What Children Need From Parents III: Beware the Extinction Burst!

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Popular culture gives us just enough information to be confused.

Not surprisingly, many parents who have never taken a psychology course know it is important to set limits on their children and to be consistent in enforcing those limits. Despite this, a good many parents don’t have the strength of will to withstand the repeated pleading of their kids, or the energy to do so.

If your child wants you to buy him a candy bar or a toy while you are in the store, many parents believe it is simply easier to give in than to listen to the endless entreaties of their offspring.

In some cases it can be too exhausting or overwhelming to have to deal with a persistent child, in other instances the parent might fear losing the child’s affection if the desired treat isn’t forthcoming, and in still other situations the parent feels guilty if he or she deprives the youngster of something.

For all the reasons I’ve just mentioned, I always tell parents before they intend to change their style from one that inconsistently reinforces their child’s misbehavior, they have to be strong enough and knowledgeable enough to be prepared for what comes next.

And what comes next is something pretty powerful.

Its called an “extinction burst.”

First, what is “extinction?” Extinction occurs when a behavior that has been previously “reinforced” (some would use the word “rewarded”), no longer receives reinforcement. Eventually, the organism (animal or person) will stop performing the behavior. Put differently, the undesirable behavior is “extinguished.”

Take, for example, a laboratory rat. You can teach these creatures to press a bar in order to get a food pellet. Rats are good at this. But, if you no longer give the rat food pellets for pressing the bar, the critter will eventually stop doing the bar press. But there is a catch here and it relates to the word eventually. And the catch is what is called an “extinction burst.”

Let us assume your child, like the lab rat, has learned something about how you deliver reinforcers. The reinforcer could be the aforementioned candy bar or toy; it could be money; it could be your attention; it could be staying home from school; it could be a lot of things.

And, let’s further assume that you no  longer want the child to keep pestering you for whatever it is that he wants. Now, remember he hasn’t gotten what he wanted every time, but often enough to learn to be persistent and keep at it until you “break” under the assault.

The “extinction burst” consists of the young-one doing even more of the behavior you want to eliminate at the point you stop reinforcing him.

That might mean he will be louder, or pursue you longer, or repeat more often whatever has worked before. It can go on for a very long time until, finally, the child learns the lesson you want to teach him; in other words, learns he will no longer receive what he wants for his inappropriate actions.

But if you finally do break down and reinforce the child with what he wants during the “extinction burst,” he will have learned an awful truth: “Well, maybe I just have to do this behavior longer or more or louder in order to get what I want.” Indeed, the child doesn’t even have to be able to think or say this to himself.

Even laboratory rats operate according to the same rules of learning, and no one I know has had a very deep conversation with a rat lately.

At least, not the four-legged kind.

Parents sometimes tell therapists they have tried to be consistent and it failed. In other words, that the science regarding “extinction” and setting limits is inaccurate.

But what has really happened in this kind of case is the parent wasn’t ready to deal with the extinction burst. Their inability to tolerate the “burst” of seemingly relentless pestering or complaining eventually led them to reinforce the child once again for the undesirable behavior; and, in so doing, made it harder to extinguish the behavior than when they started.

Had the mom or dad only be able to stay-the-course and resist the child a bit longer, the “extinction burst” would have ended.

The moral of the story is to prepare yourself before changing your parenting-style in an effort to become more consistent. If you aren’t absolutely sure you have the organization, energy, strength, patience, and self-confidence to withstand the “extinction burst,” don’t even try. You will only make things worse.

And don’t expect your child to really believe you when you say “this is the last time I will let you do this” while you once again reinforce troublesome behavior.

Talk is cheap and, like those same lab rats who can’t understand your language, your child will pay attention to what you do and not what you say.

But, if you do have the requisite qualities that any good parent needs and you are fully prepared to hold your ground with your child, you might be quite pleased at how you have reasserted yourself and gotten control over the home situation.

To do that, the earlier you start in your child’s life, the better.

You may be interested in the following post on the topic of consistency: What Children Need From Parents II: On Slot Machines and Candy Machines.

The photo of an Albino Rat was sourced from Wikimedia Commons.

What Children Need From Parents II: On Slot Machines and Candy Machines

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Do your kids see you as more like a candy machine or a slot machine?

It’s not a silly question.

The two machines are rather alike. Both require you to insert some money. Both then demand that you engage the machine, set it in motion. In the case of the candy machine, you press a button or pull a lever to make your choice. The slot machine waits for your follow-through on its lever or “arm,” hence the name, “one-armed bandit.”

That is where the similarity ends and the answer to the question becomes essential: do your kids see you as more like a candy machine or a slot machine?

The reason is as simple as it is important. The candy machine is dependable, reliable, and consistent. Every time you insert your coins and make  the selection, it provides you with the item you have chosen. If, by chance, it should not, you would quickly stop inserting coins because your knowledge and experience tell you that no matter how many more coins you deposit, the machine will not do what you want. It is broken.

The slot machine, however,  is another story. Your knowledge and experience tell you that the machine’s failure to provide you with winnings on one occasion doesn’t necessarily mean that you won’t be a winner the next time, or the time after that. It might take you a very long period of failure and much expenditure of hard-earned silver dollars before you would come to the conclusion that the machine is broken. The machine, when its working correctly delivers winnings on an intermittent (or inconsistent) reinforcement schedule.

Getting the picture? If your children see you as consistent and reliable (like the candy machine) in responding to their requests and their pleadings, they will know that asking for what they want more than once will do them no good: the answer will be the same on the 10th request as it is on the first. And once they have learned this, they will make very few additional requests of you beyond the first one.

But if they see you as similar to the slot machine, boy are you in trouble! They will keep at you, over and over, because they know that one failure at winning doesn’t mean the game is lost. Perhaps the second try will work, or the fifth, or the fiftieth. They will know you better than you know yourself. Simply put, they will know that they have a good chance of wearing you down so that they can have the toy, the TV show, the attention, or the food they want; they will know that the punishment you are trying to enforce also can be changed, maybe not by pleading their case only once, but by repeated appeals to you. Your goose will be cooked.

Kids, of course, have more energy for this sort of “back and forth” than most parents do, so time is not on your side. And the longer they have experienced your inconsistency, the longer it will take for them to “unlearn” what you have taught them about yourself.

The message is simple. Say what you mean and mean what you say. Do what you say that you will do. It will easier on you and better for your children. But before you get started, be prepared for the “extinction burst.”

What is that, you say? I’ll cover that topic in my next blog.

The above image is a Slot Machine by Jeff Kubina from the milky way galaxy, sourced from Wikimedia Commons.

Experience and Memory

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The last Canadian World War I veteran, John Babcock, is dead. He passed away at age 109 in Spokane, Washington on February 18, 2009. Frank Buckles, also 109, remains the sole surviving American veteran of the “War to End All Wars,” according to The New York Times.

With Mr. Buckles inevitable departure, we will all lose contact with what happened in Europe between 1914 and 1918 within what is called “living memory;” the contact that can only come from the direct experience of the world-changing event that shaped the lives of many of our grandparents or great grandparents. Our only available sources of information will then be in the form of books, stories that the survivors told to those still alive, old silent movie film of some of the battle action, recorded reminiscences, journals a few of the combatants kept, accounts from war correspondents, and the like.

All of which leads me to think about memory and experience. And why understanding them is important.

Experience takes a number of forms and, when the experience is past, it becomes a memory. Simple enough on the surface, but not simple at all.

First, there is the “living” of the thing, actually participating in an event. In the case of Frank Buckles, that meant driving an American Army ambulance in France during the conflict itself, witnessing the carnage, hearing wounded men cry for their mothers, making and losing friends, feeling the “pee-in-your-pants” terror of it, getting shot at, carrying a gas mask or perhaps being exposed to poison gas, ministering to the wounded, jumping into fox holes—eating, drinking, and sleeping it all. But once Mr. Buckles returned home from the front, his time there had become a memory and was now different from the actual, in-the-moment intensity of the lived-experience, an intensity that nothing in his long life after the war could match.

At another level, more removed, there are the spectators to events. We all achieve the status of “watchers” when we attend a sporting competition. We see and hear a good deal of what is happening, even if we don’t ourselves play in the game.

At even more distance from the event are those who watch at home. They will miss some of the “atmosphere” of “being there” unlike those of us independent of TV cameras, who will see the event naturally, in the way it unfolds in real-life (without the mediation of a cameraman or the interruption of commercials). And the “at-home” audience will not experience the same roar of the crowd, the heat of sun on skin, the faces of the beer vendors, and the thousands of movements and sounds of the athletes and spectators that the cameras and microphones do not record.

More distant still from the actual experience is a radio broadcast, where one’s imagination and memory of events like the one being reported tend to fill in the blanks where no visual representation of the event is present. At a further remove might be a newspaper account of the game or a friend’s description of what happened from his memory of being there himself.

Experience is one thing, memory another. Memory can only approximate the event itself and can alter or fade with the passage of time. Remember your first kiss—all the thousands of sensations happening all at once—the rush of being alive, the smell of perfume or aftershave or the person’s natural scent, the touch and texture of skin, the moistness and softness of lips, your own heartbeat, body against body—firmness, roundness—the moment before and after, the placement of your hands, the color of your partner’s eyes and their expression in those same moments? Now, as you think about it, however good your memory, I think you will admit that remembering is not the same as living it.

At least in the case of memories of things like your first kiss, you have an advantage over others’ understanding of that experience because it was yours and not theirs. It becomes a good deal harder to relate to the experience of others, especially if they have lived through something wholly unlike what has happened in your own life. The most dramatic examples I can think of come from those who have experienced severe trauma. Take the testimony of a Holocaust survivor, Magda F., from the Fortunoff Video Archive of Holocaust Testimonies quoted by Lawrence Langer in Holocaust Testimonies: the Ruins of Memory, as relatives implored her to talk about her experience:

And I looked at them and I said: “I’m gonna tell you something. I’m gonna tell you something now. If somebody would tell me this story, I would say ‘She’s lying, or he’s lying.’ Because this can’t be true. And maybe you’re gonna feel the same way. That your sister’s lying here, because this could not happen. Because to understand us, somebody has to go through with it. Because nobody, but nobody fully understands us. You can’t. No (matter) how much sympathy you give me when I’m talking here, or you understand…you’re trying to understand me, I know, but I don’t think you could, I don’t think so.”

And I said this to them. Hoping (they) should never be able to understand, because to understand, you have to go through with it, and I hope nobody in the world comes to this again, (so) they should understand us. And this was the honest truth, because nobody, nobody, nobody…

Those of us who are the children of Americans who survived the Great Depression got a little bit of this kind of understanding, I think, in late 2008, when the economy fell off a cliff and looked like it was going to continue falling and possibly repeat the Great Depression. We’d heard the stories our parents or grandparents told, we’d read the history books describing the period between the Stock Market crash of 1929 and the beginning of World War II, but we hadn’t lived in a period anything like that. Now, we were getting a taste of it, even if, for most of us, it was only a taste and not the whole meal. Now we know more, and better, what it was like for our elders (and what it is like for our fellow Americans who are losing their homes along with their livelihoods right now).

Sergiu Celibidache, the Roumanian symphony conductor, put very well the difference between direct experience and some form of pale attempt to duplicate that experience in a different time and place. Celibidache believed that it was impossible to accurately render the transcendant impact of musical performance except in a concert hall. He thought that recordings were a fraud, because they attenuated this experience and altered it, didn’t duplicate the physical and aural sensations present sitting in the hall, listening to the full dynamic range of sound as that sound was being made in the same acoustical environment as the musicians themselves. Therefore, Celibidache refused to make recordings for most of his career. And, in the days before anyone ever considered the possibility of experiments in virtual reality, he said that “listening to a recording is like making love to a picture of Bridget Bardot,” the gorgeous French model and actress of the 1950s and 1960s.

Adlai Stevenson II, as I’ve quoted elsewhere, captured the impossibility of fully communicating an experience he’d had to those who had not yet had that experience in a 1954 speech (made when he was 54) to the senior class of his alma mater, Princeton University:

“…What a man knows at fifty that he did not know at twenty is, for the most part, incommunicable. The laws, the aphorisms, the generalizations, the universal truths, the parables and the old saws—all of the observations about life which can be communicated handily in ready, verbal packages—are as well known to a man at twenty who has been attentive as to a man at fifty. He has been told them all, he has read them all, and he has probably repeated them all before he graduates from college; but he has not lived them all.

What he knows at fifty that he did not know at twenty boils down to something like this: The knowledge he has acquired with age is not the knowledge of formulas, or forms of words, but of people, places, actions—a knowledge not gained by words but by touch, sight, sound, victories, failures, sleeplessness, devotion, love—the human experiences and emotions of this earth and of oneself and other men…”

So, put another way, for example, no one who hasn’t been in love can know what love is; no one who hasn’t experienced discrimination or fought against it can really understand it fully; no one who has only watched a travelogue about the countryside really knows what it is like to be in the country; just as those who observe from the sidelines and never have played the game cannot completely grasp the clichéd expression about “the thrill of victory and the agony of defeat.”

No, life is about the living of it, not the reading about it or the watching  of it. And, so too, it is about knowing that you don’t know fully about the experiences you haven’t had. It is about knowing that you can only approximate a real and complete appreciation of another’s life; knowing that some of those things the other has witnessed or lived through are frankly unknowable without their experience; knowing that the depths of human personality, emotion, and incident are infinitely great and that one can only approach the deepest point in knowledge and understanding even as we reflect on our own live’s through the lens of memory; and knowing that the death of the last veteran of World War I robs us all of some element of connection to history and, therefore, to the forces that shaped us, our parents, and their parents.

Life is infinitely humbling, fascinating, terrifying, and touching. I imagine one could live a dozen lives, some in one gender, some another; some straight, some gay; some black, some white, some yellow; some married, some single; some in this time, some in the future and the past; some here, some there; and still not achieve the richness that is possible.

But, of course, we only get one, so far as anyone knows. That means we must get on with things.

The day is short and there is much to do.

The photo above is of Frank Buckles with Secretary of Defense Robert M. Gates on March 6, 2008 by Cherie A. Thurlby of soldiersmediacenter, sourced from Wikimedia Commons.

Rumor

What do you think of people who spread rumors? Are you one such?  Rumor mongers are certainly not thought of in a kindly fashion. We call them gossips or tale bearers, not words of praise. And how about those people who relish the rumors, listening avariciously, almost licking their lips at the prospect of some juicy gossip?

The best, most visually evocative description of this kind of person comes from The Aeneid by the Roman poet Virgil. Here it is in Robert Fagles’s translation:

Rumor, swiftest of all the evils in the world.

She thrives on speed, stronger for every stride,

slight with fear at first, soon soaring into the air

she treads her ground and hides her head in the clouds.

She is the last, they say, our Mother Earth produced.

Bursting in rage against the gods, (Mother Earth) bore a sister

for Coeus and Enceladus: Rumor, quicksilver afoot

and swift on the wing, a monster, horrific, huge

and under every feather on her body–what a marvel–

an eye that never sleeps and as many tongues as eyes

and as many raucous mouths and ears pricked up for news.

By night she flies aloft, between the earth and sky,

whirring across the dark, never closing her lids

in soothing sleep. By day she keeps her watch,

crouched on a peaked roof or palace turret,

terrorizing the great cities, clinging as fast

to her twisted lies as she clings to words of truth.

If you are so inclined, the next time you are about to spread a rumor (or listen to one), reflect on that image of eyes and tongues and mouths and ears.

They are all yours if you want them!

Do You Understand Me? On the Dangers of the IM

In the course of conversation, serious or casual, we often ask, “Do you understand?” The conventional wisdom tells us that if the question is followed by a “yes” answer, then real understanding exists.

I say, not so fast. Let me give you an example.

I remember treating  a family that included a son and a daughter. I don’t recall the precise ages of the children, but the boy was probably between 10 and 12, his sister much younger. I’d been seeing the family for some time when the parents came to their appointment in a state of more than usual alarm. The father first wanted to talk with me alone. He said that his son had threatened to “rape his sister.” I asked for the details, including whether the father had questioned his son as to his understanding of the word “rape.” “Yeah, I asked him whether he understood what that meant,” the father told me, “and he said that he did.” I then spoke with the son alone. This gentle but troubled and ashamed boy recounted the incident. Then I asked him to tell me, in his own words, what rape meant. And what came out was some version of “beating-up” his sister because she had been teasing him. Where had he heard the word “rape?” “On TV.”

Not that wanting to beat-up his little sister was a thing to be encouraged, but still, it wasn’t rape that he wanted to do, and everyone was pretty relieved once I explained the details to the parents. The point of this is that it isn’t as easy as we think to achieve “understanding” of what we are saying; indeed, if you think it is easy, you are probably creating a certain number of misunderstandings.

Consider how many serious attempts at communication are done in the form of email. Too many people routinely hit the “send” button before they have carefully reflected on how their message will be understood, and how they will feel about having sent that message in an hour or a day or a week.

What is the best way to be understood on any subject, and especially on a subject of importance? Be in the same room as the person with whom you would like to communicate, having first gathered your thoughts; and with the time to explain them and the opportunity to see if the other person can accurately paraphrase what you’ve said back to you. In this situation you will have several sources of information that can be helpful in making yourself understood, and are also available to inform you if your message has been received in the way that you were hoping. You will have words, of course, but also body-language, facial expressions, eye contact, tone of voice, inflections, the volume (loudness) of your speech, the speed with which you utter the words–all of these things, which you can vary as needed.

If you choose not to use face-to-face communication or simply can’t, due to circumstances of time or distance, perhaps a phone call will do. But understand that what you and your partner in conversation might be able to see has now been lost to you. Without the eye contact, body-language, and facial expressions to help you interpret the words you are hearing, the chance of misunderstanding grows.

Worst of all is the written word. True, if you have time and are a thoughtful person who is good with language, you might have added time to craft your written message that isn’t available when simply speaking in conversation. But, once the back-and-forth of an instant-message or text-message communication occurs, one usually loses the time for careful consideration that one had in the days of letter-writing. And you have lost not only the possible message-clarifying assistance of what you can see of the other person’s expressions and posture, but also all the things that a telephone still conveys in sound: inflection, emphasis, strain or ease, intensity, urgency, and so forth. Now your chance of being misunderstood has increased even more.

A very clever old book, How to Make Yourself Miserable by Dan Greenburg with Marcia Jacobs, puts it very well in Exercise #4 from a section called “Seventeen Masochistic Exercises for the Beginner:” “Write a letter to somebody, mail it, then figure out which part could be most easily misunderstood.” Greenberg wrote the book well before the days of IMs and text-messages, so one can only imagine what an update might look like given the destructive possibilities inherent in those speedy missives.

Sometimes the oldest advice is best: when you want to talk about something important or emotionally charged, take a deep breath and wait. Write if you need to (just to get your feelings out–don’t send it), talk to friends or a counselor, but take time before you address the issue to the person himself. And, when you do, if at all possible, do it face-to-face with lots of time to sort out the details. Beware of the IM and the text-message.

And if you are old enough, remember back to the Cold War days when the initials often heard in daily conversation were not IM, but ICBM–meaning Inter-Continental Ballistic Missile.

An IM can be a little bit like that, but might just blow up in your face.

How to Grieve, How to Live

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You might think that grieving is not an uplifting topic. But there are ways in which that is precisely what it is.

We start with the pain of loss, specifically a loss of something of value. If you lose a penny, you won’t much care. But if the loss is of something of great importance to you, you will care greatly. The pain of loss points to the value of the thing that you have lost; and the value you place on a thing points, at least potentially, to the pain to which you are vulnerable.

What are the things we value? A job, a relationship, friends and family, a promotion; our physical-self, which can be defaced or damaged… many things: money, status, a good name, a pet, and power, too. Take your pick. You decide what is important and whatever is inside the basket in which you put your emotional pain or your vulnerability to such pain — that item has value.

Grieving involves opening yourself to the pain. Now, you might think, “It must be only a recent loss that causes the hurt.” But the heart has no clock attached to it, no timer reading off the digits of distance between you and the loss; so, if you had a difficult childhood, you might still be holding the pain inside even though it is decades old.

Not only must you open yourself to the pain, but you must do it with a witness, a listener, someone who cares and who is present, who is “there for you.” This is necessary to reattach you to human contact — to life, to intimacy — rather than closing off and pulling away from people. And in this sharing — this openness, this talk and tears and gnashing of teeth — the pain eventually subsides. It’s a little bit like kneading dough — you continue to work it until it changes. The story of your feelings will be repeated by you, if necessary, dozens of times in different ways, until the emotions are changed and the excruciating intensity of the loss passes.

How long does this process take? Six months to a year would not be unusual, although it can be longer. The first anniversary of the loss is often especially hard; so are birthdays and holidays in the first year and sometimes beyond. But if you do not do the grieving “work,” the process can be extended and a sense of melancholy or a lack of vitality can follow you relentlessly.

To grieve doesn’t mean you will forget what you have lost. And, indeed, if it is a loved one, certainly you will never forget and you will never be untouched by the memory. There is a dignity in this. We honor the loved ones who are lost in this way and perhaps they live, metaphorically speaking, inside of us. As the Danes say, “to live in the hearts that you leave behind is not to die.”

But “how” to do this grieving — that is the problem. If you have lived your life trying to be tough, you will find that the toughness might prevent you from doing the emotional work that will allow the grief to end. If you maintain that “toughness,” you might find yourself living as if you are numb, or displaying a sunny disposition totally at odds with what is felt deep inside, in the place where you have buried your hurt. And if you have deadened yourself enough, you will have a hard time “living,” since you will be closed-off to feelings. Joy, abandon, and spontaneity will be harder to achieve. Instead, the time ahead of you would be better called “existence” than “life.”

But perhaps you are afraid that if you allow all the pain to come out, you will be overwhelmed to the point of being unable to function. And, indeed, this can happen, at least temporarily. Or perhaps you are afraid of what others might think of you if they see you without your typical emotional control, and you are afraid of their negative judgments.

And so, grieving involves having the emotions without the emotions having you; accepting them and not struggling with them; metaphorically speaking, it is like driving a car with the radio on, but not so loudly that you are overcome by it. In other words, you will have the emotions but still be able to drive — still be able to lead your life.

To do this you must open the pain in a place that is safe and in a way that it is neither deadened or perpetually out-of-control. You must hold the hurt not too tightly and not too loosely, but gently, since it is precious; not walling the emotions off or letting them carry you away from active life for days at a time. Part of this is simply allowing yourself to be human, to honor the injury, not judging or trying to change what you feel (the change will happen by itself if you allow it), but permitting yourself to do what our mammal relatives do — to lick your wounds (metaphorically speaking) and accept the support of others, whether they are friends, lovers, relatives, or therapists.

And, in the end, if you have grieved and have the courage, good luck, and time to continue the human project that we all have been given, you are likely to heal enough to venture forth into the world, again putting yourself into the things and people you hold dear, risking injury once more, not hiding from the dangers that life brings, but also experiencing what is good in life — all the things you still value.

You will be alive again, and the grieving process will have led you there.

The above image is The Grieving Parents, Kathe Kollwitz’s 1932 memorial to her son Peter, who died in World War I.

Psychotherapy Humor

Hoping that the above title is not a contradiction in terms, I’ll tell you a little story.

Before I get to the funny part, however, this appeared very early in my blogging life and was ignored by almost everyone. If, after you read the story, you care to let me know why, I’d be interested. The tale is true.

First, to set the stage, I am a man of conservative appearance; quiet, thoughtful-looking, definitely not a hell-raiser. My picture, I suspect, gives this away. With that in mind …

A few year back I was treating a retired woman. She was a bit hard of hearing, but quite pleasant. I typically saw her on Monday afternoons and she always asked me what I’d done over the weekend. On one particular day, I answered this way: “Oh, my wife and I went to a tapas place.”

“A topless place!” she shrieked, almost hysterical. Well, eventually I was able to calm her down and explain to her that it was a Spanish-style tapas restaurant at which my wife and I had eaten, not a burlesque show.

But still, I’m not sure that she ever again looked at me in quite the way she had before her innocent inquiry regarding my weekend activity.

What Do Antidepressants Really Do?

I believe that the oldest reference to an antidepressant medicine comes in Homer’s Odyssey, which “could not have been completed much before the end of the eighth century B.C” according to Richmond Lattimore. The reference occurs when Menelaos (brother of Agamemnon),  Telemachos (son of Odysseus), and others are grieving the loss of friends and relatives in the Trojan War. Helen, the wife of Menelaos, is also present. It was her departure to the walled city of Troy with Paris that triggered the assault on that fortress to retrieve her. Having since returned to her husband, she wishes to salve the emotional pain of the men who are gathered at her home. The passage reads as follows in Lattimore’s translation:

“Into the wine of which they were drinking she cast a medicine of heartease, free of gall, to make one forget all sorrows, and whoever had drunk it down once it had been mixed in the wine bowl, for the day that he drank it would have no tear role down his face, not if his mother died and his father died, not if men murdered a brother or a beloved son in his presence, with the bronze, and he with his own eyes saw it.”

That would be a potent brew indeed. But the idea of it prompts me to say a few words about what an antidepressant can and cannot do, for there is much misunderstanding on this point. And, by the way, the first real antidepressants only became available in the 1950s.

An antidepressant does not make you giddy about your life or impervious to emotional pain; it doesn’t make you forget bad things. In other words, it is not what Helen of Troy administered. If an antidepressant is working well, it helps put a floor under you. That is to say, many people with depression feel as though there is nothing holding them up (metaphorically speaking), no bottom to their suffering.

An effective medication creates that bottom, relieving them of the sense that they are without any support underneath them. It reduces their suffering too, makes them less prone to crying, less exhausted, and less subject either to over-eating or having no appetite, and usually able to sleep better. In other words, the medicine helps you tolerate life and helps normalize that life.

Some people, including quite a number who shy away from psychiatric medications or medication or any kind, actually are attempting to “doctor” themselves with drugs or alcohol.

There is danger here, naturally.

You probably know some of the dangers, but one I want to mention in particular is the depressant-effect of alcohol. It might make you feel better in the short-run, but in the long-run it is likely to fuel your depression, not to mention create a dependency.

As the old Chinese expression goes, “First the man takes the drink, then the drink takes the man.”

I suspect that you know someone who believes that psychotropic medication (and perhaps psychotherapy too) is a crutch. There is no denying that being treated for emotional problems can produce negative judgments and a stigma. Moreover, historically speaking, insurance companies have paid less well for therapy and psychotropic medication than for “physical” illnesses. That has just changed in 2010, but the stigma won’t be legislatively erased by the US congress, as was achieved by “parity” legislation that now requires equal insurance coverage of both physical and “mental or nervous” conditions.

Yet some categories of depression are certainly just as “physical” as an imperfect gall bladder is, for instance. Specifically, Bipolar Disorder, also called Manic-Depressive Disorder, is one such biologically-based psychiatric category where medical intervention is often enormously helpful, if not essential.

Would you want your severely diabetic loved-one to avoid the “crutch” of necessary medication? If your answer is “no,” then you shouldn’t be put-off by treating a biologically-based depression with a proper medication to stabilize his mood.

Nonetheless, it is true that many depressed individuals do not have any biological flaw or chemical imbalance, but rather are reacting emotionally to difficult life circumstances such as repeated losses (e.g. divorce, job loss), unfinished grief, or abuse of one kind or another. Very often psychotherapy is able  to successfully treat these people without the benefit of medication. Indeed, sometimes patients are too quick to obtain antidepressant prescriptions which take the edge off their feelings enough to reduce their motivation to address difficult life circumstances, including repetitive patterns of behavior that lead to unhappiness.  In that event, they will risk having to stay on antidepressants lest they fall back into depression.

For those patients, on the other hand, who successfully address their issues in psychotherapy, antidepressants may never be needed or, if they are used, might be required only temporarily.

If you are seeing a therapist for depression, talk with him about medicine for your condition, especially if you feel that you need immediate relief or are having suicidal thoughts. Beware equally of therapists who never want their patients to go on medication, as well as those who always do.

I should mention that while many depressed people obtain medication from their family or primary-care physician or general practitioner (GP), this isn’t always the best source of psychotropic mood-altering substances. While some GPs are both comfortable with and experienced in prescribing such medication, some are hesitant or unsure. The latter group may be less adept at identifying the precise antidepressant which is best for you given your particular symptoms; moreover, their hesitation can cause them to give you too low a dose to obtain a therapeutic benefit.

A good psychiatrist, by contrast, is absolutely up-to-date on everything about the medications available to treat you, adept at identifying which of the available antidepressants is the best fit for your particular situation, and knows how to get you to a therapeutic level of the medicine as quickly as possible. Since those in pain so often feel as if there will be no end to their suffering, and since antidepressants often take a several weeks to produce relief, getting the medicine right as quickly as possible is very important.

If you do choose to obtain medication, be sure to educate yourself about your condition and the possible side-effects of the medication being suggested. Not all physicians are good about describing those side-effects before-hand, even including the sexual side-effects produced by some antidepressants. Be your own advocate. Don’t be passive in treatment. It is your body, it is your life.

Last I heard, you only get one of each.

Relationship Warning Signs: Fighting the Last War

http://upload.wikimedia.org/wikipedia/commons/thumb/e/e6/Oscar_Wilde_portrait_by_Napoleon_Sarony_-_albumen.jpg/240px-Oscar_Wilde_portrait_by_Napoleon_Sarony_-_albumen.jpg

Relationship choices are a little bit like the old military saying that generals are always preparing to fight the last war. Military men are apt to focus closely on past mistakes, without realizing the dangers of a new strategy, perhaps inadequate for whatever lies ahead.

In the same way, we try to avoid past relationship mistakes, without being aware our strategy might produce new, unfortunate problems in the future.

Let’s take an example. Suppose your last relationship was with an authoritarian, demanding, insensitive, maybe even somewhat abusive man. Now you want a lover who won’t be like him. Now you want someone who won’t push you around in any sense of the word — a companion less threatening and more accommodating. This might work well – for a while.

But, perhaps gradually, you will notice the same person who gives-in to you is also giving-in to others; not standing up for himself or for you; spending too much time away from you, instead doing favors for his parents or his friends. Perhaps you will conclude he is too passive and, that while he won’t often say “no” to you, you must push him to do the things you want.

Or maybe your last boyfriend wasn’t ambitious and industrious. You had to lend him money or serve as his source of financial support. You got tired of this of course. Now, you only choose to date someone who is hard-working and successful. You pick a workaholic mate and hardly ever see him, and you must do the job of raising the children pretty much on your own, even if the joint bank account is substantial

Or the discarded mate was easy with money and piled up debt. So now you select somebody with a dead-bolt lock on his wallet, cheap in the extreme, frugal to the point of wanting an accounting of every dollar spent by you, and nearly every small purchase the two of you make is treated with the gravity of buying a house.

Or your last companion didn’t pay much attention to you, seemed more interested in being with friends, playing football and computer games. So you target someone who wants to be with you nearly every minute and gets jealous when you even look at another man – a mate who requires an itinerary of your daily activities and seems interested in controlling you more than loving you.

Last but not least, the boring, by-the-book, ever-cautious man who you trade-in for a dashing, spontaneous, risk-taking, unpredictable, funny, charming, devil-may-care partner; later discovering he is reckless, unreliable, and inconsiderate.

The list goes on. The point is, as with so many of life’s offerings, the opposite of what you have is often as bad or worse, only in a different way.

Best to consider all sides of the human mating grab bag and not pick someone at either extreme of most any dimension.

Just like King Midas, who wished for the power to turn everything into gold, sometimes you must be careful about getting too much of what you thought would be a good thing.

Or, as Oscar Wilde said, “there are only two tragedies in life: one is not getting what one wants, and the other is getting it.”

The image above is Oscar Wilde in a photographic portrait by Napolean Sarony from about 1882, sourced from Wikimedia Commons.

Hope For the New Year: Old Words After a Tough Twelve Months

Its been a tough year, but not the first in human history. These old words from the great nineteenth-century Scottish writer Robert Louis Stevenson seem just right:

“Give us grace and strength to forbear and to persevere. Give us courage and gaiety and the quiet mind. Spare us to our friends and soften us to our enemies. Give us strength to encounter that which is to come, that we may be brave in peril, constant in tribulation, temperate in wrath and in all changes of fortune, and down to the gates of death loyal and loving to one another.”