Death and Life
Posted on August 11, 2008
Mortality is a difficult thing to talk about. One would expect that something so commonplace as death would be better accepted, but that is not the way most humans, at least the people I know, handle the issue. For most of us, death is ignored as long as possible, and then only momentarily dealt with when we have our noses rubbed in it so to speak. We prefer to live in our delusion of immortality as much as possible. As if by contemplating death, we are contaminating our existence here.
Thinking about death is “morbid”, and is considered mostly to be unhealthy. I think the concern is that in dwelling on it, somehow one will want to die in order to check it out. For most of us, this is far from likely. Although, it may be true for seriously depressed or grieving people, who may not feel that life continues to offer them anything. For them the hope raised by belief in an afterlife may make death appealing, as the gateway to that afterlife.
However, in general, I’m not even sure that encouraging depressed people to avoid thinking about death is a particularly effective way of preventing suicide, or even helping people recover from their depression, though from a cognitive behavioral standpoint I suppose there may be some merit to the suggestion. It could be argued that thinking about dying in such a circumstance is entirely reasonable and in fact healthy. Certainly the fact that these types of thoughts are so commonplace in these situations is suggestive of a purpositive reason for these thoughts from a biological or evolutionary standpoint.
Recently, I was told by one of my patients about a study which was done of survivors of suicide attempts. According to him, the consistent thought of those who had, say, jumped off the bridge, was “I want to live!” as they were falling. And when they did, the depression that had driven them to suicide in the first place had lifted. This is illustrative of the fact that a close confrontation with death in most cases is followed by a renewed interest in life.
Unfortunately, I have to acknowledge that as a psychiatrist I have met many people who have attempted suicide more than once; so obviously this doesn’t work all the time. However, it is my own experience that being (or feeling) near death leads to a heightened awareness of life, and the preciousness of the gift we all (briefly) share.
I would indeed argue that this existential issue is foundational to our psychological structure, and that facing it is (eventually) a painful necessity. Though most of us would like to put off that time as long as possible, I personally do not consider those who do so earlier as necessarily pathological.
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Money Isn’t Everything (Happier Revisited)
Posted on June 30, 2008
Sorry for the long delay since my last post. I’ve been in an introspective cycle I guess.. At any rate I want to get the juices flowing again by following up on my last post regarding the book: Happier, by Tal Ben-Shahar.
Besides the need to balance present and future benefits in our lives, the author makes an additional important point that I wanted to emphasize: Money in and of itself does not provide (most of us) with happiness. With the exception of those for whom the making of money is a pleasurable game in itself, for most of us money is simply a tool which allows us to do things or buy objects. It has little intrinsic value in itself. The “currency” with which we should be measuring our success is our level of overall happiness, not the size of our bank accounts.
This is perhaps a difficult concept for most of us to grasp, but I think it is crucial for us to consider. Striving for more money will not make most of us happy. What is more important is to identify the things that make us happy, and then do them. Most of the time, if we do the work, we will find the things that make us most happy (meaningful relationships, service to others, respect of our peers, pursuit of knowledge; to name a few personal examples) often have very little to do with amount of money we have. Of course, in our market-driven society we need enough to provide for our basic needs, and it’s nice to have a little extra for present enjoyment. But it is so easy to get caught up in the fantasy that if only we had more money we would be happier. Especially since we are constantly bombarded with the propaganda that the latest fashion, the newest cell phone, or the fastest car will make us happy, fulfilled people.
The proof of this is easy: Consider for yourself the second-to-last big thing you bought. Which you perhaps lusted over, and fantasized about before buying. Remember how excited you were while you were contemplating the purchase? What you imagined you would do once you owned it? How happy you would be! All of us have experienced this.  Reflect on how you feel about that object now. Perhaps you still enjoy it, perhaps you are bored with it by now. However, it’s unlikely that object in itself has been the key to long term happiness in your life. Food for thought, and perhaps an important insight to consider.
I’d like to end this post by relating how much I enjoyed the discussion with the folks who came to my presentation at Imagine Atrium. (It made me happier!)Â Many thanks to those of you who were able to be there!
‘Tags’happiness’Money’» Filed Under Philosophy | Leave a Comment
Happier
Posted on March 2, 2008
Happiness is one of those core emotions that I think just can’t be defined further. You know it when you feel it, and that’s it. Having said that, I agree with Tal Ben-Shahar Ph.D., that it really should be considered the “ultimate currency”, and the final measure of success.
Many may disagree, but I think the primary aim of psychotherapy, or psychiatry should be the promotion of happiness in our clients and patients. This doesn’t necessarily mean immediate happiness. Many times the road to future happiness is painful to travel at times. No one enjoys finding out unpleasant things about themselves for example, and going about changing them can be even worse. But in the long run, that work pays dividends in the future. (There are also many other benefits to psychotherapy.)
So, psychotherapy can be one route to happiness. Another for people to consider is the “self-help” route, generally finding a book or author who prescribes a particular method to follow. One disadvantage here is that people are almost always blind to their own failings, and to find those things out one often needs an outside observer who’s observations can be trusted and not defended against out of hand. Conversely, self-help approaches can encourage a certain self-confidence and self-reliance (if they work and are appropriate to the person and situation). Some therapists attempt to combine the two approaches with assigned readings, etc..
I have previously mentioned The Power of Now, by Eckhard Tolle. Today I want to mention a completely different approach, that taken by the followers of positive psychology, as espoused by Dr. Ben-Shahar in his book: Happier. In Happier, we find a structured, programmed approach to happiness. He lays out a general idea: That being happy means combining short-term pleasure, with long-term meaning. And then sets forth exercises to follow to help guide oneself on the path of achieving that. I think many people will find the book a rewarding read, and its ideas worth considering.
For those who are interested in the book, I have agreed to give a little presentation and lead a discussion about it on Friday evening 3/7/08, at Imagine Atrium in Jersey City, NJ. If you are able to read the book ahead of time, that would be great. If you can buy it from them that would be even better. As a small independent bookstore, they would appreciate your business.
‘Tags’happiness’positive psychology’» Filed Under News, Philosophy | Leave a Comment
The Morality of Sexual Orientation
Posted on February 28, 2008
Some of you may have seen the recent news that researchers at the University of Illinois at Chicago have been able to control the sexual orientation of fruit flies, by exposing them to a chemical. Specifically, they were able to induce homosexual behavior in previously heterosexual male fruit flies. You can read the press release here.
You may wonder what this has to do with morality. I’ll begin by mentioning briefly that in the early to mid 1900’s it was felt that homosexuality was due primarily to aberrations in psychosocial development, and so theoretically could be “cured” with appropriate psychotherapy. That view has been displaced by the belief that sexual orientation is largely “hard-wired” genetically. Homosexuality is no longer considered by mainstream psychiatry to be a mental disorder.
However, there is still very influential religious and social teaching that homosexuality is “sinful”. And a great many are caught in the intensely stressful situation of feeling compelled to do what they have been taught (and believe) is wrong. They feel themselves “sinners”, “bad” or even “possessed”. People have tried to be “deprogrammed” from homosexuality with intensive therapy and conditioning. Some even claim to have succeeded. These non-mainstream programs continue to the current day.
Which leads me back to this current tidbit. What if sexual orientation is in fact biologically controlled, and not psychologically determined? It seems to me that most of us reserve moral judgments to those things about which we have some control. For example, if a parent steals to feed her family, when she has no other way to do so, most of us find that morally acceptable. Likewise, if we are faced with life-threatening violence, we are allowed to use violence to defend ourselves. In other words, when we have no choice we can do what we have to do, morally if not always legally.
For now, I would argue that if sexual orientation is biologically determined, it should favor the moral acceptability of homosexuality; on the grounds that it is not a matter of choice, but is determined by our genetics. It remains to be seen what will happen in the future if (when?) a pill is available to change that orientation, and it truly does become a matter of choice.
Quite frankly, I imagine psychiatrists will do a booming business “helping” people “cure” their homosexuality, as it will once again be an “illness” that can be treated. Unfortunately, that will likely make the underlying moral considerations more difficult for those affected, and not less.
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Sad in a Joyous Season
Posted on December 16, 2007
For most of us, the Holiday season is one of joyful anticipation. As children, we anticipate receiving presents with increasing excitement. As parents, we anticipate the happiness of our children. For those who are religious, there is the celebration of God’s blessing. And for all ages it is a time for family to gather and share.
However, for a sizable minority of us, this time of year is anything but pleasant. It has been my experience that this time of year is very difficult for many. For some, there is the remembrance of the death or injury of a loved one which took place during this time in years past. Or perhaps a serious injury or trauma was suffered directly. Many of us do not have happy memories of childhood, or of a warm and nurturing family that blesses others. Some of us are isolated from friends, family, or religion, at a time when the days are short, the nights long and cold. Perhaps the year has not gone well economically and the stress of buying presents which cannot be afforded is too great.
If, for whatever reason, you find yourself sad this time of year, here’s the deal: you are probably OK. While it’s not pleasant to be depressed or down, it is a fact of human existence that we all go through it at one time or another. Certainly, being depressed allows us to appreciate being happy, and vice-versa. So the first thing I would like to posit is that sadness is not in and of itself pathological. If you are not thinking too hard about killing or hurting yourself (or someone else), have a reasonable idea of what’s making you sad, can look forward to a time in the not too distant future when what’s making you sad will be done with, and you will be happy again, you’re probably alright. If you don’t fit into the above category, you may want to consider seeking professional advice, but otherwise, read on!
So, during this Joyous Season, you find yourself anything but. What to do? Here are a few suggestions:
1) Accept yourself as a basically good person, even if you are sad. This may seem obvious to some, but believe me there are others of you out there who will find this very difficult. But try, and keep trying if it is hard. Many people I work with tell me they have no trouble at all honestly advising their friends who are depressed that they are good people, but cannot believe it of themselves.
2) If you have some close friends, you can share with them how you’re feeling, but don’t do it too frequently or give them the idea you expect them to “fix” the problem. Most of us want to be helpful, but if we cannot help we may try to avoid a painful situation (or depressed people). Let them know they’re helping by listening.
3) Fake it. If you’re in a group with a bunch of happy people, fake it and be happy too. You can go back to being sad later, and meantime you haven’t messed up their fun, and they’ll be more likely to ask you out again.
4) Take care of your body. Eat plenty of fruits and vegetables, try to minimize sweets and alcohol. Exercise, walk, stay clean. Sleep when you’re tired.
5) Help someone else. Do things for others who are less fortunate than yourself, and be careful not to expect anything from them in return. You may be surprised at the power of this one!
There are lots of other things my patients have taught me about dealing with sadness, but this list should get you started. If you have other suggestions, feel free to pass them on! And if you have friends who are sad now, feel free to pass these on to them. I wish you all the best!
‘Tags’Depression Tips’Holiday Blues’Holiday Sadness’» Filed Under Philosophy | Leave a Comment
TherapySafetyNet
Posted on November 20, 2007
As a private practitioner, I am not infrequently put in the difficult position of having to turn away otherwise suitable prospective patients who cannot afford my services. As someone who has at various points in his life been unable to afford healthcare, I empathize with their plight, and wish that I could help everyone who needs it.
Of course I can’t, but I applaud any effort to help those with mental health issues get the help they need. So, I’d like to give positive mention here to TherapySafetyNet.org, which has been getting some good “buzz” lately. TherapySafetyNet was set up by Geoffrey Steinberg, Psy.D. to be a referral service for lower income folks who can’t afford the going rates for mental health care here in New York City. While not exactly charity work, it does allow those of us who have some flexibility in our pricing to help at least some of those who otherwise could not afford our services. If you know of someone who might benefit, you might refer them to the website for more information.
‘Tags’Helping the needy’Therapy’» Filed Under News | Leave a Comment
Confronting the Shadow
Posted on November 12, 2007
The Shadow is a concept which is pretty much unknown in mainstream psychological thinking. This is a result I think of the general avoidance and suppression of Carl Jung’s work which arose as a result of the split between Freud and he in the early days of psychoanalytic history. I want to give here a brief look at this idea, and to point out its utility and descriptive power to some who may not have been exposed to it previously.
In brief, the Shadow consists of that part of our psyche which conflicts with our persona (which is the side of ourselves which we prefer to see, and which we want other’s to see). We suppress or repress this part of ourselves, and so generally the drives and desires which make up the Shadow become unconscious. It becomes apparent at times in our dreams as a particularly distasteful person, and at other times can be seen in unexplainable negative emotional projections which we sometimes have towards other people.
Much of the work of psychoanalysis can be explained in terms of becoming more and more aware of the shadow aspect of ourselves, and the process of owning and acknowledging one’s shadow can be very helpful in helping us to understand that much of how we interpret the actions of other’s, and in fact how we view the world, is determined by this “Shadow’s” remaining just out of our conscious awareness.
This also ties in with the idea of projection, in the sense that projection is typically an unconscious process. Things in ourselves of which we are conscious we are more likely to “own” as our own “stuff”. Things in ourselves of which we are unconscious we tend to project onto others, and call “theirs”.
Thus, much of the hatred and distrust which we aim towards others (and which is aimed towards us) can be explained as a lack of awareness of our own Shadows.
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Variance vs. Criminality
Posted on November 8, 2007
It seems to me that as a society we have become confused about individual variance, either in behaviors or thinking, and pathology. In one example I’d like to discuss, a man in a hostel was found in his locked room by the cleaning staff, apparently masturbating with his bicycle. The man was charged in the case, and ultimately placed on a sex offender’s list, which as many of you may know can lead to severe social isolation and persecution, including severe employment, residency, and financial issues. (Some concerning issues with sex offender’s lists I may take up in another post.)
I have to admit that personally I do not find bicycles to be satisfactory sex objects. However in my daily work, I meet many people who have likes and dislikes which I do not personally share. And to be honest, if a patient of mine disclosed that he or she liked to have sex with his or her bicycle, I would find it interesting, and likely something worth exploring in therapy, but I wouldn’t have the least inclination to call the police, and much less would I feel the need to punish them or “protect society” by having them placed on a public sex offenders list.
‘Tags’criminality’psychological variance’sex’» Filed Under News | 1 Comment
The Power of Now
Posted on October 31, 2007
I recently attended a two day talk here in New York City, given by Eckart Tolle, the author of The Power of Now, a best-selling self-help book, and a number of related books and tapes. For those who are not aware, Mr. Tolle’s major thesis goes something like this: Most of us live most of our lives in preoccupation with the future or the past, leaving the present moment very short shrift. As a result of this, we miss out on the enjoyment of life which comes from just being present to the wonders of the world around us, and instead tend to fret about things which either might happen, or may have happened to us in the past. His framework posits an “observing entity”, which is separate and ultimately superior to the “mind”, which is the “thinking entity” which he identifies as the “ego”, which most of us identify as ourselves. Since the ego’s thinking is compulsive, and constantly takes us away from the present, the work is to progressively dis-identify ourselves from our “mind”, and align ourselves with “being” or the observing entity, which allows us to maintain present moment awareness.
His viewpoint has many similarities with the Buddhist and Taoist traditions, which both offer a “here and now” approach to life, although echoes of this point also exist in the Judeo-Christian-Islamic traditions as well, and for that matter in many other religious traditions and psychological frameworks.
I recommend his work for those continuing their own paths of self-discovery, although perhaps his approach is not as immediately appealing or intuitive for others as it is was for me. I am also considering how to incorporate his insight into my own work with patients, and how to integrate this with other psychotherapeutic frameworks.
‘Tags’Psychotherapy’Therapy’» Filed Under News | 1 Comment
Dependency
Posted on October 11, 2007
Dependency and independence represent one of the fundamental issues which we as psychotherapists and physicians must struggle. There is a fundamental conflict between our dependence on our patients for our livelihoods, and our duty to encourage their independence and self-reliance, which I think is not acknowledged enough. This issue can be most easily appreciated in the context of long-term, insight oriented psychotherapy, but can also be noted in the context of other therapeutic modalities including psychopharmacology. I have seen situations where a patient is doing well, and has voiced a desire to withdraw from therapy, or perhaps has begun missing sessions, which are interpreted back to the patient as an unconscious treatment resistance which requires more therapy to overcome. While in some cases this may be an appropriate diagnosis, I also believe in many cases this represents treatment success, and is an indication that the patient is ready to attempt either a therapy or medication wean. I believe as therapists we need to be aware of our own needs (financial, psychological) which drive us to attempt to maintain a therapeutic relationship past the point of diminishing returns for the patient.
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