Monday, June 16, 2008

RENEWING OUR LIVES BY GIVING TO OTHERS

VERSE FOR TODAY: Therefore, we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day.
                                                                                                                        2 Corinthians 4:16

 

The 3.8 million United States seniors who celebrated their 85th birthday before the year 2000 constituted the fastest-growing segment of the population. By 2030, this group will number 9 million, and then will swell to 19 million by 2050. Rather than extending our life span, giving to others—putting others first—renews us spiritually and invigorates us.

Studies at Duke University’s Center of Aging and Human Development have clearly shown that people who devote their lives to thinking of others first instead of living for themselves will renew their strength and retard wasting away spiritually and physically. Here are some examples of people whose giving to others first produced a robust life:

v    At 93, George Bernard Shaw wrote the play, Farfetched Fables

v    At 90, Pablo Picasso was producing drawings and engravings

v    At 89, Mary Baker Eddy directed the Christian Science Church

v    At 89, Bob Hope finished a world tour for the USO

v    At 89, Albert Schweitzer headed a hospital in Africa

v    At 82, Winston Churchill wrote A History of the English Speaking Peoples

v    At 81, Goethe finished his play, Faust

 

PRAYER: Lord it is easy to lose heart and quit. Our daily problems have caused us to want to think about wasting our talents and becoming self-absorbed. Give us the inner strength to think of others first and to use our talents for your glory.

                                                                                                                                    AMEN            

Sunday, June 15, 2008

A GOOD FATHER

            There was a boy who played in the Little League. He played baseball, but he wasn’t very good. He was pretty bad player. He was a bad player actually. He couldn’t hit the ball. Everybody on his team groaned when he came up to bat. They knew he couldn’t hit the ball. He couldn’t hit it at all. If he did hit it, the ball just dribbled off his bat and the short stop could run up and get it and throw it to first baseman. “Out,” the umpire would yell and the boy would be out before he got half-way to first. The boy was happy when he hit the ball. No. Happy is not the right word. He was relieved. “At least I hit the ball,” he said. “I didn’t strike out that time.”

            The boy couldn’t catch the ball and he couldn’t throw it as far as the other kids. They put him in right field. You know—in Little League they put all the bad players in right field. The boys who can’t catch and can’t throw, they put them in right field, because in Little League not many balls get hit out there. The boys who can’t play, they stand out in right field and no ball comes to them. They just stand there and look at the grass and flowers, because no ball gets hit out there.

            This little boy had a father who was an important man. His father traveled a lot, going to meetings and making money. The father didn’t see his boy play much, because the father was out of town, going to meetings, making money.

            One time the father didn’t have any meetings so he went to see his boy play baseball. “Oh, no,” the boy thought. “My father is coming to see me play. I hope they don’t hit the ball to me.” He would be out there in right field, praying. “Please don’t hit the ball to me.”

            The first inning, the other team was batting and the first three boys to bat got on base. The bases were loaded. The boy in right field prayed harder, “Please don’t hit the ball to me.”

            Crack. The ball was hit out in right field. The boy ran in to catch the ball, but he misjudged the ball and as the boy was coming in the ball was going out. Suddenly, the boy saw he made a mistake. “Oh no,” he said. He stuck his glove up but the ball went way over his head and rolled all the way to the back fence. The boy turned and ran after the ball. He picked it up and threw it with all his might, but the ball didn’t go very far. It bounced two or three times and just started rolling and the second baseman had to run out and get the ball. All four runs scored. The boy who hit the ball scored too. He hit a inside the park home run.

            The boy in right field, just put his head down and he thought, “Oh, no. I goofed up. My dad came to see me play and I missed the ball.”

            When it was time for the boy to hit, he didn’t do any better. One. Two. Three. He struck out. In the fourth inning he struck out again and in the sixth inner he struck out. That was the last inning. In Little League, they only play six innings.

            The boy walked to the car with his dad. The boy got in the car and the dad was driving home. The father said, “I saw the ball that was hit in right field. The one that was hit over your head. You ran in and the ball went over your head.”

            “Yeh, it went over my head,” the boy said.

            “You know what I noticed,” the father said. “When the ball went over your head, you stuck your glove way up in the air as high as you could stick it. You did your best to catch that ball, but it went over your head.”

            “And then you ran after the ball and got it and threw it back toward the infield as hard as you could. You put everything, you had into that throw. You threw it with all your might.”

            “When you came to bat, you struck out three times didn’t you?” the father asked.

            “Yes, I struck out three times,” the boy said.

            “You know what you did, every time you came to bat?” the father said.

            “No,” the boy said.

            “Every time you came to bat, you swung three times. Every time you batted, you swung three times. You did your best every time you batted you swung. Nine times you swung. You gave your best. You swung nine times. That’s as good as anybody can do. You didn’t just leave your bat on your shoulder and let the ball go over the plate. You swung—every time.

            There was another boy. His father said, “I’m going to make you a good player. I’m going to make you fearless. You are going to be so fearless and so though you will be the majors, playing baseball with the best.”

            Every time the father threw the ball, he threw it right at the boys head. He threw it right at his head, as hard as he could throw it. Every time. The boy cried, but the father said, “Stand there, don’t be a sissy. You stand there and hit that ball.” And the father would throw another ball—right at the boys head.

            Everyday the father would make the boy go out in the back yard and the father would throw the ball right at the boys head. The boy would cry. And then one day the boy got mad. He got real mad and he started swinging. He swung at the ball with all his might. He was mad and he swung every time harder and harder.

            The first boy grew up. He lived in a little white house. It was a cottage really—just a small little house with two bedrooms and a bath. It was small, but it was very neat and clean around the house. The grass was always mowed. There were flowers in a flower box outside. His wife planted the flowers. People liked to go by the house. They said it looked cozy.

            This man’s wife planted flowers in the flower boxes and she baked oatmeal cookies for the neighbors, and sang in the church choir. The man and his wife had two cute daughters, with blond hair and rosy cheeks. You know they were cute and as sweet as they were cute. The man and his wife and their two little girls did everything together. They were just happy doing the simple, everyday things—living in a simple little house and having fun together doing the simple everyday things. The man became a schoolteacher. He didn’t make much money and no one had ever heard of him except his neighbors and the people at church and his students who loved him. Those students just loved him, because he always encouraged them and found something good the say about everyone. Even the ones who weren’t smart and not very pretty and the boys who couldn’t play ball—he found something good in everyone of them.

            The other boy grew up and became a major leaguer baseball player, just like his father said he would. He was a good player. He hit a bunch of home runs and he made more money in a year than you and I make in a whole lifetime working as hard as we can. He was a famous player. In fact, if I told you his name, you would know who I was talking about. He was on TV and you would read about him in the paper. He was a great player. Nobody liked him. They said he was mean.

Saturday, June 14, 2008

Making Life or Death Decisions

Knowledge, knowing what to do in a certain situation, is the wisdom of God put into action.

v    Two types of knowledge

o      The physical, the intellectual, the worldly, the material, the temporal

o      The spiritual, the Godly, the eternal

§       For we fix our eyes not on what is seen but what is unseen. For what is seen is temporary, but what is unseen is eternal.

                                                                                       II Corinthians 4:18

v    Modern medicine—and in particular psychiatric medicine—has the opportunity to bridge the gap between intellectual knowledge and spiritual understanding--and in doing so encourage a dialogue between life and death decisions.

Friday, June 13, 2008

PROLONGING LIFE, NOT DEATH

The 3.8 million United States seniors who celebrated their 85th birthday before the year 2000 constituted the fastest growing segment of the population. By 2030, this group will number 9 million, and will swell to 19 million by 2050. The new focus on aging must go beyond extending the life span. Rather than delaying death, medical science must work toward prolonging a fully lived life.

Thursday, June 12, 2008

Metaphor in the Wizard of OZ According to 1964 High School History Teacher, Henry Littlefield

Oz = oz., an abbreviation for ounce

Kansas = the hardships of life

Cyclone = the financial panic of 1893

Silver slippers = silver as a monetary standard

Yellow brick road = gold as a monetary standard

Emerald City = the fraudulent world of greenback paper money that only pretends to have value

Dorothy = the naive and simple American people

Tin Woodman = the dehumanized industrial worker

The Scarecrow = the farmer

The Munchkins = the ineffectual ordinary citizens who are controlled by politicians and big money


Wednesday, June 11, 2008

PONTIFICATING PEOPLE: A short play in two acts.

Act one, scene one: in heaven.

GOD (adjusting the HD TV): Hey, boys, come in here that sitcom from earth, Pontificating People, is about to start.

JOHN THE APOSTLE: Great, I’ll make some popcorn. How about some wine?

MATTHEW: Cool it, John. What a party guy. You’ve never been the same since that wedding in Cana.

LUKE: I left that miracle out of my book. Sorry John, but compared to the other miracles I didn’t consider the water-into-wine miracle worth mentioning.

 JOHN THE APOSTLE (entering carrying a huge bowl of popcorn): Hey, where’s Peter? He loves this show.

GOD: He’s over at the Sea of Faith practicing the water-walking thing.

MARK: And Paul? It would do him some good to laugh a little.

GOD: At the library writing a letter to the Martians. Shh. It’s starting.

Act 2, scene one: on earth at a home Bible study.

JIM: Because I’m an engineer, believing in this spiritual stuff gives me a little trouble at times.

BILL: It’s a heart thing not a mind thing.

LARRY: No. Jim’s predestined to think that way.

ANITA: Stop talking about predestination. If we didn’t have free will, we’d be like puppets.

PHYLLIS: I think you might want to consider a third option. As it says in the Bible, “Don’t put all your eggs in one basket.”

A FIRST TIME GUEST AT THE BIBLE STUDY: I didn’t know that was in the Bible, but I haven’t read it that much. As Shakespeare said, “Much study is a weariness to the flesh.”

KAREN: That’s in Ecclesiastes, not Shakespeare.

JOHN W. (interrupting): Phyllis is right. You can have predestination and free will at the same time. Its called antinomy.

GOD: That guy’s such a know-it-all. He makes me laugh.

JOHN W. (droning on): It’s sort of, like Plato wrote in The Republic. There are two horses in the sky pulling a chariot. One horse is named Passion; the other is named Reason. They’re pulling against each other. That’s a metaphor for predestination and free will.

GOD: That guy’s a hoot.

PETER (entering while toweling off): To me he’s just a big bore.

KATHERINE (back at the Bible study): I think it’s all free will. Like the Weegie Board thing. We thought we had set the evil spirits free.

PAULA: I’m kind of leaning toward predestination, because when we got Coach Fran, we weren’t given a choice.

JOHN W. (interrupting again): Dante wrote about free will and predestination too. In The Divine Comedy, he used Rebecca and Rachel to represent faith and reason.

PAUL (entering carrying a huge scroll): That’s a non sequitur. He’s showing off again. He’s so arrogant, he’s funny.

PETER: Yes, but in Heaven he’ll get a little tiresome. Where am I going to put that guy when he comes through the pearly gates?

JESUS: As I said, “My house has many mansions.” You’ll find a place for him.

PETER: I think I’ll have him bunk with Erasmus. They’ll put each other asleep with their pontifications and we won’t have to listen to them.

GOD: All those guys down there think they know all the answers. Haven’t they read Job? Who are they to question me?

THE HOLY SPIRIT: I enjoy trying to influence their thinking…. and their heart.

JESUS: When you are around them a lot you begin to really love them.

GOD: I’m glad you like them boys. It took quite a bit of dust to get them started.

LEON (back at the Bible study): It’s time to stop. We can have it at our house next week.

JOHN THE APOSTLE: They are so funny. I can’t wait until next week’s show. I’ll bring the wine in the new skins.

Tuesday, June 10, 2008

Sonnet 116

Let me not to the marriage of true minds

Admit impediments. Love is not love

Which alters when it alteration finds,

Or bends with the remover to remove:

O no! it is an ever-fixed mark

That looks on tempests and is never shaken;

It is the star to every wandering bark,

Whose worth's unknown, although his height be taken

Love's not Time's fool, though rosy lips and cheeks

Within his bending sickle's compass come:

Love alters not with his brief hours and weeks,

But bears it out even to the edge of doom.

If this be error and upon me proved,

I never writ, nor no man ever loved

Monday, June 9, 2008

Thank God For Hurricaine Katrina--The Storm Gave Me Hope

The Lower Ninth Ward in New Orleans experienced calamitous flooding from Hurricane Katrina in 2005. The storm surge came from the east via flooded Saint Bernard Parish and from the west through two large breaches in the Industrial Canal flood protection system, creating violent currents that smashed homes and tore them from their foundations. The storm became the costliest natural disaster in U.S. history. At least 1,836 people lost their lives in Hurricane Katrina and many more thousands were rendered homeless.

            A College Station resident commiserated with one of the Hurricane evacuees temporarily housed in a local church:

            “That must have been the most terrible thing that ever happened to you. You lost your home. You lost your clothes and all of possessions. You have no money. You can’t get in touch with your relatives. Your friends have been displaced. What a tragedy. How will you ever recover?”

            The evacuee replied:

            “Surely that storm was a terrible thing. I was scared and pretty well knew for certain I was going to die. Then a boat came and they took us to the Superdome, and it was like the devil himself had come down and was torturing us. We were all crowded together and squashed-up. People were yelling and crying. It was hot and dirty. And we all got thirsty and hungry. It smelled bad and it seemed there was no hope for any of us. But somehow, we got rescued and took care of. And now here I am in this nice church. We have food. And water. And air conditioning. And good people are helping us and looking after us.

            Yes, that Hurricane was a horrible thing and I never want to go through nothing like that again. But, you know, that Hurricane—no matter all the bad things that happened—was the best thing that ever happened to me and I am thankful for it.

            I’m not discounting the bad things that happened to so many people and all the dead people and people who never will find their families, but for me that hurricane was good. If it hadn’t been for Katrina, I would have been trapped in the lower ninth ward for life. Before the hurricane, I had nowhere to go. I had no idea how to go. I had no money to go. I was just there and that was my life. But the big wind came and blew me to a better way of looking at things. And now I have a new life, a new start on life. I’ve got possibilities. Yes, thank God for Hurricane Katrina. I’ve got hope.” 

Sunday, June 8, 2008

THE TRAGIC FAILURE TO CHANGE

            Some people have difficulty changing because they are caught in financial or geographical traps. Let us consider those people, however, who have every opportunity to change, but, nonetheless, continue to engage in self-defeating behavior despite ongoing negative consequences:

v    Smoking, obesity, and alcohol abuse can lead to chronic illnesses and premature death. Despite ominous health warnings that are more certain than storm alerts from the National Hurricane Center, surveys by the Centers for Disease Control and Prevention show that very few people are willing to stop their self-destructive unhealthy habits.

o      20% of American adults smoke

o      More than 30% of Americans are overweight

o      15% of Americans are binge drinkers

v    People are often noncompliant to medical treatments

o      50-65% of Americans fail to follow their doctors’ treatment recommendations

o      10% of hospital admissions among older adults result from failure to follow doctors’ directions

o      Almost one-third of patients visiting a physician fail to get their prescriptions filled

o      A Case Western Reserve University survey showed that 54% of glaucoma patients failed to use their eye drops as directed even though these patients knew they would go blind unless they complied with their doctors’ instructions.

o      70% of patients receiving treatment at a community mental health center dropped out of treatment before the third visit.

v    Most serious attempts to maintain behavior change are unsuccessful. A University of Scranton study found that only 19% of those who had made a significant change in a problem behavior maintained the change when surveyed two years later.

v    People continue to engage in patterns of behavior—anger, violence, nagging, dependency, and jealousy—that are destructive to their relationships and their well-being.

Saturday, June 7, 2008

A Reason to Resist Change

v    EMOTIONAL AMBIVALENCE. A woman complained vociferously about her husband who controlled her. He wouldn’t let her out of the house alone. He wouldn’t let her drive a car. He wouldn’t let her visit friends. When asked why she didn’t leave her husband, the woman replied, “I love him so much.” When the woman was seen two years later. She had the same complaints about her husband. She remained married.

Friday, June 6, 2008

REASONS FOR LACK OF CHANGE


v    CIRCULAR EXCUSES. Common explanations for lack of change become circular arguments. People may blame their resistance to change on stubbornness, an addictive personality, or self-destructiveness. An explanation for refusing to improve a situation may go this way, “Because my situation is hopeless, I can’t change.” The behavior is then used to support the explanation, “I can’t change because my situation is hopeless.”

v    REBELLION. Telling someone to change often exacerbates the situation. A highly directive approach causes a person to adamantly resist change. One study showed that the more alcoholics were directed to change the more they drank.

v    INERTIA. Systems resist change. Physicists call this resistance to change “inertia.” The first law of motion indicates that people, like objects, tend to keep on moving if they are moving and remain standing still if they are still.

v    BLAMING. It is easier to make excuses for our problems than it is to assume responsibility for our own behavior. The statement “If she didn’t nag me so much, I wouldn’t drink,” is an example of blaming others.

v    LEARNED HELPLESSNESS. Put an animal in a cage. Apply a mild electrical shock all over the floor of the cage. When the animal discovers that escape is impossible, the animal lies down and passively in the corner of the cage and accepts the shock. Then the electrical shock is applied only to the corner where the animal is lying. The other areas of the cage are shock free. The animal continues to stay in the corner. Humans that are constantly exposed to conditions from which there appear to be no escape will eventually give-up and surrender to the situation. 

Thursday, June 5, 2008

FORCES THAT IMPEDE CHANGE

Psychological Forces

Thoughts and Habits that Limit Change

Pain versus Pleasure

The immediate pleasure of the habit (gambling) is more powerful than the delayed pain (financial ruin).

Fear of failure

“If I don’t change, I will feel even worse than I do now.”

All or nothing thinking

“I must lose 50 pounds; losing 10 pounds is unacceptable”

Unconscious conflicts—unaware of problems

We may repeat maladaptive behavior because we fail to recognize the destructiveness of our acts.

Change is unpredictable

The discomfort of the status quo may be preferred over the anxiety produced by change.

Resisting authority

“I don’t like anyone telling me what to do.”

An undesirable habit may provide unmet needs.

Drinking relieves stress. Physical abuse provides attention. Eating fills a psychological void.

Wednesday, June 4, 2008

UNDERSTANDING BORDERLINE PERSONALITY DISORDER

I HATE YOU, DON’T LEAVE ME

            Borderline personality disorder (BPD) is a misnomer. The term "borderline" originated in the 1930s when psychiatrists thought that emotionally unstable patients dwelt on the border between neurosis and psychosis. The classification, Emotional Instability Disorder, better describes those individuals who demonstrate the following:

Ø    Ambivalent feelings about others—an “I hate you, don’t leave me” attitude. The borderline has intense love-hate relationships—thinking that a person is angel or a devil with no realization that all of us have “good” and “bad” traits. A few minutes or hours later, the borderline might idealize an individual and the next hour (or minute) the borderline will consider the individual worthless or evil.

Ø    Chaotic relationships

Ø      Frantic efforts to avoid real or imagined abandonment

Ø     An unstable self-image

Ø     Self damaging impulsivity such as overspending, sexual indiscretion, substance abuse, reckless driving, binge eating

Ø     Recurrent suicidal behavior, gestures, or threats

Ø     Self-mutilating behavior—cutting or burning self

Ø     Rapid onset of intense and profound depression

Ø     Rejection sensitivity—considered the slightest inattention of an individual as a totally rejecting attitude

Ø     Chronic feelings of emptiness

Ø     Inappropriate, intense anger—screaming, yelling, throwing things

Ø     Transient paranoid thinking, self-image, and behavior.

Ø     Emotional instability that disrupts family and work life

            People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). They may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. Suicide threats and attempts occur as a maladaptive attempt to prevent abandonment. Intense anger develops when the borderline feels rejected. Self-mutilation results from an attempt to reduce emotional stress. For the borderline, physical pain is preferred over emotional distress. People with BPD exhibit other impulsive behaviors, such as excessive spending and risky sexual activity.

ORIGIN OF BORDERLINE BEHAVIOR

            Anyone who has a child knows that around 18-months of age the youngster toddles out of the room plays alone for a few minutes and then toddles back in the room looking for mother. With a wide-eyed smile, mama picks up her toddler, gives a warm hug, and coos encouragement. Consistent maternal and paternal affection enables the child to develop a stable sense of self and, with dependable parental behavior, the child develops the ability to sooth the self—the ability to tolerate the vicissitudes of life.  

            When the-soon-to-become borderline toddles back into the room, mama has disappeared or is drunk or is verbally, emotionally, physically, or sexually abusive. Inconsistent, negligent, and abusive parental behavior generates a fear of abandonment and retards the toddler’s emotional development. The toddler feels alone, lost, and worthless.

            As the years pass, feelings of worthlessness, and a poor sense of self cause frequent changes in careers, jobs, friendships, and values. Borderlines view themselves as fundamentally bad or unworthy. They feel unfairly misunderstood or mistreated, bored, and empty. These feelings result in frantic efforts to avoid being alone. The emotional clinging behavior exhibited by borderlines repulses others. The fear of abandonment felt by the borderline generates hostile behavior that results in the very rejection that the borderline fears.

NATURE VERSUS NURTURE— A GENETIC OR A PSYCHOSOCIAL ORIGIN?

            Although no gene has been identified as a precursor to borderline personality disorder, neuroimaging studies are intriguing. PET scanning and fMRI studies demonstrate enhanced amygdala and prefrontal activation in subjects with BPD. Excess activity in the cingulate gyrus is associated with borderline personality disorder. These findings are nonspecific indicators of intense emotional activity.

            Common sense indicates that some children are more sensitive than others. Just as some geneticists believe they have isolated a gene for shyness, a gene that serves as a biological marker for BPD may be identified. Remember—a gene must be activated before an illness occurs. That is, many of us may have a genetic marker for schizophrenia, but a stable emotional life prevents the gene from becoming activated.

NEUROCHEMICAL MARKERS

            The chemical messenger serotonin helps regulate emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. An imbalance of dopamine, the so-called pleasure neurotransmitter, may contribute to impulsivity and anger. Antipsychotic medications can help regulate dopamine balance.

Illnesses ASSOCIATED WITH BORDERLINE PERSONALITY DISORDER

            BPD often occurs together with other psychiatric problems, particularly bipolar disorder and depression. While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger and depression that may last only hours, or at most a day.

            BPD is one of four related personality disorders associated with dramatic-erratic behavior, poor impulse control, and emotional instability. Narcissistic, histrionic, and antisocial personality disorders are also distinguished by dramatic-erratic behavior. While almost 75% of borderlines are female, the vast majority of sociopaths (antisocial personality disorder) are male.

            Bulimia and other eating disorders, dissociate states, and anxiety syndromes are commonly associated with BPD. Substance abuse is a common problem in BPD. 50% to 70% of psychiatric inpatients with BPD are drug or alcohol dependent.

 

DIALECTIC BEHAVIOR THERAPY

            Dialectic behavior therapy is based on the Socratic method of discovering the truth. The therapist asks a series of questions exploring the what, where, when, why, and how of conflict and stress. Asking questions helps the patient learn appropriate responses for managing stress and conflict.

three elements of dialectic behavior therapy

  1. The therapist communicates verbally and nonverbally to the patient that the therapist cares enough to be involved in helping the patient learn self-disciple. The therapist sets limits. He/she does not give into the excessive demands of the patient. At the same time, the therapist is reliable and steady. The therapist avoids rescuing the patient when the patient gets into difficulties in his/her daily activities of living while remaining kind and understanding. 
  2. The patient keeps a daily journal that records events and feelings and thoughts generated by daily events. The therapist asks a series of questions to enable the patient to learn better ways of handling conflict.
  3. Therapy allows the borderline to learn specific skills in dealing with stress and interpersonal conflict:

v    Evaluation of distorted thinking—the patient is helped to see different viewpoints in a conflict and to focus on present issues instead feelings from the past.

v    Dealing with stress—the patient learns to manage emotions that are triggered by distressing events, including those that cannot be immediately resolved.

v    Dealing with conflict with others—the patient is assisted in maintaining good relationships with others. Through a series of questions the therapist helps the patient learn that certain rules of society must be followed to get along in the world, and that to break social, ethical, and moral rules leads to self-destruction. Using the Socratic method the therapist helps the patient find ways to fulfill his or her needs in a way that allows others to fulfill their needs.

v    Developing emotional stability—the patient learns self-soothing behavior by changing distorted beliefs and inappropriate actions. For example, a series of questions can help improve the patient’s response to perceived rejection:

ü     What are you thinking (or doing) right now?

ü     Is what you are thinking (or doing) helping you?

ü     What thoughts (or actions) can help you feel better about yourself? (Several options may be formulated until the best solution is discovered.)

ü     Will you commit to changing your thoughts (or actions)?

ü     How will you demonstrate that you have committed to change?

FAMILY/MARITAL THERAPY

            The crux of family therapy involves educating family members regarding BPD. Improving communication will help resolve the two poles of inappropriate family response: over involvement (rescuing) and neglect. 

Tuesday, June 3, 2008

ELEMENTS OF CHANGE


v    Because ambivalence to change maintains the disease process, books, tapes, and didactic lectures help reveal unconscious psychological conflicts that retard progress.

v    Cognitive behavior therapy teaches more appropriate ways of thinking about conflicts.

v    Fellowship—developing friends who model appropriate behavior helps generate change.

v    Spiritual transformation provides love, joy, peace, patience, kindness, generosity, faithfulness, gentleness, and self-control.

Monday, June 2, 2008

TWO REASONS PEOPLE CHANGE


1.    Pleasure—realizing that new behavior patterns will produce more pleasure than maladaptive behavior patterns brings change. Believing that we can have a better life engenders different approaches. The power to visualize a successful outcome gives the courage to try new ways of doing things.

2.    Pain—understanding that maladaptive behavior causes intolerable distress stimulates an alternative lifestyle. Drastic environmental consequences may be required before inertia can be overcome. Imprisonment, financial ruin, homelessness, or the treat of death may be necessary before transformation occurs. Allowing a person to suffer may be the best way to generate change. 

Sunday, June 1, 2008

VALENTINE CHOCOLATES

            He sits there for a while, looking at her. She is still beautiful. Her freckles have faded with the years, but her skin radiates warmth, moonlight bathing the contours of her face. Her hair, silver now, softly falls all around the pillowcase. Her emerald eyes, magnetic as always, pulls him to the first time he had seen her—in college, in Professor Mangum’s Freshman English class. He remembers her eyes and her voice, resonant as she recited Shakespeare:

 

As you were when first, your eye I eyed,

Such seems your beauty still.

 

            She was a young girl, filled with excitement and wonder. Her laughter filled the gloomiest day with sunshine. Her radiant smile warmed his life. He had never seen a face so expression filled, ever changing like ocean waves.

            Her body athletic, firm and well proportioned, stomach flat, legs tanned, reflected health and feminine strength. When he wrapped his arms around her body, she seemed to melt into his, summoning sensations of soft snow falling. Her kisses opened the door to heaven.  

            A bird starts to sing outside the window, and he turns his head. Outside the rolling lawns shaded by towering oaks, make life seem secure somehow. He sits there quietly, enjoying nature’s beauty with her.           

            He marvels at the privilege of being married to her for 43-years. He is grateful for the steadiness of her love and her support, even when his mistakes were unsupportable.

            He remembers her hugely pregnant; her long and difficult labor that had him worried, and the doctor too. The sudden x-rays “just to check if her pelvis is big enough.” The pain she experienced standing and twisting to the instructions of the technician as the contractions intensified.

            After the delivery and she was tucked in warm and safe, he walked back to their apartment numb from the ordeal, crying softly for her and her suffering. He was trying to study for the Medical Board exam scheduled that afternoon when a call came from the hospital. She was bleeding. He ran back to find her pale and clammy. He felt guilty—Why did he leave so soon? He knelt beside her bed, praying. Emergency surgery was scheduled. A small section of placenta extracted. The danger had passed.

            Now the menace is different, a slow, progressive slide into oblivion. An aide enters the room to take vital signs and fluff the pillow, interrupting his thoughts. As she leaves, he recalls his flight surgeon days, the vertical power of the F-4 Phantom, over the top, negative Gs. The thrill of riding the helicopter hoist to help those below. The daily adrenalin rush. He had ignored her needs then and she began to pull away, becoming more independent. Sadly, she placed second during the years of medical specialization, the pleasures of academia, and the demands of medical practice. Worldly things made him less considerate to her needs, never knowing how much she needed his attention, and he, hers.

 

The world is too much with us; late and soon,

Getting and spending, we lay waste our powers…

We have given our hearts away.

 

            Making money and buying things. Ambition. Competition. Wanting it all. More recognition. Bigger cars. Larger homes. The best schools. Trying to beat everybody else at everything.  All these things get into the way of what is most important—loving those we care about.

            A crisis. Then a coming together with a better understanding of needs they each had. As was his bent, he remembers other ways that he had let her down and had disappointed her.

            He looks at her. She smiles peacefully. He asks if she remembers walking in the Angelina County rain, drive-in movies Friday night, country summer evenings, the first time he told her he loved her, sitting together after Caribbean lunches, sunset sails, walks along Carolina Beach. She doesn’t.

            He tells her about their trips to tennis tournaments with the kids; reading out loud together; kneeling for nighttime prayers, mountain cabin excursions, board games with the family, card games together—how she always seemed to edge him out in the end.

            He reminds her of riding the jeep on mountain road switchbacks and campfire ghost stories—the Battery Beast, Chug Houndlicker, the Ditch-dog Killer, Gunner Shellachumm. She smiles at his enthusiasm, but the stories fail to register.

            He tells how she laughed when on a canoe portage she fell, the backpack pressing her, turtle-like, into the mud before he ran to help her. He laughs about their first fight when he couldn’t get the wet wood to light. As a last resort, he tore their hiking map throwing it on the kindling. Finally, the fire started, but she refused to let him grill the hamburger patties because “they had been out too long.” She remembers none of it.

            He told her about the basketball games. She would yell loudly for their team, but when it got to crunch time and the game was close, she would hide her eyes with every shot, asking, “What happened?” Ditto for movies. In the scary parts, she always hid her eyes. He would kid her and suggest that they request a ticket rebate because she only saw half the movie.                       

            She shivers slightly. He stands and pulls the covers over her shoulders. Returning to the bedside chair he remembers the mornings when he would make the coffee, and bring it to her in bed where they would talk of prayers and promises, their family and friends, their children and their hopes.

            Gradually, they learned the value of putting God first in their lives, and, paradoxically, when they did so, they became closer. When their children left the state for prospects elsewhere, they became almost inseparable. Friendships became more abundant and more intimate.           

            He considers her biggest fault—one of her few faults. The fault that bothered him the most was this: She never told him what she wanted. She never asked him to do something for her. Because he got the most joy out of giving her joy, he would have given her anything she wanted. But she never told him what she wanted. “You should know,” she said.

            He remembered her father’s funeral when he learned something about her that he had never known before. At the wake she had said:

            My father was such a wonderful man. He had integrity. He was loyal. A good provider. Understanding. He allowed me to make small mistakes that taught me life lessons, while standing firm on rules and regulations that kept me out of real trouble.

            It seems strange, but one thing he did keeps returning to my mind. Every Valentine’s Day he gave me a box of chocolates. That gift of chocolates came every year, as certain as the sun rising.

            Chocolate? He didn’t understand what made her father’s gift so special. In contrast to his father-in-law who gave chocolates, he was a “candy-is-dandy-but-liquor-is-quicker” man, a fast track guy. Run for a gift at last minute, charming the clerk to wrap it. What’s the big deal about chocolate? He was clueless.

            Months later at a party, the discussion turned to chocolate—the flavors—dark chocolate, milk chocolate—chocolate with names he had never heard discussed, chocolate imported from Europe and Asia! My goodness!           

            From then on every Valentine’s Day, he bought her big boxes of chocolates, lots of boxes. He overdid it, she said. Finally, he learned the chocolates that were special to her. Thereafter she got her special chocolates, the ones she liked the most “in the whole wide world.” Her happiness warmed his heart.            

            A rain taps tiny drops gently on the windowpane, bringing his thoughts back to the present. He reaches down. He takes a red package out of a gift bag. He places the package on the nightstand.

            She looks at it.

            “What is it?” she asks.

            “Chocolates.”

            “Chocolates. I love chocolates, don’t I?

            “Yes,” he says.

            “David?” she says. “David. You’re David aren’t you.”

            “Yes,” he says.

            “I’m sorry,” she says. “I didn’t know who you were and I was afraid to ask. I was afraid I would hurt you. You were so kind to me, but I couldn’t remember who you were. David… David…I’m afraid I will forget who you are again.”

            “You remember who I am now,” he says.

            Slowly he gets out of his chair. He goes to her bed. He lowers the bedrails and lies beside her. He wraps his arms around her body. She seems to melt into his, summoning sensations of soft snow falling.