Collaborative Approach to Psycho-pharmaceutical Treatment

As we know, there is a wealth of material about everything readily available to us at our fingertips on the Great Wide Web. (While I appreciate the inherent dangers, I embrace the convenience, having spent hours of research in library stacks decades ago.) Recently, I’ve discovered that the internet can also be an avenue for collaboration with patients who want to be involved in choosing their medication. I suggest that they research the pros and cons of the medications for us to consider as a treatment team. Of course, the final decision is mine. I will not prescribe any medication that I do not think is an appropriate choice. 

 

A recent example is a person who has experienced treatment failures with a few psychiatrists in the past. To me, this history suggests a particular diagnosis. I have suggested that they research medications that have been effective for this diagnosis. They have appreciated the suggestion and done their research. We look forward to our collaboration as we discuss and try some psychopharmacological options. 

 

Dear Reader, I look forward to your comments.

Jsimon145@gmail.com

Some Thoughts on "A Beautiful Noise," the musical, based on the life of the Singer-Songwriter Neil Diamond

The morning after I saw the scintillating musical on Broadway, A Beautiful Noise, I found myself asking the question: what is the relationship of the artist’s work to understanding himself? This query has occupied thousands of writers’ minds and resulted in almost as many books that explore the intriguing question. 

I applaud this production, an interpretation of the life of a star, in which the therapist’s office serves as a backdrop for Diamond’s music. Admirable too is the depiction of Diamond as less than an ideal client. He is resistant: He doesn’t want to be in this space undergoing an exploration of his deeper self. He is here because his wife Katie sent him. He reluctantly reveals that she finds him “difficult to live with.” After the failure of his past two marriages, he is receptive to heeding her advice.

 

We psychotherapists prefer a client who is open, willing, and eager to undergo the therapeutic journey. But in this production, the clever therapist hooks Mr. Diamond as he’s about to walk out the office door. She opens a thick volume of his lyrics and asks about a specific song. She has captured his interest. Now he can’t escape the task ahead of recognizing the aspects of himself that he has buried and that now create some inner conflict and express themselves in his relationship with his wife.

 

Although Diamond’s songs are an expression of himself and document his journey, they do not accomplish the task of psychoanalysis. The relationship of the artist to his work embodies a deep and personal connection that emanates from his experiences. It is a form of self-expression and communication with the world but doesn’t substitute for a psychotherapeutic exploration. 

 

The therapist accomplishes the task to help the client discover his inner conflict, the thoughts and feelings that veer in opposite directions. She accepts her client and mirrors or reflects to him what she hears in his words and adds an occasional comment of interpretation. As he participates in the therapeutic relationship, the client comes to recognize and accept aspects of himself that he hadn’t recognized, avoided or denied. In Diamond’s case, it is the failure to acknowledge a part of his identity: his early years as the lonely little boy, a nobody from Brooklyn. Through the psychotherapeutic experience, he recognizes and accepts this aspect of himself. The joyous, uplifting song I Am…I Said expresses the delight in acknowledging his full identity. The lonely boy from Brooklyn joins hands with the world-traveled singing star. He doesn’t have to perform on stage for the rest of his life to be Ok. 

 

Conclusion: The goal for a celebrity and for each one of us is the same: coming to terms with who we are, our deepest self in the past and present that helps to guide us on an authentic path. 

 

Dear Readers, I welcome your comments. Jsimon145@gmail.com

My Psychotherapeutic Journey: Deprivation and Motivation

Whether we realize it or not, in some ways, we are all deprived children. This statement may jar and even antagonize some of you readers. Nevertheless, I persist in my exploration of this topic that I find intriguing. 

Deprivation can occur in the physical, mental or emotional realm. For this essay, I’ll focus on the psychological realm in which the deprived state causes a deviation from the (theoretical) optimum. Most often, a deprived child finds one way or another to compensate for the unmet need. 

Taking myself as an example of a deprived child, when I was ten years old, my third brother was born. I experienced the feelings of happiness and sadness. Confused, I began to write down my feelings to try to understand these contradictory feelings. Committing my thoughts and feelings to paper helped me define them. I discovered they made good sense. I was happy to have a baby brother. (I pretended that he was my baby.) But I was sad because my mother now devoted her time and attention to him and had little left for me. Journal writing helped to give me a sense of mastery over my environment and lifted my spirits. 

In retrospect I see my adjustment of journal-writing as (a kind of) deviation from normal. Most ten-year-old children would be playing with their peers or taking a dance class or a piano lesson both of which I craved but weren’t available to me. 

When I got to college, I did not know what a feeling was. The girls on campus regularly asked each other, how are you feeling today? I knew there was something wrong because I could not answer the obvious question. To explain: I was the oldest of five children, reared by an intelligent, conscientious mother, who worked full time to support us. She had no time or energy to pay attention to the feelings of each of her five, demanding offspring. (She considered herself successful in providing each of us with a quart of milk on hot, summer days.) 

Uncovering feelings of deprivation in our childhood can help to explain some of the choices we’ve made as well as our life course. Somewhere along the way, I decided that if I became a physician, I’d have some control over my life and enough money to do what I wanted. As a psychiatrist I could justify my own psychotherapeutic journey and help others on their own. 

My first psychoanalyst, Dr. A did not understand my feelings of childhood deprivation. In his eyes, I’d been raised by “loving” parents; they had provided me with a good education and supported my journey through medical school. Dr. A’s lack of understanding caused my depression, stemming from a failed marriage, to deepen. Perhaps Dr. A hadn’t known the depth of deprivation in his own childhood, or at least had adjusted well enough in life, not to have probe deeper into his own psyche. Was he fortunate or not? (Hint: There is no right or wrong answer.) 

Then, through social connections, I met a gestalt therapist who recommended his brand of therapy. As an eager patient in a gestalt therapy group, I experienced support and learned an approach with tools that were able to reach my deprived psyche. 

Then I was assigned a new psychoanalyst, Dr. B, to continue my psychoanalytic training. Fortunately, she understood deprivation and I had a healing experience. I learned too that more important than a therapist’s training, is their ability to recognize the psychological needs of their client. 

Dr. B knew how to use the techniques of the neo-Freudians like Karen Horney. whose down-to-earth books were helpful but not entirely healing. She understood self-psychology advanced in the writings of Heinz Kohut who expanded the psychoanalytic toolbox to include mirroring and empathy, tools that reflect a client’s state of being. 

Perfect empathy in our imperfect world is impossible even in near-ideal circumstances with good-enough parenting. Parents are burdened. They too have baggage, and with their busy lives, rarely have the chance to unpack it. Without necessarily meaning to they may transfer a portion of their less-than-optimal adjustment onto their offspring. 

In conclusion, many of us have experienced some degree of emotional, physical and/or spiritual deprivation in our past that points us on a journey to repair or compensate. Most often the details lie deeply buried in our unconscious mind. If we are fortunate, we get by without recognizing the specifics. When we encounter some major obstacle in our personal and/or professional lives, we may turn to psychotherapy (and at times psychopharmacology too) to unravel what stumps us in our journey. 

I continue to work on myself, writing a daily journal and an occasional poem, fascinated by the unending conundrums of living. I find writing nurturing, reinforcing the creative journeys I travel with my clients. 

Dear Reader, I welcome your comments: jsimon145@gmail.com

Poems from The Ravens Perch

 

Dear Reader, 

I would like to share my poems that were published in an online international literary and visual arts magazine on October 4, 2023. 

Fish Out Water 

Dad showed his interest
in us kids by clipping
articles from the New York Times

Clipping was safer
than kissing, or brushing
flesh on flesh

The coelacanth, a fish thought
to be extinct was rediscovered
trapped in a fisherman’s net

We envision his lunge
eons ago from sea to land,
unwieldy body, sprouting
lungs and appendages

Like Dad, unmoored,
an outsider, searching
for his spot on earth

Dad, an odd fish. We
five kids agree, days
after the newsprint fades

Today we ask: what drove
the coelacanth from the sea?
What spurred Dad
to leave us, his family?

Perhaps it was curiosity
that led him to risk an
unraveling, the long,
arduous journey
to end in a curious,
dubious finale.

Muse 

I train my muse daily.

Her wings light as a fairy’s
so I coax and treat her gingerly
to earn her visits frequently.
How mightily with unpredictability,
she alights and ever too soon
flits away: turns lights out like
a June bug taking off July.

The Entertainer 

He is always proving to someone that he exists.
On the ship’s deck,
at the 6am breakfast
he aims to entertain the entire round table
of six, blurry-eyed passengers
with his whiskered joke.
Suddenly their eyelids lift
because the punch line is coming,
racing around the corner
outruns the first cup of coffee
to win the race and fill
the passengers and the entertainer
to the brim.

Please send your comments or questions to jsimon145@gmail.com. 

Some Thoughts on Feeling Powerful

The impetus to tackle this vast topic comes from my recent dialogue with a nine-year-old boy who has been preoccupied with power from an early age and has worked diligently to achieve it. From the beginning, he’s had a rich internal life and appreciates an audience who will listen to his stories about it. Furthermore, he excels in karate and academics. Last night he asked me if I had the chance to be president or a master of karate, which would I choose. As a result, I’m inspired to explore the subject of power and offer a few thoughts.

As a psychotherapist-psychoanalyst-psychopharmacologist, with my toolbox of psychodynamics and my knowledge of psychopharmacology or a combination of both, I aim to empower individuals. Therefore, tackling the broad subject is not completely outside my ken.

We first learn about our personal power as toddlers. The toddler learns to say “no.” He has just achieved some kind of awareness that he exists as a separate person. He immediately begins to test the limits of his power. (Because he has no sense of limits or danger, he requires a vast amount of attention to keep him out of trouble.)

I’m a big believer in teaching people how to deal with the power of authority. As a psychotherapist, I hear stories from some who have no awareness of how and when they endanger themselves or their positions when they fail to recognize the power of authority and their vulnerability in the face of certain circumstances. To demonstrate, I share a personal experience.

A few years ago, I was inadvertently exceeding the speed limit on a Virginia highway and was pulled over by a very tall police officer in an Army-green uniform and a matching tall hat. He abruptly demanded that I get out of the car and put my hands high up in the air. Already a middle-aged woman of five feet and less than one hundred pounds, I felt he addressed me with an inappropriate tone of voice. I nearly told him so, but fortunately, quickly assessed the situation. Observing the pistols in their holsters and his hands not far from the triggers, I suppressed my impulse to speak. I don’t remember if he gave me a ticket or not, but I do remember how close I came to challenging his authority. This close encounter helps me empathize and caution others who might be confronted by authority when it is quite clear that they wouldn’t come out on the winning side.

Exercising our personal power follows avenues from innocent to deadly. Annoying another person is a display of rude, petty power. An example comes to mind of my behavior in ninth grade when I flew paper airplanes in algebra class. (The teacher refused to believe that a smart, usually polite student like me could be capable of this behavior.) Why did I “act out,” as we say in psychological terms? Because I was bored, I exercised an inappropriate, disruptive and annoyingly petty show of power. Bullying is another (too prevalent) example of exerting petty power over others out of a sense of powerlessness.

Today’s news reported a man on a motor scooter who rode by some bystanders and intentionally shot his pistol at them, killing one and injuring several others. This destructive power exercised by a desperate, deranged person is an example of someone who feels powerless in his life. Sadly, individuals who maim and/or kill others have gone astray in a society that has failed to recognize, redirect and show them how to achieve a personal sense of positive power.

Personal power implies a modicum of control over our minds, bodies and feelings. As individuals we usually choose to develop one or another brand. We may focus on brain power to become academicians or professionals. Athletes, of course, concentrate on bodily power. Artists and those involved in some kind of creative process hone the power of their feelings. Power over our environment is most highly developed in explorers of land, sea and air. These divisions are artificial: we each exert and integrate varieties of competence.

As I see it, the goal for each and every one of us is to own a sense of personal power without impinging on anyone else. If we do become powerful over others, the ideal goal is to use it constructively: to benefit humanity rather than ruling as a dictator or despot capable of killing to maintain power. Positive power over others is found in our great presidents.

Can we accomplish sufficient power in our lives without injury to others? This complicated question requires thought. For example, banning toxic chemicals to save the earth impinges on the revenue of the manufacturers of these substances. We can hope that these corporations will acknowledge and alter the nature of their products to aide rather than destroy. We can only anticipate that awareness helps us to direct our efforts to harness power in positive directions and minimize its negative potential.

Dear Reader, Thank you for reading this blog. Please send your thoughts and comments to me at: jsimon145@gmail.com

For Mother’s Day

 

For Mother’s Day

 

My daughter asks what I’d like 

for Mother’s Day. I answer,

“Empathy, Sympathy, Understanding

all those ephemeral essences,

invisible and they take up no space

in my closets or drawers.”

 

She makes a face, almost a grimace.

“But Mom, buying a bouquet of roses

for you would be so much easier.”

Mom would be 106 years old

Dear Readers, My mom would be 106 years old today. Oddly enough, the longer she has been gone,

the more I appreciate her. Today I post a poem I wrote about her a while ago. Tomorrow I will post

a few thoughts about parents and ambivalence. Dear Readers, I would welcome your thoughts on the

 topic of our mixed feelings toward our parents. 

Raisins

On the lucky grammar school days, 

I found a little box of raisins

in my lunch bag packed by Mom

On the red box, the picture 

of the sun-maiden shone. 

She always wore a white apron 

and flashed a peaceful smile

as if to radiate the warmth

of the star that nurtures each one

of us and all the raisins in the world 

Mom passed on fourteen years ago

to this day. So, it is natural that I think

of her in this way. I think too 

about how we’re cut from the mother- 

cord of flesh and blood

while the grape is yanked 

from the mother vine of wood. 

What a treat, each raisin sucked

then chewed. Of course, I always 

wanted more of them. 

Don’t we always want 

More of any sweet fruit? 

But Mom sensibly warned 

that one box was enough. 

More lead to pain and sorrow

The sweetness held in these 

wrinkled skins once smooth 

now enhanced by sun and age. 

Oh, to see myself as one 

who harbors some sweet-secrets

A shriveled mortal morsel, passing

through nature’s order and disorder

that comes with time, the view 

from inside and outside our skins.

detached, we shrivel too to be boxed

and consumed by earth’s ravenous hunger