counseling

April 25, 2010

Sex and (S)ex-pectations

Sexual performance.

There, I said it. Of all the things men hate to talk about in any realistic detail, this is it, with the possible exception of colonoscopies. Oh, young men in the cloistered confines of a locker room will talk about their prodigious sexual performance; occasionally, those self-proclaimed exploits even bear some resemblance to the truth. But, too often, the male of the species wants his male acquaintances to believe that he is some sort of super-hero, capable of great feats of stamina, if not strength, that are well-beyond his actual capacity.

In reality, the fact that the sexual organ of the man can be observed by his partner contributes to the performance anxiety of many men. Even those males who are relatively secure might wonder how they compare to other men.

My purpose here is to provide a bit of grounding, just a little bit of the truth, so that you or your lover do not need to feel inadequate. To wit:

1. It is infrequent for any couple to be able to sustain intercourse for more than 12 to 15 minutes.

2. More typically, the intercourse lasts from two to seven minutes.

3. The entire sexual encounter typically takes from 15 to 45 minutes.

4. Even among sexually content and well-matched couples, less than 50% of the sexual encounters are optimal.

5. There is a great deal of variability here, and things like timing, affection for one another, alcohol or drug abuse, age, time of day, stress, and physical problems all play their part and influence what happens.

There. I hope you don’t feel so bad.

If you’d like to know more, you might want to consult various of the publications of Metz and McCarthy including Coping with Premature Ejaculation and Coping with Erectile Dysfunction.

—

The image comes from the Dancehouse Theatre’s “Kiss Bike Kiss” at the Manchester Bike Culture Festival of 2008.The author is Echomrg and it is sourced from Wikimedia Commons.

April 7, 2010

Health Care Reform and Unintended Consequences: A Prediction

Health care reform has been necessary for a long time. But having said that, I’d like to give you an example of how the expected changes might lead to some unfortunate results, as well as some that are helpful.

My example will focus on Medicare. Everyone knows that Medicare is expensive for the government and that it will ultimately suck the life out of the national economy if costs are not restrained. One way to restrain costs is to require physicians to accept lower fees for their services, something that Medicare has struggled to do for a while, even before passage of the recent health care legislation. Providers are already getting paid less than they were a few years ago, but even more extensive mandated annual changes have been regularly rescinded by the Congress. If they are actually accomplished in the future, Medicare would pay out still less to those same MDs, Ph.Ds, and other health care professionals.

What will happen when reduced fees become more significant? Some healers will decide that it is financially unwise to see patients who are covered by Medicare. They will drop out of the Medicare panel of providers. The greater the fee reductions, the smaller the number of physicians available to see Medicare patients, while at the same time the number of individuals covered by insurance is increasing, led by the large expected additions to the rolls of the insured because of recently passed health care reform legislation.

Let’s say you are the following person: someone covered by Medicare who doesn’t have the cash to pay for treatment out of your own pocket, who also has a medical problem or concern that cannot wait very long. The good news in this hypothetical example is that your MD still accepts Medicare. But when you call your doctor’s office, you are told that you can’t have an appointment for four months—again, hypothetically speaking. The problem and the pain aren’t getting any better in this period of time, maybe they are even getting worse. So what should you do?

First, you will probably try to find another medic who accepts your insurance and has a nearer-term appointment for you. But given the anticipated shortage of people who do take Medicare patients, it will be unlikely.

Eventually, however, you will do what any sensible person would do once the problem becomes really acute—and what your doctor’s office will probably advise you to do under the circumstances—go to the emergency room of your local hospital.

Since emergency room care is notoriously expensive and since the condition might be harder to treat because you waited, this will only serve to drive up the amount of money spent on health care, something that the intended reduction in doctor fees was expected to reverse. Whether the decrease at one end will outweigh the increase at the other, I do not know.

And, instead of the growing number of  people who had no health insurance being the impetus for the increased use of the ER, it will now be people with health insurance who are using it more because they have no other readily available alternatives.

I don’t have a handy solution to this problem. My hunch is that there is some amount by which doctor’s fees can still be cut before they start dropping out of the Medicare system in large numbers. It may be that only trial and error will determine exactly how much cutting is possible before producing the unintended consequences I’ve described. The good news, however, is that where there is a high demand for services, eventually supply does catch up, although in the case of producing more docs it will takes years to do so.

Surely, there will be many more unintended consequences of health reform just around the corner. Some might actually be beneficial, but certainly not all. The system we have is not working well for many of our fellow-citizens, so the status quo is not a good answer. Doubtless, once legislators hear enough complaints about problems such as the one I’ve described, they will attempt to alter the system further. How long it takes before we get something that works well is unknown. It is likely that we will eventually have a two-tiered system: a universal, government-run insurance plan on one side, and some number of pretty rich people simply paying for health services out of their own pockets on the other.

In the short run, all of this reminds me of an old joke Woody Allen told at the end of one of his nightclub routines.

It went something like this:

I’d like to leave you with a positive message.

But I can’t think of one.

Would you take two negative messages?

March 26, 2010

Jackie Robinson, Ford Frick, and the National Health Reform Debate

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With even one eye shut and one ear covered it would have been hard to miss all of the acrimony expressed by and toward our elected representatives in recent days. And, some are saying, that this is unprecedented—this loss of civility, this frank hatred, including acts of vandalism and threats of murder.

Many are decrying the failure of some Republican politicians to rebuke the hate-mongers in an unconditional and decisive fashion, as Republican Representative John Boehner has: “I know many Americans are angry over this health insurance bill, and that Washington Democrats just aren’t listening. But, as I’ve said, violence and threats are unacceptable. That’s not the American way. We need to take that anger and channel it into positive change.”

Well, unfortunately, angry words and angry actions are really nothing new in “The Land of the Free and the Home of the Brave.” You will find them on both the political left and the political right within living memory: the violent “Weather Underground” of the Vietnam War era, The Black Panthers, the lynchings of blacks in the period between the end of the Civil War and the passage of Civil Rights legislation, the hate crimes against gays, the gauntlet of verbal abuse shouted at black children trying to integrate the schools of Mississippi and Alabama in the mid-20th century, the bombing of abortion clinics; the Oklahoma City bombing; the assassinations of JFK, Martin Luther King, and Robert Kennedy; and on and on.

But, every so often in the midst of all this angst—this stuff that makes one despair about the human condition—someone stands up and does something remarkable; something that makes you proud to be an American, and hopeful about the future of the human race.

Turn the page of your history book back to 1947 and to Jackie Robinson of the Brooklyn Dodgers, the first black man permitted to play in the Major Leagues in the 20th century. What follows is heavily dependent upon (and quotes from) Jules Tygiel’s Baseball’s Great Experiment: Jackie Robinson and His Legacy.

—

Robinson faced a revolt by some of his own teammates who attempted to organize a petition against him. Kentucky-born Pee Wee Reese, who was to become a great friend and supporter of Robinson, later remembered, “In the park that I grew up in, there were no blacks allowed. Blacks got in the back of the buses, they had a special fountain to drink from. I don’t guess that I ever shook the hand of a black person.” Reese expected Robinson to fail because white people in his part of the country always believed that Negroes had no guts.

“You hear this all your life, you believe it.”

The petition died aborning because most of the players would have no part of it, and because of threats from management. But the bigoted sentiments were still there for Robinson to deal with. His teammate Kirby Higbe was asked on a radio interview how he’d come by such a strong arm. His answer? From pelting Negroes with rocks.

Dodger manager Leo Durocher laid down the law: “I don’t care if a guy is yellow or black, of if he has stripes like a f___in’ zebra. I’m the manager of this team and I say he plays.”

The Philadelphia Phillies were the worst of the race-baiters. Led by Alabaman Ben Chapman, the Phillies showered unspeakable derision on Robinson in their first series with the Dodgers early in the 1947 season.

According to Harold Parrott, “At no time in my life have I heard racial venom and dugout abuse to match the abuse that Ben sprayed on Robinson that night. Chapman mentioned everything from thick lips to the supposed extra-thick Negro skull…(and) the repulsive sores and diseases he said Robinson’s teammates would become infected with if they touched the towels or combs he used.”

Chapman knew that Robinson couldn’t fight back because of the disruption that would cause, the very thing that many predicted and used as an excuse to defend the segregation of the Major Leagues. Everyone soon came to know that Robinson, who received varsity letters in four sports at UCLA, was a sitting duck. “Plenty of times I wanted to haul off when somebody insulted me for the color of my skin,” Robinson later said. “But I had to hold to myself. I knew I was kind of an experiment…The whole thing was bigger than me.”

One teammate thought that Robinson, the sole black on the field, was the loneliest man he had ever seen. Red Barber, the Dodger’s radio announcer, said that Robinson was the only man he had ever seen who could actually play better when he was angry.

The death threats flooded in—the people who wrote that they would be carrying a rifle into the ball park to kill him. Opponents tried to spike him, pitchers threw at his head and body. Even his Southern teammates received hate-mail for allowing themselves to take the field with a “n____r.”

But Robinson’s teammates stood up to Ben Chapman and the Phillies. Fellow Alabaman Eddie Stanky called Chapman a coward. Meanwhile the St. Louis Cardinals baseball team plotted a May strike against Robinson and the Dodgers. Ford Frick, the National Baseball League President, quashed the strike and faced down the Cardinals:

If you do this you will be suspended from the League. You will find that the friends you think you have in the press box will not support you, that you will be outcasts. I do not care if half the league strikes. Those who do it will encounter strict retribution. They will be suspended, and I don’t care if it wrecks the National League for five years. This is the United States of America, and one citizen has as much right to play as another.

The National League will go down the line with Robinson whatever the consequence. You will find that if you go through with your intention that you will have been guilty of madness.

—

As I said earlier, we have been here before, in this dark place in America that seems to surface especially in difficult economic times or in times of change, of which we have both just now. America is changing today, just as it was changing in 1947, and that metamorphosis brings out the worst in some of us. But the courage of people like Jackie Robinson, and the decisive confrontation of unfairness by people like Ford Frick, are heartening.

At the 1948 Democratic National Convention, Senator Hubert H. Humphrey made an impassioned speech in advocacy of a strong civil rights plank that failed to become a part of the Democratic Party’s platform in that year’s election. His words are worth remembering, as he recalled the founding of the nation in 1776:

To those who say, ‘we are rushing this issue of civil rights,’ I say we are 172 years late. To those who say, ‘this issue of civil rights is an infringement on states rights,’ I say that the time has arrived for the Democratic party to get out of the shadow of state’s rights and walk forthrightly into the bright sunshine of human rights.

—

Eventually most of Robinson’s skeptical teammates and competitors came to think differently and act differently than they had, at least to the point of accepting that blacks had as much right to play the “Great American Pastime” as they did. Still, the animosity did not end immediately.

As noted by Stuart Miller in the April 25, 2010 New York Times, Robinson continued to be the target of pitched balls in those days before batting helmets. In his first eights seasons he was lower than third in HBP (Hit By Pitches) only once. Moreover, the handful of blacks then in the National League—people like Monte Irvin, Sam Jethroe, George Crowe, Billy Bruton, Ernie Banks, and Hank Thompson—were similarly treated. In the American League, Larry Doby, Luke Easter, and Minnie Minoso found it no different.

Time passed, the hard-line bigots left the game, and others who were more open and less shocked and offended by integration took over the field of play. When Ernie Banks joined the Chicago Cubs in 1953, management saw to it that he join the club at the same time as (and roomed with) Gene Baker, so as to avoid the issue of having one black man and one white man live together.

It took 10 years from the time of Robinson’s debut for the Philadelphia Phillies to allow a black man into a Major League uniform, with the Detroit Tigers behind them. The last to integrate was the Boston Red Sox squad in mid-1959.

Along the way America changed too, for the better. And one must believe that the voices of the fulminating, frustrated few on the political landscape today will eventually be replaced by those who are less self-righteous and more in control of their emotions.

As a therapist it is impossible to do my work without believing that people can change.

It doesn’t always happen, of course.

But it happens more than enough to keep pitching.

March 22, 2010

Therapist Humor

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It seems that the psychiatrist and his wife found themselves unexpectedly alone at home on a Sunday afternoon. The youngest of their children, the only one living with them, had departed for an event anticipated to keep him away for a few hours. And so, the long married couple decided that love in the afternoon was in the offing.

But, much to their surprise, the teenager returned a good deal earlier than planned — in the middle of everything. Their bedroom had two doors, and they quickly sprang up to lock them both, so that the boy wouldn’t catch them in an embarrassing situation.

Just then, their offspring yelled to see if they were home.

No answer.

He ran up the stairs and tried the near door of their bedroom, once again calling for them.

No answer.

He ran around to try the far door of the bedroom, again knocking and turning the door handle, still loudly crying their names.

No answer.

Finally, he stopped moving, staying in front of the far bedroom door.

This time, he called not for them, but yelled something a bit different.

“What, sex makes you deaf?”

—

The above image, Laughing, was created by Eric Ward and is sourced from Wikimedia Commons.

March 17, 2010

What It Means To Be a Man: Reflections on the Ides of March

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We hear the expression frequently—“Be a man!” Usually when we are small and usually directed to males. In the context of an admonishment, it typically means to “be tough,” show little emotion, be stoic, have courage, avoid whining.

But, when you are a little older and more thoughtful you might come up with a different definition. The German word “Mensch” (“man” or “human being”) provides us with a starting point.

You will recall that Friedrich Nietsche gave us the idea of an “Übermensch” or “superman.” Not someone who “leaps tall buildings in a single bound,” but a superior creature to whom a new set of life rules applies. Indeed, the Übermensch creates a set of values, discarding those that belong to a world that he rejects and a god that he thinks to be dead.

Goethe, the great German poet, scientist, and philosopher of an earlier time, had something quite different to say about man in his poem The Divine:

Let man be noble,
merciful and good;
For that alone
Distinguishes him
From all the living
Beings we know…

In Yiddish, a language that has German roots, to be a “mensch” means to be decent, forthright, strong, honorable, and dependable. Someone to be leaned on and counted on. A person of principle, with both a good heart and a good head. A fellow to be reckoned with; a companionable individual of integrity, unafraid of self-assertion.

But there is a different version of “being a man” in the popular culture. In my mind, it is associated with the likes of Clint Eastwood and John Wayne, as portrayed in the numerous “Western” movie roles they took on; on the political front, George W. Bush probably is a rough equivalent.

This “man’s man” is a tough, intimidating, austere, cocky, unrepentant, decisive, and unflinching he-man who never complains or cries out in pain. A guy like this doesn’t look back. He is the opposite of the “Alan Alda,” version of what it means to be a man, which emphasizes a kind, empathic, more sensitive side of human possibility.

The popular vision of a man is someone who is more into solving problems than dealing with feelings, someone who is “logical,” someone more in touch with his head than his heart. When a woman opens herself to him with an injury, he is prone to offering a solution or trying to “fix” things rather than patiently listening and holding her hand.

This rock-solid, heroic figure is the strong-silent type, uncomfortable with public (and sometimes event private) emotion, and a person of few words; certainly not one given to eloquent speech. He is much more inclined toward action than talk. The “John Wayne” version of a man is well described in the closing lines of Shelley’s Prometheus Unbound:

To suffer woes which Hope thinks infinite;
To forgive wrongs darker than death or night;
To defy Power, which seems omnipotent;
To love, and bear; to hope till Hope creates
From its own wreck the thing it contemplates;
Neither to change, nor falter, nor repent;
This, like thy glory, Titan, is to be
Good, great and joyous, beautiful and free;
This is alone Life, Joy, Empire, and Victory.

In any discussion of manhood, one must also inevitably give a nod to “manhood” as it is understood in every day speech; that is, male sexuality. It takes a few forms.

One is simply the ability to be commanding and sexually appealing, to be an experienced and confident lover. Another is the capacity to perform sexually. The problem that follows from this, of course, has to do with the pressure to perform, the anticipated evaluation of that performance, and sometimes the failure to perform.

In old age, both the capacity and interest in such activity have been known to fall away, leaving it to the man and any companion or spouse to determine whether manhood should still be subject to judgment about anything to do with sex. Medicine is perhaps making such considerations irrelevant with the easy availability of Viagra, Cialis, and the like.

On the other hand, a failure of potency, that is, the ability to perform sexually coupled with an inability to foster children, remains a problem in the minds of most such men and one that still lacks a scientific work-around other than adoption or artificial insemination of the man’s wife by someone else, a solution that most males find decidedly abhorrent.

Finally, if you’d like a more Shakespearean commentary on the subject of being a man,  you must read Julius Caesar. Those of you who know the play are aware that Caesar is not the main character, even if he is the title character.

Rather, the story is about Brutus, Caesar’s friend and admirer, who is persuaded to believe that Caesar has become a tyrant and will visit evils upon the Roman people. Others among the conspirators have their own axes to grind against Caesar and seek personal gain by his overthrow. But Brutus agrees to the plot despite the fact that it is against his nature, only because he concludes that the assassination of Caesar is in the best interests of his fellow countrymen, in order to free the Republic from Caesar’s control.

As so often occurs in classical tragedy, the conflict between one’s public obligations and private loyalties is the undoing of the hero, in this case Brutus. And so, the famous murder happens in the Roman Senate on March 15th, 44 BC, 2054 years ago this week, after Caesar ignores the warning “Beware the Ides of March!” There is a fantastic movie rendition of the play starring James Mason as Brutus and a young Marlon Brandon as Marc Anthony, Caesar’s ally.

After Caesar’s death, Anthony is targeted for death by Brutus’s fellow conspirators, but Brutus stops them, allowing Anthony to speak to the people and eulogize the fallen Caesar, only to rally the Romans against the conspirators and ultimately, to defeat them in the ensuing civil war. It is Brutus’s essential humanity, decency, and sense of fairness (all qualities that contribute to “being a man”) that call him to let Anthony speak.

You will recall the words “Friends, Romans, countrymen, lend me your ears…,” so persuasively rendered by Brando in the aforementioned film, that stir the Roman crowd against the conspirators. Had Brutus been less honorable, he would have avoided the risk that Anthony’s words might incite the rabble against them and perhaps even agreed with his co-conspirators to kill Anthony. And, as portrayed by Shakespeare, it is the decision to allow Marc Anthony to live, not the murder of Caesar, that is the proximate cause of Brutus’s downfall.

The play ends with Brutus dead, and Anthony reflecting on who Brutus was and why he was worthy. And, it is Anthony’s words that provide us with a final comment on what Shakespeare has already told us in the play about what it means to be a man.

Please note that the word “gentle,” as used by Shakespeare, means something approximating “true, cultured, and affable:”

This was the noblest Roman of them all:

All the conspirators save only he

Did that they did in envy of great Caesar;

He only, in a general honest thought

And common good to all, made one of them.

His life was gentle, and the elements

So mix’d in him that Nature might stand up

And say to all the world ‘This was a man!’

—

The bust of Julius Caesar above is to be found in the Musée Arles Antique. The image was created by Mcleclat and sourced from Wikimedia Commons.

March 13, 2010

Moral Choices

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It is easy to judge others, but are not without blind spots in judging ourselves. In the domain of moral choices, this becomes particularly problematic. How many times have you heard or thought to yourself, “If I were he, I would have done that differently.” Or perhaps, “If I were he, I wouldn’t have done what he did.” But how many times have you said to yourself, “If I’m honest, if I were in the same situation, I really don’t know what I would have done.”

I’ve listed below a few such moral dilemmas, some drawn from real life accounts. I hope you will put yourself in each one and ask yourself three questions:

1. What is the right thing to do?

2. Would I do the right thing?

3. Am I absolutely sure what the right thing is?

A. If you have seen the 1957 movie Abandon Ship, you know the moral quandary in which Alec Holmes (Tyrone Power) finds himself. Holmes is second in command of a luxury ocean liner which strikes a mine. He takes charge of a life boat when the captain (Lloyd Nolan) dies from injuries sustained in the explosion. The small vessel is seriously overcrowded (including numerous people who are hanging on from ocean-side), has limited supplies of food and medicine, and is in shark-infested waters with only small amounts of  shark repellent in hand. Those hoping to survive include the young and old of both genders, some of whom have been grievously injured as the ship went down.

Soon they become aware that no SOS was sent, because the explosion destroyed the radio. Concluding that no rescue ship will be looking for them, Holmes determines the infirm and weakest must be ordered off the so that the remaining individuals can have a chance at survival by rowing the very great distance to the nearest land mass, with enough food to sustain them until they reach it. What would you do if you were in charge?

B. This comes from the oral history of a Holocaust survivor as described in Holocaust Testimonies: The Ruins of Memory by Lawrence Langer. Imagine that you are one among many Jews swept up in the Shoah (the Hebrew word for the Holocaust). You have been separated from your parents. You aren’t certain whether they are alive or dead. In fact, the Nazis have taken a large group of Jews, including your mother, to a place in the forest. They have required these people, at gun point, to dig a long, deep trench. While doing this, the soldiers are joking, smoking, and drinking. Once the trench has been dug to an adequate depth, a handful of the soldiers shoot their machine guns at the diggers along the line of the trench. Some are killed instantly, some dive into the trench to escape the gun fire, and others are wounded to various degrees of severity.

Meanwhile, you are far from this action. Perhaps you heard the gun fire in the distance. But once it is finished, the Nazis assemble a group of Jews to fill in the trench, to cover over their dirty work, quite literally. You are in this group, assigned to this grisly task. The soldiers have their guns on you and your co-workers, reminding you to work quickly or else. Much moaning and screams of pain are heard from this place. And one more thing: From the trench in front of you, a familiar voice is also heard, quite distinctly. It is your mother’s voice. She is telling you that she is not wounded and pleads for your help. What should you do? What would you do?

C. You are Agamemnon, the leader of the Greek expedition to Troy, provoked to war by the abduction of Helen of Troy, the wife of your brother Menelaeus. Before you and your 1000 ships can reach Troy, however, your fleet is stuck in place, stopped by the intercession of a god named Artemis. Time passes. Your supplies of food and water are dissipating. In addition to your family responsibility to defend the honor of your younger brother and help him retrieve his wife, you are aware that Zeus, the most powerful and important of the gods, has demanded that you sail to Troy. A seer is consulted to determine what might be done to appease the god Artemis and enable the fleet to be launched. You are told that you must sacrifice your virgin daughter, who is not far away. What should you do? What would you do?

D. The economy is tough. You have been out of work for some time. You don’t want to lose your home or apartment, and you are afraid that if you can’t find work soon, that might eventually happen. But, you’ve been networking, and it finally pays off. You are offered a job selling AK-47s, assault weapons that fire 600 rounds per minute, whose principal use is to kill people. While you would only be expected to sell these arms to “legitimate” buyers, you are also aware that the AK-47 is one of the world’s most frequently smuggled weapons and the rifles you sell are likely to get into the hands of criminals and drug lords. Should you take the job? What would you do?

E. An elderly aunt dies, one you have not seen in many years. She has named you the sole beneficiary of her estate, a total of $600,000. You are doing well financially, so the money is not a necessity for you, but you can certainly imagine an enormous number of uses for it (including charitable giving), not to mention the fact that it would allow you some peace of mind, knowing that you will be even more financially secure. You also have two siblings and two cousins, none of whom were more or less close to your aunt than you were. You are under no legal obligation to share the money with them, but you wonder whether you should. What would you do?

F. You are politically “pro-life.” You have campaigned for candidates who believe, as you do, in the sanctity of life from the moment of conception. You believe that abortion is murder, without qualification. Financially stable, you have donated money to prevent abortion. A young woman approaches you, someone you know, and who knows and respects the aforementioned beliefs. She is pregnant out-of-wedlock. She would like you to adopt her child. She knows that your two children, who you had when you were quite young, are grown, and believes you would be just the right parents for the new life she carries inside of her, in part because of your moral stance against abortion. She is terrified to give up her child to someone she doesn’t know and who might not provide the kind of home that she believes you and your spouse can provide. But the two of you had decided some time ago that you only wanted two children and, in fact, you have been looking forward to any empty nest and to the freedom it would permit you while you are still in your 40s. What should you do? What would you do?

G. The Holocaust again. This time you are a German gentile. You have a spouse and children. You are not wealthy, but you are getting by. You are not sympathetic to Hitler, but well aware of how the Gestapo works, and that anything seen by them as disloyal to Hitler and the Reich would likely cause you to be interrogated, perhaps sent to a concentration camp, or worse. Your family depends on you for their livelihood. A Jew comes to your door after dark. You know him, but only very casually. He asks you to hide him. You have heard rumors about what is happening to the Jews once they are sent away and, in fact, have been told by a witness that they are being murdered. What should you do? What would you do?

—

I am not here to give you answers to these questions, assuming that I would be able to come up with just one acceptable moral choice; or that I am some sort of moral authority, which I am not. It can be argued that some of these situations do not allow for a “right” action; not all situations in life offer absolute clarity. Life can be complicated, as these examples demonstrate.

To be sure, none of us are as good as we could be, but that does not mean what is good is always apparent. Indeed, in Aeschylus’s telling of Agamemnon’s story, the title character utters the words “(Which) of these things (choices) goes without disaster?” in describing the the conflict between his public responsibilities as leader of his troops, head of his (and his brother’s family), and the demands of the gods Zeus and Artemis versus his private responsibility as the father of young Iphigenia. The heart break is readily apparent in this man’s dilemma of whether to honor all the aforementioned interests except the one closest to his heart in “such sacrifice of (the) innocent blood…(of) the beauty of my house.”

On a daily basis, we can only do our best to lead moral, principled lives. Not just to talk about it, or formally worship a deity on a holy day, or even to donate some money, but to weave those beliefs into the fabric of daily, commonplace interactions, and try not to fool ourselves when we fall short; to minimize the everyday fibs, moral compromises, and inconsiderations; to show kindness, be forthright, go out of our way for others. To do what is right when no one is looking.

On the other hand, if we want to find out if our morality goes the distance, then we have to be tested — confronted with something difficult and costly, if not dangerous, if not horrible in its implications, as in the examples I’ve given you above; and until then, be humble, not knowing exactly what we would do.

Being a “nice person” is easy enough … until the chips are down.

Most of us won’t ever know the answers to the kinds of questions I have posed, that is, what we would do if actually faced with them.

Best not to know, I think.

—

The photo above called Choices, choices… is the work of Duncan Lilly, originally sourced from geograph.org.uk, sourced for this blog from Wikimedia Commons.

March 11, 2010

What Children Need From Parents III: Beware the Extinction Burst!

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Popular culture gives us just enough information to be confused.

Not surprisingly, many parents who have never taken a psychology course know it is important to set limits on their children and to be consistent in enforcing those limits. Despite this, a good many parents don’t have the strength of will to withstand the repeated pleading of their kids, or the energy to do so.

If your child wants you to buy him a candy bar or a toy while you are in the store, many parents believe it is simply easier to give in than to listen to the endless entreaties of their offspring.

In some cases it can be too exhausting or overwhelming to have to deal with a persistent child, in other instances the parent might fear losing the child’s affection if the desired treat isn’t forthcoming, and in still other situations the parent feels guilty if he or she deprives the youngster of something.

For all the reasons I’ve just mentioned, I always tell parents before they intend to change their style from one that inconsistently reinforces their child’s misbehavior, they have to be strong enough and knowledgeable enough to be prepared for what comes next.

And what comes next is something pretty powerful.

Its called an “extinction burst.”

First, what is “extinction?” Extinction occurs when a behavior that has been previously “reinforced” (some would use the word “rewarded”), no longer receives reinforcement. Eventually, the organism (animal or person) will stop performing the behavior. Put differently, the undesirable behavior is “extinguished.”

Take, for example, a laboratory rat. You can teach these creatures to press a bar in order to get a food pellet. Rats are good at this. But, if you no longer give the rat food pellets for pressing the bar, the critter will eventually stop doing the bar press. But there is a catch here and it relates to the word eventually. And the catch is what is called an “extinction burst.”

Let us assume your child, like the lab rat, has learned something about how you deliver reinforcers. The reinforcer could be the aforementioned candy bar or toy; it could be money; it could be your attention; it could be staying home from school; it could be a lot of things.

And, let’s further assume that you no  longer want the child to keep pestering you for whatever it is that he wants. Now, remember he hasn’t gotten what he wanted every time, but often enough to learn to be persistent and keep at it until you “break” under the assault.

The “extinction burst” consists of the young-one doing even more of the behavior you want to eliminate at the point you stop reinforcing him.

That might mean he will be louder, or pursue you longer, or repeat more often whatever has worked before. It can go on for a very long time until, finally, the child learns the lesson you want to teach him; in other words, learns he will no longer receive what he wants for his inappropriate actions.

But if you finally do break down and reinforce the child with what he wants during the “extinction burst,” he will have learned an awful truth: “Well, maybe I just have to do this behavior longer or more or louder in order to get what I want.” Indeed, the child doesn’t even have to be able to think or say this to himself.

Even laboratory rats operate according to the same rules of learning, and no one I know has had a very deep conversation with a rat lately.

At least, not the four-legged kind.

Parents sometimes tell therapists they have tried to be consistent and it failed. In other words, that the science regarding “extinction” and setting limits is inaccurate.

But what has really happened in this kind of case is the parent wasn’t ready to deal with the extinction burst. Their inability to tolerate the “burst” of seemingly relentless pestering or complaining eventually led them to reinforce the child once again for the undesirable behavior; and, in so doing, made it harder to extinguish the behavior than when they started.

Had the mom or dad only be able to stay-the-course and resist the child a bit longer, the “extinction burst” would have ended.

The moral of the story is to prepare yourself before changing your parenting-style in an effort to become more consistent. If you aren’t absolutely sure you have the organization, energy, strength, patience, and self-confidence to withstand the “extinction burst,” don’t even try. You will only make things worse.

And don’t expect your child to really believe you when you say “this is the last time I will let you do this” while you once again reinforce troublesome behavior.

Talk is cheap and, like those same lab rats who can’t understand your language, your child will pay attention to what you do and not what you say.

But, if you do have the requisite qualities that any good parent needs and you are fully prepared to hold your ground with your child, you might be quite pleased at how you have reasserted yourself and gotten control over the home situation.

To do that, the earlier you start in your child’s life, the better.

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You may be interested in the following post on the topic of consistency: What Children Need From Parents II: On Slot Machines and Candy Machines.

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The photo of an Albino Rat was sourced from Wikimedia Commons.

March 7, 2010

What Children Need From Parents II: On Slot Machines and Candy Machines

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Do your kids see you as more like a candy machine or a slot machine?

It’s not a silly question.

The two machines are rather alike. Both require you to insert some money. Both then demand that you engage the machine, set it in motion. In the case of the candy machine, you press a button or pull a lever to make your choice. The slot machine waits for your follow-through on its lever or “arm,” hence the name, “one-armed bandit.”

That is where the similarity ends and the answer to the question becomes essential: do your kids see you as more like a candy machine or a slot machine?

The reason is as simple as it is important. The candy machine is dependable, reliable, and consistent. Every time you insert your coins and make  the selection, it provides you with the item you have chosen. If, by chance, it should not, you would quickly stop inserting coins because your knowledge and experience tell you that no matter how many more coins you deposit, the machine will not do what you want. It is broken.

The slot machine, however,  is another story. Your knowledge and experience tell you that the machine’s failure to provide you with winnings on one occasion doesn’t necessarily mean that you won’t be a winner the next time, or the time after that. It might take you a very long period of failure and much expenditure of hard-earned silver dollars before you would come to the conclusion that the machine is broken. The machine, when its working correctly delivers winnings on an intermittent (or inconsistent) reinforcement schedule.

Getting the picture? If your children see you as consistent and reliable (like the candy machine) in responding to their requests and their pleadings, they will know that asking for what they want more than once will do them no good: the answer will be the same on the 10th request as it is on the first. And once they have learned this, they will make very few additional requests of you beyond the first one.

But if they see you as similar to the slot machine, boy are you in trouble! They will keep at you, over and over, because they know that one failure at winning doesn’t mean the game is lost. Perhaps the second try will work, or the fifth, or the fiftieth. They will know you better than you know yourself. Simply put, they will know that they have a good chance of wearing you down so that they can have the toy, the TV show, the attention, or the food they want; they will know that the punishment you are trying to enforce also can be changed, maybe not by pleading their case only once, but by repeated appeals to you. Your goose will be cooked.

Kids, of course, have more energy for this sort of “back and forth” than most parents do, so time is not on your side. And the longer they have experienced your inconsistency, the longer it will take for them to “unlearn” what you have taught them about yourself.

The message is simple. Say what you mean and mean what you say. Do what you say that you will do. It will easier on you and better for your children. But before you get started, be prepared for the “extinction burst.”

What is that, you say? I’ll cover that topic in my next blog.

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The above image is a Slot Machine by Jeff Kubina from the milky way galaxy, sourced from Wikimedia Commons.

March 4, 2010

The Upside of Depression and the Downside of Medication

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Are there advantages to being depressed? Something good about something we think of as so bad? A recent New York Times Magazine article by Jonah Lehrer makes just that case: Depression’s Upside.

The essence of the argument is that some episodes of depression allow for and encourage a kind of analytic rumination that is productive. Put another way, the tendency in depression to focus on a problem, mulling it over to the exclusion of other thoughts, permits the sad person to find a solution to his difficulty and change his life in a positive way.

The counter-argument, however, is that the ruminative process is both painful and unproductive — that it often creates a kind of self-flagellating preoccupation with one’s trouble rather than a process that leads to something good; that unhappiness and focusing on pain and its concomitants simply feed on themselves to no helpful end.

In my clinical experience, therapy with people who are depressed over loss or injury often breaks down into two phases. The first of these is a grieving process, where the person expresses and processes (or sometimes purges) the feelings of anger, sadness, emptiness, desolation, and hopelessness that come with the loss of something of value — a love, a job, high social status, a capability, a fortune, etc.

The second phase involves learning from one’s painful experience about how to live differently, make different decisions, associate with different people, become more assertive, overcome fear; value things differently in life such as money, material things, status, accomplishment, friendship, and love.

Naturally, neither of these two phases is absolutely discrete — they blend into each other and overlap each other. As a practical example, someone who has had a series of bad relationships will typically need to grieve the unhappy end of the most recent one and, in the process, learn how he happened to choose a person or persons who made him so miserable; then changing whatever needs to be changed internally and externally so that different and more satisfying choices occur in the future.

People who are like the hypothetical individual just cited usually come into therapy in emotional pain and seek relief of that pain as promptly as possible. This desire is entirely reasonable — who wouldn’t want this? Some of them request medication, which is often the fastest way to “feel better.”

But many are leery of psychotropic drugs and see them as artificial, hoping that therapy will produce a more lasting fix without dependency upon a foreign substance. Indeed, while a good therapist will strongly encourage the use of medication for someone who is seriously depressed, i.e. suicidal, unable to work, sleeping away the day away (or almost unable to sleep); that same therapist will also know that medication sometimes serves to “de-motivate” the patient, giving him or her a relatively quick solution that allows that person to tolerate an intolerable situation. In the New York Times Magazine article mentioned above, Dr. Andy Thomson describes this problem eloquently:

I remember one patient who came in and said she needed to reduce her dosage. I asked her if the antidepressants were working, and she said something I’ll never forget. ‘Yes, they’re working great. I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.’

Clearly, this woman was aware that she needed to be in some amount of discomfort in her relationship with her husband in order to be motivated to get out of it. The drug made her feel better, but, it also reduced her incentive to change herself and her life. It was, in effect, a kind of band-aid, rather than a real cure. It anesthetized her and, in so doing, robbed her of something that was essential for new learning and behavior change to occur.

Unfortunately, most people who come to therapy are neither as courageous or insightful as the woman just described. Once they feel significantly better, whether due to therapy or medication, it is common for them to be less interested in continuing treatment. They have recovered from the event that precipitated their entry into therapy, but they might not yet have learned enough to avoid making the same mistakes that contributed to the problem in the first place.

Such a person can reason that the cost of therapy (both financially and in terms of time, effort, and the difficulty that comes with changing one self) is now greater than emotional pain from which they might still be suffering. Put another way, at this point, doing therapy “causes” more difficulty and pain than not doing therapy, just the reverse of what seemed true when they started the treatment process.

At this stage, those who continue in therapy have something that an old mentor of mine, Truman Esau, used to call “therapeutic integrity.” What he saw in some of his patients was an almost heroic desire to make themselves better regardless of how much the actual process of doing so was difficult, uncomfortable, or painful.

These patients didn’t shy away from problematic truths about themselves or others. They worked hard to stretch and challenge themselves, knowing that it was crucial to improve. They didn’t simply want a quick fix. Like the woman in Dr. Thomson’s example, they recognized that some pain was essential to being motivated. They knew that there was no such thing as “a free lunch,” and were willing to do whatever it took to repair and better their lives.

If you are in therapy now, it will be important for you to be sensitive to this shift from the often intense distress that brought you into therapy, to the point when the therapy itself might seem distressful. This can mean that the therapist is not skillful or that he is pushing you too much, but it just might also signal that some of the most difficult life changes you need to make are still ahead of you, even if the cost of making those changes seems greater than when you started treatment.

If you leave therapy because it is hard and unpleasant work, the problems you have won’t care. They will simply continue to reside in you, work on you, and trip you up. It is not enough to get over your last disappointment or unhappiness, but to change yourself enough to avoid future problems.

Few things that are worthwhile come to us for free.

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The above image titled Depression is the work of Hendrike, sourced from Wikimedia Commons.

February 27, 2010

Experience and Memory

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The last Canadian World War I veteran, John Babcock, is dead. He passed away at age 109 in Spokane, Washington on February 18, 2009. Frank Buckles, also 109, remains the sole surviving American veteran of the “War to End All Wars,” according to The New York Times.

With Mr. Buckles inevitable departure, we will all lose contact with what happened in Europe between 1914 and 1918 within what is called “living memory;” the contact that can only come from the direct experience of the world-changing event that shaped the lives of many of our grandparents or great grandparents. Our only available sources of information will then be in the form of books, stories that the survivors told to those still alive, old silent movie film of some of the battle action, recorded reminiscences, journals a few of the combatants kept, accounts from war correspondents, and the like.

All of which leads me to think about memory and experience. And why understanding them is important.

Experience takes a number of forms and, when the experience is past, it becomes a memory. Simple enough on the surface, but not simple at all.

First, there is the “living” of the thing, actually participating in an event. In the case of Frank Buckles, that meant driving an American Army ambulance in France during the conflict itself, witnessing the carnage, hearing wounded men cry for their mothers, making and losing friends, feeling the “pee-in-your-pants” terror of it, getting shot at, carrying a gas mask or perhaps being exposed to poison gas, ministering to the wounded, jumping into fox holes—eating, drinking, and sleeping it all. But once Mr. Buckles returned home from the front, his time there had become a memory and was now different from the actual, in-the-moment intensity of the lived-experience, an intensity that nothing in his long life after the war could match.

At another level, more removed, there are the spectators to events. We all achieve the status of “watchers” when we attend a sporting competition. We see and hear a good deal of what is happening, even if we don’t ourselves play in the game.

At even more distance from the event are those who watch at home. They will miss some of the “atmosphere” of “being there” unlike those of us independent of TV cameras, who will see the event naturally, in the way it unfolds in real-life (without the mediation of a cameraman or the interruption of commercials). And the “at-home” audience will not experience the same roar of the crowd, the heat of sun on skin, the faces of the beer vendors, and the thousands of movements and sounds of the athletes and spectators that the cameras and microphones do not record.

More distant still from the actual experience is a radio broadcast, where one’s imagination and memory of events like the one being reported tend to fill in the blanks where no visual representation of the event is present. At a further remove might be a newspaper account of the game or a friend’s description of what happened from his memory of being there himself.

Experience is one thing, memory another. Memory can only approximate the event itself and can alter or fade with the passage of time. Remember your first kiss—all the thousands of sensations happening all at once—the rush of being alive, the smell of perfume or aftershave or the person’s natural scent, the touch and texture of skin, the moistness and softness of lips, your own heartbeat, body against body—firmness, roundness—the moment before and after, the placement of your hands, the color of your partner’s eyes and their expression in those same moments? Now, as you think about it, however good your memory, I think you will admit that remembering is not the same as living it.

At least in the case of memories of things like your first kiss, you have an advantage over others’ understanding of that experience because it was yours and not theirs. It becomes a good deal harder to relate to the experience of others, especially if they have lived through something wholly unlike what has happened in your own life. The most dramatic examples I can think of come from those who have experienced severe trauma. Take the testimony of a Holocaust survivor, Magda F., from the Fortunoff Video Archive of Holocaust Testimonies quoted by Lawrence Langer in Holocaust Testimonies: the Ruins of Memory, as relatives implored her to talk about her experience:

And I looked at them and I said: “I’m gonna tell you something. I’m gonna tell you something now. If somebody would tell me this story, I would say ‘She’s lying, or he’s lying.’ Because this can’t be true. And maybe you’re gonna feel the same way. That your sister’s lying here, because this could not happen. Because to understand us, somebody has to go through with it. Because nobody, but nobody fully understands us. You can’t. No (matter) how much sympathy you give me when I’m talking here, or you understand…you’re trying to understand me, I know, but I don’t think you could, I don’t think so.”

And I said this to them. Hoping (they) should never be able to understand, because to understand, you have to go through with it, and I hope nobody in the world comes to this again, (so) they should understand us. And this was the honest truth, because nobody, nobody, nobody…

Those of us who are the children of Americans who survived the Great Depression got a little bit of this kind of understanding, I think, in late 2008, when the economy fell off a cliff and looked like it was going to continue falling and possibly repeat the Great Depression. We’d heard the stories our parents or grandparents told, we’d read the history books describing the period between the Stock Market crash of 1929 and the beginning of World War II, but we hadn’t lived in a period anything like that. Now, we were getting a taste of it, even if, for most of us, it was only a taste and not the whole meal. Now we know more, and better, what it was like for our elders (and what it is like for our fellow Americans who are losing their homes along with their livelihoods right now).

Sergiu Celibidache, the Roumanian symphony conductor, put very well the difference between direct experience and some form of pale attempt to duplicate that experience in a different time and place. Celibidache believed that it was impossible to accurately render the transcendant impact of musical performance except in a concert hall. He thought that recordings were a fraud, because they attenuated this experience and altered it, didn’t duplicate the physical and aural sensations present sitting in the hall, listening to the full dynamic range of sound as that sound was being made in the same acoustical environment as the musicians themselves. Therefore, Celibidache refused to make recordings for most of his career. And, in the days before anyone ever considered the possibility of experiments in virtual reality, he said that “listening to a recording is like making love to a picture of Bridget Bardot,” the gorgeous French model and actress of the 1950s and 1960s.

Adlai Stevenson II, as I’ve quoted elsewhere, captured the impossibility of fully communicating an experience he’d had to those who had not yet had that experience in a 1954 speech (made when he was 54) to the senior class of his alma mater, Princeton University:

“…What a man knows at fifty that he did not know at twenty is, for the most part, incommunicable. The laws, the aphorisms, the generalizations, the universal truths, the parables and the old saws—all of the observations about life which can be communicated handily in ready, verbal packages—are as well known to a man at twenty who has been attentive as to a man at fifty. He has been told them all, he has read them all, and he has probably repeated them all before he graduates from college; but he has not lived them all.

What he knows at fifty that he did not know at twenty boils down to something like this: The knowledge he has acquired with age is not the knowledge of formulas, or forms of words, but of people, places, actions—a knowledge not gained by words but by touch, sight, sound, victories, failures, sleeplessness, devotion, love—the human experiences and emotions of this earth and of oneself and other men…”

So, put another way, for example, no one who hasn’t been in love can know what love is; no one who hasn’t experienced discrimination or fought against it can really understand it fully; no one who has only watched a travelogue about the countryside really knows what it is like to be in the country; just as those who observe from the sidelines and never have played the game cannot completely grasp the clichéd expression about “the thrill of victory and the agony of defeat.”

No, life is about the living of it, not the reading about it or the watching  of it. And, so too, it is about knowing that you don’t know fully about the experiences you haven’t had. It is about knowing that you can only approximate a real and complete appreciation of another’s life; knowing that some of those things the other has witnessed or lived through are frankly unknowable without their experience; knowing that the depths of human personality, emotion, and incident are infinitely great and that one can only approach the deepest point in knowledge and understanding even as we reflect on our own live’s through the lens of memory; and knowing that the death of the last veteran of World War I robs us all of some element of connection to history and, therefore, to the forces that shaped us, our parents, and their parents.

Life is infinitely humbling, fascinating, terrifying, and touching. I imagine one could live a dozen lives, some in one gender, some another; some straight, some gay; some black, some white, some yellow; some married, some single; some in this time, some in the future and the past; some here, some there; and still not achieve the richness that is possible.

But, of course, we only get one, so far as anyone knows. That means we must get on with things.

The day is short and there is much to do.

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The photo above is of Frank Buckles with Secretary of Defense Robert M. Gates on March 6, 2008 by Cherie A. Thurlby of soldiersmediacenter, sourced from Wikimedia Commons.