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Meaningless, Meaningless, all is Meaningless
“The really important kind of freedom involves attention, and awareness, and discipline, and effort, and being able truly to care about other people and to sacrifice for them, over and over, in myriad petty little unsexy ways, every day…. The only thing that’s capital-T True is that you get to decide how you’re going to try to see it. You get to consciously decide what has meaning and what doesn’t…. The trick is keeping the truth up-front in daily consciousness.” – David Foster Wallace
I wish I was artsy and I would put it in graphics and maybe it would become a facebook meme. I was looking at Amazon recommendations and kept coming across his name and looked him up on Wikipedia. Probably recommended because I always pre-order anything by Pynchon and I’ve already crushed his oeuvre (a cool word I can’t spell or pronounce).’
I think Wallace nails it here though and makes a couple of important points that I kind of hammer on myself, if you know me. One is that its the little day to day things that are most significant in our lives. The small little courtesies and shared experiences that let people who are struggling a bit know that we are all in this together.
I also think he makes a great point about meaning and how it is a created thing. That I think is one of the fundamental truths. We know meaningful work is one of the few correlations with happiness. Knowing meaning is within your power to create is powerfully empowering. There are things about work or other life situations that have some relationship but there is a lot of freedom in interpretation. Researchers define meaningful work as having three qualities: Autonomy, Mastery, & Purpose. Sometimes a shift in focus can help move things into the meaningful category.
I always use working in a fast food restaurant (another word i can never spell) as my example. Its routinized, of dubious social value, low paying with little autonomy. But when you see someone working there with a developmental disability, pleased as punch to be wiping tables and picking up trays. Proudly in their uniform being out with the people and having a purpose you can see that even McDonalds offers an opportunity for some pretty intense meaning, as long as your bringing it.
I’ve touched on it in verse with a stanza out of “Untitled #1”:
Spring can be as cold as winter
For the mind without purpose
The heart without love
New life is inevitable
But not your life
Not our lives
Our Acts of Being
Are as meaningful
Or as meaningless
As we allow them to be.
Spring can be as cold as winter
When we refuse to allow
The Life Force to shine out
Brilliantly and forcefully
eulogy for my father
Its coming up on six months ago since Dad passed away. I’ve been missing him as baseball season winds down. He would have been so happy seeing his Tigers winning the division and playing so strong going into the playoffs. He admitted to me that it was a bigger deal the Tigers winning the World Series then me being born back in 1968. They hadn’t won since 1947 and he had other kids. He denied it when I teased him about it later but I didn’t take offense. There was no competition in his love for baseball, it was welcoming and I knew it didn’t mean he didn’t love me a lot, he just really loved baseball. Watching it with him taught me some of its nuance. I’m still not really patient enough for baseball but its coming.
I wrote the first half the night that Dad died. It opens very strident and I guess I was mustering gumption to do something different, defy convention. The second I wrote the weekend after and put most of a week into feeling my grief full time. And walking the dog. It was time well spent and Dad had an easy story to tell and I was blessed to be privy to the details.
These words brought me a lot of comfort and I am indeed blessed to have been raised in such away to cultivate them. Dad was really a poet. One of the last things really hit his lyricism, “I’m so tired of holding my eyes closed”. He could be sparse like that, spare I guess is a better word. Well its already a long piece so I shouldn’t put in too much of a prologue, except to say I hope it makes you think and if it brings you comfort I’m glad.
“Eulogy For My Father”
3780 words or so
“This above all, to thine own self be true. “ I am not really a minister and I don’t really want to be doing this. I am a grieving son and I want to be sitting next to my brothers and sisters, crying some, laughing some, squeezing an arm in reassurance, an arm across my back in love and support. I want to hear words of beauty and consolation in celebration of a life well lived by someone who knows and loves my Dad and will tell his story with truth, compassion, and respect, in accord with what my dad believed in a way that resonates with what I believe, with what we all believe. That was simply not going to happen. There is a narrow band of belief that dominates most discourse on matters of the spiritual. If you adhere to one of its dominant strains you might not have even noticed, or only noticed the slight difference when you hear someone talk from another dominant strain. But many of us are outside of that, un-believers or simply un-churched. We patiently sit through funerals, weddings and the like and listen to stuff that is irrelevant at best and often frankly offensive. So if I talk about some stuff that church people feel uncomfortable with just hang in there and bear with me, hold on to what is good. Believe it or not, I’m trying to be a uniter not a divider. Take what you need and leave the rest. But for a half hour at least these words are mostly, for the rest of us.
Mr. John Paul Trapp Senior has a story that is long and complicated. It spans generations, a continent, and is in small part outside the bounds of what the masses of men believe perhaps, at least what men say they believe. Funerals are fundamentally an act of the sacred and need touch upon the ineffable, the spiritual wonder of the transition to the next great adventure, or how else are loved ones to be comforted?
John was never comfortable about talking about spiritual things. When asked what he believed I always described his spiritual orientation as backslidden Christian. He believed in that whole thing, sort of, but wanted to do what he wanted to do. Mostly drink beer and smoke cigarettes work hard and raise his kids right. So how does a backslidden Christian raise his children? He exposes them to church, lots of them, if they want. Doesn’t encourage it or discourage it, but makes it clear he is not really into talking about it. He’d heard enough about it already, he would say. Enough to feel judged, unworthy perhaps; but also defiant, resilient, and able to stand on his own two feet.
About a year ago Dad solemnly informed me that he had become an atheist. What???? An atheist at 73? Who does that? There are no atheists in foxholes the liars say who preach a spirituality of cowardice, of toadyism for rank gain, a theology of threats and bribes.
Dad had been watching the Discovery Channel and had heard about the Big Bang and it seemed a lot more reasonable, he informed me. And the Big Bang is a beautiful and wondrous way to understand where we all come from. Condensed to a single point, a place with no dimension, only location. Containing all the matter in the universe. And then bam, everything there is flying apart in all directions, hundreds of millions of years pass and the uniform layer of hydrogen has ripples and perturbations and clumps coalesce and begin burning through nuclear fusion and stars are born and grow the heavy elements and die and explode and the star stuff keeps flying apart. Bigger and bigger.
12 billion years pass and dirt and such collects and spins around a midsized yellow sun on the spiral arm of a typical galaxy that we like to call the Milky Way, and so is born the planet Earth.
It is a beautiful story in its stark simplicity, and the lesson it teaches is the truly grand scope of creation. It has all the more power for being factually undeniably true. You can generate testable hypotheses and learn more about its nature, that is how science advances. In all the creation stories of all the peoples the Actual Truth turned out to be far more vast and far more wonderful. For when John declared his independence from the belief in god he was not rejecting the God Who Made the Universe. He was rejecting some weird little cartoon god he had heard about when he was a kid. A god who rejected all that was fun and demanded the humorless life of a drudge. A god who judged and made one feel small and unworthy.
I took John’s atheism as a step in the right direction. A rejection of something that should be rejected. And the universe is a vast and wondrous place. Currently in my day job I am a substance abuse counselor and I wrestle with helping addicts find a source of spiritual support when drugs and alcohol have taken control of their life. It is no accident that a chapter in the AA Big Book is called “We Agnostics”. Recovery is developing a way of life that is so positive, healthy and fulfilling there is no longer any room for nonsense, and so it becomes an exercise in serenity. And so they say: God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.
But what of atheists and agnostics, is sobriety denied to them? Not by any means. I have heard a number of workarounds, Good Orderly Direction (G.O.D.), the program, door knobs and file cabinets, anything to reject the toxic selfishness inherent in addiction. I, a little from the outside, as a treatment person not a recovery person, humbly propose the Universe. The universe is sufficient for the serenity prayer and has the advantage of being self-evident to all. ‘For I believe the universe exists for I have seen and heard parts of it. I have tasted of the summer fruit and smelled the coming rain; felt the gentle breeze as it rolls across the plain.”
The serenity prayer neatly divides the universe into two categories and gives us advice on how to deal with both. First, there is everything under our control. And what is under our control? Only our own actions and those we meet with bravery. Everything else, literally everything that is not our own actions are outside of our control, and so we meet everything with acceptance. The intersection of bravery and acceptance is where we find wisdom. And the universe is sufficient for the serenity prayer. It will hold the things we must accept, it is sufficient for serenity. It offers peace in a time of loss. You can say it with me if you want to try it on for size. “Universe grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.
So does a belief in the Universe as science understands it preclude a belief in God? Absolutely not. 96% of Americans believe in God and that included Einstein and most scientists. The universe doesn’t compete with God as creator but is the fundamental proof of the scope of creation and that its source must be vast and mighty. For this message is not one of atheism or agnosticism for I am fact am a believer, a passionate dedicated believer in the God Who Made the Universe. This universe, the real one. Personally I believe that like my body has a spirit which animates me the physical universe has a spirit which animates it. But I know what I believe is not what everyone believes and for today I want us all to reach for common ground in which to lift up the spirit of John Trapp in communion and love for remembrance, celebration, and comfort.
For even though he called himself atheist once, Dad told me that Mom was waiting for him. Dad was on a ventilator toward the end and when they took him off and brought him out of sedation, he told me, he had died, and he told me, with assurance, that Mom was waiting for him. I believe him. It is in her character. It is about all I ever saw my mom do. And so it begs the question if Mom was waiting for him where exactly was that? I can honestly say that dad didn’t care and didn’t put much thought into it. I already said he was uncomfortable on matters of the spirit. He was not uncomfortable in contradiction. And neither am I. The truth is too vast the universe too big to not contain many contradictions. I like to believe in a personal god who cares about me. I like to believe in a universe governed by immutable natural laws that can be known and predicted and depended upon. I like to believe in miracles. I like to believe that Mom and Dad still live still love me and care about me, still speak to me with their wisdom. I know they still live in my heart if nowhere else.
John Trapp was a simple man and when I asked him how he wanted to be remembered it was as a Working Man. He worked hard growing up on an organic farm, though in those days they just called them farms. He was born in the heart of the Great Depression and the war years were lean ones on the home front. But the Trapp family was self-sufficient in a way that now we can scarcely understand. He had to churn the butter, pluck the hens, weed the row crops, feed the animals, there are others here who know these stories better than I so I will leave it at that he worked hard even as a small boy. But he played hard too. Fondly remembered tales of hijinks and adventure, messing around with the dogs, sledding, skating, hunting, how he earned his switchings, his sister Alice and her friends holding him down and kissing him.
But mostly he talked about working. Mowing grass, being the first to get a chain saw and cutting down trees. Hiring out as a farm hand, eventually for his sister Norma and her husband Joe. When the season ended he moved to the kill floor, slaughtering beef, hogs, and veal. It was a short trip from there to being a meat cutter. A dollar an hour until the union came and then he moved up to $2.65 cents an hour. Good money in the 50s and he still played hard. Drinking, dancing, roller skating, shuffle board and pool leagues, convertibles and drag racing; mishaps and near escape. Some reckless driving in Monroe that inexplicably ends with him joining the army. Trained as a mechanic he was stationed in Germany when the Berlin Wall was doing its Berlin Wall thing. There he developed a lifelong love affair with trucks. Most of his army stories though are about baseball or drinking beer. Good local beers with each town its own.
After his time in the service he returned home and to meat cutting, bought himself a brand new 1963 Ford Falcon Convertible, courted and married Frances Eileen Allen. He didn’t care that she had three kids he loved kids and promised to raise them as his own. John still had a little growing up to do but rose to the occasion with his readymade family and tried to be a good father to Bob, Betty and Brenda and three more boys when they came. Dad worked hard and we camped in Lake City in the summers.
Tragedy struck early and hard on this little family when John’s youngest son Dennis drowned in the swimming pool in the backyard. Dad blamed himself as the army had only taught him adult CPR and he later learned it was different for little kids. He drank beer and pitched horseshoes, all four by himself. Eddie Trapp came over and walked with him, no one had anything to say. Dad couldn’t handle family life anymore. He was broken in a way that luckily few of us will ever get to really understand. It was only 7 or 8 years ago that he told me he had finally gotten over Dennis dying. He went on a six month drunk from what I understand I am too young to remember.
He couldn’t stay home and didn’t believe in leaving, John was no coward, so all there was to do was to become a truck driver. He bought a straight truck and started hauling furniture for Beakins Van Lines. He would always point out the parking lot where he learned to drive when we drove through Circle City, as he liked to call it. North America became his home.
He took his first trip and was frightfully lonely. I had the great pleasure of finding and reading some of his letters home to Mom, before moth and rust destroyed, and they were heartfelt and touching. A demonstrative loving side of John I had never seen. On his second trip he threw me up in the cab with him and we were off to see the country. I was three years old. I would stay up all night to help keep him awake and we would talk about everything. I was his confidant, sounding board, and in many ways the repository of his hopes and fears. What an incredible gift to give to a child, your total attention, sharing from your heart. Showing him the country. I am so incredibly blessed I cannot describe. Having such an enriching early childhood in large part shaped who I am today. I was able to learn that people live all kinds of different ways and you can go to places and see stuff.
Dad was a character on the road. He knew this country comprehensively. Everywhere. He gave his own names to the flowers he saw. He knew the phases of the moon and how the stars change overhead with time and distance. He grew to be wise. He learned to instantly make friends. To make the most of a chance encounter. To be real with people. He stayed true to Fran though she had her doubts as she had seen him flirt, a lot. But he stayed true to her in death as he did in life and as easy and convenient it would have been to find another woman to take care of him. Instead he struggled on alone learning how to take care of himself for the first time in his life.
Hauling furniture was hard work. He would work hard all day and drive all night, running hard after the elusive dollar. But he also learned the culture of the truck driver and prided himself on acting as a Professional Driver. Driving safely and courteously, safeguarding fellow travellers, and caring for shared spaces. Looking for opportunities to do someone a good turn. Flashing in trucks when they passed with his running lights a quick flash of thank you when another truck did the same. He was also a friend to hitchhikers and transients, scooping them up giving them honest work and a chance to see the country, starting many in a career.
He helped many a stranded motorist or someone just down on their luck. Early in his career he was the first on the scene when a truck had smashed into a pick up full of migrant workers. There were bodies all over the road the truck driver who caused the accident was weeping and doing nothing. Dad began pulling bodies off the road, living or dead he could not always tell but he had no assurance traffic would stop and it needed to be done. He was a brave man who acted with honor whatever the cost.
Once after he was done with furniture and hauling freight for BJ McAdams he picked up a hitchhiker in spite of the company rule against it because the kid wasn’t wearing shoes. He drove him somewhere, bought him a meal and gave him some money, and didn’t think much of it. Some months later he was tracked down by a private investigator from a fuel slip. The kid had remembered his handle, Trapper John in those days and John was flown in as a surprise witness in a Perry Mason kind of way and exonerated the kid from a bogus charge of armed robbery. Dad did a lot of heroic shit. Stopped rapes, beat men down for disrespecting women and was pulling out his deer rifle out of his truck when the police gunned down a mass killer in a bar he was drinking in. If the cops had been three minutes later John would have taken care of it himself.
He ended his long career, 37 years and well over five million miles driven without a major accident with Anderson Trucking, ATS. Dad loved Harold Anderson, a war hero, truck driver who parlayed his truck and a granite contract into a billion dollar company. He treated John square. They recognized Dad’s excellence and made him a trainer. As racist and sexist as John could be they tried to give him all the women and black folks because he treated people decent and gave everyone a fair shot.
John hauled freight and ATS specialized in specialty loads. A lot of granite and all kinds of big stuff, mining equipment, giant machines, and cranes. It allowed him to be a piece of history. He hauled in granite for the FDR memorial. He hauled scaffolding for crowd control for presidential inaugurations. He hauled a fair chunk of our industrial capacity to the Mexico border and brought back the things we used to make here. He hauled pieces of the space shuttle. He hauled the Disney Parade and towed the Goofy Car in the parade when it wouldn’t start. At the end of his career he specialized in Wind Mills. Technically difficult blades being 150’ long the rear wheels of the trailer were steered by an escort driver. He also loved being part of something good, something for the future. He drove truck until he was 70 about as old a driver as I have ever seen.
Retirement brought some new challenges but also some new joys. He got a little dog he named Myrtle. He had always called his trucks Bessie and his trailers Myrtle and Myrtle followed him around like a little trailer and was a faithful friend when he suddenly for the first time in his life had time on his hands. She was a little dog a chow mix with a leaky heart valve that left her short winded and easily tired. John could relate he was as well by this time. He struggled to pay the bills on a fixed income and could not work his way out of his spending problem like he always could in the past. I made him a deal, I would buy a house if he would come and live with me and help me with the upkeep.
It was a beautiful arrangement that renewed his sense of meaning to his life. Work, that could be done but didn’t need to be done. Perfect for a working man winding down. As my friend Lisa said in a consolation message: “Mike, I’m so sorry about your dad. I know that he has been a huge part of your life these past few years and you will feel his absence every day. You made such a difference to him during these past few years. I could tell that being part of your bustling, friendly household made him feel connected and loved. You took such good care of him.”
As Dad began to decline he began to lose interest in things. It’s a process I’ve seen over and over as people prepare for death. The Tao Te Ching 16th chapter speaks to this and has been a source of strength and guidance for me since my mom was dying:
Empty your mind of all thoughts.
Let your heart be at peace.
Watch the turmoil of beings,
but contemplate their return.
Each separate being in the universe
returns to the common source.
Returning to the source is serenity.
If you don’t realize the source,
you stumble in confusion and sorrow.
When you realize where you come from,
you naturally become tolerant,
disinterested, amused,
kindhearted as a grandmother,
dignified as a king.
Immersed in the wonder of the Path,
you can deal with whatever life brings you,
and when death comes, you are ready.
If you wonder why we had John cremated it’s because he’d be spinning in his coffin as I have decided to end with a song. John had to abandon music when he married a woman who not only was tone deaf but could only make tone deaf children. I sing this not only because it is the only song I have written about John but I wrote it when Mom was dying and it speaks to what I believe about these things.
When your wife is dying in the summer time
The ministers go on vacation
The road workers do their excavation
But the truck driver stays at home
Alone with his regrets
He drinks cheap beer and he frets
About his dying wife and his debts
And if he should have stayed on the road so long.
And when your mom is dying in the summer time
The birds still sing in the morning
The red skies give the sailors warning
But the sad boy does not sail on
Alone with his worst fears
He stifles back his tears
He tries to bring his family cheer
As he writes another sad sad song.
And when someone’s dying in the summer time
People still go to the beach
But happiness is so far out of reach
We just all stay home
And we sit alone together
And talk about the weather
And what’s going to happen to Heather
When her grandma dies before too long.
But the birds still sing when we mourn
And with every death new life is born
We’re all just part of the Goddess anyway
So I’ll wipe away my tears
And learn to face my fears
And know there’s a new part of God to hear me pray
I know there’s a new part of God to hear me pray.
relaxation
most people i tell about relaxation aren’t trying to relax, they’re wanting relief from anxiety. i tell them its easier to start something positive then stop something negative. stopping being anxious is hard, better to work on cultivating relaxation. unless someone is attached to their anxiety because it meets some other vital need or they gain great benefit from it most people can get significant to total relief pretty quickly with some pretty basic techniques.
if the techniques are easy and actually pretty well known why don’t people get better on their own? mostly its two main mistakes. one is thinking you can make yourself relax and failing at it, a sort of learned helplessness because the act of making runs counter to relaxation. it is instead a process of allowing, akin to going to sleep. still it is an act of the will and so is known as passive volition.
The second pitfall is what inspired this post. “I tried that relation thing when i was feeling anxious and it didn’t help”. of course it didn’t. when you need it is a terrible time to try to learn it. you practice it when you’re already relaxed, before bed or after meds if you use those or a time when you’re already close. ‘seek the lord when he can be found’.
after that its pretty simple. all relaxation techniques involve slowing and deepening the breathing and relaxing the muscles. i like to breathe in my nose and out my mouth slowly and deeply and pay attention to the feeling of air going by my septum. usually i do progressive relaxation tightening muscle groups one by one starting with the toes and then relaxing. noticing how it feels to feel tense. noticing how it feels to feel relaxed. i learned it in a book when i was 16, been doing it off and on ever since. i credit with saving my sanity and perhaps even my life. best migraine treatment i’ve tried, even the pills that dissolve under your tongue and give you a three day hangover.
for anxiety you add in self talk. think about what you would say to a friend who felt that way. its ok, just breathe, its going to be ok, anxiety is just a feeling and feelings can’t hurt me. and scaling, numbering it between 1 & 10 like the pain scale and working your way down one point at a time. makes it concrete and feel more manageable to name it. especially something so prosaic as a 6. learn to be aware and catch it earlier if possible. learn that you can live with a four. we all get anxious some time. it is a dangerous and uncertain world.
anxiety is like the warning light on your dash board. it tells us something is wrong and we need to be aware and take some action. taking a pill is like putting a piece of black electrical tape over the light. it doesn’t address the issue. if you worry over the bills and drink or take a pill it doesn’t pay the bills.
you have to take some action. setting goals keeps us targeted and allows us to tolerate greater discomfort as we work for better things. visualization can help. i like to imagine tension as a darkness flowing out of me. i like to breathe in flexibility and breathe out tension. sometimes its as simple as working the tension out of my shoulders.
the emotions are not directly controllable so we have to push them indirectly through our thoughts, or our bodies, or our actions. exercise is great as well. it uses the same energy to be anxious that get used up by exercise or hard physical labor.
anger can be managed the same way, stress as well. if you breakdown the symptoms they all look pretty similar.
vicarious trauma vs burnout
Vicarious Trauma is the secondary effect of the therapeutic process and is intrinsic to good work. Empathy is the foundation of all successful practice. Empathy comes with listening and grows in depth and intensity over time with focused application. It can look like burn out but it is fundamentally different. Burn out is an over-application of energy or a lack of appropriate boundaries or limits or even a lack of self care. Vicarious Trauma comes with the job. The people who show up for treatment are almost always the walking wounded. Horror scarred trauma survivors who need someone to listen to them and feel their pain. Ask them questions about solutions and when they’ve done well and tell them they can do it. This is not without cost.
We know how empathy works in the brain. If you are given an electric shock certain brain areas light up on an f-mri scan. If you watch someone given an electric shock the same areas of the brain light up. Mirror neurons i think they call them that underlay our theory of mind. how we get into other peoples heads. What if you are an artist of getting into peoples heads. Maybe the negative energy would build up in you all day, almost every day so that by the end of the week you almost tingle with bad vibes.
Other peoples stress hurts your back and you feel that if you might be touched all you could do was shudder. You might become estranged from your own body and be soul sick empty. It might go up and down as your ability to tolerate it grows and becomes depleted from circumstances, real life events, that sort of thing. You might become afraid to handle it. shake it off. work it out. allow it to pass over and through you but not be you. maintain a core inviolate. but what if that just leads to ratcheting up the pressure. more. more. more.
I know what i can take and how much is good for me and i am solidly in the middle between the two. the only time i’ve worked in the field and not held symptoms of burn out was with cortez. i worked maybe 32 hours a week. 2-3 groups and maybe 10 clients, seen once weekly. i took a 4 day weekend every month, a week off every season and a month off in summer. i set my own schedule.
but i made squat and poverty has stresses of its own. the world is not organized this way. the world expects 40+ and more hard hours. i love being a clinician but it is not good for me. not in this world. but i’m learning and remain cautiously optimistic that i can find a way through the apparent inherent contradictions and do great things in a less costly way. Definitely success, people getting better, making a difference, more positive feedback then is good for me, is a counterweight to the hurts and pressures. my self care of course has a lot of room for improvement and that is probably where i need to go. the only factor really subject to change because it is under my power. gratitude of course. its whats carried me through this week til i ran up short feeling estranged and worn out but happy too at happy hour. putting it out there feels good too. i’m hesitant to share about my days unless they’re good. but one good thing about this space i don’t fear trouble. i am way beyond that.
interventions for co-occurring mental health symptoms
wasn’t feeling well today. a day of rest behind me and i don’t feel substantially better. will allow the days events to carry me through. feeling better then the neighbor though i imagine she was just taken away by the police. that is never really a good thing. it was the campus police which always weirds me out because their cop cars say “Mu Police” which always makes me think agents from the lost continent are prowling about.
i am watching the tigers game, up on the whitesox by 2 in the 3rd. planning on doing a little work. I have a training i am doing on wednesday and i swore i would write a handout. as per usual i like to do my creating on my own time in my own forum so that i own the fruits of my labor. plus work is a terrible place to try to create. you need space free of demands to make something new. mostly my work creativity is drug out me responding to situations. allowing solutions to develop.
if your a new reader i am a counselor at a substance abuse treatment agency where i coordinate some of our mental health programming and staff training. i have been trying to increase the counselors comfort in helping individuals with co-occurring mental health disorders because its way to common for me to handle all those folks.
Integrating Co-occurring Disorders Treatment into Substance Abuse Counseling Sessions
Principles:
The client is the biggest expert on their situation. You don’t have to know anything about the disorder to help the client manage it. So tell me about disorder X? What does it mean for you? Is there a time when it has been better then other times? What was that like? What did you do that made it better? Oh, that sounds like a good idea, do you think we could try that again?
There are no magic wands or “experts” who can do substantially more then you can. When I was a young clinician i referred out most tough stuff but when i did follow up contacts i learned that those referrals that were so hard to hustle up rarely yielded results. Appointments don’t get made, eligibility changes, someone doesn’t get engaged, there are endless ways that things go wrong. I began to notice my simple interventions were usually the most helpful thing. If you’ve got them engaged then likely no one can help them more then you can.
Mental illness is a concept with a lot of give and uncertainty. They can be thought of as nothing more then names we give to clusters of symptoms. Breaking down what symptoms are occurring and developing separate management plans for each symptom can be tremendously helpful.
Data is really useful and collecting it is good for you. Documenting negative behaviors decreases their frequency and the data collected can point to management strategies.
Treatments that people believe in are more effective. Treatments that individuals believe will not be effective will not be effective; we call this the Nocebo Effect and it is real and measurable and more powerful then morphine. Present yourself in a hopeful and confident manner, share some brief success stories.
Listening is still the most helpful thing you can do for someone. When someone tells their story to a supportive listener their self efficacy increases. A rising tide lifts all boats. Validate their struggle.
Techniques by Symptom:
Depression: Sunlight and exercise. Reframing. Separating feelings from behaviors. Cognitive approaches.
Mania: Catch it early. Sleep every night. Progressive relaxation.
Impulsivity: Slow things down. Strengthen powers of reflective thought. Keep long term goals in working memory. reward curbing impulses. work on something that happens all the time and then generalize.
Hallucinations/Delusions: Ask if they know if its real or not. If they do tell them don’t attend to them or give them energy. Learn to ignore it. Shift to the concrete. Never feed into it or ask for unneeded details. If they can’t tell its real they have to ask people they trust.
Paranoia: note if they describe it as such, it means they know its not real. If they truly think people are out to get them de-escalate and reassure.
anxiety: cognitive approaches work well as does data collection. scaling and exposure are the classic approaches. de-escalation and teaching self soothing is also key. exercise.
attention deficit: point out there are times they can pay attention. measure them and grow them systematically with rewards.
OCD: cognitive approaches.
suicidal ideation: ask, contract, normalize
SIB: validate as a valid coping mechanism, identify healthier coping mechanisms
Sleep Problems: exercise earlier in the day, cut back on caffeine, routine, progressive relaxation, Trazodone
Nightmares: Propranol,
Finding a doctor: Primary care is not a bad place to start they use less psychiatric medications in lower doses which can be a good thing for patients with addiction. If no insurance contact the Family Health Center (214-2314)and ask for the medical social worker for a referral to Medzou. If you frame it as a psychiatric issue he may not refer.
The Phoenix psychiatrist is reserved for existing patients and MAT evaluations. Good candidates: have no insurance, are alcohol or opiate dependent, have had numerous treatments, are willing to do aftercare with Phoenix for the long haul.
hot & wet
the heat continues here in the show me state. there is a heat advisory until friday at 7:00 pm. we were lucky the last couple of years so i am trying to bear it with good grace. no, that’s not strong enough. i am trying to enjoy it for what it is. been just running the air 24/7. we keep it on 79 here on leslie lane and with lows close to that and humidity there’s no real point. usually i like to let the dogs come and go in the morning at least, but this am i tried it for about 2 minutes and a bitter hot wind was flowing in so i closed her back up.
did spend a little time outside this morning. watered everything in the back. used city water because i didn’t want to fritter away the shade hooking up the hose to the water barrels. i want to do it in the morning because the water can get hot. trevor just got a wooden barrel for his house. i want to upgrade when these go to pot.
friday we went on a bit of a float trip. drove out to overton bottoms with jared and met up with eric and a buddy of his and trevor and a buddy of his although didn’t end up seeing them much. fido came along had a real good time. ended up smelling like a swamp. dove off the canoe twice and did some swimming. we canoed down but couldn’t get through to the river. canoeing through the woods is a rare experience.
yesterday canned pickles with sarah, went to the market and drank coffee with harry. saw the pitiful state of memorial hill and weeded it while the grill got going. roasted a local chicken over a can of ginger ale with some garlic thrown in. smoked it up with apple wood and fresh sage & brined it in balsamic, sugar and salt. roasted some sweet corn & polished off the cabbage/pasta salad.
for our outdoor adventure john and the dogs and i hiked up bear creek. went right the creek bed which gives it more of an outdoor feel dropping out of the sounds of the city and the dogs could be off leash some. fido got confident and started to wander so i leashed him up.
made for a long day so i went to bed early and slept late. had a long involved dream again largely work related. a client from the agency shot me in the shoulder with an electrical gun. hurt like hell but i was stoic about it and told him not to worry about it that i had bated him. i had said “go ahead and shoot me” or something of the sort, new it was the wrong thing to say at the time but dreams. the overall feeling was a stunned bemusement so that appears to be progress. usually my overall feeling is being overwhelmed or annoyed/frustrated. haven’t had a panic work nightmare for many years and several jobs.
this morning made french toast with black bear bakery wheat bread. i had sliced thick as it was crumbly and let air out but the slices were to thick and the batter didn’t seep all the way in so it was a little on the hardy side. french toast is not supposed to taste like its good for you. had a nice flavor though i fresh grated vanilla bean, nutmeg, cinnamon stick & star anise into the batter.
mowed the front lawn before it got unbearably hot. drinking my second round of coffee before gearing up for the next project. i’m going to make some zucchini soup i got out of the tribune. maybe i’ll be early enough on it to serve it with supper. going to do something with the left over chicken probably throw in my annie’s mac & cheese with some grape tomatoes and fried cabbage (if the moths left me any. my cabbage has been almost a total loss. handpicking was inadequate for the task so i am looking for a more aggressive organic solution or i may have to look at poisons or give up on home grown cabbage).
adventure can be inspiring
Its a hot day outside and enjoying some rare ac at home “relaxing and enjoying the work of justin verlander” to use the commentary without the expressed written consent of major league baseball. Its a slow game though and with only evenings and weekends for entropy control and to advance projects it seemed a good time to blog. as i said a post or two ago i am committed to blogging weekly if for nothing else to give the computer enough time online to do updates. i feel like my last couple read like that too.
Overall, i’ve been a little low energy which is not unexpected but inconvenient as the world expects me to jam, all day almost every day. i’ve been on top of that but not much else, personal life items i’ve left without the attention to detail and positive effort they require. but today i am tired but a good kind of tired. not as tired as verlander, its 98 in KC and he’s over the century mark and a fast hurler. in his defense he’s in much better shape, which sort of relates to what i’m going to be blogging about. adventure can be inspiring.
friday i lit out of work right on time and threw some things together for a float trip with eric and trevor. we were going to go camp somewhere close and then float the grand, conditions permitting. [verlander’s getting some rest after an inge error cost him his shut out, there’s bases loaded with a 1 run lead] i loaded a lot of stuff since i had the space and time and wasn’t exactly sure what the camping would be like. i also gave everything a good solid drink in the garden because it was supposed to be hot and stuff was thirsty. i also found this ginormous tomato horned worm and squished him. he’d done some damage and i feel like there’s at least another one but i can’t find him. maybe tonight when its in the shade.
at close to 6 i decided i would see if i could load the boat. if you’re not a regular reader i have short and stubby plastic canoe that slides nicely into the back of the popster’s f 250, one strap and its secure. its really growing on me. my brother got it for a float with smokey down the big muddy and its both short and has a huge keel which makes it maneuverable for a solo boater. also makes it convenient not to have to strap it on top. plus people are always impressed with all the cup holders. john calls it “the Cadillac of cheap canoes”.
but i never got to see if i could load it myself because mark, who i knew was a possible drove up and helped me load it and ably strapped it down. i have a thing about scraps and am majorly inept for having been dealing with them my whole life. its probably a complex but i’m almost 500 words into this post and haven’t even left yet so i got to pick up the pace. mark followed me over to trevor’s and we had a PBR in the front yard and strategized. the grand was flooded and there was no nearby camping so we decided to do locust creek through pershing state park. [the royals announcer gave a nice run down on victor martinez, he came to the tigers not up to potential, got in ‘short stop shape’ and this year he’s an all star. cabrerra has also dropped some pounds (but he was a monster last year big as a house)]
mark rode up with me and it was nice to reconnect as we both have been through some stuff and could relate and we had a good talk about grief. we stopped in macon for mexican food. i got alleged tamales which were either these little deep fried things which were pretty good or a mass of corn meal with an array of chicken and hamburger. not bad but not tamales. i also realized i forgot fido’s bowl, remembering i had let it be when i thought to pack it in case he wanted to eat before the treat. i walked over to walmart and got some iam’s little dog cereal and a couple of other things.
so with all that we rolled into pershing state park pretty late. it was an rv kind of park but the entrance was empty so we were off by ourselves and they have showers. not bad really for $11 i think for a nonelectric site. i didn’t want to chance setting up the tent not really knowing if its mine. john and i both had Marmots and he had packed up the camping stuff conflating our things and i couldn’t remember what model i have. so i decided to just sleep on the cot which was a bad idea from the start because of the mosquitoes and not packing a sheet. plus the raccoons were persistent and fido was barking and facing off and i didn’t get to sleep until they called it a night at sunrise, except for the four stuck in the dumpster. [valverde holds the lead and the tiges go into the all star break in first beating out the hated cleveland racists] so maybe 2 hours sleep tops.
but i woke up a little groggy but feeling good. eric makes this coffee concentrate and i mixed it strong and everyone enjoyed the can of condensed milk i broke out. a camping trick i learned from the popster who liked to live large. it was also good with the oatmeal mark made with lots of chopped almonds as it sweetened it up a little. i read the paper and drank my coffee and felt human enough to do the dishes. we drove south to find a pull out, checked out a little iron bridge and talked to a local who didn’t know anything about floating conditions. we drove south and found a spot and left the red truck.
we drove up to 36 i think and went west to the first pull off and found a good put in place. this is norther missouri bottom land. flat and rich mostly agricultural. there’s a nicely maintained riparian zone down the creek and it was muddy but of a goodly size. trevor saw a flat turtle and we both encountered a snake at the first log jam. it looks like he was fishing were everything just suddenly comes to a halt. we looked around and he disappeared. we ended up with a fairly lengthy portage which we did with good sport and a lot of gratitude as we ran into some really great wooded wetland with some really big old beach trees that certainly predated settlement. they didn’t look as big as the biggies in the spot of alleged old growth in Houston Woods in Ohio but they were really good sized and it was a mature forest.
we pushed through both poison ivy and stinging nettles to get back to the creek and were glad to get in the water and ended with no ill effects of either except from some nettle-itch at the time which is invigorating if you can look at it right. we ended up having 2 more portages and saving a third one by lifting the canoe over a fallen log at the third obstruction. nonetheless we all had fun and the portages made it more of an adventure, our own voyage of discovery and a good time was had by all.
especially fido who enjoyed his first float. he enjoyed being off leash as we scouted pull outs and put ins and had been on a swim and was reluctant for me to grab him up and throw him on the canoe. He jumped out once preferring to swim or run along side but he got used to it. we stopped to pick a couple of ripe blackberries (in a week or 2 it will be an excellent float with a lot of berries pickable by boat. I had fido on a leash when we picked berries or he would have abandoned the expedition.
I bet he’s glad he stayed though cuz we hiked in out of the way places, swam when we got hot. one nice place had a shady log and there was one of the few bluffs and the creek had carved out a nice deep swimming hole. fido swam across even though it was wide and deep with a strong current. he is a doughty sailor dog just like bichon frise’ are supposed to be. we had lunch really great cheese and avocado on black bear bakery bread which were very yummy. i wish i would have brought my first tomato though, although we may have that for dinner tonight. kevin made hummus and tabbouleh.
at our lunch stop i really struggled. i sank into the mud up to my knees and lost a shoe and was really stuck for a minute. had to have help to scramble up the muddy bank to the luncheon log. it really struck home my desire to get into better shape and the need to be way more on it now that i am getting older. i’ve been cutting myself to much slack for having a hard life and still need exercise more and eat better. i was more convinced when i was the only one that was completely done in (except for fido) at the end of the day. eric was kind enough to drag my boat out and carry it up to the truck.
but the adventure was fun. it could have been an ordeal which that uncertainty is a prerequisite of adventure. we were all resourceful, flexible and laid back so we would have rolled with whatever and made it work but it was big enough to be a challenge but doable enough to be pure fun. we all enjoyed some country cooking and had the buffet and i ate good. but not so good as has been my habit of late.
been pretty on it today too. slept hard and good and woke up refreshed and feeling like i’d done something. drank coffee and read the paper. roasted my first batch of beans, an ultra-light Guatemalan that looks awesome and i’m eager to try. i’ll let you know in a day or two how it is. then i mowed the back yard before it got to hot, got some laundry hung and made it to the wabash farmers/art market. got some sweet corn, cucumber for the humus, and some peaches (pricy but good). decided to skip malick’s new one but saw it was playing through thursday so i might still catch it. been thinking about asking someone out. haven’t done that in many years.
Four “A”s
I am putting together a new group for work and as always I prefer to do my creative efforts at home in my own time. I have always worked that way finding the day to day grind and meeting responsibilities, deadlines and helping people makes work fairly frenetic most of the time and not a great space for thoughtful creative enterprises. I’ve had my best therapeutic insights, come up with a new approach to a stuck problem in just musing on it a bit on my own time. When I was married I would get checked for not leaving work at work but if you enter the helping professions sometimes a little more is asked of you. I don’t fret about work, worry about my clients, or beat myself up over outcomes. I do sometimes brainstorm, ponder, muse, pray for the people who are struggling who cross my paths. Its part of caring about people.
I also like to do my creative thinking at home so that I continue to own my own thoughts. If I were laying this out on my office computer on the clock then there would be every expectation that the fruits of my labor would belong to my employer. Now I am pretty much anti-copyright but I would hate to see a situation where I don’t have access to my own ideas because someone else owns them. So most of my original stuff makes its first appearance here.
The state of Missouri pays substance abuse treatment agencies for two types of groups, education groups and process groups. Education groups you teach something and that is my preferred mode of operation. Education is not a particularly effective intervention for people struggling with drug abuse and addiction. Most of them know drugs and alcohol can be bad and recovery can be a road out when you’ve lost the ability to find your own way. Motivation is actually the name of the game and so education groups have become an opportunity to grow my motivational speaking abilities. Its more akin to preaching then teaching and has been a lot of fun.
Process groups are group therapy. In education groups I make my personality very large and in process I make it very small. I start each group with a check in. Your name and how are you feeling. I point out identifying and resolving feelings is key for recovery. Rather then provide a feelings list (there are many if you google them) I want to stimulate creativity and honest expression I just ban a few meaningless pleasantries: good, fine, OK, & alright. I also ban “tired” as a body feeling and rarely an emotion. Then I define what process means and ask people to do it, sit back and watch. Nod, call on people and ask questions when no one is talking. If everyone didn’t participate I do a check out of what stood out in treatment today?
It works fine, have heard many times, “that was the best process group I’ve been in”. But my new slot is 7:00 pm, much too late for an unstructured member driven process group. So instead I want to do something highly structured that is still a group process activity. I have been kicking around a self help/social change group for many years. This seems an ideal time to kick it off. I am going to call it an Accountability Group and organize it around what I call the 4 “A”s: Awareness, Assessment, Action, and Accountability. I thought about calling it 4 A or AAAA as well. It will be set up on a level system and to go with the 4 “A”s there will be 4 life areas: physical, mental, emotional, and spiritual.
We’ll begin the group with a check in and perhaps expanded introduction. The first week will be all about Awareness which begins the change process. Identification and informal observation.That can last one week to forever. Out of that Awareness we will develop Assessment tools to measure and create a baseline. Usually for two weeks. Out of that data an Action Plan will be developed. Accountability will come from the group as well as mutual support and the sharing of ideas.
I envision a 16 week process and leveling people up as they get things done. Making it easy to start, just be aware but making the next levels having concrete achievements tied into it. After you move through the whole system for all four areas you are ready to start your own 4A group. We’ll develop tools for each level and documentation and accountability systems collaboratively over time.
January’s done
Hello faithful readers. Sorry I have not been posting. January was a challenging month and I continue to have some computer problems that I haven’t felt like dealing with. I also had my boss talk to me about a negative mood state I incidentally mentioned and that has had a chilling effect on what I want to post about. Now I see why more people don’t have an honest and revealing blog. Nonetheless this is a periodic blog and so regardless of the consequences I am going to periodically blog something. Today I am up early waiting for the snow to start. We are awaiting Columbia’s first blizzard warning. 18″ to 22″ by tomorrow noon. We have gotten a lot of snow this winter and I have been really enjoying it.
My New Year’s resolution was to work on getting in better shape this year. I started with weigh ins on most days and writing down everything I ate and all the exercise I did. A solid plan that started out nicely but as the month continued I started to get depressed and decided this was not the time for any volunteer upheaval in my life. I am stretched to meet the things I need to do. The only piece I kept was the exercise peace. If you know me at all I am not one for the gyms. I enjoy real physical activity that is purposeful and utilitarian, so mostly I walk. Almost every day. The weather really challenged that this year and I have risen to the occasion and gotten out there anyway. Its been really cool getting out on the bear creek trail and seeing no tracks but what fido and i laid down on our last walk.
Sidewalks have been my obsession. Most people don’t shovel here in Columbia, which offends my Michigan sensibilities where almost everyone does. It makes it a lot more challenging when you get pushed out into the road, especially with a small dog. The alternative is to push through deep snow on the sidewalks. Fido wears out pushing through chest deep snow on a steady pace the leash demands. He’s great off leash. He leaps and hops and catches his breath and continues the mad dash. He can run circles around me, literally, but can’t trudge. So when he is exhausted before the trail and we have to turn around and go home, probably walking down the road with car’s not slowing and some not even looking up from their texts it frankly pisses me off and has been a source of rancor all winter.
I want to approach McKnight plaza as a concerned neighbor. They have a lot of sidewalk and if they shoveled it would have a huge impact on the neighborhood. It would even be in their own interest and not just a community service. They are trying to lease a big chunk of it and if they shoveled it wouldn’t tip their hand that their isn’t a lot of foot traffic. If the sidewalks were cleared there might in fact be foot traffic. I would approach them as a faithful Itchy’s customer (awesome flea market) but I feel like a hypocrite with my work’s sidewalks unshoveled across the street. I almost shoveled them myself and looking back I wish i would have. Feeling a need to do something and not doing anything is not a good way to feel better about something. With the blizzard coming I don’t know when i’ll be able to get out with the little dog. After knocking out my driveway I might just walk down the street and knock it out at work. then i might give Mcknight a call.
Writing this I can see I’ve lost all perspective. little things can loom large in the narrowing of winter. Dad too has been down. Dennis’s birthday on the 15th has historically been a hard day. Less so over the years but this year seemed tough. With Mom’s b-day coming up on 1/31 i was a little concerned. Talking it over with a co-worker she suggested we do something special. So last night we went to Outback Steakhouse. On one of my folks’ few vacations they had gone to Branson and loved Outback. It made what could have been a tough day kind of festive and a time to celebrate. Not a bad recipe for most difficult things.
complaint free me
Last week was long and challenging. I’m working around a couple people’s work schedule and just working more in general. I went in last weekend and got caught up a bit which felt good the first part of the week when i could knock out some little things because i didn’t have the constantly existing backlog. Last session Wednesday I fell behind and then never got a chance to get caught back up. Jamming all day every day and falling a bit more behind. I’m not complaining just painting a context for where i was at friday afternoon when a co-worker asked if she could incorporate acomplaintfreeworld.org bracelets in her group. How it works is you where a bracelet and every time you complain you move it to the other arm. You do that until it stays on one wrist for 21 days. She said its 21 days because scientists say that’s how long it takes to form a habit. I questioned that. Sounds more like folk wisdom. She likes the gratitude angle and I do too. I asked her if gratitude has a downside. If it does we didn’t know it. I discussed venting, and she offered a venting exception, which I pooh poohed. Venting has a dark side, the rehearsal for a blow out. It keeps negative emotions alive when sometimes they just need to pass I told her. I said there has to be a way of letting off steam without complaining and I put it on. I said I would probably have to wear it for years. She said she ordered a 100 for when it wears out. It was late in the day and served as a nice reminder. I would’ve complained twice before leaving work if I hadn’t been wearing it. The bracelet was working. After work started to putter around the yard, beautiful day and a lot of projects to do. learned dad hadn’t eaten yet except for some candy. so i didn’t garden but got right on supper. i was already complaining and switching the bracelet. Dad had talked about cooking together because he had gotten all the stuff for walnut crusted chicken breast and a broccoli side dish out of Wednesdays Columbia Tribune. I washed the dishes and Dad talked about his day. Amy had come over with Olive Oil to play with Fido and Dad told me the blow by blow. Olive stayed over while Amy went to the dentist. she brought a box of tea and a bag of starbucks house blend. I’m pretty thankful for Amy. Comes over twice a week and hangs out with the popster for puppy play dates. I read through the recipes and decided to chop up everything then start the water for the pasta. i was chopping the walnuts when dad came to cook to. said i should crush the walnuts with a pop bottle. I told him advice wasn’t help and swapped the bracelet. i said i would just cook. the chicken called for chicken breasts pounded down to 1/2 ” thick. salt and fresh ground pepper on them. then you dip them in egg white and roll them in corn meal with cayenne. back in the egg white and then roll them in chopped walnuts. fry in olive oil until done. the broccoli dish called for boiling some pasta for 5 minutes, add broccoli, finish boiling pour off all but 1/4 cup add 2 tbsp olive oil and a clove diced garlic. the chicken took a lot longer than i anticipated and my rice pasta fell apart. sliced some maters, a black plum, yellow teardrop, what was supposed to be a green zebra but they keep turning orange (orange zebra?), and a store bought with some cottage cheese. Dad was trying to tell me about amy and michael’s date night, i told him i was busy, he said what, i yelled i was busy, 2 complicated dishes after a long complicated day i could not listen too. i couldn’t move the bracelet my hands were gooked up with chicken gook i totally lost my composure. i took a breath decided to complain again so it was on the right wrist and just get ‘er done. supper was excellent, the chicken really out of this world. the broccoli was tasty as well even dripping in gloppy rice scum. dad was complimentary. said he could see where i was coming from. it was really sweet. saturday though i got going rehashing friday night to sarah and harry. made my point about venting. there wasn’t anything unresolved, we talked about it fine, i was heard, it was acknowledged. the next day gripe was resentment pure and simple, with no need. a few more incidental complaints then i hit a stride. today complaint free, even though dad told me “quit complaining” when i was telling him he shouldn’t be buying the dog junk food treats. that was just telling him my view on our shared beast even if he knew and even if i’d said it before. mostly though i’ve just been a bit more positive. It’d be easy to take out my frustrations on dad, he’s around, it can be frustrating as i start to pick up even more of the upkeep of the house. but it wouldn’t be right. it wouldn’t be what i am about. i am looking forward to hitting day 3 tomorrow and being more grateful and less resentful.
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