suffers from self hate and depression. She doesn’t feel she deserves to be successful or loved.  Factors in her early environment failed (in some way) to support her talent and healthy psychological development. She doesn’t see a purpose in her life in spite of  her gift to create art and can’t “take in” the positive feedback she receives from the outside world.

Self-hate is like an eraser at the end of a pencil that wipes out a person’s accomplishments, rendering them imperceptible to the achiever. Like the reverse of the Hans C. Andersen story of the emperor and his new clothes, we outsiders perceive accomplishments that remain invisible or imperceptible to the achiever.

For a person who hasn’t grappled with self hate or depression the “erasing phenomenon” may seem incomprehensible.

Our intimate relationships can have the effect of adding Chaos and/or order to our lives. In fact, they probably cause the pendulum between the two states to swing back and forth, from moment to moment. In the final analysis though, a “good-enough” relationship adds a sense of increased order to our internal and external worlds.

In Tennessee Williams’s great play,  TheGlass Menagerie, currently running on Broadway, the mother, Ms. Wingfield embodies the tragic example of  a mother whose words create Chaos in her offspring. She achieves the opposite of an agenda she espouses, namely to want the best for her children. In bragging about her past accomplishments, and nagging them about their inadequacies, she undermines their self-esteem, driving them into their own private world of fantasy, detached from the “real world.”

The character of Ms. Wingfield  reveals a gapping flaw:  she lacks  self-awareness. If Ms. Wingfield were aware of her unconscious motives-to diminish her children in order to gird herself (against unconscious self hate- she might choose to change her tactics. Awareness grants choice and in turn, offers order.

Chaos has been generally viewed as a negative and order as the goal, but a recent article about Chaos in the New York Times Magazine (Clean up Your Desk! by Gretchen Reynolds, September 22) complicates the dichotomy. The author summarizes a recent study at the University of Minnesota (published online in Psychological Science last month) documenting the effect of messy and neat office environments on college students. The study found that a less- than- neat environment led to an increase in creative thinking, while a neat environment enhanced productivity. In other words, an advantage can be found in both order and Chaos.

Perhaps a valid goal is to consider organized Chaos, a situation   in which we’re sufficiently ordered to be able to connect thoughts, actions, and events, yet open enough to allow novelty.

 Awareness is the master key that opens the doors to increased order.  By contrast, lack of awareness adds Chaos to the psyche, the interpersonal world.

(For me, writing a daily journal is a powerful tool that increases my self-awareness and diminishes the Chaos and disorder in my mind.) 

Conclusion: The common denominator of awareness adds order to the physical, mental and spiritual levels while the absence of awareness adds Chaos. The process, of course, is unending, as infinite (we hope) as the ebb and flow of our oceans.

Dear Reader, I welcome your thoughts on this complex cycle.

Jsimon145@gmail.com.

Our Neurons and Ourselves

We are on the frontiers of an exciting time in neuroscience. Dr. Eric Kandel, the recipient of the 2000 Nobel Prize in Physiology or Medicine, explains that the area of the brain responsible for depression has been documented (in some cases) and the type of therapy to which the patient responds can be predicted (The New York Times, September 8). He cites a recent study in which Emory University’s Professor Helen Mayberg has demonstrated that people with below-average baseline activity in the right anterior insula responded well to cognitive behavioral therapy. These contrasted to those with above-average activity who responded to medication. In other words, observing the baseline activity in this area of the brain, the right anterior insula, can predict a depressed person’s response to specific treatments.

The case of Mr. M. exemplifies how this kind of predication could be helpful. He consulted me for long-standing depression, unresolved after ten years of psychoanalysis with Dr. L.  Mr. M. functioned like a car, running on three of a possible six cylinders; he declared he’d received no benefit from treatment. Within a few months on antidepressant medication, he felt like a car in which all six cylinders fired on time. He was able to access the knowledge he had gained and change his life.

Some people suffer for years unwilling to consider a pharmacological approach. Another segment of the population thinks pharmacotherapy is the only solution. The new research opens up a vast territory of possibility that would help to determine who will respond to which approach.

Dr. Kandel concludes the following:

1.              Neural circuits disturbed by psychiatric disorders are very complex.

2.              In certain cases, markers of a mental disorder can be identified and can predict the outcome of psychotherapy and medication.

3.              Psychotherapy as well as pharmacotherapy is a biological treatment that produces physical changes in the brain.

4.              The effects of psychotherapy can be studied scientifically.

Conclusion: Some amazing recent discoveries of the brain and mind include the budding potential to predict who will respond to a variety of biological treatments that include psychotherapy and pharmacotherapy.

Dear Reader, I welcome your thoughts on the advent of this exciting frontier of neuroscience. Jsimon145@gmail.com.