Book Review- “Dirty” (A Search for Answers Inside America’s Teenage Drug Epidemic)

This is not a newly published book.  In fact, it was published in the fall of 1993.  It still resonates however for parents, teachers and mental health providers who want a unique window into America’s teenage drug epidemic from a deeply personal vantage point.

Meredith Maran, a talented and prolific writer in the Berkeley-Oakland area, writes intimately about several high school teens that she followed for a year.  She documents their hopes, dreams, challenges, successes and failures from a vantage point rarely achieved by adults:  The day-to-day involvement in their lives both at and away from home.  This is a compelling book, sure to leave your own hopefulness as well as your awareness of the depth of this dilemma much expanded. 

Ms. Maran takes us on a journey that all parents wish they could take, and anyone interacting with teens should take.  

See more about Meredith Maran’s past work and pending projects at:  www.meredithmaran.com

Once I built a railroad…

The US Labor Dept says that approximately 1.3 million jobs have been lost so far this year, with 50% of that loss coming in the last three months!  Increasingly the stresses and multiple challenges of job loss will be the presenting problem for clients seeking therapy.  California is now 3rd in the nation for unemployment rates.  The East Bay Corridor counties of Solano, Contra Costa, Alameda and Santa Clara have been particularly hard hit, out-pacing nearby Napa, Marin, San Francisco and San Mateo counties.

Everyday there are reports of more companies announcing lay-offs and closings.  The fear and axiety about real and potential job loss is mounting.

I provide low-cost therapy and counseling to people who have lost their employment and therefore their health insurance.   It’s important for anyone facing unemployment to become mindful of the impact on them and the  ways in which they might deepen their losses through inaction or inappropriate actions that negatively affect their family and friends, and their potential to find new employment.  In addition, maintaining or re-building self-confidence is critical to successfully finding another job, and therapy can  help to re-establish a health sense of self-confidence.  There will be increasing competition for available positions, and your personal presentation is the first and last thing that prospective employers see! 

For success, prepare yourself mentally and emotionally to confront the challenges of job loss effectively and positively, and to present yourself favorably to employers by using therapy to help clarify your goals and re-kindle your imagination.  You want to show the best of who you are, and therapy can help.

GRIEFS by Emily Dickinson

Emily Dickinson’s poem is poignant, piercing, and eloquently expressive of how one can be touched, and held, by grief.  After my previous post, I thought it might be helpful in a different way to read her words. 

She says it so much better than do I.

 

I measure every grief I meet 

With analytic eyes; 

I wonder if it weighs like mine,

Or has an easier size.

I wonder if they bore it long,

Or did they just begin?

I could not tell the date of mine,

It feels so old a pain.

I wonder if it hurts to live,

And if they have to try. 

And whether, could they choose between

They would not rather die.

I wonder if when years have piled-

Some thousands-on the cause

Of early hurt, if such a lapse

Could give them any pause;

Or would they go on aching still

Through centuries above,

Enlightened to a larger pain

By contrast with the love.

The grieved are many I am told;

The reason deeper lies,- 

Death is but one and comes but once,

And only nails the eyes.

There’s grief of want, and grief of cold,-

A sort they call ‘despair,’

There’s banishment from native eyes,

In sight of native air.

And though I may not guess the kind

Correctly, yet to me

A piercing comfort it affords

In passing Calvary,

To note the fashions of the cross,

Of those that stand alone,

Still fascinated to presume

That some are like my own.

Grief: a brief review of a common experience.

One often hears the cliche “We are all more alike than we are different.”  When we stop to consider the most common of human experiences however, we seldom name Grief as one of the most common.  Grief is generally understood by both professionals and lay persons to be a complex and difficult emotional experience that can result in a wide variety of both functional and dysfunctional behaviors, and that can be of uncertain duration.  But perhaps the most compelling aspect of grief is that it ubiquitous in the human experience.  No one will have a life without loss, and therefore everyone will at some time, and usually several times, grieve the loss of someone or something cherished… something that is a part of our identity, and without which our self-concept is changed, sometimes temporarily and sometimes irrevocably. 

The most understood clinical catagory in the grief continuum is Bereavement, diagnosed in relation to the loss of a loved one.  This loss is something we all fear, yet all of us accept that it will be a part of our lives.  Grief is less understood and less often recognized in that it can have many antecedents.  There are many kinds of losses that result in a person feeling grief.  Often the depth of the grief is unrecognized by the people around the grieving person simply because some losses seem so commonplace that the impact of the loss on a particular individual is misunderstood.  The loss of a marriage or a loved one is easily identified and understood by most people.  But different kinds of losses, though noticed, may fade in how we “hold” the person who is suffering.  The loss of physical functioning, financial security, health or career can all result in the person grieving invisibly after others have given their condolences and moved on. 

Now, at a time when more and more Americans are losing their jobs, we must understand the emotional impact of job loss, and the associated losses such as status, material possessions, work-based relationships, and self-identity.  Grieving will be a major part of the psychological life of people who lose their jobs, and recent estimates are that approximately 1.3 million people lost their jobs in 2008, with 50% of those losses coming since July!  With more and more companies announcing lay-offs, we have every indication that job loss and the associated loses will be a major contributor to mental distress over the next year or more.  Because job loss has a more pervasive impact than might first be recognized, practitioners must be especially alert for signs of deep despair that might lead to suicidal thoughts or acts.

If you have experienced recent job loss, please recognize that grieving the multiple levels of loss from the initial one is an expected part of your healing process, and seek therapy and support early so that problematic symptoms don’t overwhelm you.  If you are a practitioner, get more information about grief and the strategies that you can use to assist clients through their grief process.  In particular, learn to make the differential diagnosis between Normal Grief, Complicated Grief, the newly identified Prolonged Grief Disorder (not yet officially accepted into the DSM), and Major Depression.  Each diagnosis requires knowledgeable and thoughtful assessment and intervention for therapeutic and safety reasons.  And remember to enquire about the full range of losses the person is experiencing.  The kinds of losses and the resultant grieving most likely will be more extensive and more painful than is evident if you don’t take time to ask, and listen.

Personal care while giving support to others.

Giving  ones talents, time and resources to support others is admirable, and can result in deep personal satisfaction… but not for long unless the “giver” is able to thoughtfully manage their time and resources for concommitant self-care.  Use the airlines as a model for giving aid to others in need:  “In an emergency, put your own oxygen mask on first.”  Only then, according to the well-known pre-flight recording, should you attempt to put an oxygen mask on anyone else.  Well, it only makes sense!  If you pass out- or more aptly for purposes of this post – if you deplete your own psychological resources, you will be unable to sustain the “giving” that is needed or expected by another.

Perhaps a different analogy will resonate:  Consider the entrepreneurs who are the stuff of legend… the Kennedy family, or the Gates’.  The Kennedy’s have long been known for their brand of social activism that can be viewed as entreprenurial in that the purpose has been to “seed” progressive politics in our society.  There are many examples from accross the various spectra and persuasions of our social fabric.  But there is one thing they all have in common.  They spend their “interest” and not their “principle” in their entreprenurial activities.  The do NOT spend down their primary means of self-support or they would have nothing left to continue their giving.

So too, if you are in a care-giver role, it is important for you to adopt an entreprenurial perspective to your giving.  Taking care of yourself by nourishing your body, mind and spirit with moments of gentle peacefulness, casual pleasure or even heart-thumping excitement is critical to maintaining the emotional stamina needed to be a consistently caring support to another person.  Yes, taking some time away from giving – ensuring that we “don’t spend our principle, only our interest” is what enables us to sustain an entreprenurial perspective and maintain our “giving” over a life-time. 

Giving to oneself is the key to “being there” for others.

Public vs Private Mental Health

I have been a mental health practitioner for more than 35 years.  The earlier part of my career was spent in public mental health settings working with people labled with Serious and Persistent Mental Illness or Substance Abuse.  [More about these labels in another post.]  The latter part of my career was a mixture of clinical administration for a non-profit provider agency, and private practice providing psychotherapy and counseling to people with less debilitating yet still distressing mental health concerns.  I now work only in a private practice setting.

I have often heard practitioners who work in only one of these arenas, public or private, express wonderment about what might motivate the “others.”  Sometimes there are even disparaging comments made about those “on the other side” … money-hungry vs socially-progressive, or “government-dependent” vs “entreprenurial.”

If you work in only one of these arenas, it’s time for you to consider a wider, more comprehensive view of what “community health” really means. 

If you are a provider in a public mental health setting working with clients in publicy-funded program with indigent clients, remember that the bank tellers, bus drivers, nurses and landlords your clients interact with may sometimes want and need the support and therapeutic interventions found in engaging a private therapist.  By seeking and finding a healthier adjustment to their life situations, these individuals may become better able to manage interactions with others they encounter, including those individuals, who due to poverty and social alienation, seek their treatment in the public health system. 

If you are a private practitioner, remember that the honor and integrity of our society-the society we all live in- is best understood by how it cares for those among us who do not have the means to purchase your services, or much of the other “staples” that we regard as symbols of social success.  Your colleagues in the public sector are working to maintain the honor of our society’s promise to it’s citizens.

Increasingly, professional providers in the mental health field work in both public and private arenas, and so have a realistic understanding of the relationship between the two.  It’s up to those of us who have had this dual experience, or still do, to counteract the stigma that can flow between us, and help to create the society we all wants: one that honors everyone for their capacity and contribution.

Each one reach one.