Sanity requires:

Sanity requires one of two choices:

1)      A general sense of control of one’s life. This requires a healthy dose of denial and luck. And it can be work. 

2)      Embracing the ambiguity, chaos, and imperfection that life is. Letting go of inflexible black/white expectations. This does not require a sense of control or has to utilize denial, but instead it requires ingenuity, creative imagination, and the ability to wing it in the improve that is life. And it is work. 

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Why Marijuana will increase my business

As a psychiatrist I have seen a change in how people are presenting to my office. These days people mostly show up for Adderall as everyone believes they have adhd. The second most requested medication is klonopin.  Many if not most people these days are self-treating themselves at home for just about everything  with marijuana.  And it works, “Doctor, Medical Marijuana is the only thing that works for me,” that is for a while.

Cannabinoid the Pharmalogically active substance obtained from the marijuana plant is a Sympathomimetic (sympathomimetic drugs (also known as adrenergic drugs and adrenergic amines) are stimulant compounds which mimic the effects of endogenous agonists of the sympathetic nervous system.) -Wikipedia

I.e. what Marijuana does physiologically is the opposite of what it does psychologically.  Over time this creates a widening paradox. You are anxious. Marijuana makes you feel calm but internally it’s speeding you up. Over time as you build tolerance not only doesn’t it calm you down but you have been conditioned to expect the calm but now you feel the stimulation and interpret it as anxiety separate from the marijuana.   This anxiety only worsens over time and now you feel you are having panic attacks but really is just that you screwed up your sympathetic nervous system. You have turned it up by trying to turn it down.

You now come to me complaining of anxiety to the point of panic and the inability to focus.  Marijuana actually contributing to if not causing both. 

The inability to focus is caused by the dopaminergic effect of marijuana as Dopamine controls memory and motivation.  Over time Marijuana affects the feedback mechanisms for dopamine in the brain causing a loss of motivation, focus, and memory. 

You now come to my office asking for Adderall and klonopin.  Keep on toking.

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I have nothing to wear:

Dear Dr. Brilliant Cliché,

I am a dad and as a man I just don’t get it. My 13 year old daughter has more clothing than anyone I ever knew. The other day she gathered up about 70% of it and said. I have never worn it. I will never wear it. I want to get rid of it. So, to good will it went. The next day she looks into her closet and says I have nothing to wear. I need clothes. Please take me shopping. I got mad. That was all perfectly good clothing she got rid of. Much looked new.  I told her the next time we go shopping is when she can contribute to buying the clothes, so do more chores. She gets not an allowance but money for non-routine chores like mowing the lawn. We don’t pay her for routine things like picking up her room or putting away her laundry.

I hear from my friends her behavior isn’t unusual for a girl. I just don’t get it. I still have much of the same clothes I owned at 13! I don’t want to teach her to be frivolous and wasteful. I don’t want to pay for more clothes! Am I wrong?

Buy more Dad.


Dear Dad,

You are not wrong. Many children of privilege have no idea what it is to be of want.  They throw out more than many ever own.  So, I am backing you in her contributing to her clothing budget so she appreciates more of what she has and that there is some connection that money really means time plus effort.


There is only one caveat. At 13 girls might be developing a style. If she is examining her belongings to match a personality style she is trying to develop and it is one you approve of for instance, Travel sheik? I believe she not only has a right to do this but that if it is one you approve of, it should be encouraged.


The reason I say this is it is impossible for a 13-year-old to really obtain what she needs for this on her own and if it is a nice style, as styles come with personality and in packages, I think if you have the means you should encourage it. Default American styles might be less expensive but not as healthy in total packaging for instance Emo or grunge.  The people places and things associated in each style can have lasting impact on her personality, your relation with her, who she befriends, and how well she does and is treated at school.


If she is throwing out good clothes to replace them with ripped black cleavage clothing I wouldn’t encourage it by making it to easy. She can work more chores, baby sit, and pay for those silly expensive ripped Jeans and antidisestablishmentarian statement clothing. The expense might change her mind? The effort might influence her style.


Dr. Brilliant Cliché


The Granny Dr. Comments:

I think you hit the nail on the head in the 2nd sentence: Many children of privilege have no idea what it is to be of want.
Your friends may say her behavior isn’t unusual,
but I suspect you have friends who have money.

But honestly, the first mistake was letting her direct you to give her clothes away.
If a 13 year old is allowed to run the show,
she has to be made to accept the consequences of her actions.
Otherwise, make her think twice before tossing.


 A Dad wrote in with a different strategy:


He says don’t buy back to school clothes in September. Wait instead to October so this way the girl will see what’s her friends are wearing and she won’t have to throw out the September purchases’ like what happened in the vignette described.


A wife commented:


Her trying out different clothing styles is her developing her own style and personality and that her wanting to fit in and match everyone else is a style in itself.


Dr. Brilliant Cliche replies:

I say encourage the style you agree with. I don’t agree with the Mall Rat! This style I would require her contribute financially.

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Our Rape Culture:

There is a lot of disclosure going on currently in social media about rape as a result of The Weinstein scandal. Why this didn’t happen with Trump as a sustained outrage for he displayed the same behaviors I will never understand.

I’ve seen Recent reports that if all phenomena people describe as rape behaviors are included the tally adds to 70% of all woman have some sort of self-described exposure. I was taught 1 in 4 woman have been raped but google says  1 in 5.

Sexuality in our culture is very convoluted and messed up. There is a huge double standard that feeds a non violent rape phenomena. Sex for a woman is still not really an accepted social norm and there are no formal rituals or vehicles for sexuality in our greater culture. There is an educational campaign NO Means No but in our culture, it really doesn’t.

A very common  female sexual fantasy is soft rape, Being taken, often by the handsome stranger. A recent example is the 50 shades of Gray, the #1 selling female novel of its time! But this is nothing new. The media has been selling rape as somehow romantic and hot for a long time.  The same book has been written again and again for hundreds of years. Frankenstein and The Beauty and the Beast in its many versions are older 50 Shades books.

Nearly all religions and cultures in America sexually repress woman. The stepwise resistance a woman displays during sex and the expectation for the man to push past this resistance, a common dance in our culture, I believe is a result.  It alleviates a woman’s guilt and allows her to not take responsibility for her sexual acts. I remember being taught by my peers no means yes and how to push past a woman’s resistance starting by putting an arm around her then progressing slowly from there.  I doubt despite No Means No campaign that peer education has changed much as it certainly hasn’t in literature and cinema.

I believe the only way to change current culture would be to start educating children from elementary school about their bodies, normal development and Secret touch as described in Jan Hindman’s ,  A Very Touching Book--For Little People and for Big People. This book empowers children with skills that differentiate behaviors that you can shout out to the world as good behaviors and those that have to be kept secret as bad behaviors.  This skill applies to just about everything for the rest of their lives. It’s even in AA , if you will have to say sorry, don’t do it in the first place.  We currently educate children via Good touch and Bad touch but this is the same as no means no when in fact it doesn’t. Way to confusing, many gray areas, and not generalizable. Of course even with the secret touch idea there’s gray in as we get older there is a difference between secret and private. It isn’t often polite to discuss in company ones masturbation habits, that’s private.

Another problem in our culture that makes woman vulnerable to the more violent type rape is that we teach that people are basically well intentioned and good. This actually isn’t true. Behavioral economic research has shown that people behave morally good if they feel they are being watched but when they feel they aren’t being observed they tend to act more selfishly and slide on moral rules. The expectation of goodness of others leaves one surprised, shocked, unprepared, and vulnerable. We should instead teach self-defense.

Secret touch skills, acceptance of woman’s sexuality as norm and Krav Maga (common sense self-defense initially designed for woman) might make a difference to change our Rape normative culture.

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Quantum physics and computing explained simply:

I started a book today that takes place in the early 1700’s and it describes a game changing event that occurred in science that changed the way people experienced the world. In 1655 the first clock was invented and for the first time, time and distance could be measured. This changed everything. Science evolved at that moment from alchemy (theoretical that looked like magic) to empirical based on observation and measurement.

We are again at this junction as we have discovered another property of nature that looks on the surface like magic but we are learning how to manipulate, measure, and observe it.

The example I use to visualize it is think of a forest made up of threes. Above ground a tree either is or is not and each tree exists individually in time and space. 1 represents is a tree and 0 represents is not a tree.  Every aspect of a tree can be explained this way as is or is not. This is the tangible world we know and see and exist in. If you want to find any one tree in this Forrest it takes a lot of time as you need to create an algorithm describing lots of this tree is this and is not that. To find this tree amongst all other trees is very burdensome as you have to sort through many groupings of qualities trees.

Recently we have discovered another aspect of nature. I think of it as below ground where all the tree roots are entangled. There doesn’t exist any 1 tree as is or is not as they all the roots both are and are not any one tree. Below ground time and space do not exist as is or is not and cannot be measured independently for any single tree.  Here is described as 0.1. and 1.0. It might be or might not be exists together.  If you want to find a tree here you need to link (entangle) some aspect of the tree you are looking for to below ground and it will seemingly just be there.  To us now this looks like magic but it is not it is just another property of nature.

I believe below ground existed before above ground and above ground probably sprang from below ground the instant time and space began.  In reality, there is no above and below ground, this is just metaphor or a way of thinking about it.

If the human race doesn’t destroy itself the exploration of below ground will be magical. From artificial intelligence, to instantaneous communication across time and space, space travel, and who knows time travel?

This makes me hope we don’t fuck it all up. 

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Don’t be like my mother!

I saw a client the other day who was 72 yrs old and she is lonely and depressed. She is used to a life of being busy working and doing tons for others. I told her don’t be like my mother!

Since my dad died my mom is just essentially waiting to die herself. She mistakenly feels she isn’t long for this earth so there is no point bothering to make the effort to change or step up to the challenges she would face to be again needed and useful. Being needed and useful would make her content. Like this woman my mom is in fairly good health and has yet a long time ahead of her.

What is ironic is that limbo sucks. It’s both boring and anxiety producing. It would take no more energy facing life’s challenges that it takes to face the negativity within oneself. Both these women are used to being so busy as not to have time to think so they haven’t a philosophical reason for their existence. They just know their importance and self-worth in terms of the tasks they were fulfilling for someone else or just surviving. Now they are fed, don’t have to work, there’s no one to make breakfast for or walk or get to school. There’s no job to go to. They never had time in their lives to paint or crochet or photograph so they don’t have any self-busyness skills. They have had many times in their lives where they waited for or on others and that is what they are doing now, waiting.  Only this skill works against them in this instance.

You are what you do so when you just wait you don’t really exist. Fighting fear isn’t any worse than fighting boredom. But independent headstrong people are shitty at taking advice. I hope they both someday realize that when one is busy time passes quickly and contently then you die!

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Evil dates and what I learned from a fisherman:

I have a pet blue gill bass. It is so much more interactive than a fish store bought fish. It maintains eye contact with me. It swims happily when I enter the room and follows my every movement. It even eats from my hands.   A fisherman I spoke to also has a pet Bass. What he told me is that these behaviors are all because it is a predator. Mr. Fish’s attention is on me essentially because he wants to kill and eat me. Where store bought fish are usually not predatory varieties they are more content in their surroundings, scavenging, and seem oblivious to their people.

I got to thinking how this relates to humans. In my practice woman often ask why am I attracted to bad men? I believe now it is because these men are predators. A predator pays attention to you. A predator is aware of details. A predator captures and maintains good eye contact. A predator appears in control and strong. These are all seemingly attractive assets as they are there solely to lure you in.   These traits can be easily mistaken for “chemistry or love at first sight,” BEWARE!

Where as a non predatory date, a more content with themselves date, might be more aware of their surroundings and what’s going on overall and not solely devoted and focused just on you. They might not hang on your every word. This can come across as poor “chemistry” and unattractive. Possibly even disinterested.

I find this fascinating.

As a side observation whenever I picture a predator I picture Trumps lurking behind Hillary, tracking her, during their debate. That was an awesome display of Predatory body language.

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No pain doomed to do it again.

Ketamine appears to be magic in the treatment of depression. 1 dose and depression gone. Is this a good thing? It certainly isn’t a new thing.   Years ago when I was in training they used to use phenobarbital to get people off opiates. A person would come in they would put them to sleep for 3 days while they tapered phenobarbital and when they woke up wala off opiates,  done,  no withdrawal.   Why isn’t it being done now?  Because there was a 90% relapse rate. Sudden change without the stepwise learning and skill acquisition was more or less useless and didn’t justify the risk of death the treatment had associated with it. Ect suddenly and immediately stops depression  but again most people given that alone relapse as well.  Are the risks and consequences, the side effects justified ?  Ketamine isn’t consequence fee it can effect most major organs might have long term cognitive effects and is wildly addicting.  When and if  it becomes standard of treatment there will be huge diversion issues. Suboxone was marketed as addiction and diversion free but it is hugely abused and diverted. If you add klonopin to it which almost everyone does it changes its metabolism such that it is turned into methadone  and you can get high off of it.  When it comes to human behavior  nothing is simple. Nothing is consequence free and the easy road is usually the wrong road. Pain and suffering is part of the learning process, without it people tend to do what they have done before.

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Black and white thinking is a suicidal risk:

Today I just learned a friend’s teenage son committed suicide. He had graduated HS and was starting college next month. Her brother committed suicide when he was that same age.  Was it a genetic time bomb, inevitable?  I don’t believe so. When I was in HS I did a report looking up the data that 50-60% of all HS students think of suicide at some point but the overwhelming majority don’t actually do it. Often suicidal thought (not ideation as in a fixation) isn’t related to depression either. It can be fear, frustration, being overwhelmed or just the grief that accompanies any change good or bad. It is just one of the myriad of options the brain presents amongst all options available. Those that actually do it I believe are concrete in their perceptions, all or nothing, black white thinkers.

I saw two teenagers today with chronic suicidal ideation both had the same belief,  they were done. There wasn’t anything going to be new under the sun for them. They both believed that the way things were was the way that things would always be.  They thought for sure they knew!

They also thought concretely, things were either all good or all bad. No in-betweens. Neither teen had any skills in ambiguity. As reality is always ambiguous they were wrong!  Interestingly one of the two wasn’t depressed. He only described anxiety. The other one also had anxiety as his main thing but he was also  depressed.

I believe it is this black and white , all or nothing thinking that is both inheritable and the largest suicidal completion risk.   It is also related to a hyper focus. Focusing on a detail and missing the big picture. It can make one argumentative as “I am right”  “I already know that”   Tweens are all like this but by late teens the brain should be playing more with ambiguity. Things can be more than one way at the same time as in two people can be saying the opposite things and both be right.  I can be both right and wrong at the same time depending. Everything is relative and everything is imperfect. Nothing is always 100% anything. 

The Romeo and Juliet syndrome is about this. You’re my everything means when the 1 thing goes wrong and one can no longer be with the other they feel like there is nothing left. You were my  everything now I have nothing.  This is always bullshit but concrete people are more in danger of acting on it.  Romeo and Juliet were actually tweens.  Tween exclusive dating is a bad idea and risky business because they are concrete naturally in the developmental cycle. Late Teens should be over this but many are not as just because the brain has the capacity to deal in ambiguity and relativity by late teenager hood it is a learned skill and our culture is a black and white concrete culture so many never do learn it. 

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Anxiety is just the tip of a very large iceberg:

Anxiety is probably the number one reason that brings people to my office. People just want it to go away.  Many people have already found multiple ways to numb their emotions thus their anxiety. Drugs, alcohol, marijuana, xanax, gambling, cutting, sex, fighting.. I have seen endless ways people use to avoid anxiety thus all feeling.   IT doesn’t in the long term work.  Nothing can, No method can last forever.

The human body is built to feel anxiety. It’s like pain as a method the body uses to avoid danger. IF something makes you anxious your body is telling you that you shouldn’t do it, agree with it, or be there. It is information you direly need!

Sometimes it isn’t the moment at all but a more general theme or style creating ones anxiety, for example, a person that doesn’t ever say no, people pleasers. They get in over their heads all the time and are always overwhelmed by the commitments they make to people. These people often express general anxiety or panic whenever they are around crowds. People to them are overwhelming and represent helplessness.

Although it might feel that way, anxiety isn’t usually random, sudden, and chronic. It is often tied to a behavior one is doing that they don’t realize puts them out of sync with their goal or intent. A behavior that is contrary to the solution they might wish to have.

Anxiety is often a default feeling that happens when one is trying to avoid another emotion that is more directly tied to circumstance.

Some examples:

A young man complaining about panic attacks upon examination pinned the anxiety to thoughts he was having about men. He was noticing men in the locker room and panicked “I am not gay” . upon exploration he didn’t realize this is normal and what he was experiencing was really ENVY. He was comparing himself to the other men in the way of what they had or didn’t have. Again we discussed this as normal as men couldn’t be marketed to if all men didn’t feel these same emotions. Why does a 14 year old want Jordan Sneakers, because they recognize he is cute wearing them and that will get them notice or women or success yada yada.  So the anxiety for this man was really ENVY. Treating the panic would have suppressed normal developmental issues resulting as more  immaturity in his adult years.

A woman complaining of paralyzing anxiety and panic upon examination is in a shitty almost physically abusive relationship. She sets no boundaries until she is so overwhelmed and angry that she imagines killing her husband. Her anxiety is really hate then fear then guilt then manifesting as anxiety. Treating her paralyzing anxiety only facilitates her shitty relationship skills, unrealistic expectations of humans,  and poor boundaries. It would enable her not to change anything and inevitably things would get worse.

Another woman complaining, “why am I so anxious?”, insisted on playing the game of life via a 6 year old rule set. She needed others to play life the way “I want them to play” and “life isn’t a game.”  This forcing of others to play life as she would prevents her from being adaptable and to be able to learn how to play life more efficiently.  Her anxiety was really frustration and disappointment.  Her life albeit in the best of intents became that of denial, enabling, codependency, being abandoned, being invisible and taken for granted, essentially she was another giving tree.



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