You Tell Me Control

I've been thinking a lot about control over the past week or so. Mostly because several things have happened in various areas of my life, and I've had almost no control over any of it.

In my work with clients, I spend a lot of time talking with parents about their children's "high need for control." They wonder why a child would do something so obviously self-sabotaging as laughing at a parent's reprimand or intentionally hurting someone. They're shocked that the child seems to be so excited and delighted at causing them distress and frustration.

Sometimes the word "manipulative" gets used.

I always shy away from that particular term. Words are powerful, and if you use a word like that, I think it attaches a lot of adultish meaning and intention to the behavior of a child.

So instead of "manipulation", we talk about control. And how some kids, some people, seem to need it more than others. It comes out in so many different ways, too. Some good, some bad. The need for control is a basic human feature, after all. One central to many of the rights and values we hold dear. It's important. But some of us are better than others at letting it go, or at facing the reality that we don't really have that much to begin with. And some of us struggle with it.

That's what I've been thinking about. Now I'll give you an example from my own life, from just last week, which, I confess, was a rough one. Because she is lovely and sensitive, Kathleen, my agent, asked me if there was anything she could do in light of the various things I'm dealing with (nothing life-threatening or devastating, so no worries!). She reassured me I could take longer to get certain things done, et cetera. And I said to her--send me the revision notes for my WIP as soon as possible, please. I need to dive into them. I need to bury myself in something. I need to feel like I have control over something.

She came through for me; she sent me a five page editorial letter. And for the last few days, I've been happily tinkering with the world I've built within this WIP, writing new chapters, clarifying character motivation, slicing out inconsistency, wrestling with how to shoehorn the economic concept of the gold standard into a futuristic monetary system based on electronic credits (it's an action-packed urban fantasy/romance, I swear).

Let me tell you, this revising felt good. Cleansing and thrilling. This was something that was all me, all about what I could do in response to critique, how far I could stretch my creativity, whether I could meet the challenge. If these revisions suck, that's because I screwed them up. If they're good, that's me, too. I'm so grateful to have had this task--because I needed something to control.

While I sort out my control issues, tell me. Do you have a high need for control? How does it come out in your life? How about your writing? When does it help, and does it ever hurt you or get in the way?

Remember to check out Lydia's Medical Monday post and Laura's Mental Health Monday post today!

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More Great Quotable Quotes from People Who Agree with Me About Stuff

Today's post is the second of a series of two containing some of my favorite recent quotes that center around themes discussed in this blog. 

As mentioned, I have been collecting the quotes and putting them on my Facebook fan page at http://www.facebook.com/pages/David-M-Allen-MD/80658565761?fref=ts. The ones posted here started in January of 2014, and are loosely organized by topic. 

Family Dysfunction

"Taking responsibility for something and self-blame are horses of two entirely different colors. The former is empowering; the latter is paralyzing." ~ John Rosemond, Ph.D

Chronic Mental Illness

Our prison population is bigger than Slovenia
Cause we put people in jail instead of treating schizophrenia 
        ~ John Oliver

On trying to find the cause of schizophrenia: "30 wasted years of looking for bad mothers followed by 30 wasted years looking for bad genes." ~ E. Fuller Torrey, M.D.

Psychiatric Practice, Electronic Medical Records, and Managed Care

"The shift from benzodiazepines [for anxiety disorders] to antidepressants is one of the most spectacular achievements of propaganda in psychiatry." ~ Giovanni Fava, M.D., clinical professor of psychiatry at SUNY in Buffalo.

"You're complaining about a Freudian slip? Freud should be able to wear whatever he wants." ~ Tony Kreitzberg

"Why would anyone want to teach me to tolerate my pain? My only interest is in removing it!” ~ Cynthia Mueller, a blog reader, when first exposed to the DBT treatment model for borderline personality disorder.

"Methadone and Buprenorphine [suboxone] should be our first line opiates for use in the treatment of severe acute pain. That way, if patients become addicted to them, they would already be taking the appropriate treatment for their addiction!" ~ Steven A. King, M.D.

"The current EHR has destroyed the narrative, especially in psychiatry, and converted the basis of care to a checklist." ~ George Dawson, M.D.

"It's not just about doing the right thing for your patients, it's about proving to someone else that you've done the right thing, and sometimes "I can't quite remember if I'm an underpaid physician or an overpaid data entry clerk!" ~ Dr. J.D., Family physician.

"The proving [that I did right by a patient] takes longer than the doing." Chrisitine Sinsky, M.D.

"You don't need any research to show that if you are cycling people with serious mental illnesses in and out of short stay psychiatric units in 3 - 5 days and basing their stay there on whether or not they are "dangerous" and using treatments that take weeks to work that by definition you are appearing to treat many more patients but providing adequate treatment to very few. You don't need any research to show that when you shift mental health care from psychiatric units run by psychiatrists to county jails that the outcomes will be worse. You don't need any research to show that when people do not get research-based psychotherapies in the manner that they were designed and instead get a few crisis oriented sessions that do not address their basic problems that outcomes cannot hope to be better. When your attitude is that all mental health treatment can proceed by treating common problems with definite social etiologies with medications as fast as possible and not having an intelligent conversation or working alliance with the person affected - it is logical that treatment outcomes will not improve. Treatment outcomes do not improve if you do not provide effective treatment and that is the mental health landscape at this time." ~ George Dawson, M.D.

"I don’t know if anyone has ever not tensed at being told to relax." ~ Carolyn Hax

"Health care systems that allow patients to rate their doctors on satisfaction ratings without considering that patients might be dissatisfied with reality should be held to task." ~ George Dawson, M.D.

"You want a tale of two cities...look how the financial services industry has captured regulation to their advantage vs. how doctors have been battered by regulation. But it's based on the mind-set of Goldman Sachs vs. the mindset of the family practitioner...who politically shows up for a gunfight with a butter knife." ~ James O'Brien, M.D.

"Managed care has done an expert job of cost shifting by developing business friendly treatment criteria, abandoning the social and community mission of treating difficult problems associated with mental illness and addiction, and removing the element of humanism from psychiatric treatment. When I first started to practice, discharging people from a hospital when a psychiatrist had serious concerns about whether or not they could make it or whether they would be safe was very uncommon. Today those discharges are the rule rather than the exception largely due to the imaginary dangerousness criteria. "~ George Dawson, M.D.

Drug War

"When we talk about marijuana as a gateway drug, we have to remember that the last three occupants of the White House have smoked marijuana. We can very well say marijuana is a gateway drug to the White House” ~ Carl Hart, Ph.D

Psychiatric Diagnosis

"Then there’s the matter of testing a child to determine if he has ADHD. The plain fact is that none of the published diagnostic criteria depend upon test results. They refer to behavior, period." ~ John Rosemond, Ph.D.

"A [mental] disorder does not operate with [social environmental] discrimination. If something was “wrong” with [your child], she would be obnoxious in front of friends, their parents, teachers, and the people in white coats who came to take her away (tra la, for those who appreciate the reference)."
~ John Rosemond, Ph.D.        

            ("Actually, "Ha Ha" and not "Tra La" ~ Napoleon XIV)

A reader writes that her friends 'recently spent around $300 on their daughter’s birthday party—her first. They bought lots of stuff to entertain their young guests and extended family. The child, a baby, obviously had no clue what was going on. I should mention that the parents are struggling to make ends meet.' As my readers know or should know, I am a psychologist. That qualifies me to determine and assign psychological diagnoses. As such, it seems obvious to me that these parents suffer from a now-commonplace parenting malady known as just plain nuts." ~ John Rosemond, Ph.D.

"One symptom does not make a diagnosis " ~ John Rosemond, Ph.D.

"Test anxiety is frequently not an aberrant psychological response - it is instead the normal anxiety anyone would feel in facing a situation for which they were inadequately prepared." ~ Barbara Oakley, Ph.D.

"Under the influence of intense affects, EVERYBODY becomes an idiot."~ Otto Kernberg, M.D.

"Only in America does 'gotta' substitute for 'wanna' so we can avoid the guilt. " ~ The Last Psychiatrist

ADHD

"An often trivialized cause of irritability, difficulty concentrating, reduced vigilance, distractibility, decreased motivation, lack of energy,and disturbed mood: insufficient sleep syndrome. People with this syndrome, common in our 24 hour society, intentionally curtail sleep for work, social, family, or other reasons. According to the International Classification of Sleep Disorders, a practical and effective remedy does exist: more sleep." ~ Psychiatric News.

"The maps of child obesity in the U.S. look suspiciously like those of the ADHD epidemic, with the highest rates in the deep South." ~ Psycritic

"It’s truly surprising how many parents have been told that if their child did not have ADHD the child would not respond to stimulant drugs. In the blitzkrieg of World War II, German bomber pilots took a stimulant drug with a chemical structure similar to that of Adderall. When the American military discovered how much the stimulants helped German pilots, they put stimulants in the kit of every American and British bomber pilot to improve their concentration and alertness on long-haul missions. Surely not all these pilots had ADHD." ~ Marilyn Wedge, Ph.D.

"...after taking the [drug company-designed screening] ADHD quiz, I've realized that both I and my cat have the dreaded disease. I'm off to get us both the treatment we need." ~ Anonymous comment on one of my blog posts.

Evolutionary Psychology

"Selfishness beats altruism within groups. Altruistic groups beat selfish groups. All else is commentary." ~ David Sloan Wilson, Ph.D.

"We mammals are curiously preoccupied with social hierarchy. You may say you don’t care about status, but if you filled a room with people who said that, they’d soon form a hierarchy based on how anti-status each person claims to be." ~ Loretta Breuning, Ph.D.

The Manny Diaries Chapter Fourteen Someone Whacked Me on the Head and Stole My Pants

The Manny has had a spate of bad luck lately, but I want to reassure all his fans that he is absolutely fine, despite the rather ominous tone of this post's title. If I were more verbose, the title of this post would have been "Someone whacked me on the head and stole my pants, shoes, and underwear, and then some ladies found me lying stone cold naked from the waist down in a bush," which is decidedly worse. Because who steals underwear?! And why leave the shirt and take the skivvies?

This is so much more acrobatic than it must have really looked, and my Photoshop is poo, but how long do YOU want to Google terms like "Hairy male legs protruding from bush" before you have to permanently clear your browsing history and take a scalding shower? 

But let's back up. A while back, we got a phone call from Manny, who had suffered a stroke/seizure sort of thing and was slurring and hiccuping uncontrollably. Luckily, the stroke/seizure sort of thing had occurred while his kind landlord, Rudolfo, was on hand unstopping the toilet.

"Apparently, you're not supposed to put TP in the toilet in Mexico," says Manny. "Because I got it all clogged up. Why do they call it toilet paper, anyway? If it doesn't go in the toilet what kind of paper IS it?"

Manny suddenly keeled over and whacked his head on the floor and commenced bleeding and writhing. He related the story as such:

"I fell flat on my head. I almost died! I was bleeding out on the floor! Rudolfo, he sticks his wallet in my mouth so I won't bite myself. But it's too late. I already swallowed some of my tongue! I mean, a big chunk of my tongue! I think I swallowed it!"

"So anyway, Dora, my landlady, calls the Red Cross. She says to me, you're not going to die today, and especially not in my apartment. Meanwhile, my skull is cracked open. It was too much! Did you know that a quarter-inch of my tongue is missing because of the crazy-ass seizure I had?"

"The Red Cross tell me I have brain enamelies. I was fledge-e-ling around all over the floor. My arms were in the air! I bit my tongue off! My mind is crazy! The Red Cross told me that my tongue will fix itself."

He seemed okay, though, and fairly jolly despite what had happened. The Red Cross didn't charge him a penny. He hiccuped and blamed it on the "brain enamelies." He didn't drink anymore, of course!

He went on, sharing more details of his life in Mexico:

"So then, the lady with the scorpion tattoo calls me. I met her at the Learning Library—all the gringos go there. She tells me about the guy who put scorpions in the Mezcal. He cuts their stingers off. Charges $250 a bottle. Hey, my eyes are doing weird shit. There is a guy here who is trying to sell me an AK-47. I've gotten old, and OLD! One day this crazy German chick shows up at my door. She wants to sleep with me!"

"Did you sleep with her?" one of us asked.

"You know I'm a private guy! I don't like to talk about that stuff! How dare you ask me! Yeah, I did.

See, I'm glaringly honest about everything now. I'm like a retarded child! And I'm not drinking a drop."

Then he started talking about how awesome Mexico was and how we all had to come down and live there because it's so beautiful and so safe and marvelous. He planned to rent a beach house. He hoped that we would serve as his "memory," because his brain was doing weird tricks and couldn't remember things properly anymore. 

It might have had a little bit to do with the night, a few weeks later, when someone whacked his skull with a crowbar and took all the clothing off his nethers. He was lost, walking around dazed in some neighborhood, when someone gave him a whack and left him slumped in the weeds, free of pants and shoeless.

"They even took my underwear," he said. "The Red Cross made me some paper towel underwear. I still have a big dent in my head. Like a HOLE in my head, Miss Jennifer. It was awful."

Disposable undies. Not the finest.

During the incident, the poor man bit his tongue again. Maybe a wee little chunk went down the gullet?

But he's still in fighting form, despite the fact that on top of all this, he had a heart attack not too long ago. The Red Cross told him he probably had the heart attack because he stopped drinking so suddenly that it shocked his system. "Remember that day you picked me up on the side of the road?" he said. "That wasn't alcohol. It was my HEART."

But, mind you, he is not drinking now. Ahem. His landlords are the kindest people possible—much unlike his previous landlords, who kicked him out for giving the Mexican workers free beans and rice. The Mexicans shouldn't "get used to the idea that they get anything for free."

"You don't do that to people, that isn't right," he said. "He told me, you will either be shot or arrested. So I left."

He's a good person. He delivers meat to some of the local men, whose wives reportedly hate him because all they serve is beans and rice, and he shows up with steak and mushrooms.

"My life right now is the best thing that's ever happened to me. I pay $235/month to live here. And they feed me three meals a day," he said. "Oh, and I'm about to get married to their niece. She's only 25, and she likes me. Her name? What? No, I didn't forget her name, I just don't remember it. She likes me a lot! We're going to move into a bigger place. She wants to take care of me!"

Manny had just been to a 9-year-old's birthday party, where he had been offered alcohol, and he vociferously refused. Purportedly.

"I'm so much healthier. Listen to how I'm talking. This is not crazy! I feel so much better. I am healthy! I am not worried about drinking too much. I love it so much here. They knock on my bedroom window at 11 at night and bring me tostadas. This is a good world. This is a good place."

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