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Archive for March, 2010

The People’s Therapist received an interesting and important letter a few weeks ago from a 3L (I’ve redacted it and altered some details to preserve anonymity):

Mr. Meyerhofer,

I have a question (or perhaps a topic suggestion for a post, as I’m sure many students are wondering about this) about the character and fitness part of the NY bar application.

I have seen a therapist several times over the years for issues relating to depression, eating disorders, and self-injury. On the NY bar application it asks whether you have any psychological issues that might effect your ability to perform as a lawyer. I have absolutely no idea whether I’m required to disclose my psychological treatment history, or if I do, how much of it. Is the determination based on what I personally think, or is it a reasonable person standard?

As I’ve had to go to the ER several times over the years, objectively I could see how someone could interpret that as something that could affect my performance. However, I personally don’t think that it does.

I don’t really know who I could ask about this, as I don’t really want my school administrators to know about my issues. Any information you might have would be much appreciated. Thank you so much for your help!

Sincerely,

“Stumped in Syracuse”

To begin with, here is a passage from a pamphlet, entitled “Are you fit to be a Lawyer,” published by the New York State Lawyer Assistance Trust:

Neither receiving treatment for alcoholism, drug addiction or mental health concerns, nor the status of being a recovering alcoholic or recovering addict are grounds for denial of admission to the bar.

In New York, the focus of the inquiry is on whether chemical abuse or addiction or a mental health condition impairs the applicant’s current ability to practice law.

The bar application asks whether the applicant has “any mental or emotional condition or substance abuse problem that could adversely affect” the “capability to practice law”, and whether the applicant is “currently using any illegal drugs.”

While honesty in disclosing past conduct (for example, arrests and convictions) is essential, disclosure of past treatment is not required. No questions are asked about past treatment. The Committees encourage law students who are experiencing drug, alcohol or other addiction or mental health issues to address those issues as soon as possible, regardless of when the student plans to seek admission to the bar.

The bottom line seems clear – there’s no legal duty for Stumped in Syracuse to disclose his past history of treatment on his bar application unless his mental illness currently impairs his ability to practice law. Under this standard, it would require a severe mental health condition to trigger this duty, and the majority of situations involving mental illness – certainly the ones described in Stumped in Syracuse’s letter – would not require disclosure.

The real issue here – as Stumped suggests – is stigma. Stumped, like any rational person, is afraid someone will find out about his condition and jump to the unfair assumption that he is unfit for his job. That would be a disaster for anyone interested in preserving his professional reputation. For Stumped, the ignorance surrounding mental illness may pose a greater threat than the illness itself.

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The first researchers to observe chimpanzees in the wild were left with an idyllic impression of our close ape cousins.  They appeared to be a peaceful tribe of vegetarians, who cuddled and groomed and cared for one another in extended family units, sharing fruit and showering their young with affection.

Only later, when in-depth studies were attempted, did it become clear that this was merely part of the picture.  These serene vegetarians were also capable of shocking violence towards members of their own species, including murder.

Chimpanzees are gentle, loving and family-oriented within their own territorial mating group.  But with chimps from outside that circle, they can turn vicious.

In this respect, chimps resemble humans.

You, for example, would never display intentional cruelty towards another human being.

That is – unless you knew that other human being wasn’t like you.  Then you might be surprised at what you could do.

Welcome to in-group/out-group psychology.

Consider the guards at Auschwitz.  They thought of themselves as nice people.

An album of photos was made public in 2008 containing photographs taken by members of the SS who worked at Auschwitz. These pictures are not what you would expect.  Dating from 1944, they show laughing, singing, smiling people reveling at Solahütte, an SS recreation home located just outside the death camp.

There’s even a shot of an SS officer lighting the Auschwitz Christmas tree only a few miles from the place where millions were being starved, beaten and gassed.

The question becomes how you convince yourself that other human beings are not like you – that they are outsiders.

One common method is to place them outside of your religious system.  Religion is often credited with teaching morals and enforcing good behavior among human beings.  More often, it is used to justify the abuse of out-groups by defining the parameters of an in-group.  As Freud put it:  “a religion, even when it calls itself the religion of love, must be hard and loveless against those who do not belong to it.”

Freud watched Hitler march into Austria during the Anschluss in 1938, as the powerful Roman Catholic church stood by offering no resistance whatsoever.  As Peter Gay describes it:

“The Austrian prelates, keepers of the Roman Catholic conscience, did nothing to mobilize whatever forces of sanity and decency still remained;  with Theodor Cardinal Innitzer setting the tone, priests celebrated Hitler’s accomplishments from the pulpit, promised to cooperate joyfully with the new dispensation, and ordered the swastika flag to be hoisted over church steeples on suitable occasions.”

Freud managed to escape to England with his immediate family.  Four of his sisters, each of them over 70 years old, were not so lucky.  These helpless elderly women were murdered in concentration camps.

In-group/out-group psychology, coupled with religion, explains a lot about wars, inquisitions, crusades, burnings at stakes, pogroms, terrorism and the ugly history of mankind in general.

Another way to ostracize a group is to link them to disease.  When Glenn Beck calls Progressivism a “cancer” in America, he implies that Progressives, those people like myself who believe in Progressive causes, are the embodiment of that cancer.  He is borrowing a page from Adolf Hitler’s playbook.  One of the Fuehrer’s favorite tropes was to compare Jews to tuberculosis bacilli infecting the German nation.

If people are tuberculosis bacilli – or cancer cells – it becomes much easier to abuse them.

Still another way to justify dehumanizing a group of people is to isolate them because they have a different ethnic background, or physical appearance. This country began as a slave colony, based on the firm notion that people with dark skin could be beaten, abused, tortured, murdered, and bought and sold as chattel because they weren’t really “human” at all – they were more like animals.  This is another example of in-group/out-group psychology at work.

The Tea Party movement lends itself to in-group/out-group psychology because it is a homogenous population – an excellent candidate for an in-group.  According to a CNN poll, active supporters of the Tea Party, those who have attended a rally or donated money, are much more likely to be wealthy, male, have graduated from college and reside in rural areas that are already GOP and conservative strongholds.  According to a Quinnipiac University poll, 88% of the Tea Partiers are white.  They are also almost entirely Republican.  It’s a fair guess that most of them are Christian, too, and probably fundamentalist.

This might explain their obsession with attempting to prove that Barack Obama, the President of the United States, was somehow not born here or is somehow not American.

He’s different from them.  That makes him a member of an out-group.

Mr. Obama’s out-group status, in turn, permits the Tea Party people to justify treating him in ways they would never treat one of their own.  That explains shouting “You lie” at him in the middle of a joint session of the US Congress, or flaunting firearms at events where the President is speaking.  Since he is an out-group member, they can justify treating Mr. Obama with a level of disrespect that might otherwise be difficult to fathom, especially from people who claim to respect the office he fills.

More disturbing, perhaps, is the way the Republicans treat their fellow Americans who happen to lack healthcare.

If another human person were injured or ill, and needing to be taken to a hospital, it is hard to imagine anyone, whatever their political or religious beliefs, refusing to come to that person’s aid.

But the Republicans have managed to convince themselves that denying healthcare to their fellow Americans is morally defensible.  Perhaps it’s a Christian doctrine that an atheist outsider, like myself or Sigmund Freud, could never comprehend.

More likely, for the Republicans, it’s simply that any American living without healthcare must be a member of an out-group.  Perhaps they are all Socialists, African-Americans or Progressives, or even part of the “cancer” that Glenn Beck battles on tv.

The latest example of in-group/out-group psychology at work has appeared in the form of threats of violence by radical Right-wingers against Democratic politicians who supported the healthcare bill and voted it into law last week.  Black and gay politicians have had nasty names shouted at them.  One Democratic congressman was called “baby killer” by his Republican colleague on the floor of the US House of Representatives.  There have been death threats and acts of vandalism.

You wouldn’t do these things to someone whom you considered an equal.

The truth seems to be that, for the Republicans, anyone who disagrees with their political agenda is an outsider.  The code word for “outsider” is that you are not a “real American.”  Sarah Palin warned you about those people, the “fake Americans” – the outsiders.  You can place gun targets over their faces.  You can threaten their lives.

As I’ve said time and time again, this column is strictly without political bias.

But perhaps it is time for the Republicans and their Tea Party minions to rise above the level of chimpanzees and Nazis, and to recognize the humanity of their fellow citizens.  For decades, tens of millions of us have been denied access to decent healthcare.  As a result, each year tens of thousands of us have died.

The issue of healthcare is finally being addressed with a mainstream political solution, thanks to President Obama and the Democrats.

But the Republicans still need to learn a basic lesson in citizenship.

They are not the in-group, and everyone else is not the out-group.

There is no out-group.

There is one America, indivisible, with liberty and justice for all.

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I write a lot about unconscious regression – mostly how to prevent it.

That’s because you want to learn to parent yourself – to live your life as an adult, not a child, to be awake and embrace awareness so you can take charge of the life you lead.

On the other hand, sometimes being an adult can be exhausting.

At the end of each day, you go to sleep – a regressed, unconscious state.  You cannot survive without this nightly departure from reality.  Sleep deprivation is harmful, even fatal in extreme cases.   It is necessary for your physical and mental health to disappear into your unconscious to rest and recover.

You also need to play.  Perhaps that’s what dreams are – the play of the unconscious mind.

Conscious play – what the psychoanalyst Ernst Kris termed “regression in the service of the ego” – is also critical to staying healthy in mind and body.

It’s interesting that children play at being adults.  They bang away at a little workbench, or play “house” or pretend to care for a doll.  They are practicing for the time when they will leave the regressed, dreamy state of childhood, and assume adult responsibilities.

Adults do just the opposite.  When you play as an adult, you regress back to childhood activities.  You might occupy yourself with sports, vegetate with a video game or disappear into a novel or a movie.  You might sit on the beach, look at a palm tree and think about the world.

A change of physical scenery can be restful.  It’s nice to escape from your familiar adult world and take yourself someplace new, where no reminders exist of adult responsibilities.

You might find it useful to go somewhere without walls – and with long horizons.  There’s something about seeing a great distance that sets the mind to turning over new possibilities.

The German philosopher, Friedrich Nietzsche, wrote that a man who transcends the conventional thinking of his time “must be accustomed to living on mountain tops.”

It is healthy to gaze into the distance – from a mountain top, or out over the ocean – and consider what might be.  You can best re-evaluate where you are when you can see a long way ahead.

The People’s Therapist is going on a vacation.

I’ll be back in a week’s time – rested and ready to continue in interesting new directions.

But for a few days I’ll let my child take over.

He wants to build a sand castle and splash in the waves and maybe read a good book.  A little sea air and a sun tan – and possibly a margarita – might be nice.  Maybe some good food and a little dancing.

I’ll see you when I get back.

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Remember when you were a kid, and you got caught doing something you shouldn’t, and a big cloud formed over your head?

You were “in trouble.”

The other kids sort of inched out of your path and exchanged looks. They didn’t want any piece of what you had coming. Mom was going to talk to you later. Or dad. You’d done something wrong.

It feels that way sometimes at a big law firm – in fact, a lot of the time.

Maybe you forget to ask a crucial question during a deposition. Or you wrote a memo that didn’t have the answer your partner wanted. Maybe – and this happened to me once – you ended up getting berated for being “too friendly” to the other side at a drafting conference. Maybe you’re still not sure exactly what you did wrong, but it must have been something. It’s always something.

The cloud hangs over you in the office and follows you home. When you were a kid, it eventually dissipated, but now it lingers indefinitely. What’s really going on?

A little dose of anxiety is being injected into you, in the form of a thought.

Anxiety is triggered by cognition – predictive thoughts. You predict something bad is going to happen, so you clutch up in preparation – tense up and prepare for attack.

At a law firm, the standard predictive cognition – the expectation – is that you are going to be criticized. They do that a lot at law firms. It is a fair guess that if something goes wrong, you are going to be blamed – and things go wrong all the time.

It got to the point for me, at Sullivan & Cromwell, that I felt my entire body clench in preparation for attack just walking through the doors of 125 Broad Street and stepping into that elevator.

When you spend long periods of time tensed up, on alert for attack, it takes a toll on your nervous system. In fact, it can produce lasting damage.

In World War I, soldiers spent weeks in trenches under fire, crouched in terror, waiting for that next bomb or bullet with their name on it. Those were some of the first documented cases of what was called “shell shock” then and PTSD now – Post-Traumatic Stress Disorder.

It might seem a stretch to suggest that lawyers at big law firms suffer from PTSD symptoms.

But that’s exactly what I’m doing.

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I wrote a column a few weeks back on Prince William and Kate Middleton.

I possess no expertise in the British royal family.  I merely stumbled upon an article in a gossip mag comparing the Prince’s girlfriend to his mother, and it provided an excuse to discuss why you might choose a spouse who resembles your parent.

The column became a best-seller.  I still get hundreds of hits each week from a stream of readers fascinated with the British royal family.  I’ve been posted on royal chat sites, Prince William discussion forums, Kate Middleton fan blogs – the works.

It was so popular that now I’m writing another column on the British royal family (or, as I’ve come to know them, Elizabeth, Philip and the kids) to explain why the first one did so well.

You – or a great many of you – are fascinated by these people.  It doesn’t take a genius to see why:  you want to be them.

Everyone does.

That’s because the British royal family are treated like children.  And you want to be treated like a child, too.

How are Elizabeth, Philip, Charles, Andrew, Edward and the others infantilized by their role as royals?

They live the life of a pampered young child.

They do not work – and they do not have to work.

They have everything they could ever want, let alone need, provided for them.

And most importantly:  they have your attention focused on them like a laser beam.

Someone’s eyes are on a small child perpetually – or they should be – making sure he doesn’t get into trouble, and celebrating his every achievement.  A child’s first pair of shoes are bronzed, and his first lock of hair preserved.  His first steps are photographed and met with applause.  Like Louis XIV at Versailles, even his bowel movements are cause for furious activity.  And a young child never has to apologize for demanding so much attention – it is simply taken for granted that it is his due.

William and Kate exist in a similar world.  They can’t go swimming without a paparazzo recording each stroke through a telephoto lens.

That must be just awful (you say to yourself, tut-tutting sympathetically.)  They can’t get a moment’s peace.

And they rebel sometimes, too, don’t they?  Spitting fury when an annoying scandal breaks, an embarrassing revelation about a legitimately personal aspect of their lives which none of us has the least right to know anything about.

At this point they become like teenagers, rebelling against adoring parents – insisting that when they lock their bedroom door they bloody well want mum and dad to stay out and leave them alone.

Poor things.

And yet…you never had that problem…because…it’s a good problem to have, isn’t it?

You never basked in one ten-thousandth the attention – or the adoration – to which William and Kate are subjected on a daily basis.

It must feel like heroin, directly into a vein.  A major rush.  All that attention – directly on YOU.  And you don’t even have to ask for it – let alone apologize for taking up everyone else’s time.

So you fixate on them.  And identify with them.  And dream about winning the lottery of life and actually BEING them.

It would be heavenly, wouldn’t it?

Let’s not kid ourselves, either.  You cannot love people intensely without also being angry at them.  It’s Newton’s Third Law of Motion translated to emotions:  for each and every emotion there is an equal and opposite emotion.

You adore William and Kate.  And you are angry at them, too – because they are receiving what you never received.

You deserve that attention, too.  You always have.  You are just as good as William or Kate, and you know it.

Your anger is expressed as an aggressive sense of entitlement.  You are entitled to photos of them swimming.  You are entitled to juicy bits of gossip about their personal lives.  Fair’s fair – isn’t it?

It all works out in the end.

The royals seem to be doing just fine – and your celebration of them is a way of celebrating yourself.  Lavishing attention on William and Kate (and dreaming of being them) amounts to lavishing attention on yourself because you are dreaming of being them all the while.

That’s why it feels so good.  It’s nothing more than play.

It’s perfectly natural for adults to unwind and relax through healthy regression – playing at being children – just as children prepare for the challenges of life in the opposite way, by playing at being adults.

No harm in fantasizing about being the royals – the most pampered children of all – so long as it doesn’t become an obsession that occupies your every waking moment.  (For most of us that isn’t an issue – it’s just a hobby.)

So go ahead and have your fun.

Imagine what it feels like to step out of that Rolls Royce and into the bursting flash bulbs.

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One of the hard parts of psychotherapy  – and the unavoidable realities –  is remorse.  Inevitably, once you become more aware of who you are, and how you’re living your life…you wish you’d done so sooner.

Patients are always telling me they’re kicking themselves for not getting to my office (or at least someone’s office) years before.

One patient this week wept as he reviewed all the relationships he’d wrecked over the years by behaving exactly like his father, suspicious and controlling, exhausting the women he dated until they finally left in frustration.

“All those wasted years,” he sighed.  “All those wasted opportunities for happiness.”

There isn’t much I can say to that, except that’s how awareness works – when it arrives, you always wish it made the trip a little quicker.

Then I remember what Gerald Lucas, a psychotherapist and institute director, used to say at times like that:

“What a fool I was at 80, said the 90 year old man.”

There’s no such thing as perfect wisdom.  Lena Fugeri, another psychotherapist I used to work with, used to say you never finish with psychotherapy because as soon as awareness arrives, life throws you new challenges.

Lena was right.  My patients in their teens are struggling with their first relationships and finding meaningful careers. My patients in their 40’s and 50’s might be dealing with raising children, navigating a marriage with a partner, learning to manage others on the job, or the death of their parents.  And my patients in their 60’s and 70’s and 80’s and 90’s are handling growing older and the entirely new set of issues triggered by that process.

You are like a lotus flower – the more you peel the petals away, the more petals you find within.  There is no center – only more layers to peel away, new hidden wonders.

Instead of beating yourself up for not achieving awareness sooner, it makes sense to emulate one of my favorite figures from Buddhism – the Bodhisattva of Compassion.

The Bodhisattvas, in Buddhism, are followers of the Buddha who achieve sufficient wisdom to attain enlightenment, the state of nirvana.

The Bodhisattva of Compassion, alone, chooses to remain behind in the world, to assist mankind on its journey to awareness.

In one famous story, three monks wander the parched desert until they reach a walled garden. They hear the tantalizing splash of water within.

The first monk climbs on the shoulders of the others, and leaps into the garden, disappearing.

The second monk laboriously scales the wall and is also soon hidden amid the plants and trees.

The third monk clambers up all alone and perches himself atop the wall, studying the lush garden and cool, clear spring.

Then he slides back down, and returns to wander the arid waste.

This monk’s job is to search for other lost souls. He shows them how to locate the garden.

This is the Bodhisattva of Compassion.

You might be wiser now than you used to be.  I hope psychotherapy helped you acquire some of that insight.

But please don’t forget – part of wisdom is passing on what you’ve learned to others.

Don’t sit in a walled garden, thinking you’ve got it all figured out.  You don’t.

Share what you’ve learned.

You’ll acquire more wisdom showing others the path to enlightenment than sitting in a garden surrounded by walls.

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A New York Times article from a few weeks ago holds enormous potential ramifications for lawyers bent over their desks at big law firms. The tentative conclusion of the piece was simple: if you are dealing with minor depression, or in fact, with anything other than massive, serious depression, popping anti-depressant pills is probably a waste of time. In fact, a placebo might do you more good.

How many lawyers are currently taking anti-depressants? According to the admittedly anecdotal evidence from the lawyers I’ve seen over the years in my private practice, quite a few.

It’s such a lawyerly thing to do. You figure out you’re depressed, so you do something about it – march over to your doctor, or maybe a high-powered shrink with a top reputation, get diagnosed, and get your pills. The whole thing takes a few minutes, and you’re back on the job. No wasting billable hours, no whining and complaining on a therapist’s couch – you take care of the problem and move on. Take a pill and knock it off with the martyr routine.

However, there are a few problems with anti-depressants…

First, like I said, they might not work. Don’t believe me? Here’s an excerpt from the article:

Some widely prescribed drugs for depression provide relief in extreme cases but are no more effective than placebo pills for most patients, according to a new analysis released Tuesday.

The findings could help settle a longstanding debate about antidepressants. While the study does not imply that the drugs are worthless for anyone with moderate to serious depression — many such people do seem to benefit — it does provide one likely explanation for the sharp disagreement among experts about the drugs’ overall effectiveness.

Second, the side-effects. This includes the “sexual side-effects” – which might mean, if you’re a guy, erectile dysfunction, and whichever gender you are, inability to reach orgasm. And there are “regular” side effects, too – like weight gain.

Third, anti-depressants only work while you’re on them. I’ve heard of people staying on anti-depressants for decades, but I have no idea what the long-term effects are because no one knows. If you’d like to experiment on yourself, I’m sure the pharmaceutical industry would be fascinated to find out.

Fourth, to the extent they do work, it’s by erasing feelings. Anti-depressants tend to narrow the bandwidth of what you feel, chopping off the top and the bottom – no more highs, no more lows. That can bring relief, but at a cost.

Fifth, other than the vague explanation that they “affect neurotransmitter levels,” no one really understands how they work. Anti-depressant medications, especially the new generation of drugs, are a relatively recent development, and the exact mechanism that produces the results isn’t fully understood.

Is there another option?

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