In memoriam

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?

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?

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

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...

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?

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

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.