Setting your agenda for the New Year

It’s that time of year when we all take an accounting of where we’ve been, where we are, and where we want to go as we prepare for a New Year.New Year's Resolutions, Goals, Visions, Plans, Agenda

This end-of-year inventory taking can be surprisingly useful if it identifies unfinished business, perhaps a fence that needs to be mended or a kindness repaid.  Or, if it results in an honest and balanced appraisal of the current state of our lives.  Particularly beneficial might be an application of the part of The Serenity Prayer that talks about “the Wisdom to Know the Difference.”  That will separate the wheat from the chaff when it comes to wasting energy and worry over that over which we have no control… always worthwhile knowledge to have.

The final piece of the Past/Present/Future triumvirate is the yearly New Year’s Resolution debacle… always made, seldom realized.

Perhaps a better idea is to pick out an area of life that’s been nagging at us… maybe the ever-messy garage or the steadily expanding waistline… and decide to address the problem with patience, structure, strategy and planning.  Leave the urgency to the resolution makers. Plan to address whatever it is that needs addressing as a long-term process that minimizes or eliminates usually unrealistic short-term goals (e.g. “25 pounds lighter by Valentine’s Day”).

How about setting an agenda which is realistic and possible.  How about setting it in a gentle, non-self-reproachful manner.  Yeah, sure you’re overweight or your garage has looked like something out of a Hoarders episode.  OK.  We both get it.

Start on the journey and stay on the path.  See it as an adventure.  Give it a chance.  Don’t even consider perfection.  That’s a surefire curse…

Like the Nike ad says: “Just Do It.“

Good luck.

Wish me luck.

Happy New Year.

- Mark

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OnDecember 2, 2014, posted in: addiction, goals, mental health, therapy by

It’s all a terrible blur

I was recently soaking up the early morning news while doing cardio in the gym when, on a TV screen several down the line from the one I was watching, I saw a picture of the bizarre, orange haired, bug-eyed guy who is on trial for shooting… what?  What and where did he do his shooting?  What’s his name?  Which one is he??

My next set of thoughts were concerned with my own confusion and how this bizarre/previously unheard of/horrific element of our society has become so commonplace that one terror has begun to bleed into the next and into the next, causing us to go to Google to figure out that the image was that of James Holmes, the Aurora, CO movie theater shooter.

It was not lost on me that this level of uncertainty on my part speaks to just how crazy, threatening and unpredictable things have become for us as we simply try to muddle along and manage well in this day as we anticipate the next.  A very sad and legitimate question has evolved… “Will there be a next?”

Which brings me to Adam Lanza, the executor of the most recent and undeniably horrific episode in Newtown, CT at the Sandy Hook Elementary School…

How dumbstruck we were.  How emotional, how visceral were our reactions.  I was no exception.  It hit close to home… too close… for me because, like you, it touched me as a parent.  When I processed this a little bit and identified with the parents of these supremely violated babies, I, like you, became sad.

Over and over I heard the question “How could he do that?”

In thinking about this I kept coming back to “psychosis and video games.”   This, before, on day two, the media widely reported that Lanza was both addicted to insanely violent video games and was, himself, extremely crazy.  His mother, as you may remember, was in the process of having her son involuntarily committed to an in-patient psychiatric facility.  He shot her 11 times, as she slept, before departing for the school.  Violent and Crazy.

How do I link the mental illness and the technology?

First, many severely mentally ill people have what we call a “Formal Thought Disorder.”  This means a disorder in the form of thought.  For you, A leads to B leads to C leads to D, and so forth.  There is a logical, sensible link between the elements in the progression of thought.  The clothes are dirty.  Bring them to the laundry room.  Throw them into the machine with some soap, turn on the machine and you’re good to go.  You take that logic and order for granted and, because you’re psychologically intact, you can.

The untreated person, suffering from some particular mental illness, does not have the capacity for ordered, logical thought and reasoning.  Not in all mentally ill people and not all the time with those who do demonstrate the presence of thought disorder, are these breakdowns in perception and reasoning present.

But, in those who are subject to this condition, there may be no logical, reasonable connection between one thought and the next.  In fact, the lack of connection, reasonable to the thinker, may be simply, objectively crazy.  Hang the laundry in the apple tree and tell it to go play baseball.  Crazy.

Another important consideration in assessing a person’s mental status is the existence and state of an individual’s Ego Boundaries.  Simply put, this relates to a person’s ability to distinguish who he is, what he believes, what he’s thinking etc. relative to others.  I know that I am typing this blog and expressing my thoughts. There is no confusion about this.  I am I, and you are you.  When I watch a great movie I may identify with a character but I never become the character.  I know that someone is portraying a character in a movie that I’m watching and that defines my reality quite accurately.  I’m a spectator watching a movie and not in the movie.

When I encounter you in conversation I know that my words and thoughts are mine and yours are yours.  I am I, and you are you.  My ego boundaries are intact.

Not so in the case of individuals with psychosis.  Sometimes their ego boundaries break down to the extent that “I and Thou” become indistinguishable.  There is no ability to own one’s thoughts and distinguish those thoughts and words from those of the other.  The ego boundaries have eroded, leaving the door wide open for psychotic thinking to take root.

Some mentally ill individuals hallucinate.  They hear things and see things that aren’t real but they experience them as though they are, because in their chaotic, nonsensical thoughts they do “hear” hallucinatory messages.  Any suggestion to the contrary by a friend, family member or therapist may very well be perceived as a threat or a trick, thus undermining further communication with that individual.

In some instances, the hallucinations come in the form of commands.  These are called Command Hallucinations, e.g. “go shoot.“

It’s my contention that all these factors merged into the horror that occurred at Newtown, in pristine Fairfield County.

My, nearly immediate, connection between video games and psychosis was substantiated by the news that Lanza was isolated in his house, communicating with no one outside, and obsessed with violent, shooter-maimer-avenger-protector-hero, video games.  He played them incessantly.  For hours on end. Around the clock.  For days and weeks and months.  He became the shooter, the hero, the avenger, the protector.

He killed the babies and staff at the school because he had to.  Why?  Who knows?  More important, who can ever know?   We can’t find out by trying to superimpose rational analysis on the insane jumble within Adam Lanza’s mind.

When one asks the question “How could he do this?” it’s equally legitimate to ask “How could he not?”

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OnJune 1, 2014, posted in: mental health, psychotherapy, therapy by

Do alcoholics ever QUIT alcohol?

Many years ago I asked a group of therapists and counselors, all working in the addiction/recovery field, if they believed that at least some percentage of their clients, as a direct or indirect result of therapy, gave up alcohol or their drug of choice.do alcoholics ever quit alcohol?

Met, not for the first time that day with stares of incredulity, they raised their hands affirming that belief.

They were wrong.

If you were to sit in the back row of any of the hundreds of AA meetings in your area you’d likely see a row populated by an elderly grandmother, a construction worker, a guy in a nice business suit, a kid with piercings and neck tattoos, and a pretty woman in nursing garb.

How different they appear and, indeed, how different their lives and histories really are in so many ways.  Yet, they seem to be connected and comfortable with one another, despite their obvious surface differences.  The connection they share is real, and it is powerful.

They are bonded through a common experience of pain.

Each of these disparate individuals at some point, usually later, in their drinking/drugging histories, came face to face with enough pain — loneliness, fear, shame, self-hatred, guilt etc. — that the denial which is common to the alcoholic/addict broke down.  They saw, with crystal clarity, that the disarray and chaos in their lives was due solely and directly to their use/abuse of whatever substance they’d come to love and depend on.

They decided that they couldn’t stand any more of the pain that they now linked inexorably to the addictive substance.

Love it though they did, they became willing to do whatever was necessary to rid themselves of their anguish.

If AA could do it for them then, so be it, they’d give it a go.

They found a way, in Alcoholics Anonymous (or other spin-off Twelve Step programs) to achieve lasting, meaningful abstinence.  It worked!

All of them had quit the pain.

All of them understood why their neighbors in the row were there.

- Mark B. Dunay, LICSW, LADC 1

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OnFebruary 1, 2014, posted in: 12 Steps, AA, addiction, alcoholic, alcoholism, counseling, psychotherapy, recovery by