Monday, March 24, 2014

Book Review: Identical

Realistic, scary, and surprising.
The author once again manages to make real characters, with real problems.  She tackles an immensely difficult topic – incest.  Hopkins manages to show the horror, the guilt, the causes and effects of incest in a very real and very appropriate way.  She is able to describe the terror of a daughter who fears her father’s drunken state, because that is when he comes for her.
Hopkins describes it without being graphic, without being gratuitous and gross.  She is able to give you that queasy feeling and make you uncomfortable without stepping over that line into disgusting description and voyeurism. 
She handles the topic accurately, and shows what happens as a result of sexual abuse – from the eating disorders to the cutting to the drug use etc.

This book is much like Crank and Glass and all the others.  It is terrifying not because of shock value, but rather because it is realistic.

Wednesday, March 19, 2014

Book Review: The Reality Slap

I started this book almost 2 years ago.  In a one month period I tried to read 4 books about ACT therapy, a book on DBT, a book on CBT, and another on psychodynamic psychotherapy.

Yeah - I was nuts. (fitting for a shrink)

I finished all the other books, but never completed Russ Harris' "The Reality Slap."

This week I picked it back up - and I'm very glad I did.

I'll admit - I don't like Russ Harris' writing style.  I don't think we'd work well in a clinic together.  I can do "mindfullness exercises," but not the way he writes them.  I'm not as "touchy, feely" as he is.  I don't think I could use most of his exact words with my patients.

He doesn't fit my personality, my style, or the way I like to relate to people.  AND - I think he's a great author and this book has real value.

He begins with a great point: "All self help books could be lumped into two categories: those that claim you can have everything you ever wanted in life if you only put your mind to it, and those that claim you can't have everything you want but can still lead a rich and rewarding life." (this book is the latter)

Harris points out that being happy with what we have doesn't mean giving up on goals, needs, wants, etc... It means we don't depend on them for our well being and vitality.

Harris is realistic.  He knows that for most of us, challenging our negative thoughts, repeating positive affirmations, and even self-hypnosis don't work long term.  "Our minds continue to be harsh, judgmental, and self critical."

He points out the fact that our brains don't stop.  We churn out thoughts all day long.  When we're driving, walking, eating, talking, listening, watching, reading - our brain just keeps going.  Thoughts about what we're doing, or not doing, or the girl who just walked by, or the movie we saw, or the political turmoil on the world, or how we should have responded differently to our boss last week when he gave us that assignment.

Our minds tell us we are smart, funny, silly, stupid, ugly, strong, inept, over-qualified, under-appreciated, etc...  It judges us.  Sometimes correctly, sometimes incorrectly.

Harris doesn't tell us to ignore our thoughts, or to fight against them, embrace them, hate them, or change them.

He asks us simply to acknowledge them.  Know they are there.  See them for what they are - thoughts.  The may be painful, joyful, true or false - but first we just recognize them, and accept the fact that they exist.
He doesn't ask us to enjoy painful thoughts. He knows they suck.  They hurt us because we care.

The only things that hurt us are the things we care about.  Our pain shows us what we value.  Pain is not the enemy.  It sucks, it's not fun, but it is not the enemy.  Apathy is the enemy.  When you don't care anymore, when you are unwilling to feel pain, you are also unwilling to feel joy.  That is the message Harris brings.

He also brings stories, research, exercises, and step by step instructions about how we can accept the pain in our lives, and with that pain, move forward living the life we value.

The book title is genius - The Reality Slap.  What do we do when we realize that our life is not what we want? When we get slapped in the face by a death, a cancer diagnosis, a job loss, addiction, etc...  What do we do when we can't meet our expectations.  Do we "try harder" or "lower our expectations?"  Or is there another option....

Sunday, March 16, 2014

My Day As A Patient

For months now I have wanted to spend a day as a patient. I work at an adolescent Residential Treatment Center, and I'm trying to find more ways to understand what these kids go through.
I've starting reading the books they read, imagining myself in their shoes, and now, I finally had a chance to live (more or less) like a patient for one day.

I knew that the staff and all the kids would know who I was.  They would treat me differently.  There was no real way around that... but I could still make it as real as possible.

I followed all the rules: No belt, no shoelaces (just a zip-tie), no ring on my finger, no hat, etc…
I arrived at the treatment center about 6 am, used my keys to walk through the 4 locked doors to get to the patient hallway.  Then I went to the nurses station and the staff lockers.  I put my bag inside, then my phone. I hesitated before putting my keys in there.
I knew the staff would let me out at any moment. I could even order them if I wanted.  I’M A DOCTOR!  But that still didn’t change the feeling of helplessness when I put my keys in the locker, closed it, and walked through the auto-locking door onto the patient hallway.

I couldn’t get out on my own.  I had no access.  No keys. No phone.  It suddenly felt very real.  I walked down to my assigned room, and waited for the morning to start.
I first learn how boring the morning is, and how many times you get woken up.  First they shine a flashlight on you every 15 minutes during the night to make sure you are still in bed, alive, and not hurting yourself or trying to commit suicide. Then the phlebotomist wakes up anyone who needs their blood drawn for labs that have been ordered. (likely by me)
Then we get woken up again by the sound of “med-pass” when all the kids who take morning medications have to go to the nurse one by one, take their pills, swallow, open their mouths and move their tongues all around to show that they really swallowed and didn’t “cheek” the pill. 
Then it’s shower time.  I have to push the button every 25 seconds to keep the hot water coming, and there is no bathroom door or shower door – there are curtains only.  The curtains are only held up by Velcro, so you couldn't use them to hang yourself.
I can’t look out the windows – the shades are drawn between the double panes of glass.  The windows are also nigh unto bullet proof.  The beds, tables and cabinets are also bolted to the floor and thoroughly caulked to leave no sharp edges.  Oh – and the hangers for your clothes can only hold about 5 pounds before they “release” so you can’t hang yourself from them either.  (This place is very “safety” minded.)

We line up for breakfast.  "FACE FORWARD" is yelled and I quickly learn to be an arm's distance apart from the person in front of me and behind me.  No talking, no turning around.  Two staff members walk us through 3 locked doors to get to the cafeteria.

I am told I can take fruit, juice, milk, or oatmeal – but I follow the other kids lead and take 4 mini-boxes of cereal like everybody else.
We sit at assigned table.  No “cross-talking” means I only get to talk to kids at my own table.  We eat cereal and chat about life, music, who has which doctor, whose therapist is boring, whose parents are giving up custody, and which girls are hottest.
One kid has already been assigned to sweep the cafeteria and another to clean off the tables.  After 15 minutes the ‘upper level” kids get to have seconds.  If you’re new like me, you’re the last to get seconds, which means you have no time to eat.  You have to quickly line up to dump your tray. When I get to the trash can I am told to hold out my utensils and drop them in so the staff can see I didn’t pocket a plastic fork or spoon (that could be used to cut myself or someone else.)  Then I dump my trash, put my plate and tray through the slot in the wall, and go back to the unit and get ready for school.

Again, face forward, eyes ahead, arm’s length away from the person in front of me.

Time for school!  I go to class.  Up first is a 30 question Spelling/Vocabulary test based on the 5000 words most used on the SAT exam.  I look around.  2 kids are actually doing the quiz.  3 are ignoring the paper entirely.  1 is asking questions non-stop for 5 minutes and driving the teacher insane.  I’m trying to figure out the definition of “Aeronaut.”

Back to the patient hallway for “Sunrise.”  I hear the gong, then have 12 seconds of “mindful breathing” before I learn the skills for the day.  “Radical Acceptance” and “Big Picture” are selected, and then we recite the DBT Pledge.  (It’s actually quite nice, and most of the other patients have it memorized.)

We talk about who has what assignments in the Cafeteria and in the halls.  Then it’s back to school for 2 more classes.

I watch CNN Student News and take a 15 question quiz on it.  Next class is all about Tsunami’s and after a long quiz we watch the first 20- minutes of the movie “The Impossible.”  Pretty scary stuff.  Most the kids paid attention to that one.

Lunch!  Beef stroganoff. and blue Powerade - it was either drink that  that or caffeine free diet sodas.  The foam cups were small so my drink was gone pretty quick.  I started to stand to get a refill and the kids quickly told me to sit back down and raise my hand.  Permission must be asked before getting out of your seat.

So I asked  - DENIED.  No drink refills allowed until "seconds" is called, which would be near the end of the meal.

Confession - I was getting sick of the rules at this point.  Seriously.  They seemed arbitrary and unhelpful.
So I waited till no staff were looking and then refilled my Powerade.  The kids looked at me shocked like this was quite the coup - then they told on me and I got put on "freeze" at which point I was sent back to my bedroom to fill out paperwork about my disobedience.  I had to write out a "behavior chain" listing what happened, what led to my infraction, how I felt, when I I could have changed, the pros and cons of my actions - and what committed action I was going to take in the future.

Then time for gym.  Outside - basketball court, large sand area, and picnic tables.

20 kids sat at the tables immediately and looked like they weren't going to do anything.  I picked up a basketball and asked who wanted to play.  Five boys decided to play and we had a serous game of 3 on 3 basketball for about an hour.

For the entire hour we played and sweated and laughed and struggled, while 20 other kids sat and did nothing.

(No wonder the kids here gain weight - if you take psych meds, eat tons of carbs all day long, and don't exercise - you're going to pack on the pounds fast)

The afternoon was the most useful.  Therapy groups!

DBT skills, mindfullness, being able to tolerate strong emotions.  How to live a life worth living, how to move forward living your values no matter what situation you are in.  It was impressive to watch the therapist teach and demonstrate all the coping skills for an hour.  He was speaking to a room full of teenage girls who cut themselves, constantly threaten suicide, have eating disorders, have been abandoned, were sexually abused, and are addicted to multiple drugs.

He was able to connect with each of them, squelch arguments, build relationships, and chip away at the  harsh exterior a lot of these girls present.

The next therapy group was "Job Skills."  All the girls had already learned about job applications, resumes, how to prepare for an interview, and to day was "mock interview day."

They were supposed to pretend they were being interviewed for a job at Subway.  I worked at Subway of and on for 5 years.  I had been through that interview, and had interviewed others myself.

It was a great class as I was allowed to be the interviewer and help these girls learn how to present themselves, how to answer, what to mention, what to leave out.  I felt like it was a very practical class, and very useful.

Then came the best meeting - SUNSET.  The whole hallway got together and discussed what they did well and what needed improvement that day.  They talked about what skills they used, when they failed, and what they want to do differently tomorrow.  Those who had offended others made a public apology and made a commitment, stating what they would do differently in the future.  

Dinner was much the same as the other meals.

Then room time alone to work on things we hadn't finished during the day.   We were told to write out one more behavior chain about something that had happened that day. What led up to it, how we felt, what our "primary emotion" was and what our "secondary emotion" was as well.

Then it was time to let the kids relax.  Friday night - movie or dance party.  My hallway chose dance party.  So out came the Xbox Kinect and "Just Dance" and for the next 90 minutes we danced and sang and laughed and joked while the techs gave us hot chocolate.  Some kids went and did Yoga in a side room, others went to watch an episode of "Heroes."

Me - I danced and joked and laughed and had a blast.  I saw that this was the time for the kids to use everything they learned in a more natural setting.  Be themselves.  Have fun with friends.  Make mistakes and screw up and just laugh it off and keep dancing.

When 8:30 finally came it was time for bed.  Lights out on the hallway. 
The kids saw me walking toward the nurses station and said "Hey, you getting discharged?"
"Yeah - one day.  Must be a record!" I called back.

The nurses opened the door for me.  I'd like to say I got my stuff and went home, but there were orders to sign and a few kids who needed to be seen by a doctor really quick before I went home for the night.
I was completely exhausted.  I didn't even bother to put my shoelaces back in - I went home wearing zip-ties.

One day.  14 hours as a patient.  I see how residential treatment can help.  I also see how it can drive you up the wall, make you want to scream, and leave you overweight and out of shape when you leave after 90 days.
I can see how it seems pointless at times.  I felt a little bit of the helplessness these kids must feel, and that was even knowing that I wasn't REALLY locked in there.

How would it be to spend 90 days there? How about 180 days like some kids I've seen?  Or worse - be told you're going to Disneyland with a short stop on the way and then find out your parents lied to you and they've admitted you to a locked psychiatric facility?  (It's happened multiple times)

I still don't know what's it's like to be one of them.  But if I've gained even an ounce of empathy for these kids - it was well worth the 14 hours that day.

Book Review: The Litigators

** Glimpses of the “old classic Grisham” but overrun by monotonous predictability.

I have read every John Grisham Book.

“The Client” was the first novel I finished in less than 24 hours.  I think “The Firm” and “The Pelican Brief” and “Runaway Jury” are some of the greatest books ever written.  I loved “An Innocent Man.”
I keep “The Confession” on my bookshelf at work to remember the effects of the death penalty.
I have been thoroughly disappointed in recent years as all his books became boring, predictable, and kind of pointless.

THIS BOOK had glimpses of greatness.  It had some fun and intriguing characters, a few fun side plots – but the main plot was obvious from the very beginning and never deviated.  I was getting bored through the middle of the book and I kept waiting for some great twist or development to make the book exciting again.

It never came.  Oh sure – during the trial there was a moment of fun, but it didn’t make up for the hundreds of pages of buildup.

The “escape” at the end was also predictable – since it was the ONLY side plot fully developed.  It’s like John Grisham wants to make all his new books as realistic as possible – and he can’t find a way to make great twists or unpredictable outcomes seem realistic – so he short changes us.

He’s still a great writer.  He still writes well – but his ideas aren’t what they used to be.
This book is the best he’s written in years, but it’s still pale in comparison to his first four books.