Tales from the Couch

HAPPY NEW YEAR

2011-12-31T15:20:00.001-08:00

In the words of one of my Idols:
Learn from the past, Live in the present, Hope for the future.
Albert Eistein

The lights of Hope

2011-12-23T15:33:00.000-08:00

“I hate Christmas” she said, tears of sadness and anger welling up in her eyes. “What is so wonderful about this season? Take a look around: people are out of work, they walk with scowling faces, and a kid a wonderful young man is diagnosed with cancer” now the tears are streaming down her flashed face. They can take their cheer and shove it…”

She is right you know, in a world where Europe, the cradle of Western civilization, the Alma Mata of many of us, is collapsing like a house of cards; where the Middle East remains a Tinder box ready to explode; where our young men fight and die in a back water country where women are killed because they had the temerity to get raped; In a world where USA has 13 million people out of work it is definitely hard to find the cheer in Santa’s HO, HO, HO.

And yet, and yet… I look at the Christmas tree in the corner of my office heavy with lights and ornaments. Every single ornament lovingly unwrapped and placed on just the right branch because every ornament has a story and a wish attached to it. From time to time I allow myself to get lost in a fantasy of glitter and sparkle. There is the golden ball of hope, and the red one for our most treasured passions, and the glittery sparkling stars to guide our quest for self-understanding and tolerance, and the bells to remind us of something, although I don’t quite remember what, maybe responsibility? And yes, I believe everyone should have a tree. It symbolizes the part of us that has remained tall and proud and untarnished by the toxicity of our world. It is the part of us, the part of humanity that every now and then stretches its branches to the stars, like it has done for hundreds of thousands of years, and yearns and demands to be adorned with the ornaments of appreciation and the lights of hope.

So, all the sorrows and pains of this world notwithstanding lets trim the tree and light it up with as many lights as possible because we all need a break from reality and a magical place and time to nurture Hope.

THE INVISIBLE GORILLA

2011-11-08T09:03:00.000-08:00

THE INVISIBLE GORILLA

Freud was famous or infamous (depending on how one chooses to look at it) for saying that his job was not to make people happy but instead to get them rid of their illusions.

Whether we dare to acknowledge it or not, the fact is that we all fall victim to a large number of illusions some of which we begrudgetly acknowledge and rationalize while others we are totally blind to.

Our brain is “hard wired” by evolution to be prone to illusions. Many of these illusions have been sanctioned, reinforced and promulgated by societies and religions from one generation to another through time immemorial. It is an indisputable fact that many of these illusions have helped us survive as a species and flourish. On the other hand, it is also equally and painfully indisputable that a number of these illusions have led to massive injustices and genocides (race, IQ, gender, religion just to mention a few).

Science has managed and continues to unravel many of the dangerous illusions while others continue to defy proof and logic in most stubborn ways. The latter include: Beliefs in the accuracy of memory and the infallibility of eye witnesses, our convictions that we are too smart to be manipulated, that we always have free will and choice, that we know a lot more about events and people than we really do, the belief that our personal moral code is or should be a universal dictate and I am afraid a lot more. Based on these illusions we make decisions about who to marry, who is innocent and who is guilty, when to terminate a relationship or marriage, who to vote for, when to go to war, the way to rear our children and many other decisions from the smallest to the largest.

Now, I am not saying all this because I woke up in a bad mood this morning and decided to spoil every one else’s day too. I am saying it because I believe that with a bit of knowledge and a good deal of courage we can rid ourselves of dangerous illusions. Therapy goes a long way in opening peoples’ minds and so do science and education.
What prompted me to write this blog today is a book that I just finished reading: “The Invisible Gorilla and other ways our illusions deceive us”. It was illuminating and in many ways shocking. I highly recommend it to all brave souls out there who wish to free themselves from the fetters of illusions and/or misguided assumptions.

The tears the eyes will not shed the body will weep

2011-07-13T10:52:00.000-07:00

I have for years preached to my patients that grieving does not start
when you lose a loved one or even when you burry him. Grieving begins
when you really let the beloved go, in your mind.

I thought I had cried enough, I was convinced that I raged plenty against
the slings and arrows of the outrageous fortune, but his food bowl stayed
on the floor, his favorite pouch next to the fireplace, his bed on the
family couch and his toys strewed all over the place. Any well meant
suggestion that I should be putting these objects away met with a mix
of tears and anger.

I constructed a mausoleum and Sadness and Guilt, the inseparable
companions of Grief, fanned the flames of an irrational, primitive
illusion: what if he is really not gone? As the flames of this insidious
illusion strengthened the headaches started, like a vise around my head
squeezed tighter and tighter every day for 2 months.
Then the “core could not hold anymore” the walls of denial crumbled.
In-between my sobs I heard myself asking: He is not coming back, is he?
No, sweetheart, he is gone my husband said.

As the tears subsided the vise around my head began to loosen itself.
In my mind’s eyes I saw Him prancing into the woods, his tail held
straight up like a little periscope, his ears erect. He turned his
head back to look at me: It was a great life, mom, thanks, and so long…..

2011-05-11T12:53:00.000-07:00

J.R

Love is to fall head over heals for 2 huge bright eyes and a tinny mischievous face

Love is to lose yourself and life’s hard edges in joyous playing and laughter.

Love is to share life’s moments, the elation of success and the pain of loss.

Love is to nurse him with tenderness while your heart is shredded to pieces.

Love is to let him go although you want to hold on with every ounce of your body because his dignity demands it.

Love is to reach out and love again and gain because anything less is an insult
to the gift of love he brought into your life.

2011-04-04T18:10:00.000-07:00

How many ruined lives will it take?

I was writing a few short weeks back that our technological advances have by far outsripped our ability to understand and integrate them in our ever day living with often disastrous consequences. And here I am again, sounding like a broken record, asking again what would it take for the community, the parents, the educational system to wake up?

Front page in the New York Times last Sunday: A Girl’s Nude Photo, and Altered Lives: At 14 she thought it perfectly logical to sext her boyfriend nude pictures of herself, he in tern found it self aggrandizing to forward these pictures to his best friend who in the penultimate wisdom of his own 14 years on this planet thought nothing of forwarding them to the girl’s archenemy. You can imagine the rest. Or can you? Did you know that circulating pictures of underage kids(even if they are circulated by other kids) is considered distribution of child pornography, a charge carrying imprisonment? Well the kids had no clue, even scarier; their parents had no clue either.

Parents think that it is totally innocuous to give a kid a phone or a computer and leave him/her alone with them. They never stop to think that they are handling their kid a loaded gun and license to destroy lives with impunity. But to be fair, how would parents know the apparently unending possibilities and applications of the new technology? Who is educating the parents?

Would, I wonder, break the budget to have classes for parents, starting from kindergarten all through high school, to educate them about the ethical and legal hazards of the new technology? How much money or time would you be willing to spend to save the live or future reputation of your child? Schools have mandatory inoculations to prevent the spread of epidemics, yet there is an epidemic that is spreading like a wild fire among the youth: the epidemic of ethical irresponsibility out of ignorance. Would it be too much to ask for mandatory inoculations for this epidemic too?

2011-03-02T13:47:00.000-08:00

Sometimes a cigar is just a cigar….

He came to therapy because of his mood swings. He would go from a sweet, laid back, funny guy who everyone loved, to losing his temper because someone cut him off while driving or the kids were too loud or the wind was blowing the wrong way. You name it, it could set him off. If I don’t get my Mr. Hyde under control I will lose my family doc, he said to me in tears.

So, we worked on stabilizing his moods. “Keeping it level” became his new mantra while his great sense of humor kept everyone in his life steadfast in “his corner” while he worked on his issues.

One day he came in with the familiar twinkle in his eye that invariably forecasted a joke.How are you doing? I asked expectantly.
Well, he said, yesterday I went to pick up a pizza for dinner. It smells great, I told Antonio as he handed me the steaming box of pepperoni, my mouth watering already. “Yes, man” Antonio said “keep it level.” I thought it was divine providence reminding me of my resolution not to lose my temper. You too man, you too, I shot back at him with a broad smile and walked out of the restaurant. It was not until I opened the box at home and saw that the whole cheese and sauce had dripped to the side of the box that it dawned on me: “keep the box even, keep the box even!!”

Sometimes a cigar is just a cigar or… a pizza. Thanks for all the laughs Joe.

The little silver Treee

2010-12-19T14:37:00.000-08:00

I have a little silver Christmas tree in my office. It went up a few years back with the 3 or 4 ornaments patients brought me as gifts, and just like that a new and wonderful tradition was born: Four weeks before Christmas the tree goes up; during the last 2 weeks patients come in, like the biblical Magi, ornament in hand; we walk up to the tree, they find a free spot, hang their ornament up and whisper a wish.

Today the little silver tree stands heavy with all its ornaments; its branches proudly holding all the dreams and hopes people entrusted it with. There is the shinning red ball for Good Health, and the glittery gold one for that Hoped for Special one, and oh… look, look; do you remember that pink one over there? It was for the much hoped for Baby, and many cat ornaments for the cat-loving therapist (yours truly). On the top sits a crystal star I call Hope because as long as there is hope to light up the path, Psych will unfold its potential and life will find its way.

Through the years a lot of those wishes came true, others are still hatching in the glow of Hope. This year with the dark cloud of the global financial collapse still hanging over us and still in the midst of uncertainty and fear; I too walked up to The Tree ,as I had done so many times before, hung up my ornament and whispered the same ancient but never dated word: PEACE.

How my cat taught me humanity

2010-11-05T18:59:00.000-07:00

He is 38 years old very attractive with a stellar career
steadily unfoldingin front of him. He was brought up with all
the privileges that money affords and with a sense of entitlement
and solipsism that in his mid 30s left him empty and bored.
He brought his depression, existential angst, and frustrated
quest for meaning to my office, deposited them in my proverbial
lap and in not so many words led me to understand that he expected
me to address and cure all his plights, after all isn’t that what
he would be paying me for? A few months into therapy it dawned on
him that if he wanted answers he would have to roll up his sleeves
and work at it just as hard as I was. He proved to be a good sport,
however, as he did not complain too much about this first disillusionment
in this enterprise called therapy.

In our work together we came upon the same often insurmountable
obstacle: his ego-centered view of the universe. His multiple
relationships with women came to the same predictable and unhappy
end, he was told time and time again that he was not “listening”
and he was sincerely puzzled about it. How could they have a
world view different from his? How could they tell him that he
did not do enough for them when he knew what they really
needed a lot better than they did? When I told him that everyone
sees the world through his or hers own “lenses” crafted by unique
and individual life experiences he told me that if you are short
sighted you don’t keep bumping into furniture, you go to the
optometrist and get glasses. He saw himself as everyone’s
corrective lenses to emotional or intellectual myopia, you see.

And then a year into therapy it happened. He was passing by
Pet Smart one day with his girl friend de jour: “oh” she exclaimed
“kittens can we adopt one, pleeeeease?” “And I did” he said
dropping his eyes to the floor with shame and guilt, “to impress
her,” but then Tyson took total possession of my house and my heart.
Why the name Tyson? I asked. “would you believe it”he said,
“this fur ball climbed onto my chest and started boxing me” I did
not have the heart to tell this X quarterback that this “furball”
was “seeing” him as its mommy and was kneading his chest to
stimulate lactation just as it had done with its “biological” mom.

I sat back and listen with barely contained glee how the
“furball Tyson” steadily turned a elegantly and expensively
decorated bachelor mansion into a kitten’s playground. Pillows
and throws now covered the custom designed couch, cat toys
were strewed all over the house and a floor to ceiling
cat condominium featured right next to the humongous flat TV,
because “it is more fun to watch him playing than football.
” Into the trash went playboy and sports illustrated to be
replaced by an assortment of cat books and magazines.“And you
know something doc” he told me one day “I don’t need those
sleeping pills anymore. Tyson snuggles up to me
and begins to purr and I am out like a light”

The finishing touches of this “miraculous” transformation
came when Tyson got sick and required scheduled medications
and care. Gone were the after work drinks with his friends,
the 15 hour work days and lunch was spent driving home to
comfort Tyson. It must be tough for you, all these life changes,
I tested him one day.“Not at all” he said sincerely surprised
that I would say such an inane thing “I love taking care of him”

I thought that things don’t get much better than this, but he
surprised me once again. One day he told me beaming with joy
that he was now part of an animal rescue and adoption organization,
“ and the people are sooo nice too!” he tells me “a little eccentric,
but who am I to be talking”. He was exchanging the crown of
egocentricity for human camaraderie and tolerance. He was now
fostering 3 more cats. “You know ” he said “I think I am beginning
to get it, this whole thing about believing in something bigger
than yourself? You can tell Tyson’s story in one of your blogs.
Maybe there is another self-righteous, know-it-all guy out there,
like me, who needs to be rescued. I have a few Furballs willing
to volunteer for the job”.

“I don’t know if it is all these cat pictures in your office
that led me to adopt Tyson, but he is the best therapy ever.
Don’t take it personally, you are a great therapist, but Tyson
taught me humanity” he tells me.

It takes a village.....

2010-10-09T10:56:00.000-07:00

The recent suicide of the Rutgers student has once more pushed the needle of our moral compass to the levels of outrage and moral indignation. The prosecutor is asking for a 10 year prison sentence, parents are outraged and the school is mortified for more than one reasons.

The fact is that our technological advances are speeding with such a velocity that have left our ability to emotionally integrate these changes and their repercussions in every day living in a blinding dust of confusion and ignorance.
The fact is that as parents, schools and society we have all failed both the kid who saw death as the only way out of humiliation and those who thought that their prank was innocent and harmless.

As a citizen and a tax payer I would like to know where the mandatory classes are, from Kindergarten to undergraduate levels, which teach our youth how to balance their right to free speech with someone else’s right to privacy. Young people think nothing of exposing every aspect of their lives as well as someone else’s on the world wide web for everyone to use and abuse. I would like see in the kids’ grammar and high school curricula classes on the Safe Use of Internet. I would like to see mandatory college courses on Ethics In The Age of Internet.

If we are assuming that we can de facto apply the ethical, moral and legal code of 50 years ago or even a decade ago to today’s technology we are dangerously naïve and if we expect our kids to figure it out on their own we are foolish and need to wake up before it is too late.

The internet is a powerful tool and in the hands of a notoriously immature and impulsive group, such as teenagers, can as we have already seen be deadly. Today’s culture encourages and rewards kids and teens to turn their lives into an open book. The same teen that would have a temper tantrum if the parent went into her draw will not think twice putting her whole daily itinerary including pictures of herself in all compromising positions on Facebook.

It takes a village to raise a kid especially in the age of information. Parents and schools have the responsibility of teaching our kids that with the freedom and power to publish what they want whenever they want comes a great deal of responsibility.

If it is in the News, don't believe it...

2010-08-02T11:50:00.000-07:00

Gulf Coast Oil Disaster
Woman charged in France for death of 8 babies
Second U.S sailor found dead in Afghanistan
Scores die of cholera in Cameroon
80 die in ferry accidentAt least 90 people dead in Pakistan flooding
Indonesian woman gets 3 years for harboring terrorists
Anthrax kills 82 hippos, 9 buffalo in Uganda
Hoarding called a public health issuePriest stabbed to death in Mexico church

These are just 8 of the headlines that bombarded and invaded the walls of my
sense of security this morning as I perused the pages of the newspaper, I counted 39 more alarming headlines after which I simply stopped counting. No wonder those of us who are slaves to the News experience a conscious or unconscious sense of doomsday or despair. I propose that newspapers and TV news come with one of those warning labels that they put on noxious substances: “WARNING hazardous to your health”

But, let’s not blame it all on the news reporters, biology and evolution wired our brains to be more responsive to bad and shocking news than to good news. It made sense for our cave dwelling ancestors to sit up and pay attention to stories about lions lurking in the bush. Stories about women sharing berries around the camp fire did not make the “editors’ cut”. So, next time you are stack in traffic for hours getting angry and wondering why does everyone have to stop and look at the accident on the side of the road, calm down and blame it on evolution.

Anyway, I recently came across a cure for the News induced anxiety and despair. It’s a book called “the Science of Fear.” I have to admit I felt somewhere between humbled and totally stupid to realize how easily I can be manipulated by overzealous news reporters, corrupted politicians and even well meaning scientists and experts. Pick it up. I promise, you will never look at News the same way again.

Dysregulation,eating disorders and other mishaps

2010-06-26T08:46:00.000-07:00

Dysregulation, eating disorders and other mishaps

Through the many years I have worked with patients with eating disorders I have come to examine and understand the problem from different perspectives. Like the old and wise story of the blind men and the elephant, I too got a different view of the “animal” depending on what part of its “body” I got to touch at each particular time. So, some times I saw it as the result of an over controlled childhood, sometimes it was a loss of identity, other times it appeared to be the result of over sexualization and objectification of women living in a chauvinistic society or all of the above and more.

Today, in the midst of an avalanche of bad news like the fiasco on Wall Street, the nightmare of the housing market, the catastrophe of the BP spill I am coming around and looking at the elephant from yet another view point: Self regulation. It has become evident that in becoming the land of plenty, America has also lost its ability to self-regulate. The instant gratification of our yearning for the ever elusive bigger house, bigger car, bigger burger, fancier phone, more oil, more energy and so on has become part of our American identity.

From birth on we are training our kids to seek more and more frequent gratification.
The plethora of toys in the nursery which infants do not need and which are over stimulating, the mountain of toys under the Christmas trees that is equally overwhelming, the surfing of the 150 or so TV channels, the ipods, the phones, the computers, should I keep going? In their wish to please parents have become eager contributors to easily bored, restless and demanding kids.

A part of our brain is wired to seek gratification and pleasure. Every time we do something pleasurable Dopamine is excreted in our brain and it makes us feel like a million dollars. So, we seek more of the good staff. Gamblers know this all too well and every time you get excited with the ding sound of a new e mail message you get your dose of the juice too.

It is our job as parents to “train” this part of our kids’ brain that is blindly seeking pleasure. Gratification should be tempered with moderation and balanced with knowledge of consequences. Rewards should be the consequence of work not an entitlement. This culture of self indulgence, from the unearned BMW at 17 years of age to the no-money down mortgages is the path to destruction. Look at history if you do not believe me. It happened to the Roman Empire.

Eating disorders is another example of our inability to self control and self restrain in a world that offers a dizzying variety of foods. I believe the government has recently recognized the need to help people self regulate by mandating better labeling of foods, better education on mortgages and credit cards. But this is just the beginning, a good step but only a step. Restrain, moderation, and responsibility starts in the cradle.

The rise and fall of ....Humanity

2010-05-05T10:53:00.000-07:00

I have been thinking about Greece a lot these days, for obvious reasons, with a range of emotions. But most of all I have been asking a lot of questions, such as:

How did the Birth Stone of Western Civilization become the tombstone of decency?
How did the pursue of the Golden Mean become an uncontrollable decent into moral bankruptcy?
When did Justice, the godess that even all the other gods revered, become an exiled beggar?
How did industriousness turn into unearned entitlement?
When did "know thy self" become mental apathy?
When did moderation become greed?
How did the alchemy of the mind (turning vice into virtue, turning the darkness of ignorance into the bright light of knowledge) become the alchemy of the Stock Market (turning horse manure into "gold")?

This past Easter I stood in Plaka, the ancient market place in Athens, with Acropolis looming mormidable above me, just under the cave where Socrates drunk the poison defeding his principles to its last bitter drop and I wondered with trepidation what the Teacher would have said about his beloved town. I stood at the Lyceum where Aristotle taught that towns will flourish only when kings become philosophers and philosophers kings and I wondered how he would have felt at the sight of Greece now, and I cast my eyes to the ground in shame.

But, does the fallen angel have something to teach the rest of the world? I believe so, maybe even the biggest albeit most bitter lesson of all. I believe world empires, beacons of civilization such as Greece and Rome did not fall because they became too big but because in doing so they lost their moral moorings.

Please tell me what is wrong with this picture: I am walking to the door of Starbuck's, two coffees in my hands, the 14 year old ahead of me opens the door exits and lets it slam in my face while her mother looks on and continues to blabber on her cell phone unperturbed by her daughter's rudeness. My father would have made me go back and apologize and followed it up with a 20 minute discussion about the virtues of politeness, respect and cooperation.

Do you prefer a different picture? Try this one: Two adults fighting about a parking space, yes a parking space, using a language totally inconsistent with that social status their cars and clothing so loudly advertise. A bunch of adolescents 50 feet away egg them on. One screams "kill her, kill her" which is followed by another one's pearl of wisdom " I hope he blows her head off"

One needs to ask: If a 14 year old has no social conscience, if his idea of conflict resolution is: "blow her head off" why would we expect the 30 year old wiz with an MBA from the Ivy League School of Live and let Die have any consideration for the society at large when he skillfully manipulates numbers to sell manure for gold?

What would Washington have to say about His beloved country? I lament the decline of my birth place and I hope that my equally beloved America will not follow the trajectory of Greece and Rome. But, hoping is not enough. We need to be the models, the paragons of morality that our youth needs and deserves. We need to teach, guide and monitor our young. We need
to wake up.

In memoriam

2010-03-16T09:53:00.000-07:00

together as a team we navigated the ineffable horrors of your past and survived. We faced the external prejudice and the internal persecution and we prevailed. What we did not anticipate and took us by surprise, like a storm in a clear day, was the cancer that ravaged your body in the course of just a few months.

We sat at your front porch watching the setting sun paint the lake red, or was it my anger for this awful injustice that colored my vision? You told me that you were at peace with the world and God. Our work, our journey was not for nothing that because of what we had accomplished you were leaving this world a Free Person.

I am thankful to you, Carol, for all you have taught me, for your courage facing life and your dignity meeting death. I am thankful for your humor and laughter, and for your caring.
Good night sweet princess, and flights of angels sing thee to thy rest.

Is it better to live a good man in a delusional world or a monster in reality?

2010-03-12T14:09:00.000-08:00

This was the question that the protagonist in the movie Shutter Island asked his psychiatrist. It is the same question in one form or another that patients have been asking me for the past 20 years.

We all construct illusions to help us deal with the horrors of our past or present. Illusions are the guardians of sanity. If we were constantly conscious of all the pains and stresses of our lives past and present we would have a mental melt down. Through the eons of evolution our brain has developed many elaborate defenses against the ravages of life from the very complex ones like splitting into different personalities to simpler forms of denial and repression such as forgetting a medical appointment or our mother's birthday or just escaping into computer games, alcohol/drugs or convincing ourself that the lip stick on our husband's shirt collar is just tomato sauce.

So, if illusions are our life saver, why is therapy so infamously trying to punch holes in it?what is all this fuss about Reality? Well, the problem with these gaurdians of sanity is that they are frequently exploited, burnt out and often fall asleep on the job. The fact is that the more you rely on denial and repression the less effective they become. When the pressure of all that has been locked up for years mounts and pounds on the locked doors of consciousness our guardians get overwhelmed and drop the ball. Pandora's box opens: depression, anxiety, phobias, obsessive thoughts not to mention an assortment of physical symptoms exotic enough to stomp the best of our medical profession comes flying out. You see, the tears that the eyes will not shed the body will weep. With the advancements of neuroscience we can now take colorful pictures of the brain when emotions are not handled right and these pictures beat Scorsese's scary scenarios.

Trying to run away from our emotional reality is like trying to outrun a freight train, eventually it is going to catch up with us. A patient told me once that she was so mortified to acknowledge that her husband was just like her father that she had for years blinded herself to her daughter's abuse. Reality finally hit her when her daughter attempted suicide. How is this for a Scorsese movie?

Illusions are often hard to give up and reality unbearable to live with. A therapeutic and supportive environment is often essential to abolishing the walls of illusion. An old saying advises us that if you save someone's life you are now responsible for him. The same goes for illusions: if you take someone's illusions away you better be prepared to give him something equally sustaining in their place. This is what therapy offers people. You see, the question is not whether it is better to live in reality as a monster, but rather whether there are really monsters or just human beings who make mistakes, learn from them and move on with their lives in spite of the horrors of their past and sometimes because of them.

In Defense of antidepressants:culprit or falsely accused?

2010-02-17T15:27:00.000-08:00

In 2004 the FDA added a "black box" warning on all antidepressants, advising parents that antidepressants prescribed to children and adolescents may increase suicidal thoughts and or behavior, mind you, the operative words here are "may" and "increase"

Now, here is some interesting news: According to a September 2007 CDC report, from 1990 to 2003 the combined suicide rate for people age 10 to 24 declined from 9.48 to 6.78 per 100,000 persons. But from 2003 to 2004 the rate increased from 6.78 to 7.32 per 100,00 people for the same age group.

Do you see where I am driving at here? Let me elucidate: Another study surveyed non-specialist prescribing physicians(meaning physicians that are not psychiatrist) and found that 91% misunderstood the warning to mean that there was a risk of death associated with antidepressants. This means that physicians stopped prescribing medication to youngsters who would have benefited from it. Parents are less inclined to take their children to psychiatrists and even less inclined to give medication that their doctor is telling them will cause their child to kill himself. According to the above mentioned CDC report suicide rates that had decreased since the advent of antidepressants have risen since the warning was added.

I believe that in this case we have thrown out the baby with the proverbial bath water. What research has unequivocally shown is that a combination of therapy and medication, in cases where medicaiton is necessary, is the most effective approach. Instead of outright rejecting medication for moderately to severely depressed kids and adolescents parents should work closely with their physicians and their psychologists so that they can integrate medication with other treatments that are effective, like psychotherapy. Well documented research and my own professional experience has shown that therapy is as effective as medication and has more permanent results, but there are cases where medication is necessary and life saving at least until therapy has been given time to produce results. So, before we write the final epitaph for antidepressants lets give them another serious and educated look.

I have to let you in before I let you go

2010-01-22T07:54:00.000-08:00

I have often been asked by grieving patients and survivors of wrecked relationships how to let the sadness and most of all how to let the lost person go.

Human beings have never been good accepting loss. No matter how explainable the loss is, to one degree or another it is interpreted as a personal affront by some malevolent deity. In Robert Frost's eloquent words:

Ah, when to the heart of man
was ever less than a treason
to go with the drift of things
to yield with a grace to reason,
And bow and accept the end
of a love or a season

Another ubiquitous human trait is that we tend to either canonize or demonize the person lost to us. Dead people tend to automatically attain sainthood status, halo included. Divorced partners tend to acquire horns and tails, good traits and memories forever drowned in a pool of anger and hurt.

The probem with this is that we can not mourn for saints/idols, we can not let them go either. We propitiate, ador, and/or fear idols, we do not let them die. Ex partners who are transformed into avatars of Evil are for ever wedded to us with the bonds of hate.

We have to see the person lost to us as a real person, beauty and warts included, before we let him go. Healthy mourning involves many and conficting feelings: love and hate, affection and anger, relief and yearning, freedom and loneliness, resentment and guilt and many others. We have to experience all of these with regards to the departed.

You see, when we transform someone into a saint we would want to keep this saint around to feel protected by him/her, to feel loved, to feel proud of our roots, to function as a paragon of goodness to which everyone else, including ourselves, will be compared to and more often than not fall short. Most of all by cononizing the departed we avoid the messy feelings like anger and regrets that tend to complicate the image of the person we would like to maintain.

When our divorced partner is made into evil personified the wish for retribution and justice for our hurt ego will keep feeding the anger and blinding us to the fact that more often than not it takes 2 to make a good relationship and the same two to break it. It prevents us from learning from our mistakes and moving on.

A patient with an idealized, or I should say deified image of me, told me once when the subject of ending therapy came up: "why would I ever want to let you go?" He was totally flabbergasted and appaled by the idea that someone would want to take his perfect "mother", omniscient god away from him. Later on in therapy when he learned to have a more substantial and realistic relationship with me he was able to see me as a mere mortal and one day he had an epiphany: " I have to let you in before I can let you go" he said beaming with the excitement of his insight. What he meant was just this: He had to see me as a person, well meaning but with many limitations, before he could let me go. It did not make any sense to him that he would ever want to let go of a god, do you blame him? But when the time comes he will be able to mourn for and let go of the physical me while maintaining the momories of me as a person (good and bad, frustrating and encouraging, often knowledgeable at times clueless) who had an impact in his live.

As the years go by...

2009-12-31T07:23:00.000-08:00

The years mercilessly
change
childhood memories begin to
fade
When did I exchange my little red
dress
for the daily work
stress?
Can't we stop this crazy
train
for just one moment to
celebrate
like the time we were
young
when the world was innocent and
fun?

May your new year be filled with fun memories.

who stole the souls of our youth?

2009-12-19T14:49:00.000-08:00

Who stole the soul of our young and brightest?

He is a mathematician and an amateur philosopher, the spirit of the Queen of sciences personified in a young and attractive guy. But he is telling me that he sees no purpose in living. He half challenges half begs me to give him a logical reason for existence. He is asking me for the rope of hope that will pull him out of the sea of annihilistic thoughts and lugubrious life scenarios.

And then there is the medical student and the gifted artist both steeped in the same pessimism. The same pleading eyes looking at me expectantly and I get scared that I may be their last recourse, terrified really that neither my affinity for philosophy nor my training in psychology will measure up to the challenge. I have visions of all the high school students who in the past 5 years walked in front of trains in Spring Lake and Manasquan believing…what really? That death is the ticket to immortality? That their death publicized and romanticized will be the ultimate punishment for all those who ignored them and hurt them? That life at 16 and 17 and 20 has nothing to offer worth living for? Who stole the souls of these young and promising people?

I have been hearing over and over again from adolescents that they feel alienated that their parents or teachers can not understand them that faced with serious problems they would not turn to their parents for help. How did we lose track of our kids?

When did chasing the mighty dollar chase our kids away? When did the Coach bag or the new car become the substitute for real connection? When did teachers become afraid to talk or touch our kids less they are accused of one impropriety or another?

I remember my Grammar and High school teachers with deep fondness, unwavering admiration and endless gratitude. None of them were geniuses, what the memorable ones had in common was the desire and willingness to reach out to us empathically and understand the angst and tribulations of our youth and gently without criticizing direct us and inspire us to search for and discover the meaning and beauty of life. I do not believe that the youth of today needs anything less or more than just that.

I see the spark of hope ignite in the eyes of my young patients when I am willing to suspend my objections to their young and often immature reasoning, shut up and just listen. It is only when they know that I have understood their world that they invite me to be their guide, direct and inspire them and I discover again and again that their thirst for guidance their desire to connect and need for role models that are more substantial and meaningful than the empty faces in People magazine are as strong today as they were in my school years as they were with the young people that flocked to Socrates and Plato.

So, here is the challenge to both parents and teachers and yes, therapists too: Let’s not confuse indulgence with understanding, love with reckless abandonment, and dogmatism with teaching. We don’t need to be perfect just willing to get off the mouse wheel and listen.

Let’s retrieve the souls of our kids.

Inoculation for anxiety and depression

2009-11-24T08:55:00.000-08:00

Inoculation for anxiety and depression

So, you may not have been able to get the swine flue vaccine, but here is a “vaccine” that is widely available:

You have heard it many times from many different sources that exercise is good for you. But just in case the connection between exercise and mental health is not clear, let me attempt to make it transpicuous:

The research is coming out of Princeton University and the results were presented at the Society for Neuroscience in Chicago. The research team working with mice found that exercise did not just produce a temporary good mood in the mice, but it actually altered the brain of the mice that had been put through an exercise program. Exercise actually created new brain cells that remained calm under the stress that the mice were exposed to subsequently. The brains of the mice that had been exercised were biochemically and
molecularly calmer under stress!

Parallel research in the University of Colorado presented data showing that moderate exercise dampens the effects of oxidative stress (anxiety in mice and people has been shown to be linked with excessive oxidative stress).
The Colorado team showed that mice that had been exercised prior to been exposed to severe stress did not run and hide in corners like the unexercised mice but rather they actively explored their surrounding. Exercise inoculated brain cells and created neuronal pathways to handle toxic stress.

These changes did not happen overnight. It appears that in both studies effects started after 6 weeks. And although we do not know exactly what the timing will be with humans, one lesson seems to be clear to everyone: “don’t quit”. Reduction of stress may not happen after your first hour at the gym, but the molecular, biochemical changes will begin and will become evident with time.

So, here is my prescription/wish/ gift to you for this particular stressful time of the year:
Hit the gym, the treadmill the boardwalk and inoculate yourself.

Freeing Sisyphus

2009-10-19T15:17:00.000-07:00

Freeing Sisyphus

How do you say goodbye to the person who held you in her arms, whose breast quieted your hunger pangs whose eyes and face were the mirror you looked into to define and know yourself? How do you let go of the person who gave you life and then for some unfathomable reason made it unbearable?

I have been asked this question so many times by so many patients. Souls divided between love and hate searching for understanding, comfort, absolution, peace.

Their personal agony tags on my professional responsibility to make sense out the whirlpool of their emotions. After all, am I not the Psychologist, the doctor who is supposed to know the workings of the human mind?

Like Ariadne I am asked to lead them deep into the heart of the Labyrinth where understanding and forgiveness are waiting to be mustered. But understanding more often than not does not fill the emotional void while anger becomes the final bond that ties us to the abuser in an insouciant search for both love and revenge.

Understanding abuse demands of us to transcend the childhood illusion that our parents are all- knowing, all- powerful, paragons of emotional health punishing us only for our own good and only because we are intrinsically and hopelessly “bad and stupid”. It requires that we put our pain aside and search for theirs. It asks us to do something that we often resist with every fiber of our being: seeing the abuser as damaged, tortured, herself a victim of abuse, emotionally retarded and pathetic. Forgiveness requires a level and kind of empathy (understanding a person’s emotional limitations) that our anger and the yearning for acknowledgement and retribution often do not allow.

Do you see how maddening this vicious circle is? We want an emotionally retarded, morally bereft person to acknowledge and understand the wrong of her actions, but if she was capable of this kind of understanding she would not have done them to begin with. The fault is not with the victim’s ability to explain how she was hurt, but with the abuser’s ability to comprehend. It is like expecting someone who never learned Greek to read the Odyssey in its original.

But isn’t understanding and accepting the abuser’s pathology and limitations letting her off the hook?
NO.
Letting go of the yearning to be validated, which feeds and multiplies the rage of the original abuse and abandoning the demand to be loved in the way you understand love is not saying to the perpetrator that what she did is ok. It does not even mean that you will ever have to talk to her again if this is not what is best for you.

What it does mean is that you will not let the anger corrode your soul. That you will not be tied to an abuser with the chains of an illusion: for ever seeking love and acknowledgement, incessantly explaining, placating, ingratiating or as a last resort threatening and forever been crashed.

Put down the boulder Sisyphus. This is an impossible task.

2009-06-12T12:12:00.000-07:00

Au Revoir

In the classic and wonderful book I never promised you a rose garden the young girl about to be released from the mental hospital is telling her beloved therapist (in real life the eminent psychoanalyst Frieda Fromm Reichman): “the worse thing about getting better is having to say goodbye”

As therapists we have to say good bye to so many people we came to know deeply and love and care for sincerely. As spiritual guides we watch people freeing themselves from the shackles of misguided notions and atavistic beliefs to find their own path and discover their own unique talents. And when their wings are wide and strong and beautiful we have to let them fly away with a mix of wonder and pride and nostalgia.

How do you do it? my patient asks me with tears welling up in her eyes. I imagine you at the end of your long day going to a mystical cave and seating around a healing fire with other healers and a golden dust rains down on you all and you get renewed and ready to come back and do it all over again the next day. She is right of course, but this magical cave is no other than the sacred space created between patient and her therapist. My own mentor said that “if you allow them, your patients will heal you”. I tell my patient that in the journey that we took together we both learned from each other. Both our consciousness were raised a few feet higher.

When I am settled in my new place, she tells me, I will continue to rescue and shelter stray and abandoned animals. Every time I write a check to take care of another cat I will do it in your name. Yes, she has learned to love herself and follow her passions and out of this new place she extended a loving hand to touch my own most sacred core in a most tender way. She just sprinkled a good amount of the magical, healing dust on me.

You saved my life, she continues with the tears streaming down her face now, and I will probably never see you in my life again. Oh, but she is not right there. You see she may not have realized it yet, but I have taken permanent residence in her prefrontal cortex, somewhere above her left eye. From there I will be able to remind her (whenever I have to) not to be so harsh on herself. I have set a camping site deep in her brain, somewhere between the hippocampus and the Amygdala. From there I will remind her not to be afraid of her feelings and when she feels alone or disconnected I will remind her that somewhere a few thousand miles away there is someone who knows her deeply and cares for her sincerely.

So, no goodbyes are necessary, I’ll be seeing you around…

Sin Athina kai xira kini

2009-03-26T13:55:00.000-07:00

Yesterday I came across this story in the news: Tunisian pilot who paused to pray instead of taking emergency measures before crash-landing his plane, killing 16 people, has been sentenced to 10 years in jail by an Italian court along with his co-pilot.

My first reaction was to laugh, then as I kept reading horror replaced my defensive initial reaction. Picture this: you are a passenger on a plane happily anticipating a vacation to Sicily (where the plane was heading) or some business deal, or seeing grand mom and giving her a big hug. All of a sudden a fuel-gauge malfunctions and the plane starts to rumble. At this life and death moment your pilot abandons his training, the established aviation procedures, his instruments and instead begins to …Pray! Pray? While the plane takes a death dive into the ocean? Sixteen passengers dead, sixteen families devastated, a grand mom still waiting with her eyes pinned on the road and her arms yearning for the promised hug, and survivors clinging to a piece of the fuselage that remained floating after the ATR turbo-prop aircraft splintered upon impact.

My third reaction was rage. The pilot was sentenced to 10 years for 16 deaths, a little more than 6 months per death! Shouldn’t there be an outcry against the architects of his religious indoctrination? Who should write something about the stupidity, the arrogance and the utter irresponsibility of this kind of religious dogma? How far away do we have to go from the ancient Greek adage that titles this blog and which loosely translates: along with your prayers to Athena start rowing your boat, before we come back to our senses?

When are we going to leave the gods alone and take responsibility for our own actions? When are we going to demand from those who hold our lives in their hands to abide by the same ancient wisdom? After all, the ancient Greeks flourished under this dictum to become a world power unparalleled in human history.

A Prescription for the economic jitters

2009-02-17T10:05:00.000-08:00

A Prescription for the economic jitters

It appears that fear has become our constant companion these days. You turn the TV on and here comes the dreaded red arrow of the stock market taking yet another precipitous dive. You switch the computer on, same Friday the 13th scenario. And as you watch one business after the other being axed and friends losing their jobs you fear that the bells will toll for you next. It is evident that fear has overtaken our brains.

Now, the thing with fear is that although it has consistently saved our you-know-what through our evolutionary struggles to survive as a species, when it overtakes us it leaves very little space and time for anything else but saving our skin. Fear breeds avoidance and retreat both of which are serious obstacles to progress. So, now that more than any other time we need our creativity, inventiveness and thinking out of the box all we can do is fortify our box and make sure that we keep what we have.

Fear and pain are neuronally very closely linked in our brain. It has been shown that when our brain senses pain or anticipates loss, we tend to hold tightly onto what we have. Have you ever noticed how when you see in the news that a kid was harmed or kidnapped you want to hurry back home hug your kid and never let him out of your arms? When it comes to the economy when everyone holds on to what he/she has at the same time the result is the economic paralysis the whole world is presently gripped by.

This brings us to the prescription for the fear jitters: Pessimism is contagious, so avoid people who are overly pessimistic about our economic outlook. Turn off the media’s incessant talks about economic solutions (just remember what all these brilliant economists got us into), and unless you make a living trading stop watching the Dow’s impressive acrobatics.
I am not suggesting total denial just a healthy dose of it. I am not advocating blissful irresponsibility just a little less paranoia. No, now maybe not the time to buy that red Porsche but letting your hair turn white or walking around with holes in your stockings maybe taking it a bit too far.

When I first came to this country and I was trying to adjust, my mother in law gave me a very wise advice: when you feel blue go buy yourself a pair of stockings. The other advice comes from History: Americans have from the get go overcome inordinate obstacles on their way to becoming the greatest power on earth. They said that the settlers will never survive the wilderness of the new world. They said that they will never beat the Brits. They said that they will perish during the great depression. They said that we will never beat the Germans in splitting the atom. They said that we will never get to the moon. Yes, we heard it all before. And they were wrong!

In the words of our wonderful poet Maya Angelou;

Leaving behind nights of terror and fear
I rise
Into a daybreak that’s wondrously clear
I rise
Bringing the gifts that my ancestors gave,
I am the dream and the hope of the slave
I rise
I rise
I rise.

THANKS...

2008-12-09T07:56:00.000-08:00

This is the time for sincere wishes, heartfelt thanks and reminiscences…

There is one particular group of people in my life that I feel very grateful to: my patients, past and present, the hundreds of people through the years that invited me to share their journey of self-discovery. Some of those journeys were short, some long. They all taught me something invaluable, something about myself, something about life, something about human nature.

I remember one of my first patients. I was an intern at Elizabeth General Hospital, wet behind my proverbial therapeutic ears, scared, anxious and eager to do a good job. He was a gruff, big guy who for months said very little and he looked at me even less. At the end of my year as an intern when I was saying good bye to him he said that he wanted to give me a gift. He put a knife on my desk and informed me that he had carried it to every of our sessions for the whole year. Life had taught him to trust no one but, he said, I had taught him that there was one person he could trust. Thanks Antonio for sending me off to my new career with a boost of confidence.

I remember my first job as a staff psychologist at the hospital, still nervous, still a baby in the proverbial deep and challenging woods of psychology. I remember the woman who sat in my little office and said; “I know I need help, but she is telling me to tell you to f…off.” Who is telling you that I said baffled, “the voice in my head, she calls herself Ella”. And there and then she chose for me my specialty in DID (a.k.a Multiple Personality Disorder) and Trauma related disorders.

This was the most horrifying, challenging and rewarding learning expedition ever. It opened the door to the ineffable horrors human nature is capable of and at the same time the resilience and wonders of the human mind and its ability to heal. Along with these tortured souls I questioned life and its purpose. Along with them I lost faith in humanity and my nerve as a therapist and together with them and through their struggle to put the shattered pieces of their lives back together I redeemed both hope and faith.

I remember the old lady, a concentration camp survivor, the horrors of her past carved in the deep lines of her face as indelibly as the haunting numbers on her arm. She had just lost her son to cancer. She saw the tears in my eyes looking at the horrifying numbers on her arm and said : “oh Liebchen, I had kids, and grandkids, I still laugh and cry. I am here talking to you. He did not win, I did” Thanks Aida for the lesson in courage.

And then there were all the people that I could not reach, I was not able to help. They too had a lot to teach me about my shortcomings, about the dark places in my mind that I was unwilling to explore in order to help them. They disillusioned me and taught me humility.

For all the lessons taught,
for all the tears shed,
for all the laughs that lifted my spirit,
for all the journeys taken.
For the privilege and the trust that you have given me….

THANKS…

All acquaintances should certainly not be forgot
And they will always come to mind….

Vaccine or Assassin?

2008-12-03T10:30:00.000-08:00

It is the flu season, in case you have missed the sniffles and the pains and the fevers and all the unsolicited "gifts" from the foreign invaders to our bodies. So, the skeptic and cynic that I am, I did my own research into the benefits of flu vaccines and I came across some disquieting findings. My source is Donald Miller, MD who is a cardiac surgeon and professor of Surgery at the University of Washington in Seattle. He is also a member of Doctors for Disaster Preparedness. So, this is what the good Dr. tells us:

Vaccine makers grow the viruses in fertilized chicken eggs with 500,00 eggs per day for up to eight months. Formaldehyde is used to inactivate the viruses. It is a known cancer-causing agent. Aluminum is added to promote an antibody response. It is a neurotoxin that may play a role in Alzheimer’s disease. Other additives and adjuvants in the flu vaccine include Triton X-100 (a detergent), Polysorbate 80, carbolic acid, ethylene glycol (antifreeze), gelatin and various antibiotics - Neomycin, streptomycin, and gentamicin- that can cause allergic reactions in some people.

If this did not gross you out here is some more yummy ingredients put in the mix: 100 million vaccines made for the 2008-09 flu season ( about 2/3 of all the vaccines made) contain full-dose Thimerosal, an organomercurey compound, which is 49% mercury by weight. Each shot contains 250 times more mercury than the Environmental Protection Agency’s safety limit. Mercury is a neurotoxin that has been implicated in Alzheimer’s and Autisms.

In addition to the “milder” side effects of the vaccine ( joint inflammation and arthritis, anaphylactic shock) it can also cause Guillain-Barre syndrome, and no you definitely do not want to risk this.

So,you say to yourself: Ok, I take all these poisons but at least I will not get the flu, not so. In September 2, 2008 New York Times published an article titled
“Doubts Grow Over Flu Vaccine in Elderly”. A study done by the Group Health Center for Health Studies in Seattle found that the vaccine does not protect the older people against developing pneumonia. The evidence in young children are not much more favorable either. A systematic study involving 260,000 children age 6 to 23 months found no evidence that the flu vaccine is more effective than placebo).

I don’t know about you, but I would think long and hard before I take another flu vaccine. Maybe next year I’ll take an extra vitamin C, wash my hands more diligently and hope for the best…

Smoking gun...

2008-11-19T08:56:00.000-08:00

Smoking gun…..

I recently came across some very interesting, albeit disturbing research findings and in my self-proclaimed role as the Gadfly of the soul, decided to share them with you.

We have 700,000 new smokers every year and almost all of the newly afflicted are youths. So much for negative advertising! What accounts for this discrepancy between all these cautions about the dangers of smoking and this new statistic? Researchers suggest that early attitudes about smoking and early experimentation may give smoking enough of a foothold to become a lifelong addiction. A study involving 30,000 teenagers in New Zealand found than many teens reported at least minor symptoms of addiction after just a handful of cigarettes.

In addition the researchers suggest that smoking may change brain chemistry making people resistant to antismoking messages.

Here is a view into the chemistry lab of your brain. Dopamine, one of the neurotransmitters, is a “wonderful” substance. It is the “I feel good, man” chemical, but in excess it interferes with the learning process and prevents us from learning from our mistakes. Too much of the good thing, you see. Well, what fMRI studies saw (taking pictures of your brain as it does its work) is that smokers have elevated levels of dopamine in their brains. In tasks involving learning new skills administered, smokers did not learn from their mistakes as well as non-smokers.

A little more brain physiology? The Thalamus is the part of the brain that acts as the traffic controller, it filters out information that otherwise would be too overwhelming at any given moment. The problem is that with smokers this controller is overly diligent. Nicotine blocks out even more than the usual and expected amount of information especially the unpleasant type. You have heard smokers claiming that smoking calms them down, it does, but at high price it appears. So, going back to negative advertising, what do you think the smoker confronted with a picture of rotting lungs would do? You got it! He would light up and block out the unpleasant information.

Is there any salvation, you ask, or did you just want to gives us bad news? Well, yes I think there is good news. The more we know about how exactly nicotine gains an early foothold in the brain the more able we will be to develop medicines and behavioral therapies to snuff out the habit.

For the time being we do know that early impressions are strong and long lasting. So, feel free to start your kids’ anti smoking education as early as first grade. The earlier they understand and believe that smoking is gross and not “cool” at all the better insulated they will be against later peer pressure. And above all, do what you preach.

Wall street explained

2008-10-21T10:59:00.000-07:00

Wall Street explained

An older and much wiser cousin of mine recently explained the financial mess
this country and the world in general is presently facing. So, here is
how the old story goes:

Once upon a time in a little village somewhere maybe in Greece maybe
in some other part of the world lived a smart and maybe unscrupulous man.
This man, let’s call him Tom, announced to his fellow farmers and citizens
that he would buy monkeys for $10 a piece. The men in the village
(women were a little skeptical, they have after all been cleaning up
men’s monkey business ever since Adam) verged out in the forest
trapped as many monkeys as they found and brought them to Tom who
gladly bought them for the agreed upon price. However, as more and
more monkeys were caught the population of monkeys available began to
diminish and thefarmers stopped hunting them.

Tom now announced that he would be paying $20 per monkey and again the
men went out and more diligently now harvested some more of the poor
creatures. But now the available stock diminished even further.

Tom told his fellow citizens that he fully understood the shortage of
monkeys and he was now prepared to buy them for $25. Again the men went
out and caught the few remaining ones.

So, Tom now tells the men that he is painfully aware of the shortage and
he is prepared to pay $50 but he will be out of town for a few days and his
trusted partner will be handling all transactions.

The Partner calls a town meeting and tells the villagers: look, Tom has
filled the whole stable with monkeys. I will sell you the monkeys for $35
each and when Tom comes back you sell them back to him for $50. The men
did not think about it much, they collected their savings and their last
pennies(again against the women’s protestations, you see they know how to
sniffing out rotten fish) and bought the monkeys for $35 a piece.

Yes, you guessed it, they never saw Tom or his partner again.

Welcome to Wall Street.

Move aside Bernanke, here comes my cousin George the story teller.

The Sectrets

2008-10-01T12:56:00.000-07:00

The “secret” for success

There has been a lot of talk about the “Secret” these days. Personally I have found nothing new or conspicuous about the“ Secret”. And having said as much, I feel compelled to impart some more truisms about secrets of success.

Patients often ask me what made me successful. So, here are my secrets, and feel free to disseminate, no copy right.

1. Whatever you decide to do be passionate about it. I am talking about heart- pumping, adrenalin-running, mouth-drooling at the sight of your heart’s desire kind of passion. At the age of 15 I discovered “psychology” in my 10th grade. And there and then I vowed to be a psychologist. The decision took me to a journey from Greece (my birth place) to S. Africa, my first adoptive and beloved county to America my second adoptive and equally loved country.

2. When you find your love and passion, work hard. I shed tones of proverbial mental and emotional bullets studying psychology and philosophy and a bunch of other subjects in a language that was not my first, in a university that is considered to be the Harvard of S. Africa.Hard work makes you good at what you do and when you are damn good at what you do people will come to you and they will be happy to pay for your expertise.

3. On your journey to Ithaca there will be many Sirens attempting to set you off course. Your need to Focus. Like Odysseus you will need to close your ears to their alluring songs and move on. As I was going through graduate school people in my profession were talking about psychologists becoming an extinct species, private practice not surviving the managed care monster. I kept moving and I am still here.

4. Conquer your shyness and doubts. The first time I delivered a paper on existentialism to my philosophy class I thought I would have a heart attack. My fellow students joked about my very becoming green face color. Things got a lot better after this.

5. Do not allow anyone to give you crap (incidentally crap stands for Criticism, Rejection, Assholes, and Pressure). I had a lot of those from the get go. My mother to begin with, well indented albeit, had expected me to be a good little Greek girl, marry a Greek guy and have kids. There were others along the way who interjected their wisdom about what women can and can not do, or about NYC being a tough place to make it and a lot of other crap. I Persevered. I won.

6. Find people that are supportive, encouraging, your best fan and if need be the kick in your butt when you want to give up and let them be the wind beneath your wings. Yes, I had one of them too.

7. Do not be afraid to discover new things, new ideas, new ways of doing things. Life is about change and adjusting to it and thriving.

These are my “secrets” and now yours.

A Recipe for Success

2008-08-28T09:40:00.000-07:00

A Recipe for Success

Ingredients:

1. A 15 year old kid (or adult) with HDHD (or any other “limitation”)
2. An inspiring, genuine and creative Coach
3. A loving, involved, persevering mother ( or friend or spouse, or therapist)
4. A lot of hard work and sacrifices
5. A dream to reach the stars

Result: The best Olympian in the modern history of Olympics.

Michael Phelps taught us that we can overcome limitations, that we do not need to be space scientists to reach for the stars, that success is 95% perspiration and 5% inspiration and he did it all in his quiet, humble, innocent way.

If he can reach for and grab the gold ( 14 in his case) what excuses do the rest of us really have? The recipe is really there. All we have to do is follow it.

Thanks for the lesson Michael!

Love in the stock exchange

2008-07-15T07:01:00.000-07:00

I was reading an article in Sunday’s New York Times that impressed me for its cut to the chase, stripped to the bones approach to love. I am not particularly enamored with economists, especially considering the recent, multiple and apparently unending financial fiascos( and mind you my brother is one of them, not the fiascos, the economists)but I have to give this particular author the credit he deserves. For those of you who missed it I thought I'd summarize, augment, opine, etc.

So, here is then how our friend the economist brokers love:

1. Love is an investment: the more you invest the larger your return. You invest caring and interest and giving you will receive dividends of the same kind and amount. Assuming of course that the other person subscribes to the same philosophy. This last caveat is important and not negotiable.

2. Love is a "bond" and like all bonds the high quality ones yield more return than the junk. The implication is clear: High quality people will yield high quality relationships. If you believe you are in a junk relationship it behooves you to start running as fast as possible. And if you think that you will find a piece of coal and turn it into a diamond, forget it! This job is reserved for highly qualified tradesmen, called psychologist.

3. Research pays: since in matters of love diversification is impossible, learning not to judge a book by its cover is very important. Do your homework. What glitters is not always gold.

4. Returns are greater when there is monopoly. If you have to compete for someone, just forget the whole thing. There are other opportunities waiting.

5. Long term investment pays off. Impatience will not be rewarded. One night stands are doomed to eventual years of emotional bankruptcy.

5. Be realistic. Nothing comes from nothing and for most of us going from sitting in the couch watching "the biggest looser" to having Prince Charming head over heals in love with us, just does not happen.

6. Finally, when you find the winner, stick with him/her.

And my all times favorite: have many cats and dogs. They are the unending reservoir of love and acceptance.

Does this all sound too unromantic? Oh well, welcome to the 21st century.

In Treatment

2008-04-16T17:29:00.000-07:00

No really what do you think of it?

So, my curiosity got the best of me, my patients goading me on helped too: “come on Doc. you’ve got to watch it”. I am talking about the HBO series In Treatment.

So, I watched one and then I watched a second one… and then I was hooked!
I found myself talking to the TV. Things like: “in God’s name Paul, what on earth are you talking about” or “Good boy Paul, you’ve got it!” or the best yet “ Have you gone out of your mind? Are you seriously going to do that?” All these while a little voice in some forgotten recess of my mind kept repeating: “hypocrite, haven’t you done this same thing or thought that?”

I got mixed reviews from my patients. Some gave me the stamp of approval: “Paul is saying some of the things you say, I feel I understand therapy a lot better now”. Thank you Paul!

Others told me that they were disturbed by it. They do not want to think of me as “human” having real life problems, struggling with emotional turmoil.

One tried to convince me that having a romantic relationship with me is not unethical or illegal because Paul was about to have one with Laura.

What I found appealing is that Paul is a real person who is trying to do his best while life is happening all around him. No matter how much he hurts, when he opens the door for his next patient he tries to connect, he tries to do his best. He cares about his patients because he has gotten that much right: you can not do this job unless you really care.
You do not need to be perfect, you do not need pedestals to sit on, you just need to try and you need to care. Oh yes, and you do need the skills and the education.

What do you think?

Holiday Blues

2007-11-21T14:27:00.000-08:00

Holiday Blues
Helpful tips and tasty remedies

For a lot of people, the holidays are a time of fun and excitement. For others, however, the Jingle bells are a prelude to the Holiday Blues. Frenetic shopping, family reunions and fights over “who’s house is it going to be this year”, unrealistic expectations, tense family relations, missing friends and family, and sad memories associated with the holidays are some of the factors related to the holiday blues.

Stress symptoms include: sadness and mood swings, headaches, excessive drinking, overeating, problems sleeping. These symptoms can at time continue even after the holidays have passed. Here are some helpful tips:
• Most families are not the Brady bunch. Be realistic about your expectations from family members. Fights and jealousies happen in all families and they will happen during the holidays too. Other families may not be happier or more loving than yours.
• Expensive gifts do not bring good time, people do. Keep in mind that the joy of giving does not have to become the nightmare of dept.
• Organize your time. Be realistic about what you can and what you can not do
• Do not drink too much. Alcohol is a depressant and excessive drinking will cause depression.
• A dry turkey is definitely not the end of the world. And talking about turkey:

Turkey along with pumpkin seeds, bananas, figs, dates, and tuna, are natural antidepressants. These foods contain an amino acid called tryptophan. Tryptophan is the precursor of seretonin and seretonin modulates moods and sleep patterns.

So, enjoy good food, good friends and have a

Happy and healthy holiday season

coping

2007-08-24T14:44:00.000-07:00

Let’s talk about “coping”

Do you feel the stress barometer rising, or is it just me?
The kids are going back to school and so are the parents: Homework, PTA meetings, practices, dance lessons, and what seems to be endless driving from one place to another. And the holidays are coming!!
For most of us juggling 5 balls at the time is the norm rather than the exception. Finding ways to cope is the proverbial “life boat”

Here are some suggestions for life’s small and big problems:
• Make connections. Support groups or friends may have a fresh perspective or simply a clearer mind.
• Avoid making mountains out of molehills. “Stuff” happens; just don’t step on it.
• Life is full of changes. Keep in mind that it is the tree that does not bend with the wind that breaks in the storm.
• Make clear and attainable goals and move toward them. Size does not matter small accomplishments do count.
• Make up your mind. Indecision is anxiety’s best friend.
• Never stop learning about yourself. A crisis can make you stronger if you can learn something valuable out of it.
• Maintain a hopeful outlook. Think of what you want not of what you are afraid of. Visualizing success is the first step toward it.
• Take care of yourself. Exercise, eat healthy, feed your spirit and maintain a positive image of yourself.

Second chances

2007-07-30T11:55:00.000-07:00

I have a brother older than me, smarter than me more accomplished than me(I think I may have won in the looks department but this is debatable). So, this brother of mine is a professor of economics at Erasmus University in the Netherlands and for the past few years he has been invited to teach a series of courses in Singapore. Yes, you remember Singapore the avid enemy of chewing gum? Where throwing chewing gum on the streets gets you whipped publicly? Well being arrested for possession of drugs gets your neck in a noose and your soul to its maker.

In this land of wonders a couple of years back a 26 year old guy was put to death for possession of 400grms of heroin. The news caused a loud roar from our European neighbors across the pond. Curiously American news papers
were conspicuously silent. So, my brother the professor, maybe because I am a psychologist maybe because I consider myself an American formally requested my thoughts and feelings on this particular subject and on the death penalty in general. What follows is my response.

Personally I am pro death penalty for rapists, murderers (other than self-defense), pedophiles and child abusers, women batterers and some other psychopathic manifestations such as animal torture and sadism. I consider sociopaths beyond the scope and hope of rehabilitation and I can muster no empathy for them

But what about this patient of mine who at the age of 20 and during one of his college extravaganzas decides to buy some coke for himself and his friends and gets arrested. He is put on PTI (pre-trial intervention, a form of probation but with no permanent record) and mandated to seek therapy (enters Dr. Charalambidis-Urban). It is now 10 years later and he is a pediatrician, religious NA (Narcotics Anonymous) participant and contributor. Do I tell Dr. K. that he should had been hanged at the age of 20?

Or what about the 21 year old girl who after being raped by her father for what she decides to be the last time she drives to Asbury Park ( a shady city at the shore) to buy anything that she can get her hands on to do herself in. Fortunately she approaches an undercover narco-cop. After it is ascertained that she is suicidal she is sent to the hospital. Act II, enters yours truly. Act III takes place about 11 years later and she is now the head nurse in the ER at the hospital. Through the years she has recounted many stories of lives she has saved including that of a cop who was shot by a drug dealer. Do I tell her that it would have cost the society a lot less if she was executed? Or do I tell the cop she saved that the world would have been a safer place without her?
No, I am not making it up. But, if you have a few more hours I can tell you a dozen more stories. These people were not sociopaths. They were lost souls caught in the grinds of an outrageous life and needing someone to pluck them out and give them a second chance.

I wonder if Singapore’s peremptory morality is about justice or about what we psychologists call Splitting: we split, disown and dissociate the most shaming, tenebrous aspects of our psych and we project them on someone else, preferably someone weak, whom we then proceed to punish mercilessly and sadistically. Incidentally the Bush administration has been doing this exact thing for the past 6 years. It was Hitler’s dream too.

I too want to sleep with my door open, or walk to my car without thoughts of being raped, but not at the price of moral tunnel vision. It is a lot easier to use the same moral yard stick for everything, to adopt a moral indignation that shields us from disturbing dilemmas, but then I do wonder what happens to our humanity, critical thinking, and imagination. Would this be the path to evolution or devolution?

I too get scared when Euc goes to Amsterdam, I am scared because I know that young people experiment, and thumb their noses at danger and death all the time. That they make mistakes and give into temptation. I get scared because I know that the path of individuation is through rebellion, challenging of the status quo and breaking rules, even if they are re-adopted later on or new ones are made. And where would the rest of us be without the Galileos of this world (They too broke some very sacred laws). But can you imagine if I had to worry that he will be hanged if he was caught with a gram of coke? I could not live with that, could you my brother?

This over-sanitized over-civilized hyper-“cerebralized” society that Singapore aspires to be reminds me of an old star trek episode, the Festival. Do you remember?

My years in the therapist’s chair have shown me over and over that EVERY one’s psych is a simmering and babbling primordial soup which once in a while (to our shock and dismay) spits out some very insalubrious ingredients, whether there are laws against it or not. I would sleep better if I believed that at that time I would be judged with a little more leniency than the chronic and stone- hearted sociopath. Maybe that’s my own utopia.
Furthermore, if we attempt to allay our fears about safety with draconian and hegemonic rules aren’t we creating the Orwellian negative utopia that a lot of us confirmed “democrats” vehemently object to?

Ok, as the song says, I said too much

kisses
2

Broken heart

2007-06-13T11:48:00.001-07:00

Is a “broken heart” more than an old saying?

Researchers in the Karolinska Institute in Stockholm found that marital stress can triple the risk of having a recurrent coronary event for women who have coronary heart disease.

Researchers followed 292 women for about 5 years after they had been hospitalized for acute myocardial infraction or unstable angina pectoris. They found that those with high marital stress were 2,9 times more likely to have further coronary heart problems. Marital problems were an even bigger factor than work stress.

The study suggests that emotional strain and lack of social support may add to women’s poor health by discouraging them from following a healthy life style or medical regimens and also by inducing damaging effects on neuroendocrine and physiological regulatory mechanisms.

So, here is the question: Is any mariage, any relationship worth a broken heart?

can it be that it was all so simple then or has time re-written every line?

2007-03-23T07:41:00.000-07:00

I was reading in the New York Times magazine section a couple of weeks back that Neuroimaging technology is breaking new and exciting grounds. Daniel Langleben at the Uninversity of Pennsylvania has developed the Guilty Knowledge test. He is using f.M.R.I machines to compare the brain activity of liars and truth tellers. Langeleben found that certain areas of the brain lighted up when people lied. But this is just the beginning. Michael Gazzaniga, a professor of psychology at the University of California, Santa Barbara proposes that within 10 years, neuroscientists will be able to show that there are neurological differences(again in f.M.R.I imaging) when people testify about their own previous acts and when they testify to something they just witnessed or heard. And no, this is not the end, there is more mind-blowing news (pan intended): A little further down the road neuroimaging technology would be able to read neuronal firings and translate them into voice, text or movies. Yes, you got it; science is catching up with science fiction.

The article focused on the legal ramifications of this technology. But, I am a psychologist who through the years treated many survivors of childhood abuse. I empathized with their pain, joined them in their anger and rage and questioned along with them the validity of memories too painful to accept without feeling that your soul has been stained and your trust in humanity shattered for ever. Not to mention worrying about the possibility of attorneys and families suing me for “implanting” memories (as if trauma memories were bean of tomato seeds).

So, the questions that have “haunted” me ever since I read this article were: If we had the chance to “see” our childhood would we take it? If we could watch our lives moment by vivid moment and had uncontroversial proof of the mistakes or atrocities perpetrated on us or by us how many of us will be brave enough or foolish enough to do so? How do we love, forgive and live with ourselves and our families without the merciful help of repression, denial and editing of the past? Could it be that as the song says:
Memories, may be beautiful and yet
what’s too painful to remember
we simply choose to forget

Would the truth set us free or deliver us deeper into the pit of depression and madness?

As a way of an introduction

2007-03-13T11:03:00.000-07:00

One of the giants in the field of psychology once said that “our patients teach and heal us.” So, after twelve years of sitting across from the therapy couch and patiently listening to people, I believe I have learned enough to begin to share it with whoever wants to learn and heal too.

I’d like to use this space to share information that has changed my life, life stories that have touched my heart, jokes and anecdotes that have lit up not only my days but also the darkest corners of my being. I’d also like to extend an invitation to new voices, fresh opinions, more life stories.

Like a new parent, I have all sort of dreams about my “creation” but I am trying to put any preconceived notions away and allow this “newborn” to manifest its hidden potentials freely, to surprise and challenge me with every new step .

Come and join me in what I hope it will be an interesting journey.

Dr. Urban

Women and depression

2007-03-13T09:53:00.000-07:00

Women and Depression
Sometimes it seems that the World is laying on our shoulders

Today’s woman often finds herself having to wear different hats all at the same time: A wife, a homemaker, a mother, an employee, a professional, a businesswoman. Superman has retired only to pass the baton to the SUPERMOM! No wonder drug companies are making billions selling antidepressants.

One out of five Americans are suffering from depression with the majority of them being women.

Research has shown that some forms of depression are due to a chemical imbalance. It has also shown that all forms of depression are triggered by life stressors such as separation, divorce, death, going to college, work, etc.

Many women experience intense depression after the birth of a child. Postpartum depression is often caused by hormonal changes after birth. However, if there are other stressful factors in the woman’s life such as marital/family problems or history of depression or anxiety, post partum depression can become a serious and long lasting problem with serious repercussions for the whole family.

Depression is not anyone’s fault and it is not weakness. It is an illness that needs professional help by a qualified mental health professional often in corporation with your physician.