thoughts about thoughts and emotions

Today I’m reflecting on some of the problems I see in therapy…. Borderline personality disorder (extreme instability in mood, self-image, and relationships, which often has emerged from early abuse experiences) reminds me of a hormonally driven adolescence: Anguish, self-destructiveness, and desperate behaviors. Thank god that wanes for most of us as we age. We replace it with generalized anxiety and sporadic dysphoria,  but with various coping skills that usually meet the challenges at hand.

A more ubiquitous problem is procrastination and the perceived lack of control over one’s own behavior. Ironic, isn’t it? The one thing people can control, they perceive that they cannot. That then can become a self-fulfilling prophecy, and a rationalization for taking the path of least resistance.

Then there are misjudgments, cognitive errors and distortions, and impulsive decision making. I appreciated a 10-10-10 rule published in Bottom Line recently: A suggestion that before acting we should ask ourselves how something will affect us for the next 10 minutes, the next 10 months, and the next 10 years.  And of course there are the two common questions asked by cognitive therapists: How likely is the event you are worrying about, and how bad would it really be? What’s the book title? Don’t sweat the small stuff, and it’s all small stuff?

darkness

I became poor; it is not the first time: I work.
I leave work; it is night: I am not expected.
I arrive home; it is dark: I did not leave a light on.

I became poor–been before.
I leave work at night.
I arrive to a dark home.

happiness

Positive psychologists want to enlighten us with the results of studies that are interpreted to mean that having greater wealth is not associated with happiness, or that what is important is not wealth but wealth relative to that of our neighbors. Do any of us care about these studies? I for one do not; at least, I am not inclined to readjust my goals because researchers tell me I will not be happy getting what I want. If I were inclined to do anything, it would be to scrutinize their measures of wealth and happiness, to see how often their definitions of wealth translate into real, liquid, disposable resources, for example. And I suspect that how happy their study participants purport themselves to be has little bearing on the difference between how I feel when I have needed resources or do not. At least positive psychologists do acknowledge that wealth makes a difference when we are very poor. It is sort of like health, or job security: We do not think about them or care too much until they are gone. We take them for granted. We may generally value what we have, but these things really come into awareness when there are serious deficits. Fortunately, it is true that we adapt to the conditions that we find ourselves in, but that is not a good argument that these things do not matter to our well-being. The subjectivity and relativity of “happiness” do not impress me. Yes, we can make ourselves happy through our perceptions. Big deal. More relevant, and depressing, is the point that this outlook has a lot to do with our inherited genetic tendencies.

Freud really had it right, however, when he pointed to the importance of love and work. Cardiologists and introductory textbooks alike trumpet correlations between being in love, feeling loved, having a confidante, being in an intimate relationship with happiness and health. Similarly, job satisfaction and happiness are highly related, and probably contribute to each other.

tree

I have a huge tree in my backyard. It grows around the telephone wires. It can be seen a long way away because of its height. I had it trimmed this summer and I can now see more of its trunk and branches, with fewer leaves on the low branches to obscure them. It is odd to think of owning it, a live thing, this tree. The grass around it is dying in spots, as it is hard to keep the lawn watered enough, but I guess the tree’s roots go deep, and it thrives.

I sat in my backyard looking at this wonderful tree yesterday, and contemplated the end of summer. Today we have to be back on campus, for meetings. Reports have to be given, syllabi distributed, classes taught. It is always bittersweet to have a long summer away from the classroom, of course. We experienced it as students all those years and now we get to as faculty. One almost forgets how to do it, the classroom thing, over the summers. And so as a student we can show up, still not up to speed, and suffer through half-heartedly at first. As instructors, we have to gear up a little more quickly. And we have to deal with the throng of people wanting to add the course, ask questions, challenge the work or evaluation processes we are imposing.

All of the summer projects that did not get done will now probably remain undone for another 11 weeks, the endless cycle of the quarter system, the blocks of time we live our lives in. Now we have to meet deadlines and get lectures done.

things always look better in the morning

Depression is supposed to be worse in the mornings, but who wants to commit suicide before the first cup of coffee? Okay, bad example. But it does seem that when you are alone late at night, contemplating that you are alone late at night, those are not good times. It is like the difference between having to go to school in the fall, or to work in the morning, as opposed to having to stay in school as spring turns into summer or at work as day turns into night. Being alone is somehow okay in the mornings.

By the way, is it a problem if the person you are in a relationship with says she is not ready for a relationship? What about if someone you are in a relationship with says she is looking for a “real relationship”? These statements beg questions that I did not know I did not know the answers to. Once a student wrote on an evaluation form that I should teach the material, not just review it. That was a good point, but at the time I was confused by it. (For one thing, I had probably made the naive mistake of assuming the students had read the assigned chapters.) And of course people do tell me to learn how to drive, while I am actually driving, so none of these things should be that surprising.

Even therapy relationships can be screwy. One of the best Freudian slips I have heard was when a patient intended to tell me that she wanted to set up an appointment to discuss transference issues and accidentally said she wanted to set up a relationship. And if you say that there is no benefit from therapy but you want to keep coming so you can see the therapist, that is too much like real life. And maybe I am becoming cynical but I have decided that it makes sense to miss the appointment that is scheduled to discuss termination. And sometimes it seems that providing individual therapy is only surpassed by providing couple therapy as a way to facilitate a break up.

What is that citation for the study that showed that depressed people view things more realistically? Was that one ever refuted in this current positive psychology zeitgeist? Why does positive psychology seem silly when one is being negative?

del potro

Juan Martín del Potro did a number on Nadal, shutting him down by allowing only two games a set. I have to admit, though, it was moving to hear the 6′ 6″ Argentine, just shy of turning 21-years-old and now in his first U.S. Open final, indicate this may have been the best moment of his life.

serena

It was remarkable. Kim Clijsters was leading Serena Williams in the U.S. Open Semifinals. She had won the first set 6 games to 4, and was ahead in the second set 6 games to 5. In the last game, Williams was serving and down 15-30. She seemed frustrated at hitting the last two points into the net. On the next point there was some crowd noise, a low-key remark by the chair ump to the crowd regarding quiet, a slight pause, and then she served and it was wide. On her second serve she was called on a foot fault, possibly or probably incorrectly and in any case unusually (though earlier in the tournament it had also been called against her). That put the score at 15-40. She then walked over to the line judge and cussed her out, and apparently telling her she would like to shove the ball down her throat. When it persisted, the chair umpire called the line judge over to ask what Serena said, and this repeated, with Serena re-approaching the line judge and the line judge returning to the ump. The tournament referees came out. It was Serena’s second code violation of the match, because she had smashed a racket on the court at the end of the first set. Now it was match point, and a second code violation costs a point, so she lost the match by default, which she accepted. She walked to Clijsters and shook her hand, patted her shoulder, and exited the court, pausing to once again to make contact with Clijsters briefly. In the postgame interview, Serena indicated she had no regrets, but also that she had not realized she would get the point penalty. Her outburst toward the line judge was extreme, walking up near her and shaking the racket at her, and warranted a default by itself. It reminded me of the degree to which another American abuses umps, though typically via sarcastic questions–Andy Roddick (Serena is from Compton, by the way–near south central L.A.; Roddick is from Austin). Williams provides a strong contrast to the temperament of Nadal, who seems incapable of anger other than at himself. Clijsters will play Wozniaki in the final tomorrow (Sunday) 9-11 p.m. Eastern on ESPN2.

The men’s semifinals are also tomorrow: Nadal will play Juan Martín del Potro first (12-4 EST on ESPN2) and then Roger will play Novak Djokovic (4-7 on CBS). The final will be Monday (on CBS 4-7 Eastern). Del Potro beat Nadal in March in the Rogers Cup on a hard court in Miami, but we can hope for a Nadal-Federer final on Monday. Nadal has been bothered by an abdominal injury (and his knees), but after the rain delay against Gonzalez in the quarterfinals Nadal came back very strong, and I imagine that he will bring his usual physicality to bear on the Fed, and complete his career slam–the U.S. Open his one remaining quest. I for one am rooting hard for the Spaniard. And how about 17-year-old Melanie Oudin, from Marietta, GA, who made it to the quarterfinals?

people

I think the delusion that I share with some psychotherapy clients and a good number of acquaintances is the narcissistic notion that I should somehow be treated special. Therefore, life serves as a continuous source of disappointment. People do not come through in the way that we hope that they would. People disappoint. People let us down. We have unmet needs. We do not get what we deserve. People forget about us, in the same way that we forget about other people. People miss opportunities to help. People abandon old loyalties and even courtesy.

Then there are days when people surprise us. I remember once when I was trying to snag a roadside oceanfront campsite in the Ventura area. I turned the motorhome around in the road too quickly and caught the rear bumper in a sand dune, bending it in half. Once I got parked in the campsite, all of the neighbors came over and fixed it for me. They took off the bumper, straightened it out, and put it back on. I was floored.

The other day a friend thanked me for several things that I had forgotten that I had done, and said such kind words to me that it lifted my spirits for the whole day. I would never have expected for it to have meant so much to me.

Monday morning my infant son stared at me happily for a long time while we sat in the dining room, and it brought tears to my eyes. Soon he will be old enough to tell me to go stuff it, but for the moment it is all good. There is the screaming for food thing, but that is okay. Happy to do it.

Seems that when we remind ourselves of the good parts…it is a lifeboat in the ocean of sadness. I guess I say that sort of thing a lot. It is probably getting old. I think I just needed to remind myself.

OCD vs. GAD

Studies have shown that anxiety disorders often go untreated. Generalized anxiety disorder (GAD), which is characterized by repetitive worry, is perhaps easiest to fail to recognize, but some variants of obsessive compulsive disorder (OCD) can be insidious. GAD is a problem involving ruminative worry, and OCD involves obsessions and compulsions. Unlike GAD, however, OCD typically involves obsessions regarding one or two particular worries or concerns, and compulsive rituals that serve to psychologically “undo” the danger and lower anxiety. Interestingly, however, the rituals may be mental ones, such as running through a certain set of statements to oneself, and therefore may be less noticeable. Therefore, if someone has OCD, it may look like GAD, but involve ruminating about a particular set of concerns in a ritualized way. People with GAD can always find something to worry about, but those with OCD have their own existing concerns to guard against.

In OCD, the content of an individual’s obsessions are often unrelated to the rituals that follow, except via superstitious belief. For example, one person believed that harm might befall a relative if he did not turn light switches on and off repeatedly. Another avoided intrusive and bothersome thoughts by sitting in a certain seat in every room, and had characteristics of post-traumatic stress disorder (also an anxiety disorder). Many have avoided high levels of anxiety by washing hands excessively after touching certain objects that are considered contaminated (sometimes merely by having been associated with a particular person), or keeping those objects quarantined.  Whereas those individuals were well aware that their problems were clinically significant, many people with GAD and some with OCD are reluctant to accept that conclusion. About 5% of people in the U.S. (more women than men) meet criteria for GAD at some point during their lives, and about 2.5% of men and women will develop OCD.

It can be difficult for an individual with worries to discern that the worries are irrational. The worries may be interfering with functioning and causing distress, but not to the extent that she seeks help for that problem. Instead, she may seek help for physical symptoms of anxiety such as chest pain, for depression, possibly ensuing from long periods of dealing with untreated anxiety, for other problems in coping with stress, or not at all.

Because we all experience some degree of anxiety, it is tempting to view all anxiety problems as being reasonable, until at some point observers such as friends and family realize that the person’s beliefs or behaviors are irrational; for example, continuously discussing particular concerns that keep coming up again and again, and being unable to let go of things that are uncontrollable or long in the past. Treatments primarily involve cognitive-behavior therapy and antidepressants (which have significant benefit for anxiety as well as depression), and are generally effective. Treatment is important in part because of the long-range health consequences of extended periods of stress and elevated physiological arousal.

jinxed

Okay, I jinxed it. Granted, I’m not west of the 5, but it is 109 F here. And the hills are on fire. Expecting a plague of locusts next.