Low Cost Therapy Interest on the Rise

It is hardly a novel idea to suggest that psychiatrists, as a group, tend to be less inclined to take insurance than those in many other medical specialties. The reasons for this reluctance are manifold, including flattening insurance support for mental health issues, and the hassle of managing insurance copays through a private practice. But a recent study shows that the numbers have grown stark indeed:

The study, published Wednesday in the journal JAMA Psychiatry, found that 55 percent of psychiatrists accepted private insurance, compared with 89 percent of other doctors.

Likewise, the study said, 55 percent of psychiatrists accept patients covered by Medicare, against 86 percent of other doctors. And 43 percent of psychiatrists accept Medicaid, which provides coverage for low-income people, while 73 percent of other doctors do.

Not everyone can pay out of pocket for analytic therapy, of course. Which is why there is growing interest in low cost therapy here in New York and across the country.

Finding a good low cost therapy is easier than it may sound: Simply reach out to the professionals at PPSC for a referral. Affordable psychotherapy is always in reach if you know where to look. And insurance shouldn’t ever have to play a starring role.

Toward Better Psychological Research: The Waitlist Problem

It has often been pointed out that in the field of psychology, it can be difficult to conduct controlled science. The number of mitigating factors, from the varying skill of each individual therapist to the difficulty of quantifying things like emotional improvement, work against perfecting a research process. But there is one mainstay of psychological research that creates predictable problems time and again: the waitlist control group. One recent commentary defined it this way:

In psychotherapy research, there is no pill. So a long time ago, some researchers developed what they believed to be a similar control group as those receiving a placebo — the waitlist control group. The waitlist control group is simply a group of subjects randomized to be placed on a fake “waitlist” — waiting for the active treatment intervention.

The idea here is sound: If you want to take a baseline reading of how people are progressing without any psychological help at all, tell some people that the study hasn’t yet begun. Yet the problems with this approach are manifold, including the possible placebo effect of knowing that help is on the way, and the very real possibility that many people on the list will engage in self-help remedies while the clock ticks. One solution from Psych Central: replace the waitlist with something that more closely approximates therapy, minus the training:

The best way to do this is to throw out the waitlist control group and replace it with a group of participants randomized to receive weekly check-ins with the equivalent of someone showing concern for the individual. This can be an individual one-on-one session, or a small group of participants.

The goal here is to separate the well-known value of generic concern from the putative added value of psychoanalytic psychotherapy – or another modality – conducted by a trained professional. It is an intriguing idea, and of course at PPSC we welcome any chance to demonstrate the lasting benefits of analytic therapy over various alternatives.

Can’t wait for the next study? Find a therapist today by clicking here.

Can Depression Therapy Prevent a Heart Attack?

The connection between mind and body is a mysterious one, hardly better understood today than it was in the age of Pericles. Clinicians are well aware that such a connection exists, of course; we have a surfeit of evidence to suggest that the power of belief can transform meditations into medications. But just how far does it go? A new study has concluded that treating depression with drugs and psychotherapy may significantly reduce the chance of a cardiovascular event later in life:

Patients who had no evidence of heart disease at the study start who received antidepressants and therapy for their depression almost halved their risk of a heart attack or stroke during the eight years of the study, compared with the standard care group, the researchers found.

This is provocative data because it seems to resolve one of the great questions about depression and poor health: which precedes which? Is depression a causal factor in developing heart disease, or its inevitable byproduct? Reducing the chance of heart attack by treating depression seems to illuminate which way cause and effect flows here: first comes depression, and then, the deluge.

Here at the Psychoanalytic Psychotherapy Study Center, we offer a strong foundation in depression therapy through analytic techniques. If you’d like to improve your quality of health, and possibly stave off future health difficulties in the bargain, we urge you to contact our New York psychotherapists here.

Wait, Humans Have How Many Emotions?

A provocative new study out of Scotland studied human facial expressions – and our ability to read them – and came away with the conclusion that human beings are really only hardwired for four emotions:

This leaves us with four "basic" emotions, according to this study: happy, sad, afraid/surprised, and angry/disgusted. These, the researchers say, are our biologically based facial signals—though distinctions exist between surprise and fear and between anger and disgust, the experiment suggests that these differences developed later, more for social reasons than survival ones.

http://youtu.be/6ptmo8dAwwA

Of course the study looked only at computer-generated expressions, which are somewhat less nuanced than you get from actual people with actual emotions. And to see something in an instant is wholly unlike the experience of navigating real-world feelings such as anxiety, depression or love on a daily basis. One could be forgiven for calling this a study of responses rather than feelings per se, a point the authors concede:

"Our data reflect that the six basic facial expressions of emotion, like languages, are likely to represent a more complex set of modern signals and categories evolved from a simpler system of communication in early man developed to subserve developing social interaction needs," the authors wrote. By that they mean these four emotions are the basic building blocks from which we develop our modern, complex, emotional stews.

Other cultures might disagree, of course. And there is no question that these studies, while valuable, do not begin to address what happens when experience and circumstance combine into the puzzle of human psychology.

Want to explore more about analytic psychotherapy or psychoanalysis? Check out our analytic training programs here today.

So Funny, It’s Psychotic

It’s not often that researchers take the world of stand up comedy especially seriously. Which makes one recent study all the more remarkable: Researchers in the British Journal of Psychiatry have discovered that comics score significantly higher than control groups for so-called psychotic personality traits. Some of this study is perhaps self-evident. The findings that comics tend to be somewhat disorganized, and that they chafe at conformist pressure, qualify as something close to conventional wisdom. But of the four traits associated with psychosis, one in particular stood out to us: “‘introvertive anhedonia’ – reduced ability to feel social and physical pleasure.”

This is yet more confirmation of the deep link between depression and comedy, a phenomenon which has been described in many places over many years. Theories abound about what lies behind this association – is the comedy simply a coping mechanism to leaven the misery, or do both qualities spring from a similar emotional place? Whatever the explanation, it seems likely that no two people ever arrive at a humorous worldview in precisely the same way.

Depression therapy can be a great relief to people whose talents are undermined by periods of deep despair. If you’d like to find a therapist in New York who can help unpack your own feelings of “introvertive anhedonia,” please contact the Psychoanalytic Psychotherapy Study Center here today.

Road Rage and Transference: Traveling Companions

A grisly road accident that seemed to have no specific cause began garnering attention recently when witnesses helped authorities piece together what happened:

Other drivers that had been on the road at the time described two cars that had been engaging in “a deadly road-rage game of cat and mouse,” as cops told a local NBC reporter. One car was aggressively pursuing the other; when one car flipped and crashed, witnesses said, the other one “just kept going.” Police said that the 27-year-old woman’s death was “being treated as a case of road rage.”

What is road rage? It is a disproportionate response, of course. Road rage arises when a minor slight – getting cut off, being tailgated – becomes first a cause, and then a mission. Revenge fantasies which might otherwise evaporate in an instant are made manifest through the mighty instrument of the car itself. Drivers accelerate wildly, jockey for a “winning” position, and trade epithets as best they can.

That road rage is self-evidently dangerous seems unable to discourage its practitioners. Even though this behavior can and does lead to injury or death, these concerns seem to hold no water against the overwhelming compulsion to enact payback.

What is going on here? Feelings this sudden and powerful are rarely just about the present. One psychologist consulted for this story hit the nail on the head:

He says that the psychological root of this behavior is often something called Hostile Attribution Bias—the belief that every accidental injury or threat is purposeful, and personal. People with IED over-personalize every interaction, and then over-react with immediate aggression.

Jargon aside, this description nicely mirrors the notion of transference in psychoanalytic thinking. Whether you want to call this irrational response road rage, IED, or transference, the mechanism is much the same. Deeply emotional memories inform the things we do and feel well into adulthood, imbuing them with resonances that do not always reflect visible reality. If feelings of helplessness were a theme in your childhood, for instance, you might respond in an unduly explosive way to any gesture that causes you to revisit those feelings, no matter how small – a reaction which can look “crazy” to an outside observer.

The only way to unlock how your past may be coloring your present is through psychoanalytic therapy. Here in New York, PPSC is home to dozens of psychotherapists who can help you understand why overwhelming feelings are still dictating your behavior and holding you back – and help you resolve what is behind them.

The New Challenges of LGBT Therapy

At PPSC, we’re proud of our reputation as one of the most progressive analytic communities in New York for gay-friendly therapy. With multiple analysts on staff who identify as LGBT and a robust curriculum addressed toward understanding the particular issues of the queer experience, we believe there’s always more to learn about how we can provide insightful and effective LGBT therapy. Which is why this recent article in the magazine of the American Psychological Association caught our eye. It talks about how the issues facing LGBT patients have shifted over time: Although discrimination and its echoes remain paramount, other questions have crept into the mix which require their own breed of psychotherapy:

At the same time, Haldeman says, psychologists are seeing "a whole host of other issues related to the creation of LGBT families, LGBT people in the workplace, generational differences and the reality of multiple-minority identities--issues that demand our best research and clinical skills."

The whole article is worth a read. Generational questions, identity questions and a rising tide of body image issues are all giving gay-friendly therapists new topics to engage. If you are struggling with these or other issues as an LGBT person, we can help you find a therapist who will meet you halfway and help unpack what may be behind the difficulties you face.

Living with Anxiety

A vivid article on anxiety in last month’s Atlantic ignited a powerful response across the media. In it, author Scott Stossel describes the searing panic and existential dread that can overcome him even at in moments of relative calm:

On ordinary days, doing ordinary things—reading a book, lying in bed, talking on the phone, sitting in a meeting, playing tennis—I have thousands of times been stricken by a pervasive sense of existential dread and been beset by nausea, vertigo, shaking, and a panoply of other physical symptoms. In these instances, I have sometimes been convinced that death, or something somehow worse, was imminent.

Stossel addresses public speaking in particular as the classic anxiogenic situation, or one that produces anxiety. And his approach to calming his nerves goes far beyond any instructions on the label, including huge doses of Xanax and vodka:

Only when I am sedated to near-stupefaction by a combination of benzodiazepines and alcohol do I feel (relatively) confident in my ability to speak in public effectively and without torment. As long as I know that I’ll have access to my Xanax and liquor, I’ll suffer only moderate anxiety for days before a speech, rather than sleepless dread for months.

Stossel avers to having tried everything under the sun, with minimal results. His is a case of uncommonly acute and intractable anxiety, one which appears to resist both emotional remedies such as psychotherapy, and physical remedies such as prescription drugs and even low doses of alcohol.

Yet anxiety isn’t untreatable. In many people, it bears many of the hallmarks of obsessional disorders such as OCD:

Even when not actively afflicted by such acute episodes, I am buffeted by worry: about my health and my family members’ health; about finances; about work; about the rattle in my car and the dripping in my basement; about the encroachment of old age and the inevitability of death; about everything and nothing. Sometimes this worry gets transmuted into low-grade physical discomfort—stomachaches, headaches, dizziness, pains in my arms and legs—or a general malaise, as though I have mononucleosis or the flu. At various times, I have developed anxiety-induced difficulties breathing, swallowing, even walking; these difficulties then become obsessions, consuming all of my thinking.

Many of our patients here at the Psychoanalytic Psychotherapy Study Center are able to unpack the causes of their worry through focused anxiety therapy. Sophisticated psychotherapy remains one of the most powerful responses to chronic emotional conditions like this precisely because it treats causes, not symptoms. Many people discover that what lies beneath their anxiety can be addressed, and remedied, through nothing more than conversation with a trained psychotherapist.

If you’d like to learn more about anxiety therapy in New York, please don’t hesitate to contact us.

A Hunger for Analytic Therapy in More Places

The benefits of talk therapy have long been known, but innovation continues to touch the world of psychotherapy. Concepts such as mindfulness and specialties such as LGBT therapy are constantly adding ferment to the field, for instance, and the advent of the Internet has added many new topics worthy of study. Recently much of the “talk” in therapeutic innovation has centered around the possibility of Web-based psychotherapy. The idea involves a version of Skype, where patient and therapist meet somewhere in cyberspace and conduct a conversation over an encrypted video connection. As a recent article in Wired described one website peddling such technology, “Patient and practitioner connect via TalkSession’s video platform—no couch required.”

Is Teletherapy Real?

There are some inherent advantages to this approach, including improved accessibility for remote patients, enhanced convenience for both patients and therapists, and freedom from the sigma of mental health appointments in communities where such prejudices remain.

Yet sites such as TalkSession cannot readily substitute for the real thing -- yet. There is a shared experience that takes place in the room which cannot easily be duplicated. (Witness the confusion that arises when your partner on Skype begin reacting to things you can’t see.) And of course there remains a formidable series of regulatory hurdles to surpass, including a byzantine national licensing system that makes out-of-state therapy a legal minefield.

Still, there is no question that teletherapy will arrive someday. What this news demonstrates most clearly to us is that vital specialties such as depression therapy, anxiety therapy and relationship therapy are still needed throughout the country. If you’d like to find a therapist here in New York City, please contact the Psychoanalytic Psychotherapy Study Center today.

A Rare Candid Conversation on Depression and Therapy

It is rare, albeit less so all the time, for celebrities to open up about their personal battles with clinical depression. Older stars in particular tend to maintain a culture in which all mental health issues came with stigmas attached. Which is why it was unusual this week to see two stars of a more senior generation, Dick Cavett and Stephen Fry, openly discussing their struggles with depression on the Huffington Post. Mr. Fry offered an illuminating assessment of what makes depression unique, namely that its agony, while invisible, may still lead to suicide, even in busy people:

Fry emphasized how seemingly-contradictory the messages we send about depression can be. "Okay, you've got this problem, it doesn't stop you from being a high-functioning individual," he said, and yet on the other hand, it can cause death. It's not to be taken too lightly, he said, and at the same time, it's not to be taken as a death sentence.

Of course this is the point: depression doesn’t have to paralyze you to impair your life in significant ways. The classic image of the depressive who can’t get out of bed in the morning is simply one face this problem wears; other symptoms may include quiet moments of despair, chronic sleeplessness, broken relationships and diminished productivity.

Depression can be caused by genetics, chemistry or psychology. The only way to know for sure is to try analytic therapy and explore whether your issues may are emotionally based, or simply biological in nature.

To find a therapist in New York who specializes in depression therapy, please contact PPSC here.

The Connection Between Insomnia, Depression and Talk Therapy

Several outlets reported this week that a new small NIH-funded study has affirmed an earlier finding that talk therapy could be an unexpectedly effective cure for insomnia – and that curing insomnia could relieve the symptoms of depression. Here’s the New York Times:

Curing insomnia in people with depression could double their chance of a full recovery, scientists are reporting. The findings, based on an insomnia treatment that uses talk therapy rather than drugs, are the first to emerge from a series of closely watched studies of sleep and depression to be released in the coming year.

Although most researchers and clinical psychologists have long considered insomnia a symptom of depression, it turns out that the causality may flow both ways:

Several studies now suggest that developing insomnia doubles a person’s risk of later becoming depressed — the sleep problem preceding the mood disorder, rather than the other way around.

It is an encouraging finding for the field of therapy for depression, and yet more evidence that talk therapy can give rise to deep-seated changes which cannot always be matched by drugs. The study in question focused on a form of cognitive therapy known as CDT-I (“I” for insomnia), but no study has yet been undertaken that compares this type of therapy to another modality such as analytic therapy. Either way, the tidal wave of new evidence underscoring the timeless power of dialogue continues to color national conversations on mental health.

When Psychotherapy Meets Mindfulness

The mindfulness movement has gained many fans in recent years, and with good reason. This nonjudgmental, suspended state of attentiveness can be remarkably helpful. What may at first blush seem like an extraordinarily simple proposition – be still, note your thoughts, and “live in your body” – turns out to have some lasting positive effects on mood and clarity. But is it therapy? One of the foundational practices of analytic therapy is an emphasis on free association – letting the mind forge and find connections without interruption. If this sounds a bit like mindfulness to you, you’re not alone. Both practices share an emphasis on following your thoughts where they might lead.

But the differences are important. Mindfulness demands frequently returning to the present and the literal – note your breathing, dismiss ruminations as they arise. Psychoanalytic therapy is more interested in nurturing tangents and distractions to discover what complex insights they might yield.

Both mindfulness and psychoanalytic psychotherapy have a place in easing the burdens of anxiety, depression and obsessional thinking. Indeed, it’s not unusual to find analytic therapists using a mix of both techniques, sometimes beginning with mindfulness to achieve clarity, and then discussing what surfaced in greater depth. As with most of psychotherapy, the art lies not in dogmatically clinging to one modality over another, but in carefully determining which tool is most likely to unlock the mysteries of the moment.

The NYT Comes Out In Defense of Psychotherapy

Analytic therapy is under assault from multiple groups, including the neurobiologists, the pharmacologists, and the genetic determinists. Yet the chief issue with psychoanalysis is not that it’s archaic or ineffective; it’s simply that this form of therapy simply doesn’t have an adequate mouthpiece. At least that’s what the New York Times recently contended in a thoughtful piece, pointing out that most patients crave in-depth and emotionally attuned therapies:

As well they should: for patients with the most common conditions, like depression and anxiety, empirically supported psychotherapies — that is, those shown to be safe and effective in randomized controlled trials — are indeed the best treatments of first choice. Medications, because of their potential side effects, should in most cases be considered only if therapy either doesn’t work well or if the patient isn’t willing to try counseling.

Yet the article rightly asserts that “there is no Big Therapy to counteract Big Pharma.” That is, there exists no powerful lobby flush with cash to make the point so many of us consider self-evident: that psychotherapy works, and that a great deal of evidence suggests it works better than many alternatives.

Our only quibble with this particular article is the short shrift it gives to true psychodynamic therapies, citing only studies that stop at 20 weeks. Psychoanalysis and its offshoots may take longer than that to work, but the effects can be permanent and life-altering in ways that are not easily quantified.

If you or someone you love is interested in finding psychoanalytic psychotherapy for the treatment of depression, anxiety, relationship difficulties or other long-term issues, please contact PPSC here today.

Welcome to the Revamped New York Psychoanalysis Blog!

Finding a therapist in New York City can be a confusing and fraught experience. You want to find the right therapist, with the right approach, and the right background. And you want to accomplish all these things on a budget that makes sense, and within a timeline that’s actually useful to you. At the Psychoanalytic Psychotherapy Study Center, we are constantly exploring what makes a good therapist, and how people are best served by the therapeutic process. We read the latest studies, surface cutting edge research of our own, and train some of the finest candidates for psychoanalysis in the nation.

Our intention with this blog is to create an online touchstone for some of the most important questions, ideas and news in the field of psychoanalysis. We’ll be posting regularly on a number of subjects that continue to generate interest among our faculty, including LGBT therapy, relationship therapy, and therapies focusing on OCD, depression, anxiety and other psychological symptoms. We’ll also address some of the most common questions about psychoanalysis, from readers and patients alike.

We are truly excited to relaunch this blog and share compelling new material with you each week. Please bookmark this site and check back often. Welcome aboard!

Explore the Cutting Edge of Psychoanalysis at the PPSC Annex

Regular readers already know that the Psychoanalytic Psychotherapy Study Center has two principal missions: to bring people affordable psychotherapy in New York City, and to offer advanced psychoanalytic training to professionals. One of the most enjoyable dimensions of this second mission is that our faculty puts together several fascinating workshops for therapists each year. Read through the titles and you will find seminars that cover a number of goals, subjects and pain points New York psychotherapists are likely to encounter.

The full list is here. You can see from the page that our faculty does it all, addressing such diverse topics as:

• The Adoption Experience: An Exploration into the Lives of Adoptive Parents and Adoptees
• Heal the Pain, Restore the Trust: How to Treat Infidelity in Couples
• What is EFT? An Introduction to Emotionally Focused Therapy
• CBT: Bridging the Worlds of Psychodynamic and Cognitive-Behavioral Therapies

For professionals at any level, these workshops represent a unique and valuable chance to plunge deeper into some of the field’s most pressing topics. And for patients, these titles offer a bit of insight into the deeply curious and constantly evolving faculty of PPSC.

Check back often for the latest listings, and please don’t hesitate to contact us for more information about all the PPSC Annex has to offer.

The Limits of Psychiatric Diagnosis

 “Back to Normal,” by Enrico Gnaulati

This thoughtful piece in the New Yorker On-line has gotten some attention in recent weeks. It discusses this recent book by Enrico Gnaulati and its take on the difficulties of diagnosis, focusing particularly on what to do when fairly normal behavior becomes “pathologized” in the popular imagination.

The question of overdiagnosis is an ongoing conversation within New York psychology and psychoanalysis circles. Although many people fall into one camp or another – either believing wholeheartedly in the gospel of the DSM, or rejecting any checklist-like approach altogether – the truth is often far more nuanced.

There is no question that some disorders of the mind are likewise disorders of the brain – witness the chemical storms of schizophrenia and psychosis. Other symptoms may be more hybrid in nature – for example, Depression or Obsessive Compulsive Disorder, both of which can exist either as wholly chemical, or as wholly psychological maladies. And then there are those issues which are clearly emotional in origin – such as loneliness and relationship difficulties. At least for this last category, some labels do little to illuminate or alleviate the problems.

As the author notes, the principal limitation with the book is that it paints Attention Deficit and Hyperactivity (ADHD) and Autism Spectrum Disorders with the same reductive brush:

Psychiatric labels in kids have large consequences, and overdiagnosis carries risks: unnecessary pharmaceutical treatment, self-image questions, and the potential for long-term stigma. Yet underdiagnosis does, too, because early intervention can greatly improve outcomes for children, especially those with Autism Spectrum Disorder.

The surest way to discover what is causing your emotional symptoms and distress is to talk about with an expert in analytic therapy. PPSC is comprised of several psychotherapists who specialize in particular subspecialties of talk therapy such as LGBT therapy or depression therapy. You can begin your search here today.

Can Neuroscience Replace Psychology?

A debate has been raging for some time now; recently it has been heating up. It’s a debate about the exploding field of neuroscience, and specifically about whether a greater understanding of the chemicals inside our brains will ever unlock the mysteries of the mind. A number of voices have entered the fray, but one response has caught our eye over here at the Psychoanalytic Psychotherapy Study Center: this measured opinion piece by legendary New Yorker writer Adam Gopnick.

Gopnick gamely reviews several new books that have entered the arena, concluding something that some in the field of psychoanalysis consider self-evident: that neuroscience is still in its nascency, and has little to teach us about the complex emotional underpinnings that drive human behavior:

[N]euroscience can often answer the obvious questions but rarely the interesting ones. It can tell us how our minds are made to hear music, and how groups of notes provoke neural connections, but not why Mozart is more profound than Manilow.

The process of psychotherapy is concerned principally with the many nuances of personal history and symbolic meaning that color our experience as people. To be sure, these things must be located somewhere – there is no doubt that the brain houses the mind – but our crude fMRIs and imaging technologies can only tell us what we already know: that our brains are doing something.

Neurology is a promising field that augurs well for the science of the mind. But we aren’t remotely at the point where understanding biochemistry could supplant the far more complex enterprise of talk therapy. One day, the sciences of psychology and neuroscience will perhaps converge into a single whole that captures the fullness of human experience. Until then, your best bet for addressing emotional issues remains the quiet wonder process of psychoanalysis.

MAD MEN (Season Six)

Season Six Premiere "The Doorway"

"What's the difference between a husband knocking on the door and a soldier getting off a ship? 10,000 volts." -- Don Draper

Guess who's got his finger in the socket again. While Draper can see the "Eros" of his ways, the thrill of knocking on the door of his neighbor Sylvia appears to be a shock he can't resist. Yet Don insists, "I want to stop doing THIS." It seems that Sylvia's door is the same old trap door that leads to nowhere. As Roger despairs in his psychoanalysis, "...that's all there are: doors!....Look, life is supposed to be a path, and you go along, and these things happen to you, and they're supposed to change your direction, but it turns out that's not true. Turns out the experiences are nothing. They're just pennies you pick up off the floor, stick in your pocket..."

To Roger who has just lost his mother, experience is just change, as in pocket change--not real life change. While life can change on a dime, it doesn't add up to much. The emotionally impoverished, narcissistically challenged, Roger is defending against any shred of feeling that arguably could be valuable to him. (We can empathize with his shrink who is trying to get Roger to feel anything...only to be shut down in spades.) Interestingly, Roger's catharsis comes upon learning of the sudden death of his shoeshine guy whose shoe repair kit has been bequethed to Roger as he was the only one who called that day. (Ironically, his analyst can't repair his soul, but the man who fixed his soles can move him deeply.) There seems to be some identification with the anonymity of this man's life and death that speaks to Roger's growing sense of isolation.

Yet, Don attempts to turn his dissociated despair into a winning ad campaign. His creative for The Royal at Waikiki showed a man's clothes strewn on the beach with footprints leading to the ocean. (The man is nowhere in sight.) The tagline: Hawaii. The jumping off point. His clients could not miss suicidal implications of the ad. Hawaii was looking way too close to heaven....

In defending this ethereal ad, Draper said, "No man is there...just his footprints." Don was rhapsodic about this state of paradise: "...You don't miss anything. You're not homesick...you're different." (Possible Draper Translation: Places can change you, you can become them. You can shed your skin. You can die and be reborn...somehow.)

While Roger's world of doors leading to nowhere casts a dark shadow, Don's has a tropical glimmer, a come-hither wink which only make his hell a lot more inviting. Aloha, let's see where the season takes us.

TEENAGE OBESITY

Recently there was an article about an obese teenager who chose to have the controversial lapband surgery to help her lose weight. The article was full of statistics about nutrition, the obesity epidemic and issues with this type of surgery. They also quoted the girl's trepidation about the procedure.

"I'm just so nervous to fail my own diet. There's a diner downstairs from my apartment, and a Dunkin' Donuts." "The key is moderation, having a little mashed potato but not a portion" the doctor said. "I'm not good at moderation" she replied.

She has not been able to comply in spite of going through a surgery, being exhorted by physicians and others, and receiving nutritional counseling, etc.

Many people commented on this story. A large number focused on her being lazy, stupid, lacking in will power, unknowledgeable about nutrition; or criticized her mother for not providing the right foods. What was missing was an understanding of the nature of eating disorders and the addictive process, about which this girl has no control.  She would need a lot of emotional help; maybe also a twelve step program, like Overeaters Anonymous. For starters, this would be essential her to success.

If this were your loved one, how would you support them?

15 WAYS TO DESTROY THE RELATIONSHIP

Just saw “Carnage”. A great demonstration on how couples can fight in order to destroy each other. Spoiler alert: here are just some of the rules, according to the movie: 1. Treat the other with contempt and sarcasm; bully them overtly or covertly 2. Engage in character assassination 3. Expose and pick on your partner’s areas of self-hate 4. Tease your partner about their values or aspects of themselves that matter to them 5. Change the focus to unrelated, but awful, issues, making them seem as if they are part of the conversation, thus throwing your partner off balance 6. Throw up on something that was valuable to the other person 7. Keep your phone on and pick up all calls, or text throughout 8. Belittle or dismiss the other 9. Start drinking heavily in the middle of the fight 10. Call your partner names or insult them: “You’re DISGUSTING!” “That’s the most idiotic thing you’ve every said!” 11. Distort the meaning of what they are trying to express into something hateful 12. Do this in front of other people 13. Do something to deliberately provoke the other like handing out cigars to your guest when it’s always been a house rule not to smoke in the house 14. Say nasty things about your partner to the other people, like, “She’s always hysterical like this” 15. Throw a punch at your mate

V.L.F.