The Opportunity of Envy

Envy has been relegated to the (category of the) taboo.  But instead of shunning it, we can learn from facing and probing this “despicable” emotion. Acknowledging what we envy offers the opportunity to direct or re-orient our lives to achieve our goals and second, to avoid acting out our feelings to the detriment of ourselves and others.

The Queen Mother in the fairy tale of Snow White and the Seven Dwarves is a tragic case of envy acted out destructively. She envies her beautiful young daughter and instead of recognizing her emotion (and directing it to an advantage), she attempts to poison Snow White.

Envy is like a yellow light signaling  “stop, look, listen.”

True we can’t always have what we envy. The loss of youth is an unavoidable deprivation.  The challenge (of la condition humaine) is to discover how to turn loss to advantage.

Holding on to envy leaves us empty, dissatisfied, and resentful, sapping us ( of the greater goal) of fulfillment. Recognizing her envy, the Queen Mother could have re-directed her efforts toward, for example, espousing a philanthropic cause, which would in turn have helped her experience purpose and fulfillment and be remembered as a “good” person.

We envy something we’d like for ourselves. I found myself envying another person’s free time. He scheduled his hours according to his own design, allowing him the luxury to read several newspapers every day.  My envy signaled that I wanted more free time, and I re-directed my effort toward this goal.

Conclusion: Feeling envious offers a valuable opportunity to examine our lives and redirect our energies.

Dear Reader, Your comments are welcome. jsimon145@gmail.com.

The Error of Assumptions

Assumptions constitute a quandry of la condition humaine. We have to assume a great deal to get through our day, yet assumptions can lead to disaster. Each of us walks an invisible tightrope, assuming just enough but not too much. The outcome depends on judgment and perhaps a smidgeon of luck.

Recently, I experienced a minor mishap when I assumed that the stylist knew what products to use on my hair. That assumption resulted in a less than ideal outcome.

Here’s an extreme example of faulty assumptions. A study of plane crashes revealed a pattern that surprised me. The usual cause of most accidents wasn’t mechanical failure but rather human error. And worse, the mistakes could be summed up in the word assumption. Because of their status, the pilots assumed they had all the answers, and as a result failed to heed the warnings from their crew. This simple matter of assuming resulted in disaster.

In his book "The Tipping Point,“ Malcolm Gladwell quotes Earl Weener who was chief engineer for safety at Boeing for many years. “Airplanes are very unforgiving if you don’t do things right. And for a long time it’s been clear that if you have two people operating the airplane cooperatively, you will have a safer operation than if you have a single pilot flying the plane and another person who is simply there to take over if the pilot is incapacitated.”

Clearly. If a pilot assumes he “knows it all,” he will not question his assumptions or allow anyone else to do so either.

Conclusion: In our daily lives, we walk the tightrope of making and questioning assumptions in order to thrive and survive.

Dear Reader, Your comments are welcome. Jsimon145@gmail.com

The Cat as Metaphor

The Cat as Metaphor

My cat, Gigi, has improved in appearance and sociability since I’ve begun to dole out her victuals in small quantities. She’s shed a pound and in spite of ripe middle age, has become more agile and personable like a kitten.

(Apparently, filling her bowl once daily caused her to overeat and become lazy and fat.)

Let’s consider the metaphor: A little struggle in life can be a blessing. A cat or a person may overindulge and develop a feeling of entitlement when receiving everything offered to them (too easily or on a silver platter).

Dear Reader: Your comments are welcome. Jsimon145@gmail.com

Of Real Estate and Relationships

Hundreds of thousands of books have been written about real estate and perhaps more, on relationships. But for all the pages devoted to them, (the value of) each of those topics can be captured with one word. For real estate the word is location and for relationships, it is communication.

Real estate value changes as locations rise and fall in desirability and popularity. Forces beyond our control, like natural and man-made disasters contribute to the unpredictability of its value. 

By contrast, we have more control and “say” in relationships. Their value increases depending on our  willingness to communicate.

Communication is complicated; even the superficial exchange of words is rarely straightforward.  To listen and really hear the words and their meaning requires the investment of time and attention.

Imago therapy founded by Harville Hendrix, author of  Getting the Love You Want, focuses on one member in the relationship hearing the other accurately. (Each person repeats the other’s words in order to correct the distortions).

An example from my practice is the wife who experienced her husband’s words as “pressure,” although he was attempting to express “concern” in urging her to undergo a test for cancer. 

Words have a greater impact on children, which is reflected in their behavior.  Because they can be ruthlessly honest and direct, children make excellent teachers in helping us recognize the innuendos of our words.

Honing our communication skills increases a relationship’s assets. Conversely, ignoring the impact of our words may result in disaster, similar to a plant that withers from insufficient water and light.

Conclusion: The value of relationships increases through investment in accurate communication.

Dear Reader, Please contribute your comments. Jsimon145@gmail.com

Paradoxical Nation

I’ve just returned from San Francisco after attending the meetings of the American Academy of Psychoanalysis and Dynamic Psychiatry and the American Psychiatric Association. More than 13,000 psychiatrists and mental health workers gathered from over 50 countries, and occupied more than 31 hotels. The smorgasbord of presentations was overwhelming. The diversity of interests, approaches and opinions seems as vast as the Titanic.

Several seminars and symposia touched on the failure of our present-day U.S. system to take care of the vulnerable, seriously mentally ill people.

Perhaps the metaphor of the Titanic has greater relevance than we’d like to think. The ship, thought to be unsinkable, too closely resembles the sinking of our humanitarian principles.

Since the 1970’s, state institutions have closed down. The fact that more funds are spent on mental health now, does not equate to better quality treatment for the seriously mentally ill.  From one public psychiatric bed for every 300 Americans in 1955, the ratio fell to one for every 5000 in 2012.  

Three times as many mentally ill are incarcerated rather than hospitalized as a result of new spending priorities, according the founder of the Mental Illness Policy Org., to D.J. Jaffe.

Mentally ill offenders in prison suffer from serious  afflictions such as schizophrenia, bipolar disorder, trauma, sexual and physical abuse. In spite of the Right to Treatment Act, they do not receive treatment but, conversely, mistreatment, misunderstanding, and neglect.  People with psychiatric disabilities are more likely to be victims of homicide and suicide than the general population.

At least part of the solution lies in establishing residential facilities staffed by mental health professionals, according to Dr. Herbert Pardes, New York-Presbyterian Hospital’s executive vice chairman of the board, who delivered the presidential address at the American Academy of Psychoanalysis and Dynamic Psychiatry.

Beyond the amount of dollars and cents, the answer is how and where they are directed. Recommendations include:

1. Mental health consultations and formal training of police officers.

2. Careful screening of incoming jail detainees

3. Diversion to the mental health system of mentally ill persons who have committed minor offenses

4. Assertive case management and interventions to assure outpatient treatment.

5. The ability of the courts to order treatment when necessary.

6. The availability of 24-hour structured care.

7. Guidance to provide support for families.

8. Funds directed more appropriately to provide adequate mental health treatment for all.

Conclusion: The general consensus of opinion of many diverse professionals is that current policies in our country have led to a regression in treating the seriously mentally ill, reminiscent of  our failings in the 19^th century.

In spite of our status as one of the wealthiest countries in the world, our paradoxical nation falls short; in 2013, without proper direction of funds, the ship of humanitarianism seems to be sinking.

Dear Readers, I welcome your opinions.

Thoughts on the Diagnostic Statistical Manual (of Psychiatric Disorders)

In May 1817,  the first mental health hospital in the U.S. was founded in Philadelphia by a group of Quakers. Known as The Asylum for the Relief of Persons Deprived of the Use of Their Reason,  today it still stands as the Friends Hospital.

When it was founded, mental illness was widely misunderstood and treated as criminal behavior. Mentally ill people were tied up, put in chains, isolated, and/or beaten.

I’m posting this week’s blog from San Francisco at the annual meeting of the American Psychiatric Association, where

almost two hundred years to the day of the founding of the first mental hospital in the U.S., the fifth edition of the DSM-5 of the American Psychiatric Association makes its debut.

The initial impetus for developing a classification of mental disorders in the US was the need to collect statistical information. In this regard, it has been a colossal failure. To my knowledge, none of my colleagues regard this manual as a tool of statistics. Rather, we use it in obligatory ways to interface with various systems like health insurance companies,

Like me, many of my colleagues regard the protection of the patient as more important than statistical correctness. We don’t choose a diagnosis that may interfere with employment opportunities, unless, of course, the individual is unable to work.  We serve as allies, not adversaries, of our clients.  Furthermore, accuracy in diagnosing a psychiatric “disorder” on the basis of phenomenology, or observation of symptoms, is subjective and changeable.

The good news is that we no longer categorize mental disturbances as “criminal behavior.” We continue to elucidate the complex mechanisms of the intricate brain in order to decipher the nature of mental suffering.

Although the DSM has attracted praise for standardizing psychiatric diagnostic categories, it has also unleashed torrents of controversy and criticism for an unscientific system that has been said to enshrine the opinions of a few powerful psychiatrists.

Other criticisms include: ongoing issues about validity and reliability of the diagnostic categories; the reliance on superficial symptoms, and the use of artificial lines dividing  diagnoses from “normality.”

In general, psychiatrists are not enamored of any editions of this manual; I think I speak for many of my colleagues when I say we regard its existence as a necessary evil at this point in our evolution. In another hundred years, it may be categorized as a relic along with the chains, ice picks and bloodlettings of previous centuries.  

By design the DSM is primarily concerned with the signs and symptoms of mental disorders, rather than the underlying causes. It claims to collect and organize them based on statistical or clinical patterns. As such, it has been compared to a naturalist’s field guide to birds, with similar advantages and disadvantages. The lack of a causative or explanatory basis, however,  is not specific to the DSM, but rather reflects a general lack of patho-physiological understanding of psychiatric disorders.

Each of us humans is unique and less predictable than any animal on earth and therefore won’t fit neatly into a diagnostic label.

On April 29, the director of the National Institute of Mental Health (NIMH), Thomas Insel, announced that the lack of validity of the D.S.M. was limiting progress in mental health research. Less than two weeks “after throwing DSM under the bus,” he issued a joint statement with APA President-elect, Jeffrey Lieberman. DSM, they wrote, “represents the best information currently available for clinical diagnosis of mental disorders.”

Gratefully President Obama is allotting funds for research on the brain. An elucidation of the neurosciences will benefit us all.

Conclusion: Good-enough psychiatrists relate to the individual, to build a working alliance, regardless of diagnostic category, and to elucidate and minimize obstacles that interfere with a constructive and satisfying life.

We have come a long way since 1817; we’re on the path of the neurosciences to discover the underlying mechanisms of  “phenomenology.” In the meantime, patience and an open mind to change will ease our journey.

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

Terrorists and Our Personal Power

In last week’s blog, I wrote about the gradual downhill spiral in which an individual becomes disillusioned, hopeless to achieve his ambition and connect to other people, and finally resorts to acts of violence, like terrorism.

But what can we as individuals do to ameliorate the situation? I think we have some options.

1.     We can become indifferent, sport the attitude that this just happens; it’s a part of life in 2013.

2.     We can foster the attitude of denial; this simply won’t happen here (to me).
3. We can become overwhelmed- that problem is too big for one little person like me to tackle.
4. We can recognize our real, individual power and take action.

 Each of us plays a role in becoming vigilant.

1.     The owner of the New Hampshire fireworks store where the Tsarnaev brothers bought explosive powder determined to train his salespeople to recognize signs of potentially dangerous individuals. Ideally other storekeepers and distributors of fire arms can rise above the profit motive, to recognize their power to prevent the perpetration of violence.

2.     We can reach out to engage people who seem to be in trouble, who seem disillusioned and isolated, whose activities and mannerisms have changed.

3. We can try to identify individuals who speak and/or write about aspiring to violent acts.

4. With the help of modern technology (cell phones, video cameras) we can record and help identify perpetrators.

Paradoxically, the same tool of communication-the Internet- that allowed homegrown terrorists to manufacture weapons can be used to prevent crimes of destruction.

Conclusion: Our human nature encompasses constructive and destructive forces and in this regard is unlikely to change. However, its manifestations continuously metamorphose. The good news is that each of us can make the world a better place with awareness and a willingness to do so.

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