Contact Me
Insurance Information

Medical Boundaries: Which Are Necessary?

AsklepiosPrize

Did you hear the one about the doctor who went fishing with his patient?

Neither had I until a friend told us about a trip he’d taken with his doctor to go fly fishing.

I wondered if he always went fishing with his doctor and he said, “No, if I have to take off my pants we meet at his office.”

This set me to thinking, as usual. In my training as a social worker, boundaries were—if you can imagine this—simultaneously rigid and blurry. They were rigid when it came to three basic things:

  1. Whatever is done must be done for the benefit of the patient. Period.
  2. No sexual relations whatsoever—implied, verbal, or physical—with any patient even when that patient has been terminated from treatment.
  3. No manipulation of the patient for personal gain, e.g., getting particularly close so you can meet his Hollywood producer cousin.

After that, however, the rules are fuzzier. In social work, the office is not the only place treatment takes place—it happens in the home, on the street, in homeless shelters, domestic violence advocacy centers, in schools, and just about anywhere else people get hurt or feel unhappy or need help. It is one of the few schools of psychotherapy that accounts for the person in situ—that we are more than a conglomerate of neural impulses or internal motivations. We live, breath, and move in an environment. We are driven not only by our own minds but by the currents that surround us. Interventions, then, must not only take those forces/currents into account, but deal with them. Sometimes that means that we move the office outside into the patient’s life.

But what about being—rather, more specifically, would I become friends with a patient? Or, conversely, would you be friends with your doctor?

Personally, there’s something about the idea that makes me nostalgic. There was a time, not that long ago, that a doctor was not a deity surrounded by the impermeable membrane of incomprehensible technology. A doctor was just another member of the community. He raised children that went to school with our children. He went to religious services with (or near) us. He got sick, took walks, bought food, and went fishing just like everyone else. We knew his first name. He knew all of ours.

Healing was not some private province. It was part of the large, bumpy wheel of living and dying.

If I’ve told you all this story before, forgive me, but it’s one of my favorites. My father is a doctor. Retired for 15 or so years, he still goes to Grand Rounds at 91 years old to learn and talk shop. Besides my mother, his only true love was and still is medicine. After he served on an army hospital ship in the South Pacific, he opened a small office in the Bronx.

Most of his patients came and went like they do in most physicians’ offices. One couple was different.  Harry was a strapping Scots-Irish trucker who was as easy-going as a man could be and as hardy as an oak tree; his wife, Irene, was as delicate as a porcelain tea cup and a consummate worrier. They came in for physicals or those occasional minor complaints that fill a family practice, until one day he came down with a fever of unknown origin. (There were far more of those fevers then than there are now.)

They called my father’s answering service in the middle of the night. The phone rang in our home and my father ran out with his medicine bag (he still has it) at 1 or 2 in the morning. He stayed there with them, holding Irene’s hand and doing whatever doctors did for mysterious and dangerous fevers until it broke. It was hours and hours.

The point of the story is not just that Harry got well or that Irene was happy. They became friends. They stopped at my father’s office to say hello, to bring pastries, to help with odds and ends. They started coming to the house for birthday parties and holidays. We called them Uncle Harry and Aunt Irene. And they still went to my father for medical care until the day they moved into a retirement village hundreds of miles away. And even then, they did nothing without consulting my father first.

How would that fare today? I honestly don’t know how most medical doctors would handle it. I suspect that most would avoid it for a number of reasons, not the least of them being liability anxiety. In social work, it is a bit easier to go out on a limb for a patient, to step out of the office for a moment. I have done it more than once—gone to graduations of clients whose families were far away, attended baptisms, stood quietly at memorial services, and walked frightened patients into health care centers when they wouldn’t (or couldn’t) go alone. It sits well with me. And it seems to have been good for them, which is how I measure it. I mind the basics (those three rigid rules) scrupulously, but I leave liability to the side, where it belongs.

Maybe I shouldn’t be so carefree about it, but I believe that proper (meaning spiritual rather than romantic) love—more than technique—is the source of cure. Especially in my work. Maybe not so much in the emergency room…but even there I think a point could be made for it.

I occasionally meet with one M.D., who is also a classical homeopath,  to discuss cases. He has been a teacher and a friend over the last few years. I’ve watched him work and he seems to feel the same way about medical boundaries. I don’t think he walks his patients into advocacy centers, but I’ve seen him attend his patients in his home office with a compassion and warmth that is unique in the business today. He dresses casually. He listens. He offers water or tea. He makes himself available both in terms of time and emotion. I don’t think he frets too much about liability either.

I guess people just have to do what they are comfortable with. If they are afraid of being sued, then perhaps they should take the precautions they need to avoid it. I don’t know if that makes it better or worse. They say we draw in what we fear most. I do know one thing. Harry and Irene lived a long time and they loved my father till the day they died.

 

 

Homeopathy and Cancer

This is a guest blog by Faith Franz, who researches and writes about health-related issues for The Mesothelioma Center. One of her focuses is living with cancer. I am presenting it here in the hope of offering information and options to people who are looking to be healthier and happier. 


calmBenefits of Homeopathy for Cancer Patients as an Alternative Medicine

Cancer patients turn to treatment to reduce their symptoms, boost their mental health, improve their quality of life and – if possible – reverse tumor growth. Homeopathic approaches and allopathic approaches both yield some or all of these benefits, but the way that they achieve them is drastically different.

Homeopathy provides benefits in a much gentler manner with fewer risk factors than traditional medicine. Traditional cancer medicine uses the most potent dose of therapy available in gross molecular quantities, while homeopathic medicine aims to use what is called “the minimal dose,” as few active ingredients as possible. Often the dose is below Avogadro’s number (the mole) and the medicine given is delivered energetically.

Homeopathy also encourages patients to use only one remedy at a time, switching treatments only if the first is not the right fit. As a result, patients typically experience do not experience what are commonly referred to as “side effects” from homeopathic treatment as they do from a traditional treatment regimen, which adds one drug to the next to the next, often to deal with the problems caused by the first drug.

Traditional medicine tries to eradicate tumors and their associated symptoms as quickly as possible. Homeopathic medicine takes the time to heal the underlying cause. Homeopaths understand that sometimes patients will experience a brief increase in symptoms before the disease is cured; this is the body’s natural way of releasing the disease.

Patients also benefit from the highly personalized nature of homeopathic medicine.

Each remedy in the repertory (the master guide to homeopathic solutions) is matched to a specific set of conditions. In traditional medicine, doctors prescribe one or two medicines to treat the same general symptom. Homeopaths choose from dozens of remedies for each symptom after evaluating the other characteristics of the patient’s case.

For example, an allopathic doctor would prescribe a patient Metoclopramide or Prochlorperazine if they become nauseated after chemotherapy. A homeopath might prescribe the patient one of the following remedies, based on the patient’s other symptoms and overall constitution:

  • Cadmium Sulphate
  • Kali Phoshorpicum
  • Nux Vomica
  • Sepia
  • Ipecacuanha
  • Uncaria tometosa

Because the solutions are chosen specifically to be closely tailored to the patient’s overall condition, patients will obtain highly individualized benefits from homeopathic remedies.

What Cancer-Related Conditions can Homeopathy Treat?

Even when a cancerous condition is very advanced, homeopathy can yield benefits for a number of physical cancer-related conditions. These include:

  • Pain
  • Fatigue
  • Nausea/vomiting
  • Constipation
  • Diarrhea

Homeopathic remedies can also relieve symptoms that are unique to a certain cancer. For example, patients with asbestos-related cancers of the respiratory tract can take antimonium tartaricum or related remedies to curb dyspnea and coughing that includes a great rattling in the chest.

Although classical homeopathy does not seek to suppress, rather to cure, in some cases, alleviation (or palliation) of symptoms is the moral mandate, for even when we are beyond cure, we seek to ease suffering.

Thus,  homeopathy can also be used to help patients manage emotional complications that stem from their cancer diagnosis. Homeopathic remedies can help diffuse stress, fear and mild depression without the use of anti-anxiety medications. This mental health aspect of cancer treatment is just as important as the physical care, and often, the two overlap. When stress and other emotional symptoms are under control, patients are much less likely to experience insomnia and other anxiety-related conditions.

Some patients take homeopathic remedies with the intent of reversing tumor growth. These treatments require a homeopath’s prescription. Data varies regarding the efficiency of these remedies. Because they rarely cause any harm in the process, many patients choose to see if their body positively responds to the solution.

 

Judith’s note:  As always, when presented with a medical condition, please consult your physician and/or a classically trained homeopath with experience in the treatment of your complaints. Please do not use homeopathic remedies over the counter without engaging in your own study or benefiting from the advise of someone with training. 

 

 

Negotiating with an Emotional Terrorist

Negotiating with an Emotional Terrorist
mad babyB.B. (identifying details changed) sat at the kitchen table pushing her phone around like a piece on a game board. Waiting to find out whether or not she had to go visit her biological father for Father’s Day, she sighed, grimaced, texted, and picked at food in which she had no interest.

I asked her why she didn’t just stay home to celebrate with the man who helped raise her, whom she adored. Her face twisted in guilt, she said, “It’s not that simple. He’s going to do or say something that’s going to make me feel horrible or he’s gonna get insane. I think I may just ask him to pick me up. He hates to do that and maybe I’ll get to stay.”

B.B. is a young woman with an old soul. She is sensitive, artistic, and compassionate. She became this way despite being raised for a portion of her life by a deranged and sometimes violent narcissist who took his umbrage at the world out on her mother. They survived and prospered, but it has left her with an emotional Achilles heel: She is terribly worried about being nice, especially when that niceness promises an escape from confrontation or further abuse. She has been trained by an emotional terrorist.

I’ve known an inordinate number of people who have learned to seek refuge in being careful, who see being nice to people who are incapable of returning the kindness as a way of protecting themselves. They hope against hope for the impossible: That if they just say the right things, tilt their heads the right way, defer at the right time—all will be well. They will be reprieved and the abuser will be redeemed.

But the rules that apply to political terrorists are the same ones that apply to emotional madmen: there is no negotiating.

What I’ve called emotional terrorism has also been called emotional blackmail by psychotherapist Susan Forward and refers to a form of psychological manipulation that uses implied or overt threats and/or punishments in order to control another person’s behavior. Often it can be so subtle that observers can’t see it when looking casually. When it works the one who is manipulated becomes (in varying degrees) the hostage of the terrorist. It is a horrific position to be in.

The price for being a hostage is not obvious at first. Initially, it seems like a relief. Ah, I got it. I found the button that will make him leave me alone.

But it doesn’t last. And as time rolls on and the manipulations up the ante, the hostage finds himself constantly on edge, disappointed, persecuted and confused, and—the worst irony of all—enabling the very behavior(s) they wanted to avoid in the first place. The negotiations turn out to be a psychological gym in which the terrorist gets to work out and build up. The hostage finds himself in an increasingly hyper-vigilant and outgunned position precisely because they are often the sorts of individuals who are conscious of what others feel. An emotional terrorist is not hampered by empathy.

According to Forward(*1), one of the things these emotional terrorists will do is utilize the most intimate knowledge of the hostage to lock them into a psychic neck hold so they will do what the terrorist wants or needs them to do. This is especially easy with more sensitive people like B.B., and others I’ve known, who long for love, approval and harmony and will go to great—even self-sacrificing—lengths to obtain it.

I knew one young man who was caught in the middle of a fire-fight at the dinner table. His father and younger sister were yelling at each other about a broken fixture in the house. He said she did it, but she denied it and became indignant, even though it was clear she had done it. In order to stop the fighting, the young man admitted to breaking it and had to pay for it out of his savings. The harmony was worth the price for him. It never occurred to him that the fact that his sister didn’t step up to the plate to save him by telling the truth was selfish and uncaring. He saw himself as saving her and his family from unnecessary conflict.

Fascinating. There are no straight lines in the human brain.

And in situations like these, the truth is permuted to such a degree as to be nearly invisible. In fact, the avoidance of the truth is the one immutable common denominator in all psychological terrorism. The terrorist doesn’t want to face the truth about himself, his life, or his relationships (if there are any).

And in order to maintain short-term survival or safety, neither does the hostage.

Thus, they both lose. Because the terrorist is an easy subject to blame (rightly), it is easy to forget or downplay the unconscious complicity of his or her victims. Most victims are people who in one way or another have been primed to accept and deal with that sort of behavior. They are highly vigilant, supremely sensitive to the needs and expectations of others, and highly motivated to seek approval.

Is there something intrinsically wrong with wanting to please others? No. Or with empathy? Hardly. There was nothing to blame in B.B.’s desire for harmony, for peace. Her heart was righteous. She wanted people to be happy. The problem was not in her longing, but in her approach. Satisfying the unreasonable demands of a psychological saboteur only leads down a rabbit hole of endless capitulations and anxiety. She may have been raised to do that, but it doesn’t have to stay that way. She is grown and free to see—and take—other options. For B.B., as for all of us, it starts with recognizing what it is we do that facilitates being victimized so we can stop it and, in so doing, stop them.

Many people feel that psychology has gone off rail in the insistence on limit-setting, that it is a handy excuse for heartlessness. They say that becoming so rigidly “boundaried” is simply another form of hypervigilance and that the unfortunate result is an equal, if not more loathsome lack of empathy, generosity, and kindness on the part of the victim, who now becomes another sort of perpetrator.

Personally, I do not see that happening with good limit-setting or a solid, healthy recovery from a life of emotional imprisonment. Saying “no” may be life-saving not only for the victim but for the perpetrator. I have seen many people let go of being victimized (and the perpetrators) and they turn neither into heartless ministers of vengeance nor benumbed agents of apathy. They live well. They learn to love and receive love. They drop the fear and take up faith. They are formidable human beings on so many levels. And most importantly, they learn to see and tell the truth.

Quite a bit back, I was counseling the parents of a very bright and very manipulative little boy. He had them both turning cartwheels to exhaustion with a mix of tantrums, pouting, and splitting. If he couldn’t get what he wanted from one parent, he went to the other. And often he succeeded. The parents fought and eventually he got what he wanted. They wanted to be good parents, loving parents, and thought they were doing the right thing—they gave him what he wanted (“it was such a little thing, really”) and they kept it quiet, at least until the next time he demanded something he did not need. By the time I met them, they were fit to be tied.

This was a more common hostage situation than one might imagine. In any case, we worked on a contract with their son, a plan for building unity in the marriage so they could say “no”, and a prep course in behavior modification so they could anticipate and tolerate the inevitable peak in acting out they could expect when the “no’s” began in earnest. Terrorists do not give in easily. Even though healthy limit-setting often feels like swaddling—it contains them and gives them a sense of safety—even young manipulators will usually put up some kind of a fight. So, what actually occurred surprised everyone.

After two weeks, they came back to tell me that something amazing had happened to them. Their son had come in to them demanding a new game that “everyone” at school had.  They followed the plan: They talked to each other first. They came to a single decision. “No,” they said unilaterally.

“I said to him,” the father continued, “No, you cannot have the game. Your mother and I talked and WE decided that it’s not something we want to buy right now.”

“You won’t believe what he did!” the mother exclaimed happily.

“Try me,” I said, sitting forward on my chair.

“He stood there.”

“He stood there?” I was puzzled.

“He was so stunned that we agreed he just stood there. He never argued. There was nothing.”

“It was beautiful,” the father leaned back, sighing into the couch. “It was the most beautiful ‘no’ I ever heard.”

Yes, it was.

 

(1) http://en.wikipedia.org/wiki/Emotional_blackmail

 

 

Why Is Death So Shocking?

In Memorium: Bugsy 1996-2012Bugsy and Dave near Sandia

You would think after the supposed millions of years we have been “evolving” or adapting that we would be as surprised by death as we are by eating and elimination. You would think that if it were just another natural process that it would be as shocking as summer following spring, as stunning as another morning coffee. Why do we accept the brittle decay of maple leaves with such ease, yet when it comes to ourselves, to our friends, families, and pets, we are benumbed with grief, baffled by the finality of something that, by all scientific accounts, should be normal?

You would think after the supposed millions of years we have been “evolving” or adapting that we would be as surprised by death as we are by eating and elimination. You would think that if it were just another natural process that it would be as shocking as summer following spring, as stunning as another morning coffee. Why do we accept the brittle decay of maple leaves with such ease, yet when it comes to ourselves, to our friends, families, and pets, we are benumbed with grief, baffled by the finality of something that, by all scientific accounts, should be normal?

I have been told by very wise people that I have to make friends with Death. I believe they are right. But I have not yet been able.

Today, at 7:15 a.m., my husband’s dog, Bugsy, died after an old-fashioned Western, three year stand-off with cancer. Diagnosed with sarcoma in August of 2009, he was given about a month to live. Like the time he got his teeth wrapped around the edge of a flank steak, he took that to the track and he just kept going.

This is not an article about what we did to prolong his time with us or give him what we hoped was a beautiful quality of life. We did a lot of things—raw diet, classical homeopathy, at the very, very end steroids and antibiotics. We did whatever we could reasonably do without putting him through endless procedures or making him uncomfortable. We didn’t spend a lot of money. We didn’t go crazy. We took it one day at a time.

Which brings us to the point of this article: We had three years to prepare.

But as we knelt beside him and the doctor delivered the final injection, even though we knew exactly what was going to happen, we could not fathom it. When he took his last breath, we held ours, too. Were we waiting? To see if he would somehow defy the odds yet again?  Despite all our knowledge and all the obvious evidence, we could not believe he was gone. We stood looking at his little body and wondered where he went.

How is that?

How can we not believe it? How can I be in shock about Bugsy’s death any more than I’m in shock when the sun goes down or a breeze pushes back my hair? How can I say, “I can’t believe he’s not here!” when I’ve seen death in full frontal form with family members, friends and other pets.

But I was in shock. Again.

Maybe it has something to do with the kind of dog he was, with the kind of presence he had, with the way some people said, “He’s like a person.”

I thought if he had been a person, he would have been a Keystone Cop and he would not have been acting. He was cantankerous, funny, loving, protective, goofy, and he was my husband’s Guardian Angel. He was the dog that saved his life.

It was the night after Christmas. He’d been playing at a private party. At 4 a.m., he got a call from a friend saying they’d found a dog frozen to the street. He was about 4 to 6 weeks old, no more than that. His step-son, Stephen, had been asking for a dog for months, so he went to look at him. When he picked him up, he crawled up his chest. “I thought he was going to lick my face, but he jumped off my shoulder.” That was the beginning of a 16 year story of near-death adventures.

He had worms, a heart murmur, a gimpy leg from being frozen or possibly broken early on, he hadn’t been weaned and was not socialized. His was a slippery slope from the very beginning and raising him took work and attention but his crowning achievement was learning how to catch and crack pistachios, eat the meat, and spit out the shell.

Years passed and my husband suffered through several major disappointments—“rough times and hard drinking,” as he calls it. What saved him was knowing that Bugsy not only loved him, but needed him.  He had to stay alive, no matter how he felt. “He kept me coming home and he kept me waking up. He stared me down, waiting for me to wake up, some days, but I did, because he was there.”

When he was struggling with getting sober, he committed himself to a daily ritual with Bugsy: they would wrestle and play until they were both exhausted.

One day, he had given Bugsy a bath. It was his custom to dry him off with a towel then Bugsy would run through the house. But on this occasion, he jumped out completely wet, shook the suds off on the tile floor, and shot into the kitchen, where he waited behind a wall. Dave ran after him, flew up feet first, landed on his arse—hard—and Bugsy poked his head out, smiled (literally), and laughed, “HAH!”

He was a dog’s dog, a man’s dog, and eventually, he became a pack dog and a family dog when he became a part of our larger home life. He was the most adaptable dog I’ve ever encountered. There were incidents (one in which he was held by the nape of the neck by one of our bigger dogs until he squealed “uncle”), but he found his place and his peace.

When I told my mother about Bugsy’s passing, I started crying again. And as soon as I wept, she did, too. In between our sniffing and sobbing, I somehow managed to rail at the universe again, to be shocked again, to wonder again—how, why, what the heck was all this about, anyway? I told her, “I’m so sick of death.”

And she said to me, “You know, that’s the problem. You can’t stop it. You’re not eternal. No one’s eternal.”

And I remembered what Peter Kreeft had to say about that: Maybe the problem is the other way. Maybe we are eternal. Maybe we are continually shocked by death because it represents the antithesis to our highest natures, to our spirits. I may be wrong and if I am, I guess I won’t know it anyway. It’ll just all be gone and over, nothing. If I’m right, though, I’ll be kneeling down with Bugsy behind that wall, waiting to see Dave slide across a sudsy floor and we’ll both go, “HAH.”

 

Trending Now: Prescription Addiction

pill-manIs the medical profession finally catching on? I recently saw signs of hope.

In the February 22/29th edition of Jama (*1), the editors described a report issued by the CDC in a splendidly titled tome, Morbidity and Mortality Weekly Report.

Throughout the dryly presented data were intertwined subtle sirens of alarm: The rate of unintentional drug overdose deaths in the United States has risen over 600% in the years between 1997 and 2007.

We are not talking about heroin or methamphetamine or crack. We’re talking about prescribed analgesics. Prescribed. According to the CDC, “drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg. of morphine per person in 1997 and approximately 700 mg. per person in 2007,” a dose high enough for everyone in this country to take a standard 5 mg dose every 4 hours for 3 weeks.(*2)

The report continues its assessment and finally makes this stunning observation: “Prescription drug abuse is the fastest growing drug problem in the United States…and has been driven by a class of prescription drugs called opioid analgesics.”

It goes on: “For every unintentional overdose death…nine persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence and 461 report non-medical uses of opioid analgesics.”

Why? How could this be? Are these drugs being stolen? Manufactured by thugs in a trailer in the desert? Sold by wayward pharmacists? Smuggled from Canada? Hardly that dramatic. In fact, we are being addicted by the people we trust the most: “In an attempt to treat patient pain better, practitioners have greatly increased their rate of opioid prescribing over the past decade.”

Did someone say there was a war on drugs?

Allow me to share a more personal and human rendition of these statistics. One was a patient (name and details changed) whose situation was far too common, and one was a personal experience I had after a back injury.

The patient came to me with minor anxieties and some depression in large part due to unresolved grief. She was in her mid-thirties, a nurse, without major medical complications. Almost all her complaints centered on her fear of abandonment in relationships. Early on in treatment, she slipped at work (trying to move a large man from bed to a wheel chair) and injured her shoulder. After MRI’s and doctor visits that lasted months, they finally determined that she had some injured tendons. They put her on Vicodin. They refused her any other form of treatment.

That was 15 years ago. Needless to say her doses increased dramatically over the years as did her anxiety, her depression, and finally she was able to witness the abandonment she so feared. Her marriage fell apart. She was so addicted to the Vicodin that the withdrawal was more frightening than the dissolution of her family.

I have seen this scenario in different forms at least a hundred times. I have made phone calls begging physicians to please reconsider their choice of medication and allow for other medical solutions: acupuncture, physical therapy, massage, homeopathy, mindfulness meditation, hypnosis. With the exception of a few truly open-minded practitioners, the answer was a uniform “no.”

Why would anyone object to an alternative treatment if it brought relief at lower cost and without the risk of addiction and all the associated medical risks?

I found this out for myself personally not more than a few years ago. I fell (hard) and twisted my back. When it happened, I was more embarrassed than in pain and told myself (and everyone else watching), “Oh, I’ll be fine. It’s fine.” Within the time it took for my adrenal glands to stop pumping, the pain became intolerable. I could not walk. My husband took me to urgent care and they told me it was a muscle sprain because there was nothing on the x-ray. They urged me (I mean this literally) to take pain killers.

I said, “No, thank you.”

The doctor on staff looked at me cross-eyed and said, “What do you mean, ‘no, thank you?’”

I said, “I mean no. I don’t want them. How about some aspirin or ibuprofen or something like that?”

He reluctantly gave in and wrote the prescription but not without saying, “You’re going to be sorry.”

The pain was not going away as quickly as I’d hoped but I had seen what opioid analgesics could do and was determined to do whatever I had to do to avoid it. After putting up a fight with the insurance company that lasted two months, I finally went for an MRI where they found the bulging disc that was impinging on my sciatic nerve.

I found a physical therapist who was a hands-on genius and she relieved the pain with a combination of deep tissue massage and abdominal strengthening. We also used guided meditation. She used to tell me to “imagine the butter melting” as she focused on releasing the Iliopsoas, particularly Psoas Major which is the muscle that connects the hip to the spine. It was miraculous and immediate joy.

It was getting better. I was still in pain and not as limber as I used to be, but it was moving in a good direction. And I was willing to work hard to get better. That is, until the insurance company insisted on a new doctor. He looked over my chart and said, “You’re going to need Vicodin.”

I said, “No.”

Once again, that same look: “What do you mean, ‘no?’”

I said, “I don’t want dope. The massage and exercise works. Why can’t we continue that and forget the drugs?”

“Because you’re at maximum improvement. You can get the drugs but not the therapy.”

It was my turn to look at him cross-eyed and I said, much to the amusement of the nurse in the room with us,
“Are you crazy? Who are you working for?”

“According to the insurance company, this is medical standard now.”

I wanted to ask him when the insurance companies and bureaucrats became the arbiters of medical ethics and practice. It became clear to me that because of the structure of medical care today, people who would have otherwise had options and been good doctors, were being led in another direction, a new “standard” set by insurance companies and pharmaceutical interests.

Instead, I just said, “What about your oath?”

“I’m sorry.”

I looked at him and said, “Yes, you are,” and that was that. I walked out. No therapy and no Vicodin. And I had to pay for my own massages and take responsibility for my own recovery. And perhaps this is simultaneously the crux of the problem <em>and </em>the solution. Taking charge of my own healing instead of laying it on the doctor’s shoulders and demanding an immediate pain solution was not easy. In fact, it is an ongoing decision because I still have days with spine-shivering pain. But it has been infinitely better than what I’ve seen with my patients, people who had been struggling with aches and pains or broken hearts turned into addicts with broken homes, empty pockets, and symptoms so wildly erratic they were sometimes mistakenly diagnosed as bipolar instead of addicted. So rather than getting them off the opioids, they were given ever-increasing doses of medication that eventually made reaching–or treating–them impossible.

So, this war on drugs we’re waging? Maybe we should start in the doctor’s office. And it seems to be up to us in more ways than one. I don’t see the pharmaceutical companies leading the battle. Do you?

*1.    CDC Grand Rounds: Prescription Drug Overdoses–a U.S. Epidemic, MMWR, 2012;61:10-13, cited in The Journal of the American Medical Association, February 22/29/20120, Vol. 307, No. 8, page 774
*2.     Ibid.

Initials on a Tree: How Love Lasts

[This article recently appeared in The New Paltz Times, The Woodstock Times, and The Poughkeepsie Times. Courtesy of Ulster Publishing.]
Scan_Pic0009It’s 1962. My brother, Bill, is 19 and his new girlfriend, Cheryl, is just 17. They decided to go for a drive in his new yellow Opel with the fuzzy dice hanging from the rear view mirror. They headed north from New York City towards New Paltz to take a hike in the Mohonk Preserve in the Shawngunk Mountains, a glacial ridge of sacred beauty filled with trails, wildlife and rock scrambles. Nestled in one corner of the mountains is a dirt path that leads up to the Mountain House, a historic hotel overlooking the Catskill Mountains. Behind it is a quarry lake so deep, the water so black, I imagine it as a nesting place for wishes, a portal to possibility, destiny, even magic, a holding space for lovers’ memories.

It was their first summer together and she can recall parking the car in a small lot and heading up a winding path toward the hotel. Sometimes they walked tandem over a narrow precipice, sometimes together holding hands.

At one point along the trail, Bill took out a pocket knife and carefully etched a heart with his and her initials into a tree.

Did he know then? Did she? That he wasn’t just another boyfriend, that she wasn’t another girlfriend? That it was a life-long love and could be engraved into an oak trunk that would bear witness to that walk and to those feelings for a hundred years?

***

It’s 1965, the year Cheryl and Bill were engaged. Right before he proposed, he sat down with our mother, who looked at him with uncharacteristic seriousness and asked him, “Are you sure?” And he said with uncharacteristic certitude, “Yes.”

***

It’s 2012 and Bill died three years ago. This week I went to find that tree and the hand-carved note he wrote into his future.

He and Cheryl were together for 47 years.

On The Trail of a Tree

Initials. How many initials carved into trees are a testament to too little judgment and too much moonshine? How many are a testament to loves lost and hearts still aching? How many are able to draw us a picture of two people on a trail, walking a little slower, perhaps, but still holding hands?

We used to see more of those hearts and letters years back. They used to be on trees or on park benches, occasionally you could see one on a bus, carved into a seat or scrawled onto an ad. Over time, instead of carvings, we saw spray paint splattered onto rocks and concrete bridges: “CS and CJ,” “I love Lane,” “Joey loves Marcy.”

Now, we see them rarely in any form. Instead of initials, you see graffiti celebrating the self or splattering rage. But it seems that fewer and fewer people are willing to make even the temporary commitment to paint. Carving initials into a tree that can last longer than we’d live? Never.

I asked Cheryl if she knew he was the one when she met him. “It wasn’t for me, but it was for him,” she laughed. “He talked about marriage from the beginning. He was open, honest. He poured out his whole life on our first date.”

And that communication proved to be the bedrock for the duration. “I could talk to him about anything. And there was nothing he wouldn’t do for me. I remember one time, it was snowing and he couldn’t drive to see me. But he was determined. So he started walking from Yonkers. He called when he reached the Whitestone Bridge to Queens. He walked miles in the snow. My mother had to tell him to go home, not to dare cross the bridge in a storm.”

Is that sort of love predictable? Chemical? Repeatable? Is it even noticeable? Can we tell the difference between lasting love and young lust? Is it a choice, a learned capacity, or a gift?

Schipani interviewed dozens of couples for an online article in The Ladies’ Home Journal (http://www.lhj.com/relationships/marriage/basics/long-lasting-love/). They were all married more than 20 years and reported themselves to be happy.

How did they do that? Each one had a different story. For Margaret C. it was about being satisfied with what was offered. For Russell S. a happy marriage was acceptance.

Cheryl thinks it may be generational. “A lot of the couples we grew up with are still married, but sometimes that meant keeping their heads in the sand. Our generation overlooked more than yours does. Yours says, ‘I’m outa here.’ And the women now, they have the jobs, the means to leave. It’s easier today. When it’s not that easy, you find ways to work it out. You make a conscious choice to not let a moment, a resentment, a fear take over the whole marriage.”

 

From Ladies’ Home Journal:

“If he helps around the house — washes the dishes, cooks, vacuums — and it’s not quite up to your standards, don’t complain. Be happy he is making an effort to help.” –Margaret C., married 45 years

 “Accept that you can’t change someone. You have to learn to live with whatever annoys you, and remember that you have as many faults as your spouse does.”–Russell S., married 40 years

 “When she gets mad, I just shut up, and she gets tired of talking. After a while, it’s over. In all our years being together, we have never had an argument!” –James P., married 56 years

But all of these comments, while making good sense, are retrospections not prescriptions. They are simple observations on what they have done over the years, not recipes. And they certainly don’t tell us how to know beforehand, if in fact there is a way to know. Although Bill showed little hesitation when he picked up his knife and started carving.

Love Lost in the USA: Can Science Find It?

Currently the divorce rate is one in two, maybe higher in some regions of the country. It is so common, our culture so saturated with scandal and heartbreak, the statistic barely raises an eyebrow—even in more traditional and conservative circles.

One friend told us that he’d thought about getting married again but then he rethought it because he found out there was a fifty-fifty chance it might last. He is far from alone. Americans seem to have an issue with intimacy.

What raises eyebrows is longevity, love that does last, initials carved into a tree fifty years ago that could still be carved into a tree today.

While married couples tell only of their own experience, the “experts” talk about marriage and love as if either one were in fact a science, as if there were some way to predict, control, or warranty the outcome. On website after website, in book after book, they tell us what to do and what to look for.

The authors of Lasting Love: The 5 Secrets of Growing a Vital, Conscious Relationship, wrote:

“If you want a close vibrant love relationship, you need to become a master of commitment.” I could scarcely believe that a whole book had been dedicated to something so basic. Even though I had to grant that sometimes wisdom is a firm grasp of the obvious and there are clearly people who think they can have a good marriage without actually acting married or doing what it is that marriage requires, to me, it was like saying if you want to get wet, get water. Have we gotten to the point where we need that sort of elementary guidance?

Perhaps so. Scientific American Mind ran an article entitled “The Happy Couple.” In it, the author, Pileggi, states that how your mate responds to good news is as important, if not more important, than how well they support you when times are difficult. “In the past few years positive psychology researchers have discovered that thriving couples accentuate the positive in life more than those who stay together unhappily or split do. They not only cope well during hardship but also celebrate the happy moments and work to build more bright points into their lives.”

So people who have a good time together and have a good time having a good time stay together?  Stunning.

One writer, Dee Anne Merriman, chose seven match areas to consider: Physical appearance, emotional maturity, lifestyle choices, financial style, value structure, marriage and sex, and intelligence.  All of these make fine sense until you begin to notice the inherent problems:  They are all presented as if, one, there were actually a sure-fire way to gauge or assess those match-areas, two, a way to centrifuge and separate a person as if he or she were a blood sample, and, three, even an idea of how to line those areas up between two complex beings to produce the perfect relationship.

I began to consider the possibility that this sort of pseudo-empiricism is part of the reason people experience such frustration with love and keep vainly trying to find the “perfect” match; Perhaps their confusion and resignation is due to the fact that they are told by the experts that if only they follow these simple steps, this or that proprietary program, everlasting happiness will be theirs. Of course, it rarely is.

The more I researched, the more I perused the so-called science of love, the more I was left wondering if it can ever be so well-planned or so conscious. I know I made my own “list” before I met my husband and, still, with as much “expertise” up my sleeve as anyone, my marriage certainly surprised me. It surprises me every day with its goodness, its fortitude, and the love that carries us forward—to no credit of my own, I am sure of that.

Did Cheryl and Bill ever think about things like that before they got married—match areas, accentuating the positive, lifestyles?

“We talked about goals—children, those things—but not like people do now. We were also very different. I was responsible and more grounded. Bill was…adventurous, impulsive. I was more restrained. He was an open book. I planned. He flew.”

And they were very different for as long as they were together. So are many of the people I know in long-term relationships or marriages. And not just superficially different—fundamentally so. Their marriages stand as a counterpoint to everything we are being told about how to find true love.

There is a debate deep at the heart of all this: Is love, in fact, a matter of the heart or the brain? Some would say it “depends” on what you mean by love. But I think for anyone who has actually loved another—whether that’s a child or a partner, a friend or a pet—there are no “depends.” While there is an element to it that is ineffable, inexplicable, eternal, when you feel it, there is simply no question as to its truth or meaning. It’s as solid as oak.

So that over the years as you move together through the first flush of Eros into friendship and familiarity, surf mighty high waves of irritation and frustration, it does not crash onto shore or ebb with the tide. It stays still. It digs in roots and holds strong.

C.S. Lewis wrote, “This is one of the miracles of love: It gives a power of seeing through its own enchantments and yet not being disenchanted.”

I would think of love as Lewis did, then: As a miracle, as an expression of something both lusciously earthy and other-worldly, as a glimpse at the promised Horizon through a field of waving tall grasses while tasting the juice of a single blade as you hold it in your teeth, as a Heavenly two-step, a delight of the Divine. It is not empirical. How can it be when it is a heart carved into a tree and a love that still stands, long after the tree itself has returned to the forest?

Carved Anew

We started out on the trail full of childish hope: Maybe, just maybe there would be a trail of crumbs, a sign, something that would lead us to the tree in a mountainside full of trees. We walked for hours.

It took little time until we noticed that most of the growth along the trail was quite young, from saplings to trees perhaps a foot in diameter. The older trees were set far back or lying in enormous pieces on the ground.

Fifty years. The one they carved would have to be closer to 70 or 80 years old. A tree would grow and see quite a bit in that time—flooding rains, ice storms, winds, drought. The odds of us finding Bill and Cheryl’s tree looked worse as time went on.

Then we saw a tree that finally made me accept the fact that we’d be leaving there without the photo we wanted. On a relatively young beech were two sets of names. It was the only tree we found with anything carved on it at all. The interesting thing was that the letters had been growing with the tree and were starting to widen and callous, looking in some parts indistinguishable from the bark. The names were becoming the tree. The tree had made them part of itself.

As we left, I found a poetic justice in that. They, their young affection, that day, that moment, had become part of that whole forest.

Thinking of that tree, of those two kids climbing a mountain and opening their hearts for all the world to see, of the future that would bring both drought and abundance, of children and business, of their last years together and their utter devotion, presenting love as a science reveals at best a profound lack of imagination and, if true, would leave most of us without much hope. I have never seen a list work.

So, as I often do for my articles, I asked my husband what he thought of this whole journey, the initials, whether there is a way to know, whether love can last anymore without people going to experts for answers or techniques. And, in his usual Montanan manner, to respond to the question, he took me out to our backyard and carved our initials into a tree.

 

 

 

 

 

 

Verbal First Aid and Motorcycles!

Biking Article
Montana Cross RiverUsing Your Head After A Crash.

It’s dusk in the desert and you’re relishing the open space and the glorious solitude. The sun hangs heavy as it bursts into shards of color across New Mexico skies. It’s been a perfect ride. You and your riding companion come around a tight turn as you head down into a canyon, thinking only of where you’re going to have dinner, when the lead rider hits a patch of sand and high sides into a wall of granite.

You manage to stop in time, but your friend’s bike tumbled over an embankment and while he is thankfully still on the road, he is not moving. His leg is bent at an angle not meant for human bone. He is conscious but in shock.

You’re alone. It’s nearing dark. What do you do?

If you’ve managed to reach 911 and they’re on the way, what do you say when every moment and every word counts?

This is an all-too familiar scenario for riders. It happens in the country, in the city and all parts in between. Some people, mostly those who have been specially trained to handle critical events, have the skills to approach a situation like the one above with great calm, self-assurance and compassion. Most of us, on the other hand, slip into emotional shock along with the one who is injured. There’s an old wisdom about target fixation: Never watch someone go down, because that’s where you’ll wind up. It is true on a number of levels.
But, even when there’s nothing you can do besides wait for the ambulance, there are things you can say—and ways to say them—that can help your friend survive. Words, when used strategically, can be a most powerful medicine, helping us to lower blood pressure, reduce inflammation, or stop bleeding.

Lt. Samuels (*name changed, story true) sat behind a large, conspicuously clean desk at a Westchester, N.Y.  police station. He was cool, composed, and seemed as uncluttered mentally as he was physically. The awards on his book cases and certificates on the wall attested to a long, successful career. “I paid my dues,” he smiled as he scanned the room and the work it represented. As he saw it, however, his career really started in Vietnam when he was only a teenager serving in the U.S. Army. It was there, assigned to an armored car division sent deep into the jungle, that he learned what it took to survive physically, mentally, and emotionally.

He was on a mission in the Delta, it was summer and the temperature outside had reached upwards of 115 degrees Fahrenheit before noon. Inside the tank it was at best unbearable under normal conditions. On one particular day he still remembers with stunning clarity, it was life-threatening.

“It must have been 130 or more inside. It was hot in a way I had never experienced before. I couldn’t stop sweating, couldn’t drink enough, couldn’t just get up and go to the bathroom. I was burning up. I don’t mean that metaphorically. I was literally burning up and I had to lower my body temperature somehow or I was going to die.  Funny how it didn’t scare me. It was just as clear to me as the coffee in front of me now. It was a fact. I had no air conditioning. I couldn’t get out of the tank. There was nowhere to go except a POW camp, if I was lucky enough to get caught and not killed right away. I remember thinking that I should have been panicking. Instead, I was utterly, crystal clear. It was in the space of such a small moment that I realized it was completely up to me. Whether I survived or not was between me and my own mind.” The lieutenant sat forward, his body compressed with the intensity of the experience, still vivid in him.

“For some reason, I thought about something I’d heard about some monks in the Himalayas, how they went outside in sub-zero temperatures and howling winds to meditate and never suffered any ill effects. They raised their own thermostats. And I figured if they could do it that way, I could lower it. To this day I don’t know exactly what I did or how I did it, but I imagined cool water inside me and around me, like I was dunking myself into a cooler filled with ice or skinny dipping in the lake back home. And hell if it didn’t work. I’m here. I never forgot that,” he sat back. “This,” he pointed to his head, “was my greatest weapon of all. And it has served me ever since, no matter what or where the battle.”

What he used without knowing it at the time is a simple protocol called Verbal First Aid. It is based on the simple notion that the images we hold in our minds are held in our bodies as well. What we think is what we are. What we feel determines how we heal.  Dr. Larry Dossey, one of the foremost proponents of mind/body medicine, has written, “Images create bodily changes—just as if the experience were really happening. For example, if you imagine yourself lying on a beach in the sun, you become relaxed, your peripheral blood vessels dilate, and your hands become warm, as in the real thing.”

If this is even partially true, it is an astonishing statement.

The case to definitively establish the link between mind and body was opened almost 1,500 years ago when Hippocrates wrote that a person might yet recover from his or her belief in the goodness of the physician. It was continued in 1912 when one doctor reported that tuberculosis patients who had previously been on the mend, when given bad news (e.g., that a relative had passed away) took sudden turns for the worse and died. And today the data supporting the connection between thoughts and health, indeed between mental images and survival, are mounting.

Brain scans have shown that when we imagine an event, our thoughts “light up” the areas of the brain that are triggered during the actual event. Sports psychologists conducted one study in which skiers were wired to EMG machines and monitored for electrical impulses sent to the muscles as they mentally rehearsed their downhill runs. The skiers’ brains sent the Bille instructions to their bodies whether they were doing a jump or just thinking about it.

What does this mean for a person out riding in the mountains who suddenly finds himself stuck in a downpour and unable to get out before dark when the temperature is expected to fall nearly 40 degrees? How does this help someone with an asthma attack in the middle of a lake or a rider with a broken leg one hour from the nearest town?

What some people claim is that it can mean the difference between life and death because the words we say (to ourselves and to one another) do matter, especially when we are afraid, in pain, or in shock. By saying the right words in the right way we are able to speak directly to the body, reduce an inflammatory response, help to slow down or stop bleeding, change the way an event is interpreted so that it is experienced differently IN the body.

What Can We Do, What Can We Say: Verbal First Aid in Real Life

According to medical experts, anxiety (or fear) and pain are inextricably woven together for the vast majority of people. A great deal of human discomfort comes from our anticipation of it and our perception of it. Unfortunately, there is nothing marketed as vigorously in this country as is fear. If we’re not scared to death by a headline, it’s a radio report, a movie, a video game, or a television show. We’re literally bombarded by images and ideas that promote fear. We are propelled by it and sold by it.

If the science is correct, the good news is that we can change it on every level—from the conscious to the autonomic. When we alter our thoughts, are soothed by a kind authority, or are assured that we are in good hands, we can begin to feel the changes in our bodies—the softening of muscle fiber, the opening of bronchial tubes, the quieting of pain, the start of healing. This is why so much of Verbal First Aid in the field is directed to the alleviation of anxiety through the development and utilization of rapport. In rapport, a person will feel, “She understands me.” “He is going to help me.” “I’m safe, now.” When we feel understood, our anxiety is reduced. And when anxiety is reduced, pain is relieved. Even if we are entirely alone, clinicians and scientists agree that what we say to ourselves matters and we can direct our thoughts so that our chances for survival are enhanced.

Whether you’re speaking to yourself or to someone else on the trail, how you approach someone mentally and emotionally is at least as important as the medical expertise you have, according to Winnie Maggiore, former Asst. Chief of Placitas Volunteer Fire Brigade, paramedic, former Asst. D.A., and now a malpractice defense attorney. “We saw the Bille things in the wilderness that we saw locally—snake bites, mountain bike wrecks, breaks, falls, cardiac conditions—but the injuries in the wilderness feel worse to the patient in that he’s away from familiar surroundings. Most of what we had to do in rescues was anxiety management. The first step is to let the person know you have the expertise to help. This conviction allowed us to say ‘do this’ in a way that motivated compliance.”

The other major ingredient in dealing with crises, according to Maggiore, is giving people some sort of control over what is happening to them. “When we were just learning emergency medicine, we were given a course in hypnosis so it could be used in pain control, because it could be all we’d have to work with out there. The worst part for patients was being out of control so put them back in control as much as we could, gave them something positive to focus on. Panic is a patient’s worst enemy.”

People normally want to reassure with blanket statements, e.g., “you’re fine.” When this is obviously untrue, it’s the sort of statement that breaks rapport. It’s better to say, according to the experts, that the worst is over and you’re there to help. Your caring presence is the cornerstone of the healing process. If you don’t know what to say, say nothing and listen as you wait for help or do standard first aid. Your care can do more than you might imagine.

The following are just two examples of ways we can talk to someone in distress so that they are calmed, their pain is reduced, and they are moved steadily towards healing.

Asthma Attack .

Bill and his son, Jake, went for a dirt bike ride up a trail that was almost never used. Bill was sure his son had his inhaler with him. Jake was sure dad had it with him.

It was a rugged trail that required more physical exertion than either had expected. When they finally made it up to the first crest, Jake was starting to panic from the tightness in his chest. When they realized they’d forgotten it, Bill was smart enough to take a deep breath himself so that when he turned to his son he was calm, focused, and sure-footed.

Bill:                 Jake, I can see you’re breathing but that it’s a little tight?

Jake:                (Nods, but can’t speak.)

Bill:                 Sit with me here and lean forward like this. Put your head forward like this so your bronchial tubes can open and smooth out. [At this point, Bill’s voice drops in pitch and slows down so that it’s soothing and controlled. He “paces” his son’s breath with his own, carefully so as not to hyperventilate, just enough so that there is a joint rhythm. As he speaks to his son, his breathing slows down just a little bit at a time, “leading” his son back to normal breathing.) And as you do, you can remember very clearly how your inhaler feels when you take a puff on it, a little cool, a little tingly and how it opens you up pretty quickly, you can remember how it feels when it’s working…a little more open now…a little more open, a little cooler, until you can get a really good deep, slow, even breath…

 

A High Side at Five

When we get a whiff of twisting and turning mountain roads, open vistas and the winds of freedom that fill us, it’s easy to take off on an impulse and forget basics: water, first aid kit, cell phone.

Manny and Janice took off on an early Sunday morning, the first of spring. It had been a long winter and while they remembered to charge their batteries, they forgot just about everything else. Manny and Janice pointed their bikes west, Janice leading, and kept going until a deer ran in front of Manny. Reflexively jamming on his front break, he went head over hind end until he wound up in an intimate embrace with a hundred year old oak.

When he was finally able to gather his wits, he saw Janice standing over him. Even though neither had a first aid kit, Janice knew Verbal First Aid.

Manny:            How’s my bike?

Janice:             It’s fine. It’s just taking a nap. That was some acrobatic act.

Manny:            Did you get it on video?

Janice:             Yeah, with the camera in the back of my head.  (She smiled.) I’m going to help you    now, Manny. I can see that you’re talking and thinking just fine.  Let me see  how the rest of you is.

When he stood up, though, they realized he had a deep laceration from a piece of metal

That had been left on the side of the road and blood was pouring down his leg.

Manny:            Damn it! It’s really bleeding.

Janice:             It is and that’s actually a really good thing so that it cleans out the wound. As soon as you’ve cleaned it through enough, you can stop [Janice emphasizes “stop”] the bleeding.

Manny:            Damn it. That was so stupid.

Janice:             It happens to everyone. I know you’ve gotten cut before and you’ve stopped the bleeding before just like you’re stopping it  right now. [She wraps her bandana around it and applies pressure.] You can hold it tight like this. Y’know even as we’re sitting here, it’s already starting to heal and the bleeding has slowed to a stop.

Manny:            Damned if it hasn’t!

Janice:              So… we can either wait for a car to pass or you can sit on the back of my bike…and we’ll ride into town.

Manny:            I’ll hitch.

Mental survival—regardless of where a person is, whether that’s in the extremes of battle or a cross-country ride—is often a matter of recalling or being made aware of the resources one already has. As Lt. Samuels learned the hard way, the mind is the greatest weapon of all.

 

 

 

The Luxury of Divorce

shadow-danceSince 2008, most of us have been walking budgetary tightropes—cutting a piece off of this, snipping some off of that. For a significant percentage, it’s been a steady slide into fiscal chaos, foreclosures, and fear. For some, it’s just the luxuries that have been eliminated: No more the extended vacation, the new car lease every year or two, or the $400 handbag spree. On all counts, it seems that we are a culture moving from decades of “Want It!” to the more realistic “Need It?” Coupon clipping is in again and most people are more worried about whether they’re going to have a roof over their heads than whether they’re sporting the latest Uggs. It has properly affected every aspect of our lifestyles and, hopefully, our values and priorities. But, inevitably, a change so vast has also affected our relationships.

There seem to be two trends at the same time:

On one hand, with less expendable income, there are less expendable marriages. Our new economic realities may be forcing yet another belt tightening—or heart tightening—process: People can no longer afford to get divorced.

One attorney in White Plains, N.Y., Joy Joseph, Esq., has been a specialist in matrimonial law for many years. In the last six years she has seen a very clear downward trend in the number of divorces:

“For people of moderate means, the economy has had a big impact. It is very expensive to get divorced. Only a part of it is attorney’s fees. The bigger part is that the assets are split or devalued in the process. Usually that’s the house, in which they have very little equity. Plus there’s the risk of losing the partner’s health benefits. They’re afraid to live uninsured. So, they cling to an unhappy marriage because they can’t afford to leave.”

The statistics support her observations: A new paper in the B.E. Journal of Economic Analysis and Policy (*1) shows that as unemployment rises, the divorce rate goes down: For every 1 percent increase in the unemployment rate, the divorce rate goes down by 1 percent.

On the other hand:

The NPR-Kaiser Family Foundation survey (*2) suggests that while divorce is down, discord is up. They reported that high unemployment has contributed to ruptures in many families around the country. They state that more than 20% of all Americans who have been without work for more than a year claim that their close relationships have suffered. More than 30% say their financial difficulties have had a profound negative impact on their partners’ health/well-being.

What does this mean for marriages?

Unfortunately for the truly horrible ones it will mean a forced choice between one hardship and another. I know one woman who has no money, three children, no extended family, and no friends because her violent husband has sequestered her. He has gained control of everything, including the children, through both stealth and steady emotional manipulation. He has made her afraid of leaving even though staying will eventually mean her death. She has begun investigating shelters for her and her children and a life she will have to recreate from the very fundamentals, knowing he may still hunt her down. She stands at this crossroads and trembles.

For others in less dire circumstances, it gets complicated by other matters—both material and immaterial. Another woman I know says it’s about money but as it turns out she has about $30,000 in a bank account, a good getaway car, jewelry, and a small, discrete dog she can easily take with her in a carrying case. She knows people in other states. So, why does she stay with a man who hates her, berates her, and beats her? I asked her point blank and she said it was because she likes her furniture. She’s attached to her stuff. While I know that can be true, I think it’s more.

In my experience, a lot of people, men and women, who suffer in abusive relationships do so because they don’t know anything else and have no vista for hope. Often they were so painfully damaged by earlier relationships, they were made to feel as if they deserved no better. I think in her case, it is that she truly feels unworthy and doesn’t trust her own ability to step away, make new friends, get work, and survive in the world on her own. The stuff is little more than a ready excuse.

Another couple, two women who have lived together for fifteen years but have nothing between them but a mortgage, stay because they can’t sell their home. It has been on the market for two years and they have lived utterly separate lives during that entire time.

Some experts say that this may be a situation that bodes well for couples whose marriages are in the borderland between functional and finished. Necessity is the mother of invention and, they suggest, the necessity of living together can force people to find ways to do so companionably, work out issues, and perhaps find it in their hearts to love one another in ways they had not imagined before.

I think of the few moments I was angry and fleetingly considered baling on my marriage—probably the same time my husband considered a similar solution. What made us stand still and work it through? Admittedly, besides occasional pride and obstinacy, our marriage is very stable. Was it just love, then? Surely love was a good part of it, but I don’t believe it was all of it. I believe the commitment and the difficulty of feathering apart two completely interwoven lives overrode the momentary instability. In being faced with staying, we had to work at it. Easy? Far from it. Humbling. Frustrating. Wearisome. Not easy.

But eminently worth it for us. The process brought us to an entirely new level of intimacy, validating everything the optimists hope for and all that clergy argue: that most of us take the easy way out far too easily and leave before the miracle happens.

However, the data does not support the optimism when it comes to marriages that are fundamentally unstable or violent. To the contrary—the current situation should make advocates of domestic violence prevention quite concerned.

If the Great Depression was any indicator, the divorce rate went down, but incidence of violence in the home went up. According to Stephanie Coontz(*3), a historian and professor of women’s studies at Evergreen State College, when states began to permit no-fault divorces, domestic violence dropped by 20 to 30% and the rate at which husbands were murdered by their wives was significantly lowered. According to her, divorce provides a very necessary “safety valve.”

Joy Joseph stated that her experience supported Coontz’s conclusion: “As a result of their inability to afford full divorces, people are going to mediation, which can be good if there’s something to be saved. But a lot of women get hurt in the bargain because they don’t hire their own attorney. They’ve often stayed home to take care of the kids and the husband is generally the main provider and wields the most power. Despite the social changes of the last 50 years, there’s still a great deal of disparity.

“It’s not good,” she adds. “Financial stressors are one of the biggest reasons people split up. Then couple that with the bad relationship and you’ve got a real problem.”

Coontz and others predict that as the downturn resolves, divorce rates will quickly go back up again, which make some people hopeful.

That statistical prediction strikes me as sad, even if it is necessary or inevitable.

Is it wrong to hope that collectively we can learn something terribly important from this recession? Is it wrong to pray that we begin to realize we are not the things we own, rather the relationships we have and the love we give? While I am certainly not in favor of someone staying in a marriage that puts him/her (or children, especially) at risk, I think it might do us all a bit of good to slow down, to take a bit more time between the fight and the time we scream, “I’m outa here.”

 

1)     http://www.npr.org/2011/12/20/144021297/marriage-economy-i-couldnt-afford-to-get-divorced

2)     Ibid.

3)     http://googlinggod.com/2011/12/21/how-to-stay-married-in-the-economic-downturn/

People to Watch: Hudson Valley

Judith Acosta PhotoThis was one of the best welcomes I have ever had, or could hope to have. While I’m still missing New Mexico terribly, this article about Verbal First Aid, The Next Osama, and my general practice as a psychotherapist and homeopath certainly took some of the sting out.

Hudson Valley Magazine People to Watch 2012!

 

Can We Just Call it Homesickness?

refugee tornadoSince 1935, when Dupont adopted the slogan “Better Living Through Chemistry,” we have been a culture pummeled by polymers and overly impressed by the new and shiny. Their advertising not only changed how we thought about the rush of chemicals being delivered to us (through medicine, in our water, in our foods), but reflected a new age of humanity in which biochemistry became a cruel and indifferent king. No longer were people thought of as “heartbroken.” They were thought of as chemically imbalanced.

Most people don’t know that diagnoses vary and move along social currents. Because of the authority with which words like “clinical depression” or “bipolar” are used in modern conversation, they are given the impression that those words have a permanence and solidity they do not actually have.

For instance, what we now commonly call PTSD has only been recognized as a formal disorder since 1980. During the American Civil War, soldiers returning from battle with inexplicable symptoms were said to have “Soldier’s Heart.” In World War I it was referred to as “War Malaise” or “Shell Shock,” in World War II, “Combat Fatigue,” in Korea “Gross Stress Reaction” and after Vietnam, it was cleverly called “Post-Vietnam Syndrome.”

Does it matter what we call it?

Some think it matters a great deal because names often determine approach or treatment. It makes sense. If someone is called “Your Highness” we are sure to approach him or her quite differently than if he or she were called “dear.” Similarly, if we call a state of mind a chemical imbalance, than we are very likely to approach (or treat) that state with chemicals, often many. If, on the other hand, we call it a broken heart or loneliness or arrogance or self-pity, we take a rather different tack.

This comes up because of something a patient said to me the other day. She also recently moved east from New Mexico when her husband was made a corporate offer he couldn’t refuse. She came from an old family in Santa Fe with a history that went back almost 400 years to the Spanish Conquest. She had grown up with open vistas, nearly eternally clear skies, and a community in which everyone knew one another. To say hers was a shocking uprooting would be an understatement.

She came in complaining of inexplicable and free-floating anxiety, lethargy, a tendency to weepiness over trifles, an inability to sleep through the night because of dreams and restlessness. Her first question after she elaborated on her symptom picture was: “Do you think I’m depressed?” The as yet unspoken question underneath was: Did she need medication?

Instead of answering either of those questions, I asked her about her dreams, when these symptoms started, what she’d been doing since she moved here and how well (or poorly) she was getting acclimated to a new environment and culture.

As it turned out, her symptoms began about a month after arriving, shortly after the last box had been unpacked and recycled. Suddenly, there was nothing to do. Her husband was going to his new job. Her two young children were in school. She was at home, sans friends, sans work, sans family. In New Mexico, she had not only been working, she had an extended family that occupied a great deal of her time with social engagements and care-taking elderly members. People stopped into one another’s homes fairly regularly. She had a church she loved. Here, she was alone. Worse, she was lonely.

Could someone call that depression? I imagine they could find support for it in the diagnostics and standards manual. But I’d rather call it homesickness. Not only because it is more precise, but because it gives her a way out.

Of course she misses her home. Of course she feels lonely. Of course she’s bored and restless. Of course she longs for friends and relatives. Who wouldn’t in her situation? There’s no pathology in that.

What needed to be changed were not those feelings, but what she was doing all day with them. First prescription: Volunteer. Second prescription: Find a church with her husband. Third prescription: Join a club (in her case she agreed to a yoga class).

It took about a month for her symptoms to abate.  While she still missed friends and family (and bright, endless blue skies), she was no longer as lonely, bored or restless. She slept better because her energy was redirected and expended during the day. She began to make new friends and feel a part of something bigger than her own heartbeat in a large, empty house.

The more I think about her case, the more I am inclined to think of PTSD as Soldier’s Heart. I think it more clearly sums up what we are looking at: A wound of war that breaks a heart, not a chemistry problem.