Sunday, September 13, 2009

Up To Date

To any current and any future readers:

This is the point at which all the old pieces I've already written are now on the blog.  From here on, all the pieces will be up to date.

Thanks for reading -

Best wishes,
Dan Shaw


In Tammy Wynette’s country classic, the “D” word gets spelled out, not spoken aloud, to protect the divorcing couple’s young child. Yet the lump in the singer’s throat suggests that it is she who can’t bear to confront the brutal finality of the word.

Many of the couples I see in my psychotherapy practice, and many 0f the married individuals, report that they feel so stuck, discouraged, hurt and enraged about their relationship that they don’t know if they can keep going. Still, many who are hopeless about their marriage can and do find a way back, even from what seems like total ruin.

Typically, each member of the couple will have bitter complaints that go something like this: “I hate when you do such and such to me.” “Well I hate when you do such and such to me.” “ I only do such and such because you do such and such.” “Well I only do such and such because you do such and such.” Etc.

If both partners can put their own hurts aside long enough to see how they themselves have been hurtful, the marriage has a real chance. But in many cases, one of the partners becomes more and more adamant, insisting that all the couples’ problems stem from the other person. Of course there are cases when one of the individuals is indeed so derailed – for example, from drug addiction, or chronic infidelity – that there can be no progress unless those issues are addressed. More typical, though, is a situation where there is fault on both sides – even when the fault of one is initially more apparent than the fault of the other.

Sometimes, in cases where one partner refuses to accept any responsibility, the other partner will repeatedly back down and take the blame to keep the marriage going. The backing-down partner often develops “mysterious” chronic illnesses, like headaches, gastrointestinal problems, or muscular-skeletal symptoms, and may spend a good deal of time looking to doctors and healers for sympathy. On the other hand, the partner who never accepts any responsibility for the marital problems may also have a host of illnesses, which serve as a further blockade to the kind of searching self-honesty that would allow them to see their own part in the problem.

If one of you does all the accusing and the other has to do all the apologizing, eventually there will be, if not Divorce, then Deadlock. Divorce is one way out of deadlock, and sometimes it’s the right way. Staying in a dead marriage and being depressed, or finding distractions (affairs, for example) are other, less constructive ways of dealing with marital deadlock.

Most marriages arrive at deadlock at some point, and often not just once. And most good marriages that last are ones in which both partners have worked hard, repeatedly, to take responsibility, repair damages, apologize and forgive. We humans will never be perfect, but we can keep on growing as people, right to the end. If you’re not growing as a person – learning to develop more meaningful connection with others, overcoming the shame of acknowledging and addressing the destructive tendencies in yourself that prevent intimacy from deepening - your marriage isn’t growing, either, and it’s probably time to get some help.


No, not the economic one - the other kind.  Depression, once an illness that dared not speak its name, is now familiar to most Americans.  It effects men and women, young and old, and plenty of us.  Depression can be minor or major – that is, less or more seriously afflicting.  It can come in a single episode, or it can be recurrent or chronic.

Andrew Solomon , the brilliant author of a comprehensive work on depression entitled “The Noonday Demon,” described it as “the aloneness within us made manifest.” “The only feeling left in this loveless state,” Solomon wrote, “is insignificance.”  Another great poet of depression, William Styron, likened it to “darkness visible.”   

To those who have not known clinical depression, the powerful, poisonous grip of it can be hard to understand.  The depressed person, instead of eliciting our compassion, can seem like someone who just wants pity; who isn’t trying; who wants everyone else to be as miserable as he is.  Those who love a depressed person are deserving of compassion themselves: the depressed person is often very hard to live with.  He cannot feel loved, no matter how sincerely and with how much devotion others try to love him.  He clings to his loved ones, even as he pushes them away.  His self-loathing is often turned on those who love him, who then feel the brunt of his profound disappointment in himself, his discouragement and self-contempt.  The more he hurts those who love him, the more he sinks into shame, guilt and despair.

Depressed people need help but often are too afraid, discouraged or ashamed to seek it.  Those who love them need to push, insist, or demand, if need be, that they get help.  Two things help:  medication and psychotherapy.

The SSRI medications (Selective Serotonin Reuptake Inhibitor), such as Prozac and its many successors, have been the most effective medical treatment to date.  With relatively few side effects for most people, they have helped relieve the worst symptoms of most kinds of minor depression, and they are very often successful in controlling recurrent major depression.  However, these medications do not turn sorrow into joy – an SSRI is not a panacea.  Rather, SSRIs help to diminish obsessive rumination.  For the depressed person, this can mean that the compulsion to obsess over an endless litany of cruel judgments against himself can be controlled and eventually even stopped. 

But these habits of self-loathing run deep and have not sprung out of thin air.  The terrible thoughts and feelings of the depressive have meaning – and therapy is the means by which the traumatic origins of depression can become known.  People typically think of “trauma” as a terrible incident of some kind of violent assault.  But trauma can also be developmental.  Developing as a child in a family led by caregivers who are ill – for example, with alcoholism and other addictions; mental illness; personality disorders and mood disorders  - can be a significantly traumatic experience. 
For those who have grown up under these conditions - where trauma is cumulative, and rooted in childhood dependence on unstable caregivers - the sense of utter, desolate aloneness can become a lifelong, haunting presence, like a curse one is helpless to dispel.  Too often, depressives blame only themselves for their difficulties, not realizing that their upbringing all but guaranteed they would eventually fall prey to depression.   Therapy not only illuminates the origins of depression, but helps to create a path toward healing, growth and change.

If you have healed your depression through exercise, through spirituality, through service to others or meaningful, inspiring work, or through a loving relationship – you are among the lucky.  If you’ve tried it all and still suffer, seek the help of a licensed mental health professional.  It is never too late to get help for depression, and to claim the right to a life of meaning and possibility  - a life in which it is possible to love and be loved.       

A New Year

My sister-in-law Juliet told me that one year she decided to only make New Year’s resolutions that she could actually keep. After much deliberation, she resolved to take better care of her shoes. And in fact, she has kept this resolution for many years now (except for the one pair of boots the new puppy got a hold of). It was a matter of being realistic, she told me, and not setting herself up for failure with some unattainable goal.

Which made me think about ambition, aspiration, desire.

George, a young 29 year old man who could still pass for a teenager, was going to be setting up a hedge fund. He had already made a tremendous success as a Wall Street trader, with a system he had worked out that had led to tremendous gains for his company’s clients. Now he wanted to branch out on his own.

George was driven. He didn’t really date; he’d hook up now and then, but most of his companionship came from the guys at the high stakes poker games he frequented. And when he couldn’t wind down, there was one particular pill that would take the edge off for him.

George’s father had divorced his mother when he was about twelve years old, and the father proceeded to do everything he could to ruin his mother. Though very wealthy, the father had schemed so that his wife couldn’t get at his money, and Ralph saw his mother reduced to near poverty. He decided that earning hundreds of millions of dollars would be his guarantee that his mother, his brothers, and he would never lose control of their lives again.

I believe George will succeed, and I’m sure I will both admire and envy his success. But it looks like he will spend his thirties on telephones, in front of computers, living on adrenaline, popping pills, using money as a fortress that could end up locking him up from the inside. George thinks it will all be worth it when he is 40. I hope he’s right.

Is it possible to have grandiose ambitions without being obsessed? The constant stream of celebrity meltdowns the media bombard us with suggests that it isn’t easy. And then there’s that little matter of the collapse of the global economy – oops! Hopefully we all now recognize that the glamour and hype of the celebrity culture and of the financial world is often undergirded by pharmaceuticals, rehabs, prisons and divorce lawyers. And that many seeming successes are actually just bubbles.

George had a moment recently - while high - of perfect peace, looking out at the view from his penthouse windows, feeling really good about what he’s accomplished. George is a great guy; I hope someday he can feel good about himself even when he isn’t high, and that he can open up and share his life, his amazing accomplishments, with someone who loves him.

It’s great to set goals in the New Year. I’m not saying don’t aim high. Go for it! But it’s also important to stop and recognize and appreciate what you’ve achieved, and what you’ve got. We can tend to focus on what isn’t enough, and lose sight of what is, what is good enough. So here’s an idea: resolve to relax more, to connect more with others, and to enjoy living while you can, as much as you can. And maybe take better care of your shoes, while you’re at it. Happy New Year!


A friend, and the mother of 2 lovely children, recently told me, her voice crescendoing with frustration, “You should write about what to do when your child is being so impossible that, as much as you love him, YOU ACTUALLY FEEL LIKE YOU COULD BECOME A CHARACTER IN A GREEK TRAGEDY!” Greek tragedies - you know, those ancient dramas where the parents murder their children, or each other, or all of the above?

Full disclosure: I am currently a parent of a 10 year old boy and a 7 year old girl, and all too often I know just how that mom feels. Like you, I struggle with putting good parenting intentions into action. There’s obviously far more to say about parenting than I can do justice to here – and always more to learn - but here are a few suggestions.

• Aim to stay calm as much as you possibly can. Your anxiety, resentment, losing your cool, flying off the handle, shaming and blaming – it just serves as a bad model for your child to mimic, feel hurt and rejected by, and throw back in your face. Being calm when your child is being impossible models to the child that problems, conflicts, and moods are normal human experiences that can be addressed constructively. And it shows that you are dependably in charge – not by force, but with strength.

• Do others tell you your kids are terrific, and you’re wondering why they are often so impossible at home? For kids, growing up, going to school, dealing with the social world and ever-increasing responsibilities is a constantly challenging process. Kids are doing all they can do to hold it together out there. Maybe they need to be able to fall apart a little at home, and maybe we need a little more empathy.

• Kids are super-sensitive, and they easily pick up on your bad moods. Transitions are often tough for them. Does your own moodiness lead you to focus on all their flaws and forget to notice their strengths, their efforts? Try cutting them some slack when they act out – it often helps them calm down and get themselves together more quickly.

• If your partner is a calmer parent than you, stop resenting her (or him), and resenting the kids for favoring him (or her). Instead, ask for her (or his) support to help you become a more relaxed parent.

• Work on your connection to your partner/spouse. Get your power struggles and other disconnection issues cleaned up. Your kids need unified, mutually respectful and loving parents, not embattled and embittered rivals. What kids learn about relational behavior and what they act out is often exactly what you model to them in your own relationship to your partner.

• You are not perfect, you never will be, and no one else will be either. If you can’t admit that, you are officially a control freak, which is to say that you need to get yourself under control. When you dispel all illusions about perfection being a possibility, it will be easier to be accountable for your mistakes and easier not to be expecting perfection from your kid, or from your partner/spouse. When you make a mistake and lose it with your kid, honestly apologizing is a highly effective way of reconnecting and healing. Don’t forget to model forgiveness, too, when the apology is aimed at you.

Finally, find people you can vent to about parenting who aren’t condescending and judgmental. You want to love, care for, support and encourage your kids? Make sure you’re getting all those things, too – from friends and family who appreciate how much you love your kids, how hard you try, and all the good you’re doing.

Gotta Be This or That

Without even realizing it, we are constantly making choices, from one second to the next. Yet for some, choosing is an agonizing process. Unlike the mandate in the title of the 40’s swing tune – gotta be this or that - some people cannot ever decide between this or that, and they and those around them suffer a good deal as a result.

At worst, such indecisiveness may be a sign of Obsessive Compulsive Disorder (OCD), a mental illness that runs in families. The classic symptoms, such as hoarding, fear of contamination, checking repeatedly, and ordering symmetrically, are considered pathological when the compulsive need to ritualistically perform these actions becomes overwhelming, depressing and disabling.

I’ve seen a number of people for psychotherapy who were never diagnosed with OCD, because their symptoms were not obvious.

For example, there’s the man who repeatedly stays in romantic relationships with women he won’t marry, because he fears he is making a mistake and should be with someone else. He fears the woman he is with will become controlling, demanding, overweight, and that he will lose too much money if she divorces him. He’s also turned down job offers because he felt he didn’t have enough information, only later to realize he had missed tremendous opportunities.

There’s the woman who puts intense pressure on herself to be extremely nice to others, for fear that she will say something cruel and unkind that will hurt them. As a result, she agonizes over any decision involving interpersonal transactions; and obsesses constantly over how she has been offended, or how or if she has offended others.

And there’s the woman who has to exhaustively research any choice about anything – from buying a toaster to moving out of an apartment with an abusive landlord - and as a result, feels unbearably backlogged because of all that she hasn’t been able to get done. When she isn’t utterly exhausted, she’s feverishly busy researching, and obsessing constantly about what and how much she is eating.

The common obsessive-compulsive theme for these people is the fear they have of doing the wrong thing, a fear of making choices which will have both morally and concretely disastrous consequences. They can never fully trust themselves or others, but are nevertheless always unconsciously debating: am I the bad one that cannot be trusted? or are you the bad one that should not be trusted? Is this world safe for me, or am I constantly in danger? No matter how they deliberate, they never get a satisfactory answer.

In therapy, it became clear that each of these people had difficult developmental experiences and certain family problems that seem to have triggered the OCD symptoms. But in each case there was also a history of anxiety disorder in previous family members – a good reason to consider medication.

Today, “SSRI” medications that regulate serotonin levels in the brain are successfully prescribed for OCD, resulting in the relaxing of obsessional rumination. But as with all mental health concerns, talking things out in psychotherapy is also important. For OCD sufferers, medication and psychotherapy can help uncover the underlying psychological structure of the problem, and can aid the development of hope and determination – both of which are needed to gain control of the symptoms.

Choices are often hard to make, but with OCD, choosing becomes a nightmare. If you or someone you know suffers from OCD, the best choice you can make is to consult a licensed mental health practitioner and get you or your loved one some professional help.