Thursday, December 17, 2020

What is your interior spiritual life like?


What is the good life?

Recent science offers a fresh view of depression as a developmental process, especially in light of what we know about natural spirituality, its development, and its relationship with mental health in adolescence. As we know from the science of the spiritual brain and the adolescent surge: 

• Natural spirituality burgeons by 50 percent in adolescence. The transcendent faculty is kicking in during this window of genetic expression. 

• Once spirituality surges, harnessing it into a transcendent relationship is more protective against depression than anything known to medical or social sciences. 

• Spiritual individuation helps build relationships based on commitment and love and work based upon calling. This is a blueprint for a life of thriving, meaning, and purpose.

Miller, Dr. Lisa. The Spiritual Child (p. 277). St. Martin's Publishing Group. Kindle Edition. 

A few years ago I had a 17 year old male client who was in twelfth grade, failing all his courses even though he had been on high honor roll, experimenting with drugs and alcohol, defiant of his parents rules, staying out all night, etc.

I had met with him three times at his parent’s insistence although he had no use for counseling and even further had a disrespectful, scoffing, and ridiculing attitude toward me and therapy. In our third session, not knowing what else to do, and maybe inspired by the Holy Spirit I asked him an impertinent question I had never asked a client before. Out of the blue I said, “So Jake, what is your interior spiritual life like?”

Jake looked at me stunned and like I had three heads. His whole demeanor changed. He became pensive, the cocky, know-it-all attitude immediately changed and after a few moments of silence and stuttering he finally said, “I don’t know. That’s a really good question.”

We were at the end of our meeting time, and for the first time he said he wanted to make another appointment and come back. When we got together the next time, he had given the question a great deal of thought, and he told me he wanted to finish up high school even though it was “bull shit” and go to a college in the midwest. I saw him a couple of times and his parents told me they were amazed at his change, positively, in his attitude and behavior.

I told this story to my adult daughter and she said, “Dad, nobody talks with teenagers about what is really important to them in life. The whole question of ‘what is the good life?’ never gets discussed. You’d think it would be #1 on the curriculum wouldn’t you?”

Yes, you would. It is interesting how adults have abdicated this role of discussing what is the good life to advertisers, marketers, and drug dealers.

Wednesday, December 16, 2020

What's the best way to change an abuser?

In the May/June, 2019 issue of Mother Jones magazine there is an article entitled, "What's the best way to change an abuser?"

The answer?

There is no one best way.

My clinical experience of over 50 years has taught me that the first step is a mental health evaluation to understand the person's psycho-social functioning which is composed of thoughts, feelings and behavior. The causes of domestic violence are multi fasceted. 

The Mother Jones article notes that 86% of mass shooters studied had a history of perpetrating domestic abuse.

One program that seems to help somewhat is Men Creating Peace in California. In Rochester, NY, a Social Work colleague of mine had pioneered a program for men who perpetrated domestic violence back in the 70s and 80s. I am not sure if the program any longer exists.

For services in Rochester, NY regarding domestic violence contact Willow Domestic Violence Center.

Tuesday, December 15, 2020

U. S. birth rate below replacement levels


U. S. birth rate below replacement levels

U.S. birthrate falls to 32-year low

The U.S. birthrate dropped to a 32-year low last year, the Centers for Disease Control and Prevention reported Wednesday. About 3.8 million babies were born in the country in 2018, 2 percent fewer than in 2017. It was the fourth straight annual decline. The fertility rate "in 2018 was again below replacement — the level at which a given generation can exactly replace itself," according to the report. "The rate has generally been below replacement since 1971 and consistently below replacement for the last decade." The replacement rate is 2,100 births per 1,000 women; the 2018 rate was 1.728 births per woman. "We're clearly in the throes of major social change with regard to women getting married and choosing to have children," said Donna Strobino, a professor at Johns Hopkins Bloomberg School of Public Health. [USA Today, NBC News]

Editor's note:

With U.S. birth rate below replacement levels, it will have to increase immigration rates to maintain its population.

Wednesday, November 4, 2020

How to assess your level of emotional maturity.


I often share with clients Murry Bowen's ideas of "reactivity" vs. responsiveness." 

Being emotionally reactive usually creates problems for the individual and the people they are in relationship with. By contrast being responsive, meaning that the individual has developed purposeful and deliberate ways of handling distressing emotions in their interactions with others, usually results in more satisfying and fulfilling ways to functioning.

Tuesday, November 3, 2020

Why do we choke and how to stay calm under pressure.

As a psychotherapist, I often find myself talking with clients about overthinking things. Some forethought, anticipatory planning, and problem solving is a good thing, but taken too far it becomes what we, in psychology, call "rumination." Rumination is a symptom of depression and interferes with functioning.

An effective way of dealing with rumination is to envision yourself succeeding and focusing on goal achievement rather than on all the things that can go wrong.

Monday, October 5, 2020

What is the shape of your family' s story?

What is the shape of your family story?

I am a Psychiatric Social Worker, more formally titled, Licensed Clinical Social Work Psychotherapist, licensed to practice in New York State where I have worked in this profession since 1968 over 51 years.

I continue to practice in my own office about 3/4s time at age 74 seeing clients with various mental health concerns. I see people of all ages from 5 to 100. I meet with them individually, with their life partners, in families and sometimes therapy groups.

Like all psychotherapists, I have many models of understanding about what makes people tick and how to facilitate their getting their lives on a better track. I describe myself as being eclectic when it comes to choosing models to draw ideas from that I think might help my clients. If I am forced to choose though I find family systems theory and narrative theory the most helpful. So I was delighted to find Bruce Feiler’s great book, Life Is In The Transitions, to help me further crystalize my thinking about how to be helpful to my clients in therapy.

Here is a taste of what Mr. Feiler intends to describe in his book from the introduction:

Why would knowing your family’s story help you navigate your own? “All family narratives take one of three shapes,” Marshall explained. First is the ascending family narrative: We came from nothing, we worked hard, we made it big. Next, the descending narrative: We used to have it all. Then we lost everything. “The most healthful narrative,” he continued, “is the third one.” It’s called the oscillating family narrative. We’ve had ups and downs in our family. Your grandfather was vice president of the bank, but his house burned down. Your aunt was the first girl to go to college, but she got breast cancer. Children who know that lives take all different shapes are much better equipped to face life’s inevitable disruptions.

Feiler, Bruce. Life Is in the Transitions (p. 6). Penguin Publishing Group. Kindle Edition. 

Further in the introduction, Feiler writes that what gets people into trouble is that they expect their life to be linear, a straight line from start to finish, but most lives don’t work like that any more. They are non linear with disruptions and when many disruptions occur together Feiler calls them “life quakes.”

The direction of people’s lives with their ups and downs Feiler calls their “shape.” How have our lives unfolded? Have they been straight lines, ups and downs like a saw blade, a circle, a spiral, and oblong object?

What everybody said, in one way or the other, was the same thing: My life has been disrupted, my dreams shattered, my confidence punctured. There’s a gap between the upward, dependable, “every problem can be cured with a pill, an app, or five minutes of meditation” life I was sold, and the unstable, unpredictable, utterly fluid life I’m forced to contend with. The life I’m living is not the life I expected. I’m living life out of order.

Feiler, Bruce. Life Is in the Transitions (p. 8). Penguin Publishing Group. Kindle Edition. 

What shape has your life taken? How has it unfolded? Is it what you expected or has it surprised you? Referring back to Marshall’s three types of life narratives is the story of your family ascending, descending, or oscillating over the generations?

Sunday, October 4, 2020

Book of the month discussion - Life Is In The Transitions: Mastering Change At Any Age by Bruce Feiler

 A new feature on Markham's Behavioral Health is a book discussion of the month. Every month a different book will be featured which will be discussed throughout the month. Follow along and comment as you are moved.

This month we will be discussing Life Is In The Transitions: Mastering Change At Any Age by Bruce Feiler.

The borderline Queen - "It's all about me!"


Borderline Personality Disorder can manifest itself in multiple ways. In her book, Understanding The Borderline Mother, Dr. Christine Lawson describes four role types which BPD is exemplified by: the Waif, the Hermit, the Queen, and the Witch. These role types are not mutually exclusive and characteristics of these types over overlap and inter mix.

Dr. Lawson writes that Borderline Queens are driven by feelings of emptiness, and that they seek special treatment because they felt emotionally deprived as children. The Queen has learned how to win special treatment through persistence and intimidation.

Dr. Lawson writes:

She can be intrusive, loud, inpatient, and flamboyant. She is easily frustrated, often bursting into rages than can terrify her children. She can be disingenuous and may lie in order to get what she wants." p.104

Dr. Lawson points out that giving in to the Queen is easier than resisting, and Dr. Lawson further points out that those who dare to confront the Queen may be treated as infidels and, as such, may be banished for their disloyalty. In this way, the Borderline may create new borderlines in their children by terrorizing them with rejection and abandonment to punish them for not following her will. Husbands of Queens learn that any peace and equanimity that can be obtained in the relationship with her will require that they acquiesce to her demands or arguments will ensue that will escalate until the Queen gets her way. For similar reasons, the Queen will be right about everything and never take responsibility for her own mistakes or problems. She will never apologize or say she is sorry or seek forgiveness. The Queen is sovereign and expects all to serve her faithfully and compliantly or as the Queen in Alice In Wonderland would hysterically shout, "Off With Their Heads!"

Dr. Lawson writes:

"The darkness within the borderline Queen is emptiness. Emptiness and loneliness are distinctly different emotional experiences. Whereas loneliness results from loss and evokes sadness, emptiness results from deprivation an triggers anger. However, not all Queens experienced loss in early childhood. The common denominator among borderline Queens is emotional deprivation. As children they felt robbed; consequently, they feel entitled to take what they need." p. 105

In my clinical experience, it is this sense of deprivation which gives the Queen her sense of entitlement. This sense of entitlement allows her to justify her exploitation, lying, steeling, and deprivation of others. This entitlement may lead to behaviors such as shoplifting, embezzlement, fraud, and stinginess.

The Queen can be very charming and seductive pursuing attention to fill the void of the underlying deprivation. The Queen can be quite competitive and envious of others and devalues others who are a threat to her or who do not provide gratification or special treatment. This sense of deprivation often impairs moral judgment and the Queen can be vindictive without feeling guilt or remorse. The Queen will rarely give credit to others unless there is something in it for her. People quite attracted to the Queen initially, because she usually has quite a charismatic personality, will sooner or later get burned by the Queen when they realize that for the Queen everything must be about her and if possible they will avoid her.

Dr. Lawson writes:

"The Queen relates to others with superficiality and an air of detachment. She may perceive others, including her children, as a threat to her own survival unless they relinquish their needs for hers. Queen mothers compete with their children for time, attention, love, and money. Superficial interest and a lack of attunement to the child's emotional needs are typical of Queen mothers." p.108

A little further on the same page, Dr. Lawson writes:

"In order to win admiration and love, her children must reflect her interests, values, tastes, and preferences. The Queen expects her children to dress the part, to reflect her importance." p.108

The borderline Queen motto is: "It's All About Me!"

Dr. Lawson points out that although Queen mothers emotionally sacrifice their children, their children may go to their graves protecting her.

Saturday, August 29, 2020

Attachment theory - How childhood experiences affect later life relationships

I find attachment styles a very helpful idea in understanding the problems that people experience and their interactions in relationships.

Saturday, August 22, 2020

How to make a new friend

One of the regular topics which come up in psychotherapy sessions with my clients is lonliness. Social connections is one of the key components of wellness. As we get older it is harder to make new friends. There are some good tips in this video which is informative and entertaining.


A way of understanding later life problems in living is to understand the trauma we may have experienced in childhood. This trauma is called "adverse childhood experiences."

If a person has a high score on the ACE screening tool, what can they do to lower their over all anxiety and tension level? Dr. Nadine Burke Harris describes 6 components of wellness one of which is social connections.

Tuesday, June 30, 2020

People who smoke and vape at higher risk for Covid IX

Why is vaping so bad for teenagers? -

Research at the University of Rochester Medical Center has found evidence of why COVID-19 is worse for people who smoke and vape than for the rest of the population.

Irfan Rahman, who runs a lab at URMC that studies the effects of tobacco products on the lungs, said people who smoke and vape often have elevated levels of receptors for an enzyme called ACE2.

Those receptors also allow the novel coronavirus to enter lung cells. More receptors means more viral load, which means more severe infections, Rahman said.

Thursday, June 25, 2020

How Can You Do This Work?

Disenfranchised Grief - Renaissance Life Therapies

How Can You Do This Work?

I get asked this question fregquently.

Here is my attempt to respond.

I had read Sue Mann’s article, “How Can You Do This Work?”, in Trauma, Narrative Responses To Traumatic Experience edited by David Denborough in which she describes her work as counselor in an agency serving adults who were sexually abused as children. Sue describes sharing with others, who ask, what she does for a living and them then saying, “How can you do that work?” Throughout my career of 49 years, I have continually reflected on this question myself. 

A career in clinical human services brings one continually into contact with stories of pain, suffering, injustice, and abuse. We are not only recruited, but required, to insert ourselves into situations where we witness and engage with the worst in human behavior and activity. Often these jobs pay very little, provide meager, if any, benefits, provide little, if any, social status and respect. A naive outsider sometimes asks why would a person go through the time and trouble to acquire a college education and training at significant expense to engage in such difficult and financially unrewarding work? Even further, people being aware of the vicarious trauma the counselor is subjected to in the course of her work, appropriately ask “How can you do this work?”

For more click here.

Tuesday, June 16, 2020

Fatal car crashes up 13% for 15 - 24 year old males in states with decriminalized marijuana laws

Drugged Driving Deaths, a Pervasive American Problem | Egerton Law

States with marijuana decriminalization laws experienced a 13% increase in fatal car crashes among 15 - 24 year old males. There was no increase in females, and no increase in drivers over 24.

There also were no increase in fatal car crashes in states with medical marijuana laws. It is hypothesized that the reason for the difference between deciminalized states and medicalized states is that medical marijuana laws require that the marijuana only be used at home.

From the American Journal Of Public Health, March, 2020.

For more click here.

Monday, June 15, 2020

The grieving process - Stage two: bargaining

Understanding the Five Stages of Grief | Funeralocity

Stage two - bargaining

The second stage of grief has to do with the undoing of the loss. We do a lot of second guessing. “Maybe if this, maybe if that then the loss would not have occurred.” There is often a lot of self blame and blaming of others and circumstances. “What if this had happened, or that had happened, then the death wouldn’t have happened at the time it did.”

Bargaining also involves a lot of “if onlys.” “If only I had done this or that,” or if others had only done this or that then this would not have happened.

We even, like Jesus in the garden at Gethsemane, plead with God to remove this cup. We promise to go to church every Sunday, give $10,000 to the church, put a bathtub Madonna in our yard, if only God would intervene to not let the death happen.

The bargaining stage is often the longest of the stages of grief and can last months and sometimes years. The bargaining stage prevents and forestalls acceptance that the loss has occurred and is permanent. As long as we bargain in our minds and hearts, we don’t have to accept the crushing sorrow and grief that acceptance entails.

Arguing with a person who is bargaining does not help. Reassurance does not help. Listening in a non anxious and a non judgmental way does help. As the grieving person expresses and articulates their alternative scenarios, the facts become clearer that circumstances did not allow the desired change to prevent the loss to occur and so their hopes and desires are merely a pipe dream. Having expressed their desire that things could have been otherwise, the grieving person comes to realize that the loss probably could not have been prevented or forestalled. “It is what it is” as the Buddhists say.

Bargaining can be exhausting and will eventually run its course because reality eventually begins to set in and life goes on. However as bargaining peters out, sadness and despair become more prominent. This increase in sadness and despair is the harbinger of acceptance which intensifies the emotional pain but also brings a release from which hope in a future meaningful life springs.

One of the things which helps people get through bargaining to acceptance is faith in the process of grieving. Once it is understood what is happening, it becomes less scary and more understandable. With understanding bargaining becomes easier to manage as both the person grieving and the witnesses who want to be supportive.

Sunday, June 14, 2020

Behavioral learning in the age of Covid-19 social distancing.

Wittgenstein and facial mimicry | Wittgenstein Light: Real Refreshment

"Behaviour is contagious because we catch it from other people. Much of what we do results from unconscious mimicry of others around us."

What are the consequences for this in the time of remote learning, working from home, and social distancing?

Why do people stockpile toilet paper during the Covid-19 crisis?

Coronavirus panic buying: the psychology behind toilet paper ...

While it only explains about 12% of the reasons that people stockpile toilet paper during the Covid-19 crisis, a recent study found that people who stockpile toilet paper tend to be more frightened of the threat of Covid-19 infection, and they tend to be more "conscientious."

For more click here.

Editor's note:

In my practice, I have observed that people who engage in this toilet paper stock piling tend to be more anxious, ruminate more, and tend to show signs of paranoia. The obtaining of large amounts of toilet paper seems to lower anxiety and enhance a sense of security and safety, but obtaining large amounts of toilet paper then leads to an obsession and compulsion to hoard other commodities.

Saturday, June 13, 2020

The grieving process - Stage one: Shock and disbelief

Why the Five Stages of Grief Are Wrong | Psychology Today

Stage one - Shock and disbelief

As we discuss the stages of grief it should be noted that the stages are just a general frame of reference and not prescriptive. People don’t have to go through the stages as described here. Further, people don’t experience the stages in a linear way but in an oscillating way going back and forth not one after the other. People often describe the grieving experience as a “roller coaster.”

The first stage is sometimes called “denial” but the word “denial” does not accurately describe the experience. People cognitively recognize death has occurred but often describe a sense of life being surreal. They describe being “numb” and disoriented. They say things like, “I just can’t believe this has happened and ____________ is gone.”

People describe themselves as being in a fog and going through the activities of daily life as if they were a robot on auto pilot. The feeling of disbelief is very powerful and there is a growing sense that the event of the death will be a milestone in their lives with the death marking the boundary of life before the death and after the death.

People often find it hard to eat, sleep, concentrate, and perform the normal tasks of their daily routines.

During this stage people need assistance with daily tasks and to be excused, if possible, from social obligations to others. They need to be left alone if the person wants to withdraw from social interactions or they need to be listened to if they want to share their thoughts, feelings, and anguish with a trusted other person. Providing a shoulder to cry on is a very important form of solace and consolation. The listener need not say anything to help the person feel better. Just allowing the grieving person to share their sadness, sorrow, anger, fears, regrets, and sense of loss is very helpful. Do not try to cheer the person up or reassure them things will be okay.

It is very common at this stage to observe an expression of anger and blame and guilt that someone is at fault for the person’s death. People even blame God for letting this death occur. A regression to a narcissistic state where people take the death personally is common. “How could this happen to me!”
People often feel a disorientation, confusion, and perplexity and say, “Oh my goodness, what will happen now?” There is an anxiety about how life can go on as it was lived before the death.

People often hear the dead person’s voice, see glimpses of them, or are reminded in a hundred ways of the person as living. It is like deja vu when the person is uplifted  momentarily believing that the person hasn’t died. Dreams of the dead person are very common.

This stage of shock and disbelief usually doesn’t last more than six weeks, if that. The grieving person needs to share their experience with an understanding other who can maintain a non anxious presence and non judgmentally listen to the person express their experience. Nothing need be said or done other than mere listening, and inquiring, when it seems helpful, about the person’s memories and experiences of their relationship with the person they have lost. Sometimes people want to talk about their memories of the relationship and sometimes they don’t. Either way is okay.

Thursday, June 11, 2020

Overview of grieving: general observations continued.

People may feel disenfranchised grief if... - Cruse Bereavement ...

Before we get to describing the stages of grief there are few more topics worth mentioning about grieving in general.

Disenfranchised grief is grief that people experience without any social recognition or acknowledgement. A lover of a married spouse who dies without there ever being any public recogition of the nature of the relationship. Deaths of ex spouses after divorce.

Deaths experienced by professionals of patients or clients who were part of confidential relationships. This happens freguently to health care providers in all kinds of settings.

There are many other examples where loss is experienced alone without any social recognition, acknowledgement, or support. Miscarriages may fall into this category. People who die in institutions like prisons or nursing homes or by stigmatized circumstances like suicide, drug overdose, alcoholism.

Liberating losses - Sometimes death is experienced as a relief or as if a burden has been lifted. This often occurs after a long illness where the death is anticipated, but also can happen in a sudden death when the deceased is a part of a conflicted relationship.

Moral injuries - These are deaths witnessed or inflicted in war, capital punishment, or other acts of revenge or intentional or unintentional "accidents." Abortion is sometimes thought of as falling into this category.

Wednesday, June 10, 2020

Overview of the grieving process.

A Guide For Grieving Parents | Harbor Light Hospice

What are the stages of grief?

What is about to be described here is a frame of reference. Nobody goes through the stages exactly as described in a linear way. Most people oscillate back and forth through the stages but the person can probably identify where their emotions and thoughts are predominately at a given period of time when they are going through the stages.

What is presented here is boiled down from a clinical perspective. There are other descriptions but the one presented here is what seems most helpful when talking with people about their grieving process in my practice.

Here the stages:

  1. Shock and disbelief
  2. Bargaining
  3. Acceptance
  4. Hope
  5. Meaning
This is the first in a series of articles on the grieving process.

Before a description of the stages, here are some general observations about grieving in our society.

The grieving process is not something to be fixed but a normal part of life.
Grief is not depression and should not be medicated except when extreme symptoms appear which are usually a sign of an underlying psychiatric problem and not the grief itself.

Our society is very intolerant of grief and does not have appropriate expectations about the grieving process.

The two biggest ways of managing grief are simply to sit with it and be mindful about its existence and workings, and two, having a shoulder to cry on, an understanding witness who can accept the expression of grief without getting upset oneself.

There are differences in the grieving process the major difference being an anticipated death and a sudden death.

Death is nothing to be afraid of but a normal part of the life cycle.

Social reactions to death are varied and often difficult to deal with for the person who is mourning.

Grief is best exprienced with one's natural support system. Professional grief counsling services initially following the death are not recommended even though they often are. 

While the deceased person's physical body is dead, their spirit lives on in the stories that are told about them.

To be continued

Tuesday, June 9, 2020

PHQ - 9 overestimates prevalence of depression

Patient Health Questionnaire-9 (PHQ-9) Pfizer - e-Referral

More and more primary care medical practices are using the PHQ-9 depression screening tool and sometimes the abbreviated version. I've had it administered to me on my primary care medical visits along with my weight, blood pressure, and pulse.

A new study finds that these depression screenings over estimate the prevalence of depression. A symptom check list screening is not the same as a structured clinical interview for depression (SCID).

The most common misdiagnosis I find in my clinical practice is the depression for grief. Often I find that people who screened positive for depression in their doctor's office are actually experienced what is sometimes called "disenfranchised grief." Disenfranchised grief is sorrow and mourning triggered by a signficant loss that is not socially recognized, acknowledged, and therefore not supported with consolation and solace. Often I find that these patients have been started on an antidepressant medication which not treatment of choice for grief.

There is no substitute for good mental health care by a trained clinician.

For more click here.

Monday, June 8, 2020

During school closure teens getting more sleep but it needs to be on a regular schedule

Teenagers and Sleep in the Digital Age - Spark & Stitch Institute

During the pandemic with school closure teens are getting more sleep which is a good thing because it makes them more communicative, family friendly, less moody while at home. It is important though to stick to regular sleep schedule. Staying up all night playing video games and messaging with friends is not conducive to a regular sleep schedule which is necessary to reduce inflamation and enhance physical and mental health.

I hear in my psychotherapy sessions about teen's symptoms of anxiety, depression, and irritability. I ask about their sleep. Almost always the answer is that it is disturbed and irregular in some way. This leads to an interesting observation. Is it the anxiety and the depression interfering with the sleep or the lack of sleep contributing to the symptoms? Which comes first the chicken or the egg? However you answer the question, improving the sleep cycle goes a long way in enhancing the feeling of well being.

For more click here.