The Muse Speaks

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The Courage of Ukraine 

Like many, many others, i  feel overwhelmed and amazed at the courage of the Ukrainian people. They are willing to fight and die for their freedom.

They stand against a vicious dictator attempting to impose his will on a neighboring sovereign nation. They are teaching all of us what it means to be brave.

Our time may come. I hope we will have the same courage to defend democracy, truth, and the rule of law against those who would destroy it.

The people of Ukraine should be our North Star. I thank them for showing us the way.  I pray for their success.

Sarah's Muse, 3/2/2022

Troubled Times

What do you do when all you can do is wait and worry?

Most of us are home, sheltering in place, trying to keep out of the eye of this virus hurricane.

You know the advice--stay away from others (six feet at least) to protect yourself from infection and more importantly to protect the most vulnerable in our society.

Keep the faith. By that I mean understand that this too shall pass. Most of us will suffer no or mild symptoms. We may not even know we have been infected, which of course explains why we must wait for an all clear. Because some of us will catch the virus and die, and no one wants to be the source of a deadly infection for others.

What can we learn? Most of that will come later when we discover what we must do for the next pandemic, and there will be a next pandemic. It might well be more deadly than this one, but we have a chance to understand what we did right and what we need to do differently.

In the meantime, what do we do with time and hands and concerns about our future. I start by sorting out what I can control and what I cannot. If I want something to be done differently, then I write to the people in power. I look at where I am each day. Do I have enough for this day--enough food, enough money? Am I sick or in pain? If I'm not any of those things, then I'm thankful. 

If I can, I reach out to people I know who are not so lucky. Those people who are lonely, suffering or grieving. We are all in this together and whatever we can do for one another is a gift. A great gift that helps each of us as well as the person in need.

I also make sure I find a light moment and a diverting pastime. I laugh at something that is genuinely funny. I do something I love to do. In my case that is writing and cooking. 

Nothing about this is easy, but human beings are a remarkably creative lot. If you look around you will be amazed at what people have managed to create in this time of enormous need and fear and suffering. 

Under the Influence

We are all under the influence. I'm not talking about alcohol or drugs. I'm talking about unconscious bias. We choose names for our children that we think are unique only to discover they fall into the top ten category for popular names for that particular year. We choose hair cuts, clothing, cars that others tell us are the right ones to have. 

Far more importantly, we often come by our fixed beliefs based on what others say.

I recently listened to a stunning podcast about the way in which social media guides our thinking. The structure of the internet's social media and computers in general is based on algorithms--those rules that simplify things and make them quantifiable. The danger in making things simple and quantifiable is that without meaning to you encourage and reinforce simplified thinking.

When you see bots, those bits of opinion that can get amped by being multiplied on the internet, you begin to think they must be true. But that is a dangerous and incorrect assumption.

There is no possibility of escaping bias. Our work is to recognize our unconscious bias, bring it to light, question it. 

Part of the reason we find it so hard to talk to one another is because social media and algorithms have allowed us to simplify our thinking into absolutes. We are right and you are wrong. We are good and you are bad.

A way out of this divide is to question our assumptions, to look for the nuances. 

I continue to be amazed when I recognize an assumption I've made that isn't based on fact.  Usually it is based on some oversimplification that I have never challenged. It can be painful to admit to such a recognition, but it always leads to growth.

Courage in the midst of fear

I was born with an insatiable curiosity about people and why they do the things they do. There is always a reason.

In my trip to Beaufort, South Carolina, where Sarah was doing research for her third book in the Ditie Brown Mystery series, I went along for the ride. Naturally, Sarah cannot go anywhere without me, her real-life muse.

What I discovered was a world and a history I knew nothing about. Beaufort, South Carolina is a small town heavy in the history of the Civil War.

Sarah wrote a piece on her Facebook page about a twenty-two year old slave Robert Smalls  who risked everything to sail a  confederate-owned cotton steamer through Southern waters and into a union blockade with the hope Confederates would not recognize him as a slave and that Yankees would see his white flag of surrender and not fire on him.

He had with him his wife and fifteen other slaves including three children. 

What made this man so brave? Would I have been so brave? What drives us to risk everything including life itself for what we want? 

Smalls wanted freedom. He was willing to achieve it or die, and he had the drive and intelligence to believe he could achieve it. He had courage, and he succeeded.

When I work with patients, I find it is most often fear that holds them back from living the life they wish to lead. When they can name the fear, it often gives them the courage to risk what they have for what they want.

Are these life and death decisions? Not usually, but an unexamined fear can feel that way.

And it's good to sort out the big issues from the small ones. An unnamed fear can grow to such proportions that it seems insurmountable. If we name it, we shrink it down to size. 

When we know what we are afraid of and what we want, we can decide if it's worth the risk. We can find courage in the midst of fear.

It doesn't erase the fear but it does allow us to  move on, to move through. 

The greatest power fear has is the ability to paralyze us. 

That is what I work with patients to overcome. By examining what patients really want in their lives and the fears that hold them back, many find the courage to move ahead.

Humor and Psychotherapy

Humor in therapy is a tricky business. It can be used as a weapon, a defense, or a genuine form of connection.

I hear a joke from a patient in the first days of treatment and ask myself what is this person afraid of. What does he need to defend himself against? The answer of course is everything. Beginning treatment is a hopeful, frightening time. I want you to help me. Maybe you can help me. But I don’t want you to know too much about me. I don’t want to have to change.

I hear a joke towards the end of treatment and I think our work is almost done. My patient trusts me and herself. She is relaxed. She can let me see who she is. The world is no longer such a dangerous place. She can play. 

Humor can be used as a test. If I tell you something tragic, make a joke of it, and you laugh, then maybe I can’t trust you with my darkest secrets. Early in treatment, I don’t laugh at patient jokes. I try to understand what they mean. Are they to relieve anxiety? An attempt to deflect the seriousness of our work? An attempt to ingratiate? To not be a bother? To be one with the psychiatrist? To hide anger, hostility, pain? The possibilities are endless.

You may think I make too much of a simple joke. But jokes aren’t simple. Humor can be life saving, but it can also be used to obfuscate, confuse, or deflect the listener. This is particularly true when the listener is a psychiatrist. 

I keep an eye on humor as  a way to mark the progress of treatment. I had a patient who had learned at her mother’s knee how to use humor as a devastating weapon. People were reduced to caricatures and called by their most distinctive and humiliating characteristics. The barbs were poison darts and deadly. My patient could eviscerate the enemy with a single comment. It didn’t hurt that she was extremely bright, original and a wordsmith. My patient’s humor protected her from getting too close to anyone. Like a porcupine, she could keep everyone at a distance. She was also a  lonely and lovely woman. I wondered what would happen to her humor as she got better. Would she lose it altogether? Could she really transform it into a gentler variant? 

This was a very witty patient, and while I wanted her to get healthier, I didn’t want her to lose a wonderful part of herself. It was a gradual and amazing transformation. The patient no longer had to rip people to shreds or remain silent to avoid doing that. Her humor did transform. I’m not sure I would have believed it if I hadn’t seen it over time. She was still funny, very funny, but the jokes were no longer at the expense of other human beings. She no longer had to keep people at bay.

There are people who seem to have no sense of humor. I still wonder about this. Is it true? Like people with no sense of rhythm? Can it be learned? Humor softens the edges of life. One of the worst curses in life, it seems to me, would be to live without a drop of humor to lighten the load. Laughter might not be right next to godliness,  but it isn’t far behind. The physical act of laughing makes us healthier. The emotional impact lets us have perspective. When people are deeply emotionally sick, it is their humor that fails them. The lack of humor is a sign of their suffering. But what of the person who never sees anything funny in life? I suppose it’s like learning to cope with a missing limb. Perhaps one makes up for it in the same way. One compensates by finding other emotional outlets, other ways to relieve the burdens of the world.

With some patients, I’ve found humor has merely been buried under a mound of suffering and distrust. That’s a happy discovery for both of us—like finding gold in an old, forgotten mine. It must be their humor that we discover, not mine. The psychiatrist who jokes with his patients is a little like the psychiatrist who touches them. The touch, the joke can lead to a misery of misinterpretation. I see what you want from me. I’m to be your friend, your audience. You don’t want us to get too serious in here. I’m supposed to keep it light. You don’t want to know my pain. And the problem is you’ll never know what that joke meant to your patient. He won’t tell you, unless he’s at the healthy end of his treatment. He’ll go along or maybe he’ll leave, dismissing you as someone who doesn’t want to listen to or understand him.

I am like any other caring physician. My goal is to cure. If I can’t cure, then my goal is to relieve suffering. Humor can be a part of the process. Shared humor. And it shows itself after I know the patient well, never before. It comes from my patient, not at her expense. At the end of treatment, humor sits beside sadness and joy. When it’s time to leave, my patient and I reminisce about what we’ve been through, what we’ve accomplished, and yes, even sometimes, the laughs we’ve had.   

Troubled Times

What do you do when all you can do is wait and worry?

Most of us are home, sheltering in place, trying to keep out of the eye of this virus hurricane.

You know the advice--stay away from others (six feet at least) to protect yourself from infection and more importantly to protect the most vulnerable in our society.

Keep the faith. By that I mean understand that this too shall pass. Most of us will suffer no or mild symptoms. We may not even know we have been infected, which of course explains why we must wait for an all clear. Because some of us will catch the virus and die, and no one wants to be the source of a deadly infection for others.

What can we learn? Most of that will come later when we discover what we must do for the next pandemic, and there will be a next pandemic. It might well be more deadly than this one, but we have a chance to understand what we did right and what we need to do differently.

In the meantime, what do we do with time and hands and concerns about our future. I start by sorting out what I can control and what I cannot. If I want something to be done differently, then I write to the people in power. I look at where I am each day. Do I have enough for this day--enough food, enough money? Am I sick or in pain? If I'm not any of those things, then I'm thankful. 

If I can, I reach out to people I know who are not so lucky. Those people who are lonely, suffering or grieving. We are all in this together and whatever we can do for one another is a gift. A great gift that helps each of us as well as the person in need.

I also make sure I find a light moment and a diverting pastime. I laugh at something that is genuinely funny. I do something I love to do. In my case that is writing and cooking. 

Nothing about this is easy, but human beings are a remarkably creative lot. If you look around you will be amazed at what people have managed to create in this time of enormous need and fear and suffering. 

Under the Influence

We are all under the influence. I'm not talking about alcohol or drugs. I'm talking about unconscious bias. We choose names for our children that we think are unique only to discover they fall into the top ten category for popular names for that particular year. We choose hair cuts, clothing, cars that others tell us are the right ones to have. 

Far more importantly, we often come by our fixed beliefs based on what others say.

I recently listened to a stunning podcast about the way in which social media guides our thinking. The structure of the internet's social media and computers in general is based on algorithms--those rules that simplify things and make them quantifiable. The danger in making things simple and quantifiable is that without meaning to you encourage and reinforce simplified thinking.

When you see bots, those bits of opinion that can get amped by being multiplied on the internet, you begin to think they must be true. But that is a dangerous and incorrect assumption.

There is no possibility of escaping bias. Our work is to recognize our unconscious bias, bring it to light, question it. 

Part of the reason we find it so hard to talk to one another is because social media and algorithms have allowed us to simplify our thinking into absolutes. We are right and you are wrong. We are good and you are bad.

A way out of this divide is to question our assumptions, to look for the nuances. 

I continue to be amazed when I recognize an assumption I've made that isn't based on fact.  Usually it is based on some oversimplification that I have never challenged. It can be painful to admit to such a recognition, but it always leads to growth.

Courage in the midst of fear

I was born with an insatiable curiosity about people and why they do the things they do. There is always a reason.

In my trip to Beaufort, South Carolina, where Sarah was doing research for her third book in the Ditie Brown Mystery series, I went along for the ride. Naturally, Sarah cannot go anywhere without me, her real-life muse.

What I discovered was a world and a history I knew nothing about. Beaufort, South Carolina is a small town heavy in the history of the Civil War.

Sarah wrote a piece on her Facebook page about a twenty-two year old slave Robert Smalls  who risked everything to sail a  confederate-owned cotton steamer through Southern waters and into a union blockade with the hope Confederates would not recognize him as a slave and that Yankees would see his white flag of surrender and not fire on him.

He had with him his wife and fifteen other slaves including three children. 

What made this man so brave? Would I have been so brave? What drives us to risk everything including life itself for what we want? 

Smalls wanted freedom. He was willing to achieve it or die, and he had the drive and intelligence to believe he could achieve it. He had courage, and he succeeded.

When I work with patients, I find it is most often fear that holds them back from living the life they wish to lead. When they can name the fear, it often gives them the courage to risk what they have for what they want.

Are these life and death decisions? Not usually, but an unexamined fear can feel that way.

And it's good to sort out the big issues from the small ones. An unnamed fear can grow to such proportions that it seems insurmountable. If we name it, we shrink it down to size. 

When we know what we are afraid of and what we want, we can decide if it's worth the risk. We can find courage in the midst of fear.

It doesn't erase the fear but it does allow us to  move on, to move through. 

The greatest power fear has is the ability to paralyze us. 

That is what I work with patients to overcome. By examining what patients really want in their lives and the fears that hold them back, many find the courage to move ahead.

Humor and Psychotherapy

Humor in therapy is a tricky business. It can be used as a weapon, a defense, or a genuine form of connection.

I hear a joke from a patient in the first days of treatment and ask myself what is this person afraid of. What does he need to defend himself against? The answer of course is everything. Beginning treatment is a hopeful, frightening time. I want you to help me. Maybe you can help me. But I don’t want you to know too much about me. I don’t want to have to change.

I hear a joke towards the end of treatment and I think our work is almost done. My patient trusts me and herself. She is relaxed. She can let me see who she is. The world is no longer such a dangerous place. She can play. 

Humor can be used as a test. If I tell you something tragic, make a joke of it, and you laugh, then maybe I can’t trust you with my darkest secrets. Early in treatment, I don’t laugh at patient jokes. I try to understand what they mean. Are they to relieve anxiety? An attempt to deflect the seriousness of our work? An attempt to ingratiate? To not be a bother? To be one with the psychiatrist? To hide anger, hostility, pain? The possibilities are endless.

You may think I make too much of a simple joke. But jokes aren’t simple. Humor can be life saving, but it can also be used to obfuscate, confuse, or deflect the listener. This is particularly true when the listener is a psychiatrist. 

I keep an eye on humor as  a way to mark the progress of treatment. I had a patient who had learned at her mother’s knee how to use humor as a devastating weapon. People were reduced to caricatures and called by their most distinctive and humiliating characteristics. The barbs were poison darts and deadly. My patient could eviscerate the enemy with a single comment. It didn’t hurt that she was extremely bright, original and a wordsmith. My patient’s humor protected her from getting too close to anyone. Like a porcupine, she could keep everyone at a distance. She was also a  lonely and lovely woman. I wondered what would happen to her humor as she got better. Would she lose it altogether? Could she really transform it into a gentler variant? 

This was a very witty patient, and while I wanted her to get healthier, I didn’t want her to lose a wonderful part of herself. It was a gradual and amazing transformation. The patient no longer had to rip people to shreds or remain silent to avoid doing that. Her humor did transform. I’m not sure I would have believed it if I hadn’t seen it over time. She was still funny, very funny, but the jokes were no longer at the expense of other human beings. She no longer had to keep people at bay.

There are people who seem to have no sense of humor. I still wonder about this. Is it true? Like people with no sense of rhythm? Can it be learned? Humor softens the edges of life. One of the worst curses in life, it seems to me, would be to live without a drop of humor to lighten the load. Laughter might not be right next to godliness,  but it isn’t far behind. The physical act of laughing makes us healthier. The emotional impact lets us have perspective. When people are deeply emotionally sick, it is their humor that fails them. The lack of humor is a sign of their suffering. But what of the person who never sees anything funny in life? I suppose it’s like learning to cope with a missing limb. Perhaps one makes up for it in the same way. One compensates by finding other emotional outlets, other ways to relieve the burdens of the world.

With some patients, I’ve found humor has merely been buried under a mound of suffering and distrust. That’s a happy discovery for both of us—like finding gold in an old, forgotten mine. It must be their humor that we discover, not mine. The psychiatrist who jokes with his patients is a little like the psychiatrist who touches them. The touch, the joke can lead to a misery of misinterpretation. I see what you want from me. I’m to be your friend, your audience. You don’t want us to get too serious in here. I’m supposed to keep it light. You don’t want to know my pain. And the problem is you’ll never know what that joke meant to your patient. He won’t tell you, unless he’s at the healthy end of his treatment. He’ll go along or maybe he’ll leave, dismissing you as someone who doesn’t want to listen to or understand him.

I am like any other caring physician. My goal is to cure. If I can’t cure, then my goal is to relieve suffering. Humor can be a part of the process. Shared humor. And it shows itself after I know the patient well, never before. It comes from my patient, not at her expense. At the end of treatment, humor sits beside sadness and joy. When it’s time to leave, my patient and I reminisce about what we’ve been through, what we’ve accomplished, and yes, even sometimes, the laughs we’ve had.