Wednesday, May 26, 2010

What Women Know (For Sure)

Preface: It is true that between 2/3 and 3/4 of a therapist’s patients tend to be women and I think it’s safe to assume that many of those who seek the services of a psychotherapist are not suffering from a serious mental illness. Probably though, they are unhappy about something. (Not terribly surprising given that they spend many hours trying to communicate with men.) I say this to acknowledge that my professional experience with women is skewed in a certain direction. I do not mean to suggest that the foregoing is a truism for all women but it is common for many women I speak with daily.

The following account is true. I have changed identifying information to protect the identity of my patients but the dynamics illustrated will demonstrate my concern.

Jane is a mature professional (i.e., bright and competent) she’s been married for many years to Dick. Their children are grown and have moved out. Dick retired early while Jane has chosen to work for a few more year to maximize retirement savings. Jane tells me that Dick spends much if not most of the day parked in front of a computer were he looks at pornography and goes into “online chat rooms” and has sexually vulgar conversation with individuals who characterize themselves sexually precocious teen-age girls. (Who knows – perhaps these individuals are really old, bored unattractive men who live out their own twisted fantasies by pretending to be teen-age girls.) When Jane is home and walks up behind Dick to see what he’s doing on the computer (the computer is kept in the living room), Dick immediately switches to a different screen in a lame attempt to hide what he’s doing. Jane has a pretty clear idea of what Dick is doing, nevertheless, she asks him, “What are you doing”?

Dick’s behavior may seem pretty peculiar but the part that gets my attention is Jane’s question. She already knows what he’s doing so why does she ask a question when she already knows the answer?

The above description of Dick and Jane’s behavior continues through many cycles. Frustrated, Jane say’s “I know what you’re doing! It’s sick and weird! Do you think I don’t know what you’re doing?” To this Dick responds like an adolescent who’s been caught taking money from mom’s purse. He says, “What are you talking about? I’m just reading the news and researching stock prices. You’re paranoid. You’re the weird one for even thinking I’d do anything so strange!”

Jane is positively flummoxed. Therapists sometimes like to call it cognitive dissonance (it’s that feeling we have when we try to reconcile two ideas that disprove each other.) Jane was experiencing cognitive dissonance. It’s a feeling of emotional whiplash. Jane was speechless.

So far, there has (a) been unacceptable behavior, (b) Jane has confronted Dick with what she knows and (c) Dick has denied all accusations and made his own counter-accusations.

Here’s the next part I note. Having heard Dick’s denial, Jane redoubles her determination to “catch” Dick. Why does she want to “catch” Dick? Does she want to be proven right in some imagined court of opinion? Is it because Dick’s denial somehow calls into question Jane’s sanity or judgment – and this will “prove” that Jane’s not crazy? If Jane knows what she knows, why does she need further proof? Do women need men to validate their perceptions?

Here’s the next act in our drama:

As I said, Jane is resourceful and bright. She installed software onto the computer that records keystrokes. After a week or two, she had collected perhaps 25 pages of smutty dialog between Dick and someone else on the internet. During an appointment with me, she proudly showed me her “evidence” (Did she somehow imagine that I am a judge?) proving that she was RIGHT. The following evening, she confronted Dick with the evidence – (probably not unlike the way it’s done on TV, in an interrogation room at a police station where an investigator confronts a suspect with incontrovertible evidence).

Dick: “What’s this?”
Jane: “What do you think it is?

She wants him to cop to it like it’s some suspenseful Perry Mason moment.

Dick: “I have no idea.”
Jane: “Well it’s just you and me living here and I didn’t write this.”
Dick: “Well, I didn’t write it either.”
Jane: “Well then, who wrote it?"
Dick: “I don’t know, you’re the crazy one, maybe you wrote it."

Again, it’s a moment of cognitive dissonance el grande for Jane. Probably she feels like her head is going to explode. She’s probably starting to feel crazy. She’s got all this fabulous evidence and Dick’s dismissing it. It’s like that country-western song where having been caught “in the act” of cheating, a husband sings to his wife, “… are you going to believe me or are you going to believe your lying eyes?”

Again, my question is: Why does a woman need a man to validate what she already knows to be true?

Another scenario that is too common in my office: A couple comes in – the husband confesses to having an addiction. They are in my office this day because after many episodes of unacceptable behavior the wife has “had enough”. She insists that “If things don’t change, I’m leaving!” The husband is doleful. He assures the wife he will change his ways. (Note: No behavior has changed but the husband is saying what his wife wants to hear.) “Well, OK…” the wife says, “…but if there’s any more of this; I’m leaving!”

Often this is the fourth or fifth time this cycle has been enacted with this couple. There is no behavioral change from the husband and probably there will be a period of weeks that he’s on “good behavior”… then, the process will kindle until it’s blazing again.

Why do women hinge their future and often the future of their children on what a man says? Is it fear? I usually encourage women to not be moved by words but only by months of behavior. But the questions remain: Why do women seem to need men to validate their experience? Why are women so easily bamboozled by mens words? Is it because this is the way women have been acculturated? Like a now dead president once said, “Trust… but VERIFY.”

Tuesday, May 25, 2010


Following my post of the Jung and Bill W. correspondence, I’d like to make some comments on addiction.

Probably the granddaddy of all addictions is alcoholism. After millennia of personal, family and cultural destruction, Alcoholics Anonymous evolved around 1935. Some would say, that despite the probably billions of dollars that has been thrown at alcoholism (and other addictions – some prefer to lump them together and refer to the “isms”) by the government and private industry, and to the chagrin of high-powered medical science, that AA is and remains the only consistent and most effective treatment for this equal opportunity malady. (I know, there are always new therapies touted as the "silver bullet" but most are a flash in the pan.) In the following comments, I will make repeated reference to alcoholISM. I want the reader to understand that like those who use the word, “ism”, I mean to suggest that all behaviors that closely match alcoholism to be nearly synonymous.

  • [Disclaimer #1] I am not an alcoholic or drug addict though I have had the usual youthful dalliances. I am not a member of AA or any other 12-Step program, because of that, I am on VERY THIN ICE when I make any comments about 12-Step programs. While it is true that there are no rules, per se, in 12-Step groups one of the 12 Principles is that these groups have no spokesman – so anything I say should be understood to be my limited understanding of 12-Step concepts.
  • [Disclaimer #2] I think AA is a miraculous phenomenon. That’s my belief and while I have my reasons for believing it, I have no hesitation in saying it is not everyone’s cup of tea. Perhaps at any given time, I may have 150 active patients. If all of them practiced the 12 Steps of Alcoholics Anonymous, I imagine that 80% - 85% would have no need of my service. Years ago, when I was clinical director of an out-patient treatment program, I pushed AA attendance hard & heavy. It was required in our program and it is required in most treatment programs today. There’s a reason for that. I will agree that there is more than one way to skin a cat (PETA, forgive the reference). Many people stop drinking without AA. Perhaps they were not alcoholic, but if one is alcoholic, in order to pursue “recovery”, one needs to practice the concepts embodied in AA’s twelve steps. When one practices the Steps of AA, they develop a profound change in their reaction to life. They develop a more realistic sense of how much power/control they have in this life. One develops a more vibrant spiritual life when practicing the Steps. Relationships with others and one’s self are mended. Practicing the Steps is an excellent treatment for those suffering from bloated Egos.

Imagine an oncologist is discussing cancer treatment with a patient and says the patient will have to drive long distances to receive treatment and endure painful side-effects. I’d wager the patient would be willing to do whatever it takes. They would adjust their work schedules and be willing to incur great debt. But when I speak with an untreated alcoholic who states they want to be free of the disease (A disease which left untreated is nearly always fatal and devastates themselves, their family and careers.)… I’m frequently told that they’ll think about pursuing treatment… they say they’ll get back to me… most don’t.

The American Medical Association has long acknowledged alcoholism as a disease, but there are no diseases I am aware of that are characterized as cunning, baffling and powerful – and that’s exactly what alcoholism is. While many other diseases are powerful and may be baffling, I know of none described as cunning. When I hear the word "cunning" I think of skill in deception and guile. In part, this is why alcoholism is described in part as a spiritual disease.

Before going further it’s very important that we make a distinction between alcoholISM and alcohol abuse.

Alcoholism (and all the other isms) is characterized by:
  • The repeated use of alcohol leading to progressively severe repercussions. (lost friends, lost job, lost family lost house, lost freedom, lost front teeth, lost physical and/or mental health to name just the most common).
  • An escalating isolation.
  • Dishonesty – in one’s relationship with others as well as with one’s own self.
  • Sincere delusion. This is when one seems to truly believe preposterous rationalizations for one’s ongoing use.
  • Escalating quantities or frequency of use. (Because one’s liver is sometimes damaged, it’s also possible that decreasing quantities will result in inebriation.)
  • Withdrawal symptoms characterized by obsessive thinking about a drink, shaking, drinking in the morning or waking up at night to drink.
  • Escalating shame characterized by hiding behaviors.

Abuse on the other hand is drinking too much and while it may lead to an argument, it lacks most of the above characteristics. I suppose one can abuse watching basketball on TV.

Dorland’s Medical Dictionary defines disease this way: “A disease is an abnormal medical condition of an organism that impairs bodily functions, associated with specific symptoms and signs it has a predictable natural course. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions. It’s cause may or may not be known. A cure may or may not be known."

Alcoholism can and does mimic the symptoms of physical and mental disorders. Alcohol is a central nervous system depressant. The cost of alcoholism is staggering. In 2002 the health-care costs were 176 B-B-B-Billion! (I hope this is part of the health-care solution that we are promised.) Consider the following conservative estimates of alcohol-related mortality. This year, there will be 12,000 deaths from cirrhosis, 5,00 from withdrawal symptoms, 7,000 from heart-disease, 10,000 from cancer, 5,000 from pneumonia, 17,000 in car accidents, 11,000 suicides, 12,000 murders and 16,000 “unclassified” deaths. On top of this the majority of domestic violence, child abuse, sexual abuse, (together, about 3 million cases annually) and emergency room visits are alcohol related. Alcohol-related problems are involved in 1/3 of the couples seen in a therapist’s office. If you do not have addiction problems you are probably effected by another’s alcohol problems. If alcohol (a liquid drug) were ever presented to the FDA as a medication, it would never be released due to it’s side-effects

Without doubt, alcoholism is a contender for the bane of our culture. So, if you accept, try to solve what may seem to be a paradox. Why is it that those members of AA who practice the 12 steps, frequently refer to themselves as “grateful alcoholics?”

Monday, May 24, 2010

Power/Control - Redux

Later in this article, I will use the term “myth”. In an attempt to mitigate unnecessary hypertension in some readers, allow me to clarify the use of this word. Myth is sometimes used to denote an untrue idea that is believed to be a fact; I do not intend to imply that meaning. Merriam-Webster defines it as “usually a traditional story of ostensibly historical events that serves to unfold part of the world view of a people or explain a practice, belief, or natural phenomenon”. For those wanting greater clarification, I refer you to the Wikipedia citation for “mythology”.

In an earlier post (Anger management or Power/Control) I stated my belief that all of us, from birth ‘till death, want more power and control over our environment. I believe this is an inborn instinct, neither good nor bad. I'd like to say a bit more about it here.

This instinct will become problematic if one develops an inflated or grandiose sense of how much power and control we have.

Example: Let’s agree that I believe that I can bench-press 300 pounds.
I position myself on a bench under a 300 pound bar and push – push – push…. nothing. Probably at first, I’m confused because I genuinely believe I can do this feat. If I’m really stubborn (let’s be honest… I am stubborn), I try again. Push - push – push… PAIN! OUCH! I’ve injured myself. The truth is that I could only bench-press 150 pounds. I had unrealistic expectations of how much power I had; now I will experience the consequences of my unrealistic beliefs. The consequences may last for months or a lifetime; all because my expectations were unrealistic.

I challenge you to make a list of those things you believe you have power/control of. Use a 0 – 5 scale. Where 0 = No Control and 5 = complete control. Here are some sample questions:

My personal hygiene:
My body’s health:
My employment:
My finances:
Other’s behavior:
My spending:
My thinking:
My feelings:
The weather:
Other’s thoughts about me:
My children:
My family:
What time I get to work:
What time I leave work.
Any addictive or compulsive behavior:

The truth is, we have very little power/control over most of these. Probably if you are anything like me (and God help you if you are) you’d like to have much more control over these and more.

As far as I know, humans and other animals (dogs for one) have always expressed their impulse to have more power/control. Let’s examine how deeply ingrained this power /control is.

Let’s examine the MYTH of creation according to the book of Genesis.

So God created man in his own image, in the image of God he created him; male and female he created them. And God blessed them, and God said to them, "Be fruitful and multiply, and fill the earth and subdue it; and have dominion over the fish of the sea and over the birds of the air and over every living thing that moves upon the earth." And God said, "Behold, I have given you every plant yielding seed which is upon the face of all the earth, and every tree with seed in its fruit; you shall have them for food. And to every beast of the earth, and to every bird of the air, and to everything that creeps on the earth, everything that has the breath of life, I have given every green plant for food." And it was so. And God saw everything that he had made, and behold, it was very good. And there was evening and there was morning, a sixth day.

PRETTY SWEET! How ideal!

Thus the heavens and the earth were finished, and all the host of them. And on the seventh day God finished his work which he had done, and he rested on the seventh day from all his work which he had done. So God blessed the seventh day and hallowed it, because on it God rested from all his work which he had done in creation. These are the generations of the heavens and the earth when they were created. In the day that the LORD God made the earth and the heavens, when no plant of the field was yet in the earth and no herb of the field had yet sprung up--for the LORD God had not caused it to rain upon the earth, and there was no man to till the ground; but a mist went up from the earth and watered the whole face of the ground-- then the LORD God formed man of dust from the ground, and breathed into his nostrils the breath of life; and man became a living being. And the LORD God planted a garden in Eden, in the east; and there he put the man whom he had formed. And out of the ground the LORD God made to grow every tree that is pleasant to the sight and good for food, the tree of life also in the midst of the garden, and the tree of the knowledge of good and evil. …The name of the first [river] is Pishon; it is the one which flows around the whole land of Havilah, where there is gold; and the gold of that land is good; bdellium and onyx stone are there.

Oh man… does it get any better? It’s like winning the lottery!

…The LORD God took the man and put him in the garden of Eden to till it and keep it. And the LORD God commanded the man, saying, "You may freely eat of every tree of the garden; but of the tree of the knowledge of good and evil you shall not eat, for in the day that you eat of it you shall die."

Uhhh… OK… I guess… (wink – wink) Gee, I’m curious about that tree.

Then the LORD God said, "It is not good that the man should be alone; I will make him a helper fit for him." So out of the ground the LORD God formed every beast of the field and every bird of the air, and brought them to the man to see what he would call them; and whatever the man called every living creature, that was its name. The man gave names to all cattle, and to the birds of the air, and to every beast of the field; but for the man there was not found a helper fit for him. So the LORD God caused a deep sleep to fall upon the man, and while he slept took one of his ribs and closed up its place with flesh; and the rib which the LORD God had taken from the man he made into a woman and brought her to the man. Then the man said, "This at last is bone of my bones and flesh of my flesh; she shall be called Woman, because she was taken out of Man."

Oh baby – you are CUTE!!

Therefore a man leaves his father and his mother and cleaves to his wife, and they become one flesh. And the man and his wife were both naked, and were not ashamed. Now the serpent was more subtle than any other wild creature that the LORD God had made.

Serpent? How’d the Serpent get into this? What is the Serpent? Is it that part of us, that though we have everything we need – and more, still wants more? Is it that instinctual aspect that instills unrealistic beliefs about how much power/control we have or “should” have?

He said to the woman, "Did God say, 'You shall not eat of any tree of the garden'?"

Have you heard a voice in your own thinking that says something like, “You deserve a better car – look at the nice car your neighbor has. You’re better than your neighbor; you DESERVE a NICER CAR – and a VACATION – and A BIGGER HOUSE”!

And the woman said to the serpent, "We may eat of the fruit of the trees of the garden; but God said, 'You shall not eat of the fruit of the tree which is in the midst of the garden, neither shall you touch it, lest you die.'" But the serpent said to the woman, "You will not die. For God knows that when you eat of it your eyes will be opened, and you will be like God, knowing good and evil."

This is where like Adam & Eve, we want more. We want what rich people have. We aren’t happy with what we have. We want more. We believe we’re ENTITLED to more. It’s unfair if we don’t have more

So when the woman saw that the tree was good for food, and that it was a delight to the eyes, and that the tree was to be desired to make one wise, she took of its fruit and ate; and she also gave some to her husband, and he ate. Then the eyes of both were opened, and they knew that they were naked; and they sewed fig leaves together and made themselves aprons.

I hate it when this happens in my own life; what about you? This is when I’ve tried to express the control I think I have – and find out, that again, I overestimated my control/power. In my profession, we call it ego deflation. When it happens frequently (as it does with me) one can become accustomed to it and can make corrections of my expectations. Some, who cannot accept that they don’t have as much power/control as they thought, may become very frustrated, in more pronounced situations, they can even develop depression.

And they heard the sound of the LORD God walking in the garden in the cool of the day, and the man and his wife hid themselves from the presence of the LORD God among the trees of the garden. But the LORD God called to the man, and said to him, "Where are you?" And he said, "I heard the sound of thee in the garden, and I was afraid, because I was naked; and I hid myself." He said, "Who told you that you were naked? Have you eaten of the tree of which I commanded you not to eat?" The man said, "The woman whom thou gavest to be with me, she gave me fruit of the tree, and I ate." Then the LORD God said to the woman, "What is this that you have done?"

BUSTED! We’ve all experienced this. Not only has our ego been deflated which is demoralizing and painful, but it’s become public knowledge! The narrative speaks of what happens when the naked truth is known about us. We fear it. We try to hide it by fabricating stories or padding our resume’… we thought we could get away with it… we thought… that’s the problem we thought incorrectly. We overestimated our ability. We spent too much – lifted too much – ate too much – worked too much. Some part of us said, “Go ahead, no one will ever find out.” WRONG!

Now come the consequences…

To the woman he said, "I will greatly multiply your pain in childbearing; in pain you shall bring forth children, yet your desire shall be for your husband, and he shall rule over you." And to Adam he said, …cursed is the ground because of you; in toil you shall eat of it all the days of your life; thorns and thistles it shall bring forth to you; and you shall eat the plants of the field. In the sweat of your face you shall eat bread till you return to the ground, for out of it you were taken; you are dust, and to dust you shall return." …Then the LORD God said, "Behold, the man has become like one of us, knowing good and evil; and now, lest he put forth his hand and take also of the tree of life, and eat, and live for ever" -- therefore the LORD God sent him forth from the garden of Eden, to till the ground from which he was taken. He drove out the man.

So, you see, that far before the advent of modern psychology, some would say from the beginning, the impulse has been present.

Is this impulse a “bad” thing? No.
Actually, through repeated iterations of this motif, we grow in knowledge and hopefully we grow in wisdom about what we do and don’t have control/power over. We have opportunities to see it daily. This same thing can be witnessed when a parent tells a toddler, “You can eat in the kitchen but don’t bring food in the living room” … predictably the child will knowing encroach into the living room. They are enacting the impulse that hopefully develops awareness.

Friday, May 21, 2010

The Carl Jung / Bill Wilson Letters

Many have asked or made reference to this correspondence. I decided to present it again here. (It's widely available elsewhere on the internet.)

January 23, 1961

Professor, Dr. C. G. Jung
Seestrasse 228

My Dear Dr. Jung:

This letter of great appreciation has been very long overdue.

May I first introduce myself as Bill W., a co-founder of the Society of Alcoholics Anonymous. Though you have surely heard of us, I doubt if you are aware that a certain conversation you once had with one of your patients, a Mr. Roland H., back in the early 1930s, did play a critical role in the founding of our Fellowship.

Though Roland H. has long since passed away, the recollection of his remarkable experience while under treatment by you has definitely become part of AA history. Our remembrance of Roland H.'s statements about his experience with you is as follows:

Having exhausted other means of recovery from his alcoholism, it was about 1931 that he became your patient. I believe that he remained under your care for perhaps a year. His admiration for you was boundless, and he left you with a feeling of much confidence.

To his great consternation, he soon relapsed into intoxication. Certain that you were his "court of last resort," he again returned to your care. Then followed the conversation between you that was to become the first link in the chain of events that led to the founding of Alcoholics Anonymous.

My recollection of his account of that conversation is this: First of all, you frankly told him of his hopelessness, so far as any further medical or psychiatric treatment might be concerned. This candid and humble statement of yours was beyond a doubt the first foundation stone upon which our Society has since been built.

Coming from you, one he so trusted and admired, the impact upon him was immense.

When he asked you if there was any other hope, you told him that there might be, provided he could become the subject of a spiritual or religious experience -- in short, a genuine conversion. You pointed out how such an experience, if brought about, might remotivate him when nothing else could. But you did caution, though, that while such experiences had sometimes brought recovery to alcoholics, they were, nonetheless, comparatively rare. You recommended that he place himself in a religious atmosphere and hope for the best. This I believe was the substance of your advice.

Shortly thereafter, Mr. H. joined the Oxford Group, an evangelical movement then at the height of its success in Europe, and one with which you are doubtless familiar. You will remember their large emphasis upon the principles of self-survey, confession, restitution, and the giving of oneself in service to others. They strongly stressed meditation and prayer. In these surroundings, Roland H. did find a conversion experience that released him for the time being from his compulsion to drink.

Returning to New York, he became very active with the "O.G." here, then led by an Episcopal clergyman, Dr. Samuel Shoemaker. Dr. Shoemaker had been one of the founders of that movement, and his was a powerful personality that carried immense sincerity and conviction.

At this time (1932-34), the Oxford Group had already sobered a number of alcoholics, and Roland, feeling that he could especially identify with these sufferers, addressed himself to the help of still others. One of these chanced to be an old schoolmate of mine, named Edwin T. [Ebby]. He had been threatened with commitment to an institution, but Mr. H. and another ex-alcoholic "O. G." member procured his parole, and helped to bring about his sobriety.

Meanwhile, I had run the course of alcoholism and was threatened with commitment myself. Fortunately, I had fallen under the care of a physician -- a Dr. William D. Silkworth -- who was wonderfully capable of understanding alcoholics. But just as you had given up on Roland, so had he given me up. It was his theory that alcoholism had two components -- an obsession that compelled the sufferer to drink against his will and interest, and some sort of metabolism difficulty which he then called an allergy. The alcoholic's compulsion guaranteed that the alcoholic's drinking would go on, and the allergy made sure that the sufferer would finally deteriorate, go insane, or die. Though I had been one of the few he had thought it possible to help, he was finally obliged to tell me of my hopelessness; I, too, would have to be locked up. To me, this was a shattering blow. Just as Roland had been made ready for his conversion experience by you, so had my wonderful friend Dr. Silkworth prepared me.

Hearing of my plight, my friend Edwin T. came to see me at my home, where I was drinking. By then, it was November 1934. I had long marked my friend Edwin for a hopeless case. Yet here he was in a very evident state of "release," which could by no means be accounted for by his mere association for a very short time with the Oxford Group. Yet this obvious state of release, as distinguished from the usual depression, was tremendously convincing. Because he was a kindred sufferer, he could unquestionably communicate with me at great depth. I knew at once I must find an experience like his, or die.

Again I returned to Dr. Silkworth's care, where I could be once more sobered and so gain a clearer view of my friend's experience of release, and of Roland H.'s approach to him.

Clear once more of alcohol, I found myself terribly depressed. This seemed to be caused by my inability to gain the slightest faith. Edwin T. again visited me and repeated the simple Oxford Group formulas. Soon after he left me, I became even more depressed. In utter despair, I cried out, "If there be a God, will he show himself." There immediately came to me an illumination of enormous impact and dimension, something which I have since tried to describe in the book Alcoholics Anonymous and also in AA Comes of Age, basic texts which I am sending to you.

My release from the alcohol obsession was immediate. At once, I knew I was a free man.

Shortly following my experience, my friend Edwin came to the hospital, bringing me a copy of William James's Varieties of Religious Experience. This book gave me the realization that most conversion experiences, whatever their variety, do have a common denominator of ego collapse at depth. The individual faces an impossible dilemma. In my case, the dilemma had been created by my compulsive drinking, and the deep feeling of hopelessness had been vastly deepened still more by my alcoholic friend when he acquainted me with your verdict of hopelessness respecting Roland H.

In the wake of my spiritual experience, there came a vision of a society of alcoholics, each identifying with and transmitting his experience to the next -- chain-style. If each sufferer were to carry the news of scientific hopelessness of alcoholism to each new prospect, he might be able to lay every newcomer wide open to a transforming spiritual experience. This concept proved to be the foundation of such success as Alcoholics Anonymous has since achieved. This has made conversion experience -- nearly every variety reported by James -- available on an almost wholesale basis. Our sustained recoveries over the last quarter-century number about 300,000. In America and through the world, there are today 8,000 AA groups. [In 1994, worldwide membership is estimated to be over 2,000,000; number of groups, over 87,300.]

So to you, to Dr. Shoemaker of the Oxford Group, to William James, and to my own physician, Dr. Silkworth, we of AA owe this tremendous benefaction. As you will now clearly see, this astonishing chain of events actually started long ago in your consulting room, and it was directly founded upon your own humility and deep perception.

Very many thoughtful AAs are students of your writings. Because of your conviction that man is something more than intellect, emotion, and two dollars' worth of chemicals, you have especially endeared yourself to us.

How our Society grew, developed its Traditions for unity, and structured its functioning, will be seen in the texts and pamphlet material that I am sending you.

You will also be interested to learn that, in addition to the "spiritual experience," many AAs report a great variety of psychic phenomena, the cumulative weight of which is very considerable. Other members have -- following their recovery in AA -- been much helped by your practitioners. A few have been intrigued by the I Ching and your remarkable introduction to that work.

Please be certain that your place in the affection, and in the history, of our Fellowship is like no other.

Gratefully yours,

William G. W--.

January 30, 1961
Seestrasse 228

Mr. William G. W--.
Alcoholics Anonymous
Box 459 Grand Central Station
New York 17, New York

Dear Mr. W.:

Your letter has been very welcome indeed.

I had no news from Roland H. any more and often wondered what has been his fate. Our conversation which he has adequately reported to you had an aspect of which he did not know. The reason that I could not tell him everything was that those days I had to be exceedingly careful of what I said. I had found out that I was misunderstood in every possible way. Thus I was very careful when I talked to Roland H. But what I really thought about was the result of many experiences with men of his kind.

His craving for alcohol was the equivalent, on a low level, of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God.

How could one formulate such an insight in a language that is not misunderstood in our days?

The only right and legitimate way to such an experience is that it happens to you in reality, and it can only happen to you when you walk on a path which leads you to higher understanding. You might be led to that goal by an act of grace or through a personal and honest contact with friends, or through a higher education of the mind beyond the confines of mere rationalism. I see from your letter that Roland H. has chosen the second way, which was, under the circumstances, obviously the best one.

I am strongly convinced that the evil principle prevailing in this world leads the unrecognized spiritual need into perdition if it is not counteracted either by real religious insight or by the protective wall of human community. An ordinary man, not protected by an action from above and isolated in society, cannot resist the power of evil, which is called very aptly the Devil. But the use of such words arouses so many mistakes that one can only keep aloof from them as much as possible.

These are the reasons why I could not give a full and sufficient explanation to Roland H., but I am risking it with you because I conclude from your very decent and honest letter that you have acquired a point of view above the misleading platitudes one usually hears about alcoholism.

You see, alcohol in Latin is "spiritus," and you use the same word for the highest religious experience as well as for the most depraving poison. The helpful formula therefore is: spiritus contra spiritum.

Thanking you again for your kind letter.

I remain
yours sincerely

C. G. Jung

*"As the hart panteth after the water brooks, so panteth my soul after thee,
O God." (Psalm 42.1)

Thursday, May 20, 2010

Either read this book or buy it for someone with kids

"The Epidemic" by Robert Shaw, MD

Fair Fighting

When I have worked with couples in the past, I commonly hear, “We don’t communicate”. Maybe I’m splitting hairs, but it would be more accurate to say, “We're not communicating in a way that brings us leads to more understanding and brings us closer”. (Remember this first paragraph as we go along; it illustrates a very important concept.)

Some time ago, the John Grey book, “Men are from Mars, Women are from Venus” was published. I’ve never read the book but it reminded me of what my old teacher used to say. “The fact that we are both speaking English only augments the delusion that we’re speaking the same language.” Does this seem confusing?
Let me say it another way; human communication is inherently ambiguous, (i.e., unclear. See the example in the following paragraph.)

Probably, it seems apparent what a couple “means” when they say, “we don’t communicate…” But that statement by itself leaves a lot of room for various interpretations.) When computers communicate with another computer in binary code, there is no ambiguity. The computer message consists of a series of 1s or Øs. The communication is black or white – there is no grey area. Human communication, by contrast is nearly always grey and ambiguous. Even the simplest human communication is shaded and nuanced by a person’s non-verbal behavior (the roll of eyes, the inflection of a word or hand gestures). And, it even worse than that... let’s imagine that someone says, “We’re experiencing very nice weather.” and their body language and vocal intonation are completely congruent with the statement – a successful communication requires that the recipient of the message correctly interprets the message that was intended. To me, it astounding that two human beings can communicate as effectively as we do! I’m not the least surprised that miscommunication happens as often as it
does. I am surprised it’s not an even bigger problem.

Being Right
Are you dead right?
You’re a human and so am I. There’s no argument there.
The sky is blue and the grass is green. There’s no argument there either.
After all, they’re "FACTS", and we’re all in agreement with them (right?). But why do so many of us have a need to ‘right’ regarding OPINIONS? A man driving in LA is outraged by another driver cutting him off. In his opinion, the driver who cut him off is unbearably rude. “I’ll show him,” he thinks, as he now tries to cut off the ‘rude’ driver. This incident explodes into a full-blown case of road rage, which leads to an accident and the death of the outraged driver. He might have been ‘right,’ but now he’s dead right. Does it make any sense to fight to the death over an opinion? Besides, how could the dead driver be ‘right’ when his behavior was wrong? An obsessive need to be ‘right’ is irrational, but, sadly, very common. For instance, what makes one believe that our neighbors are incompetent to think for themselves and need to be ‘saved’ by our own brand of religion (or view of reality)? And if they refuse to recognize our merciful God, we can always kill them! It’s like an anti-abortionist who preaches about the sanctity of life and then murders a doctor who performs abortions. Why do we kill others for having different opinions?

Some of us get easily upset in the workplace. We insist that others do things the ‘right’ (our) way. Yet, isn’t it more important to do the right thing than do things right? The high divorce rate suggests that married life is another arena for the clash of opinion. Something as trivial as how one’s spouse squeezes the tube of toothpaste is enough to cause anger in some people.

Quick, answer this question. What is the ‘right’ way to squeeze a tube of toothpaste? From the middle or from the end of the tube? Well, half of those who were surveyed in a university study answered, “From the middle,” and the other half said, “From the end of the tube.” So, no matter which opinion you hold, you were not ‘right’ in the mind of half of those surveyed. Can you see how ludicrous, how irrational, it is to demand that others share our opinions?

There are many reasons to give up our addiction to being ‘right.’ First, consider what we are doing when we make pronouncements that you are either for me or against me, or that it’s my way or the highway, or that I’m ‘right ’ and you’re ‘wrong.’ Aren’t we being arrogant, combative, self-righteous, presumptuous, judgmental, narrow-minded, and alienating? Aren’t such attitudes divisive and dysfunctional? Don’t they disrupt harmony and peace and lead to conflict and suffering?

When I insist that I’m ‘right,’ I slam the door of my mind. I remain locked in past beliefs. I stop growing. I have a shallow understanding of the world and limited choice. But if I change my focus from what IS ‘RIGHT’ to what IS, something magical happens. The moment I accept the fact that others have different views and willingly consider them, rather than fight them, I am transformed. Transformed from a prisoner to an adventurer and explorer. By opening myself to all ideas, I open my life to infinite possibilities. And on that day, I discover what it is to be rich.To be dead right is to be dead. To be cut off from the untold riches of life. It is also to be unhappy. For it is impossible to control the thoughts and opinions in the minds of others. So, when they fail to live up to our demand for agreement, we feel frustrated and disappointed. Does it make any sense to follow the road to unhappiness? If the demand to be ‘right’ is self-defeating, why do we engage in it? One reason is the discomfort of uncertainty. Living in a world of uncertainty makes some feel like the earth is crumbling beneath their feet. There is no stability, nothing to hang on to (except their opinions and beliefs). Yet, when we change our perspective and think of uncertainty as surprise, wonder, awe, growth, opportunity, and delight, we can embrace it.

Another reason for tenaciously clinging to our opinions is the fear that changing them would lead to the loss of our identity. But we are not our opinions. We are people who hold opinions and can let them go if we choose to. When we learn from others, we don’t lose our identity; we expand, enhance, and enrich it. A third reason for wanting to be ‘right’ is low self-esteem. Some need to show off their ‘superiority’ to compensate for their feelings of inferiority. They are afraid of appearing stupid and need the approval of others. But the way to grow superior is by opening one’s mind, not by closing it. To awaken from the delusion that our opinion is the only ‘right’ one, all one has to do is study history and the evolution of science. For when we do, we will quickly learn that we are fallible creatures. Even the brightest minds changed their opinions on innumerable occasions. In fact, that’s how they grew so bright, by integrating opinions that at first appeared diametrically opposed. And by willingly adding the opinions of others to their own. They weren’t afraid of accepting new ideas and making mistakes.

Here’s how Lewis Thomas (1913 ~ 1993) explains it in his book THE MEDUSA AND THE SNAIL, “Mistakes are at the very base of human thought, embedded there, feeding the structure like root nodules. If we were not provided with the knack for being wrong, we could never get anything useful done. We think our way along by choosing between right and wrong alternatives, and the wrong choices have to be made as often as the right ones. We get along in life this way.”

When the populace of a certain village was evenly divided on the ‘right’ way to punish a disobedient child, they decided to seek council with the village elder. The spokesman for Opinion A gave his view to the elder. As the others listened in silence, the elder spoke, “You are right.”While maintaining his decorum, but visibly upset, the spokesman for Opinion B said, “But Wise One, you have given your counsel before hearing from me!” He then shared his opinion with the elder. After listening to it, the Wise One said, “You are right.”“But, Honorable One,” protested another villager, “you have just agreed with two opposing viewpoints!” The Wise One turned his way and said, “You are right.”

If I could “make” my patients understand some specific points about communicating, the below ideas would be some of them.

Communication between two or more humans is likely to be marked by expressions of one’s thoughts and feelings. This imperfect communication is likely to be misinterpreted by the recipient of the communication. These communication flaws pile up on each other usually leading to an argument. If couples want to communicate more effectively, I would advise them to frequently confirm whether the other party has received the message that was intended. Imagine going to a foreign country whose language you don’t understand. You probably wouldn’t expect that they would understand you and you wouldn’t be surprised if you were confused by what they say. You would make extra efforts to try to make yourself clear; perhaps you’d bring a translating dictionary. In a similar fashion, we should not assume that another would perfectly understand us – even though we are both speaking English. Perhaps we use a regional expression that is not familiar to the recipient of our communication. Perhaps the other party has a pressing personal problem that distracts them from listening closely. There are hundreds of perfectly normal reasons why communication between two humans will go cock-eyed. For a couple with strong emotional ties (good or bad) there may be thousands of reasons.

Let me relate a story; recently a patient who is quite an expert in the area of computers was explaining to me that now there are various computer platforms. (Windows, Linux, Java etc.) He explained that now, even computers are experiencing problems communicating. In this patient’s profession, they call it "porting". (e.g., the data didn’t port very well to the new computer) In other words, the data was mangled and unusable by the other computer. In human relationships, it might be called an argument. When a couple encounters an argument, it’s safe to assume that there has been an error in communication. There has been a mistranslation. At this point, the couple should back up and try to discover where the communication derailed.

In grad school, we were taught about a concept described as "positive intentionality" – the idea is that basically, people intend to behave in a positive and productive manner. Obviously, those positive intentions all too often get serious mangled in the process of communication but, it’s usually safe to assume that a couple who say they care for each other want to communicate in such a way that something positive and productive results from a communication. The fact that a couple frequently argues is most often indicative of an error (misunderstanding) in the communication process. So, remember, even though we speak English it does not necessarily follow that our communication will be easily or clearly understood. It is your responsibility as the sender of a communication to confirm that the receiver of the communication understood your intentions. If you don’t confirm it, it is your responsibility that you didn’t take the time to clarify the communication. Another comment from my teacher, “It never the audience’s fault.” By this, he was suggesting a play – if the audience doesn’t like the play – it’s not their fault. The problem lies with the one who wrote the play or the performers. So, it is the responsibility of the sender of a communication to be responsible for the effect their communication – not the receiver.

If you accept the premise that communication is an inherently dicey process then it makes sense that “rules for effective communication” might be a helpful tool to reduce the likelihood that miscommunications will occur. At first, couples may balk at the idea of trying to use “rules”. They may complain that it’s unnatural or too complicated. Honestly, while I understand, I think it comes down to whining. If someone experienced a significant injury, physical therapy may be required – and in physical therapy, one exercises the injured part of the body to regain greater functionality. Where we ever got the idea that a relationship should be easy or natural, I don’t know but it wouldn’t surprise me if it was therapists. The truth is, relationships require effort. Of all the things we have, I can’t think of one that doesn’t require some kind of effort to maintain the enjoyment of the possession or relationship. If you’ve ever been at a formal committee meeting or governmental meeting, it’s quickly apparent that there are rules that govern the process of the meeting. The rules are actually written down in a book. The rules are called Robert’s Rules of Order (no relation to yours truly). I haven’t read the book but I’ve been to a lot of meetings.

The chairperson “calls the meeting to order” “old business” is reviewed, “new business” is reviewed, and if an item isn’t on the “agenda”, it gets scheduled for another meeting. Motions are made, seconded, voted on, passed or defeated. The chairperson is there to insure that the meeting is conducted in an orderly fashion. If someone thinks it’s becoming unorderly they will say to the chairperson, “…point of order”. All of this may seem terribly tedious and unnecessarily parochial, but it is done to assure that communication is clear and stays on track. When the next meeting convenes, someone (the secretary) has compiled the “minutes of the meeting”. All of this (and much more) – in the name of clear communication practices.We should take a lesson from this. Communicating is not a simple process. You may know what you believe you communicated but the likelihood that the recipient of your communication receiving it exactly as you intended it is almost never 100%.

Consider the following real-life examples; (By the way, when I refer to patients I work with I usually call them Dick & Jane and rest assured, I always disguise identifying information.)

Example #1
Dick-1, Jane-1 and their child Tim are driving home late at night after dinner with friends.
Jane-1 and Tim (age two) are fast asleep. Dick-1 is alert, on a straight stretch of open road – it’s past midnight, and there are few if any other cars on the road. Dick-1 is speeding – probably 90 MPH.
Jane-1 wakes up, sees the speedometer, and “goes off” on her husband, “Are you crazy? Are you trying to kill us? What’s wrong with you?”
Dick-1 is indignant, he replies in an escalated way, “Don’t tell me how to drive! I haven’t had an accident in 20 years – you’ve had two in the last year! If you don’t want me to speed, maybe you shouldn’t pass out as soon as we get in the car!” The argument continues until they’re home; they go to bed angry and hurt.

Obviously, this communication hasn’t achieved the intended goal. Let’s do what therapists sometimes call a post-mortem on this sequence of events and I’ll tell you what I “think” happened.

  • Dick-1 was speeding. He shouldn’t but he thought it was safe enough.
  • When Jane-1 awoke and saw the speedometer, my guess is that in her semi-awake state, she was SCARED. Frequently, scared people react defensively and we’ve all heard the saying the best defense is a good offense. Jane-1 is scared – she wants Dick-1 to slow down – out of fear, she launches an offense of her husband’s driving. She suggests he’s crazy, that he’s homicidal and that something is wrong with him. None of this helps Dick-1 understand that his wife is afraid.
  • Dick-1 interprets that he’s under a surprise, unwarranted attack and launches a counter-attack in an attempt to get Jane-1 to deescalate.
  • Jane-1 is now scared and hurt. She believes that she expressed her alarm and fear and instead of slowing down, her husband is arguing with her. She is hurt and feels betrayed – apparently, her husband doesn’t care that she’s scared and in fact chooses this occasion when she’s already upset to criticize her.
  • Dick-1 believes he was just minding his own business when he was blind-sided.

I suppose we all wish at times we could rewind time and re-do something. If Dick & Jane could have done something different, and if I were some grand cosmic puppeteer, here’s what I would have changed. When Jane woke up, I have her tell Dick about her fear, “Dick, I’m really afraid and scared.” My guess is Dick doesn’t want to scare his wife – my guess is, he’d slow down fast. My guess is, it wouldn’t have escalated into an argument leaving each feeling distant and misunderstood. My point (in case you haven’t picked up on it yet) is that people are not “naturally” good communicators. They become good communicators through some education and practice, practice, practice.

Example #2
Dick-2 & Jane-2 come to see me. They’ve been separated for a bit over a year. Their concern is some behavioral problem with their child. As they talk with me over several visits, it seems to me they really like each other. I asked them, “By the way, why did you separate?” They related the following:

  • About a year prior, during an argument, Dick-2 thought he was getting too angry and it seemed to him that the argument was becoming to destructive so he said, “I’m leaving.” To Dick-2, this meant he was going for a walk to cool down and get a better perspective.
  • Jane-2, thinking he meant he was moving out was shocked that he was ending the relationship over a fairly minor argument but said, “FINE- don’t come back!”
  • Dick-2 was shocked that Jane was ending the relationship but wanted to respect her wishes.

They had lived apart for over a year due to a misinterpretation of wha was being said. I’ll never forget the look on their faces as it quickly dawned on them what had happened.

So, class, what lessons do we take from this? (Don’t say Dick & Jane are morons… we’ve all done similar things.)

The lessons are:
  • Communication is ambiguous and requires practice to do it well.
  • If there’s an argument, it usually indicates a misinterpretation of communication

If a comment is not likely to bring you closer; don’t say it.
I’m pretty sure this next one can be blamed on well-meaning but really dumb therapists. There’s an idea floating around that if you have a thought or feeling, you should be “honest” about it and say it. This is really bad advice. We all have thoughts and feelings – but not all of them are fit for being expressed to others. You may think I’m really ugly – but how will that help anything by you saying it.

Example 3:
Dick-3 & Jane-3 have been married for years. Regrettably, Jane-3 had an affair. Dick-3 finds out – there’s a horrible rocky period for months but they decide to stay together and Jane ends the affair. Months later, their sex-life is flat. During a visit with me, Jane announces to Dick that the “other guy” was “bigger” than Dick-3. I was horrified. Dick-3 was devastated. Jane-3 said, “Well, shouldn’t I be honest?”

The answer to Jane-3’s question is: NO. Not about that. Communication is permanent. You can never “take it back”. You can’t unring the bell. How could her “honest” comment ever bring them closer? Dick-3 will never forget those words. Like you, I’ve been in my share of arguments. I have a mental picture; I’m standing in front of a burning house. In one arm, I have a fire hose with water. In the other arm, I have a fuel hose with gasoline.

Which should I use?

Hmmm… gee, I know I should use the water but the “bad-Rob” want to turn on the gas a see the house really blaze. In an argument, we are usually faced with a choice we can say things which will predictably pour gas on the fire – or we can say something that will help. If we can’t think of what will help it’s better to say nothing instead of using the gas. You can even say, “I’m confused right now – I need time to sort this out – I don’t want to make things worse – so for now, I’m not going to say anything.”

More communication is not always better.

Have you ever heard of the rule of holes? It says, when you find yourself in a hole the first rule is to stop digging. In a similar way, people sometimes have the idea that if they are in the midst of an argument they need to communicate more to get out of the argument. This is not true. What’s needed is a different kind or type of communication. Sometimes it’s better to stop – go to separate rooms for 15 – 30 minutes before continuing. Sometimes it should be stopped ‘till the next day. I tell my patients that even professional boxers (who train all day) only fight for three minutes per round. Then they sit and rest for a while. When I work with a couple, I often tell them to drop further conversation about the “problem” until the next day. I tell them, “I’m envious of veterinarians who can put those plastic collars on animals to prevent an animal from biting at stitches that have been put in.” Sometimes things need to be allowed to rest or heal. Dough needs time to raise – paint needs time to dry and sometimes we need time to consider things that have been said or time to sort out how we feel about something.Here then are some of my “fair fighting” rules. (Keep in mind that if you haven’t been practicing these for a while, it will be nearly impossible to stick to any of them for more than a short period.)

  • No surprises. Here’s a frequent scenario; Jane has been thinking about an annoyance for a while – maybe hours or days. Maybe she’s even rehearsed in her mind what the conversation will be like. Dick, on the other hand, has been doing something else. Maybe he’s been at work doing whatever he does. When he gets home, Jane says, “There’s something we need to talk about….” and goes on to lay out her concerns. Dick has been blindsided. He hasn’t had the benefit of advance notice. Maybe he’s had a horrible day. Maybe he has a headache. Maybe he’s coming down with a stomach virus. My point is this; don’t spring a conversation on someone. I suggest that you tell them you’d like to discuss something and it’s a “7” (Use a 1 – 10 scale. A 1 is an almost completely insignificant concern, a 10 is a possible deal-breaker i.e., potentially divorce, a 5 is important but is what you might consider an issue of “average” importance.) Then the other person can say, “I’m willing to discuss it, but can we do it in an hour after I wind down?”
  • Don’t try to resolve a conflict in one discussion. Too many couples I see try to resolve big issues during one conversation. Usually I’ll suggest a big concern needs to have 4 – 5 conversations. This allows each person to strongly state their views – listen to the views of the other – then drop it. In a few days, have another conversation about it – then drop it. Do this several times allowing time in-between to consider what has been said.
  • No crisis tickling. An example of this would be during an argument Dick says to Jane, “Maybe I should talk with an attorney.” Here, Dick is tickling a crisis. He’s implying that he might be exploring a divorce – without saying it.
  • Stick to the topic. Too often a couple will begin trying to resolve one issue and then start going tangent to other unresolved issues.
  • No name-calling. Need I say more?
  • Keep it brief. As I’d previously mentioned, an argument should never go on for more than 20 or so minutes. If it goes on longer than 20 minutes people are getting exhausted and there’s a greater likelihood that someone will resort to dirty fighting.
  • No arguments if someone is under the influence. I’ll say more later about substance use but it’s never a good idea to argue when someone is under the influence – even a little. Don’t do it. Walk out if necessary. (I’ve worked with couples for over 20 years. I’ve seen too many people that get thrown in jail or do something else stupid because they were arguing either with someone who was under the influence.)
  • No one is “right”. This is a pet peeve for me. It seems that everyone I know (including me) believes they are “right” and if others don’t agree they are either stupid, wrong, dishonest, mentally ill or misinformed. The truth is everyone sees things from a unique perspective. Because they see it differently from you doesn’t make them (or you) wrong. This is just the way you (and they) see it. Insisting on being “right” will result in you being very lonely.
  • No mind-reading. Dick says to Jane, “I know what you’re thinking (or feeling).” This is crazy making. You may believe that the other person is thinking or feeling something but you are not Kreskin.
  • No triangling. This means bringing a third party (Your kid, his/her brother or parents, a friend – anyone that you personally know.) into the conflict to take sides.
  • No violence or implication of violence.
  • No invoking of the past. Stay focused on the issue at hand. Stay in the present
  • No fighting after 10PM
  • No blaming. Determining fault usually doesn't change anything.
  • Acknowledge when feeling defensive.
  • If you know you are wrong, promptly admit it. It’s amazing how many couples have trouble with this seemingly obvious rule.
  • When the argument ends, each person states the solution as understood.
  • Check for leftover feelings and resentments when the fight is over. (If necessary schedule ANOTHER time to address these.)

And remember, there are no winners, no right-and-wrong. Only mutually acceptable solutions.

Wednesday, May 19, 2010

The Memo for Women

To: The Sex Memo for Women (and men)
From: Reality
Date: Today
Re: Men & Sex (Different is not wrong.)

Recently, I distributed a memo to men called the “sex memo”. 

The reason I wrote that memo is that for years, I’ve talked with women about their relationships with men and I was hearing the same thing, over and over. Often, it was about sex; I thought, “Did men not get the memo about sex?” – so, I wrote the memo. 
Since then, I recognized that though it is true that men can be (and often are bone-heads); women can often be… how shall I say this… unrealistic in their expectations of the men they are with. I’m therefore issuing the following memo as a list of common blunders women make in relationships.

1. A "primary relationship" (other than raising children) is perhaps the most difficult endeavor on which you’ll ever embark, and while challenging, it is well worth it. A relationship is not supposed to be “easy”. Two individuals from two very different backgrounds and (presumably) opposite genders will naturally have differing perspectives, thoughts and feelings regarding the same topic. This does not mean the two of you are incompatible or that there is something wrong with one of you or the relationship.
If things were perfectly smooth it would be because you are both dead. Rejoice if there’s a difference of opinion – it means you’re both alive!

2. Men are not mind-readers. Though we try; we do not know what you’re thinking or feeling. The fact that we don’t know is not an indication that we don’t love you. You must learn to
use your words in as much as possible, an unambiguous way to ask for what you need and want (without suggesting the man's intelligence is in question).

3. Men cannot and should not ever be expected to be one of your girl-friends. Men think and communicate very differently than women. Sometimes, you need to have a conversation with your girl-friend. This does not mean men are deficient.

4. My old teacher was fond of saying, “The fact that we both speak English only augments the delusion that we are speaking the same language.” Men and women use language very differently – largely it’s due to how we’ve evolved over thousands of years. Men are more inclined to give short answers – women give longer (often too long) answers. If you and your mate get into an argument it is usually safe to surmise that your communication was inadvertently derailed. Don’t
assume anything about communication. Communication between humans is far more prone to error than most people would ever imagine.

5. Sex for men is very different than it is for women. This doesn’t mean that men are perverts (though admittedly, some are). For men, sex is closeness, intimacy, emotionally healing and conveys much of what we don’t say.

6. Men do not have as large an overt emotional vocabulary as women.  (That doesn't mean the men are emotionally deficient.) Here's a corollary: Women not having the same muscle-mass as men doesn't make them muscularly deficient.) Don’t expect men to explain in a nuanced way how they “feel”.

7. Men experience closeness through a shared activity. For many men, words unnecessarily clutter an otherwise enjoyable moment. (To see an example of this, watch men doing an activity together. Probably they will say little or nothing about the way they’re feeling; nevertheless they will report that they felt camaraderie.)

8. Again, largely for evolutionary reasons, women will (generally) have more anxiety than men. This means that women will usually notice that something is out of place or needs done before men. This doesn’t mean that men don’t care. It means only that a man’s triggering threshold is higher than his partner's. It also means that
you have to ask for help – not because men are clueless (though in some cases they can be), but because men haven’t noticed it yet – ask nicely – not like we’re morons for not having noticed. A very important and destructive side-effect of this is that women often end up shouldering too much of the burden of household responsibilities. Learn to ask for what you want and need. This is YOUR responsibility, not the man’s job to intuit.

9. Regarding disciplining of children, men and women are worlds apart. Women (this is a common pitfall for women) try far too much to reason and explain to kids why something is wrong. Men tend to be terse and “clipped” when disciplining kids. This doesn’t mean that men are too harsh. When dealing with disciplining children, terse is good.

10. Maybe this will be redundant but it bears repetition. GENERALLY, because of the evolutionary process, women tend to be more emotionally sophisticated than men. This doesn’t mean there is something “wrong” with men; it’s not a disorder. Men are obviously quite adept (perhaps more so) with some things than women. Men also do not have breasts like women or a uterus – that doesn’t mean something is wrong with them. Accept men as men (a different gender); you would want the same understanding and respect.

11. Too often, women have an expectation that in longer-term relationships, (more than six months) that the passion and romance that was present at the beginning of the relationship should continue. I don’t know where women get this idea but it’s wrong. A patient I saw put it well, she said if one compares love and sex to a meal, not every night is a steak and lobster dinner, sometimes, it’s mac & cheese. It would be nice if the romance feelings and impulses would last forever but left on its own – romance dwindles. To keep romance alive it takes two to tango. Expecting men to be sweet and romantic if you’re being critical is just plain crazy. If you want romance – be romantic yourself. DON’T CRITICIZE. It never helps; I know you think it should but trust me – IT NEVER HELPS.

12. Chronic substance use in a relationship is always a problem.

  • It’s a central nervous system depressant
  • People say things when under the influence that they’d never say sober.
I’m not talking about a glass of wine or the equivalent (unless you are an addict). If one or both of you are alcoholic/addicts, get into a good 12-Step program

Anger management or Power/Control

I frequently say, “Jehovah’s Witnesses have beliefs, Mormons have beliefs, Roman Catholics have beliefs and therapists have beliefs.” Unlike most of my colleagues in other specialties of medicine, there is precious little science in psychology and psychiatry. (When was the last time you read the patient-information insert that comes with a psychiatric medicine? It reads more like a theological treatise than a medical-science document. Usually it will say some variant of, “It is believed that pharmoxatine works by…” BELIEVED? In other words, they DON’T KNOW! So, I tell patients that I have a belief… and like other beliefs, it may or may not be true.)

One of my central beliefs is that all of us from birth ‘till death want to have more power & control over our environment.

Following that belief is another. Many of our emotional/psychological problems stem from an unrealistic expectation of how much power/control we actually have.

Coming to terms, consciously, with how much power we actually have, is an arduous process. When we are repeatedly confronted with circumstances that demonstrate that we do not have as much power/control as we want, or think we have. Hopefully we gradually come to accept the our power/control is limited. For some of us, this process is not only arduous but very slow. The process is slowed if we are cursed with an over abundance of money (which allows one to exercise abnormal amounts of control over others). The process is also markedly slowed if one becomes a bully, which in essence has the same effect as having too much money.

This brings me to a professional pet-peeve that I have. Perhaps in the last 20 years, the phrase, “anger-management” has come into use. It seems to me peculiar that in modern-life we need anger-management but in decades past, there apparently was no need of it. It seems to me that my profession is rampant with OCDD, obsessive-compulsive diagnosing disorder which is characterized by seeing any disagreeable situation as a psychological disorder requiring the intervention of a therapist/psychiatrist. [Warning: rant approaching.] I submit that like many other social woes, many social problems are relabeled as psychological problems by the under-funded Court system along with over crowed jails. The same thing happens when a teen is required to see a therapist for being caught with pot. This is not a psychological problem – it is a maturity problem.

Maturity naturally occurs when one experiences SIGNIFICANT consequences for one's behavior. If one does not experience SIGNIFICANT consequences, maturation is deferred. Believe me, being required to chat with a therapist a few times is not a significant consequence.

This brings me back to the matter of anger-management. In my work with patients, I am, for better or worse, known for my… unusual (others would say outrageous) illustrations. Here’s a good example of one of those illustrations. I compare anger-management problems to (are you ready?) a bowel movement and how we learn to use a toilet.

I explain that when we are quite young, we learn to identify the sensations in our belly that signal an impending bowel movement. I ask patients how they know that they should begin to search out a bathroom. For many it is so automatic that it has become an almost unconscious process, but with a bit of thought, most will eventually identify that they sense a crampy feeling and/or an abdominal pressure. Then I ask, “From the time you first sense that feeling, roughly how much time do you have before the blessed event takes place”? Many will say that they have between 15 and 30 minutes.

I then wonder aloud with great bemusement, how, at such a young and tender age, they learned to feel, identify and take preventative measures to avert a regrettable occurrence (public defecation). How were they able to do this without the assistance of a psychiatrist?

Again, I submit for your consideration that they learned to control their bowel movements because of likely significant consequences if this skill-set was not learned. They would likely be subjected to the ridicule of their peers and probably physical discomfort.

Like bowel movements, one can learn to feel and identify the sensations that herald an impending outburst of anger allowing one to deal with their anger without making a public display of it. Granted, we learn more quickly when we are toddlers but even those who have attained physical maturity CAN learn and it’s likely will learn UNLESS we are deprived of significant consequences. Again the things that might deprive us of significant consequences can be: having a lot of money (allowing one to buy evasion of circumstances), being surrounded by enabling people who help us avoid consequences (this can include enabling Court systems, school systems, etc.) or by using the ol’ diagnosis ruse, “I’m not responsible because I have a disorder”!

OK, a little self-disclosure now. Probably more than 10 years ago, I managed to accumulate four speeding tickets in one year. I am not excusing any of this but merely relating the facts. I managed to laugh-off the first two because I had a reasonable salary. The third hurt because my insurance costs increased quite a bit and receiving a letter from the DMV saying that I was officially a public menace was disturbing. The fourth ticket was very expensive and my license was taken for six months; only by pleading with the DMV did they grant a restricted license allowing me to drive to work. But here’s the big point…. I don’t speed any more! When the consequences were significant, I learned. (Yes, I know, I’m a little slow on the uptake.)

You may wonder, “What’s this have to do with anger management or power/control”? People with (so called) anger management problems have been deprived of significant consequences. Usually, people with anger management problems have an unrealistic sense of how much power/control they have in this world.

I do not have power/control over how others drive.
I do not have power/control over others behavior
I have limited power/control of what others think of me.

How much power and control do we have in our life?

This is a question I frequently ask my patients.

Often, I draw a 0 – 10 scale and explain, “Let’s accept that this represents how much power and control we have”. On the scale, 0 represents no power/control; much like the state of a newborn. A 10 would represent unlimited power and control. Almost anyone would acknowledge they do not have unlimited control. I ask my patient to estimate how much power and control do they have as represented by this scale. On average people say, “Six”.

I’ll then ask, “Do you think your estimation is reasonable?” Of course they do – otherwise they wouldn’t have said it.

Here’s the problem. Reality suggests it’s more like three.

The difference between Six and Three – that’s a problem. If you believe you have a power/control level of six; you’ll act as if your degree of power/control is a six. “Reality” however doesn’t agree with the estimation of six.

The discrepancy between your six and “Reality’s” three is the cause and measure of much frustration and anger you experience.

If we can accept a more realistic estimation of how much power/control we have in this life, we’ll be much less frustrated.

In this life, we have precious little power and control; much less than we want to believe. I have control over my personal hygiene, whether I use a seat-belt in my car and whether I choose to obey the law. I have control over whether I drive at the proper speed.

How can things get so off-track?

Before I go on with further statements, it’s important to establish some basic ideas.

• This paper describes a model. “The map is not the territory” is a phrase coined by philosopher Alfred Korzybski. It suggests that a model of something (the map) is not the real thing (the territory) but a limited representation of the real thing. Many of us have had the experience of using a map only to learn that since the map’s publication, new streets have been added while others have been eliminated. In this brief essay, I’m presenting a model. The model does not explain every nuance or permutation of real and dynamic situations.
• Further, this essay is inherently absurd and hypocritical. I say this because I will go on to assert that some ideas advanced are “true”. I place the quotation marks around true to indicate that I fully appreciate that while I think the proposed model has usefulness I’m hesitant to assert that it is true in a concrete or absolute sense. Just as “the map is not the territory”, the ideas I suggest don’t explain all situations.

Too often, a therapist’s beliefs and statements have a valence of authority that is undeserved. Therapists don’t have special powers of discernment or wisdom. We just have our beliefs but like anyone else; we sometimes however state them as if they are irrefutable facts. Please take what follows with many grains of salt. If you find it useful; fine. It’s sometimes said, “Eat the chicken and spit out the bones.”

I have a belief (right or wrong) that all of us (whether we admit it or not) believe we are “right”. I believe that if others disagree with us, we usually believe the other person is either not as informed as we are (i.e., ignorant of the “real” facts that we have), or they’re in denial of the “facts” that we have, or they are suffering from diminished mental capacity (i.e., they’re stupid), or they are being intentionally obstinate. If they were “right”, they’d agree with us because we are “right”. I’m reminded of an argument I had with my son when he was 17. I forget the disagreement but I remember him saying, “You’re not listening to me.” I replied, “I’m listening; I’m just not agreeing.” He answered, “If you were really listening, you’d agree.”

Perhaps we’ll smile knowingly and say, “Yes, that’s the attitude of teenagers.” But I think that attitude persists for quite a long time. If we have a lot of money, that attitude may continue ‘till our dying day. Most of us have seen this insistence on “being right” in others, but can we see it in ourselves?

Why do we all seem to suffer from an insistence that “I am right”? Is it because our egos can’t face the reality that we may be wrong? Often, we continue a course of action even in the face of mounting evidence that our beliefs that led to the action were incorrect. Who among us ever believes in the moment, that we are wrong? Is being wrong so intolerable? Most would agree that in theory, we are all fallible. But in the moment when there is a disagreement, we seem to tenaciously cling to our rightness, sometimes even fabricating corroborating ideas (usually presented as “facts”). Have you noticed that sometimes our governmental leaders fall prey to this?

I do a demonstration with patients (usually couples). I first go to great lengths to explain this is only a demonstration of an idea – that, “…in this demonstration, I will say unkind things which in reality I don’t believe but I say them only to demonstrate an idea”.

I hold up a book showing the front cover to a patient. I ask them to tell me what they see.

They report what they see, “I see a book with a photograph of a screen door with a flag in the distance and the title, Independence Day.”

Looking at the back of the book, I say, “Gee you are such a liar. I’m asking a simple question, there’s nothing important a stake here but you have to lie. Let’s try again and this time, please tell the truth.”

Usually, the patient is a bit confused. Tenuously, they offer, “I see a paperback book about 6x8 inches that has a photograph of a screen door with a flag in the distance.”

In feigned disgust I say, “You are a pathological liar! Even with a simple request, you choose to lie. I think there’s no hope for the therapy until you’re able to be honest.”

I then show the patient the back of the book which has a small photo of the author with a few publisher reviews. I say, “We are looking at the same book but you see it from your perspective and I see it from mine. Just because you see something different, that doesn’t make you wrong or a liar. Just because I see something different, it doesn’t make me “right”. You don’t have to agree with what I see in order to be “right”. Being able to see different perspectives brings greater richness to our understanding of something.

I like to stay in fancy hotels – my wife prefers something more modest. Neither of us is “right”, neither is wrong. Which hotel we agree on should come from a conversation which includes valuing each other's perspectives. Perhaps we should flip a coin to decide – we should avoid the counterproductive and hurtful exercise of acting as if there is a “right” or “wrong” decision.

Returning to the original question; how do things get so off track? They get off track when we believe that our perspective is “right”. More derailment occurs when others have a different perspective but instead of allowing our own view to be broadened by theirs; we label them as “wrong” thereby maintaining our own myopic view.

What is the solution or cure? An old teacher used to say, “It’s better to be curious than furious.” It’s helpful to develop an attitude of appreciative inquiry and openness; our own beliefs should be viewed as tentative, pending more information. We should accept that we are developing a delusional disorder when we begin believing we are “right”.

Tuesday, May 18, 2010

The Sex Memo

To: Men
From: Reality
Date: May 18, 2010
Re: Sex

For those of you who didn’t get the sex memo sent earlier.
It seems many men did not get the sex memo sent earlier. Of course, there’s a reason you didn’t get it. The dog ate it, you never received it, and maybe someone stole it before you had a chance to read it. Maybe terrorists intercepted it. Fortunately, this follow-up memo recaps the essential points of the original one.

• Sex is different for men than it is for women. When we are young and unfettered by family and other responsibilities, sex can be great. It can be all consuming. Particularly in the first months of a relationship, sex can be exhilarating. It’s not unusual to have sex frequently and/or in unusual settings.

• Sex changes between months four and eight. This is how you’ll know that the relationship is entering the next phase. Once a relationship progresses to the next phase (Phase II), other factors will have a profound effect on your sex life. Some of the more common factors are: fatigue, frustration, anger, stress, kids, family, work, medicines, your attitude, your expectations, health, her attitudes towards sex, and age to name but a few. This “change” usually takes the form of females not being “in the mood” just because you “make a move”. For men the change takes the form of believing they’re “entitled” to have sex whenever – where ever they want; clinically this is known as androtoxicity.

• Also, there’s a concept called “sexual response cycle”. Basically, it means that most men can be sexually ready within a few minutes of having a sexual thought. Women, on the other hand, have a very different response cycle. For men, foreplay may take two – ten minutes. For women, foreplay may take two – three days.

• Men commonly mistakenly assume that women should respond sexually in much the same way as men. This is a deadly assumption. If you want to actually learn something about the sexual life of your partner, For Yourself by Lonnie Barbach is an excellent book.

• It is said that the human brain is the largest sex organ. Get to know what’s going on for your mate.

• If you want to “get lucky”, be sweet, help around the house, ask if there are things you can do to help, say nice things, NEVER make smart-aleck comments that you think she’ll think are amusing about her appearance. Every woman in the Western hemisphere has been trained over hundreds of years to be insecure about her body – don’t give her more reasons – she has more than you’d ever know about.

• If your mate has children, accept the fact that you will ALWAYS be number two. You may not like it but get over it – that’s the way it is.

• Different people have different appetites. You may be able to eat three cheeseburgers; not every can or wants to. Just because your partner’s sex drive is different than yours, it DOES NOT mean something is wrong with them. Unless you NEVER want to have sex again, don’t say your mate is “frigid”.

• If you liken sex to a meal, every night is not going to be a gourmet dinner; sometimes it’s macaroni & cheese.

• Criticizing your mate is a great way to kill a budding romantic mood.

• It has been scientifically proven that every time a man makes a critical comment about their mate’s body, their own “love muscle” shrinks by one millimeter.

• If you want to know what turns your mate on ask her. (It may take several days for her to answer this question.)

• Women don’t enjoy being with an inebriated (sloshed) partner.

• Porn is a lie.

• Sex is nice – pillow talk is better.

• Animals can have sex – it takes a human to be intimate.

• When women say they want romance, it doesn’t mean they want to dance the tango, hear poetry or want you to watch a chick-flick. It means they want to have time with you when they feel relaxed and cherished. Try a foot massage (10 minutes or more), look into her eyes and touch her hair.

• Your partner needs to spend time with her female friends. This doesn’t mean until two o’clock in the morning, this means for dinner. Keeping a woman from being with her friends is like not putting oil in your car. If you don’t change your car’s oil regularly, it will seize. If your mate doesn’t get to go out at least every two weeks with her female friends, she will seize and you’ll never have sex again.

• When in public with your mate; if another hottie enters your field of vision, KEEP YOUR EYES AND NECK STRAIGHT. Even women with no high school diploma instinctively know that your eye and neck muscles are under your voluntary control. If you say they aren’t under your control; that’s as dumb as saying, “OJ didn’t do it.”

• Hugging and cuddling are WAY more important than you’ll ever know. Hugging and cuddling ARE NOT an automatic invitation to start running bases thinking this may be your “lucky day”.

• Never assume you’ve got a green light. This is true whether you’re driving or when you’re with your mate. Even if the moment “seems” right & ready to you; whether driving or being with your mate, signal before making a move.

• Take a shower and brush your teeth.

The War of Art by Steven Pressfield

By now, many of you know how impressed I am with Mr. Pressfield's book, The War of Art. Maybe I like it because it's short and easy to read. In any event, there are very few books I regularly recommend - this is one of them. If you haven't added this to your library, I hope you do - soon.

His website is interesting also. Check out his video interviews. I was impressed.

Developing self-esteem in children

In our department of psychiatry, the scenario has almost become cliche.

A dynamic and successful parent(s), (sometimes one of the physicians at our own Clinic) will come to our office with their adolescent. The complaint is that in spite of the parents' providing every opportunity and encouragement for the child to flourish – and despite the fact that the parents have been assured that the child’s intelligence is average or above, the child flounders. The child seems to have little ambition. Often the parents seem invested in having us agree that the child has a diagnosable mental condition (most often depression or ADHD) that the parent hopes can be treated with medication and which will then put the child on the parent’s hoped for success trajectory. Usually, we are told by the parents that they "know" the child inexplicably suffers from low self esteem even though the parents have taken every opportunity to praise their children.

Obviously, frequent praise, economic advantage, native intelligence or talent are not reliable predictors of self esteem, confidence, competence or self motivation (even though we may have been lead to believe that by decades of feel-good, warm-fuzzy Pied Piper’s of self esteem). What then is the way to promote confidence, healthy self-esteem and creative expression that will lead to a productive and meaningful life?

A growing body of research in the last 20 years is leading us to understand that probably the single most important thing we can do for our children is to provide them with age-appropriate challenges and responsibilities. When a child shares in family chores, it is a real demonstration that they are a valued and needed member of the family and that the parents are confident that they are competent to do the assigned chores. The key, of course, is age-appropriate. At ages 5 – 7, children can help clear the dinner table; they can basically clean up their own room, put away their toys and participate in minor yard work. At ages 8 – 10, children can help with the family laundry, help prepare meals and share in the general housekeeping routine. And it should be understood that children are required to do their homework.

All of these tasks (and more) convey a powerful non-verbal message that you believe in your child’s ability, intelligence and judgment. It’s important that children should be rewarded for their efforts just as adults; we expect to be compensated for our efforts and skills. It has unfortunately become nearly endemic that children who are indulged and rewarded just for opening their eyes in the morning become self-entitled, dependent, surly and antisocial adolescents.