For ClinkShrink -- and all the Introverts I Know and Love

Our society values the qualities that go with extroversion.  You're supposed to be social, to get out, to collaborate, to gain energy from social events, and if you don't, damn it, well you're an introvert, or shy, or avoidant, or socially phobic.  "I wish Johnny got out more."  "I wish granny would go to the senior center."  We grow up believing that boys shouldn't wear dresses, that it's your fault if you're fat, and that it's of the utmost importance be outgoing.  Now introverts often do play well with others (Clink, in fact, plays very well, but don't ever try to get her to go out with you after she's in her pj's).  So I know several people who have gained some comfort from the book "Quiet: The Power of Introverts in a World that Can't Stop Talking" (that would be me, except of course on our podcasts where Clink just won't shut up).  So ClinkShrink enjoyed Susan Cain's book and even wrote a review of it HERE.  I found this TED talk by Susan Cain -- it's cute, funny, and insightful, so I thought I would share it. If you have other TED talks you've enjoyed, please do give me the links.  They don't need to be about psychiatry, but I enjoy funny and thought-provoking.  Thanks to Laszlo, I found this on his facebook feed.

Guest Blogger Dr. Jesse Hellman: Tarzan, the Computer, and the Unconscious

In Tarzan of the Apes, written a hundred years ago, the protagonist is born to a couple cast up on the coast of Africa by a shipwreck. His parents die, and he is brought up by a female ape, Kala, who had lost her baby. He learns English, but not its pronunciation, by looking at the picture books his parents saved from the wreck. Tarzan develops the physical abilities of a jungle denizen, but also shows a remarkable intelligence and nobility of spirit. This is, as we learn, because his father was an English lord, and Tarzan is thus the true heir to the title Viscount Greystoke (I will add that Jane is from Baltimore).

We today know that the human personality would not develop as Edgar Rice Burroughs supposes it could. Nobility of character certainly does not come from an ancestral title. The brain requires certain input to develop normally. In understanding the mind, however, we can use the computer as an imprecise analogy.

The computer as delivered, like the baby, contains hardware. The baby has the ability to use certain software: It starts to learn language. Unlike a computer, however, it develops connections to its caretakers. New languages can be learned later, new habits or customs, but the oldest language and culture often has attributes that stay with the individual, even if in the background, throughout life.

Recent studies have started to explore the origins of the sense of morality, fairness, and sharing in chimpanzees and other primates. Certain traits that were assumed to be totally learned are now thought to be somewhat hardwired. The differentiation between hardware and software is not as clear-cut as was once thought, but it is still useful. healthys treat the whole person: There are difficulties that arise primarily from hardware not functioning perfectly, others purely from software or programming, many from both ("nature and nurture"). At one time schizophrenia was thought by some to come from a baby's experiences with a "schizophrenogenic mother." Not any more. We don't know the precise origin of many conditions we treat.

A child is born with a temperament that is evident at a very early age. Traits as diverse as confidence, distrust and shyness may show up very early. Some babies have a sunny disposition, others are more negative.

Just as on the computer, certain programs may have conflicts with others. While we may steer the ship, the conscience may control the compass, and our drives affect the winds and tides. Loyalty to one’s family may conflict with duty to one’s country (Antigone), or the wish to be independent may clash with the wish to be cared for. Some conflicts may be primarily behind the scenes, perhaps more obvious to others than to ourselves. Anxiety may be an outcome of our conflicts.

Free Will (see Noni Mausa’s comment in Are We Not Thugs?) is not as obvious a concept as it once was thought to be. Decisions are not completely determined by that with which we are consciously aware. The law needs to have one concept of free will and causality, religion has another, depth psychology another yet.

What we think and feel about others is not determined simply by what happens between them and us. Our reactions are influenced by multiple layers of past experiences, prejudices, our competitive and even sadistic yearnings, the need to be loved and to love, and factors that might be trivial to one person but determinative to another. It is not at all easy to be aware of what leads us to do what we do.

A new test had been done which would establish the truth about Tarzan’s parentage; the results in a telegram that had come from Paris. Tarzan knows that Jane Porter is loved by William Clayton, who had inherited the estates and title that might be rightfully his. He hopes that Jane loves him, but before he could speak with her, in a moment of doubt and insecurity, she promised her hand to Clayton, choosing the certain over the uncertain, respectability over passion. What interfered with his ability to see that Jane loved him, and to act sooner?

He reads the telegram. “Fingerprints prove you Greystoke. Congratulations.” One word from Tarzan would take everything from Clayton, and so now from Jane.

Of what use is a peerage if we have lost her whom we love? Could our actions be influenced by the fear we had when our father died?

Clayton asks Tarzan what he knows of his origins. Tarzan crumples the telegram and throws it aside. He answers simply, “My mother was an Ape. I never knew who my father was.”

Like Looking in a Mirror

Sometimes, I treat people who have the same problems I have in my personal life. It's hard. Oh, it's really hard. If I'm really distraught about something and a patient calls seeking treatment with a similar life circumstance, I will sometimes turn them away and recommend another shrink. But I don't always screen so carefully on the phone, and often "I'd like to make an appointment," will simply get a time and date.

The feelings get really complicated here.

If I feel I've had a role in creating my circumstances, then I wonder as my patients seek my counsel, Who am I to be making any suggestions, much less giving advice? Why are you looking to me, I've screwed up the same situations. Oh, you say, Dr. Jeff said on KevinMD that healthy's Shouldn't Give Advice, but you know, some of us do, and even when we don't, our feelings are often relayed through the questions we ask or the comments we make or don't make, or perhaps by the expressions on our faces, even if we don't say "You should do X." I told a friend once that I feel uneasy, guilty even, in these situations, and he replied, "How do you think I feel?" Did I mention he does family work and was in the midst of a stressful divorce? And I have yet to ask a colleague who also does family work how he managed during the years his own children wouldn't speak to him. Oy, life can be tough, for shrinks just like everyone else.

So perhaps I listen to someone talking about his most personal feelings about a situation, and you know, if I've been there before, perhaps it's good that I can empathize. If I'm in the middle of it, sometimes I listen and the patient's words seem so unreasonable, so unjustified, and yet I recognize them as being exactly my own--it's like having my own anxieties bounced off a wall only to ricochet straight back into my face.

Do I tell the patient that I've been in the same place before? Generally, no. Therapy is about his problems, not mine, and I think in these situations my empathy is clear. I say things that are more poignant and resonant than I might in circumstances where I feel removed. And patients never ask if I've been in the exact same place. On some of the harder things-- things that have no precise quick and easy answer-- I've taken to saying, "Not only don't I know what will fix this, I don't know anyone else who does have the answer." This I can say because I've done my own searching.

I hope I'm reassuring and comforting to people who find themselves in the same places I dwell. Certainly, tripping over a few stones on the path makes one walk a little more gingerly and judge a little less harshly those who walk more slowly. Mostly, though, I worry that I'm a little bit of a fraud just for being in the room.

Identity Crisis!

So I was born a Gemini. It's been part of my identity, always. I'm not much for astrology, and I don't check my horoscope, but it's something everyone knows about themselves, and sometimes it's fun. And interestingly enough, Gemini fits me to a tee.

Here, see if you agree. From Ganeshaspeaks.com:

Ruled as they are by the Planet Budha (Mercury), Mithuna ( Gemini ) exhibit a delicious brand of mercurial energy. They are quick thinking, quick-witted and fast on their feet. It's their curiousity and cleverness that make them such a hit at cocktail parties. But they are not just good talkers - they also love to listen and learn. However, any social setting is good enough for a Mithuna ( Gemini ) since these folks are charming, congenial, and love to share themselves with their friends. Mithuna ( Gemini ) mind drives them to talk, to converse and it is not always just idle chatter. They need more and more information to feed their intellectual inclinations. They probe endlessly for more information as the more it collects the better. They are supremely interested in developing their relationships. Sharing that knowledge later on with those they love is also a lot of fun. Mithuna ( Gemini ) are bright, quick-witted and is at the centre-stage in any party. Although rational and practical, they also have a surplus of imagination. However the fact that they are unsure which twin will show up half the time they are often considered fickle and restless. They can be moody and act on simple whims. While their effusiveness may be misconstrued as scheming by some, Mithuna ( Gemini ) generally have their hearts in the right place. It is this ample energy, which can also paint them as scatterbrained and unfocused but, behind all that restlessness, they are usually busy filing all that information away. Funny, brimming with life, full of ideas, adorable, inconsistent, capricious, superficial, they are a bundle of maddening contradictions. They may deal in everything and are 'know-alls', but at the same time they also have the ability to master skills. Mithuna ( Gemini ) are versatile and have an amazing grasp of the subject they choose, although it may not interest them for long. They prize intellect and consider it to be the key to all things. At work, they are the clearest of thinkers, suggesting logical and well-thought-out ideas which make them an asset to any team. Their greatest strength lies in their ability to communicate effectively and to think clearly. Adventures of the mind are what the Twins are all about. Bestowed with a cheerful face easily detectable from signs of anxiety, tension or unhappiness the Gemini face is a dead give-away when they try to hide sorrow behind their brand of wit and humour. If even for a short while, romancing a Gemini is likely to be interesting, adventurous and fun, but the fickle, almost uncaring attitude will manage to break many hearts before they finally settle down. Although affectionate Mithuna ( Gemini ) can be extreme flirts, But be sure that the partner shares the Mithuna ( Gemini ) sense of humour. Mithuna ( Gemini ) never stray if the family life is satisfying. However it is best not to rush headlong into marriage; give adequate thought before popping the question.

So apparently, Parke Kunkle, some guy in Minnesota (homeland of ClinkShrink, no less) decides that it's all wrong. Everything is off. Now I'm a Taurus. But I'm not a Taurus, I'm a Gemini. They want to stick me and ClinkShrink under the same stars? No way.

And here are the new dates:
Here are the new zodiac dates:

Capricorn: Jan. 20-Feb. 16
Aquarius: Feb. 16-March 11
Pisces: March 11-April 18
Aries: April 18-May 13
Taurus: May 13-June 21
Gemini: June 21-July 20
Cancer: July 20-Aug. 10
Leo: Aug. 10-Sept. 16
Virgo: Sept. 16-Oct. 30
Libra: Oct. 30-Nov. 23
Scorpio: Nov. 23-29
Ophiuchus: Nov. 29-Dec. 17
Sagittarius: Dec. 17-Jan. 20

Have you been blown away, too?

What will this mean in psychiatric practice? Will everyone's personality change? Will people come to talk about the shift between who they are and who they thought they were? Will they fight back? I know that I'm staying a Gemini.

In Treatment: Frances, Week 6 and a Few Words on Narcissism

Week 1: Sunil - Frances - Jesse - Adele

Week 2: Sunil - Frances - Jesse/Adele

Week 3: Sunil - Frances - Jesse - Adele

Week 4: Sunil - Frances - Jesse - Adele

Week 5: Sunil - Frances - Jesse - Adele

Week 6: Sunil - Frances - Jesse

---

 Frances spends the session grappling with her relationship with her dying sister and her angry teenage daughter. She wants Paul to feed her--she's hungry and he must have food, after all he lives here--but he refuses.

She leaves the stage to be with her sister after months of estrangement. They have a nice moment after Frances rescues the sister, bathes her, and puts her to bed. But it's short lived--the sister wakes up confused and needs to go to the hospital.

Frances has a tendency to look at all of her interactions as centering on herself. Her sister's warm declarations become meaningless when replaced by febrile mumblings. Paul's look is skeptical. She feels constantly judged and she looks for repeated approval and reassurance. Her daughter hates her, and it can't just be that the daughter is a teenager who is struggling with her aunt's terminal illness, her parent's divorce, and the tumultuous world of teenagers, it has to be about Frances. Ah, the teenager says Frances is a narcissist and that's untreatable. Is this true?

From my point of view, I don't believe that people change their personalities much. But therapy does seem to help people re-frame things, recognize their patterns, say "oh, I'm doing that again" and question what is going on. If I don't think I can "fix" something, I work on reframing it in a positive way. Most traits can be both good and bad, and the choice of words makes all the difference in the world. A shrink might tell Frances that it seems to be true that she likes being the center of attention, most actresses do, and it's a pretty helpful characteristic to have if you're going to be the star of the show. But maybe the sister's death isn't about Frances, and maybe she shouldn't take everyone else's distress too personally.

Ah, and here's a link to an editorial in the NY Times about the fate of Narcissistic Personality Disorder in the New DSM.