I have had Enough thank you:

When I was in school they taught me the more medication the better. They taught me to push the doses of medications until symptoms disappear then leave people on that dose permanently. Since the time I graduated studies have shown that treating this way with medications alone in 10 years people are worse off than before they ever started treatment in the first place.  This makes sense because discomfort and suffering is the energy that motivates change. If you remove suffering completely there is no reason to change and no energy toward the motivation of change.

Medications are fine but should only be used to the point of diminishing suffering not eradicating it. It is all about balance. You don’t want to be so depressed that you can’t get out of bed but you also don’t want to be complacent in a shitty life situation.

Often you will have to tell your Dr. enough is enough.   Just because I am depressed or anxious doesn’t necessarily mean I want yet another medication or for you to increase my dose.  Instead can you refer me to a behavioral counseling program?

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Complacency in apathy:

Normally I couldn’t be bothered by politics. I always vote for president but don’t really follow anything political until the papers and news headline nothing else. Normally I am complacent in the fact that it doesn’t really matter democrat/republican – different type of the same toilet paper, not different enough to normally make me care. I can be apathetic as the system is stable enough without my input.

This year is different. I like many others are apprehensive. Trump isn’t following the standardized rules. Where Hillary is playing politics as it has been played since the middle ages, Chess, Trump is playing Poker. He is betting the whole pot, the whole system, bluffing and constantly upping the ante. A strategy that is unfortunately working. I will be pleasantly surprised if he doesn’t win this election. If trump wins he will rapidly change the purpose of his game from chess to monopoly. He will buy and sell America.

Although the system does need change, Trump is not the change we need. He is anti climate – he wants to heavily invest in coal, He wants to privatize the prison system giving financial incentive the more prisoners you have, he talked of dismantling the federal reserve, He is against the electoral system but direct democracy removes all the protections our founding fathers created, He wants to leverage the countries debt and run our country like one of his businesses. He has bankrupted many businesses and doesn’t pay his bills on others. If he follows his business philosophy as commander and chief of this country when he leverages then defaults on our debt (most likely with Russia) it would mean either we all need to learn Russian or it could instead mean War.

I don’t care how much you do not like Hillary, You should FEAR THIS MAN. Now is not the time to be complacent or apathetic. Vote or it will be too late.

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You’re kids are so lucky to have you:

I hear almost every day, you are so smart your kids are so lucky to have you as their dad ….

The greatest irony of this whole business of observing people and giving advice is you would think that all you have learned and everything you know would make a difference in your own life. Been there heard that no problem I know just what to do. But in reality it doesn’t.

Your kids know you, they do not know that what you know is wright or wrong, brilliant or profound. Your kids know you so well and they know what your buttons are, they know just how to challenge you. Developmentally they even have to challenge you to test what you know to know if it is true. That means they will be better at messing with you than anyone you have ever come across before, even your spouse.

This is why in and of itself nothing you know, no truth, no philosophy, no wisdom, really matters at home. It isn’t that they will challenge directly but you yourself and your consistency in your belief and knowledge when they try to shake it.  And shake it they will.

But if you don’t freak out or loose it too badly, and learn to stay consistent; if you understand what is really being asked; then you are role modeling your knowledge, your belief and teaching it is in fact true.

Over many years you might get to observe them in their behavior mirroring you and yours. Hopefully it was the same ones you were trying to teach rather than the reactive ones you might have modeled?

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A mom with no kid

I met a nice single lady with no kids today who can’t sleep. She is up worrying all night. She focuses on what she cannot control and doesn’t pay mind to what she can as much of what she can isn’t the end point she would like to see or have happen.   Although she has yet to have her own children she is like every mom worrying over the life and success of her child, that of which she has no control over. Too much of this Sisyphean stance toward life and one will end up feeling anxious, defeated and depressed as it causes one to feel personally responsible for everything in life that goes wrong or doesn’t succeed. It’s these boulders that one is trying to sleep on every night. We can control many of the small things in our lives like our decisions but we have no control whatsoever on outcomes.

Like my bumper sticker used to say: “Eat well, stay fit, die anyway.”

If we concentrate on the first two we can sleep. If we focus on the latter, boulder city!

There is a sixth sense humans have. It is what I will call ambience sense. Like how a color influences how you feel in a room, or how music can make you happy or apprehensive based on the rhythm and tones, this sense influences how we interpret the meaning of our surroundings. If this sense is focused inwardly and not out in our environment as it is supposed to be to help keep us alive it can make us paranoid or bitter or helpless. Everything will be interpreted via the stunted sense. It is inheritable as well. Not necessarily genetically but via another sense humans have, empathy. We pick up the mood of others and it feels like our mood. If we grow up in an environment where mom or dad are always apprehensive, fearful, angry ect. that will often be our ambience sense as well. We might walk on eggshells in life. Or try not to crack eggshells?

So how can our nice lady learn to focus on what matters, what she actually has any influence on? The most effective way to gain control is letting go of control. Only then you will learn to be flexible. Studies show that happiness is directly tied to flow. Being caught up 100% in the moment. This challenges ones brain to problem solve and improvise which are what the brain’s purpose is in the first place. It is what we are best at naturally but don’t often know it. So we never do it. We spend 90% of our lives fucking up the way our brain works best. This is the practice of what the Buddhists call the doing of non doing or active non doing. It just means getting out of the way. For instance you can’t stop a wave but you can climb on the back of it and ride it. It takes some practice but this works well for panic, apprehension, and or control issues.

It is Ironic that what we are able to do naturally and automatically is not  intuitive in our culture.  We have learned to micromanage everything especially ourselves.

Our lady, the mom with no kids, is already helicopter parenting.  But the most effective parenting for success has been shown to be in letting your kids actually experience disappointment and failure and encouraging them to problem solve.

This same Lady asked me the meaning of life. I had an answer, “BALANCE!”   One manifestation of balance is this, like with the wave, learning to climb on the back of life rather than trying to stand up to it and force it to stop for you.   There are other manifestations of balance but that is another essay.

Our Nice Lady will one day be a good parent for she really cares  but with some active non doing she will also be an effective parent.

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There is so much to know:

Today’s great student question, “There is so much to know.  How do you know all of it?”

This is a great question but as reality is ambiguous you can’t know all of it, you will not ever know all of it, and by the nature of knowledge what there is to know will keep changing.

Nothing we believe now from science to history to the how humans describe the nature of god will be the same in 100 years or for that matter maybe even next year?

The idea that there is a set knowledge to know only relates to school as academically this is true as it is called curriculum but little academically ever translates into reality once school is done.

Something I was told when I was in school that turned out true is the moment you graduate that’s when your education starts and what you need to know you will learn over the next ten years post graduation.

Academic’s is a base. This is true in all fields. You learn the masters in art not to copy them but to understand how people have looked at the same things differently. You learn rules so you can master them, understand them, then play around with them later, maybe even change them.   Nothing is ever true such that it can only be seen or done one way.

Some examples in my education that show how things changed over time:

Early in my residency I learned a dynamic understanding of people and learned Catharsis or how to help people examine and understand their life via some overview. By the time I saw that this method really wasn’t changing things for people studies began to show Catharsis doesn’t work or lead to change.

Later in residency I learned strait pharmacotherapy and the understanding that behaviors happen via chemical imbalances. By the time I saw that this method wasn’t really true studies started to show that people treated with pharmacotherapy alone after 10 years were worse off than before they ever took the medications in the first place.

Now I am a fan of a behavioral understanding of people’s life. That as long as you do the behaviors that are consistent with the life you want to have (intent) then that life can happen. If you do anything else that is inconsistent with the life you wish to have then that life cannot happen. How you feel about it isn’t so relevant or related to the outcome. Medications use is  fine if it is necessary to help one to stay consistent to their defined intent.

Books written by people with Aspergers on parenting show this to be true. They might not have any intuitive instinct on how to parent or even direct feelings about parenting but as long as they pick one parenting book/plan and stay consistent with it over the long haul their kids come out fine or better than if they had parented by feelings or intuition methods. It wasn’t knowledge or feelings but intent based consistent behaviors that matter. Studies regarding consistent strict vs. inconsistent loose parenting styles had the same outcome. Consistent strict had a higher rate of success than inconsistent loose.

So rather than fret about if you know enough, memorize the base so you can graduate then open yourself up to learn, question and observe. My patients have taught me more over the course than I ever learned in school. And READ. Never stop reading. On multiple different topics, not just your specialty. Everything relates to everything else on some level so anything you learn in any one area will help you in ways you wouldn’t or couldn’t have predicted in another.

Good Luck…..

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How do you say no:

A student today asked me “how do you say no if someone is set on some treatment and I do not think it is appropriate for them?”

The key to answering this question is a basic principle for “how do you say no” regardless of context.

Reality is ambiguous. There is never just 1 way to look at any 1 thing thus “how do you say no” is really the wrong question as it assumes there is ever only two choices, yes or no.

A better question when someone comes with an agenda is rather, “Is there a reason for me to not agree.”

The litmus test for me regarding “Is there a reason for me to not agree” (outside of obvious reasons that it is just the wrong thing to do) boils down to “Do I trust them?” If I do then they have already reasoned the situation out for me and if there is no reason for me not to agree then easy peasy my work is done. But if I don’t trust them then it would be unwise for me to agree to a perspective that not only might not be true but I sense is not true. That is a set up for failure and doesn’t do me or the client any good. Thus I am not really saying no but just stating I can’t agree with said plan or desire as I don’t feel it is the best option for either of us. If they can reasonably discuss it and come up with an acceptable alternative then that goes a long way for establishing the trust I am looking for and I might then even be more agreeable at our next encounter?

If they can’t discuss it or just perseverate on their agenda  I don’t have to say no as I can’t really say anything – end of discussion. “We are not a good fit for each other.  I can refer to someone else to work with.”

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Life is a lot like gambling: with diminishing risk return over time.

In order to be successful in any one pursuit it takes up time and resources devoted to that pursuit. This of course diminishes time and resources to any other pursuit so one’s life becomes defined by that chosen pursuit. They say if you will be a millionaire you will be so by age 25 as after that the chances diminish enormously statistically.

This is because below the age of 25 it is easier to take a risk and devote all your resources to a singular pursuit. After age 25 people have accumulated more in their life that each thing or part takes time and resources and investment in order to maintain, ie friends and relationships, commitments, and stuff.

It is easier to gamble for successes below age 25 as there is really nothing too loose. After age 25 we tend to have accumulated things, commitments, and relations thus we have more to lose and therefore become rightly so more risk adverse.

People over age 25 who continue to take risks might not be the best people to be in relationship with or be the best at parenting.  Their ability to have balance is counter their ability to take risk  as it is the balance itself that has to be put on the table and gambled to be successful.  Again easier done below age 25 for if you crash:   savings, relationships, time, all is at that point replaceable.

When you read about people who have it all, they gambled and won at a young age or were left with the resources to start with then they scaled back appropriately as they accumulated things of value to them, friends, relations.   They no longer are risking it all. They are focusing on balance.    After kids are grown and one is retired there is another opportunity to risk,  the Grandma Moses phenomena.

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Doing that thing

Every day all day long I see different versions of the same thing: Women who whenever they have a decision to make , make the wrong one by trying to do the right one.

Life is a game and when you try to play it based on the rules you learned growing up it can only work such that you created a life in which it can work. What this means is that the rules are not innate. They are not true in and of themselves no matter what you were told to be true. Therefor you can’t expect anyone else to actually follow those rules as again they are not of some greater truth but solely local and cultural no matter what you were taught to believe.  If you want those rules you learned  as a child actually apply to your life then throughout your life you need to  only introduce people into your life that reflect the same set of rules you believe.  Once you accept this look at those rules and decide if those are the rules  you wish to choose to be the rules of your game. They need not be true they only have to be chosen to be your truth. That is the definition of belief. Remember you can always choose a different set of rules if you find the ones you grew up with to be inadequate to meet the intent or goal of your life.

When you have to find people who reflect whatever given set of rules you choose to subscribe to these mutually accepted rules are definition of culture. Don’t expect anyone to believe or follow them in of itself as again they are not innately true! You have to get good at observing and seeing people for who they really are and how they truly behave without interpretation, excuses, or enabling.  Enabling is when you need these rules and truths to be true so you interpret others behaviors within the scope of your rules, making excuses and covering for them. It can’t work forever because it just isn’t true and this need for a “truth” makes it all about you rather than about reality. In this case  it can’t be mutual or reciprocal as no one is communicating or negotiating the different realities they actually live in.

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The Promise

One of the largest philosophical impediments I find working with people in our culture is the promise. We are taught an expectation of what will be that can be described by redemption, resolution, justice, love, forgiveness, the answer, the secret, all these are manifestations of some perfect utopic future picture that puts us in the position of victim to anything that happens in actual reality.   If what is supposed to be doesn’t happen we are unable to deal with what actually does happen leaving us in angry tantrum or depressive disillusionment.

The promise makes us victims and also allows us to be easily manipulated by anyone who promises to fulfill our expectations. We are unable to check into reality to see if the promised is being delivered. Instead we make excuses for them as we really need what they say to be true.

If you remove the promise or fixed expectation then, reality is what it is. But this “IS” are tools to be used toward Intent; The future to become what it will become.

Politicians are examples of the empty promise. Trump and Bernie Sanders both speak in utopic promising tweets . Living in their reality create victims of which will be angry or disillusioned.

Suicide bombers kill themselves and others based on the Promise. All lies. Manipulated by their religious leader promising utopic redemption, 40 virgins, reward and love in the afterlife.

Another working example is a woman I saw recently: She had been sexually abused as a child. She never told anyone and 30 years later she is paralyzed and angry.  Today in her reality she remains a victim. Her future vision  requires some justice or redemption that in reality will never occur. But she will wait and tantrum until it does. She continually seeks and gives herself up to those who promise justice or redemption and is again and again manipulated and victimized by them.

What she doesn’t realize is today her past experiences even her abuse are tools. Experiences used as tools can be recycled to empower both herself and others. One example would be for her to volunteer thus be a role model in a battered woman’s shelter. Shit makes the best fertilizer if you see it for what it is and for what it can become.

It is her choice. As it is all of ours.

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One great Learning disorder:

There are a zillion variations of speech, language, and processing issues that all get umbrella’d under the diagnosis of adhd (attention deficit disorder) in this country. There are many reasons for this but money is the root cause. Each of these issues can certainly cause a lack of focus and attention but the treatment of each is specific to the balance of underlying issues. In this country they all just get Adderall. As the child grows despite Adderall these underlying issues become more apparent and in some cases Adderall makes them worse. In this country instead of realizing this many kids then get a psychiatric diagnosis on top of the attention deficit diagnosis. The psychiatric medications blunt out the nuances so the child might coast for a long time but we can’t reformat brains. Inevitably the underlying learning disorders will manifest themselves again but there are no available resources for learning issues in adults.
If a person is lucky enough not to be born with any learning, speech, or processing issues to get misdiagnosed in this country. Marijuana use will provide plenty opportunity to start the process for these lucky healthy born kids. Marijuana use in children and young adults causes a multitude of processing, focus, attention and motivational issues. Many of which will be misdiagnosed and treated with Adderall and later be labeled with psychiatric diagnoses. As marijuana use is becoming ubiquitous in teens and young adults no one will get to miss out on the fun and pharmaceutical futures are looking real good.
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