Nightly Ritual

I am unable to locate the exact source but I'm pretty sure it was Fred B. Craddock who gave me the idea. Each evening he steps outside for a few moments just to look, to really look at his surroundings. For quite some time, I have been doing the same.

Last night when I stepped out on the porch, it was 14 degrees. I wanted to see if the stars were out. They were and they were absolutely brilliant. The night before, it was cloudy but through the woods I watched the head lights and then the tail lights of a pick-up truck rounding the corner. I wondered what the driver was doing out so late. Not long ago there was a shooting star.

On another night I aimed a flashlight into the dark woods and five pairs of greenish eyes shone back at me. Deer had bedded down in front of the house. Sometimes there's an owl calling to see if anyone else is in the neighborhood or geese announcing their late arrival at the neighbor's pond. A pack of coyotes trotting along the bottom land might start yipping excitedly for reasons known only to them.

I notice how sounds change. There are the early spring peepers. Later there is the sound of new growth as plants shoot up over night after a good rain. In early summer, as I watch the lightening bugs, I listen to bullfrogs warming up. Later in the summer the sounds of cicadas and tree frogs seem to crescendo with each passing night. On pleasant evenings I linger longer if the mosquitoes don't drive me inside.

There are the distinctive smells of fresh manure, a passing skunk or honeysuckle. Last night I breathed in woodsmoke on lung biting frigid air as I looked up at the stars, the same stars which, in the time of Solomon, inspired Job to write "He made the Bear, Orion and the Pleiades and the chambers of the south."

Fred Craddock calls this Doxology. I can't think of a better name.

Making progress

Today is the first day in nearly a week that I feel better than the day before. I am really encouraged that full recovery is coming soon. It is bitterly cold this morning. I just rooted through the freezer to see if I have supper makings and I do, so I won't have to venture outside for a grocery run. I plan to stay put in front of the fire which the hubster has been dutifully tending and next to the humidifier that is trying its best to pump moisture into the very dry air.

It's interesting how my brain shifts gears when I'm sick. I have done a bunch of Sudoku puzzles, watched two movies, and read some poetry. This morning I reread "The Rime of the Ancient Mariner" and as in past readings I was totally pulled into this marvelous tale. Once again I am aware how often this work is quoted and how its metaphors have become part of our language. I dug up the Coleridge because this week I was given a poem to read about the Titanic. I guess one poem about a doomed ship reminded me of another poem about a doomed ship. Once I opened the poetry anthology, I dipped into some Tennyson, some Housman, bit of Blake and finished with Robert Louis Stevenson.

I have also been reading with "The Trouble with Poetry" by Billy Collins which I bought after hearing him on the Prairie Home Companion. Until then I didn't know of him. I have been enjoying this collection very much. I do know that when an artist is popular that he gets the label of a lightweight. Those in the know (don't you know) sniff at anything that the masses (those who really have no taste) like. To the pundits, I reply, quoting my oldest daughter, "piffle". So I offer his poem "Sonnet" which I hope brings a smile and does not infringe on any copyrights.

Sick

Dang, I've done everything I could think of to ward off the various viri that have been circulating around these parts. Even though I have washed my hands diligently, I started getting sick mid-day yesterday. I'd been taking extra prophylactic vitamin C, so I increased the amount even more. I bumped up my intake of Vitamin D to crank up my immune system. Then I took some Yin Chiao, which oldest daughter recommends. I squirted Zicam up my nose. This product was recommended by younger daughter. I slurped up elderberry syrup and sucked on zinc lozenges. I drank several cups of echinacea tea and glasses of OJ. As a last resort I swished peroxide around in my ears. This is a remedy one of my patients swears by. I felt silly doing that, but desperate times require desperate measures.

Then I heard about some researcher in Wales who said that yesterday was the worst day of the year. All right! Now I've got some legitimate reason for feeling puny. So then, how do I explain why my throat is still sore this morning? Sigh! Maybe since I am no worse today, then my regime really is working. At the very least the placebo effect is operational.

Thoughts on my schooldaze

In an article in the current issue of Voices Jon Farber refers to the angry misanthropic spinster teachers he had in elementary school who "treated him to the last dying strike from the scorpion of 19th century pedagogy". As a product of a preparatory school for girls, I am all too familiar with this brand of teacher. I was terrified by teachers pretty much non-stop until late high school. Maybe by then I knew I was getting out of there soon and they wouldn't be coming with me. Not that all of the teachers were horrible. They were not. But the school was founded by a spinster and administered by her spinster best friend who worked at the school long after the first headmistress died. In fact this dried up relic was still there during my fourteen year sentence at that academy and scared me the entire time. I'd hear people say what a wonderful person she was, but all I knew was every time she looked at me, it was like that finger writing on Belshazzar's wall "You have been weighed in the balances and found wanting". I still get a knot in my stomach thinking of her.

Like Farber, I endured some very much out-dated instruction. I was amazed when I went to college and learned what other kids my age had studied in high school. In retrospect, I am grateful for having to study Latin, for a superb American History class and for exposure to a lot of Shakespeare, however my science knowledge is weak and what we did in the way of "analyzing" great literature was simply criminal.

I subscribe to the Writer's Almanac which puts a poem a day in my mailbox. Today's poem is The Walrus and the Carpenter by Lewis Carroll. In fifth grade, I had to memorize the verse in the middle starting with "The time has come, the walrus said..." That one verse was all we memorized! As I read the entire poem today, I realized it was an hilarious allegory of my education. We girls were the eager little oysters and we were taught (even required to memorize) so much nonsense. Were those spinster teachers identifying with the Walrus and the Carpenter? We were the children of privilege. It wouldn't surprise me if our teachers often resented their little charges who vacationed in Florida and played at the local country club. So we all were required to commit to memory one verse smack dab in the middle of a poem about cannibalism. Go figure! No wonder I was afraid.

The Good, more Good, the Sad and the Weird

Good news concerning the fellow I wrote about last week. His tests came back better than ever. The ticking has stopped.

Not long ago I said goodbye to a man who is leaving for boot camp. His life had become stagnant and there seemed to be little future in his current situation. He always had a dream of being in the military but when I first met him, he was too old. It was a huge regret of his life that he had missed the opportunity. Then President Bush raised the age of eligibility and suddenly it was possible for him to realize this dream. He's taking a huge pay cut to enlist. The very real possibility of going to Iraq doesn't dissuade him one bit. Heaven knows, it's not my idea of a dream, but dang it, it's neat to root someone else on as they fulfil theirs.

Doing some dream work, a patient remembered a long forgotten incident of viewing the body of a classmate lying on the pavement who had been killed in a freak playground accident at their grade school. He'd repressed that terrifying sight and now many years later in the safety of his analyst's office, he finally cried .

A couple with marriage difficulties consulted me. After a few months of work, they tell me they are doing just great. Everything is fine. Everything is wonderful. Then I am told one of them has decided to have bariatric surgery against the objections of the other. I am strongly against this...too many risks, not enough long term experience to assure me that further down the line this technique of surgical starvation won't result in malnutrition and other major health difficulties. And then there's the psychological fallout. In my work a cardinal rule is not to remove a symptom until you know why it's there. If there is difficulty at the feeding level, it's at the foundation of the personality. Not wise to go tinkering with the foundation unless the proper support structures are in position. Anyway I always err on the side of caution. Bariatric surgery appears to be a magical solution but it's fraught with risk. It is also a big money maker for the bariatric institutes. I bounced it off training analyst who said " Did you ask the patient why they wanted to die?". Thanatos, up close and personal.

Project 365

I came across an interesting challenge for photographers which is to create a photographic diary of 2007. I don't think I shall get hooked into this but it's gotten me thinking of the mental snapshots I've taken recently. Today I would capture our woods in a snow shower. Last night my picture would be of my feet wearing my bright red insulated shoes, a gift from charming oldest daughter and her delightful husband. Yesterday morning I would have clicked a photo of the head of the curious deer who was staring at me through my kitchen window in the pre-dawn darkness. There might be a shot of our town's little movie theatre where I saw "The Good Shepherd" over the weekend, or of the gorgeous pork tenderloin surrounded by brown potatoes as it came out of the oven.

My sand table at the office sits in the waiting area and attracts the play of adults and children alike. It would definitely be the subject of some photographs. Early in the week I set out three figures representing Freud's first three psychosexual stages: a shark, a snake and a sword wielding pirate. One woman stuffed the snake into the shark's mouth and added a helicopter and a tank to the scene. A ten year old little girl removed everyone and made a neat little farm complete with a straight tilled field, two tidy little animal pens and a house. No people though. Many people take the wild animal figures and bury them deep in the sand. Want to guess what could mean?

Recent images that would be in the photographic diary are the kids decorating the tree, singing around a campfire while oldest daughter plays guitar and son his banjo, cut throat games of Mexican train dominoes under the expert tutelage of son-in-law, a boxer sitting in the lap of one daughter while licking the face of the other, youngest daughter photographing her 89 year old grandmother, the same grandmother shaking her jingle bell along with our caroling assembly's rendition of Jingle Bells, the dining room table full of young people telling stories and enjoying home cooked meals, laughing while watching the wonderfully witty and creative film school assignments done by youngest daughter's Mr. Wonderful, then son and Mr. Wonderful singing "Vehicle" with great exuberance.....

I don't want to haul around a camera or fool with uploading, labeling and organizing my pictures but as I think of what I might photograph I catch glimpses of wonder in this quite ordinary life.

Walk through the bottomland

Today I bought some wet weather boots. I can't believe I've gone so many years without a pair. I've had some cute little wet weather mocs which did keep my feet dry but did nothing to keep my cuffs from dragging in the mud. I have a two great pairs of snow boots, one for work and the other perfectly suited for walking through the snowdrifts in the tundra. I'm always afraid of having cold feet so I prepare well for any possible blizzards. But proper rubber boots are what I needed today when I went for a walk in our rain sodden woods. I borrowed a pair of my daughter's which were a bit large, but I returned home with dry tootsies and clean pant legs. Yes, it was time to go to the local farm supply emporium to buy my very own pair of what we refer to as gum boots. The farm supply place's stock was picked over and all they had were tall boots in large sizes. Being a short sized person, the tall boots greatly impede my ability to bend my knees. Not a desirable thing for walking in the woods. But the local big box store carried what they call dairy boots which came up to mid-calf and fit. I felt so cool and they were only $14.00. LLBean calls such boots Wellies and charges $49.50.

The recent rains have been most welcome. Our pond is finally full and it's reassuring to see water flowing rapidly down the creek. As the hubster and I enjoyed our morning slosh along the creek, I remembered teaching our children about the Mississippi watershed. They all memorized the progression of the water they saw flowing behind their house into various tributaries of the Wabash River down to the Ohio, on to the Mississippi River, down to the Gulf of Mexico and out into the Atlantic Ocean and the world. Of course the litany grew louder and stronger as we hit the climax of the Atlantic Ocean and the world. Visiting Mud Island in Memphis, we saw the hydraulic model of this same watershed firsthand. I recall watching delighted children splash in the model's "Gulf of Mexico". It's an important lesson for kids and adults to learn that what passes through our little woods doesn't begin or end here. We all need to be reminded that we are a part of something much, much bigger.

Time Bomb

Last Friday night was a dark and stormy one. Late in the afternoon a patient called in turmoil asking if he could possibly see me that night. When he called, I was booked until 9:30pm and I doubted my brain could function effectively for another hour, so I scheduled him for Saturday morning. I wasn't pleased about coming in on my day off but I didn't think it would be wise to put off seeing him until next week. We have worked together for many years and it was rare for him to need an emergency hour. Due to an impending ice storm, the patient who would have kept me until 9:30 wasn't able to come in, so I handled her appointment by phone. I could, then, see the emergency at 8:30. And I'm so glad I did.

He was swirling and sinking in a whirlpool of paranoia over an incident at work. I listened as he told me about the crisis. He really handled it fine and it was all over. I commented that what puzzled me was his extreme reaction to an event that he managed well. I knew before he came in that whatever the overt crisis, that it most likely had to do with his fear over the tumor in his pituitary gland.

Every year he goes into a panic as he approaches his yearly visit to the endocrinologist. As the appointment date nears, his anxiety goes through the roof. Knowing this, I have him set the date for his appointment early each year so we can skip the waiting period which is analogous to listening to the ticking of a time bomb. This year, however, has been different because this was the first year he was taken completely off medication. He has done so well that his endocrinologist has released him to be monitored by his family doctor. I picked up in early December that his anxiety over the annual pituitary checkup was beginning to build. I recommended then that he get his prolactin levels checked asap. Alas, the patient did not heed the advice of his analyst.

Since then, there have been a plethora of dreams with death themes. He has also developed a whole host of psychosomatic symptoms as well. Then came the incident at work and now his world seems to be imploding. As he talks, his mood starts to lift. He admits he has been avoiding having his pituitary checked like a small child who hides under the covers so he won't see the monster in the closet. His wife has been difficult too. I mention that some women start nit-picking when they are scared and women get frightened when their men aren't functioning well. Her Mom died six months ago, so she's scared silly that she will lose her husband too.

He starts to tell me about the day many years before when he first learned he had the pituitary tumor. He had consulted a specialist. After the tests were completed, the specialist called him and said "You have a brain tumor" and hung up. He was in total shock. His father called the doctor back and got more information. He stops mid-sentence and looks at the calendar on the wall. He said that was in the middle of January. The actual date is two days hence. He tells me about his fear that the tumor has begun to grow, of losing sexual function, of going blind, and of dying. He stops again mid-sentence and says the day he learned about his tumor was a dark and stormy Friday... just like today.

At the end of the hour, he jokingly invites me out for a beer and then seriously adds that on Monday he will ask his family doctor to order the appropriate tests. The tick-tick-ticking will be ending soon.

Winners and Losers

I watched "Little Miss Sunshine" last night. I liked it a lot despite some parts where the exaggerated quirkiness of the already quirky characters was a bit extreme for my tastes. Some points the film made were that life goes on even when dreams can't be realized and that losing is not the same as being a loser.

Too many people hang their sense of self-worth on their achievements. Each test is a life or death battle. What does it mean to be the regarded as the second-best Proust scholar in the country? Even if he were the best, his first place status will not last forever. Sooner or later the best, the greatest, or the fastest will be displaced or "plutoed".

Many kids come in to see me who cannot handle losing. Losing a game of Connect 4 or Uno has become the same as losing face. Some kids won't risk playing any games or they cheat so much that no one wants to play with them. So I model losing for them. I laugh at myself to teach them to laugh at themselves and to remind them that it's just a game not a judgement of their worth as a person. I also call them gently to task on cheating. One little girl used to end games with me prematurely even if she were winning. Unconsciously she may have been telling me about her life which was interrupted when she was removed from her family by Child Welfare Services. Perhaps, too, beating her opponent was way too risky. Why someone might get mad if she beat them. Who knows then what could happen? With her, I played quick games so there was less time for her anxiety to build. For some games, I kept a log of her scores. That way each game had a frame of reference. I sent some of the games home so she could play more with her family And so, as it was in the movie, she slowly learned that her lovableness was not contingent on winning or losing the game.

Therapeutic Relationship

When beginning work with a new patient, sometimes the difficulty is clear cut. Sometimes the situation is so emotionally charged that it takes a while for the dust to settle so the real work can begin. The aim, the textbooks tell us, is the establishment of the therapeutic relationship. That's all well and good, but most people I treat don't have the ability to form good relationships and they will attempt to replicate their past ones with their analyst (transference). The Kleinians spend years analyzing transference and countertransference. But, in my humble opinion, analyzing transference might not be the best way to help people have better relationships. What helps is forming a better relationship with their analyst. This is not a static thing, however. Some days people will balk and work against me as if I were the demanding Mom or Dad of their childhood. Some days people will appear to cooperate, but quietly sabotage treatment. Sometimes they even fire me. It's not unusual for patients to test me over and over and over just waiting for me to blow up at them or to abandon them repeating some well-entrenched historic pattern.

One patient, who had an unstable, ambivalent bond with her Mom, will from time to time totally smear me or a member of my family. This usually happens around the holidays when she perhaps fantasizes me with my family celebrating happy times. She hates my family for having what she has not. She envies my children and thus attacks them. She attacks me because as much as she yearns for closeness, she fears it even more. Sometimes she sends me syrupy cards which I suspect is her attempt to cover her rage toward me. That rage is most likely anger displaced from her Mom onto me. Despite this bumpy road, we are making progress in treatment. She and her Mom are a lot closer these days. She also is developing a healthier relationship with her 8 year old daughter. She has returned to school and is within a semester of receiving her bachelor's degree in business. She has become more discriminating about the men she dates. She is growing up emotionally and spiritually. Have we formed a therapeutic relationship? I guess it would depend on the day.