“The city is beautiful in the fall,” he said, taking off his red jacket. The accent in his voice betrayed his past in New York City. “I enjoyed walking through Central Park and looking at all the colors in the trees.”
He pulled the chair away from the table, placed his left hand onto the back, and leaned into it. The skin of his hands was dry. Dirt had collected within these crevices and underneath his fingernails. My eyes traced these dark tributaries over the hills of his knuckles and through the valleys of his palms.
“There were a lot of concerts in the park. I’m not sure if they still happen, but there was a time when you could see a lot of performers for free. The city did nice things like that,” he continued. He ran his free hand across the surface of his greying hair before scratching his chin. I noticed that his sideburns were uneven, both in length and in thickness.
“Would you like to sit down?” I asked. He had sat down the last time we spoke. What was stopping him from doing so today?
“Oh, sure,” he said, pulling the seat out completely. He sat on the edge of the chair, reclined back, and slowly stretched his legs out. I could almost hear his joints creak. He unbuttoned his blue jacket, revealing a plaid green shirt with buttons underneath.
“Do you miss the city?” I asked. He did not know that the city he had left long ago is my pending destination.
“No—absolutely not,” he resolutely said. “People are too busy in New York. People don’t look at each other. They just push past you and keep going. If you went to New York, you would find that people are always in a rush. They don’t ever take their time.”
He unwrapped the brown scarf around his neck and tied it securely around the arm of his red jacket. He pulled up the faded black sock that had sagged down past his left ankle, thus obscuring the thin white one underneath from view.
“Sometimes they’re not very nice, either. They’re just so busy—they’ll push past you in the subway. And they don’t talk to you. When I was in New York, the clerk behind the counter wouldn’t ever say hello to me. I’d ask him how he was doing, maybe he’d grunt something. Most of the time, he just ignored me. Here in Seattle, they’re more likely to talk to you. I say hello, they say hello, they make conversation with me. I like that.”
He pulled a dead leaf from his pocket. Surveying it with his eyes, he turned it over and rubbed his fingers against the papery surface. He then dropped the leaf into the trashcan.
“That’s also where they put me on haloperidol,” he said. He smiled at me, revealing a space where a molar should have been. “That stuff is bad, bad, bad. I know why they put me on that stuff—I used to be worried about the KGB following me. That’s not a concern for me anymore; it’s been many years—but that haloperidol was terrible! My muscles got stiff and I felt like I couldn’t sit still. Haloperidol—no good, no good.”
I nodded. I could only imagine how this man appeared while he was in New York City. If I was speaking with him on the phone, I would not have had any suspicions that he at one time was psychotic. Obviously always intelligent, he was now clearly logical and interpersonally skilled. Eccentric, perhaps, but that was undoubtedly part of his charm. But his untamed, grey hair, the multiple layers of clothing, the numerous, empty plastic grocery bags that were stuffed into his pockets, his consistently unwashed skin—
“—and there wasn’t any place outside for me to sleep,” he said. “At least I can find an undisturbed bridge to sleep under in Seattle. I can’t stand those shelters; too many people. It’s too crowded there. Don’t get me wrong, I appreciate the social services—New York and Seattle try to protect the homeless, try to make sure that they aren’t beat up and attacked—but I just don’t like the shelters. The bridges are safer.”
—what else was going on…?
“I would never go back to New York City now,” he concluded. “I don’t understand why anyone would want to go there.”
A small, shy smile crossed my face.
15 Dec 2007 | 1 comment.
Jack of All Trades vs. Master of One.
We were impressed with what we saw.
It wasn’t the first time we had watched a videotape of a psychotherapist during a therapy session. We, however, were (are) more accustomed to watching ourselves interact with patients on tape, which usually induces feelings of inadequacy and anxiety.
Watching this person interview the patient inspired something like awe, that same sensation one feels when observing a sleight of hand magician manipulating a deck of cards, a talented basketball player successfully completing a difficult three-point shot (think Larry Bird), or a gymnast gracefully executing feats of near-impossible flexibility.
I sighed—with both hope and resignation. Wow… I want to be able to do that. I want to be good at therapy. That’s so admirable… and daunting! Do I even have the capacity to be that good? Will I ever reach that level of skill?
I conferred with some supervisors.
“Well,” they uniformly said, “these people have been doing this for years. It’s a function of experience. You’ll get there—it takes time.”
I nodded, dissatisfied with the answer. I want that now.
“And,” they continued, “these people spend a lot of time thinking about their interactions with patients. They transcribe sessions. They read the transcriptions of sessions of their mentors. When they see an effective interaction, they accost the individuals involved and ask questions: ‘Hey, how did you do that? how did you handle that situation?’ They think about their work a lot. This is the focus of their lives.”
I nodded again, rapidly running through my daily schedule in my mind’s eye. Just how much time would it take for me to review all of my sessions, read more books about interviewing, ask various people about how to hone my skill set…?
“… but, lots of things interest me,” I finally said. “I want to do a variety of things. If I devoted all that time to my skills, then I wouldn’t have time to dance, write, go out with friends, run….”
“Yeah,” one lamented. “I have that problem, too.”
“If only we didn’t have to sleep,” I dryly remarked. “We spend a third of our lives asleep—imagine all the things we could do and accomplish if we weren’t unconscious for all of that time!”
Am I destined to be a jack of all trades and master of none? Mastery is a wonderful feeling and a grand accomplishment—it’s nice to really know something and do it extraordinarily well.
“I think that skills generalize,” another one said. “I used to be so impulsive—when I was in training, people had concerns about me seeing patients. I was too impulsive—my mouth would just go off. Supervisors had to rein me in all the time. I learned a lot about patience over those years, though, and now I find I’m much more patient in all the areas of my life. For example, I can now draw landscapes with more accuracy and in less time compared to ten years ago. Back then, I’d make a lot of errors—I’d have to erase a lot or restart frequently—and now, I am able to sit still for a longer period of time and my lines stray significantly less. So I really think that everything you do affects everything else. Sometimes we just don’t think about it like that.”
Is there anything wrong with being a jack of all trades and master of none? Diversity of skill produces a wonderful feeling and is an accomplishment in of itself—it’s nice to adapt easily to different contexts and exercise flexibility.
Must it be a zero-sum game? How do we choose what we shall sacrifice in pursuit of specific goals? What do we lose (in terms of experiences, relationships, goals, etc.) if we develop only one particular aspect of our lives? What do we gain? Should we direct our energies towards achieving “perfection” (in one realm) or “good/satisfactory” (in several realms)? (”The perfect is the enemy of the good.”) How do we choose what we value?
This is the problem of wanting everything. (I think.)
13 Dec 2007 | 8 comments.
A Smile and A List.
Watching a smile form on the face of a man with schizophrenia is akin to witnessing grey clouds at twilight slowly drift apart to reveal the silver glow of the winter moon.
That smile is a pleasant and wonderful surprise. I pause in wonder—
—and smile broadly in return.
I don’t think the smile actually forms at a slower rate, but in that moment, one might believe so: You can see the muscles of the face gracefully coordinate so that wrinkles blossom around the eyes just as the corners of the lips pull back towards the ears. Teeth (or spaces where teeth should be) appear and maybe—I’m pretty sure I saw it—the eyes sparkle.
Oh! How beautiful that smile is! Where there was previously little emotional expression there is now an image of mirth, amusement, happiness, joy—
—and there is connection! His smile races through my retinas and into my optic nerves; the image coalesces within my occipital cortex and through the miracle of cognitive processing, I don’t just see his smile, I recognize it—
—and, a blink later, I see the smile fading from his face…
… and the winter clouds creep back across the face of the moon, extinguishing the light that was just there.
Professions of people with whom I have danced (lindy hop):
- electrical engineer (Boeing)
- mechanical engineer (Boeing)
- steel worker
- accountant (Expedia)
- software engineer (Amazon)
- Navy military officers (2)
- emergency room physician
- pianist
- pilot
- customer service representative for a broadband internet company
- (many) computer engineers (Microsoft)
- ballroom dance teacher
- high school sophomore
- automobile mechanic
- owner of a franchise of a shipping company
- biophysicist
- music teacher
- psychiatrist
- animation art teacher
- owner of a small computer company
- computer operator for Lexis Nexis
- law professor
- lindy hop teacher
- lawyer
- statistician
- electrical engineers (2?)
- Alaskan fisherman
- theatre actor
- webmaster
- college students
- Army officer (captain?)
- internal medicine resident physician
11 Dec 2007 | 2 comments.
Dancing and Social Context.
I’ve been dancing at a lindy hop event all weekend and learning less commonly danced jazz-era dances. As a result of all of this dancing, I have reached the following conclusions:
- People who lived and danced in the 1920s through 1940s had much stronger quad and calf muscles that we do now. (Not really.)
- Jazz dances absolutely constitute aerobic exercise. The collegiate shag is akin to running in place… which makes me think that people who lived and danced in the 1920s through 1940s had more resilient knees. (Not really—furthermore, the association between knee “wear and tear” injury and running is weak. Just to be clear.)
- Though not a girly girl, I can wear a crinoline underneath a dress with minimal awkwardness. I rather like crinolines, actually, and I was pleasantly surprised to learn that it doesn’t cause problems while dancing.
- Many men can tolerate heat well. Several men wore three-piece suits to the “formal” dance and there were the scattered few that wore heavy zoot suits and tuxedos (!). The layers hide the sweat well, but come on—that seems positively stifling!
One of the biggest conclusions I learned, though, is how frankly idiotic we are all willing to look in the pursuit of learning how to dance.
The man who arguably knows the most about the history of jazz dance (Lance Benishek) taught us the steps used in a dance called “the Big Apple” (has nothing to do with New York City; here’s a choreographed version, which is better known than the actual called dance). Related dances are “the Little Apple” and “Peelin’ the Peach”). He also taught a little bit of the collegiate shag (above) and the 1920’s Charleston (see the remark about the quad muscles above). The Big Apple is a called dance, much like square dancing (”Swing your partner!” “Do-si-do!” etc.), and some (many?) of the moves called are goofy.
I’m talking things like acting like Frankenstein (complete with screaming, etc.), playing leapfrog, marching around in a line/circle as if part of a train, and (gently) kicking people (leads) in the butt. Or hopping around on one foot while grasping the other, yelling “ow” as if the foot in hand was on fire (”hot foot”).
These are behaviors that most adults are not willing to do in the company of other adults. We all look very, very ridiculous. (… which, admittedly, is the fun of it.)
This is due to social conditioning, of course—the social context requires us to all behave this way. We agree to follow the directions of the teacher and, actually, if any of us refused to play leapfrog during the dance, that person would receive looks of surprise, if not scorn. It’s the social norm to participate and, in this case, look silly.
If someone took photographs of us hopping around like cartoon characters, it could be highly embarrassing… but because we were all learning the Big Apple, I don’t think anyone would balk at photographs of the self approaching the camera like Frankenstein (”it’s part of the dance!”). And it is impressive to see how we all comply with the directions to do these things. Lance actually had us repeat “hot foot” simply because he was so amused with how funny we all looked.
Once participants buy into the idea—any idea—people will do anything. Getting the commitment may be the most difficult part of the deal.
Classes are done, my legs are sore, my back aches a bit (and people laugh at me when I note that I am aging…), I’m tired… and there’s one more dance tonight. And my friends are putting pressure on me to go (as a reaction to my ambivalence). The social context continues to exert its power.
9 Dec 2007 | 3 comments.
Violence and Psychiatric Diagnoses.
This is a current (6:30pm Pacific Time, December 6, 2007) headline on CNN:
“State official: Shooter placed in mental health facility 5 years ago“.
Yahoo! news reports “Omaha gunman freed from centers, homes“. MSNBC leaves it at “Mourners light candles for Omaha mall victims” and the New York Times states “Details of Omaha Shooting Emerge”.
We cannot contest the truth within CNN’s headline: Yes, the public record indicates that the young man received (both in the past and recently) mental health treatment. Placing this information within the headline, however, overemphasizes this fact. Though not explicitly stated, the implicit message is “the reason why this young man shot all of those people is because he was mentally ill”. This information can be further distorted such that people then think “mentally ill people are violent”. The media communicated similar messages earlier this year following the Virginia Tech shootings and thus, one might then suppose “all mentally ill people are violent”.
Stigma increases.
So? Is it really true that people with psychiatric diagnoses are “all” violent? How about just “more likely” to be violent? By how much?
Is all of this media attention on “mental health” warranted?
What evidence is available?
One paper (”Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods“) compared people who were recently discharged from psychiatric facilities (the study group) and people who lived in the same neighborhoods as the study group. The study followed everyone for one year. For those who did not use any illicit substances, the rate of violence did not differ significantly between the two groups. For those people who did use illicit substances, the rate of violence increased in both groups and was higher in those with a psychiatric diagnosis. Most of the violence was directed towards family and friends. Of note, most of the violence from the study group occurred within the first ten weeks following discharge from the hospital (though it is also true that people “disappeared” from the study as it progressed…). There was also something suboptimal about the statistics (a field which is definitely not my forte)… though that is often said about many, many studies.
So one might conclude from this study that substance abuse/dependence increases the risk of violence in all people, though a bit more in people with a psychiatric diagnosis, particularly in the period immediately following discharge from hospitalization.
Another paper reviewed data from the National Comorbidity Survey (a mental health survey that involved thousands of people—this is the document that came up with the statistic that nearly 50% of people experience a mental disorder in their lifetime…). This data relied upon self-report. The paper concluded that
People with 12-month diagnoses of anxiety disorders, dysthymia and major depression were three to four times more likely to admit violent behaviors than those with no disorders. People with bipolar disorder or drug and alcohol abuse were eight times more likely to report violent behaviors. People with co-occurring non-substance and substance abuse disorders were more likely to report violence than those with only non-abuse disorders.
The authors also state in the abstract (I do not have access to the paper myself) that ethnicity and gender are better predictors of violence than psychiatric diagnoses (which opens up another can of worms…).
What does this information mean? That people with psychiatric diagnoses are more likely to share this information? Are we to assume that everyone was telling the truth? Was there any collateral information available?
Another paper appeared in the New England Journal of Medicine (by Richard Friedman, who I referred to a couple entries back) that also asked the question I write of now. He, too, reviews a few studies, including another large, epidemiological study (it looks like from a book?), which concluded that people with diagnoses of schizophrenia, major depression, and bipolar disorder were twice to three times as likely to assault someone as compared to those who do not have a psychiatric diagnosis. (He also comments about the increased likelihood of violence in those individuals using illicit substances.) However, he then states that the prevalence of mental disorders is very low in the population and thus contributes very little to the absolute amount of violence in a population. He pithily finishes the article with “most people who are violent are not mentally ill, and most people who are mentally ill are not violent.”
I don’t know just how much “strength” we can attribute to what data is available. There seem to be some associations, but there certainly is insufficient evidence to support the idea that all people with psychiatric diagnoses are dangerously violent.
It is both unfair and unfortunate that some major media insist on advertising in bold, large-point font that perpetrators of violence are mentally ill. Such disproportionate attention suggests causation when none exists. Do headlines ever read “SHOOTER DID NOT HAVE A MENTAL ILLNESS”? Or “GUNMAN NEVER RECEIVED MENTAL HEALTH SERVICES”?
Why not?
I do not mean to minimize the sorrow of the citizens of Omaha. We all wish for a reason for this violence—we want to assign responsibility to someone or something. A psychiatric diagnosis or history, however, is not always—and, in fact, is very rarely—to blame.
6 Dec 2007 | 5 comments.