If I End Up With Alzheimer’s…….

When we baby boomers get together, I find that the conversation often migrates over to talk consistent with our age and stage in life.  Our bodies are no longer taken for granted, as they are with my daughter and other young people we are blessed to know (all in their 20’s and 30’s).  High on the list of topics is the frightening specter of Alzheimer’s, which can slowly rob us of our identity.  No other organ can fail and strip us of our sense of self like our Sandy.Bembrains.  In a brilliantly written, deeply felt and penetrating piece in the 5/17/15 New York Times Magazine, Robin Marantz Henig tracks the degeneration of Sandy Bem, a woman of unfathomable life force who was diagnosed at the age of 65.   Upon presentation with the unalterable diag – and prog-nosis, she made the decision that when she had deteriorated to the point of being completely dependent and unable to “be myself,” she would voluntarily end her own life.

I cannot count the times I have heard friends and comrades in my generation utter with complete assurance that if they were diagnosed with a degenerative dementia, they would choose to end their lives before they reached a certain point of cognitive deterioration.  I have known people in my parents’ generation who said the same thing, and who invariably failed to do so.  Such a statement is like the thoughts that ease the pain of depression – “I could kill myself.”  Yet such thoughts, which promise relief from the pounding, dominating inner pain, are not, in themselves, a plan to suicide.  Similar is the, “If I get Alzheimer’s, I’ll…..” statement.  Sandy Bem, however, followed through in a thoughtful and very focused manner.  The story is one of fortitude, grief, and devotion.

I have never rSandy.Bem.2ead, in so short a space, a clearer portrait of the unrelenting loss of person-hood.  As her time for action on her commitment approached, her husband (from whom she had been separated, but never divorced) was her constant companion.  Her adult daughter resisted the decision and wanted one more year – one more month – whatever she could get – for her mother to spend time with her baby.  I have a good friend, Don Desonier, who has transitioned from a family lawyer and mediator to a caregiver/coach and family mediator for families struggling with this dark and painful challenge.  He was a long-time caregiver for his wife, Nancy, who died two years ago after her losing battle with dementia.

There are many changes that our society will experience in the coming decades.  My daughter’s whip-smart boyfriend said over dinner this weekend that the political landscape will be completely different in 20 years.  As we have come to accept – actually embrace – same sex unions, I believe we will accept – even embrace – conscious dying, as we struggle as a culture to address the new challenges wrought by longevity and medicine’s maintenance of the physical body.  The New York Times essay, together with the most affecting piece I have ever read  (in which Katy Butler describes the mental deterioration of her brilliant father who had been a professor at Wesleyan University) are but two of a growing number of personal reflections which wrestle with one of the great personal, familial and cultural challenges of our age.

Living the Good Life ?

A New York Times article appeared on April 27th featuring the struggles faced by recent law school graduates, 20% of whom, according to one survey, are not working at a job weatlh.1that requires a license to practice law.  This rather desperate state of affairs was introduced by the story of 29 year old Jonathan Wang, a Columbia Law School graduate who is quoted as saying, “I would spend three years at school in New York, then work for a big law firm and make $160,000 a year, and someday, I would become a partner and live the good life.”


So what is the “good life” that Jonathan and his cohorts strive to achieve?   It sounds an awful lot like making a lot of money and then enjoying all the money he made.  I don’t hear him talking about a deeply satisfying work life which responds to whatever inner calling he brings with him – be it service to a population he is attracted to, intellectual curiosity, deep engagement in the machinery that makes this society just and workable.  Does the “good life” include time with his family – the chance to spend leisurely weekend mornings lazing in bed with his kid(s) crawling all over him or the loving rituals he will share with his partner that will keep them secure and bonded?  Does “the good life” include a spiritual calling – be it a membership in an embracing congregation, or the awe he might experience in moments of private reflection?  Does it include doing good works for no compensation other than the knowledge that you have contributed to the well-being of others?

This mwealth.2ay be very generational, but I really don’t understand it when young people say they want to retire when they are 50, or even 40.  I never hear (it may be said, but I’m not hearing it) that these people, who wish to sacrifice their early adult years for a “good life” later, speak of what they want to do with this good life other than spend the money they have sacrificed to amass.  Meanwhile, they will likely find they must spend a lot of time, emotional energy  (and money) attempting to reweave the bonds with their loved ones which have frayed and stretched as they have become embedded in a culture of striving for great financial reward.  We should not forget that lawyers have a unique and valuable role in our society.  No other profession studies the way a society works – how common disputes can be resolved in a productive way.  It has been said that doctors are healers of the body; ministers are healers of the soul and lawyers are the healers of the society.  It is a bit of a perversion to see the practice of law as an avenue to riches.  It has become sadly common to think of it that way.  Yet, we can’t escape the fact that lawyers have a frighteningly high proportion of their population suffering from depression.  Google “lawyers” and “depression” and you’ll see what I’m talking about.  It’s good, actually, that the practice of law may no longer be a gilded path to wealth.  Hopefully, this will result in a greater number of young people not succumbing to the siren call of some “good life” and who may choose, instead, to contribute their skill, knowledge and earned wisdom so we can all live a good life.


Therapy Thoughts – The Importance and Elusiveness of Self-Compassion

You may have heard.  The Seahawks lost.  They didn’t just lose – they tore out the heart of a region with a poorly called or poorly executed or poorly blessed play at the end of the Seahawk.cryingSuper Bowl.  If you haven’t heard, then you’re not reading this and are probably foraging for breakfast on your deserted island.  As for the rest of us….wow!  Wow wow wow wow.  On Monday after the game, I processed this hardly imaginable disaster with a few friends and none of them had slept on Sunday night.  My wife, who doesn’t give a hoot for sports, recovered about five seconds after Butler’s interception.  I usually pity her for not being able to get excited about the drama of good sports contests, but this week I envied her.  Seriously, this was a visceral blow to those of us who were all engaged with this scintillating drama.

Then again, it wasn’t Ebola.  It wasn’t a suicide bomb detonating at our place of worship.  Tanks aren’t rolling down our street to crush dissent.  My family is healthy and secure.  Really, in the big picture, it IS a game and three days later, I’m just glad I’m not one of the team members.  Now, they must be having a real hard time right now.  Still, their families are safe and they  will be able to cash their checks.  This all got me to thinking about people in therapy who have suffered emotionally in their lives and who dismiss their pain by saying, often glibly, “What right have I to complain?  I’m not blind.  I’m not a starving child in Africa.”  Well, that’s true.  Our distress can often be easily dismissed as “First World Problems,” but to do this matter-of-factly really misses what I think is a very important point.

People who struggle emotionally have a really heartbreaking paucity of self-compassion.  There seems to be this either/or duality in our thinking, so that we think that the choice is (a) wring our hands and cry “woe is me,” collapsing into a mound of self-pitying protoplasm, or (b) dismiss our pain because we have two functioning legs (and others don’t) or two functioning eyes (and others don’t), etc.  However, I do believe that many of us hold fear, shame, grief and other honest and very real feelings inside (and usually have for a long, long time).  When we first experienced the violations or wounds that caused us to experience these, we also reasoned with our youthful brains that we could never show the world, or ourselves, the horrible pain or the belief that a powerful force outside ourselves (adult parental figures) were wrong or uncontrollable.  That would be intolerably confusing and frightening.  So we hold it inside and when we get older dismiss our deepest wounds with off-hand comments like, “What do I have to complain about…”   In dealing with most of the world, that’s a smart decision.  But in our closest relationships, or in therapy, by thinking these thoughts, we deny ourselves the care we have longed for and, at the same time, found so risky.  I have sat in amazement and great sadness watching the determined energy with which  people bat away truly caring statements from their partners in couples therapy – or me in individual work.  We are so many things in our lives – filled with such an array of feelings.  Many such feelings are safe to show to the world.  Others, comprising an essential and intense core, are very risky.  Chief among them is the grief we harbor for the love we needed and the anger, neglect and judgment we received in its stead.  For many of us, it’s part of our personality and isn’t going to simply evaporate over time.  We need to embrace it – embrace ourselves – and allow others to embrace us as well – to embrace our hearts while we are experiencing this grief.  Yes, we have both eyes or both legs – and we also have weeping hearts that we shield from ourselves and others.  If we can be able to say to ourselves, “It’s okay.  That part of myself is there along with all the other parts. I can grieve for the embracing love I needed and didn’t receive” I think we can experience our world more fully and freely – more joyously.    No one is a “victim” unless they choose to be – and that won’t ever get you anywhere.  There’s a difference, though, between embracing our own hearts and letting ourselves be cared for, now, and being a victim.  Self-compassion is one of the great gifts of personal therapy, actually.  Even New England Patriot fans deserve that  in their lives.

The Uncomplicated, Beautiful “Go Hawks”

When I was a kid in L.A., I loved the Dodgers.  It was the era of Sandy Koufax, Don Drysdale, Maury Wills (Perranoski, Fairly, Tommy and Willie Davis – if you were there, you know what I’m talkin’ about) – World Series appearances in ’59, ’63, ’65 and ’66 and a heartbreaking near miss in ’62.  Players didn’t make astronomical salaries and stayed with the same team (and city) throughout their careers.  Ernie  Banks died this week and he was a wonderful man who played with grace and joy for an atrocious Chicago Cubs team for his entire professional life.  It was a nice fantasy – that these guys were playing for us and our neighbors.  Of coSeahawksurse, there was its own brand of injustice to this sweet ideal that a 12 year old boy clutched to his heart.  Professional athletes were forced to stay with the same team by a “reserve clause” in every contract and got paid pretty much what the owners wanted to pay them.

Well, the pendulum has swung to the other pole now with whiplash-inducing velocity.  When Alex Rodriguez signed a 2001 contract paying him $25 million dollars per year, he banked more in 2 days than most fans made in an entire year (over $130,000).  The minimum salary for the major league baseball player who may spend most of the year riding the bench is now $500,000. (Who do you know that makes anywhere near that kind of money?  Few, I would guess.) When a contract is completed, they go to the highest bidder – with an annual salary of $8 million dollars not being good enough if they can make $10 million per year somewhere else.  The days when a pro athlete could remotely be considered “one of us” are long dead and buried.  So has my love for following sport waned – only to pick up if the current team, composed of some familiar and some new, big contract guys start winning.  Owners, like Howard Schultz, unload a “civic institution” like the Seattle Sonics on a group that immediately moves them to Oklahoma City because the place they play can’t accommodate wealthy business people and their hunger for luxury suites.  Professional football players are forced to play a game on Thursday night, given just three days rest after taking a beating equivalent to a mugging with a steel pipe.  Why?  More wealth for the already wealthy.  Boy, talk about the corruption of money in American life – look no further than the world of sports.

And then the Seahawks stage a miraculous comeback and land in their second straight Super Bowl, to be played in three days.  I just received an e-mail from a therapist I don’t know commenting on a piece I just wrote for a local therapists’ newsletter and she ended her message with “Go Hawks!”  I had a couple I work with in therapy end their session two nights ago with the same exhortation.  Drive through Seattle or Bellevue and you can’t go more than two blocks without seeing a “12” banner, signifying the Twelfth Man – the team’s fans.  It doesn’t matter if you are black or white, rich or poor or even freakin’ red blooded or blue blooded.  Everyone around here is pumped and an entire civic culture is joined around two words “Go Hawks.”  If Russell, Marshawn, Richard, Doug, Bobby and the rest of the Legion of Boom win on Sunday, strangers will beam with unalloyed joy at one another for weeks afterward.  If Brady and his crew of talented cheaters prevail, the disappointment well be joined, a great ride having been shared.  So for all the corruption of values inherent in modern sports, the gift to a community – of unity around a goal is refreshing, lifting spirits around this region – regardless of politics, station in life or present circumstances.  When it’s all over, weeks or months from now, we can all go back to our old divisions and gripes. For now, though….Go Hawks!

When In Doubt….Do Something

A good friend of mine who is a great fellow and an excellent therapist has this websiteadage  he likes to share: “When in doubt, do something” – meaning that if you are stuck, doubtful about yourself and feeling blue or down, take some action.  Move.  Do something.  It doesn’t have to be a “big” something.  It shouldn’t be a “big” something.  Any move is a gift.  So I had an interesting experience recently that put the proof to that statement and some may find this a helpful story.

I had been feeling down for a while and was having a hard time kicking it.  My website came to the rescue….well it helped me come to my own rescue.

I really like my website.  I worked hard on it and get nice complements.  A great designer named Stephan Laenan who lives near Portland put it together for me.  I gave him content, he designed it…but once in a while there were tweaks I wanted to make and I didn’t know the first thing about how websites are put together.  It was aggravating, since I was totally dependent on someone else who rightfully charged me for his time.  Last year I bought an Idiot’s book on HTML and CSS (how you create the code to make a website) and after reading it for a few weeks, I was so cross-eyed that I had to put it down – defeated.  Then a month ago,  a lawyer friend of mine was telling  me how he created his own site and I thought, “Well, if he can do it……..” so I checked a bunch of books out of the library and suddenly had this “Ah-ha” moment and figured out how to make all the changes I wanted.  I dove in and over the next week updated everything I wanted updated.

I absolutely felt a spring in my step.  A big weight was lifted from my shoulders and I found that things that had been aggravating me only the week before weren’t so important.  My mood absolutely shifted because….well, I did something.  (And really, it’s not a big deal to learn about website coding, even for a tech dweeb like me.)

Remember the McDonald’s Coffee Case?

Back in the 1990’s a New Mexico jury awarded Stella Liebeck more than $2.8 million against McDonald’s because she spilled hot cocoffeeffee on her lap.  This has been brought up to me many times over the years as proof of the dangers of frivolous personal injury suits.  “She sues because she is burned by hot coffee?  Ridiculous.”  A new documentary is on Netflix called Hot Coffee which explores the case and its aftermath.  I invite you to take this short quiz to see what you know about this case:

1.  Stella Liebeck was: (a) A 16 year old girl (b) A 32 year old mother of 3 (c) A 79 year old widow.   Answer

2.  When the accident occurred, Stella was: (a) Driving (b) In the passenger seat of the moving car (c) In the passenger seat of a parked car.  Answer

3.  The temperature of the coffee was: (a) Over 180 degrees F. (b) Around 120 degrees F. (c) Around 150 degrees F.  Answer

4.  Stella Liebeck’s injuries were mainly: (a) A painful rash on her thighs which lasted for a month (b) Third degree burns on 6% of her body (c) Painful blistering on her thighs and buttocks: Answer

5.  The case went to trial because: (a) McDonald’s offered to pay her medical bills, but she thought they should pay punitive damages (b) McDonald’s offered $250,000 but she wanted $1,000,000 (c)  She asked for payment of her medical expenses and lost income (about $160,000) but McDonald’s offered only $800.  Answer

6.  Had McDonald’s been given any notice that hot coffee may be a problem? (a) About as much notice as you and I have that hot coffee is hot (b) A couple of people over the past 5 years had been burned (c) McDonald’s had received about 700 complaints of burns from excessively hot coffee.  Answer

The point is:  READ ON

The Little Things

I went out to my car last week and found the rear window smashed and two things taken from my back seat – an empty briefcase and aLock.3 ratty old Jansport backpack with my gym stuff in it.  “They” did it in the middle of the night. (Don’t you want to find out who “they” are?…your own personal “they’s”)  Anyway, while the briefcase was well worn and nice, my biggest sense of loss came from the theft of my combination lock.  I remember years ago when I opened the packaging and read that the combination was 28 -2-8.  C’mon!  It just can’t get any easier than that….and I loved my combination lock.  I felt so lucky to have picked it out.

Martin Seligman, one of our greatest psychologists, has long studied happiness.  He has been striving for years to develop an approach to mental health treatment which transcends the age-old medical model of diagnosis of a “disorder” and then working to eliminate the “disorder.”  Seligman wondered why we can’t move above the baseline of functionality, into the realm of happiness and well-being.  This notion has captured the enthusiasm of a large segment of the mental health community.  Just note the surge of people incorporating “mindfulness” into their practices.  Mindfulness is both a way to ease stress and internal pain and a path to affirmative well-being.

So what does a combination lock have to do with Seligman and positive psychology?  Well, one of the most important tools for achieving well-being is appreciation.  Cultivating a sense of appreciation for the good in our lives cushions us against the deeper dismay which will always accompany loss.  Also, appreciation buoys our spirits in the day to day.  One of Seligman’s best exercises is the “Three Blessings.”  Each night before you lay down to sleep, take a notebook or piece of paper and write down three blessings of the day just ending.  This will train your mind to be alert to both the big and the little things which we can appreciate in life.  These little things can be a pleasant exchange with our partner or a friend; the burst of life in the leaves that are unfolding as Spring arrives; the wag of our dog’s tail because we are really, really loved; the good feeling from not eating something we know isn’t good for us; a great movie we just watched or the bike ride we completed.  Nothing should be taken for granted.  We live in a world which may often seem bent on eroding any sense of well-being.  We can keep that force at bay when we embrace the little treasures.

I’m going to store today and will myself to pick a lock with my birthday as a combination.  I’ll tell you how it goes.

Beautiful Ireland

We just returned from a 10-day stay in beautiful Ireland.Ireland   I had been there years ago during the waning days of a failing marriage and didn’t like the place at all.  Just goes to show how important state of mind is!  This time, my wife and I joined our 21 year old daughter and traipsed around Dublin and the Southwest and I fell in love with the land and its people.  Being away to another culture allows a wonderful insight into our own and America shines brightly through the Irish lens.  So many came from the island to the U.S. – particularly during the catastrophic potato famine of the late 1840’s (which wiped out about 1/3 of the 8 million population through starvation or emigration.  In fact, Ireland has never reached its pre-famine population!).  Hardly a person we spoke to failed to have relatives in this country.  Gracious, full of humor, delightful poetry in their expression and extremely friendly – a visit is like immersion into a warm human bath.  Yet, there is a vein of pain which runs through the Irish heart and history.  The oppression of the huge power (England) just to the east, that imposed laws which prohibited, upon pain of death, the open worship of their faith and allowed Protestants to move to the island and confiscate the land and property of the rural farmers under the policy of “plantation” – the depredations of Oliver Cromwell hundreds of years ago – the multiple uprisings seeking freedom and autonomy which were brutally put down – this was the same oppressive power that the American colonists rebelled against successfully.  Looking at the U.S. from Ireland, you see an extremely optimistic peopleireland.6 and a wealthy, wealthy land.  You can make it in Ireland, but if you make it in the U.S., well, you have made it!  I have spoken with immigrants from places like Russia and they repeat the vision of this country as having a basically optimistic spirit.  Visions which will remain include the Irish field, with plots defined by chest-high rock walls; the greenest of green grass grazed over by large flocks of sheep; occasional ruins of 400 year old (or older) castles or monasteries as you  drive from one rural town to the next; pubs, like Dick Macks in Dingle, where I walked in on a bachelor party of about 30 guys crammed into this tiny space raising their Guinness’, standing on tables and benches and singing at the top of their lungs or the traditional music jam in a Doolin pub with a fiddle, guitar, two flutes and a guy who played accordion like a god and was better as the night wore on and he got increasingly smashed; the Book of Kells which is adorned with the most beautiful inscriptions and monastic art (with scores of ways to depict in art different letters – like the letter “d” for example).  We are so young – they are so old.  Perhaps most importantly, it was revitalizing to go away for just a couple of weeks and return refocused and refreshed.  It’s good to be back with our memories and the fun and interesting work ahead.

Emotions That Are “Hardwired” (Part 2)

neurons.2Research neuroscientist, Jaak Panksepp, has been studying the anatomical basis of emotions for many years.  It has been a challenging task for many reasons.  For one, the scientific community has not been in agreement as to what comprises an “emotion” – whether they exist at all and, if so, how to describe them.  Another question is raised by those who claim (passionately I might add) that emotions are environmental and not inherently physiological.   This is not what Panksepp has found.  In fact, he has been able to identify 7 different brain circuits which correspond with discrete emotional responses.  Further, he provides us with extremely reasonable ideas about the evolutionary basis for the development of each of these emotional circuits.  While he freely concedes that there may be more to be discovered in the future, those which he identifies at this stage are:

  1. Seeking: This is the drive to explore the world – to gain stimulation and sustenance from the environment.  Interestingly the nerves’ receptors for the neurotransmitter which is most associated with this behavior (dopamine) are severely compromised or destroyed by the use of drugs such as cocaine, which explains the incredible lethargy after prolonged use and the need to keep snorting or smoking in order to maintain a baseline of alertness.
  2. Rage: Panksepp found that anger is a primary emotional experience, as it is put into service when the animal is being constrained.  It is a natural reaction to the experience of being cornered and, indeed, his representative picture is of the hissing cat backed into a corner.   This is different from the anger we often describe as our reaction when a lover hurts our feelings or betrays us.  The difference is interesting and worth further thought and discussion.
  3. Fear: This is a basic self-protective mechanism.  Our brain is programmed to protect us and get us the heck outta there when we are faced with threats to our existence.  It’s the old “our ancestors split when they saw a saber-tooth tiger roaming close-by.”  What Panksepp also observed, interestingly, was that when this circuit was chronically and continually activated, the organism lapsed into a state of anxiety – which, then can be defined as the low level, continuous expression of the fear circuit.
  4. Nurturance:  This is the classic maternal care circuit.  When it is stimulated, the body produces a load of oxytocin, which has been called “the cuddle hormone.”  It is also true that this circuit is activated, and we are bathed in oxytocin, when we are feeling close and loving to a partner.  The evolutionary basis for survival of the species is pretty self evident, here.
  5. Rough and Tumble Play:  Panksepp observed the animals in his lab spontaneously engaging in such play.  It is the expression of a physiological need to experience joy.  He associates human laughter to the activation of this circuit.  The evolutionary value of the play circuit is more speculative, but Panksepp suggests that it may facilitate basic socialization.
  6. Lust:  The drive to seek out and find a mate is perhaps the most fundamental evolutionary imperative.  Panksepp describes many, many courting rituals and other behaviors which are reflective of the stimulation of this circuit.

Panksepp has been able to generate these emotional responses, from rage to fear to sexuality, by stimulating discrete parts of the brain with mini-electrodes.  This would seem to add proof to his theories.   The seventh and final hardwired emotion really forms the basis of the couples therapy I do and I will leave that discussion to the next post.

What it Means to Have Something “Hardwired” (Part 1)

neurons.1 Listen to psychologists talk and you will often hear about how some behavior or attitude is “hardwired.”  It’s a pretty descriptive term – particularly since the brain is an organ characterized by electrical circuits.  For another example, just consider the most popular adage among neuroscientists over the past dozen years or so, “Neurons that fire together, wire together.”  It suggests a certain immutable permanence in ways we think or act.  Consider all the incredible identical twin studies in which they are separated at birth and meet decades later to find that they are wearing the same color, are married to women with the same name, pursue the same career and have named their children identically.  One great example involves two brothers reunited after 39 years.  Each was incredibly fastidious and detailed – compulsively neat and orderly in every respect.  They were both completely convinced that their character was a function of nurture rather than nature.  The first was asked why he was like that and he replied, “My mother is the reason!  She was exactly the same way and I was raised to be compulsively neat.”  The other replied, “My mother is the reason!  She was so disorganized and such a slob that I had to be this way just to survive.”

Among the researchers who have been studying the brain’s inherent (“hardwired”) character is a man named Jaak Panksepp.  His work with animals is incredible.  One fascinating observation he shares in his book Affective Neuroscience – The Foundations of Human and Animal Emotions involves the problem they had with rats who were very distressed and active after their cages were cleaned by a certain lab tech.  After some investigation, they found that the tech had housecats and some of the dander was carried with him to the lab.  What is fascinating is that these rats were born and bred in the lab.  They had never seen a cat in their lives….nor had their parents or grandparents.  They had been separated from actual exposure to a natural predator  by many generations.  Still, they reacted strongly to the scent of the cat.  That’s one great example of being “hardwired.”  What is even more important for us, is that Panksepp has found that certain emotions are hardwired into our brains.  This will be the subject of a later post.