Tampilkan postingan dengan label I. Tampilkan semua postingan
Tampilkan postingan dengan label I. Tampilkan semua postingan

Senin, 21 Agustus 2017

Knowing I only have panic attacks at night


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Selasa, 08 Agustus 2017

SANCTUM Sneak Peek I


For the next few days, I'll be posting sneak peeks of Sanctum. When you're finished reading, please consider entering the giveaway below--it won't cost you a thing besides a few moments of your time, and you'll be raising money to fund suicide prevention initiatives. Also, there are prizes.

*dangles prizes*

And here is the first of four brief excerpts from my book, which comes out two weeks from today! As you probably know at this point, Sanctum is story of Lela, a girl who sneaks into hell to rescue the soul of her best friend, Nadia, after Nadia commits suicide.

In this one, Lela's trying to deal with her grief over Nadia's death (she's even gotten Nadia's face tattooed on her arm) ... and increasingly intrusive visions.


 
Giveaway (the more entries, the more I'll donate):

a Rafflecopter giveaway

If YOU want to donate, enter here ...

a Rafflecopter giveaway

Sabtu, 01 Juli 2017

Adventures in the Veterans Hospital Mental Health Clinic Part I





Kafkaesque: of, relating to, or suggestive of Franz Kafka or his writings; especially:  having a nightmarishly complex, bizarre, or illogical quality.

Rube Goldberg machine: a contraption, invention, device or apparatus that is deliberately over-engineered or overdone to perform a very simple task in a very complicated fashion, usually including a chain reaction. The expression is named after American cartoonistand inventor Rube Goldberg (1883–1970). Over the years, the expression has expanded to mean any confusing or complicated system.

Much to my own relief, I retired recently from my part-time job at the Veteran's Affairs (VA) hospital seeing patients in the mental health outpatient clinic. While I found the patients interesting and challenging, the VA bureaucracy was at times as infuriating as one might guess. 

The Kafkaesque nature of the system in which I worked can best be illustrated by an experience I had with my picture ID card. The VA does extensive background checks on employees - as well they should - and requires fingerprinting when their identification cards get renewed every few years. 

The card contains a computer chip which allows the bearer access to the VA computer system, most notably patient electronic medical records. A few months ago, the computer chip in my ID card malfunctioned - way before its renewal date. I thought it should be no big deal to get it replaced. Yeah right. 

Not only did I have to get fingerprinted again and wait several days for them to be processed, making it extremely difficult to actually treat patients in the interim, but they also required me to produce two forms of picture identification.

The VA did not accept its own picture identification card for this purpose, which had not expired, as one of the two!

Before I go further with more bizarre stories about the place, let me make a couple of things clear. The fact that the VA is a governmentbureaucracy does not mean that private companies cannot be just as nuts - or even crazier. They can certainly be far more hostile. I used to work for one. As a friend of mine who worked for both of my former employers said, at least the VA bureaucracy was predictable in its crazy decision making, while the private firm we worked for was crazy but whimsical. Sort of like the Dilbert comic strip.

Let us turn to the issue that made the news: problems with scheduling patient appontments in a timely fashion. Much of the coverage in the news simply ignored the fact that an influx of new patients who are veterans of the wars in Iraq and Afghanistan has overwhelmed the VA healthcare system. There are just way more people reliant on VA than ever before. This happened without a commensurate increase in funding or staff until just recently, and there is still a lot of catching up to do.

In 2003, The VA expected to see 4.7 million veterans in its hospitals and clinics, up more than 54 percent just from 1996. The influx of newly-injured and/or mentally traumatized vets has continued every year since then as the wars dragged on, and funding of the system for the treatment of these wounded warriors did not keep up. Not even close. Frankly, the politicians who yell "support our troops" the loudest do NOT believe in supporting our troops after they leave the service.

In mental health in particular, visits to mental health clinics have skyrocketed as the military has attempted to change the "macho" culture that discouraged such visits in the past.

So what to make of the bureaucrats who kept phony schedules to hide the fact that veterans often had inordinate waits before they received an appointment? Well, when you give employees a mandate to do something as a condition of continued employment, and you don't give them the tools and resources needed to accomplish the mandate, they will naturally become passive-aggressive and do crap like that. They have no choice. 

And we know how bureaucracies treat whistleblowers, so everybody shuts up and goes about their business doing their best to get around the double bind they are all in.

To get patients seen in a timely fashion, you would think that the place would, at the very least, be very quick about putting in the appointment system the times when various doctors are available in their clinics to see and treat patients. Again you would be wrong. Whole clinic days of mine would disappear from my upcoming January schedule in the computer for an upcoming new year, and it would take two or three months of me complaining about it for the clinic times to reappear. I could not schedule anyone! 

I finally found out why it took so long. At least this is what I was told: There was just one person doing this job. Not one person for a few clinics. One person for the whole humongous medical center! 539 provider schedules, give or take.

Still, in the defense of the VA, at least part of the fault for patients not getting seen in time by a doctor may have in some cases lied with the patients. I can not speak for VA facilities in Phoenix or the rest of the country, but here is a photograph of an actual sign displayed prominently at the entrance to the VA hospital in Memphis:



In addition, at least in the mental health clinic I worked in, one of the doctors was always available to see every walk-in patient who came in without an appointment - even if they hadn't stopped near that sign to get checked in.

Furthermore, the hospital had what they called a "patient advocate's" office, where vets could complain about problems they were having getting seen. The patient advocate was usually very effective at getting them in.

If the patients described in the news media who died before they got in for an appointment were that sick, maybe they should have not just followed the instructions of the schedulers about how soon to come it. "I vas only following orderz" is not a good excuse.

Still, it is clear that the VA does tend to be a lot more concerned with looking good rather than actually doing good. For an illustrative example, a mandate came out that veterans who were diagnosed with mental trauma and post traumatic stress, either from war or military sexual assault, had to receive a certain number of psychotherapy sessions within a prescribed period of time after their initial evalutation.

The hospital administrators recently bragged in an e-mail to the department that they had met the target. 

What they actually did was to put all of these patients into group therapy, which in my experience was, in a lot of cases, next to worthless - instead of giving them the much more effective individual treatments. The VA where I worked does not have nearly enough psychologists on staff to provide individual treatment to everyone who needs it, and the ones they do have are mostly busy doing other things because they are maldistributed as well. 

For post traumatic stress disorder uncomplicated by major personality disorders, in my estimation the most effective psychotherapy treatment is something called prolonged exposure (PE), a type of desensitization treatment. Another treatment that is "empirically validated" - by which some people mean that there are some studies, no matter how pathetic, showing that it is minimally effective - is called cognitive reprocessing therapy (CPT). That in my experience is less effective for a lot of patients than PE.

Commensurate with my experience at the VA in Memphis, an article in the journal Psychiatric Services by Watts and others published in May of 2014 found out that, nationwide, the percentage of veterans who received any sessions of either PE or CPT was six percent. Six percent! But our VA bragged about fulfilling the mandate because the veterans were seen by a mental health professional the correct number of times. Well sort of seen, anyway.

More on looking good rather than doing good in upcoming posts in this series, coming soon to a blog near you.

Anecdotal Evidence and Inductive Conclusions in Psychiatry Part I





“Can a valid diagnosis be arrived at if laboratory tests are not available? Of course it can. Total reliance on on lab tests to the exclusion of other factors when seeking validity is not science but scientism” ~ Hannah Decker, Ph.D


In my post of April 1, 2010, Is “Data” the Plural of “Anecdote?” I pointed out that in most hard sciences, stories about a scientist or practitioner’s personal experience can be contrasted with “empirical” data from studies, and that the latter usually has more validity that the former.  

As I also pointed out, however, “many of the randomized, placebo-controlled, double-blind drug studies can be every bit as biased as the worst anecdotal evidence. We are now living in an age of 'marketing-based medicine,' as opposed to evidence–based medicine" (randomized = the use of chance alone to assign the participants in an experiment or trial to different groups; placebo = inert sugar pill; double-blind = neither the person evaluating the research subject nor the subject knows during the experiment if the subject received the placebo or the active medication).

In psychiatry, the situation is even more complex, since there are almost no objective lab tests and we can't read minds, so we must rely on the experimenter's personal observations, or answers by subjects to psychological tests in which we do not know how honest subjects are being or even if they really understand the questions, or patient self reports. All of these sources of data, while important, are highly subjective and can hardly be considered "empirical" in the same sense as, say, a chemical reaction.

Another big point about anecdotes is that they are not worthless in science. Some of the most important discoveries in all of medicine were based initially on anecdotal evidence. In Part II of this post, I will describe how to determine the validity and generalizability of conclusions generated from a group of “anecdotal” clinical observations. That is, how can we tell if the anecdotes are the typical situation seen with a particular combination of clinical variables and which therefore can lead to a conclusion that will probably apply to most patients with a given disorder? Are the conclusions probably true, or probably false? 

In this post, however, I want to contrast conclusions based on a “clinical anecdote” with inductive reasoning. Remember, the first step in the scientific method is observation.

According to Wikipedia, inductive reasoning (as opposed to deductive reasoning) is reasoning in which the premises seek to supply strong evidence for, but not absolute proof of, the truth of the conclusion. It is usually based on seeing the same phenomena over and over again without any exceptions.

The truth of an inductive argument is supposed to be probable, based upon the evidence given. The same phenomena involving two variables are observed repeatedly, and other variables which correlate with the phenomena are shown to be not necessarily connected it, and a tentative conclusion or assumption is drawn regarding the relationship between the two variables.

Deductive reasoning, whose conclusions are more certain, is the process of reasoning from one or more general statements (premises) to reach a logically certain conclusion. Deductive reasoning links premises with conclusions. If all premises are true, if the terms are clear, and if the rules of deductive logic are followed, then the conclusion reached is necessarily true.

To anyone familiar with formal logic, deductive reasoning takes the form of a syllogism:

All men are mortal
Socrates is a man
Therefore, Socrates in mortal

If the first two statements are true, then the third statement must be true. Deductive reasoning is considered the entire basis of science by some scientifically illiterate individuals. 

The problem is that both premises in the above examples are inductive conclusions! Just because all observed men have turned out to be mortal does not in any way prove that the next man you come across cannot be immortal!

The first thing you should have learned from your Geometry 1 class in high school is that there is absolutely no way to prove that the shortest distance between two points on a flat two-dimensional surface is a straight line. It is just that every time you measure it, it is. You just have to assume it.

I have a pen in my hand which I am holding about three feet off the ground. Every time I have dropped it under controlled conditions, it fell to the ground. I can never prove that the next time I let it go, it will fall. So let’s see. Well, I’ll be darned. It did it again!

In other words, ALL scientific deductions are based on premises which are unprovable inductive conclusions. Therefore, presto change-o, if no inductive conclusions are scientific, then no deductive conclusions are either. Or in other words, science would not really exist.

Syllogistically:

              All scientific conclusions are based on inductive reasoning
              Inductive reasoning never proves anything
      Therefore, no scientific conclusions are proven.

Bullcrap.






Rabu, 21 Juni 2017

SANCTUM ARC Winner! Also how I antiqued those maps



Well! Thanks so much to everyone who commented last week--I was thrilled to see that so many people feel the same way I do about maps to go with books.

In a few weeks, I'll unveil the map of the dark city, the place where most of SANCTUM takes place, on my website. Still working to get the final details in place.

But for now--one of you has won an ARC of SANCTUM, and a custom copy of that map!

And the winner (chosen by random number generator from the comments left in this post) is ...

Stephanie Diaz!

Congratulations! I hope you enjoy the book and the map!

Some of you have asked me why the maps look so aged and worn, so I will tell you: I did that part myself. It was kinda labor intensive, but very much worth it. Here's what I did:

  1. I printed the maps on heavy, 25% cotton paper that already had a cream tint to it.
  2. I painted each map with tea. Just me and my basting brush and English Breakfast. Yep.
  3. Once both sides were saturated with tea, I scuffed the edges of each map using a rag. Rubbing. Lots and lots of rubbing.
  4. I dried each map for 10 minutes in the oven. 200 degrees Fahrenheit.
  5. I burned the edges of each map in a candle flame.


For each map, this process probably took about 25-30 minutes start to finish. Now you see why only 45 copies exist :)

And I have about 6 left! So ... there will be more opportunities to win one!

Have you ever "antiqued" a document or picture before? Did you do something different from what I have here? How did it go?

Rabu, 24 Mei 2017

You should not have told me I can put GIFs on here


Just spent the last hour looking at the Bangor uni videos. Standard September night really. UCAS -> English Language -> Same courses I always look at -> Oh look the same unis -> Funny, I recognise that bedroom I'VE LOOKED AT IT SO MANY TIMES.

I seemed to finish my Personal Statement this morning. That was, er, weird.


No doubt it will get ripped to shreds by a trillion people before I submit it, but writing the last line felt good. I'm not stressed about uni really. What? What do you mean you don't believe me? Verging on mental breakdowns constantly? You've received 5 emails of distress from me? Oh.

Honestly though, September's been ace. I'm 18. EIGHTEEN!


Did somebody say September? I'm sure I heard that. It's not July is it? S e p t e m b e r? The Autumn month? Yes I thought so. SO WHY IS IT 30C today??? No am I not happy about this. I have a new coat. It's burgundy. It has a very furry hood and I look like an eskimo. LET ME LOOK LIKE AN ESKIMO. I'm sure I heard my legs screaming in horror at being let out into the light today. Gorgeous red leaves, newly fallen on the ground, were shouting, "BUT IT WAS MY TIME. MY TIME TO SHINE IS NOW. WHY AM I NOT CRUNCHING? HELP ME UP, FFS. GET ME BACK ON THAT TREE." Even the slugs fell victim to the chaos. Thinking everything was dark, wet, and cold. Poor souls. They're the ones all crunched up on the ground, not the leaves. The only ones getting away with this are the daddylonglegs. Gliding around like they own the effing place. Spiders I can deal with. But daddylonglegs unleash emotions and actions I never knew I had. 

So yeah being 18's involved going out A LOT. Going to pubs, clubs, parties, buying cigar...*fades to black and silence. head pops into shot, and body shuffles in* Hahahahahaahaha...oh, you thought I was SERIOUS?


I've been fangirling the hell out of Doctor Who, geeking out over Stephen Fry's Planet Word, adding copious amounts of books to my Amazon wishlist, and voicing the tripod in War Of The Worlds in French with my friends, consequently crying with laughter and doubling over in stomach pain. 


The only remotely 18 year oldish thing I've done is click "I am over 18" boxes on websites with TRUTH. My 18yo life > your 18yo life.  


AND, EXIT


Rabu, 17 Mei 2017

I Can Haz Insight


General dictionary definition of insight: the ability to perceive/understand things clearly and/or deeply

Psychological insight: awareness of one's own feelings, attitudes, symptoms, and the motives and reasons behind one's actions

Assessment of insight is a basic part of a standard mental status exam. People diagnosed with mental illnesses can have pretty good insight (for example, many of those with mood or anxiety disorders). They know they have a disorder, and they understand that some of their behaviors are unusual, harmful, or sabotaging. People who have schizophrenia or other psychotic disorders, as well as individuals with severe personality disorders, often have relatively poor insight. They don't necessarily recognize they have a problem at all. Often they believe the problem is other people.

Sometimes, as I sit by the sidelines and watch yet another drama unfold, I think about insight.

Insight isn't an all-or-nothing thing. Many treatments focus on helping a client develop some insight into his/her problems. You can't force insight on someone. It can't be done with logical explanations or rational argument or razor-edged criticism.

Like talking to a brick wall.
The interventions designed to cultivate insight don't focus on explanation or confrontation. They focus on creating a space in which the person has the appropriate information and the sense of safety that allows him/her to recognize what's really going on.

 Lack of insight causes a lot of frustration on all sides. It's difficult to comprehend how someone can't understand something that seems obvious to most other people.

Having insight doesn't necessarily make you feel better. Ever heard of depressive realism? Sometimes reality is kind of a downer. However, if you want to function well in this world, reality is often something you just have to deal with.

Anyway, lack of insight into one's own behavior isn't always the cause of the dramaz on the internets, but sometimes, especially in cases where one person is the clear aggressor/complainant and the rest of the avatars stand around shaking their heads at the outlandishness ... I think it has a lot to do with it.

Do you think lack of insight sometimes contributes to internet blow-ups? Can you think of an example from your electronic or real life?

Sabtu, 13 Mei 2017

Before I Die Coming To Terms With Dying Too Young


Sixteen-year-old Tessa Scott is going to die. Soon. She has had acute lymphoblastic leukemia for the past four years, and now she's been told additional treatment will do no good. That's how Before I Die, by Jenny Downham, begins.

Tessa makes a list of the things she wants to do and experience before she dies, and the book is about how she moves through that list--and the final months of her life.

When I was on internship at The Children's Hospital of Philadelphia, I did a rotation on the oncology unit. I didn't work there very long, only six months, but it was an experience I'll never forget. I witnessed the struggles of families trying to remain close, to remain themselves, despite the disease that had twisted up their lives. Some were having to help their beloved children through the process of dying.

The question that kept coming up?

Nope, not WHY. I mean, there was that, but most families had a much more pressing concern:

HOW?

How do you parent a kid who's dying? Can you set any limits and boundaries at all, or do you just let them do whatever they want (like Tessa, who wants to have sex and try drugs and drive a car even though she doesn't have a license)? How do you help when there's no fixing it?

And ... how do you deal with a kid who's just plain angry?

That one was the hardest. Right when loved ones wanted to be close, the kid was sometimes shoving them away.

In Before I Die, Tessa is angry sometimes. Inconsiderate. Even cruel on occasion. (She is also bright and generous and creative and curious and lovely.) I've read (a very few) reviews where readers said they didn't find Tessa that sympathetic.

I was stunned.

You're reading a book about a girl who's dying, and you expect her to be OK with it? You want her to be peaceful and loving all the time? Really? I mean, that would be utterly cheap (and boring), but leaving that aside ...

How would YOU feel if you were sixteen and your life was coming to an end? If you watched your healthy classmates live their lives with wide-open futures, and you'd been informed you wouldn't see another summer? If you'd found a boy who cared about you, who made you feel good, and you were counting the times he touched you, and wanting a lifetime of those feelings, and. And.

Tessa's supposed to be experimenting. Figuring out who she is and starting to solve real-life problems on her own. Exerting some control over herself and her choices. That's what sixteen-year-olds must do. And she does, all while coping with her failing body. Knowing her death is going to hurt people she loves and who love her, but needing them near her anyway, fighting with them anyway, getting closer to them anyway. How any kid, any person, wouldn't be  at least a little angry about that, I do not know.

Research shows that young people with cancer are actually reasonably well-adjusted in comparison to their peers. But those were kids in remission, not kids who were considered terminally ill.

At the beginning of Before I Die, I read out of curiosity. And admiration for Jenny Downham's tremendous gift for simple, powerful description. The novel is written in first-person, present-tense, and no other style could have worked--the immediacy of Tessa's experience is perfectly conveyed. If you want a lesson in adding detail and idiosyncrasy to a narrative to keep it grounded while at the same time rendering it unique, read this book.

So I marked (NUMEROUS) passages and reread them. And I liked Tessa. I thought she was genuine and believable. I was OK with what I knew was going to happen at the end of the book.

By the time I reached the halfway point, my curiosity and admiration were gone--in favor of feeling Tessa's fear and frustration and joy right along with her. As she negotiates a new and fragile relationship, as she has moments of hope and triumph, I was thinking:

Not yet. Not yet. Not yet.

Before I Die is a beautiful book, and also a painful one. But definitely worthy of a read.

How do you keep characters genuine and believable and relatable even when they're going through something that makes them miserable? Do you feel the temptation to soften them up to keep them sympathetic? Do you pull back from ugliness and anger because you worry you'll lose your reader? And when you read, what is it about a character that keeps you walking down that road, and turning those pages, with him/her? What makes you care about a character like this, and what puts you off?

Sabtu, 06 Mei 2017

Book Deal News FACTORY GHOST AKA That thing I wasnt supposed to write but did


This is a bit surreal.

In the fall of 2011, things were a bit hectic. I had the deal for SANCTUM, and I was smack-dab in the middle of writing the sequel. In September, I interrupted that project to write the partial for SCAN that went on submission in October.

I write to cope. And when I'm on sub, I cope hard. Once SCAN was with editors, I needed to stay busy, even though I knew that if it was acquired, I'd need to write the rest of the book on a very tight deadline. But for some reason, I didn't feel like immediately jumping back into Sanctum2 once I'd taken a break with it.

Aaaaand then I got an idea. Sneakily, guiltily, I wrote a few chapters. I sent them to Brigid Kemmerer, because she is very honest and frank (on top of being a brilliant writer), and I knew she'd slap me upside the head if I was getting involved in a project that was a total waste. But she got back to me quickly and basically said "GO GO GO!"

So I went went went, and three weeks later, FACTORY GHOST was finished. It's sort of like Phantom of the Opera meets Upton Sinclair's The Jungle, set in a fictional Asian society. Writing it was intense to say the least. But I'm *really* proud of it. And yesterday evening, this came out in the Publishers Weekly Children's Bookshelf:

Ruta Rimas at Margaret K. McElderry Books has acquired at auction Sarah Fine's Factory Ghost, a gothic YA novel about a 16-year-old girl who moves in with her father, the resident doctor for the town's slaughterhouse, and discovers that the myth of the factory ghost may not be a myth at all. Publication is set for winter 2014. Kathleen Ortiz of New Leaf Literary & Media did the two-book deal for North American rights.
Thank you, Brigid, for encouraging me to write this book even though the timing was all wrong. Thank you, Kathleen, for not freaking out (out loud, at least) when I told you I was writing another book instead of the books that were already under contract (and for supplying the color coded schedules to make sure I don't miss any of my deadlines. And for, you know, selling my books). Thank you, Ruta, as well as the entire McElderry team, for being so enthusiastic about this story.

And thank you, blog friends, for being part of this with me. I am so, so fortunate to be part of this community.

Selasa, 04 April 2017

Borderline Personality Family Dynamics The Parents Part I


In my post of 2/6/11, Dysfunctional Family Roles, Part I: The Spoiler, I opined that the basic problem in the "borderline" family (one that produces offspring with borderline personality disorder [BPD]) is that the parents in such families see the role of being parents as the end all and be all of human existence, but all the while, deep down, they either frequently hate being a parent or see their parent role as being an impediment to their personal fulfillment.

I also explained how the person with BPD develops the Spoiler role in response to the double messages that this emotional conflict leads such parents to give off to their children.

It's all well and good to try to understand the behavior of the individual with BPD in terms of a response to parental problems, but that just kicks the question of an explanation for the disorder back a generation. In order to fully understand BPD, we have to ask, "What on earth makes these parents so damn neurotic that they compulsively have children and then covertly resent them?" 

If the parents are not patients themselves, the only way for a therapist to get to the bottom of this is by helping the patient with BPD to construct a special type of family genogram.  A genogram is sort of an emotional family tree, and is a mainstay of the type of family systems therapy designed by family therapy pioneer Murray Bowen.

Murray Bowen
Using historical figures and geneology records as illustrations, the book Genograms: Assessment and Intervention by Monica McGoldrick and Randy Gerson describes how genograms can be constructed .

Monica McGoldrick

The genograms described by Bowen therapists are, in my mind, incomplete.  They concentrate on which relatives were overinvolved or underinvolved with which other relatives, and whether these relationships were hostile or friendly.  IMO, this leave out an awful lot of important information.  Two individuals may easily have a hostile and enmeshed relationships with each other over one area of functioning, say work or love, and yet still be very distant, friendly and uninvolved with each other over a different area of functioning. 

In other words, these genograms omit the content of the family squabbles.  When the content is added to the genogram, one can then look for the historical experiences of the family that may have created the picture that is taking place in the present.

While I have indeed seen the parents of adult children who exhibit BPD in therapy and traced their genograms, I have also coached patients with the disorder themselves to construct their family's genogram.  We try to go back as far as we can to figure out what family experiences led to the parents' conflicts.  Sometimes the story goes back more than three generations and we may lose the historical scent, so to speak, in that no one alive knows what happened way back whenever.  Usually, however, certain patterns come to the fore.

In Part I of this post, I will describe the one most common major issue, and the resultant behavior patterns, that I have discovered leads individuals within a family to develop a severe conflict over the parenting role.  In Part II, I will describe some other ones.

All of these issues may seem very common everywhere, and indeed they are.  Most families that face them do not produce emotional conflicts significant enough to create BPD pathology.  Rather, the issues in families that do have been magnified signficantly by an interacting tableau of historical events impacting the family and the individual proclivities of each and every family member and descendent. 

I will not describe the details of the magnification process here, but a full explanation can be found in my book, A Family Systems Approach to Individual Psychotherapy.

The most common cause of conflicts over the parenting role stems from cultural rules regarding gender role functioning.  Over the last century the opportunities open to women to explore their interests and ambitions have gradually expanded, and having a lot of children certainly put a damper on their ability to do this.  If a woman came from a family where the women were very bright and had a natural proclivity for being ambitious career-wise, this would often create difficulties for them since they lived in a male-dominated culture that was at best unfriendly to female career ambitions. 

To demonstrate how this might play out in a hypothetical family, I often discuss the evolving role of women in the United States since World War II. During the war, when all the men went off to fight, women in the United States entered the workforce in large numbers for the first time - in order to build the airplanes and tanks.  This phenomenon was known as "Rosie the Riveter." 

Some women found the experience of a career exhilerating, but when the war ended, they had to go back to just being wives and mothers once again.  The US govenment even made propaganda films thanking the women for their important work, but then encouraging them to go home and get barefoot and pregnant once again.  I have seen some of them; by today's standards they are positively jaw dropping. But effective. The Rosies did what they were told, and that is why we had the baby boom.


Rosie the Riveter
The daughters of this generation came of age in the sixties, when the women's liberation had started in earnest.  Women were more and more torn between the earlier gender role requirements and the new cultural opportunities expectations, and some women (as well as some men) did not make the transition very smoothly at all - for a variety of reasons.  One common reason: the Rosie the Riveters, having had a taste of the career world, would vicarioulsy live through the career aspirations of their daughters, but at the same time be extremely frightened by them.

Having children could easily bring the whole craziness to a head for some families.  Even today, parents feel very guilty about not spending as much time with their children as they would like, and they are often criticized at every turn by their own parents as well as the Phyllis Schlafly's of the world.  (Phyllis Schlafly was a career woman who made a career out of bashing career women).

Phyllis Sclafly
In doing genograms, one can often see just how far a family's operating rules lag behind the current cultural norms .  In anthropology, this problem is called cultural lag.  The cultural progression in Western nations, which is mimicked within certain families, was thus:  First, women really could not have careers at all.  Then, they could have careers, but only when they were single.  Then - and here is where many families with BPD members are stuck - they could only have careers when they had not yet had children.  Then, they could have careers even if married with children, but they had to give priority to the husband's career.  Last, both men and women were entitled to the same freedom.

Gender role confusion and conflict can, given the right combination of ingredients, create a nasty intrapsychic conflict over the very act of procreating. 

In Part II of this post, I will look at the rest of the historical factors and patterns that can create such a conflict: Deaths and illnesses, financial reverses, religious demands, parent-child role reversals, being the eldest child in a traditional family, and having children to "save the marriage."

Senin, 03 April 2017

Conquering Writers Block I Know Thy Enemy


Here we go! This post will be the first in a series on conquering writer's block.

I need you guys to understand one thing right off the bat: This is not going to be a bunch of tips.

I have nothing against tips. Really. But understand something about how I work as a psychologist: I don't treat problems. I treat the causes of problems. And that is because most problems of the human kind have multiple causes, and depending on which one (or ones) it is, the intervention might be different. I do things this way because it is more efficient and effective than using a one-size-fits-all approach to treatment.

So in these posts, I'm not going to be giving tips, really, at least not until we go over the causes of this frustrating condition, because the "tips" you choose should be tailored to the "flavor" of writer's block. That should make it easier for YOU to solve the problem of writer's block by selecting strategies that are more likely to work for you.

I hope that makes some sense.

Onward! First things first. Here's how things are not:



In other words, whatever drives your feelings--depression, anxiety, frustration, restlessness--doesn't come directly from an event (like rejection, or a negative review, or the fact that you've been trying to write the same scene for the past four weeks). Feelings come from that black box above. See it? Your thoughts. How you interpret the event.

And of course, it's not a linear process, right? Feelings aren't just an end result. Feelings drive behavior, and behavior leads to more events, and more thoughts. Like this:


Notice all those double-headed arrows? That's because each of these things affects the other stuff. This is the basic set-up for a model that we use to understand all sorts of problems. It's the foundation for a kind of treatment (cognitive-behavioral therapy) that's been proven effective in reducing symptoms of depression, anxiety, and even medication-resistant schizophrenia.

If you understand this model, you'll understand yourself better, and you'll understand writer's block better. In fact, you'll be able to deal better with a host of other obstacles to your writing or life success. So ... ponder it for a bit.

I'll be back on Monday with the results of an informal poll I took here on the blog and at the AbsoluteWrite forums about what goes through writers' heads as they experience writer's block. Basically, we're going to dissect that black box up there to start to get to the CAUSES of writer's block, so that you can determined what particular flavor you've got, and then we'll discuss what to do with each variation. Sound reasonable?

I hope so! Now--if you have questions about this model, please ask, because it's the basis for what I'll be posting on next week! I'll be answering questions in the comments so that everyone can see them.

Selasa, 07 Maret 2017

I will never kill you in a novel


This month's Sisterhood of the Traveling Blog question comes from Deb, who asked: "How do your pets/kids/plants (something you take care of) influence your writing? Do they help you, or distract you? Do you include them in your stories?"

Laura's answer is here, and Lydia's is here. Deb is up next week! As for me ...

First, let me get this out of the way. I don't put people I know in stories. Not family members, not friends, not colleagues, not clients. I've never even considered it, and it has to do with why I write. See, some of us write to express ourselves. Some of us write to process what we've been through. Some of us write because our heads are full of stories just waiting to be told.

I write to escape.

When I write, I am not here. I'm gone, lost in that story, dwelling within my characters. I tune everything out and go to that protected place in my head. When I am under the most stress, when I am under the most pressure, when I feel like climbing the walls--that's when my daily word count goes up (should I mention that I wrote over eight thousand words on Monday?).

That kind of escape would be hard to achieve if I took all the people I know with me. It's not that I don't love them or care about them; quite the opposite. It's just that I'm one of the most seriously introverted people you'll ever meet, and I need that time inside myself to charge up.

However ... part of Deb's question was whether something or someone I take care of influences my writing. The answer to that is yes. The people I care for, both personally and professionally, absolutely influence my writing.

They've taught me to ask a very important question: what's it like to be you?

I spend a lot of my work time, and a great deal of my at-home time, thinking about the possible answers to this question. To come up with the answer, you kind of have to shed yourself and go wear someone else's skin ... metaphorically speaking, of course (those of you who've read some of my manuscripts might be wondering).

I've learned to ponder this question whenever I butt heads with someone, whenever I'm trying to figure out why someone is behaving in a way that's hurting both herself and all the people around her, whenever I'm trying to understand someone's next move or how he might react to something I'm doing.

I've come to the realization that this question--what's it like to be you?--is incredibly useful. And not just for interpersonal interactions. For character development, too!  And I truly believe that whatever ability I have to crawl inside a character's head comes from the experiences I've had with the people I care for. I mean, if I bear some responsibility to a person, some power to change things for her, then I need to think about what it's like to see the world through her eyes. I'm grateful to every person who's been patient with me as I tried to figure that out.

How about you? How would you answer Deb's question? Do the things or people you take care of influence your writing? How?

Minggu, 26 Februari 2017

Boredom is an anagram of Bedroom which is ironic because I am bored in my bedroom


I am bored. I have been bored for 4 hours. And a bit. I am sitting on a chair in my room, which squeaks every time I move. I am wearing a pyjama top, hoody, and shorts. It is raining. Which is quite nice. I like the rain. My windowsills are soaking wet because I can't be bothered to shut my windows. I need a wee, and have needed one for quite a while. My right index finger aches from endlessly scrolling and refreshing, with minimal positive outcomes. My left hand is getting that pre-pins and needles thing because I've had a tissue pressed to my face for a good 10 minutes as I've picked a scab and now it's bleeding like frickin' Niagara Falls. My room is engulfed in a strong stench of nail varnish remover, which is probably quite dangerous, but I've left the top to the bottle in mum's room and can't be arsed to get it. I also can't be arsed to remove the rest of my nail varnish so have a green stained thing going on with my nails.

(I couldn't hold my wee any longer)

Can't believe I'm so bored I've resorted to talking about my need for wee. C'est la vie. STOP RHYMING.

Jesus.













It worries me that in my second week of the summer holidays (technically speaking, seeing as the first full week was Kos week) I'm bored already. I've done nothing today. Nothing. N o t h i n g. I should be used to doing nothing, seeing as that's what we did in Kos. We lay in the sun all day, doing nothing. Although to be fair, lying on the sofa while my little brother runs around the house with friends screaming, while my mum is screaming at them, and my dad has the football on the TV at maximum volume because of said screaming...isn't really the same. I'd do a whole blog post dedicated to mine and Clare's gallivanting around Kos, but it wouldn't be worth it because we did, er, nothing. So have some photos here instead.

Things I have managed to achieve today:

  • Get up before midday.
  • Finally persuade the 'rents to let me have an 18th birthday party at home. (ooooohyeeeeeeah)
  • Make a Facebook event for said party, and continually refresh it to see if people like me and 'attend'.
  • Eat a roast dinner. Achievement, I know. It's succeeding through battles like this that spur me on for greater future success, and make me proud to be a human being.
  • Watch 3 cat youtube videos.
  • Watch 1 adorable child youtube video.
  • Watch 1 freaky youtube video.
  • See 3 twitter fights unfold.
  • Carry on writing my book. The document is open.
  • Take off and reapply my nail varnish. (work in progress)
*le sigh*

Today IS special, though, because I have a new baby cousin. Zachary.


































So combing these photos, with the new one of Beckham and Baby...















...I now feel like my fallopian tubes are flapping around my face, while my brooding heart bleeds out my eyes with every new photo. I want a baby. Now.*

WELL, that's about it. I'm gonna goooo aaaannnddd....oh let's not kid ourselves I'll still be sitting here until midnight. But know that I am going in the Big Brother house for a day on Thursday with the likes of EMMA KENNEDY (yeah you heard right) so my boredom will be severely diminished. Ciao. X

(* I am, of course, totally lying, but I've always held a small hope that one day a baby will be left on our doorstep, or I find one abandoned on the side of the road.)

THE BELOW WHITE SPACE WON'T GO AWAY. IT'S IRRITATING, AND EVEN MORE SO THAT I CAN'T FIND A DOWN ARROW ON MY KEYBOARD TO DISPLAY IT. DAMN YOU, WHITE SPACE, AND YOUR LINGERING WAYS.





Jumat, 24 Februari 2017

I Shall Never Live With a Female Again Part Two




Wrench not pictured.

The Prozac Jitters
 
I had worked at the same company with S about a year when we decided to live together. She seemed a nice enough person, with a good sense of humor.
     She had been engaged, but the fiance had inexplicably moved out one day and canceled the wedding plans. She was distraught and, paying too much rent for a Brooklyn floor-through, wanted something more economical. I sympathized with her over the disappearance of the boyfriend. 
     "How could he abandon you like that?" I asked, indignant. It seemed capricious and cruel; later, I thought it showed a discerning nature and more than a lick of sense. He had legged it, and fast. When he broke up with her, S had idly threatened to stab him with a kitchen knife. 
     When S left her old apartment, I took the opportunity to let an apartment-hunting couple of mine know about it. They visited, approved, and agreed to take it. After S arrived with bags and boxes to our new apartment, she asked if I would accompany her back to her old place to "pick up a few things,"  such as her bedding, and a few pairs of shoes. Odd that she left them out of the moving truck, I thought, but agreed to help. When we arrived, I received my first harbinger of doom. S waded right into the apartment, through piles of wrinkled clothing, bags of half-eaten potato chips, cat toys, sponges, utensils, and sacks of garbage. I stood there, appalled, as she scooped up a few pairs of shoes. A couple of them spilled out of her arms as she shuffled back toward the door.
     S, you see, was the kind of girl who always appeared impeccably dressed, ironed, and accessorized. I had never had a hint of the chaos under the veneer.
     "Things got out of control while I was packing," she confessed. Very well. I had visited her in the apartment a few months before, but remembered nothing like this. Perhaps it was just an aberration.
     She gathered up whatever she could carry and gave me the garbage bucket and a mop to tote back to the new apartment. They looked suspiciously unused.
     "I guess you're going to come back and clean up this stuff?" I ventured.
     "Not at all." she replied. "The landlord will take care of it."
     A few days later, I received a phone call from my friends who had moved in. The apartment was supposed to have been left "broom clean." They had spent a full day, along with the landlord, toting sacks of discarded possessions and rotten food to the street. The refrigerator was filled with half-eaten bags of stale Cheese Doodles. Not only that, but S had left two big cardboard boxes stuffed full of her personal diaries. My friends were kind enough to hang onto them. (About two years later, when S still had not made a move to reclaim them, my friends cracked a couple and read a couple of tiresome, whiny entries. They were then chucked unceremoniously in the trash.)
     S, however, had brought plenty to our new apartment. Three cats, with all their accessories, moved right in. The place was lousy with cats. Her former fiance, a poet, had abandoned a full library of books in his haste to escape her. About 30 boxes of them sat in our living room. And her clothes collection was astounding. It came in big black garbage bags, on clothing racks, on hangers stuffed into boxes. Everything was impossibly wrinkled and, I soon discovered, would be summarily dry cleaned--at what enormous cost I can't fathom.
     After a couple of weeks in the new apartment, S still had not made a single effort to put away any of her belongings. They filled the common rooms from floor to ceiling, spilled out into the hallways, glutted the exits. The whole place was one goddamn fire trap. Over the piles, the three cats prowled about, yowling and urinating wantonly.
     Enraged, I demanded that S raise herself off the couch and do some work. She would tote a load of clothes up to her lair, then collapse on the sofa and smoke languidly, watching me under half-lidded eyes as I strained with more of the load.  After about 3 months of steady work, all the materials were contained. Her own room was a study in chaos: great, black garbage bags of clothes were piled around her bed like a barricade, and the clothing racks sagged under the weight. S had become so enslaved by fashion that it had literally imprisoned her; she lay in there like some troglodyte harpy, cawing out demands and complaints. She was so doped up on Prozac and other unidentified substances that she never got out of bed before 11 a.m.--especially on work days. Around her bed, an alarming supply of prescription bottles lay opened and half-spilled, presumably so she could snack on them in the night. I also noticed what I thought was a crusty old vibrator lying amongst the detritus, but I won't speak of that.
     Sometime early in our relationship, we acquired a third roommate. G moved in , full of good will. During his first week, one of the wretched cats urinated on his new leather jacket, which he had been unfortunate enough to leave on his floor.
     Despite the enormous number of feline presences in the home, S cleaned their litter box sporadically, at best. The cats rebelled. Occasionally, we would find little cat doody surprises on the kitchen floor. G and I made a pact--we would not clean the things up, no matter how terrible, because it would set a bad precedent. As a result, sometimes the poo would remain on the linoleum until it encrusted into a kind of awful museum piece. When we tactlessly mentioned the "little accidents," S would mutter and growl under her breath.
     S spent most of her evenings sprawled on the couch, a cigarette in her lips, the remote in hand. I seemed destined for weak-willed, pasty roommates with no hope of social life. A nimbus of cigarette ash and food products formed on the carpet--my carpet--under her head; the stain is there still. When I returned home from a night out with friends, S would fix a lazy, lizardlike eye on me from her recumbent position. The effect was downright creepy.
     Pretty soon, we began to notice that a pervasive odor of cat urine was infecting the entire place. The cats seemed to favor a dank, brown rug that had been laid down over the stairs and in the front hall sometime in the 1960s. One afternoon, G. and I tore up the entire carpet, picking out nails with a pair of pliers, and hoisted the sodden mass outdoors. The wood floor that was revealed was in decent shape. During our labors, S returned home, and fell into a foul humor as we had not asked her "permission" before the undertaking.
     Money also became an issue. S and I had initially agreed to share the grocery shopping. This changed after I got wise to her little scheme. At the store, she always seemed to have an empty wallet. I was constantly asking her to reimburse me for food, cleaning supplies, and other household necessities. So jittery with Prozac that she could barely write, S would grudgingly pen a check after some weeks of requests.
     During this time, she was set up by a sympathetic coworker on a blind date. On only their second time out, her purse was stolen. The date, acting as a gentleman, offered her his credit card until she could get her cards replaced. During the next few weeks, S engaged in a maniacal spending frenzy. She returned home with pairs of new shoes to add to her growing pile, and wallets stuffed full of cash-advance money--none of which, I noticed sourly, went to repay me for all her past debts. After at least $1,000 of madcap spending, S went to the bank machine and discovered she had maxed out the poor fellow's card. She explained to us, without a trace of remorse, that as his mother had recently died, he had a number of expenses on the card for the funeral and the gravestone. She seemed slightly put out that her ready cash flow had dried up. By this time, the poor man was so repulsed by her that he insisted she get out of his life--and forget about the money.
     For some time, S had taken to applying her makeup and dressing in my room after I left for work in the mornings. Her room was such a disaster that such actions were impossible. Although I kept my door bolted shut to keep the infernal cats out, S would often forget and leave it open behind her. After a weekend away, I returned home and headed for my room. Something was wrong. Terribly wrong. I patted the bed, and realized that it was a sea of cat piss--soaked through right down to the mattress. G returned home to find the sheets, featherbed, and blankets cascading down the stairs, while my tortured screams echoed through the house. To add fuel to my fire, I discovered that S had eaten a large portion of my prescription allergy medication. She must die.
     S, when confronted, suggested that perhaps the cats were angry because I had abandoned them for the weekend. She also recommended that I kept my door locked. With that, she slouched out of the room, forgetting to offer to clean my bedding. I did eventually wrench a check out of her to pay for the exorbitant cost of cleaning the featherbed (no dry cleaner within a 50-mile radius would touch it), but the situation led to the final dissolution of our friendship, as it were. After accusing G and I of a cruel collusion against her and the cats, she elected to move out. I made myself scarce while she packed. Afterward, G and I cleaned every trace of her foul presence from the apartment. I noticed that the little toad had somehow managed to pack all my music notebooks and my entire box of tools--two things which she would never use in her lifetime. She claimed she didn't have them, but I think the real reason is that she never unpacked at her new apartment. I can picture her there now, surrounded by cardboard boxes and piles of faeces.
     After she was gone, we did find one more memento of S: we made an odd discovery of a collection of giant x-rays of her skull and pelvis, stuffed behind the couch. Sadly, there was no silhouette of a metal wrench to be found that might explain the mystery of her troubled nature. Somewhat terrified, we pried up the cheap wooden boards in the dining room wall and hid the x-rays there, where they will no doubt be found by some future archaeologist.  

Jumat, 27 Januari 2017

The Power of Novelty in Visual Perception or how I screwed up the company newsletter


I work for a private mental health agency, and on top of seeing clients, I have a lot of other responsibilities. Like program evaluation and outcomes research. Training. Supporting quality control processes.

And, for some reason only understood by my boss, I also have to write the newsletter (those of you who actually know me personally will understand how funny that is).

Because our company is comprised of therapists who either go out to people's homes or practice in doctors' offices statewide, I've been doing profiles of our employees and contractors to help them connect with one another. You know, a picture and some background on the person.

Last week, I was doing this newsletter at the last minute, as always, and I put together three lovely therapist profiles and sent it out.

One of the profiles ended with the following sentence: "she participates in a training program at a local Marital Arts Center."

Did you spot the typo right away? I didn't, at least, not before I sent it out to about 120 of this poor therapist's colleagues. And I really did read it over a couple of times before I hit SEND, I swear.

Why aren't we efficient typo-catchers with our own work?

Well, I'll tell you why, because I know you were wondering. Our eye is greatly affected by what we expect to see. So much of our understanding of the world is based on the mind's ability to fill in blanks, to skip efficiently over visual information, fill in gaps, and form a cohesive whole from it. When I know the word I expect to see, sometimes it's hard to spot the missing or switched letters. But also, if it's something I've looked at several times in quick succession, my eyes skim over it even more, because I'm already used to looking at it.

Some things that might help:
  1. Obviously, have someone else read it (I don't have time to have everything proofread at work, but it's great for my creative writing if beta-readers help me with it)
  2. Set it aside and come back to it later (some of the novelty wears off if you give your brain a long enough rest from the material)
  3. Look at it in a different way (some people have talked about the benefits of printing pages instead of reading on a computer screen, and I think the novelty of looking at the printed page might help the author spot things)
  4. Take it line by line. When I make recommendations for kids diagnosed with ADHD, one of them is often to break things down, including using a paper or ruler to help the kid read one line at a time and really focus instead of getting overwhelmed by the whole page. I think this works for everyone--when it's needed.
  5. Read it right to left. Just another way to force novelty onto something you've looked at a billion times (not the most practical, I know, but if you hate typos as much as I do, it might be worth it)
What are your techniques for typo avoidance? Did you find any typos in this post? And are you skilled in marital arts (no, wait--please don't answer that)?

Take the time to check out the fabulous Lydia's Medical Monday post, as well as Laura's always awesome Mental Health Monday post!