Dear Dr. Gottlieb
I have just learned that a person with whom I was very close in years past (I was maid of honor in her wedding MANY years ago) has had an accident resulting in a spinal cord injury, the loss of her mobility, and as a result the loss of a career in which she was both successful and reknown.
Hello Dr. Dan,
I watched the movie, “The Soloist” tonight about Steve Lopez’ relationship with Nathaniel Ayers, the inspirational homeless musician in LA. I’m thinking you may have seen the movie/read the book. There are some very compelling scenes depicting some schizophrenic episodes with Nathaniel hearing voices that clearly distract him from reality. I’m wondering if, from your experiences and expertise, you can share your insights on the authenticity of the movie, especially regarding the relationship between Ayers and Lopez and the mental illness symptoms of many of the homeless people depicted in the film.
I’m a Theology teacher in a Catholic high school and in my Senior classes, we study homelessness—the realities, the impact, the causes and consequences. I’m thinking that this movie may be useful.
I look forward to any insights you can offer me, Dr. Dan.
Peace and blessings,
Dear Susie Eyler,
As you may know, schizophrenia is one of the most disabling of all of the psychiatric disorders. It affects over 2 million people in this country and about 15% of them are either on the streets or in prison. Like we saw in the movie, first symptoms occur in men in their late teens and early 20s, later in women. The hallucinations and delusions that you saw may be the most dramatic symptom of schizophrenia but far from the only ones. These symptoms make most with schizophrenia fearful and withdrawn, but sometimes they can become terrified of what happens in their minds.
And because those with schizophrenia look and act strange and appear timid and frightened, they are at high risk to become victims of violence, especially if they are in prison or on the streets.
We have known for a while that schizophrenia is a brain disorder that is based in genetics, we are still pretty far from understanding the exact causes. But that doesn't mean it's untreatable. New medications are coming out every day with more awaiting approval from the FDA. There have also been improvements in our understanding of what psychosocial treatments are more effective. Some of the cognitive therapies are also showing promise. And with good and consistent treatment, it is estimated that after five years 50% are improved enough that they are able to function independently. Another 25% are improved but require ongoing supportive therapies. Of the remaining 25%, about 15% of them are hospitalized. Sadly, suicide accounts for the other 10%.
But those statistics are for people who receive treatment. People who have supportive networks to make sure they get the treatment they need. And that is not the case with many people who have schizophrenia or other major mental illnesses. They are left to the care of public institutions that are overburdened, underfunded and unable to effectively meet the needs of those who need their services most.
Which gets us to Nathaniel Ayers in "The Soloist"
Given the Hollywood requirement for both drama and relative simplicity, I think they did a pretty good job of portraying schizophrenia fairly. But what they did beautifully was to portray the humanity behind the illness.
I discovered this as a brand-new psychologist in 1969 when my first patient, Norma, shuffled into my office for the first independent psychotherapy session of my career. Norma had schizophrenia and had carried the diagnosis for 30 years. I was 23 years old at the time! Of course, I had to prove to both of us that I was a competent psychologist who would treat her. As soon as we started talking, she nailed me. She told me in her own confused way that I had no idea what I was doing and that I was making it up! Of course, she was right. But she wasn't angry or hostile about it as I might have been if the situation was reversed. Instead, she was more playful which enabled me to get comfortable with the relationship we had rather than the one we were supposed to have. Norma and I didn't communicate well with words, often we didn't understand each other's language at all, but there was a connection. Sometimes when the words stopped, we looked in each other's eyes and smiled.
Norma never really got better, and a couple of years later, I heard that she died on the streets. I cried as I would have hearing any friend had died.
20 years later I was working with a 20-year-old girl who was suffering with depression and an eating disorder. One day she said "I feel like my soul is a diamond locked inside of a malignant tumor." Hearing that, I thought of Norma and my eyes welled up with tears.
If Norma's mind was clearer, I am sure she could have said the same thing. And my guess is that most people living on the streets could also say the same thing.
You see, in my mind, these are not street people or schizophrenics, these are people who experience their lives the same way my 20-year-old patient did.
And our responsibility as a community is to know that and do whatever we can to see that diamond.
Dear Dr. Dan,
I've been facing a very painful realization about the impact my work is having on me. I counsel cancer patients both in person and online. I’ve been doing this for years and always felt so good from reassuring people about their diagnosis and care options since I had to go it alone when I had this cancer. But I feel like I’m getting burned out.
I’m discouraged that the therapies are not more effective and that sometimes I have this private knowledge that I know someone will die. I don’t know how oncologists do it.I also worry about being older and how much future I have left and whether I’m living enough for today. I have trouble sleeping at times too. I think about “my” patients a lot, especially one I’m working with who has a recurrence.
Dear Dr. Dan Gottlieb,A few months ago I heard part of your show on the topic of caring and sympathetic doctors. The part of the show I heard was unanimous that doctors should feel the pain of their patients. I can agree with that. A few years ago I walked out of the office of a doctor who was not very caring. Doctors, funeral home directors, police officers, firemen, clergy, teachers, etc. and really all of us in helping professions can be more sympathetic. At the same time anyone who has a career in helping people, especially in their crisis times, has to be able to put away from the pain of others or that professional will not be able to survive emotionally for very long. I am a pastor, and in one day I presided at the wedding of two very special people and two hours later I presided at the funeral of a beloved person. In the morning I felt joy with one family and in the afternoon I felt grief with another family. In the evening I had to disengage from both of those families and focus on my own family. To carry home the emotions, especially the grief, of earlier in the day would not be fair to my family. Now speaking as an individual, I do have my special, unique pains that I feel and live through and I can’t expect every person to feel the pain to the same intensity that I do. I don’t want others to pretend.
thank you for writing this letter as I am going to deal with this subject in my column next week. Many caregivers suffer with what is called compassion fatigue because those of us who care deeply often have difficulty establishing appropriate boundaries.I will later which will be the subject of my column
Dan GottliebDear Dan,
I have been married for 20 years and the majority of them have been unhappy. My husband has been controlling and unloving. And we have two adolescent children.
Recently, a very good friend confessed his feelings for me. I, too, had the same feelings for him. Over several months, we tried desperately to break our relationship off and go back to our spouses.
A friend of mine was in an abusive (physically and verbally) marriage. AFTER the husband suffered brain injury in an accident, she discovered there was infidelity and other lies. The husband can no longer hurt her due to his injuries, he also does not remember the past. She is considering divorce. What would you tell her?
Your response will be greatly appreciated.
Dan GottliebWhen we think about the impact of trauma, we usually think about how it causes posttraumatic stress disorder or depression.
But an emerging field called “posttraumatic growth” takes a different approach. It is about changing the way we see ourselves and finding new meaning in life.
A friend with a severely autistic son once said: “I spent the first seven years trying to change his life, never realizing how profoundly he was changing me.”
A follow up question to your column on harsh self judgment: how do we learn to differentiate between inappropriate self criticism and the genuine need for self evaluation. I have never been able to find a satisfactory way to do a quick review of how I handled a certain situation without being extremely critical of myself.
there are no hard rules about this, but if you find that you are beating yourself up when you evaluate your behavior, it's pretty safe to say you are on the wrong track. Any review of your behavior should be done with compassion. You must trust that you are a good person and performing best you can. And that if you are not performing best you can, there are very real reasons why you have not. So a self-evaluation should not feel harsh, it should feel constructive.