It's not loneliness, it's the lack of meaning and purpose in later life.

Summary Explore the concept of successful aging, emphasizing the importance of meaning, purpose, and contribution in later life. They argue that combating the "loneliness epidemic" requires fostering a sense of usefulness and agency, rather than merely addressing social isolation. Maintaining autonomy and self-determination is highlighted, alongside the power of reframing aging to focus on continued contributions, such as the simple yet significant act of giving attention. The texts draw upon Atul Gawande's Being Mortal and offer strategies for individuals and society to support fulfilling aging experiences.

 

Psychotherapy and violence as a tool of social change

 David Markham, a mental health professional, reflects on the role of violence as a tool for social change in the United States. He observes the normalization of violence in American culture, citing recent political events and rhetoric as evidence. Markham questions the implications of this trend for psychotherapy and explores alternative approaches to social change, prompting a discussion among colleagues about effective strategies for facilitating positive change. He raises concerns about the implications for mental health professionals. The overall tone is one of concern and inquiry.

Low levels of differentiation of self makes a person vulnerable to charismatic leaders.

In the past  I have shared the idea of  the usefulness of cognitive maps for a therapist as they attempt to guide the therapeutic process. One factor in the social regression and developmental stuckness is rapid social change engendering fear but this impacts people at different levels of "differentiation of self", a Bowenian concept. 

There are many characteristics of DOS and perhaps one of the most important is anxiety levels and the ability to be self aware and regulate one's thoughts, feelings, and behavior. To use the analogy again of childhood development, most followers of mass movements who attach themselves to charismatic leaders are at a relatively low level of DOS. They are insecure and lack a sense of well integrated self. 

In thinking about how to proceed with people with low levels of DOS, we might consider how a parent deals with a 5 or 6 year old anxious child. Usually it is through reassurance along with reality testing, encouragement to "use your words" and coaching on management strategies for regulating elevated amounts of emotional arousal (anxiety.) 

Radical acceptance, a concept from DBT, can only occur when anxiety levels are decreased through soothing behaviors both self activated and facilitated by a trusted other. Radical acceptance brings peace and peace brings that ability to radically accept. So what comes first, the chicken or the egg? Basically, security is enhanced with structure and predictability.

I had a client with Borderline Personality Disorder who I have seen probably 10 or 15 times who told me in our last session "Just be honest with me. Tell me when I'm wrong and what I should do!" 

So, I have been a bit more directive with this invitation but I still walk on eggshells thinking it is only a matter of further interactions before she is offended by something I suggest and fires me and looks for another therapist.

In the long run, peace, lower levels of anxiety are not to be found externally but internally. And this I see as a spiritual problem. Radical acceptance has been known for decades in 12 step programs as "Let go and let god" or turning it over to one's Higher Power whatever they conceive their Higher Power to be.

As John Bradshaw said people are trying to fill "the hole in their soul". That's where we psychotherapists come in. How do we help people fill the holes in their souls?

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. 

The Best Way to Stall Dementia: Quit Smoking

 From Cornell University

While the number of smokers is at a historical low, data demonstrates that smoking still affects public health. Smoking increases the risk of heart and lung disease, affects bone health, and increases the risk of birth defects. A growing body of research demonstrates that smoking also affects neurological health, specifically cognitive decline.

A longitudinal study published this fall in the journal Nature Communications tracked data from 32,000 adults between ages 50 and 104 for 15 years to identify lifestyle factors linked to cognitive decline. The surveys, conducted in 14 European countries, asked about a broad range of lifestyle factors including smoking, alcohol consumption, physical activity, and social contact. The surveys also measured episodic memory and verbal fluency, two domains affected by dementia.

Researchers found that most participants showed some signs of cognitive decline over the course of the study, but current smokers demonstrated the largest and most significant levels. The only exception were current smokers who had other healthy habits including avoiding or limiting alcohol, moderate to vigorous physical activity, and regular social contact; those participants showed less cognitive decline, similar to that of nonsmokers.

Editor's note: I have spent many decades of my 56 year career as a Psychiatric Social Worker helping people quit smoking. The interesting finding is that a person who is a long time smoker makes, on average, 5 quit attempts before they finally quit for good. So, I encourage people by telling them "Don't quit trying to quit."

Addiction to smoking is one of toughest addictions to overcome.

80% of people for whom alcohol is a significant problem also smoke. The outcome research shows that quitting both smoking and alcohol at the same time gets better outcomes than quitting these chemicals one at a time.

Cinematherapy can be useful in mental health treatment and recovery.

 

Do you use movies, TV shows, YouTube videos, etc. in your therapeutic work. If so, can you name such a film or video and how you use it?

Yesterday, I finished the Netflix TV series, (8 episodes) of Escape at Dannemora. I remember when this happened in 2015. This is a soap operish kind of story with a narrative that is predictable. What might be interesting is how manipulable people can be in institutional settings and how creative people can be in totalizing circumstances. 

I am not sure how I might use this series in therapy but Tilly demonstrates some of the signs and symptoms of what might be called "inadequate personality disorder." Her insecurities contribute to compulsive sexual behavior which gets her into criminal behavior with two of the inmates.

At any rate, do you have movies or TV shows that you refer to for therapeutic purposes in your work with clients?

If you have been a mental health patient, are there movies, novels, TV shows that have helped you resolve and transcend the mental health problems which have challenged you/

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..."