I watched Requiem for a Dream (2000) over the weekend. It’s a sad, sad story about addiction, loneliness, and the impossibility of some to deal with feelings. Ellen Burstyn plays the mother of a heroin addict. She herself lives alone and is, I guess, dying of loneliness.

While I “appreciate” addiction – I get it, I’ve seen it, it’s awful, mostly an illness – but somewhere along the line I believe it’s a choice, usually of how one copes with feelings and anxiety. What I saw happen to Ellen’s character is not so much a choice - sort of. She comes from a time and culture that puts a lot of value in what a doctor says and believes. They are the professionals, what they say must be right, must be good for the patient. She gets her “drugs” prescribed to her. She becomes addicted to diet pills, and then God knows what else is prescribed in a bid to help her cope with the "side effects" (read addiction to speed).  By the movie’s sad end, she has become anorexic, psychotic, is shackled, force fed, and finally given electric shock treatment – which renders her a vegetable.

I have had so many clients come into my practice that have been prescribed medication – for depression and/or anxiety – by a GP, with no request for follow up by a mental health professional. Personally I find this unbelievable. In my training I learned (maybe wrongly, but I don’t think so) that depression usually has a predictable course, that it doesn’t last forever, and even WITHOUT medication it often resolves itself within six months to a year. I learned that medication is a SHORT-TERM solution that is intended to help “lift” the individual enough to be able to do the work one might do in therapy, to help them cope and work on resolving the depression or anxiety all together.

But that’s not what I am seeing. People are being put on medication, like Effexor, Paxil, Celexa, Prozac, Cloazepam, for years. Years! without EVER having seen a mental health professional! I have seen people being put on several different medications, to alleviate depression and to help them sleep all at the same time .. again for years. It is my belief that the end result of being on something for so long is that the brain loses the natural ability to create the neurotransmitters/hormones required to do this “work” itself. Sometimes the brain stops producing the required serotonin for example all together – why bother it says, a pill to do it for me is on the way!

I realize there are times when medication is in fact useful. Sometimes we find ourselves suffering too much and we have to take advantage of medication, not doing so would be "causing harm". However there needs to be a balance doesn’t there? There needs to be follow up, accountability, and assessment as to the outcome of taking something for so long.

A piece of the movie was very disturbing and that was the part of the doctor never even looking at the patient. He would look at the file in his hand and decide what needed to be done without ever looking at the person. I actually had a doctor like that once. He refused to answer my question, just out right refused, and then stopped acknowledging me all together. I was dumbfounded and didn’t know how to respond. That’s unacceptable behaviour.

The medical profession might do well to consider the whole person, in the context of all the resources available to them in terms of coping.  I would say the same to any mental health professional – do not get the notion that you are the only support available to a client. And if you are, then it behooves us professionals to help those clients expand their network of support. We can model that for them by speaking to each other - doctor and psychologist, doctor and therapist, doctor and social worker. Individually, we are but a small slice of their life and all clients SHOULD have a far greater network than just one therapist, or just one doctor and certainly more than just a bottle of pills.

Come on helpers, we can do a whole lot better.

Men and Work

Men, sadly, are socialized to believe that who and what they are in the work world is who and what they are period. While there has been a sea-change insofar as realizing the 25 year career in the same company is something from a by-gone era, what hasn't changed is how men  develop their identity and define themselves according to work. Workaholism is still an acceptable form of escape for men – escape from family participation, self evolution and self reflection, from the intimacy in one’s relationship, from dealing with going after what your heart “wants” rather than what you “should”  …  I say it’s acceptable because it’s often not recognized as workaholism in the first place. Most people look at a man who works 60 hours plus a week and think that he is successful, that he has a “big job”, he is important, depended on, making lots of money.

There is a new population of men however, those that have left corporate life either forcibly or of their own volition, long before retirement is even a consideration. As they adapt to another kind of life, many are finding work in the form of consultancy – offering their expertise in piece meal chunks. They report that while they no longer enjoy the “benefits” of a full time corporate gig such as a health plan, retirement contribution, paid holiday (they are hard pressed to come up with more) – they are discovering that being available for family, living on their own time frame, having time for self-care, and not marching to the corporate drum is life changing, and more importantly, extremely satisfying.

As therapists I wonder how we might help the men that come to see us. Many come questioning where they are at when this work shift happens. There is uneasiness, in the beginning, when not getting up to the sound of a buzzer, leaving the house, getting on planes, coming home late, like so many others. There is a discomfort, in the beginning, recognizing the “differentness” of routine.  Many experience a fear of becoming obsolete, worrying that the youth that nipped at their heels in the corporate landscape will leave no room for them to finish off their working years in contentment. Some, after a time, question whether they can re-enter the corporate world at all.

I don’t believe the corporate world can handle these men who have now understood the great cost to themselves and their families paid during the earlier years of their careers. The sacrifice of time away from the nurturing of a marriage, or the raising of children, and investment in one’s self, can’t be reclaimed. The corporate world doesn't have room for the conscious, relationship-invested man. It’s all or nothing. And happily, that’s just not good enough for many a man anymore.

There is a great need to redefine one’s self, to come to terms with the myth that socialization has fed us. Men are more than the sum of their career. They are human beings in need of contact, in need of a space to be vulnerable, in need of acceptance regardless of what work path they choose. It’s time to embrace the change and respect the differences among us, and the benefit of those differences.  It’s time to honour our humanness in every aspect of our lives. 

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