I’ve been depressed since yesterday, when I innocently brought my parents dinner (before work, I stopped by in the morning) and found my father hunched over breakfast in terrible pain. Lower right quadrant of the belly, a 9 out of 10. For an old stoic like my dad, that’s bad.

So I cancel out a couple of patients and take him with my mother to the ER and wait for an evaluation. Can’t wait all day, so I leave my mom with her phone. Gotta’ go. Let me know what happens.

It’s a terrible feeling, leaving your 84 year old mother in…

Every now and then I get to see a surly adolescent, the type with Pink’s so what attitude, the one who asks, in answer to almost any question, How should I know?

And these are kids, and you know they’re responding to the incredibly bad feelings that they’re feeling, trying to master life, push away people who care about them because basically, parents can be so invasive.

Not all of them, but surely some.

Did you ever hear that enmeshment is a set-up for drug addiction and alcoholism? When someone’s trying to invade your space, the best defense, really, is to be stoned,…

I haven’t blogged on TSR in a long time, so long I lost my password, and I think part of the reason, if not the whole reason, is that there just hasn’t been any time, and no head space for it, no desire to write.

That’s probably because it is work, writing, despite all that there is to say and my love of saying. It takes a certain amount of serotonin, however, and when you have stuff going on, that magical neurotransmitter gets zapped.

Used up. More rapidly.

The joke is, of course, that when you have a lot going on, when…

It’s not the first time it’s happened, and won’t be the last.

I get a call from a family physician. Do I want a really tough case? Well no, not really, unless there’s really decent compensation. And there is, so I take it.

(I’ve changed the real details) A VERY depressed man in his late fifties, out of work for two years, he says. That’s a bad sign right there. Ex-addict.

So not unusual, I tell the doctor. Problem is, of course, that chronic depression tends to end with suicide in the sixties for guys like this. Is he using now? The doctor…

If you don’t know what I’m talking about, it’s a stay sober trick. Don’t get too tired or too hungry. I think I have it right, correct me if I’m wrong.

It doesn’t take much to trigger an episode, to slip into substance abuse, not if that’s how a person copes with life. Being hungry and/or tired will do it every time.

Let’s take them separately.

Hungry

On an empty stomach, alcohol is absorbed right away. Solid food isn’t there to absorb the liquid. The toxins go right into the blood stream from the stomach. You get drunk pretty quick. Alcoholics know this, so if they…

There’s so much to love about the new Harry Potter movie, Harry Potter and the Half Blood Prince, especially the character development. We see teenage crushes in a way that reminds us how it used to be, being young and in love, just breathing for a certain someone to pay attention to us.

Love, for sure, feels like a drug, and when we’re in love there is nothing that can really bring us down, not if we can flash to that thought . . .someone loves me, and I love him someone, and that’s all that matters. The natural high. What we…

We don’t like to be embarrassed, is the truth, and our friends are a reflection of who we are, so they can embarrass us by association.

So imagine how bad it can be if we take an addicted one of these on a camping trip with people we want to impress, or worse, with family.

We unconsciously try to keep family with family, friends with friends. (Most people don’t know this). They can be a dangerous mix, family with friends, and all kinds of jealousies and rivalries and judgments and blame can spoil a perfectly wonderful time in the blender. Hey, jealousy…

I know I wrote about it before, but there’s so much to say on this one. There’s nothing like the alcoholic family that happens to be fun. How often do you hear about that?

The Set Up

It’s not uncommon for a therapist to find couples marrying people from families very different from their own. I tend to like treating these couples, especially when one of the partners is an alcoholic who has married a sober person precisely because he or she knows that sober is better, that this sober person is “good” for him.

(We’ll use “he” – could just…

Maybe I’ll be stating the obvious, but those of us in the mental health biz talk a lot about enabling, and the rule, of course is, DON’T.

Don’t make it easy for someone to stay addicted. Don’t bring him a beer, even if he’s your father and that’s what you’ve always done. If your mother’s half in the bag at your graduation, get really mad at her. Create such a fuss that she thinks, Good golly. I have a problem. I messed up. I better change.

If (s)he is your partner, you don’t go with him to the bar. And if (s)he comes…

You know I work with a lot of program people, meaning I hear many stories from people who are working 12-Step programs. And sometimes themes emerge.

Being a therapist with a research background, you look at things differently. You see your work as a series of qualitative interviews and you look for themes that cross lines.

Here’s one I find interesting. I’m sure you’re familiar with it. It’s about the idea that a person in recovery from an addiction is beginning life where life sober left off.

I find this a very sad and difficult concept to have to lay on people,…

Cat writes about recovery and changing sponsors, and it brought up all the issues I have, mainly my own insecurities about telling someone to get another therapist, get another opinion. I’m not the only doc in the sea, and am not for everyone.

It’s so ironic, you know, because the patient (or in AA parl, the sponsee) is afraid of hurting the therapist’s feelings (sometimes), and yet the therapist doesn’t want to add to the patient’s abandonment anxiety, ever.

We don’t want to add to the issue when the issue isn’t resolved.

So for me, it’s all about trying to resolve…

I’m in the car with FD. He’s driving south on 1, we’re heading for the tide pools, and two of our grandsons are kicking at the front seat.

I get a call from one of my sons, a married son with children who lives on the opposite coast. Basically, if I want to see my grandchildren, I get to get on an airplane and fly an hour or four. I’m still working it out three days later. My back is, that is.

Oh, let’s segue. I’m not complaining, although I do look silly in the galley on the plane, doing the physical…

Mother’s Day when someone in the family is addicted.  Mother’s Day when your mother is addicted.  Mother’s Day when your father is addicted.  Mother’s Day when one of the kids is addicted.

The fun never stops.

I’m sorry.  That wasn’t nice.

But people give me those looks when I say, “Well, surely nobody’s going to get wasted on Mother’s Day.”  There’s a Jewish expression, kal v’chomer (rhymes with doll-v’-roh-mare) that can mean, among other things, all the more so.

Looking at the problem with a cognitive approach (drinking/using is behavioral, not in your head), people actually think about the meaning of a person’s drinking on…

I’m so glad you guys found me, you Second Road people.

Because you know I love to talk, but am basically too shy to do that, just talk to people.  So instead I listen for a living, and occasionally, when I have something worth saying, let it roll, the mini-psychoeducational lecture, or the observation about how a person is operating, and maybe suggest, hypnotically of course, a better way.

But blogging, as you who are here well know, allows all of us to talk ad nauseum, and no one is interrupting, and no one necessarily even knows who we are, so we can…

I think that there is a stereotype about this type of family, the alcoholic family, one that is unfortunately well-deserved, if misinformed.   It is by definition a stereotype, a generalization, that alcoholic families tend to be violent.  Just as any generalization about any type of family has to be wrong, this one is too.

Each family is unique, crazy in its own way.

And yet, someone like me sees some people for about seventy seconds before thinking, alcoholic family. Maybe you do this, too.

People in 12-Step programs aptly use words like rage-aholic to describe a population of people who don’t drink,…

Okay, that’s ridiculous, of course. I just had to share this link with you, though, and couldn’t think of a good title for the post. Maybe you’ve all seen these clips before, but I hadn’t.

Check out this blogger. at DryBlog.

therapydoc

Those of you who read me regularly know that I’m from an observant Jewish background, which means that I follow plenty of rules. And I scoff plenty of rules. I’m as good a hypocrite as anyone else, as are all my friends and most people who breathe.

But we try to be better.

And probably like most religions that have teeth to them, there’s plenty of spirituality to back up mine, to make the rigor make sense.

Because a Jew’s life is one for the books, meaning theoretically, ideally, every movement could be a page from a Jewish law book, should be a…

The other day someone said to me, “I think this world, this country (meaning America) should stop drinking.  Americans could beat the economic blues, could win this war on terrorism, if they stopped wasting their brain cells with booze.

No joke.  It’s true.  What’s interesting to me is why people even want to drink, to lose themselves to alcohol the way they do.  Some of us don’t, have no physical craving, no mental “need” or desire to get stupid.  For alcohol, make no mistake, is one of those drugs that slows the central nervous system, retards our critical thinking, makes us…

Most people know that people who abuse or depend upon drugs and alcohol tend to be remiss about  important tasks in life, tasks like: parenting, helping others, being accountable, responsible, keeping promises, participating in a community, respecting time and property, giving one’s best on the job.  Things get dropped when under the influence. Or the next day.

An addict forgets to call.

An addict forgets to be there.

It’s in the nature of the brain, befuddlement of substances.  Alcohol and drugs change a mind that might have half a chance of working fairly well, into a mind that not only forgets, but fools the “self” within the…

I give patients the option of calling me and rambling to my voicemail, no promises that I’ll listen, but usually I do.  I tell them to call me back, after they have talked themselves silly, when they’ve figured out exactly what it is that I need to know.   They’re to mark the one that summarizes it all by saying, “Okay, this is all I what I wanted to say.” Then say it in a couple of sentences.

Strangely enough, the people who use this option tend to be alcoholics in recovery.  They’re in 12 Step programs and know how to use the…

Step 4: “Made a searching and fearless moral inventory of ourselves.”

Sometimes I feel so guilty pontificating about the steps, never having worked an A.A. program. But I feel, as I’ve said before, that so much of the program is steeped in Judeo-Christian thinking, that in a sense I’ve been working one for most of my life.

Skip a little adolescent acting out. Everyone is entitled to an adolescence.

So, Step Four is about looking yourself in the mirror, finding yourself in your past, owning the things you’ve done, and committing to change. Changing you. Did I get that right? It’s like…

Here’s what can and will happen in therapy (and therapy is a microcosm, a miniature world, so some of us like it).  So here’s what can happen in therapy when the doctor puts a person in charge of his or her own drinking and that person wants to be in charge, believes it’s possible, really, to control it— when it probably isn’t.

Let’s take a marital therapy case.  The sober spouse, make it a she, is the one who doesn’t drink to excess or drink at all.  Someone like me, a therapist tells her, “Do not count his drinks. He’ll monitor his own drinking. Let…

It’s a funny relationship.

I remember being about ten and sitting on the sofa watching a baseball game with my father.  I never saw him sit and watch a game with a beer in his hand before.  If anything, we drink seltzer or ginger ale.  Maybe Coke of Fresca.  But that day he had a beer in his hand and he passed it over to me and said, “Do you want to taste it?”

Now you have to understand.  If we drink anything, or eat anything in our family, it is unthinkable not to share.  And in Europe they drank beer when they couldn’t trust the water, so…

I went out of town last week, and as I boarded my plane caught a glimpse of the pilot, an older guy.  And thought, “I sure hope he’s sober.”

I treat pilots, you know.  And flight attendants.  And I’m not trying to discriminate, nor do I mean to disparage a profession, but one of my pilot patients told me, “It’s a party profession, at least on this airline.  We work hard, and after work, we play hard.”

“But you’re sober when you fly, right?” I ask timidly.

“Well, sure.  But a little hung over sometimes.  Not always in the greatest mood.  But I fly…

You know it’s a theme of mine, and it’s not easy to put it down.  Every child has that moment of reckoning, lost innocence, an epiphany that the world isn’t all that safe a place, and it is because they are hurting.

All I ask is that as adults, we put that moment off as long as we can, we protect our children.  I realize that it is virtually impossible, that we aren’t to blame when our children get into trouble.  But if we see them getting dark and cranky, we should get them help somehow.  We shouldn’t assume it will…

If you read my posts at Everyone Needs Therapy, especially the more recent post about Friend Poaching, then you know I go to a lot of weddings.  I’m at the age where the children of my friends are all either married, or they’re getting married.  Not everyone, but enough of them to really give my credit cards a beating.

I’m not complaining.

The last wedding had an open bar.  I personally appreciate this very much.  I like to walk into a shmorg and either get a mixed drink or a glass of wine, because the two go together so well sometimes, appetizers…

A patient sees me and says, “I’ve been trumped by the Third Step.”

Pray tell, what is the Third Step?

He mumbles much jibberish about letting people become your higher power and getting angry and how that is never acceptable but it happens when your ego is first and other people are not. He tells a story, and I’ll change it here, as I always do.  So let me tell you right now. I’ve changed the details of this story so much, if you think you know this person, there is no way.  You don’t. He is pure fiction.  But you’ve heard this story,…

Sometimes I think it’s cheap that I use television shows as teaching examples.  But The Office is never cheap television.  It is an exemplary show that mocks our work culture, the one particular to the office, a place where people have the opportunity to get to know each other very, very well. 

There’s potential for intimacy at the office, too much, sometimes, one of the reasons we why we find it so hilarious.

I liked last week’s show, Moroccan Christmas, for one line, really, the one at the end that illustrates so well how systems operate.  

In the show, Michael (Steve Carell) stages an intervention.   You may…

Here’s where I get stuck with alcoholics. I get stuck in the place that alcoholics stick themselves. It’s that place they get into that’s all about proving how functional they really are. You guys call it denial, and it is that. But it’s that and much, much, more.

The spouse of the alcoholic (or the parent) will cry, “She’s abusing alcohol and drugs! He’s dependent!”

And the user/addict will cry,

“So what?! I function just fine, thank you. Even better a little stoned, if you want to know the truth.”

The addicted spouse will point to the clean house, the folded clothes, the…

You know those holiday movies about Thanksgiving, the ones with all the drama and in the end everything ties up so nicely?

Sheer fantasy.

A couple of Thanksgiving tales from the archives of my brain.  I’ve changed all the demographics, and the plots, but you’ll get the basic idea.  And you’ll probably say, “I know these guys!”

You do, but you don’t.

Scene One:

The parents have come to the children for Thanksgiving dinner.  Dad has a degenerative disease, one that is slowly killing him.  Mom is the insufferable martyr who handles him alone, wants to put him in a residential setting, but he’s on a waiting…