Saturday, June 22, 2013

New TED Talk blog posting on the Huffington Post.

Dear Readers,

The Huffington Post asked me to write a response to a wonderful Ted Talk, as part of the Ted Radio Hour.
Maybe some of you are familiar with this NPR program?
The talk is wonderful.  By Candy Chang, entitled "Before I Die."
And they were kind enough to select my blog (among others) to post alongside the video, this on their
TED page.  See it at
If you feel like commenting on the Huff Po page, it makes me look good.


Sunday, March 24, 2013

Rehearsing for Life and Death

A little boy of my acquaintance is worried about death and graveyards and ghosts.  I have been thinking of comforting ways to talk to him about this—something that might be accessible to a 6 year old.  In the midst of my musings I awoke to the fact that I am just as afraid as he, although ghosts and graveyards don’t really bother me so much.   It seems that the predations and losses of aging are my own version of his preoccupation.  The inevitable debility in the body, losing loved ones, mourning recent losses,  these are my ghosts.

I think after a year and a half of working at a cancer support and wellness center in the DC metro area, I am just coming to understand what drew me to this work.  I volunteer once a week to lead a mindfulness meditation group.  I have not been officially trained to do so.  This is in itself remarkable.  I am, however, a qualified, trained, and experienced therapist and a fairly long time practitioner of meditation myself, but my teaching experience is not particularly in this genre.  In the group we mix it up with other practices and I am always drawing on my skills and various tools acquired as a therapist, to deepen and broaden the experience for my very enthusiastic group of meditators.    Remarkably, the changes in those individuals who come consistently and even attempt to practice at home are discernible to themselves and to me.
The members of the group declaim rather loudly and proudly about the benefits and positive energy of the group—they testify to and regularly recruit new members.  But I am quite aware that my benefit is at least as great as theirs.  It is the high point in my week.  Really.

There is the pleasure in doing something that is popular, useful, and positive.  But beyond that, I think I benefit greatly from my relationship with members of the group and with the group as a whole
: their optimism, their strength, their ability to grow in the face of terrifying, often painful, and always life threatening conditions. 

Many are dealing with the long term effects of treatment, more than the threat to their lives.  Surgery, chemotherapy, and radiation leave a variety of “gifts” behind.  The hair grows back, but the neuropathy in hands and feet does not necessarily abate.  “Chemo brain” may recede, but memory may never be quite the same for some.  Unanticipated pain may linger for quite some time after radiation.  Anxiety may take up permanent residence, and thin places in the fabric of family may become deep fissures.

I get a front row seat on how individuals are dealing with these challenges to their bodily integrity and mortality.   Mostly what I see are courage, dignity, and grace under fire.  Of course it’s only an hour a week and a self selected group of individuals who are well enough to sit and listen to the sound of my voice directing them to more peaceful places inside of themselves.  And I don’t observe the moments of sheer terror and rage that walk beside them as well.  But these glimpses of resilience in the woman who dons a stylish chapeau to cover her sparse hair, or manages to look fetching in her outfit despite the loss of 25 pounds or so, enrich my spirit.  The man who teaches himself and practices piano to deal with his overwhelming anxiety and depression and the generous cordiality and even gratitude of those who face the final stages of their disease, inspire and soothe me.

This opportunity to bring comforting practices and to learn from my meditators represents for me a kind of rehearsal for what is inevitable in all of our lives.  Unless we die suddenly, we do need preparation for the last chapter and the loss of those close to us.  There are few models available, for most of death and dying are hidden.  We cannot model ourselves on the brave and the resilient if we don’t know them, if we don’t see them.    They are hidden in nursing homes, hospitals, or hidden away at home.  They are for the most part unidentified.   I have the unusual privilege of meeting, working with and learning from many.

I learned to teach graduate students, something I was also terrified of, by “channeling” one of my most admired teachers and then pretending I was him.  I faked it until I made it. 

Sounds like a plan.









Sunday, January 27, 2013


It was probably 1965 when I did my co op job at  Fairfield Hills State Hospital in Newtown, Connecticut.  This was a huge state hospital campus housing thousands of inpatients from all over the state in need of (mostly) long term custodial psychiatric care.  Although this was decades ago, many of my memories of this time are fresh and crisp.  It was one of a few experiences that shaped my interest in becoming a mental health professional.

The setting, a large institution in rural Newtown, Ct.,  was woefully isolated for two young women in their early 20 's dispatched by Antioch college to fulfill their co-op job requirement. We hung out with some other co-op students from Boston and two male psychologists doing their internship at the hospital.   Gimlets at weeks end with the psychologists were all that was available for “partying.”

There was basically no town in Newtown, as I remember it.   We had to catch a ride into NYC if we expected much fun. 

My memories of the facility where we worked, me as an occupational therapy assistant, my friend J. as an art therapist, are quite positivE, however.  The woman under whom I worked was a consummate professional.  She was highly skilled at creating a program for people who were severely mentally ill and compassionate in her attunement to each individual.  I learned a lot from her.   When I wasn’t working directly with patients, she sent me down to read case records.

On one of those occasions I accidentally discovered that one of the in-patients with whom we worked had come to the hospital  voluntarily, for a short period, had somehow gotten lost in the system and was now a long term resident.  Tommy was not psychotic,  he had come to the hospital for the treatment of depression. Over time he had come to look like he belonged there and did not have anyone to advocate for him. He was heavily medicated, and a physical impairment made him look much sicker than he was.

When I shared this with Madelyn, my boss, she got busy, had him re-evaluated and in short order, "sprung" from the hospital.   Tommy was the poster boy, you might say, for “institutionalization.”  The system had swallowed him whole. It was only a lucky accident that freed him.

Madelyn was not alone among the staff of competent and compassionate employees.  This was a good facility.  Some people got stuck, but most were there because they needed the shelter and the supervision.  Many had nowhere to go.  Larry was an example.  He was in the end stages of Huntington's disease,  a neurodegenerative genetic disorder (the disease that Woody Gutherie succumbed to)  with no cure.     The end stage was often characterized by psychosis.

Larry was a very sweet, bright guy.   He had been a working jazz musician in his prime.  Now he had a hard time walking, controlling the jerky movements characteristic of Huntington’s disease.  And he had psychotic episodes.  He needed the  care that the hospital offered and had few or no other options.  Madelyn was very fond of him and took good care of him.

Patients like Tommy inspired the civil rights activists who felt that the mentally ill were unjustly stripped of their legal rights and were often incarcerated against their will.  They became “institutionalized” and were unable to care for themselves out of the hospital only because they had been socialized to the hospital setting.   In Tommy’s case all of this was true.

But they forgot about Larry, and so many other patients who derived protection from the system, not exploitation and abuse. Sadly, Larry needed the care and protection that the hospital provided.

How strange it is for me to meld my memories of Newtown with current events, in which how to care for the mentally ill is heartbreaking front page news.  My  memory is also vivid for the sweeping policy changes and paradigm shifting of the late 60’s and 70’s that emptied the state hospitals, filled the streets with the homeless mentally ill, and made it next to impossible to care for the seriously mentally ill in any viable custodial arrangements. 

In the name of freedom,  we forsook the mentally ill decades and decades ago.  Instead of re-thinking the system, we jettisoned it, de-funded it, and provided nothing to take its place. 

I join my voice to all the others calling for a humane reconsideration of our responsibilities to the seriously mentally ill.

Friday, January 4, 2013

What Good Can It (Psychotherapy) do?

What good can it ( psychotherapy) do?

The  question above is one that I encounter frequently in one form or another from friends, potential clients, close relatives.  It takes various forms:

  1. What can they tell me that I haven’t already thought of myself?
  2. Life will take its course no matter who I talk to.  My partner will die and I will be alone.
  3. I’m going to die anyhow.
  4. Talking won’t bring her/him back.
  5. I’ll still have cancer/multiple sclerosis/end stage heart disease.
  6. There really is no way out of my marital/familial/work dilemma.
  7. My depression is a result of a chemical imbalance.

I’m frequently not quick enough on my feet to respond thoughtfully, so I’d like to take a moment to do so now.

Therapy, at least the kind that I know about, is not chiefly about finding solutions, i.e., problem solving.  Intelligent people are generally quite aware of a range of solutions to their problems.   They just can’t act on them.  They are frozen.

They  think that no potential solutions are really applicable to their situation or relevant or available to them.  Or they feel, and perhaps this is the  most frequent, that in their particular case there are no real solutions.   Its almost reflexive for the listener, the relative, the loved one, the good friend, the clergy person, even some therapists to offer some thoughts as to possible solutions.  Inevitably they fail.  Its not about that.

Within most adult folks there is an inner wisdom that would offer great assist in resolving the impasses of our life. Therapy is about accessing our inner, innate wisdom, not replacing it with someone else’s.  I can think of many instances where I felt that there were no solutions.  I was trapped.  In retrospect I knew the solutions and just found them totally unpalatable.  I could not end that destructive friendship, it was just too important to me.  I could not resolve a domestic or an economic problem, I just wasn’t strong enough.

So what are the elements of psychotherapy that  enable that inner compass.

  1. the magic of relationship.  When researchers have tried to isolate the “active” ingredient in successful psychotherapies, across many theoretical approaches (CBT, psychoanalysis, mind/body  approaches)  they frequently come up with the same answer:  “it’s the relationship, stupid,” the connection between therapist and patient is the key remedial. 

Neuroscientists have a more exact way of stating this, it’s about “limbic (a key brain structure) resonance.”   Simply stated,  therapy is not so much about the rational, linear, thinking mind.  It’s more like music.  In the best situation the therapist hears the particular melodic essence of the individual, playing softly in the background and is able to tune in and hum along, maybe even in harmony.  Just this tuning in is deeply healing.  How many people in your life have actually heard your “melodic essence”?  Do you think even you have heard it?

2.  A therapist listens differently than other people. I heard a story once of a psychotherapist describe his occupation, at a cocktail party, as one of  listening  “I listen for a living.”

A therapist’s training and experience sharpen and educate their musical ear.  It has been called “listening with the third ear, (Theodore Reik)” among other things.   When things go well, a good therapist hears what others do not, even the speaker.

A therapist may hear anger where others only hear hopelessness, fear where others hear anger, shame where others hear belligerence.   Truly thrilling for both the patient and the therapist is the moment when a door opens and the narrator gets a slightly different perspective, a different way of hearing their own feelings/problems.   “Maybe its not my inadequacy, maybe I am feeling truly alone in this intimate relationship.”  “Perhaps my adversary doesn’t hate me, perhaps they are deeply ashamed of their failures in life and feel humiliated.”  And most powerfully, “maybe there is meaning embedded in my confusion and in my unremitting pain.”   Meaning can set one free.

Certainly there is much more to be said on this subject.  But I will pause here and invite readers, both those who have experienced therapy and those contemplating dipping a toe in, to share their thoughts.

Happy New Year to all!!