More Than Words

Do you remember the old E. F. Hutton commercials?

The premise was of course that “when E. F. Hutton talks, people listen”.

We have known for centuries that words can influence, motivate, demean, inspire and otherwise cause communications between people to take on all kinds of meanings. Words can elevate issues to the highest levels, and words can shut down meaningful intercourse between countries, leading to war.

We have known many famous people who use words to get their messages across.

Winston Churchill, in Great Britain’s darkest hour, was to have famously said, “Never, never, never give in.”

Dwight Eisenhower said, “I have only one yardstick by which I test every major problem — and that yardstick is: Is it good for America?”

Pope John Paul II said, “The ultimate test of your greatness is the way you treat every human being.”

That last quote leads me to write about one of the issues and stories of our time.

Yesterday, Michelle Carter of was found guilty in a Massachusetts courtroom of involuntary manslaughter in the death of her friend Conrad Roy III. She is to be sentenced on August 3rd, and she faces up to twenty years in prison. She is twenty years old.

At issue in this case was whether or not words, simple words, can cause the death of another person.

You by now know the story. Roy was a shy, anxious boy, a troubled teenager who had a mostly technological relationship with Carter from 2012 to 2014. Carter had her own baggage and demons, and these seemingly clouded her good judgment when it came to how she responded to her friend’s anxiety, depression and suicidal ideation. At first, Carter encouraged Roy to get help for his troubles, but in the two weeks before he killed himself on July 12, 2014, she seemed to abruptly shift gears, telling him repeatedly that he should simply go ahead and commit suicide.

The guilty verdict did not seem to hinge on the many text messages between the two, no matter how inappropriate or negative they were. In the end, the judge focused on the phone call that took place between the two as Roy was sitting in his truck, which was rapidly filling with carbon monoxide. He seems to have changed his mind about killing himself at the last minute, as those who struggle with these thoughts often do, and got out of the truck. He told his friend that he was scared.

Instead of telling him that he did not have to complete the act, or that he should call someone for help, or instead of calling someone herself, she simply told him to get back in.

She knew, after two years of communication with him, about his ambivalence, his fears, his worries, but she disregarded all of that.

She told him to get back in.

She knew that he would most likely die, that he had said that he wanted to die, and she encouraged him, by phone, to stay in the environment that eventually killed him.

This was a landmark case, in that most of the time, someone who is contemplating suicide or carries out the act has thought about it, maybe even planned it out as Mr. Roy had. It is considered to be an act of free will, a person deciding that they no longer want to live and taking steps to insure that their plans to kill themselves come to fruition. In this case, Carter knew that by telling her friend to get back in the truck that he would likely die, but she did nothing to stop that eventuality. She did not tell him to get out, she did not call his family, she did not call the police and she, by her direct words to this unfortunate young man, directly contributed to his death.

The prosecution, and the presiding judge in the case, evidently felt quite strongly that her physical absence from the scene of Mr. Roy’s death was immaterial.

Katie Rayburn, an assistant district attorney, said, “She was in his ear, she was in his mind, she was on the phone, and she was telling him to get back in the car even though she knew he was going to die.”

Such a sad case involving two very troubled teenagers whose very investment in each other turned sour and caused the death of one and the possible incarceration of the other.

When people speak, especially those who we admire, respect, love or try to emulate, we listen. We may listen superficially, we may dwell for a time on what they say, or we may obsess about it.

We may act on what we hear.

Our actions may have consequences.

Whether coming from a pope, a statesman, a president of the United States, or a friend who is as troubled as we are,

words matter.

Future Shock

There is a lot going on in our world right now.

From senate testimony in various hearings to war in foreign lands to giant bombs being dropped (no, not F-bombs, but then again…) to Brexit to special elections to Juneteenth celebrations to the near-explosions of talking heads because of the sheer volume and ambiguity of it all.

We really don’t know from day-to-day what will greet us in the newspapers that we read, podcasts that we listen to, or social media outlets that we frequent. If you’re like me, and many of you must be, or you wouldn’t read this blog, you can’t get enough of the excitement and frenzy of it all, but at the same time it scares the living daylights out of you.

What does the future hold?

No, I mean really. What does the future hold?

How can we know? How can we know, given the impulsivity of our leaders, the shallowness of thought, the depth of misery around us and the unpredictability of the world around us today?

The short, slightly comforting answer is that we can’t know.

How then can we focus on, contemplate in a serious manner, think about intentionally, plan for, reasonably anticipate, embrace, and not fear the future?

I’m trying to take this bull by the horns in a few ways.

One is to break down my response to that lump in my throat that rises periodically, fueled by uncertainly and fear, into three easily considered and actionable steps that I can take every day.

  1. I intentionally contemplate three things that I’m looking forward to tomorrow.
  2. I think about three things that I plan to do in the next year.
  3. I think about three really important things that I want to do before I die.

This may not work for you, but along with other intentional reviews of my activities, my short, intermediate and long-term goals and my actionable plans, it works for me. It keeps me grounded, helps me make achievable plans and keeps me looking at the future as a time that will be healthy, happy and exciting for me and my family.

I also conceptualize the way that I look at the future in this way, utilizing a series of feedback loops:

One of my goals is to decrease fear.

One of the ways that I know really helps me to tame my fear is to learn more about the thing that is making me afraid.

Once I learn more and thus decrease my fear, I am more likely to take action.

When I take action, I experience growth.

Growth further decreases my fear, which helps me to take more action, and so forth.

Growth also leads to happiness, and with continued, ongoing happiness, contentment.


Does the future make you feel afraid?

Try the simple contemplation exercises I listed above.

When you are afraid of something, learn more about it, take action based on what you learn, experience the growth that comes with actionable knowledge, and from that growth begin to experience happiness on the way to true contentment.

We can’t fully predict the future, but we can productively shape our responses to it.

Have a great Thursday.




Repeat After Me

I was just listening to the Slate Political Gabfest, The “I Expect Loyalty”Edition Live from Denver, Colorado, this evening. One of the guests was Colorado Governor John Hickenlooper, who was at one point in the conversation talking about dealing with people who get very upset for various reasons. He was using the example of getting upset when visiting a restaurant. His take on this, and his espoused method of dealing with it, was to look directly at the person, listen to what they have to say, and then repeat exactly that back to them, multiple times, over and over again. His reasoning was that when the person heard what they were saying reflected back to them many times over, they would fairly quickly come back to their usual, more calm ways of processing things on a more rational basis.

I have had similar experiences in the past, most recently a few weeks ago when I was working my emergency department  telepsychiatry job. I was asked to see a young male who had threatened suicide, who was thought to be very depressed, and who was quite agitated and hostile with the staff who were trying to help him. I introduced myself, we talked, and then we got to the point in the interview when I wanted to get an idea from him what he thought would help him regain control, get better, and be allowed to leave the ED.

Almost immediately he got quite angry and hostile, drew nearer the screen, glared at me with unblinking eyes, and began to shout how he did not want to take any medications, using a few choice words just to make sure I understood his seriousness. I countered with medications that might be better tolerated, that he might get some benefit from, my usual drill. He became more and more hostile, fuming at me and getting more red-faced by the minute.

Then, the “Hickenlooper Principle” hit me. I understood what I should by all rights have picked up on many minutes earlier.

“So, I hear you now, loud and clear. You don’t want to take any medicine.”

“No! No! I don’t want to take any g–d—-d medication!”

“I can hear that now, You really don’t want to take any antidepressants or any other medication.”

“Damn right I don’t. I was stuck in prison for three years and they pumped me full of that crap and I had no choice and I don’t want to take no f—–g medicine!”

“So, I hear you. No medicine. No medicine, okay. ”

Like magic, he visibly relaxed. He sat back from his close encounter with the monitor and camera and cocked his head just the slightest bit at me, like he was hearing a far away, high pitched whine that no one else could hear.

I waited thirty more seconds.

“So, no medication then. Good. Now, what do you think might help you get better enough that you could get out of here and go home?”

A completely different conversation ensued.

I think Governor Hickenlooper is right. Sometime, simply stating and restating what an angry or hostile or upset or frightened person says to you is enough to defuse the situation, just enough so that something more productive can be said.

Have you ever been in one of these confrontational situations?

Might you handle it differently the next time?



Ode to Joy

I stood in the bright, warm San Diego sunshine outside the entrance to the Museum of Man, in the shadow of the California Tower. I had just walked the one hundred fifty steps to the Tower’s observation deck, then back down. The three hundred sixty degreee view of downtown San Diego, Balboa Park, the San Diego Zoo, and the most colorful and vibrant flora I’ve  seen in ages left me feeling exhilarated, humbled, and thankful. Such wonderful beauty is almost excruciating. It’s impossible to fully describe in words. 

Then, as I contemplated my next activity, I was witness to something even more beautiful. 

She was about three, thin and tanned with the flowing blond hair of an angel. She was crossing the street in front of me, trailed by her pregnant mother, watching her closely. She was excited, jerkily running along as only toddlers can. She pointed towards the steps leading to the museum entrance, balancing herself with the other arm pointing behind her. 

“Gwamma, Gwampa! Gwamma, Gwampa!” 

I looked to my right and saw them, an older couple, faces beaming, accompanied by who appeared to be the little angel’s father. 

She ran at a steady pace, making the small transition over the curb, then reaching the steps, then taking them one, two, three, four, slowly and deliberately, never taking her eyes off her goal. 

“Gwamma, Gwampa, I MISSED you this morning!” she exclaimed with toddler glee. 

They embraced, this little family. They loved each other in public. They affirmed, with tiny movements and shouted I love yous that beauty and love and family and belonging are alive and well in this world, not only in this idyllic part of Southern California but in every corner of the globe that humans call home. 

I heard the joy in the little girl’s excited shouts to her grandparents today. 

I saw the joy in exquisite works of art from the fifteenth century. 

I smelled the joy in flowers so meticulously crafted that only One who knows beauty can perfect them. 

I even saw joy in the agonized responses of those who gave succor to the victims of the Manchester bombing. 

We are here. 

We love. 

We care. 

Fear and terror cannot win, because there is joy in the voices of children, the petals of flowers and the centuries-old artistic mind of man. 

Joy will prevail. 

Joy will always prevail. 

Gait, Gait, Do Tell Me

Two sisters (religious order, not biological relation, as far as I know) live in one of the condos across from us. They are very nice, older ladies, warm and pleasant, always ready with a kind word and a smile as they see others in the complex come and go. They seem, at least on casual observation, to lead very busy lives. They rise early, heading out to do whatever it is sisters do in the world nowadays. One drives a minivan, one a small nondescript sedan. All pretty ordinary, I suppose, except for one thing that always strikes me about one of them.

Sister gets up early most mornings. She almost always beats me out of the parking lot, and I’m an early riser and starter myself. When she exits her front door she heads for her minivan, parked about fifty feet away if that, with the speed of a sprinter and the determination and conviction (again, at least as I perceive it) of a person who is going to change the world. She is diminutive, casually dressed, doesn’t stand out, but she is driven to get to her vehicle and start the day. She walks determined, rapidly, not wasting a moment of her early morning time. If I am leaving at the same time and she sees me, she will offer a cheery hello and a wave. Then she is off.

Now, come with me to my office a little later in the morning. We walk up the clinic hallway to the waiting room up front, open the door, and call out a name. The patient is in her mid-twenties, somewhat disheveled, is chewing gum, and has earphones in her ears connected to an oversized phone. She saunters to the door from the couch on the far side of the room. She is wearing dark sunglasses, which she does not remove.

I have never met this young woman, so I welcome her, introduce myself, and thank her for coming to see me. She makes no eye contact, looks straight past me, does not acknowledge my greeting, and continues her slow roll through the door and into the hallway. We stroll, no other word for it, down the hall to my office at the far end of the building. As I begin my usual interview questions, she looks at me blankly, shades still hiding her eyes, offers one word answers, and looks quite bored. This young lady does not appear to be the least bit interested in being here, in acknowledging me, or in moving the process along toward any definable goal.

What would you say about these two women, knowing only what I have told you? Granted, we acknowledge that there is  lot more about both of them, their stories, their motivations, that we do not know. However, I am being intentionally superficial in my description of them for the purpose of this post.

What does physical gait, movement, and apparent drive tell us about each other?

Of these two women, who do you feel is most likely to have set a goal, or multiple goals, for herself for the day? Which of them is more likely looking towards accomplishing something measurable before lunchtime? Of the two, which one knows what she is trying to achieve by being in the physical place she occupies this morning?

We telegraph our demeanor, our intentions, our plans, our desires, and our energy levels  to others all the time. Without saying a word, we look motivated, driven and highly focused on whatever is coming next, or we appear tired, bored, lackadaisical and aimless.

How will you present yourself to your coworkers, your boss, your spouse, your friends and to strangers today?

Will they see you as leaning into the day, full of energy and vigor, ready to accept whatever challenge comes your way?

Or, will they see you as someone who has no plans, no energy, no spark, and no reason to move any faster?



Easter Eggs

There are these little pieces of code or images or popup surprises that sometimes lurk in the nether regions of a computer program or DVD or computer game. If you are not aware of them, or do not know to look for them, you may never see them. The programmers that put them there know they are there and they are happy just knowing that, whether you ever find them or not. It’s like an inside joke for geeks. Sometimes the benevolent geeks leave little direct or indirect clues to help you get at these surprises, and what fun that is when you get there! Sometimes you are on your own and may never find them. You still enjoy the game, but not the secret.

These little hidden jewels are called Easter eggs.

Now, you may be celebrating the Easter holiday today or you may not be. That’s your thing, not mine. Easter, the religious holiday, is about atonement, redemption, dying to the old and arising again to start anew. A religious reset button for the game of life, if you will allow me to extend the metaphor.

Children all over have been furiously hunting for Easter eggs, getting baskets full of pink plastic straw and chocolate bunnies wrapped in golden foil and jelly beans galore. It’s a serious religious holiday, more impactful than Christmas if you are a believer, as commercial as Halloween if you are not.

What I want you to think about are those hidden Easter eggs. Not in the grass behind the shed. Not in the computer game that came in the colorful DVD package.

The Easter eggs that are hidden in our daily lives.

I got home about one AM this morning after a long telepsychiatry shift. As I walked into the downstairs bedroom and deposited my stuff and got ready for sleep, I could see that my wife had left a little card on the bed where I usually shed my clothes. It was a little German card, with bunnies wearing golden crowns and Happy Easter Holidays in German on the front. A sweet note graced the inside.

I (and one of the nurses who works with me) got another unexpected card at work the other day from the sister of a long time patient whom we had helped to secure and maintain her United States citizenship. It was sweet, heartfelt and expressed the kind of thanks that does not have to be documented formally but that warms your heart and makes you feel good pretty much forever after you get it. We had done only a little for her, but she was so grateful to us.

I got a phone call the other day, right out of the blue, with good news that was as unexpected as it was wonderful.

Easter eggs.

They are hidden everywhere. No, you don’t have to look for them or even see them at all. Your life can be rich and rewarding without them. You can live your life, be happy and be quite comfortable never having seen one.

But that day that one of those little surprises pops into your life, unexpected, refreshing, wonderful, can be one of the best days you’ve ever had, maybe one of many best days if you become more attuned to the hidden mysteries that surround you.

I hope you enjoy your Easter holiday if you celebrate. Even if you don’t, I hope that as spring settles in and stays with us that you will pay attention, look for the clues that the Programmer puts in your path, and that every once in a while an Easter egg will provide you with that true, unbridled joy that makes this life worth living.



“No, I cannot forget where it is that I come from

I cannot forget the people who love me

Yeah, I can be myself here in this small town…”

Kenny Chesney, John Mellencamp
When I began my psychiatric training in earnest thirty three years ago, after a challenging rotating internship, the indoctrination that began was regimented, sanctioned, scripted and complete. I knew from a very young age, training-wise, that my job was to ask a few very open ended questions, listen, formulate my thoughts about my patient and his reason for coming to see me, and then to discuss this with my supervisors in order to come up with a treatment plan. A plan that sometimes was, oddly enough, kept a secret from the very person it was supposed to help. The name of the game in those days was to figure the patient out before he did it himself, and then to guide him with judicious rigor and well-timed and brilliant interpretations toward increased insight and mental health. Yes, I was trained in a predominantly psychoanalytic program that was only beginning to bring in the psychopharmacologists, who would later dominate the agenda. 

I was taught to be the proverbial blank screen. I was to show little emotion, offer little to no spontaneous conversation or banter, and to never divulge anything of note or merit about myself except under the direst of circumstances. I embraced the psychiatrist persona that was the norm for that time. This therapeutic stance was just that, but it was not real or fun to me to practice that way. I will never forget how shocked, and yes, maybe a little hurt, I was when one of my long term psychotherapy patients (a lady who had a panic disorder that would be quickly and fairly easily treated today) blurted out, ” I might as well be talking to that doorknob over there as to be talking to you. You never say anything!” When I took this to my supervisor, a prominent psychiatrist who had literally written the book on these kinds of interactions, he praised me for maintaining my therapeutic distance and stance through this obvious transference-based outburst by my patient. He gave me pointers on how to proceed from there, mapping out a strategy for the next several months. I dutifully went back to work. The patient came to see me one more time and never came back. She was not getting what she needed to get better, and she quit. 

Today, I am working in a small South Carolina town. One of my duties this morning was to go over to the probate court at the courthouse building, five minutes away from my office by car, and testify about an evaluation I did a week ago. On arriving at the probate court office, I encountered the judge sitting at her secretary’s desk, taking  phone call. 

“Aren’t you in the wrong place?” I teased her. “Your office is in there.” 

“I know! One of my staff had a death in the family and the other one had already planned a vacation, so I’m doing it all today.” 

Soon afterward, we entered the hearing room, which is just that, a room with one long wooden conference table, a dozen mismatched chairs, a wall full of musty bound county record ledgers, and us. The judge was joined by me, a clinician, the patient, her appointed attorney, and an unsmiling bailiff. 

The format, unlike the proceedings one county up in another courthouse, was informal. Information was shared, the usual legal wrangling was dispensed with, and we all made it clear to the patient and each other that we cared about her, wanted her to get treatment and supported her in doing this. Even in her pre-psychotic state she seemed to grasp the feeling in the room, the common sense of purpose, and the unification of all involved. We even joked and laughed together a few times, which felt wonderfully good and real to me. I realized, mid-hearing, that I was doing something in this sunny small town courthouse that was going to make a real difference in someone’s life. 

I will always be grateful for my training, my supervisors, my colleagues and the experiences and baseline knowledge and skill set they imparted to me. I use those skills every single day. 

However, that can never hide the fact that “I can be myself in this small town”, and it feels good when I am. I’m proud of what I can do to help people here,  and that’s exactly the way it should be.