Looking for trees? Check my mailbox.

Our mailman does not seem to like us although Barb and I both consider ourselves to be as likeable as the next guy. Whenever I meet him at our mailbox, he doesn’t respond to my characteristic jolly greeting, but simply hands me my mail, grunts, looks straight ahead and drives away. Old habits die hard and this old psychiatrist still tries to understand aberrant behaviors. Consequently, I have attempted to understand what may have precipitated his apparent animus.

 

The Investigation: Why does my mailman hate me?
It is true that I forgot to leave his traditional tip in the mailbox at Christmas time, but of course that was several months ago.

There was also the Floyd incident, but I wouldn’t anticipate his blaming me for my dog’s exuberant behavior. Floyd loves to ride in the car and isn’t choosy about the type of vehicle or driver. Consequently, when the mail truck pulled up to mailbox one summer day, Floyd seized the opportunity. He leaped into the mail truck with excitement with big plans to accompany our mailman on his route. Unfortunately, in the process Floyd was forced to run through a gauntlet of boxes and crates of mail resulting in the rearrangement of their contents. However, the mailman was remarkably calm throughout the incident and accepted my apology, although I did note that he was muttering to himself as he restored order to the crates of mail.

 

My Epiphany! It’s not me. It’s those damn catalogs.
After all of these deliberations, I have concluded that the ire exhibited by my mailman has the same genesis as my own.

You see, just yesterday he delivered 23 catalogs in addition to two magazines and multiple solicitations from organizations, some of whom I have never heard of, and this was only a routine day. If history is any guide, the volume will increase as the holiday season approaches. Instead of emptying my paper recycling bin once a month, I now must empty it every few days. No wonder my mailman becomes frustrated since he must stuff all that stuff in my mailbox daily.

 

Nothing unites like a common enemy.
His pain is my pain! I sympathize with my mailman’s frustration. I get angry each time I have to unload that mailbox, cursing as I sort the scams from the legitimate mail. As a bona fide card-carrying curmudgeon I must tell you that I remember the day when if one wanted a catalog they asked for it. Today, if you order something  from a catalog, you will soon be buried in an avalanche of slick pictures of beautiful people wearing cool clothes and hawking gadgets I’m sure I need but know I’ll never use. Not only do I resent their audacity of sending the catalog without me requesting it, I resent that they believe they can convince me that I look as cool in those duds as the suave handsome dude who models their stuff.
Some of these catalogs feature stuff way beyond my pay grade. For example, I do not ordinarily shop for $1500 leather jackets, $600 sweaters, or $750 shoes. One such high end catalog featured of all things a $250 pair of jeans faded in all the right places to make them look old. I do occasionally browse and sometimes find interesting inventory. For example, one which featured home health aides also had a two-page display of dildos. I was surprised to find they came in so many different sizes, shapes, and colors. Barb vigorously denies having ordered the catalog, but I have my suspicions.

 

The good ole’ days of face-to-face relationships
It is no secret that there is a flourishing market for names and addresses of potential customers and that these catalogers have no hesitation in selling us to the highest bidder. I recall the time of the mom and pop stores when the relationship between customer and seller was built on mutual trust and therefore personal. The storekeeper was more interested in customer loyalty than making a sale, trusting that if his customer was “treated right” he would come back. Likewise, the customer trusted the salesperson to give an honest representation of the product sold. In many cases shopping was as much of a social event as a series of business transactions. I suppose that now as even we former Sears catalog devotees fade-away, we will become even more depersonalized as we become numbers in Amazon’s super computer. Our computers will order from their computers, our orders will arrive untouched by human hands, and one more avenue of human interaction will close.
Shopping: Art, Science, Disease, or Therapy?
Enter my beautiful, charming, and aesthetically gifted wife. She is a former shopkeeper one of the last to conform to those qualities I mentioned, and whose store continues to receive rave reviews from former customers. Among her other talents she is a world class shopper. As our daughter Molly (now deceased) said regarding her Mother’s shopping prowess: “when Mom gets the scent, you better get out of her way.” For Barb, Christmas shopping is not a project, it is a mission. She scoffs at the idea that it would be much simpler for her to give the kids money and insists on finding a gift (or unfortunately–gifts…plural) which are perfect for each one whether they realize it or not. Things to be considered include: hair and eye color, stature, personality, and consideration of their known personal preferences unless those preferences are in extremely poor taste.
Within the past year the last department store as well as the last men’s store in our town closed their doors. I recall a time when our main street hosted three department stores and multiple specialty shops which have all folded as the big boxes took over. Having fought and lost the good fight with the big guys, and since she places online shopping in the same category as those big box adversaries, the best Barb can do is to reluctantly shop via catalogs even though she disapproved of the one featuring dildos. I presume this change in her shopping habits is responsible in large part for the appearance of our names on a few hundred mailing lists.

 

The List Contagion: It’s a real thing
It’s not only the merchandisers who will pursue you. Barb is a sucker for those tear-jerking ads on TV, which has resulted in reams of solicitations for real and non-existent charities. I wonder if they make more money selling my name and address than from my feeble contributions. In my zeal to become a good steward of my government, I once made the mistake of contributing to a political campaign online. Now, I start my day by deleting pleas to contribute to this or that political cause or candidate. They assure me that without my contribution a worldwide calamity is immanent or that I will be to blame for the extinction of the white rhino.

 

Privacy?
On a more serious note, it has been said that with a few key strokes one can know more about me than I do about myself. This is undoubtedly true e.g. I don’t know where I ate a year ago but that info is available somewhere. Our privacy is said to have been eroded, but it is probably more accurate to say it is gone. Now, as more DNA results are collected not only will more be known about your behavior but your body and your relatives. Nevertheless, the blatant disregard of our rights to privacy as this little essay illustrates is only one small example yet enough to piss me off big time.

 

Ground Zero
Maybe my overzealous anger about the catalogs goes beyond the senseless time spent sorting and recycling and even beyond the invasion of my privacy. Maybe it’s a symptom of something bigger that concerns me. A change in our society that is worrisome. While many say technological changes make it easier than ever to connect with one another, it seems we are more disconnected than ever. Less human interaction. More loneliness. Clicking the chat button as you order gifts on the internet, or even talking to a live person when you order from one of the thousand or so catalogs, is a poor substitute for the process of old-fashioned shopping at the aforementioned brick and mortar establishments where you talked to retail clerks, shop owners, and even fellow shoppers.

 

A little over 100 years ago, a sociologist name of Emile Durkheim coined the term Anomie which he used to describe situations where societies in large measure feel a sense of alienation because their only feeling of attachment is to the system in which they don’t believe or feel a part of. He thought this came about due to division of labor (this was in the midst of the industrial revolution) and rapid change from a traditional society to a modern society.

 

The pace of changes which Durkheim witnessed were trivial compared to the last 50 years, and it change continues to accelerate at a speed almost beyond our ability to comprehend. Yesterday, I awoke to hear news of the second mass shooting in less than two weeks. I believe it noteworthy that most of the perpetrators of these horrible acts were described as people with few if any acquaintances and no one who was willing to call them a friend. They were described as quiet and uninvolved in their communities, in short: alienated.

 

It also seems noteworthy that in spite of relatively good economic times, suicide rates in the U.S. have increased 24% from 1999 to 2014. Likewise, murders increased 8.6% in only one year (2016). According to the non-profit that tracks gun violence in the USA, (www.gunviolence.org) incidents have increased each year since they started tracking statistics in 2014. Conventional wisdom is that our current President was elected and continues to have widespread support from those who feel they have been “disenfranchised.”

 

Who is the patient?
This all suggests to me that we need to look farther than individuals with mental illness as the major factor in gun violence. It may be that it is our society that is ill, and in need of treatment. Human connection, kindness, and compassion might not help cure all of society’s mental illnesses, but it can’t hurt.

 

P.S. Catalog UPDATE
By the way, I just now picked up today’s mail and there were only 18 catalogs, but an armload of solicitations for money, some bills, and a letter from my only friend who still writes via snail mail.  Remember to be kind to your mailperson (especially this time of year).  There may be other Floyds out there and I’m sure there are even more catalog targets like me and Barb on every mail carrier’s route.  (Break for reminiscing): When I was in college a couple of centuries ago I worked as a mailman during Christmas breaks, and occasionally someone would invite me in for a cup of hot chocolate on the coldest days.  I wonder if that happens anymore.

Editors Note: While editing eshrink’s blog, I found this non-profit whose mission is to help us cancel unwanted catalogs: Catalog Choice . However, I haven’t told eshrink yet because I don’t want to rain on his curmudgeon complaint parade…he’s on a roll and I think it energizes him! Love you dad.

Transitions

This title was chosen by my son for reasons which will soon be obvious. His youngest has just left home, this time for good, and he and Sue are now presiding over the proverbial empty nest. It is a frequently quoted truism that if you truly love someone you will let them go when it is in their best interest to leave. I was reminded of this last night as I watched Casablanca…one of my favorite movies in which that theme was paramount. Though it is a noble act to let go of those you love, separation is painful, and usually results in significant changes in our lives.
We experience multiple types of transitions during our lifetimes, but since we are at heart social beings, or to put it more crudely, tribal in nature, changes in our relationships are apt to generate the most intense feelings. It is something of a paradox that as the world gets smaller, we find so many people of whom we care to be geographically farther away. Yes, indeed we are able to communicate with ease yet Facebook is a rather poor substitute for a next-door neighbor, or a relative living in the neighborhood. Prior to the industrial revolution, one’s cadre of friends and relatives was unlikely to change very much, and most people were born and died in the same place, often even in the same house. Now neighborhoods are in a constant state of flux, and there is a lower expectation of lifelong relationships.

STUCK WITH THEM
No wonder our children are among the very most important people of our lives. Since humans require nearly 2 decades to reach maturity and carry our DNA, we tend to form very strong bonds. We are often identified as “Johnny’s” father or mother. We live vicariously through them and share their triumphs, failures, joys, and sorrows. In many ways they are our second chance at life as we attempt to steer them away from repeating our mistakes. As the years go by our intimate involvement in their lives blurs with our own–they become part of us and in doing so shape our identity, i.e. who we are.
GRIEF WITHOUT A CORPSE
With all that in mind, it is not surprising that separation anxiety is a common affliction. When the kids grow up and leave, something more than their presence is missing. It is as if a part of ourselves is gone. Not only is the nest empty, but we feel an emptiness within ourselves, a kind of psychological amputation. In my experience, this emptiness is most profound when the youngest one leaves  for with it comes the realization that nothing will ever be the same. This time they are leaving to build their own nest.
THE FUN TIMES
Life is an ever-changing process. We begin as totally helpless and dependent creatures and experience a myriad of transitions during our lifetime all designed to produce an individual capable of building and presiding over that nest. Some of those changes are more dramatic than others. There are the first steps, the first words, the first solo bicycle ride, the first day of school, the first sleep over and a few thousand other adventures all with a goal of achieving sufficient independence to allow them to face the world on their own.
WHY DID I GET INTO THIS?
But it is not all sweetness and light. There is the messiness, the lack of discipline, the terrible twos, the out of bounds phase, the adolescent rebellion, the sleepless nights, and the continued testing of limits to name a few of the frustrations inherent in the child-rearing business. Those little buggers are also expensive. According to the USDA the average cost of rearing a child in 2016 was over $245,000 which does not include costs for higher education (but for the kids, I could have been a millionaire). Considering all the chaos they generate it is little wonder that we don’t occasionally wish them to be grown up however; one should keep in mind the maxim to “be careful what you wish for.”
BEGINNING AND END
According to the Bureau of Labor Statistics 67.3 % of high school graduates enrolled in college last year (2017). It seems safe to assume that most of these kids would leave home while in school, but retain a close connection to their old familiar environs. In many cases the college transition is a prelude and training for that final fly away. The days when we dumped kids and their gear off to a strange new environment were certainly memorable to Barb and me.
Our first experience with the off to college scenario was painful for all involved. Molly, our firstborn (now deceased), who suffered from serious medical and emotional problems was unable to complete that transition. Next in the line of succession was Peter, who was much too macho to display his feelings, but I was already missing him by the time we pulled away from his dorm. After a four-year hiatus, it was Trudy’s turn. Trudy, the adventurous one, was on the phone almost immediately, tearful and very upset to find beer being consumed at the sorority rush parties that she attended. We had no idea where this came from for temperance had never been emphasized at home. As you probably already suspect. her distress was short lived and as was her habit she soon became involved in everything.
THE LAST ONE STANDING
Of course, those separations were painful, but none so telling as Maggie’s departure for we were now returning to a house inhabited only by Barb, myself and Grover the dog. Maggie was one who had insisted on an out of state school, for she was eager to assert her independent status. She wanted distance from childhood connections. Her reaction to the college transition was a convincing testimonial for that “be careful what you wish for” thing. Permanently engraved in my memory is the sight of that sobbing, skinny little red-haired girl who stood there all alone in that huge empty parking lot making feeble attempts to wave goodbye as we pulled away. Barb wanted to go for one last hug, but I insisted she had already had several last hugs. We were later told that she cried for the next month and lost 20 pounds. [See an earlier blog post about Separation Anxiety + Mental Health}
NOT ALL SWEETNESS AND LIGHT
In case you are thinking this gang of mine is the Partridge family incarnate, think again. It is true that to date we have come through our transitions relatively unscathed, but not without trials and tribulations. In spite of their best efforts some families are overwhelmed by circumstances beyond their control. Barb and I are indeed fortunate that in spite of our screw-ups we have ended up with 2 generations of exceptional people, and the beat goes on.
STILL AT IT
It so happens that this month marks the beginning of significant transitions for every one of my Grandchildren which of course they will undoubtedly handle better than do their parents (or Grandparents for that matter). My three oldest grandchildren are already emancipated and starting new and more challenging jobs. Another is off to her first year in college, and our youngest is entering high school. As mentioned in my opening statement, Carter’s room is empty, and home is now in another city far away. Trudy’s is the only nest still occupied.
LIFE GOES ON
Whatever distress the kids may feel from leaving those years of memories behind is apt to be short lived compared to that of their parents. There is hope for Mom and Dad however. In return for enduring the vicissitudes of child rearing God has rewarded us with grandchildren. Thus, we have an opportunity to get all the goodies and none of the crappy stuff ,which leaves me wondering what it would be like to be a great grandparent. Stay tuned for the answer!

LIFE AND DEATH

Last night I happened upon a documentary about death on PBS. It included an introductory presentation by a woman who reports that she had found resolution to her fear of death by directly confronting it. She had made a point of viewing dead bodies at every opportunity and had even taken a job at a crematorium, which seemed like overkill to me. To complete her story, a vignette of that entire process was shown. I did not find watching the incineration of bodies as particularly entertaining, and Barb left the room saying she was repulsed. In spite of my interest, (I had always wondered how this procedure was done), I shared Barb’s feelings perhaps even more intensely for this is the method I had chosen for my disposal.

 

THE BIG QUESTION
Many years ago, I think it was the late 60s, Peggy Lee recorded a song titled: IS THAT ALL THERE IS? which has haunted me all these years for it expresses to me the most fundamental existential questions. What is life, where did it come from, why are we here, how did it happen, who or what caused it? When the answers to these questions seem almost within our reach, new questions arise and we end up confounded all over again. We humans are undoubtedly unique in our ability to even ponder such questions. As a matter of fact, we have no clear idea what life is let alone what it is all about. Our definitions of life are simplistic and do little to help us understand what it is. For example, for some time there have been efforts underway to actually synthesize a living cell, but those involved in such efforts cannot agree on the criteria for determining when something is alive.

 

WHAT IS DEATH?
Death on the other hand is defined as the absence of life, but is it? At this time of the year, one third of the world’s population is celebrating their belief that life is eternal. Muslims likewise hold strong beliefs in an afterlife as do many other religions. Freud described religion as a symptom of neurosis or in some cases psychosis. Karl Marx famously insisted that religion was the opiate of the masses. Both saw religious dogma as a defense against the vicissitudes of life: for Freud, defense from anxiety, and for Marx defense from the pain of domination. In spite of his atheistic beliefs Freud was reported to have said during a prolonged, and painful terminal illness that he envied those who had strong religious beliefs.
As our brains evolved to become huge cauliflower like globs of neurons, we developed the ability to not only perceive reality but to predict future events. This ability has served us well, but there is a down side in that we became aware of our mortality. Floyd, my dog who sleeps at my feet as I write this, is able to predict certain outcomes. For example, he has learned some of the routines of the house and knows when I put on a coat that he might be able to bum a ride. He will undoubtedly see dead animals during his lifetime, may even experience grief, but I feel fairly certain that he does not realize that in a few short years he will die.

 

RELIGION AND THE DEATH PROBLEM
Back in my younger days when as an academic I knew almost everything about everything, I found that death was one of those things even I did not understand. I was especially interested in how our awareness of mortality affected our thinking, values, behaviors, personality development, and even our mental health. My research on the subject of attitudes toward death indicated that certain diagnostic categories of psychiatric patients had attitudes significantly different from the norm. All very interesting, but I was left with the classic chicken egg dilemma, did their illness cause their unique attitudes or did those attitudes contribute to the illness? But that’s how it is with any scientific endeavor, to answer one question will only lead to more questions.
The study did tend to confirm what everyone already knew in that some people look forward to death while others fear it. In the former category is the late Billy Graham who on multiple occasions insisted that he was looking forward to his earthly death, and the beginning of a new (much better) life. Muslims are so convinced of an afterlife in paradise that they are willing to martyr themselves to ensure their admission. As a matter of fact, all religions seem to have in common the pursuit of a solution to the death problem. Those of strong faith have been shown to have less fear of dying, but in one study those adherents uncertain of an after-life were even more fearful than atheists who were convinced that there was nothing after death.

 

DEATH OR RELIEF?
Death may also be attractive to those suffering from extreme pain either physical or mental. Patients whom I have known to have suffered both serious physical and emotional distress at various times in their lives invariably report the emotional pain to be more difficult to endure. When combined with feeling there is no hope, for such people suicide may seem their only option.

On one occasion in the days before Google, I was approached by a patient asking what would be the lethal dose of phenobarbital. He reported that his mother had been ill for several years with several surgeries leaving her without ability to speak, a horribly disfigured face, and severe pain. She was on large doses of pain medications, and her illness was terminal. She had told her family that after careful consideration she had decided she wished to die sooner rather than later and wanted her family to be with her as she died. Had she been a family pet her assisted suicide would have been declared merciful, but in her case it was criminal. Go figure. On the other hand many agree that to countenance euthanasia is to start down a slippery slope.

 

CLINGING TO LIFE. FIGHTING DEATH.
There are others for whom life is so precious, or is it that death is so threatening, that they cling to life in spite of enormous pain or disability. Such was the case with my daughter who shortly before her death said: “I don’t want to die Daddy.” Was she afraid? I will never know for my response was to reassure her she was not dying rather than to address her feelings about the death she knew was imminent. Thus, her cry for support was brushed off and she was left to deal with the most difficult time of her life alone. I should have known better. Sometimes it is difficult to practice what you preach.

 

A recent example of one who chose to follow Dylan Thomas’s advice to “Rage, rage the dying of the light…….” Is exemplified by the late Stephen Hawking, who was diagnosed with Amyotrophic lateral sclerosis as a graduate student and told he could not be expected to live more than two years. In spite of total paralysis and the loss of his ability to speak, he went on to become a major contributor to the science of cosmology and was described by some as a modern day Isaac Newton. He was a prolific writer in both the scientific and lay literature in spite of limited ability to communicate. In his later years, he gave lectures all over the world with the use of a voice synthesizer operated by his only remaining functioning muscle group which was in his cheek.

 

LETTING GO
Sometimes death can be viewed as an opportunity to be reunited with a loved one. One very personal example of this was with the death of my Mother. My Father had been dead for a couple of years and Mother was staying with us. Her only known medical problem was a few episodes of cardiac arrhythmia one of which had resulted in hospitalization and successful treatment. I suspected she would be discharged the following day and stopped in to see her as I made morning rounds. I was surprised at her response when I asked her how she was feeling when she said: “I am feeling just fine, but I have been thinking a lot lately and have decided it is about time for me to be out there (the cemetery) beside your Father.” I thought little of her comment and went on to my office. A short time later I received a call from her nurse telling me she had died. We should all be so lucky as to go that way, in charge and at peace. This and similar stories have led me to believe that we have more control over our demise than is apparent.

 

SEX AND DEATH?
Perhaps the weirdest thanatophilic attitude toward death is in its libidinization which was not only observed in my research but in Greek mythology. In the story of “The Rape of Persephone,” Pluto, guardian of the underworld ascended from Hades to seduce the maiden Persephone. Throughout history this theme has been repeated many times in different iterations. You may be thinking: how can there be anything sexy about death? I told you it was weird. This brings me back to the young lady who was interviewed extensively on the PBS special. She not only presented her story of how she overcame her fear of death, but was filmed giving a lecture to a group of alleged thanatophobes. It occurred to me that she possibly could have gone overboard as she talked of the joys of death in a husky voice accompanied by a sexy smile. But in case you want to learn about even weirder stuff you might want to check on the necrophiles who enjoy sex with corpses. There is also John Wayne Gacy who admitted to having orgasms as he watched his victims die.

 

NEAR DEATH EXPERIENCES
None of those interviewed in the PBS documentary seemed more certain of life after death than those with histories of near death experiences. Their stories were consistent and the interviewees were very credible. Many others speak of witnessing from above the attempts made to resuscitate them, and report seeing a tunnel with a bright light in the distance. There have also been some who have reported very unpleasant experiences, and following their recoveries vowed to change their ways. There is one neurologist who suggested these experiences were simply the result of cerebral ischemia (diminished blood supply to the brain), but there is little doubt in the minds of these survivors that their experiences were real. One such survivor suffering from a terminal cancer reported she was looking forward to her death and we were told she died two months following the filming of the program. The others all said their lives had been changed since the experience, and that they had developed a kind of serenity they had never known previously. Although not mentioned in the broadcast, I am also aware of at least two books written about going to heaven and one describing a 20 minute visit to Hell, accounts which I found less credible.

 

CREATING YOUR OWN AFTERLIFE
Spookiest of all in my opinion was an in depth look at the so-called cryogenic procedure in which bodies are frozen in liquid nitrogen with the hope that in future years technology will allow their illnesses to be cured, and they will be able to do a secular version of the Lazarus trick. Cellular biologists believe it is impossible to do even a very quick freeze without doing permanent damage to the body’s cells. Nevertheless, there are people who are willing to pony up large sums of money to have their bodies frozen and stored in hopes of being brought back to life. One website reports they have over 100 such bodies stored in huge tanks of liquid nitrogen. As for me, I think I would prefer to take a shot at heading down that tunnel toward the bright light.

 

DEALING WITH OUR MORTALITY
There are many behaviors unique to humans for which one could make a good case to result from awareness of our mortality and even the concept of death. Denial is the most powerful tool that can be used to decrease anxiety, and typically the way most of us deal with the reality of death. Those things we don’t understand are the ones we find most frightening. Freud for all his foibles had much to say about death, although discounting religion, he presented some interesting comments about our denial. One which rang true to me was his statement: “It is indeed impossible to imagine our own death, because whenever we attempt to do so we can perceive that we are in fact still present as spectators.” I can’t help but wonder if he got this idea from Mark Twain’s story about Tom and Huck attending their own funeral. Nevertheless, he does make a point. We like to give instructions as to how our funeral or lack of should be conducted sometimes with great detail, and without consideration for the idea that such services should be for the benefit of those who grieve. Do we really believe we will be able to hear what hymns are played?
In spite of our knowledge of the inevitability of death we continue to seek token immortality. We select monuments, have portraits made, buy life insurance, establish charitable trusts, write wills, work hard in order to be able to leave something behind, and even write blogs in hopes we will be remembered; and continue to live in the minds of others. Not surprisingly there are often attempts to retain control after death. I recall one example of a friend who was noted to be an in control kind of guy who liked to keep his wife under his thumb. He wrote a will in which he specified that her inheritance would go to charity in the event she should remarry after his death. There are so many other questions which have gone unanswered. For example, to name a few: why do some enjoy the thrill of risking their life, why do some like to frighten others with the threat of death, why do some appear to actually enjoy killing. We seem to be unique among the animal kingdom in those behaviors.

ARE THERE ADVANTAGES TO THE REALIZATION OF OUR OWN MORTALITY?
Lest you think I am totally morbid in these thoughts, I should admit there are some obviously useful things surrounding this mortality thing. We tend in many ways to view death as punishment. We use terms like “he deserved to die,” and “the wages of sin are death.” Throughout history, assassinations have been carried out to punish those accused of misdeeds, and the most serious crimes are still punished by death. If we were convinced we would live forever, would we behave instinctively without regard to consequences, in other words would we have developed a super-ego? In like fashion what about creativity and the urge to complete projects if time were not limited? There would be no need for monuments or for offspring to mourn. Would we feel the need to band together with others? It sounds to me as if life would be boring.

MY STRATEGY
Well, enough of this death stuff. I hope the next PBS program will be about life. Meanwhile, I plan to adopt the “eat drink and be merry” strategy. Barb recently told me she had decided to concentrate on living each day to the fullest as long as she could. I suppose this would not leave much time for worrying about such mundane issues as dying. Maybe she will be willing to give me some lessons.

Addendum by retired eshrink editor:
My dad and I discussed the topic of this blog before he wrote it. I told him of a pivotal moment during college when a marketing professor posed the question, “What if this is all there is? Despite what you’ve been taught in church or by your parents, what if this life is all you get?”

It was if a light bulb went off! Religion uses “heaven” and “hell” (the “afterlife” in general) to relieve us of the anxiety of our own mortality and in some instances, to control us. You want to get to heaven. You don’t want to go to hell. Here’s what you need to do. As if, all chaos would ensue if we thought this was the one life we get to have.

Indeed, that was the point I got from this professor. The realization that this life is the one that is real and I better be a full participant because it’s the only one I know I have. Don’t use an “afterlife” idea to put off living this life fully. Don’t get me wrong, I hope there’s something really good after this life. My version of “heaven” is being able to use the heaven TV network to check in on all my people to see what’s going on because I don’t want to miss anything! Also, I would like to create my own weather, get to choose my own “age” during my time in heaven, visit with everyone else who is dead, and most of all, get all of those big questions answered. I freely admit that I’m afraid to die because I’m afraid of the unknown…I’m with Freud, I’m envious of those people who have no doubt in religion’s teaching of an afterlife. However, I must admit I have never understood why highly religious people who think their dead family member has gone home to Jesus to the next life, cry so much at the funeral. If you truly believe that without a doubt, wouldn’t you be happy for them?

However, I do believe there is something more and hope there is something more, but no proof to date.

So, I try to use mortality to make sure I live well in this moment that I have been so fortunate to be given and even more, to put life’s perceived “stresses” in perspective. “It’s not life and death” I’ll tell myself.

Since my husband died suddenly at a fairly young age , I also use “death” as a way to live my life double for those who don’t get to be here. I try very hard not to take one minute for granted. Life’s short. It’s not a dress rehearsal. Treasure the gift. Be present. Make every minute count.

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.

THE POPE AND I

No, I did not have an audience with the Pope. I confess that this title is a bit misleading, but you must admit it got your attention.

The Pope’s visit got everyone’s attention especially viewers of CNN, for their coverage was non-stop from arrival to departure. This must have made their bean counters happy, since I imagine their bottom line could be adversely affected were they to pay independent journalists to cover the horrors taking place in the middle-east and Africa, or the desperation of immigrants around the world.

You may be wondering why I didn’t change the channel to Fox and watch them trash democrats or MSNBC, as they did the same for republicans, or even to Sesame Street in case I wanted to learn something worthwhile. The problem is that Barb likes CNN.

Although I don’t wear a long white dress and beanie, I found his speeches interesting and even inspirational. At one point I nearly pulled a John Boehner and could feel a tear about to erupt. In most cases, his thoughts and opinions paralleled mine therefore; he must be pretty smart. In particular, his speech at the U. N. caught my attention when he talked about the need for people to bond and trust each other. I concluded that the Pope had much in common with this old Presbyterian. It occurred to me that our need to bond with each other seems to be universal and can have both good and bad consequences.

My understanding of Pope Francis's statement, which would result in people caring for each other, and in so doing to learn trust. There is little doubt that if such feelings for our fellow man were present in everyone, this world would be a much more pleasant place in which to live. Of course, this in not a novel idea. Many have espoused it for the past couple of thousand years, if not longer, but with minimal effect. In fact, religions both past and present, expect their members to meet and worship together. They usually encourage fellowship, and the experience of belonging to a caring group of people is fertile ground for the development of trusting relationships. The Pope must have felt there was a lot of bonding going on as millions flocked to hear his words and receive his blessings.

The Pope and I agree that bonding and trust are important. A very common complaint by my patients was of loneliness, and feeling a lack of connection to others. As a matter of fact, most of the perpetrators of the recent spate of mass murders are said to have been alienated from society. Notes they left reflect the anger they felt at being left out and alone. Group therapy has been a useful tool in dealing with such problems as it provides an opportunity to relate in an atmosphere where one can share in a safe environment, and learn to trust and be trusted. This need to bond appears to be so ingrained in our very nature that we sometimes look for other ways to satisfy the need. Those whose lifestyle or physical infirmities limit their relationships may find solace in a pet. There have even been instances reported in which prisoners who are isolated attempt to befriend the rats who visit their cells.

It is not clear when this need, so powerful that if unrequited may lead to suicidal or even homicidal behavior, became so ingrained in our psyche. There is evidence that earliest man  learned the advantages of close relationships. Indeed, it is likely that without such bonding, our prehistoric ancestors might not have survived, and could have become extinct as did other branches of the hominid progeny. Indeed, in a world where predators threatened their existence and competed with them for food, it would not have taken them long to realize there is safety in numbers. Likewise, as they developed carnivorous tastes they would have found that teaming with others would contribute to successful hunting. Such lessons learned were not unique to humans for many other mammals found that bonding with others of their species enhanced their chances of survival. With such a history spanning thousands of years, it should not surprise us that this need to bond would eventually become imprinted on our DNA.

There are some, myself among them, who are concerned about the ways in which our children are limited in developing relationships to which they can bond. Home schooling has become more popular and is likely to become more so as the digital world expands. I have long been concerned as I have seen the consolidation of small neighborhood schools to become institutions that are so large it is very easy for a child to be left out of the mainstream. Since K through 12 school is where children learn social skills, and develop much of their self-image, such feelings of alienation can have serious consequences. Parents face a great deal of stress sometimes working two jobs, and stay-at-home moms are less plentiful. It appears that kids spend much more time texting than talking. The rest of their free time is often spent playing video games. And, yes I know that a previous generation had the same concerns with the invention of the telephone, as my Grandson eloquently pointed out to me a few months ago. I agreed that the phone was a step down from looking one in the eye, but did preserve voice inflections and thereby we were not quite so insulated from the feelings of callers.

Most people would agree that neighborhoods are not as neighborly as they once were. The current generation prefers distance from their neighbors as witnessed by the current housing developments where larger lots are preferred and “houses are not jammed up against each other." Studies of large city apartment buildings indicate that many residents do not even recognize their neighbors. On the other hand, I did recently read that some companies are now eliminating the cubicles in which they isolated their employees, as they have decided that their workers were much more productive in an open office space. It was felt that the changes also resulted in feelings of camaraderie with coworkers, company loyalty was strengthened, and absenteeism was reduced. Such examples illustrate when barriers are removed, there is a natural tendency to bond.
Of course the ultimate bonds are those with our immediate families, but for most this does not seem to be enough. When populations grow so large that physical contact is impossible, they still find ways to bond. Witness any athletic contest and you will see groups sometimes numbering in the thousands banding together to cheer on their team and boo the bad guys. Though there are some loners among us, most seem to have a need to closely align themselves to a group or organization. There are lodges, fraternities, sororities, clubs, religious and political groups, reunions, and volunteer organizations to name a few. There seems to be an almost universal need to belong, to be attached in some way to others.

History tells us that nothing unites a group of people, whether it is a neighborhood, tribe, or country, like a common enemy. It makes little difference if the threat is real or imagined. Throughout history leaders of nations have been able to mobilize and bond their subjects by convincing them they have an enemy. Coaches have long known that their team’s success depends to a great extent on the relationships between their players, and their ability to function as a unit. Those who work in dangerous positions such as fire fighters, policemen, heavy machinery operators and such must depend on others to “watch my back;" consequently, trust is essential, and camaraderie is a prerequisite. Many religions bond together in their struggle against demonic forces of one kind or another.

Nowhere except within families is bonding more intense than in the military. Recruits soon unite by learning to hate their drill sergeant. The entire unit may be punished for the transgressions of one; thereby teaching him a sense of responsibility to his buddies. One may enter the service for a variety of reasons, but once in combat they report their allegiance is to those who fight beside them. The bonds formed are so intense that some experience grief after leaving their unit in spite of the dangers and horrors they may have faced. This sense of loss in addition to the survivor guilt often felt are undoubtedly factors which account for the epidemic of suicides by returning soldiers from our latest war. Some have volunteered for return tours of duty apparently hoping to recapture that which was lost.

It is true that relationships are not only pleasing, but probably necessary in order for us to maintain sanity. Indeed, one study from many years ago where volunteers were subjected to total isolation, all developed psychotic symptoms in as little as two weeks. It is also true that throughout the ages there have been the cunning and unscrupulous who have perverted this need of ours to service their lust for power. The mechanism as I mentioned previously is simply to convince a group of people that they have a common enemy and that they must unite to protect themselves or punish the miscreant for his alleged misdeeds. One need only to turn on the nightly news, and hear about the violence and chaos that persists throughout the world to see how successful these strategies have been as populations bond together to destroy their own version of the bad guys.

Although in the U.S. we moderns no longer have saber tooth tigers to fear, there are many who have no difficulty finding people to hate and whom we should fear. We have the white supremacists who are convinced we are in danger of being persecuted by blacks, the gun lobby who wants us to fear everyone, and other groups too numerous to mention. And let us not leave out our politicians as the republicans convince us we should fear the democrats and the democrats tell us the republicans are the ones who will do us in if given the vote. In other words, we are encouraged to choose sides, bond, and fight with each other. In order to fight we need a leader to save us, and there are always those who are gracious enough to be that person if only we will vote for him.

If I ever did have an audience with the Pope, I would enjoy discussing this bonding and trust stuff with him. I would probably agree that more bonding and trust is needed, but that in many instances those same qualities can also be used for nefarious purposes. In that vein, I can see myself saying, “Frank, be careful what you wish for” or in his case it would be more appropriate to modify the admonition by substituting the word "pray" for the word "wish."

The Big C and Me

Editor’s Note: This is an excerpt from the book “Reflections for the Future” that includes many of my dad’s writings (e-shrink). You can order it on lulu.com (hard back) or download the pdf of the book for free. Dad referred to this article in a recent blog post so I’ve copied it here.

They faxed the results of my CT scan the other day, and it showed no signs of reoccurrence. Briefly I felt a sigh of relief, such as I imagine the men on death row must feel when they get a reprieve to delay their execution. This journey began nearly a year ago, only a few weeks after my brother died of a rapidly progressing lung cancer. Fortunately, he had little time to suffer as he died only three weeks after he was diagnosed. My wife insisted that I should have a chest x-ray, and there it was, “a right upper lobe mass.” My hopes that it might be a benign lesion were dashed when the follow-up scan was interpreted as “Probable bronchiogenic carcinoma” and confirmed when the PET scan “lit up.”

One would think that my training and research interests would have prepared my to deal with this problem, for back when I was an academic my colleagues and students jokingly referred to me as the “Angel of Death.” This was due to my interest in thanatology (death and dying). At least on a conscious level I was interested in how awareness of our mortality affected such things as personality, super ego development, motivation, mood problems, suicidal and other self destructive behaviors. I now wonder if much of my interest had more to do with my own personal conflicts than a strictly scientific interest. My research led me to the believe among other things that Freud was correct when he stated that people generally were unable to imagine their own non-existence. He was also quoted as having said while he was dying of a painful malignancy that he envied those who believed in an afterlife. Billy Graham seems to have something in common with the Islamic suicide bombers in that he has said that he is looking forward to death for he is convinced that he will have another one much better than his current one. I have also seen many patients who yearn for or even attempt to hasten their death in order to rid themselves of unbearable physical or emotional pain. For some my studies seemed to indicate that there may even be a sexual component to their fantasies of death, and for others a reunion with loved ones who have “gone before’. These are attitudes which I labeled as thanatophilic.

Unfortunately, I am not a thanatophile, On the contrary I am quite thanatophobic, I love my life and as is the case with most things, with the threat of its loss it becomes more precious. My education in the sciences has given me an appreciation for the awesome complexities of life, and some understanding of its fragility, but it is more than the sum of its parts. Now more than ever I look out our kitchen window and marvel at the birds as they all struggle to sustain their life and are programmed to replace themselves so that “life goes on”. I am overwhelmed with their beauty and grace. Is life just a complicated chemical process or does it house something spiritual? I am certainly not the first person to pose that question. When I attempt to understand the physicists as they theorize about the nature of matter and the vastness of the universe, it seems my life must be very insignificant; however sometimes I act as if the world could not get along without me. I guess Freud really was right in that I can’t imagine myself as being dead.

When I first received the shocking news that I had cancer, it suddenly became very clear that my musings and “scientific” investigations into how people think about and cope with death were of little use to me. Kubler-Ross was a researcher at University of Chicago who had beaten me to the punch with her book on death and dying; consequently I had always criticized her for what I considered an overly simplistic explanation of the dying process. Much to my chagrin I found myself to be a poster boy in following her descriptions of people’s behaviors as they faced death. The 1st stage she described was one of grief, and I did that one well all the while attempting to hide it out of a sense of embarrassment. Initially I tried to regain control by trying to “get my affairs in order”, but that rapidly gave way to a feeling of intense sadness which was most severe when I thought of my Grandchildren. I found myself suppressing tears whenever I thought of them. I told myself this was ridiculous, for how could I anticipate feeling this sense of loss if I were dead. If I were dead I wouldn’t feel anything or would I?

It has been said that ignorance is bliss, and also that a little bit of knowledge is dangerous. I knew my body had betrayed me and that my own cells were attempting to destroy my vital organs. I could picture them as they would look through a microscope with their bizarrely shaped nuclei, many of them in the process of dividing as they rapidly reproduced themselves. I knew the traitors had spent the last several years quietly multiplying in my lung preparing for the final assault. The obvious defense against this army was to totally destroy them, and this could be accomplished only with surgery. There would be collateral damage of course, but pulmonary function studies indicated that my body could survive the loss of a lobe (approximately ½ of my right lung). Barb made me promise to “fight like hell” and I vowed to do just that; however as the day of surgery came closer I became more fearful. My fear was that I would wake up attached to a ventilator with my arms restrained and unable to speak, or of some other complication ( I could think of many) that would render me helpless. The idea of such helplessness had always been terrifying to me. The ultimate horror I could think of was quadriplegia with right sided stroke a close second. It turned out those fears were groundless and I tolerated the surgery well for an old bugger. The epidural almost completely eliminated the post operative pain for the first few days, and other than being tethered to a couple of garden hoses protruding from my chest wall I was reasonably comfortable, after Barb had raised enough hell to get me a more comfortable bed than the slab on which they initially placed me.

The pathology report was favorable with no tumor cells found in the lymph nodes ( the most likely route through which the they could spread) and although the tumor involved the visceral pleura ( the covering of the lung) it did not appear to have penetrated into the pleural cavity. This invasion of the pleural cavity is what had killed my brother. The five year survival rate with this type and stage of lung cancer is sixty seven percent. I am told that this could be improved by seven more percent with chemotherapy: however the side effects from the extremely toxic drugs designed to kill those little devils that might have escaped can also do serious damage to healthy parts of my body. I decided to take my chances without it.

My spouse who has been a cancer survivor for twenty years has been a rock, and we have rather deftly switched roles with me now dependent on her for support. She acknowledges my fears, discourages my somaticising, and encourages me to live in the here and now. I have gone through Kubler- Ross’s “bargaining stage”. In my case this involved pleading with God to allow me to stay here to see my grandchildren grow up. I have been amazed at the number of people who knowing of my illness say they are praying for me. This includes friends, casual acquaintances, and even patients all of whom seem to know of my ordeal. I have decided that with all of the problems facing God it is presumptuous for me to expect special treatment, so I have decided to keep my eye on the ball and do what I can to follow his will as I imagine it to be. I hope to stick all these death and dying fears back in some corner of my mind. It has been my experience that one of the major problems with worrying is that we usually worry about the wrong things and the bad things that happen to us are the ones of which we never thought. The fact that I don’t want to die is a testament to how fortunate I have been to have such a wonderful life. Maybe my luck will hold and I will die in my sleep in another twenty or thirty years.