10 items or less sign in grocery store

Eshrink and Editor – Point/Counterpoint? | Everyday Irritations | The 10 Items or Less EXPRESS Lane

Hello Loyal Eshrinkblog readers!

This is Maggie, daughter and editor of Eshrink’s blog. We’ve been on hiatus with technical difficulties, both computer related (more detail in a future blog post I’m sure…here’s an oldie but a goodie about computer stuff) and health related. Since Eshrink has been using his hospital stay and convalescence as an excuse to slack off, I decided I better find a way to get us jump started before all of his loyal readers abandon him for YouTube! In his defense, he tells me he is working on a masterpiece (the one he already finished once, but the computer deleted it)…in an attempt to lighten the load and return to our Curmudgeon Roots (a.k.a., a safe place to complain about “first world problems” in hopes we can all find some common ground, deeper meaning, and comfort), I’ve taken on a point/counterpoint about the EXPRESS LANE…specifically, violation of the Express Lane/Line…whatever

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Today’s topic: The EXPRESS Lane (note EXPRESS in all caps). We’re talking about the 10 ITEMS or LESS lane at the grocery store. 

I was at the grocery store today on my lunch break when I had to face the ugly truth: I exhibit rule bias.

I race to the checkout lanes, five items in my hand, and when I turn the corner, the line of people stretches across the aisle into the produce section! I have my coat on, balancing my items in my hand because who would need a cart in the express lane? Apparently, people who can’t read; people who don’t think the rules apply to them; people who think their time is way more important than anybody else’s; and people who just don’t pay attention. Anyway…the non-express line is longer than the “express” so I evaluate the situation.

Side bar: the lesson I’ve learned to successfully navigate these “First World Irritations” is to conduct mental gymnastics in order to make me feel better about said irritation, excuse other people, and somehow make myself feel like a kind person who is helping the world. The mental gymnastics can be exhausting…more detail below.

Okay…back to the grocery store and the rule bias…or even “bigotry” I mentioned earlier. In front of me…WITH THEIR CART…was an elderly couple. I didn’t want to be too obvious as I stretched my neck to inventory their cart, but I counted at least 20 items. In the past, I would have simply said to the Express Line Delinquents, “Since I have less than 10 items, do you mind if I jump ahead to check out?”

Side bar: However, I waive that option if I’m not in a hurry and want to make myself feel like a good person by saying to myself, “I’m not in a hurry, I bet they have to pick up kids, get to work, are having a bad day, on their way to visit someone at the hospital…” it goes on and on.

I had a colleague who told me he viewed behavior above (in addition to politely telling loud talkers in a movie theater that their talking is making it hard to hear the movie) as me being confrontational. Really? Confrontational? I just feel it’s way more productive and actually nicer than muttering under my breath, “How rude! Who do you think you are holding up the express lane!” I find the annoyance leaves much quicker after I say something to the person in a polite/professional manner. I’ve had different responses in the past that range from “Oh my gosh…I’m so sorry…I didn’t see the sign” to “Sure…go for it” and only one or two snotty, “I’m in a hurry…I don’t have much more than 10” or the “What are you…the line-Nazi” look accompanied by an adolescent eye roll.

But during this “express line breach” the fact that I was in full hot flash, in a hurry, and irritated did NOT prompt me to correct these express-line violators. And that’s when I realized, I’m a bigot (if they wouldn’t have been a cute, elderly couple and it was a yuppie-looking GQ guy, or Escalade-driving stay-at-home mom, I would have felt obligated to enforce the 10 ITEMS or LESS RULE and “make a scene” as my dad used to threaten). Instead, I decided to ride it out…mentally telling myself that the cute elderly couple might feel awful if I pointed out they were breaking the rules, also…it’s a lot more difficult for them to stand in a long line than me, and finally it’s just not that important in the big scheme of things. Once I decided to accept the breach, I felt better and low and behold, a cashier opened a new line and waved me over…

DAMN…another dilemma! When a new line opens, you always send the people IN FRONT OF YOU WHO HAVE BEEN WAITING IN LINE LONGER THAN YOU to the new line…or at least give them the option. But I just didn’t have the time! I rationalized that the new line opened as my reward for the mental gymnastics I successfully completed to fully accept the Express Lane Rule Breakers with a good heart…but that’s how it starts…it’s a slippery slope as they say 🙂

Eshrink: I’m turning it over to you. Express Line Violators is the subject. What do you think is the best way to handle them? The rules are clear, the penalties are severe…treat them all the same? We are nothing if not a grocery store of rules? Maybe some passive aggressive tactics are warranted? Write below the line please.


ESHRINK EXPRESS LINE RESPONSE

On a planet of 7.7 billion inhabitants, it is clear there will be many different opinions as to what is acceptable behavior.  Amongst the animal kingdom, there appear to be unwritten rules which have evolved in the service of the survival of each species.  Since we humans with our big brains can find infinitely more ways to screw things up, we have developed millions of rules, most of which are ignored.  Nevertheless, there have been many examples of the serious consequences to a society when there is no enforcement of rules as we now see in Central America, and even worse when rule makers and enforcers are corrupt leading to all kinds of atrocities.  Our own country is now experiencing a crisis of sorts over the interpretation of rules.

 

As a matter of fact, for many, the reason for rules has been long forgotten, and some seem to enjoy circumventing them whether by robbing a bank or cheating at the check out line.  I must admit there is something satisfying about “getting away” with something and there are instances when civil disobedience is honorable.

 

Although I consider myself to be a follow-the-rules kind of guy and would never consider violating the 10 items or less rule, I do recall  pleasurable feelings regarding my violation of the “though shalt not steal” rule about 75 years ago.  My friend Bill and I with malice aforethought carefully planned a midnight raid on the cider press In Jake Davis’s apple orchard.  Although our presence was announced by Jake’s coon hounds, we managed to escape with a gallon jug of freshly squeezed cider which we proceeded to drink under cover of a near by haymow*.  It was one of those clear crisp October nights when the grandeur of that night sky with its limitless canopy of stars was overwhelming, and one could hardly doubt the existence of a God.  Nevertheless, we wallowed in our sinfulness without thought of retribution and quibbled over who was drinking the most cider.  Now , I can attest to the fact that a half gallon or so of fresh apple cider can have a dramatic effect on an adolescent colon.  This can  be especially disconcerting when said adolescent spends much of a cold autumn night perched over a privy* hole.

 

You may be wondering what this has to do with the question at hand and the answer is probably nothing. However, I do remember thinking that I would never ever steal anything again.  Could it be that by extension, that mantra includes other forms of ethical behaviors, leaving me stuck with the compulsion to heed the 10 or less item sign?

 

Regarding Maggie’s query as to how to handle the problem, I have no answers, but as usual can offer a complaint.  Rules are made to be if not broken as some would have it, at least to be tested (a la the Trump response to congressional queries); consequently if there are no penalties rules are unenforceable and therefore worthless.  If a store makes a rule, they should be prepared to enforce it otherwise, as Maggie points out, they are complicit.  As for confrontation of the offender- probably not a good idea in the era of concealed carry permits.

 

What’s Love Got To Do With It?

If you have read any of my recent blogs, you may have noticed the following quote from Lao Tsu, an ancient Chinese philosopher: “to be loved deeply gives you strength, to love deeply gives you courage.”

 

The wisdom of those words explain much about behaviors I observed and attempted to treat as a psychiatrist. Feeling unloved was indeed a common complaint and the cause of a great deal of pain and misery.  Without the experience of feeling loved one is weakened, and thus may lack courage to face even the ordinary demands of life.  This may progress to a conviction that one is not only unloved but unlovable, resulting in self-loathing, depression, thoughts of harming oneself, and according to Anthony Storr, may generate violent aggression which he says is: “a complex mask for a repressed longing for love.”

WHY DO THEY DO IT?

There seems little doubt that we are now in the midst of an era of increased incidence of depression and unsanctioned violent aggression. Mass murders by otherwise ordinary people of all ages are now occurring at a level never before seen in the U.S.  Most perpetrators have a history of relative anonymity.  Neighbors usually describe them as quiet and unassuming, a person to whom they would speak to in passing but never engage in conversation.  Acquaintances when found describe their relationship as superficial, and express profound surprise that the person was capable of violence.  There is little evidence of any closeness let alone intimacy in their lives.  Could such horrible deeds be as Storr said: a result of anger over the lack of love in their life?

THE THIRD MOST COMMON CAUSE OF DEATH

There has been an alarming increase in the number of kids diagnosed with clinical depression which is not limited to those who are disadvantaged or abused.  A recent Center for Disease Control and Prevention survey of young people between the ages of 10 and 24 years resulted in shocking statistics. They report 4600 lives lost each year by suicide (most experts feel the actual number is higher due to a tendency for many to go unreported), and that rate has nearly tripled since 1940.  Emergency rooms throughout the country report 157,000 young people treated for self-inflicted injuries each year.  In their Nationwide survey of high school students, the CDC reported 13% admitted to seriously considering suicide, and 8% actually made an attempt to take their own life.  The report goes on to list a number of risk factors however; at a time in their lives when they are dependent on others to establish an identity and self-worth, it seems to me that relationships deserve to be at the top of the list.  Indeed, many teen-age suicides do implicate such problems as precipitating factors.

MORE OF THE SAME, ONLY WORSE

Rollo May in his 1960’s book LOVE AND WILL, says  “Our culture pushes people toward becoming more detached and mechanical,” but that observation doesn’t come close to what we see now that the digital age has enveloped us.  The addiction of our children to cell phones and other electronic gadgets contributes to their alienation.  Consolidation of schools and overcrowded classrooms have made it easier for kids to fall through the cracks.  Social media has become a convenient vehicle through which kids can be disparaged or bullied.  They are often attacked where they are most vulnerable i.e. their lovability consequently; the common theme “no one likes you” can be devastating to developing minds.  Now we hear there has been a dramatic increase in suicides in recent years among not only teenagers but pre-teens.   Although there is no proof of a link to feeling unloved, logic suggests there often is.

DON’T CARE? SURE YOU DO

There is ample evidence that we are herd animals, consequently; it is not surprising that I spent many hundreds of hours listening to patients with relationship problems, for when people are so very important in our lives, dysfunction can present problems.  Although we often attempt to comfort ourselves by professing to not care what others think, in truth we usually do care more than we would admit.  During all those years I spent in the shrink business I must have seen hundreds of people who were contemplating suicide or had actually made serious attempts.  Although there are obviously many factors that may lead one to seriously consider killing oneself, I recall often hearing: “Nobody cares.”

DO WE KNOW WHAT IT IS?

It would indeed be presumptuous of me to attempt to explain what love is all about.  It has certainly been a popular topic for poets, philosophers, musicians, theologians, and artists, through the ages.  The stories of wonder, ecstasy, and tragedy associated with love resonate in pop culture to this day. There have been myths, and legends and attempts to define love by categorizing it (erotic, agape, filial, spiritual, etc.), but the force responsible for this peculiar phenomenon remains a mystery to me.  My favorite definition of the term is from psychoanalyst Harry Stack Sullivan, as follows:

The validity of such explanations is confirmed by the intense love relationships experienced by warriors throughout the ages.  The myriads of reports of heroic efforts put forth by battle hardened veterans to protect their comrades, even risking or forfeiting their lives in the process gives credence to Sullivan’s ideas.  Indeed, when questioned as to why those who would in other situations have been considered unlikely heroes are questioned about their behavior, they will acknowledge that it had nothing to do with military or political beliefs, or patriotic fervor, but rather their devotion to their buddies (“No greater love hath man……”). That phenomenon has not been lost on those charged with training the military, consequently; camaraderie is encouraged and interpersonal dependency guarantees bonding.  One cannot wonder as to the part that the loss of relationships, solidified by the heat of battle, factor in the alarming rate of depression and suicide among our veterans.  Many report they worry about their comrades who are still fighting which may  also account fir the significant number who volunteer for additional tours of duty with their old outfits in spite of the known horrors they will likely confront.

WORTH THE TROUBLE?

Obviously, love has been a major contributor to the success of the human race.  Humans isolated from their kind rarely survive.  Sullivan posits that love is caring for others as for oneself and the old Chinese dude says as a result of love for each other, man gained the strength and courage to take on woolly mammoths and those guys in the next village who were trying to muscle in on their territory.  It is the latter part of that statement that has caused a lot of problems.  We seem to know a great deal as to the effects of love, but little about from whence it comes.  The neuro-physiologists and brain mappers continue to look for specific love loci, and geneticists will likely say that it is in our DNA, but I doubt that CRISPR will ever be able to install a love gene.  It would be great if such could be done, for we currently have little treatment for those who seem incapable of love, i.e. psychopaths.

I KNOW IT WHEN I FEEL IT

It may be that love is like the dark matter of our universe in that we know it exists and feel its effects even though we are unable to see, hear, smell or touch it.  Could it be that love is simply a product of evolution?  If so, how could we have survived long enough for natural selection to kick in?  The creationists insist that God snapped his fingers and we instantly appeared on the scene fully equipped.  Atheists on the other hand think the whole thing was an accident.  Others see love as spiritually endowed.  There are 4300 religions in the world with Christianity leading the pack and Muslims close behind.

WHAT ABOUT RELIGION?

Since I have been reared as a WASP, I have very little understanding of the other religions of the world or in particular where they stand on the love thing, but am pleased that love is at the core of Christianity.  When it comes to Biblical scholarship, I am a dunce, but I do find inspiration in those first few pages of Corinthians which are all about love.  The first 2 of the 10 commandments are also about love, and love is said to be the greatest of all, never fails, and is even better than faith or hope.  There is also that thing about loving your enemies and turning the other cheek, but most of all were the teachings of Christ who was all about love.  Of course, many see an inconsistency in a loving God who lets crappy things happen in spite of being all-powerful.  Since Christians are people it is not surprising to find they have found ways to subvert the love philosophy, and resort to violence with all sorts of rationalizations.

Loving others as much as oneself is a great idea, but very difficult to implement on a grand scale.  Excessive cheek turning is guaranteed to result in a lot of broken jaws.  Nevertheless, there have been many attempts to use love as a mechanism to provide peace and tranquility, which has been met with success in some instances.  In a rare instance of wisdom, our government eschewed the policy of gathering the spoils of war after WWII.  Instead they initiated a policy aiding even our enemies to rebuild their virtually destroyed countries which lead to their becoming our closest allies.   Of course, I was also around during the “love ins” of the sixties.  Although they seemed to have emphasized the erotic rather than agape version of love, they did call attention to long neglected human rights issues and war mongering.  There was also Nelson Mandela and Martin Luther King who both emphasized reconciliation and learning to love each other.

We certainly could use more love in this world, but the chances of EVERYONE following the Golden Rule seem to be unrealistic.  Nevertheless, when I look back on our history it seems there has been some progress in the love department with more emphasis on inclusivity and acceptance.  Although it may seem that love is in short supply, it is alive in well and we can only hope the day will come when The Golden Rule is ever present. Even as millions of our fellow humans face horrors each day, there are millions of people who devote their lives to helping others individually and through organizations, which gives credence to the dictum that love never fails.

Corinthians 13:4-8 gives tells us everything we need to know: “Love is patient, love is kind. It does not envy, it does not boast, it is not proud.  It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs.  Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres. Love never fails…”

PART III: CONFESSIONS OF A RECOVERING MALE CHAUVINIST

This morning I saw Theresa May, the British prime minister, on television discussing the recent terror attacks on her country. Prior to her, Margaret Thatcher (the Iron Lady) held forth as the country’s leader all during the eighties. Angela Merkel is the highly regarded prime minister of Germany; Canada has a female Prime Minister; and we recently came within a hair’s breadth of electing a woman President. Nevertheless, at last count there were women heading 9.1% of countries worldwide and 4.6% of fortune 500 companies with female CEOs.

In my last blog, I discussed the significant progress women have made towards gaining equality and respect, but these numbers tend to confirm that they have a great distance to travel. The evidence presented also points to major differences between women and men both in the way they think and the way they relate to others. I reported on research which demonstrates that some of these differences are evident at birth. My interest in this subject originated from the random speculation on what the world would be like were it operated by women, which of course raises the question as to the effect these female qualities would have on their ability to lead.

TELL ME IT ISN’T TRUE

My daughter, Maggie, thinks that men lead by controlling while women seek to find consensus. There can be little doubt that women are more nurturing than men, and studies I mentioned in a previous blog confirm that they are also more empathic and observant of others’ communications. By contrast, she feels men are not as open to suggestion, are dogmatic, less tolerant, and less patient. You may be thinking “Oh sure, just another man hater,” yet a study of 7,280 leaders published in the Harvard Business Review shows women scoring higher than men on 12 out of 16 competencies thought necessary for good leadership. More surprising was the fact that the gap was even wider between men and women in upper levels of management.

ITS NOT MANLY TO ASK FOR DIRECTIONS

This latter factor could be explained by results contained in the same study indicating that women continue to consult with others as they reach a higher status, while men do not seek other opinions as they climb the corporate ladder. Perhaps men are more likely to become satisfied with their accomplishments as they reach the top of the corporate chart; consequently, they don’t feel the need to look for input, new ideas, etc. Or it may be that as men reach the top of their game they don’t like to admit they need help, whereas women are probably less likely to see inclusiveness as a sign of weakness or incompetence.

YAK, YAK, YAK

We guys know that on average women are more talkative than men, and that most women seem to hunger for conversation. It makes sense that with all that practice they should be better listeners. In a prior issue, I quoted a study indicating that females are more attentive and interested in both verbal and non-verbal cues, even at birth, so little wonder that in this study they were found to “communicate powerfully and prolifically.” As one would expect, women scored well above men in the “nurturing competencies,” i.e. building relationships or helping and inspiring others. What was surprising is that they also beat out their male counterparts on categories traditionally ascribed to men. For example: the largest disparity was with the competency “takes initiative,” which seems to negate the idea that women are too meek and passive to lead. We men can take heart that we were victorious in the category “develops strategic perspective.” Even so, I suppose those women’s libbers would say this means we guys can’t see the forest for the trees.

MITE MAKES RIGHT

Men have evolved to have superior upper body strength, which adapted them to be hunters and warriors. This has also made men uniquely qualified for many jobs in the industrial age. Women, on the other hand, are less physically powerful but posess superior manual dexterity, adapting them for infant care, food preparation and making clothes. Now, society is on pace to virtually eliminate the need for physical strength as robotics take over the jobs which required muscle. Conversely, most jobs, if there are any, will involve pushing buttons and fine tuning instruments. Even the warriors of the world will be out of work, for all the strength needed to fight a war will be the ability to look at a screen and push buttons. In that regard, women’s fingers are known to be more facile than men’s.

NEVER FEAR, WE CAN DO JANITORIAL WORK

If the foregoing assessments are correct, male employment prospects may soon be in jeopardy. In order for women to take over the world, they would also need to take the lead in politics. In addition to the aforementioned qualities needed for leadership, effectiveness in government requires consensus building, another talent in which women are said to excel. It has not been so many years ago that the thought of a female president of the United States would have been laughable, so lookout guys—they are gaining on us! All those strategies which we have used so effectively in the past to keep them in their place are not likely to be effective much longer.

NOT FIGHT FOR OUR COUNTRY?

In the event that it comes to pass that women are able to make use of their advantages in a digital world and become the top dogs, would the world be different and, if so, in what way? In pursuit of the answer to that question, I queried my favorite expert on the subject of women. Barb replied without hesitation that there would be no more wars. If that is true then she has answered the question of how to eliminate the most horrible activity of man—an answer that has been right under our noses for thousands of years. That idea seemed overly optimistic to me, but the idea certainly was appealing. Imagine a world without defense budgets and the ability to use resources to benefit people rather than to kill them. Of course there would be a down side in that the military industrial complex would no longer be needed, and that could cause some economic problems. Unfortunately, we cannot be sure that all women share Barb’s anti-war sentiments. After all, there was Joan of Arc, and women in the military continue to lobby for more involvement in combat roles; although, in general, men seem attuned to the so-called glory of war while women focus on its horror. Thus, it is reasonable to expect women to look for other means of problem solving.

COULDN’T SOLVE THIS ONE BY BEING NICE

If women should achieve the highly unlikely status of leaders in those countries famous for the most barbaric treatment of women, would they see fit to stop those practices, even though their religious leaders and judicial systems condone and even encourage such practices? Would rape victims be punished while their assailants go free? Would so-called honor killings continue to go unpunished? Would there be any serious consequences for those men who carry out genital mutilations in order to guarantee chastity? In many cultures, women are denied the most basic freedoms and are virtually imprisoned. Would women in leadership roles be prone to accept many of these practices as appropriate since they had been firmly ingrained in their culture for hundreds of years?

THEY ARE NOT PERFECT EITHER

The premise that power corrupts was accepted as gospel by our founding fathers, who took pains to see that nobody had too much of it. Since one of the highest scores for women in the Harvard study was “Displays High Integrity and Honesty,” one would expect women not to be as susceptible to such corruption, yet there is one example of such a happening. Indira Gandhi was the first female Prime Minister of India. She was much admired all over the world for the policies she had initiated to help achieve equality for a people who had been victims of a caste system throughout their history. She initiated many reforms including equal pay for women, which was indeed a revolutionary concept in those days. However her legacy was tainted by an about face in her style of governance when faced with an economic crisis. She became authoritarian, jailing her political opponents, limited freedom of the press, and was eventually convicted of “dishonest election practices.” I find it interesting that she was quoted as saying: “To be liberated, woman must feel free to be herself, not in rivalry to man but in the context of her own capacity and her personality.” It sounds as if she was on the right track, but slid off the rails.

Can we take from this example that women would exhibit the same flaws as men when it comes to governance, or would they function differently in a world dominated by women, where rules from a male dominated world no longer apply? Research cited in Psychology Today confirms that “men are more oriented toward impersonal or invidualistic goals, and women are more oriented toward social integration,” a result consistent with Baron-Cohen’s studies (see Part II of this series). In other words, men tend to gloat over a victory while women feel sorry for the loser.

“WINNING IS NOT THE THING, IT IS THE ONLY THING?”

Revered football coach Vince Lombardi also said “No leader, however great, can long continue unless he wins battles. The battle decides all.” For women, the most satisfying resolution to conflict would be that negotiations result in a happy outcome for all; most would probably prefer to avoid the battle. This does not mean that women are not competitive, far from that, but “happy ever after” is still their favorite ending. We men also have that problem with testosterone, which stimulates aggressiveness, a need to dominate, and may affect our judgement in some cases. Vince said one can’t lead unless he or she wins battles, but women would rather discuss the matter over tea.

Conflict has undoubtedly caused more pain and suffering throughout the ages than all other factors together. Politically, this has not changed since Cain and Abel. Nations in particular respond to an attack, real or imagined, “proportionally,” which is not much different from the way children react i.e. if you hit me, I will hit you back, and the excuse is always: “He started it.” Conflict usually results when one entity feels it is under assault of its person, possessions, beliefs, or integrity.

Early in my career (before the days of the 15 minute session), I was very involved in attempts at conflict resolution due to a special interest in family and couples therapy. We were able to categorize conflicts based on the methods the participants used to deal with alleged assaults by another person. As I mentioned in an earlier blog, the most malignant and destructive relationships were the result of an attack-attack system: a perceived attack, physical or verbal, is reciprocated by an attack of equal or more intensity. As you might expect, in such situations the level of anger escalates, and violence may ensue even though the basic disagreement(s) may be trivial, which is further evidence that “violence begets violence.”

That term was first published in this country nearly 200 years ago in an editorial in the New York Times. There are biblical references to that same truth, but we continue to ignore it. Our leaders continue to seek military solutions to the world’s problems. They give lip service to negotiations but refuse to talk to their enemies, while millions are homeless, starving, and face death or worse. My research in writing these essays has convinced me that in situations where women leaders come in conflict with each other, a non-violent resolution is more likely to occur, and winning will be defined by the degree of satisfaction felt on both sides rather than by a body count.

WHO WOULD HAVE GUESSED?

Recently, in the midst of all these ruminations, I happened on to an interview of our ex-president. Mr. Obama admitted, in front of God and everyone, to being an avowed feminist. He even went on to say that he thought women would do a better job than men at running things. It is not clear to me the gender of his audience; however, I see no advantage for him by currying favor with any group since he doesn’t need their votes anymore. Although I am in basic agreement with his conclusions, I must confess to some reservations about a total transfer of power.

LITTLE WONDER THEY ARE PISSED

Feminists say their cause is equality, yet many of their leaders show signs of animosity towards men, perhaps aggravated by their prior experiences. Maggie recently allowed me to read  an article she wrote about some of her experiences in the workforce. I was shocked to hear about the insults and unwanted physical contacts she had experienced. Although she had previously made casual mention of some of these experiences, I had no idea that she had actually been assaulted, which is probably just as well, otherwise she might have spent her free time visiting her old man in the slammer. There was probably also an element of my excusing much of those behaviors as only a little good-natured teasing as we men are wont to do. It is to their credit that women in “the movement” are educating us guys as to the hurtfulness of some of these behaviors. Laws designed to protect women from discrimination and exploitation have also led many organizations to initiate more stringent rules against such behaviors. In spite of all these attempts at protection, discrimination persists, as evidenced by such obvious things as unequal pay and opportunities for promotion.

NOT PERFECT?

While contemplating this vast change in the gender hierarchy, a number of questions come to mind. If women were to become leaders, would they be immune to the corrupting influence of power? Would their attitude towards men be conciliatory, or would they reverse roles and become the discriminator? Would they be inclusive, and allow boys in their sandbox? Would their means of problem solving be more effective? Would they be concerned about environmental issues? To what extent would they become peace mongers? Would they be staunch defenders of liberty or would they be too wishy-washy?

As is usually the case, when performing these kinds of mental gymnastics, of which I am fond, the quest for an answer only results in more unanswerable questions. I did conclude that when men and women are working together, it is best they leave their hormones at the door. In such an environment, they are most likely to reach a common goal by combining their unique talents and thereby gain in respect for each other. We could use a lot of that.

THAT MOTHER THING

These days, it is difficult to forget Mother’s Day as there are plenty of reminders on TV, radio, newspapers, billboards, and now even the internet.  Although the holiday (it even seems disrespectful to call it that) has been a boon to florists, candy companies, and greeting card businesses, it also generates a type of sentiment not found in other celebrations.  According to Mr. Google, there have been times set aside to venerate mothers and motherhood since ancient times, but our modern version is said to have its origins in Grafton, West Virginia in 1908, when Anna Jarvis promoted the idea of a day to honor mothers. She was soon to be disappointed when the day which was sacred to her became commercialized.  Anna spent the rest of her life attempting to correct the image which she felt dishonored her Mother, and died penniless in an institution.

DON’T MESS WITH MOM

We are all aware that motherhood is necessary for the propagation of the species, but the relationship between a mother and her offspring is like no other.  Mothers will fight to the death and endure any amount of hardship to protect and nurture their offspring.  This is true for most of the animal kingdom, but especially for humans.  Most animals who have live births nurture their young until the kids are able to make it on their own, but human moms never stop mothering.  You might think since they are around for a couple of decades it might be that they simply become like an old pair of shoes which you don’t like to get rid of, but there seems to be much more to it than that.

Back in the old days, when country doctors did pretty much everything except major surgery, I delivered a lot of babies.  Many times I would hear my patients in labor crying out that they would never go through this pain again, but when that baby was delivered into her arms the room would brighten with her smile.  The ordeal of birthing would soon be forgotten and often at the six weeks checkup there would be talks of having another child.  The mother of my children describes her feelings of holding our babies as a feeling of joy which she could not find words to describe.

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Kids do grow up and leave the nest, but they carry a piece of Mom with them for the rest of their lives.  No one or no other relationship will have such a profound effect on their lives.  Without nurture, it has been shown that children will grow up with significant deficits similar to those seen in Harlow’s monkeys when they were deprived of maternal contact.  With that in mind, it seems clear that mothers’ roles involve much more than merely giving birth and providing sustenance.

When children are born, they have no sense of who or what they are.  One can see an infant at times appearing to discover his toes and other body parts.  Likewise, in their early years, they will need help to develop an identity, and to do so, they will depend upon those with whom they spend the most time. However, perhaps the most important issue they learn concerns their lovability.  In my practice, those who felt as if they were unlovable were among the most unhappy.  They found it virtually impossible to establish meaningful relationships.  They lacked self-esteem, often to the point of self-loathing; consequently, they were vulnerable to exploitation of all kinds.  They were often used and abused, which they felt they deserved.  This opinion of self, which appears to have its origins in childhood, resists change and seems to persist throughout life even when told their picture of themselves is inaccurate.

ALL YOU NEED IS LOVE

Obviously, the only way one can know they are lovable is to be loved, which brings us back to the subject of mothers.  Traditionally, they are the ones in charge of loving.  Their love is constant, unremitting and lifelong.  They continue to love even when their children are total jerks or perpetrate the most dastardly of deeds.  It has been said that a father’s love is conditional.  I have always resented that characterization, for I felt I loved the kids as much as did Barb, yet I must admit that her capacity for forgiveness and tolerance exceeds mine.  After all, I was only an observer and not a participant in their entry to this world.

If you think mothers are lovers, take a look at grandmothers.  With the responsibilities of teaching kids manners, discipline and societal survival skills gone, there comes an avalanche of unimpeded love.  For me, grandparenthood has been an opportunity to enjoy the kids without feeling any responsibility.  I have concluded that grandparenthood is God’s reward for enduring the vicissitudes of parenthood.

It is true that in the past mothers have received a bad rap from we psychiatrists.  Mothers have been accused by us of causing everything from autism to homosexuality.  This fad began with Freud, who attempted to unravel some of the mysteries of early childhood.  Although his work provided an impetus to learn more about the effects of childhood experiences on later life, many of his conclusions have been discredited.

IT DOESN’T GET EASIER   

In the past, motherhood was a full time job.  Although mothers would engage in activities outside the home (my grandmother helped with the milking), their primary function was to care for their families.  Today’s mothers amaze me in that a majority of them also have full time jobs outside the home.  That puts an exclamation point after the time honored phrase “woman’s work is never done.”  Granted, fathers are now more involved in domestic activities than in the past, but I seem to remember reading something about a study that indicated the duties of the woman of house have changed little over the years.  Without our so-called modern household conveniences, it would probably be impossible for the hardiest of souls to accomplish what these warrior mothers do.

However, the most amazing mothers, to me, are the single moms who take on the total responsibility for feeding, clothing, teaching, disciplining and loving their children.  The fact that many single mothers accomplish this without any outside help is inspiring, especially when one considers the number of kids who grow up to be good people.  Unfortunately, these mothers are often derided rather than praised.

THEY AREN’T ALL MUSHY

You should not be surprised to learn that I too had a mother.  She loved me for no good reason that I could fathom, and I loved her too (although I would never admit it when I was growing up).  Mom was not a hugger.  She was a patter—i.e. when she was glad to see me, or pleased with something I had done, she would wrinkle her nose and pat me on the arm or shoulder a couple of times.  I suspect this was a result of her childhood, for her family was not demonstrably affectionate and never wanted to be “showy.”  She was a great cook and enjoyed feeding us.  In later years, a visit would see her “throw together some leftovers” with little obvious effort, and they would always be delicious.  I was a child of the Depression and barely recall my parents on occasion telling my brother and I they wanted us to eat first.  It would be years later before l realized why they did that.

SUPER MOM

It has been my good fortune to meet and marry someone who was born to nurture, and I have watched her in action for quite a few years.  When we were married, she announced that she wanted to have four children.  I thought two would be plenty, so we reached a Barb-type compromise and had four.  Since they were all exceptional from the very get go, I agreed to keep them all.  It was a good decision.

As with most mothers, Barb continues to exude love from a reservoir that never runs dry.  Every now and then, she will reminisce about those days when she had them all fed, bathed and tucked in, and how she felt “so rich.”  When we see a baby in the grocery, she tells me how she would like to hold it.  If there is a young one in a restaurant, she will approach the mother ask its age and tell her how beautiful is her baby (she seems to have never seen an ugly one).  Those tear jerking ads on TV featuring small kids do a number on her.  She insists were she a little younger she would adopt some of those starving African kids.

As for the grandchildren, don’t ask unless you have some time to spare.  It takes a while to tell you how wonderful they all are, but you will be able to see those tired brown eyes come to life.  Like it or not, you will probably also hear the complete package which includes their parents who are also “above average.”

SHE WILL JUST SAY YOU SHOULD SAVE YOUR MONEY 

Meanwhile, it is nice to send your mother flowers and stuff, but all she really wants from you is love.  She deserves all you have to give.

FAMILIES

FAMILIES

In previous blogs I have discussed the importance of relationships in our lives; however none are more important than our relationships with our family of origin. They will be a powerful influence as to how we view the world and other people.  More importantly, these experiences will be major determinants in the development of our personalities.  Those fortunate enough to grow up in nurturing environments will find it easier to nurture their offspring.   To feel loved is likely to protect one’s self-esteem, and allow one to experience the joy of loving others.  Our values are in many ways shaped by family for even if one is rebellious and rejects what he has been taught, his new found truths often originate from the nature of his family relationships.

Apprenticeship to Adulthood

We humans are unique among mammals in the length of time required for us to reach maturity. Not only is our rate of growth slow, but there is much to learn if we are to survive and thrive in a complex society.  Although much is determined by our genetic make-up, we learn behaviors and perceptions primarily by unconsciously mimicking others.  In that sense, growing up is much like an apprenticeship.

The 21st Century Family

An accurate definition of family is now difficult to pin down. There are no longer traditional roles for family members, such as were the norm in my generation.  Since most parents work, there are fewer stay-at-home moms.   We now see an occasional stay-at-home dad, something unheard of in my time.  Other than widows, single mothers were not nearly as prevalent during my youth as they now are.  Modern mobility has limited the number of nuclear families who can experience the support of extended family members.  Many of our children grow up barely even knowing the names of their cousins.  Blended families composed of his, hers and their children can face special challenges.

The Power of the Family Bond

In spite of these changes, the bonds between family members are among the strongest of all our relationships. This is evidenced by the fact that one of the first phases of recruitment by cultists is to alienate the prospect from family members, usually leaving siblings and parents confused and devastated.  The same tactics are used by those who would attempt to relieve the elderly and infirm of their possessions.  In both cases, they discredit the families of origin and attempt to break the bonds between the victim and the victim’s biological family.  Those in positions of leadership of all stripes realize the strength of familial relationships, and seek to provide an atmosphere in which a surrogate family can develop.  Street gangs likewise are said to provide family like bonds, which have been lacking in the lives of those they recruit.  The search for the type of relationships found in families seems to be a common human need.

“I found it difficult to remain therapeutic while feeling homicidal.”

Although families offer the best environment for rearing children, they can also be the scene of horribly abusive behaviors. I have had little experience dealing with such problems, especially when they involve children.  I generally avoided treating such cases as I found it difficult to remain therapeutic while feeling homicidal.  In like manner I find that the understanding of other cultural practices such as honor killings, genital mutilation and such to be way above my pay grade, and in spite of being paid quite well.  Consequently, I will confine my remarks to treatment of more mundane problems.

Who is the “real” patient?

Most families seeking help are usually concerned about the behavior or mental status of one of their members. They are often coerced into treatment by the identified patient’s therapist.  That term (identified patient) is useful in that one may find that the person in treatment may be the healthiest member of the family, and labeled as sick because he is out of step with the rest of the family (i.e., the identified patient is actually the most emotionally healthy of the group who is reacting to an unhealthy family dynamic).

The importance of family therapy

There are multiple reasons that I believe involvement of family is critical in the treatment process:

  1. Family members may be able to provide valuable information about the patient’s behaviors.
  2. It allows the therapist to view family relationships first hand and thus provide insights as to the stresses in the patient’s environment.
  3. Family members may provide a more complete family history
  4. It allows the therapist to assess the level of support available, and to encourage such support
  5. Perhaps most importantly, it is a mechanism in which the dilemma of providing family with needed information about their loved one’s illness without violating the confidentiality inherent in the doctor-patient relationship. This becomes even more important in those cases where there are paranoid tendencies, or there has been a great deal of conflict.

The Complexity of Family Relationships

Although the average family size has shrunk considerably over the last century, relationships between members can still be complex. It must come as no surprise that there are often conflicts within families.  Since it is difficult to walk away from one’s family, those conflicts are not easily resolved, and over time may escalate.  To be chronically angry can be debilitating and painful, and as such, blaming another for those feelings comes easily.

The Blame Game

As mentioned in previous blogs it is important that the therapist avoid joining in the search to establish who is at fault, for to do so merely perpetuates the problem. He must be able to analyze the problem from the outside looking in, that is, learn how to be a meta-communicator. Hopefully, the members will find it difficult to continue blaming each other if the therapist redefines the problem as blaming rather than defining the problem as identification of who is at fault.

The Power of Brevity

In order for the therapist’s comments to be effective, they must be brief if they are to be remembered. The importance of brevity as with most things in my practice was learned from a former patient during a chance encounter, during which he thanked me for having helped him several years previously.  He credited his recovery to one statement of mine.  He said: “The thing that helped me most was when you said ‘you think too much’ and now whenever I start to worry about all the things which could go wrong those four words come into my head and I am able to move on.”  I cannot take credit for any brilliant insights for I didn’t even remember the incident, but it is an example of how an offhand comment may be more effective than hours of therapy.  The same principle applies to our everyday lives, as the most memorable comments are those expressed in a few words.  The lengthy ones are often forgotten before they are completed.

Obviously there are many reasons for families to seek counseling other than to deal with hostility, but no matter the problem it is helpful to look at it as a communication system gone awry. Imbedded in many different behaviors is a message, and thus can be seen as a form of communication.  For example, what is the message being sent by a teenager who is acting out?  It could be that they are angry about limits set, unrealistic expectations from parents, lack of trust by parents, sibling rivalry, or resentful that not enough limits have been set, or for reasons which have nothing to do with the family.  Of course, the teenager is almost certain to be the last person likely to divulge such information.  Disclosure can many times offer a pathway to an understanding, which may be therapeutic.

Can’t see the forest for the trees

It was not my intent for this paper to be a treatise on family therapy; however I thought it might be useful to see how some of the concepts could be useful in understanding not only our own families, but relationships in general. As I mentioned in a past blog as with marital relationships, it is almost inevitable that one will be so caught up in seeing the trees that he will become oblivious to the forest.  That is, he will not realize what is going on even though he can hear the words.  This was brought home to me several years ago when following a party a colleague said “Smith I can’t believe how you treat your wife.”   I was shocked, could he be talking to me, the couples therapy and family expert?  After all, I had no doubt that I was among the world’s best husbands, but Barb later confirmed that my friend was correct in his assessment.  As has been said, “None are so blind a those who will not see.”

Reframing

For example though all have separate personalities, they also have different roles to play as family members. For example it is common for families to have a star and a black sheep.  Parents may lament that they don’t understand why the black sheep can’t be more like the star, and continue listing all of black sheep’s misdeeds and faults.  In such a case the therapist might address the black sheep kid by saying, “That is such a loving thing, doing all that stuff to make your sibling look good.” No matter the response the system is changed, and this is apt to open up some different dialogue. This is a process therapists call “reframing.”

Scripting

There are many roles that kids and parents may unconsciously adopt. There are the placaters or people pleasers, the mascot or clown, the lost child or withdrawn person, and as mentioned in the previous vignette the hero or achiever, and the black sheep or scapegoat, to mention a few.  Family roles may develop in order to fill a need or may come about by the process of scripting.  I mentioned previously the role families play in the development of our identity, and when they convince us we are a certain type of person, we are apt to follow that script.  Some have gone so far as to say if you can convince someone he is a homicidal rapist, he is apt to become a homicidal rapist.  Obviously, there are many influences other than our families which affect our identity; however, the opinions of our parents and siblings are undoubtedly the most powerful.

Disagreements

In this time of rapidly changing mores, it is not surprising that there will be frequent disagreements between we old folks and the kids. Of course disagreements between siblings seem to be written into their DNA, and disagreements between parents is certainly not unusual.  When family members cannot agree to disagree, an argument is likely to occur, and such arguments often lead to verbal or even physical attacks.  I don’t mean to suggest that disagreements are all bad for as Walter Lippmann famously said, “Where all think alike, no one thinks very much”.  When we tell our kids what to think while telling them we want them to learn to think for themselves it is little wonder they become frustrated for that is a classic double bind, or in today’s vernacular a no win situation.

Systems of Conflict Resolution

If a disagreement reaches the point that one feels threatened or under attack, either verbally or physically, he may respond in a variety of ways.

Attack/Attack system

He may retaliate in kind which is an attack-attack system. This is almost guaranteed to increase the level of anger, as each participant attempts to outdo the other.  These are the types of interaction which can lead to violence.

Attack/Placate system

The attack-placate system is often seen in cases of spouse abuse, when the abused attempts to talk hubby out of his anger by reassuring him and in other ways spreading oil over the troubled waters. This too usually fails as the abuser may feel patronized.

Attack/Divert System

Another type is the attack-divert system which as you might imagine can become rather bizarre. This might be effective in minor skirmishes, but simply changing the subject in the face of overt hostility is weird, and leaves the problem unresolved.

Acknowledge the Affect

For the best method to deal with such emotionally laden situations, I hearken back to my mantra of “acknowledge the affect.” In such cases, the message the attacker is trying to send is that he is feeling some kind of negative affect such as: anger, hurt, envy, jealousy, or fear.  Statements such as “I can see you really feel strongly about that” or “are you angry with me?” will often defuse the situation.  It is not necessary to change your opinion or point of view, but simply to communicate that you understand how he feels.  If your attacker’s affect is not available then one can use his own such as: “I feel …………” The concept has wider application, for in any emotionally charged situation it only makes sense to deal with the emotions rather than to ignore them.

What’s Next?

In my next blog, I plan to focus on child rearing. I am well aware there are probably hundreds of books written by people who are convinced they know better than you how you should raise your kids.  I don’t plan to do that since I have made plenty of mistakes in that department; although my kids all turned out well in spite of my screw-ups.   Rather than directions as to how one can raise perfect little people, I plan to provide helpful hints on how to screw up your kids lives: I call it “How to screw up your kids without even trying.”

Thanks for reading!

DO YOU HEAR ME NOW

Editor’s Note: Image not approved by e-shrink, but I needed some eye candy 🙂

In a previous blog, I promised an encore presentation on the subject of interpersonal communication. Your patience is about to be rewarded for I will now set about to fill these pages with the words of wisdom promised.

Actually if one excludes extrasensory communication and similar spiritual phenomena, there is little mystery about how we communicate with each other, but it is amazing how we can screw it up. It appears that all creatures have some means to communicate. Some plants are said to communicate with each other, and I just read an article in Scientific American presenting evidence that some bacteria send signals to others of like kind.

The Dawn of Communication

It is impossible to know exactly how earliest man communicated, but it can be assumed that job one as they came together as groups and then tribes, was to be able to communicate with each other. They would soon find that gestures and other nonverbal means were not sufficient for them to be successful carrying out joint efforts, like gathering food, providing shelter, and protection. Sound would prove to be the most effective means. Messages could be carried over distances without interrupting the sender’s activities. For example a certain sound may have been agreed upon to sound a warning. Meanwhile, man would be evolving physically with very versatile machinery to produce a variety of complex sounds which we now call words and language was born.

Necessity is the mother of invention

Since our Great, Great, Great, Great………..and so on grandparents, like us, were never satisfied with the latest technology, they would undoubtedly start looking for ways to communicate distances beyond their range of hearing. It would also be nice to save and share messages. Smoke signals and other such signaling procedures would have little useful utility. They solved that problem by devising symbols for each word thus enabling them to not only hear, but also see all those words. Fast forward a few thousand years, and here I sit recording words in this mysterious black box. As you are all aware this is not the end of that story, but more about that later.

Most of us talk better than we listen

Of course humans have developed the most complex system of communication centered on our verbal language skills. As a matter fact, many anthropologists rate our ability to use language as the major factor which allowed man to become the dominant creature on the planet. It is language that allows me to write this paper, and to communicate ideas, opinions, directions, knowledge, feelings, or indeed any thoughts which come into my head to anyone who is inclined to listen, and therein lies the most common flaw in any communications system, i.e., most of us talk better than we listen.
Psychiatrists listen, it is what we do, as a matter of fact sometimes that is all we do. It has always amazed me how therapeutic listening can be. There are many times when patients have left my office saying they felt much better after venting their particular problem, in spite of sparse verbal responsiveness on my part. It makes me sad to think that some people find it necessary to spend money to have someone listen to them. Come to think of it, if we all would be better listeners it might save a lot on shrink bills.

 

I can identify with those people who feel no one listens for I have always envied those guys with deep commanding voices who are able to dominate a discussion. In those situations I am rather soft spoken and sometimes feel excluded. My attempts to change the timbre of my voice have been unsuccessful; consequently; I am usually content to let my wife take the lead in those social situations as she is very good at social repartee.

The Nuts and Bolts of Communication

Everyone knows that in order to have a communication, one must have a transmitter and a receiver. For the sake of brevity (my readers seem to appreciate that quality in these blogs), I will limit my comments to communications between people; although, I realize there are now many machines that communicate, and that animals communicate with each other and with us. It is important to remember that in the presence of other people it is impossible not to communicate, for paradoxically not to communicate sends a message: therefore a communication has taken place. When one ignores another person, it may send a powerful message, but one which can be interpreted in many ways. The message may be clear depending on the situation or context, but can also be confusing.

An outstretched middle finger pointing skyward will rarely be misinterpreted

Verbal conversations are the most versatile and intimate of our means of messaging while written messages are less likely to be misunderstood. Non-verbal messages can also be very precise, for example in our society the presentation of an outstretched middle finger pointing skyward from an otherwise closed fist will rarely be misinterpreted. In spite of such exceptions, words are generally the more precise tool. The superior quality of verbal versus non-verbal communication is evidenced by the difficulty those born without hearing experience as compared to those who are blind. It is well known that a person’s lack of one special sense will result in a compensatory increase in acuity of its opposite. The result for deaf people is that they can become markedly adept at sign language, but to converse with hearing people becomes very difficult. They must either use crude gestures, or depend on written messaging, the first being ineffective and the second inefficient. Lip reading is apt to be fraught with errors and may not even be possible for those born deaf. Blind people however converse with little difficulty and their enhanced hearing may allow them to hear inflections which might go unnoticed by those with normal vision which could help make them superior communicators. The result is that deaf folks often prefer to relate to others who are deaf, while blind people find it easier to assimilate into ordinary society.

The Art and Science of Listening

As I mentioned previously, I believe that failure to hear is usually due to a failure to listen. Listening requires effort. In order to be an effective listener one needs to use all of his faculties, including not only his ears, but also eyes, touch, and sometimes even his sense of smell. It goes without saying that it is essential to be attentive, and to maintain eye contact unless the one talking seems uncomfortable. Observing a person’s posture and movements are all part of the listening process. For example, folding one’s arms across their chest indicates they are not likely to be receptive to your comments. Of course there are many less obvious non-verbal cues which are delivered unconsciously, to which we may respond to without awareness they have occurred.
People who study non-verbal communications can gather amazing amounts of information by simply watching a person. While teaching both individual, couples, and family therapies, we often would show a video tape of a session without sound, and speculate as to what the body language revealed. If the therapist who conducted the session was present he/she would usually be surprised at his/her lack of awareness of some their own non-verbal behaviors. Although a thorough review of the subject is way beyond the scope of this paper, we can learn some things which can be helpful to enhance our abilities to really listen just by watching.

Listen with your eyes

Most cues will be obvious, the breaking of eye contact, leaning forward or backward in a chair etc. One very telling clue as to our engagement is the shifting toward or away from symmetrical positioning e.g. the mirroring of postures. If the person with whom we are conversing mimics our sitting position, it is likely that they are engaged in the conversation, and to change positions will indicate disengagement. We are likely to sense those changes in others more easily than in ourselves. Leaning forward toward the conversant will indicate interest and encourage more talk on the subject while leaning back can be interpreted as: “enough of that subject.” At the same time it may be helpful to remember that if you are bored you probably will look bored, and you will give off the same signals as your bored companion. As mentioned previously, words are still your best shot to receive a clear message, and the non-verbal stuff should be viewed as ancillary.

The Transmission

Now that you know everything there is to know about being a receiver, we can move onto how you may become a talented transmitter. If you are to become a scintillating conversationalist, or a raconteur par excellence you must learn how to deliver a clear and succinct message. This must not be as easy as it sounds for even when listening as hard as I can, I sometimes have no idea what is being said. The KISS acronym (keep it simple, stupid) is still a good rule when it comes to personal conversation. Complexity tends to obscure rather than illuminate. Most contemporary poetry violates this rule in my opinion. My attempts to understand it leaves me with the same feeling I get after spending a half hour working on a rubric’s cube. I confess that I carry a few big words around to use when I want to impress; however long multisyllabic words should be avoided if a little one will do. (You may notice that I have used some of my favorite fancy words in this paragraph, and I trust you are duly impressed).

Direct vs Indirect

Conventional wisdom is that one should always be direct with one’s communications, and “not beat around the bush” as my grandmother would say. In general that is a good rule to follow; however there are times when one might need to deviate from that practice. It brings to mind the solution that my wife Barb found to a vexing problem. It involved a young man who did some office work for her from time to time. The problem was that he had a persistent very strong body odor. She was concerned for him, and suspected the B.O. might well have something to do with his limited social life. Of course, she was reluctant to confront him directly. Although her maternal instincts had kicked in, she did not feel close enough to him to be comfortable discussing his problem directly. After considerable deliberation she resolved her dilemma by giving him a box of deodorant soap for Christmas. Unfortunately, she had no follow up with which to judge the success of her coded message.
There are times however when a direct communication is the best choice in embarrassing situations. One personal example happened while I was giving a lecture to a group of nurses. I noted some snickering among them which was puzzling since grief was the subject of the talk. I later learned that my fly was unzipped. It would have been an act of kindness to have been informed of my zipper problem. To make matters worse, I was forced to endure taunts by colleagues that this was an obvious Freudian slip.

Sending manure and roses in the same box

Although words are of the utmost importance in communicating, we must not forget the music that goes with them. By that I mean the tone, volume, cadence, pitch, and other elements produced by the noise maker in our windpipes. The mechanisms we use to produce sound is remarkable in its versatility and is capable of expressing innumerable emotions which can accompany our words. What we say can be modified, enhanced, diminished or even totally changed in their meaning by our voices. When the words fit the music it can add clarity, but when they don’t it can be confusing. This also applies to visual clues as previously discussed. In those situations in which sound contradicts the words, we have two conflicting messages in one. The purpose of double messages is usually to express hostility, but make it difficult for the recipient to respond as we used to say at the lab: “to send manure and roses in the same box”. In such cases it may be difficult for one to decide which is the more pungent odor.

Sarcasm and the double message

Sarcasm is probably the most recognized form of the double message; however there are some who are masters of the technique. Some women are said to be “catty” in their conversations with other women For example at a dressy social function Miss Catty might say, “What a nice dress, I saw one just like it on the dollar rack at K-mart the other day.”The recipient of this message is apt to remain speechless unless she is quick enough to come up with an equally sarcastic response. In any event the two are unlikely to become friends. There are words and phrases which can be interpreted differently. Some idioms can be confusing and even suggest opposite viewpoints. Since language is never static some may change in their meanings as for example the phrase, “cute as a bug” usually referring to a younger person now seems to be accepted as complimentary; however I don’t believe many people would consider bugs cute.

Anger vs Hostility

Many people find it difficult to deal with anger either of their own or others. This can be limiting in their ability to form lasting and honest relationships for there will always be reasons for anger towards others whether real or imagined. Unexpressed anger will result in either hostile behavior or depression.

In our so called civil society it is often deemed inappropriate to express anger directly, but rest assured it will be communicated by all those non-verbal means we have talked about in spite of our best efforts to conceal it. Contrary to public opinion anger and hostility are not synonymous. Anger is an emotion while hostility is a behavior. Hostility is unlikely to resolve the issues which perpetrated the anger, and furthermore the response to hostility is apt to increase one’s anger.

The efficient and healthy way to express anger

There is a very simple and efficient way to express anger and that is to say “I am angry with you.” This will allow the source of your anger the opportunity to ask about your anger and consider options other than fighting. As I mentioned before, you are the only expert on your emotions so they can’t be refuted by others. If he shows no interest in resolving your differences, you are best off to just dump the sucker.

When you’re on the receiving end of anger

The opposite side of the coin is when you are the recipient of the anger or hostility. If the person is sufficiently enlightened to open the conversation with their feelings of anger, you have a good chance of resolving the issue, but it is more likely that it will be hostility, e.g., name calling, accusations, jealousy, or even physical assault. In the latter case just run unless you have a ball bat handy.

Acknowledge the affect

In other circumstances you may be able to diffuse the hostility by acknowledging the affect. The affect for you non-shrinks is the word we use for feelings. As a matter of fact that phrase: “acknowledge the affect” became my mantra when teaching psychotherapy. Phrases such as, “you must be very angry, or you really look mad,” may lead to a more productive discussion. In some cases it may be more effective to use your own affect especially if there is no response to your acknowledgement of his anger. Whatever you say must be honest, like “I feel sad, this hurts my feelings, or you are scaring me.” Although these strategies do not guarantee success, they are less likely to result in escalation of the conflict. Of course sometimes we would rather fight and in such cases that remains a prerogative; although it is often difficult to determine the winner.

Being assertive without hostility

Many of us have grown up in homes where we were taught to be submissive. This is probably true for women more often than for men. Then we grow up and find that we must be assertive or be ignored. Our childhood experiences of assertiveness was usually linked with anger, but as we grow up we learn that to be accepted into society we must learn civility. The result is that in this competitive world we must assert ourselves or be left in the dust. The problem is that we don’t know how to be assertive without being hostile. This was a problem for many, many of my patients. As women strived for more independence, and learned to work alongside men who were accustomed to being considered the dominant gender their need for assertiveness training increased, and this need is not confined to women. Learning to recognize feelings will help one to compartmentalize them and learn how to communicate without unwanted hostility. In other words acknowledge the affect.

The Awesome Complexity of Communication

The subject of interpersonal communications is obviously much more complicated than what is presented here. It is estimated that our vocabulary includes between 10,000 and 17,000 words depending on age and education level. When the myriad non-verbal modifiers are added coupled with the thousands of ways words can be arranged we become aware of the awesome complexity of this function which we take for granted.

P.S. I am a bit anxious about submitting this for publication as I have a grandson who is about to graduate with a major in communications. I can only hope he will be merciful in his critique.
Next time, I hope to share some thoughts about families.

MY LEFT FOOT

My left foot is under assault by some nasty little microscopic creatures. I like both my feet, but my left one is my favorite. Since I am left handed, it naturally follows that I should be left footed; consequently, I find that such activities as kicking something or someone, stepping on an insect, climbing a stair, or putting on my pants are always led by my left foot. If I am dancing or tapping my foot to music, my left foot leads the way, and the right one follows. When I feel the need to show my anger at having been bested in an argument with Barb, it is my left foot which will be loudest as I stomp out of the room. Of course these are minor functions when compared with its utility along with its companion on the right in providing a convenient means of getting from point A to point B. For these and many other reasons, I would very much like to keep my foot as I do need it.

The problem first appeared two weeks ago when I noticed redness and swelling on the dorsum (that’s doctor talk for top) of my left foot. I thought it looked like a cellulitis, a condition which can progress rapidly with very serious consequences. With that in mind, I talked my way into a next day appointment with my doctor’s colleague (my doctor was on vacation). He agreed with my diagnosis, and started me on an antibiotic with instructions to return “ASAP” if there were any signs the infection was spreading. There was no change after two weeks so he changed antibiotics and informed me that he would admit me to the hospital for IV antibiotics if there was no improvement after a week on the new bug killer. I was a bit shaken by this new game plan.
You may be thinking: what is the big deal about going to the hospital for a relatively benign treatment? Surely I would submit to the harshest of treatments if I thought there was the slightest risk of losing that left foot of which I had become so fond. Although I had spent thousands of hours working in that hospital, I felt some trepidation about becoming a patient there, simply because a hospital is a dangerous place.

One study reports 440,000 preventable hospital deaths annually, making such errors the third leading cause of death in the U.S. I believe these numbers are inflated somewhat, as preventable does not necessarily mean they could have been foreseen in time to intervene. Even so, if these numbers are even half accurate, one must consider hospitals as dangerous. They are further contaminated by including hospital infection rates. We are currently experiencing an epidemic of infections in hospitals. The CDC reports 724,800 such cases in 2015. 4% of all patients admitted will contract an infection while in the hospital. This in itself is scary enough, especially when one considers that hospital infections are apt to be treatment resistant.

The problem of hospital infections continues to bedevil the medical community, and most experts believe that it has evolved due to the inappropriate use of antibiotics which results in the development of bacteria which have become smart enough to develop immunity to the effects of antibiotics. The most common of these organisms are: MRSA (methicillin resistant staphylococcus aureus) and clostridium difficile which is usually referred to as C. diff. The elimination of these bacteria from hospitals has been a daunting task on which most hospitals expend a lot of resources. Such infections do present a significant danger to those whose immune systems are impaired or patients who are weak and infirm. They appear to be spread throughout the hospital by caregivers who are at risk of carrying an infectious agent from one patient to the next.

The VA reported they were able to reduce hospital induced infections by 40 percent by the simple expedient of requiring all staff members to use an antibacterial lotion on their hands when leaving or entering a patient’s room. Compliance was carefully monitored in the study. It is now common practice to have antibacterial dispensers near the entrance of every room; however, there are always those who will not follow protocol. It is also true that lotions are ineffective against most viruses.

Sometimes the mode of transmission is less obvious, for example in one case a number of patients all belonging to a particular surgeon contracted a MRSA infection. Eventually the source was traced to the surgeon’s necktie after it was noted by a nurse that when bending over to examine his post op patients his tie came in contact. A culture confirmed that the tip of his tie was contaminated. Some post-surgical wound infections have been traced to closed circuit ventilation systems commonly used in surgical suites with a mechanism of spread similar to that seen in Legionnaire’s disease. The increase in the use of medical devices, and other invasive procedures, both in diagnosis and treatment, also undoubtedly increases the risk of infection. Although it seems probable that lack of caution is responsible for many of these infections, I submit that if an event is not predictable it is not likely to be preventable, and I don’t believe the statistics I have quoted take this into account. However; whatever the cause, the numbers are frightening.
A few years ago (I dare not say how many), my wife Barb’s first job after nurse’s training was what was then called private duty. As such, she was employed by her patient to provide nursing care exclusively for him, and therefore, except for very brief periods, was in constant attendance during her shift. I suppose such care is still enjoyed by the super-rich but is beyond reach for most of us. Besides, if one arranged for such a nurse, it is unlikely said nurse would be welcomed by the hospital.

Now, many wisely suggest that if hospitalized, one should arrange for an advocate. The wisdom of such an arrangement was brought home to me when I was hospitalized a few years ago. When I did not get an adequate response after pushing the nurse call button to get help for what I believed to be a serious problem, Barb channeled the tigress within her and attention was immediately forthcoming. It appears to me that the most highly trained of the caregivers, the RNs, spend much of their time with administrative functions, while the hands on care is delivered by others, yet the RN is in charge and is expected to know all about the patients under her care. As Barb says “I learned more about my patients while giving a back rub than from taking a formal history.” But alas, back rubs are mostly a thing of the past.

None of this is meant to disparage hospital nursing staffs, for I believe nearly all are fully dedicated to the most noble of all professions; however, many to whom I have talked complain they are not able to spend enough time with their patients, and consequently worry that they might miss something important.

There are several factors that may contribute to the problems of medical errors.

Due to cost cutting efforts by third party payers (a code word for insurance companies), the criteria for admission to hospitals are more stringent than they have been in the past, and there is intense pressure to discharge patients. The result is that the typical hospitalized patient is sicker and therefore more vulnerable to even minor mistakes.

Modern miracles in medicine require many people to get in on the act. Diagnostic and treatment procedures are much more complex and require the involvement of those with specialized skill sets and knowledge. In addition to consulting doctors there are therapists of many disciplines, and others trained in specific diagnostic procedures who are likely added to the mix. It is generally accepted that the more people involved in an activity the greater is the chance of a screw up.

The latest statistics on hospital errors suggest that those involving medication top the list. The most common as you might expect is due to misidentification of the patient, although errors in the pharmacy are certainly possible. Any who have been hospitalized in the past year or so probably noted that whatever was done to them was preceded by a question as to their name and birthdate, which was then verified by reading the hospital wrist band. The fact that mistakes still occur in spite of all these precautions confirm the impression that as humans we are all fallible.

Mistakes in the operating room can be especially disastrous. One of my closest friends, who also happens to be a retired orthopedic surgeon was forced to have back surgery twice because his surgeon picked the wrong vertebral level on the first try. This confirmed my impression that whatever status I thought was conferred on me as a doctor would do little to make me immune from an unwanted assault on my body.

Other mistakes can be even more serious. I recall hearing of an instance in which a person had the wrong kidney removed, necessitating her being put on chronic renal dialysis. There have been similar rare reports of people who have returned from surgery to find their good leg has been amputated, and the bad one remains. I once had a patient who was scheduled for X-rays, but realized she was taken to the wrong place when she found herself surrounded by people with caps, masks and long gowns. The transportation person insisted he was told to take the patient in bed two to surgery, and the charge nurse was equally adamant that she had instructed him that surgery was waiting for the patient in bed one. Fortunately, the surgery staff discovered the error at about the same time as did the patient, but the incident raises the issue of how important those repeated questions about name and confirming birth date can be. I also remember having three patients by the name of Smith in one room back in the days when most hospitals had a few four-bed wards. You can imagine the problems that situation could cause.

Now that modern medicine has contributed to an average longevity greater than nature intended, we have a much older population and since the prevalence of many illnesses is directly proportional to the amount of aging, hospital populations have become older, weaker, and susceptible to many problems which may interfere with their equilibrium. They are also more likely to be on medications that may affect their balance. Put these factors together and it is easy to see why falls are more common amongst the elderly. Since old folks are more susceptible to injury, falls are a serious problem and nowhere more so than in the hospital.

Recently, I visited an old friend who has had unsuccessful back surgery. He was in a rehab facility to get physical therapy, and has been unable to walk. It was a nice day so I got help and placed him in a wheelchair and took him out for some air and sunshine. As I got ready to leave, I noted that he was slumped over a bit in the chair and I was concerned about leaving him there without something to prevent him from falling out of it. I was especially concerned as he has had a couple of falls since his surgery, one time by falling out of bed. When I asked for something to keep him from falling out of the chair, I was told that I couldn’t do that as it would be considered a physical restraint which could not be used in their facility. I thought that was the dumbest thing I had heard since the last presidential debate, and decided to do a little research on the subject. What I have learned is that there has been a great deal of debate about the use of physical restraints, and that some courts have issued rulings about their legality. Some researchers insist that restraints cause more injuries than they prevent. They insist that even bedrails designed to keep people from falling out of bed are dangerous as patients will often try to climb over them and sustain serious injuries. They point to cases of strangulation by so called “soft” restraints often used to prevent confused patients from pulling out catheters, endotracheal tubes, chest tubes, etc. sometimes causing serious damage. I am always bothered by such research, for although it documents carefully the injuries caused by such restraints, there is no way to know what injuries if any they may have prevented. Of course the best solution would be for the patients to have someone in attendance constantly, which is unlikely to happen.
In the interest of full disclosure, I must confess that I have been guilty of using “full leather” restraints on a few occasions when dealing with severely agitated violent patients who are determined to do harm to themselves or others. It was never for very long and I was usually surprised at how well they tolerated it. It may have been because there was someone assigned to be with them, that they realized they had needed to be subdued, or simply that it gave the medication time to work.

Ordering such treatment always made me shudder for I am quite claustrophobic for which I blame my older brother, rest his soul. When we were kids he delighted in putting a blanket over my head and pinning my arms until I panicked. I have dealt with homicidal patients in the past without totally losing my cool, but find that anything which prevents free movement of my arms takes me all the way to the edge of a panic attack. The thought of being handcuffed with my hands behind my back fills me with dread. The only fear I have of surgery is that I will wake up restrained as is often the case when complications result in a patient being attached to a respirator. A couple of years ago l was forced to have my left arm pinned against my chest and to lie flat for 24 hours following a procedure. I, the one who feels nerve pills are for everyone else, begged for Xanax. And you thought psychiatrists didn’t have hang-ups.
No treatise on hospital errors would be complete without mentioning the current fad of electronic medical records, and as you can imagine I have a lot to say about that subject. In addition to reducing costs, and increasing the quality of care, these systems are touted to dramatically reduce hospital errors, but for now I will spare you my ruminations about that subject as Maggie has chastened me about making these things too long. As for my favorite foot the current medication seems to be working and hospitalization seems unlikely.