The rating scales beyond physical pain: optimism/pessimism, energy, mental clarity

Optimism flooded through me—optimism, my great weakness or my great strength (depending on whom you asked and on my own mood as well). In Voltaire’s Candide (whose full title is Candide, ou l’Optimisme), the hero’s positivity in the face of the world’s horrors is close to idiotic. (If this is the best of all possible worlds, then those parallel universes must be hellish indeed.) When I wrote my novel Quichotte I lampooned my own nature by making my title character an optimist of the Candidean kind. And now, bedridden and gravely injured as I was, I began to believe that the worst was past, that Milan’s arrival was a sign that a corner had been turned, and happy days would soon be here again.

Rushdie, Salman. Knife: Meditations After an Attempted Murder (p. 81). Random House Publishing Group. Kindle Edition.

Salman writes about his experience in rehab which I found interesting because I have spent five months in orthopedic rehab from September of 2023 to February of 2024. One of the things I noticed was how the nurses would frequently ask me to rate my pain on a scale of 0 - 10. Luckily my pain was usually minimal. However there were three other things that were very noticeable and troubling to me and I constructed my own scales to rate them daily and sometimes hourly.

After pain, my second scale was “mental clarity.” I often experienced a fogginess and lack of concentration.

The third scale was “energy level.” There were many times when I just didn’t have the energy to engage in minimal things like talking with visitors. There were many days when my energy level was at 2 and 3.

The fourth scale is “optimism/pessimism” which Rushdie describes in the passage above. There were days when my optimism was 0 and I wanted to die. Had MAID, medical assistance in dying, been available in New York State as it is in 17 other states and Canada I might have killed myself. I was that despondent and pessimistic. That’s when you need someone to love you. I am blessed by three good friends when my family abandoned me and I obviously got through that desolate period to write this post.

The turning point for me was finding an apartment I could be discharged to. Finding the apartment, a place to go, gave me something to live for. Also, the PTs and OTs were very helpful and encouraging. Without them I couldn’t have recovered to the extent I have.

Yesterday, August 23, will be one year since I tore the quadriceps tendon in my right leg, and tomorrow, August 25th will be one year since I tore the quadriceps tendon in my left leg. On the 29th of August it will be one year since I had the surgery on both legs to repair the tendons and I woke up from the surgery in two leg braces from my upper thighs to my ankles at full extension with no flexibility for 6 weeks. I was a beached whale, totally bedridden, and totally dependent on others for even the smallest things like picking up things I dropped on the floor from my bed.

Optimism when a person’s life has been totally turned upside down is a huge thing. I am filled with joy to learn that Salman got his optimism back. Been there, done that as they say.

Editor’s note: I am a member of the online Allnonfiction book discussion group which discusses a different nonfiction book every month.

During August, 2024, we have been discussing Salman Rushdie’s book, Knife, which describes his attack by a man wielding a knife at the Chautauqua Conference Center in August of 2022 as a result of the fatwa proclaimed in 1989 by the Ayatollah Khomeini for what the Ayatollah said was blasphemy in Rushdie’s novel Satanic Verses 33 years prior to the attack in 2022.

The book being read and discussed by the Allnonfiction book discussion group in September, 2024 is Being Mortal by Atul Gawande. 

Does Narcissism Fade With Age?

If you’re hoping the narcissist in your life will make sweeping behavioral changes, you are likely to be disappointed, according to a systematic review published in the journal Psychological Bulletin.

For more click here.

Editor's note: As a Licensed Clinical Social Work Psychotherapist with 56 years in the field of mental health I have observed that some people with personality disorders do change in positive directions or at least "mellow" in their older age. However, I also have observed that some people, as this study finds about people with Narcissistic Personality Disorder, not only don't change but the symptoms even become worse.

Another sad observation is that people tend to die the way they have lived their lives. The old expression "you make your bed and you lie in it' is pretty accurate. Death bed conversions make great stories and movies but are exceedingly rare that's why they are so valued and appreciated if and when they do occur.

However a good story about end of life change is told in Dr. Irvin Yalom's book; "Love's Executioner: and Other Tales Of Psychotherapy" in the second chapter "If rape were legal..."

Nature draws out a happy place for children New study explores children's perception of their own wellbeing using art

 "We identified indicators of wellbeing that were made explicit in children's drawings, such as the need for safety, happiness and positive relationships. Interestingly, the representations of nature mainly exist in the background and were rarely the main focus of the drawings..

"The drawings depicted nature and outdoor spaces as being interconnected with all aspects of wellbeing. For example, being able to play outside boosts physical wellbeing, while being able to stay calm and appreciate the beauty of nature can be linked to emotional or mental health.

"Previous research has shown that wealth affects access to nature, with children living in deprived areas significantly less likely to have access to green spaces and outdoor places to play. Our research suggests that nature and open spaces underpin these children's consideration of wellbeing.

"As such, making nature explicit, and restoring the interconnectedness between the arts and nature should be a key priority for research to help improve children's wellbeing."

For more click here.

Editor's note

The report of this study reminded me of Richard Luov's book, Last Child In The Woods: Saving our Children from Nature-deficit Disorder which was published in 2008.

I find that children with Attention Deficit Hyperactivity Disorder especially like and benefit from playing outdoors.

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Feel Better Book For Little Tears

Feel better book For Little Worriers

Gotta Keep Reading

Editor's notes:

There are plenty of studies that show the benefits of reading. People who read books tend to more mentally healthy than people who don't. In fact, the opposite is true - Beware of the person who doesn't read books.

Psychotherapeutic humanities, Book, An American Marriage by Tayari Jones

Book Review

An American Marriage by Tayari Jones

An American Marriage is a novel about a young black couple who get married who are from different social classes. The wife, Celestial, comes from a wealthy upper class family while Roy comes from a working class family. They both are college educated but coming from different backgrounds seem to have different values, beliefs, and preferences.

Roy gets arrested and is falsely accused of rape and sentenced to twelve years in prison after the first year of his marriage to Celestial.

Celestial stops visiting Roy after about three years saying that she can’t live like she is, as a single woman, while Roy, her husband, is incarcerated. Celestial has taken up with Andre her childhood friend who also was Roy’s best friend and is the person who introduced Roy and Celestial to begin with. Roy is released after five years when his case is overturned on appeal. Roy’s homecoming to find that Celestial and Andre are planning to marry when Celestial sues Roy for divorce brings the plot, the love triangle between Celestial, Roy, and Andre, to a climax.

The ambivalence each character experiences about these love relationships creates the creative tension that gives this novel its appeal.

The subplot deals with the injustice of the criminal justice system as it pertains to prosecuting and incarcerating black men and the damage this does to families and the communities beyond the injustice done to the alleged offender.

Tayari Jones is a good writer but the story is a bit like a soap opera. The moral of the story is a muddle. Whether Roy and Celestial would have made a go of their marriage had Roy not been incarcerated is hard to tell. It may have dissolved anyway, but after a year of marriage the bond was not strong enough to weather the enforced physical separation.

Celestial and Roy had talked about having children but had put it off. Had they had children one would wonder if this would have made a difference.

Why the novel is entitled “An American Marriage” is not clear. What makes the marriage between Celestial and Roy “American” is never addressed. The dynamics of the plot involve an African-American couple, but would be similar if the couple were white, or Hispanic, or Asian.

Reading “An American Marriage” reminds me Stewart O’Nan’s novel, “The Good Wife” which has a similar plot except the wife is pregnant when her husband is incarcerated and she stands by him and raises their child for 28 years.

An American Marriage gets a 6.5 on the MBH 10 point scale.

Book - The Journal of Best Practices: A Memoir of Marriage, Asperger Syndrome, and One Man's Quest to Be a Better Husband

Wondering how to handle a marital relationship when one of the partners has Asperger Syndrome?

Books - The Square and The Tower by Niall Ferguson

Two organizing ideas about how society is organized can be described as hierarchies and networks. Both have existed throughout human history. 

Understanding social organization is important because the structures and dynamics of the ways of organizing social life at a marcosystemic level influence behavior at the microsystemic level.

Most of the macrosystemic organizing structures and dynamics are unconscious and as such, people don't understand why they think what they think, why they feel what they feel, and why they do what they do. The individual and the micro systems the individual is partipating in are influenced by higher level forces and dynamics. Knowing what they are is the source of social power.

Niall Ferguson does a good job tracing the operation of hierarchies and networks over the human history. Significant changes in human society were advanced with the printing press, transportation systems, and especially the internet in the last 25 years.

Ferguson points out that the democratization of society which the internet promises has been replaced by the manipulation of huge oligapolies like Facebook, Amazon, and Google. As we have seen in our last election in the U.S. in 2016, and with the Brexit vote in the United Kingdom, the manipulation of these communication mediums for the purpose of propogandizing populations is undermining the ability of citizens to rationally decide policy options for their governance.

The use of these communication systems to advance special interests which may run counter to the welfare of societies is a huge new threat in our modern age.

It is easy to manipulate people who don't know they are being manipulated. Raising the consciousnesses of the targets of these propoganda efforts is important to restore integrity to democratic processes.

Understanding the structure of the society within which one participants is a major contributor to healthy functioning.

The Square and The Tower is a book with important ideas. It earns a 5 out of 5 on the MBH book rating scale.

Books - Crow Lake by Mary Lawson

What happens when parents suddenly die in a car crash and leave a 17 yr. old son, a 16 yr. old son, a 7 year old daughter and a baby daughter in a rural farming community in Northern Ontario, Canada?
Grown up Kate, now in her 20s tells most of the story.

It is a narrative full of love, sacrifice, loyalty, persistence, projection, and descriptions of attachment styles that are fascinating.

Kate certainly has become avoidant although she had been every attached to her brother, Matt the youngest son. This attachment dynamic is the plat of the book. While Luke the oldest, and Bo the youngest are interesting characters, the primary creative tension revolves around Matt and Katie, 16 and 7 when tragedy strikes the family.

This novel is an extraordinary description of sibling relationships and the significant role they play in our growth and development.

I give Crow Lake a 4/5 and recommend it if you are interested in family dynamics especially those between siblings who are thrown upon their own resources to care for one another.
I would recommend this book to students entering the helping professions especially for its depiction of attachment styles.

Books - The Underground Railroad by Colson Whitehead

There are plenty of slave narratives. Do we need any more?

Colson Whitehead's novel, The Underground Railroad, tells the story of a young slave woman, Cora, who escapes the Randall plantation in Georgia with a male companion Caesar and makes her way north and west on a literal underground railroad whose tunnels have been dug by abolitionists committed to undoing the bonds of slavery.

The scenes about slave torture and killings are terrible and offset to some extent by the kindness of strangers who help and conduct the slave escapees to freedom.

This is a story about the tenacity and perseverance of the human spirit against the evil of economic forces and power which exploit, subjugate, oppress, and terrorize to maintain power and dominion. It is a more extreme story of what is happening in America today with Trumpism and the championing of racism, mysogony, xenophobia, deceit and using fear and terror to undue civil liberties and the rule of law.

The Underground Railroad is an old narrative going back 300 years in the United States and continuing on in more subtle and insidious forms in our country today.

Cora and her companions seeking freedom and human development in the face of life threatening terror and domination is a souce of inspiritation and hope. The people who help her and her companions are the unnamed saints and martyrs for the cause of human dignity and respect. While a difficult book to read because of intentional pain and suffering deliberately inflicted to dominate and subjugate human beings, it is more importantly a book not only of resistance, but of endurance, hope, and triumph.

I give The Underground Railroad by Colson Whitehead a 4.5 on the Markham Behavioral Health 5 point scale.

Attachment In Therapeutic Practice by Jeremy Holmes and Arietta Slade

I just finished Attachment In Therapeutic Practice by Jeremy Holmes and Arietta Slade.

Attachment In Therapeutic Practice is about attachment theory and how this understanding of human development and behavior can be used in psychotherapeutic practice. Even with 49 years of experience in the mental health field as a Psychiatric Social Worker, I am still learning more every day. Many of the ideas that Holmes and Slade describe I have been familiar with, and their way of connecting the dots is very helpful.
A human beings attachment style gets set in the first two years of life and is determined by a number of factors. The primary factor is the interaction between the infant and the primary caregiver. This interaction contributes to four attachment styles: secure, anxious, avoidant, and disorganized. I have come to realize that I have an avoidant attachment style which was formed by a relationship with my father in which I was afraid of him, and a relationship with my mother which was somewhat secure but at times questionable.
There are many components of attachment styles and one of the most significant is trust. Here's how trust plays out in attachment styles:

1. Secure - I usually trust that people will like me and I can depend on them.
2. Anxious - I never know for sure whether people will like me and I can depend on them.
3. Avoidant - I know that you can't depend on other people. The only person you can depend on is yourself.
4. Disorganized - I know people won't like me and bad things usually happen to me.

These "internal working models" IMWs, are usually unconscious. They significantly affect our relationships with ourselves and other people. Which pairings do you think might be the happiest on long term committed relationships like marriage?
Also, the client's attachment style has significant implications for work with a psychotherapist which involves developing a helping relationship. A psychotherapist must be aware and skilled to develop different relationships with clients based on the client's attachment style.
This is article #1 in a series on attachment theory.