Staying Relevant: Aging and the Social Networking Revolution

This morning I took the time to create an album on my Facebook site. As usual, it was not an easy process. Through the course of the 90 minutes it took me to achieve some semblance of success, I inadvertently tagged family members, littering their pages with entirely too much of a good thing, I twice lost my work in progress by some unintended swipe of the screen and I ultimately realized that I had already posted half of the photos in this group over a month ago within a different album.

Even with that latter memory misstep, I might have walked away from today’s endeavor giving little thought to my aging place in the world. After all, I have heard the complaints of many younger than I about the challenges of social media. No one seems to have an easy time navigating this virtual world, a world hobbled by the unchecked proliferation, planned obsolescence and proprietary obstacles underpinning all that is IT. Users are at a disadvantage and should feel proud for engaging at all. This has been my mantra.

But today’s encounter offered up something different and personal. Today’s encounter brought my advancing maturity into full relief. Today, as I carefully and diligently loaded precious images of me with mine, Facebook’s facial recognition tool wrongly identified me, and preemptively tagged me in several pics, as... my mother. Ouch.

Now I am proud that my mother, at her age, even maintains a presence in the arena of social networking. And I am the first to admit the woman sports a youthful profile pic for someone in her 90s. But my mother is also someone with whom, insensitive as this may sound, I would prefer not to be confused by any vehicle, human or otherwise, given she is 35 years my senior. “Maybe they go on facial structure,” one of my friends offered by way of solace. Maybe.

In any case, the experience gave me pause for reflection. It started me thinking about aging and identity and purpose. About how our interface with social media may shape all of these in some way, a way previous generations were spared. What are we coming to believe about ourselves as we blitz the internet? Why is the data suggesting that this frenetic connecting leaves many of us feeling more, not less, isolated? Less, not more, adequate? How do I understand my own intentions of engagement, tiny as my footprint may be, let alone offer guidance to my patients?

My mother is currently a resident in an assisted living facility in California. She moved into the place, as likely most of us will when our time comes, with grief and doubt and a hint of rage directed toward her offspring. But New Year’s marks her first anniversary in her new home and I am amazed by how well she has dug in. She is president of the resident’s association. She never misses the Monday afternoon knitting group. And she strolls through the dining room at mealtime greeting, without exception, every soul in the place, staff and diners alike. As you might guess, not all gathered are a fan of this ritual, most especially her visiting children who move right along and grab a chair to minimize the collateral damage to their sense of decorum and the triggering of their childhood memories. But, she forges on and her resilience impresses me.

It is an act of patience to engage with the other residents seated at her table. You are dealing with a population that is hard of hearing but frequently eschews their hearing aids; a population that appears relatively content in their surroundings but perseverates about how they ended up in the facility in the first place (Tales that frequently paint adult children as an ungrateful lot.); a population that has minimal recall of what and to whom they have already detailed their opinions or sufferings but who plow ahead with the telling anyway, even when enlightened to the fact; a population that is as hungry to be heard as any of us; but a population that is not, as a majority, feeding this hunger online.

When I first started joining mom for meals, I found myself only half listening to the other residents sitting at our table. Why was I dismissive? Their age? Their redundancy? The absence of editing and photo-shopping that likely falsifies the stories we’ve come to tell about ourselves on the web? Here, in this community dining room, were human beings unplugged. Stories unpolished. Faces unpainted. Here was raw and spontaneous and rambling and genuine. Greater interpersonal risk? Maybe.

I did get over my resistance. Through the visits I’ve managed the past year I’ve heard remarkable tales. A woman who survived four years in a Japanese internment camp in China. A woman who hobnobbed with local celebrities. A woman who influenced the fashion industry on two continents.(A determined and finely dressed woman who has tried her best to instill in me a sense of wardrobe and style, but to no avail.) I’ve been surprised and entertained; enlightened and humbled. In some incremental way, I’ve grown. And I’ve always walked away from these encounters feeling, well, fed.

Have I experienced any of that when logged on Facebook? On LinkedIn? On my own website? If I have, what has prompted growth, expanded my perspective, has been the clips and quotes that draw universal appeal, the clips and quotes that we like and share and post again and again. Like best-selling fiction, the images or the stories that ‘go viral’  touch something universal within us. A good film can provide that as well.

But universal and intimate are different. Public and personal are sometimes at odds. And reflecting on this dichotomy as I write now, I do not believe I’ve ever closed out of my social networking tools feeling the same depth and quality of connection that I have at times experienced with my mother’s co-residents over a shared meal. People significantly my senior. People who I barely know.

Questions of how to preserve our personal relevancy while joining in the ever expanding public domain of social media are not unique to me, or to any age group. This American Life recently aired an episode entitled, “Status Update.” Act One features three teens “describing the complex social map that is constantly changing in their phone.” Actively posting photos of themselves, and monitoring for ‘likes’ and ‘comments’ throughout the interview, these young woman explain that selfies, and the potential validation units they carry, are the primary measure they use to assess their ever-evolving place in the social hierarchy. The word they use frequently, the word that I have employed for this blog, is “relevant.” Is my face relevant? Is my status relevant? Am I relevant? Where do I stand on the ladder of popularity now? And now? And now?

How will this generation, with their escalating preoccupation with face and form and standing, cope with aging?

While it would be tempting to conclude these three are the exception, Ira Glass reminds us, and I’m paraphrasing here, that this need for external validation, and the propensity to compare, is keenly present in us all. We send out signals and then lie in wait with our radar on full power. Was my post worthy? Was my photo unique? Was my comment on point? Am I being seen? Am I being heard? Am I relevant?

Naturally we are constantly returning the favor, proportionally, I surmise, to the time we spend logged on. And when an individual maintains hundreds, even, still unbelievable to me, thousands, of contacts on a single networking tool, maintaining this never-ending validation stream can easily become a full time job. And how genuine, how reassuring, are these ‘like’ blips showing up on our screens? Am I relevant? Yes you are. Yes you are. Yes, indeed, you are.

Mental health requires a certain behavioral flexibility and emotional adaptability. And no question social media offers many benefits, or these sites simply would not have, could not have, commandeered their current place, centered, in our activities of daily living. Yet I suspect that our desire to be recognized, to count, may be proportionally denied in these venues. The larger the stage on which we yearn to be seen, the lesser visible we are likely to be. And the more our core sense of self becomes tethered to the tail of this continually morphing social networking tiger, the more opportunities for self-doubt are spawned.

For me to suggest that there are psychological risks to social networking is not news. Much research has been done, and many conclusions have been drawn, on the topic. But my purpose here is more basic. An invitation really. As we age, which all of us are busily doing no matter the decade we currently find ourselves, I encourage us all to plant the seeds of our identity, our sense of relevance, less in the mixed furrows of social media and more in the rich soils of direct and intimate contact with our fellow human beings. Perhaps we can simply learn to ‘like’ ourselves... for holding open a door, for making room in traffic, for offering a shoulder to cry on, for listening, truly listening, even when we doubt the individual in front of us is, well, relevant.

In the end, might we discover that this unplanned and unpolished exchange is far more validating of who we are as people than all those ‘likes’ and ‘comments’ waiting for us online? Maybe.

Mother of all Expectations

Please no more therapy
Mother take care of me
Piece me together with a
Needle and thread

                                                   Polaroids by Shawn Colvin

Of all the expectations to which we cling, to be loved and nurtured by our mother may be the most primary. Where ever we look, religion or art or poetry or songs through the ages, the point is underscored. And that's not all. Whereas father* we hold to the core obligation of creator, mother* we hold as our core protector. The paternal assignment rings time limited. The maternal never ending. And while I can think of many men I've met through the years who conscientiously fulfill both roles, I have met many women through the years going it alone. On a planet burgeoning with factions of every ilk, the guardian role is growing ever more daunting.

The mythology of mother power has echoed through the eons, but modern psychiatry dove into this fray with a vengeance. 'Mother' became a duty laden with perfectionistic ideals, and heaven help the woman who was unable to walk the narrow line. The irony is striking. In a world favoring male authority, we increasingly expected female energy to serve as our shield. 

Some would try and convince me things are changing. And I long to agree. But when I continue to see images of mothers stepping in front of every conceivable weapon of human destruction in, often futile, attempts to save their children,
my heart remains unconvinced. 

I do believe a solution is possible however. I do not believe our future hopeless. And so I will be bold and ask: Might we all learn to mother? Could we all step up, biological mother or no, male or female, and lead with a commitment to protect first? Could all our creations be predicated on that which we ultimately value as individuals: care, affection and safety. 

I recognize how deeply naive, even corny, that may sound to you. And I accept the criticism as legitimate. But I also still believe in the potential. In our final hours, regardless of our past, I believe most of us seek a legacy of peace. And if you want to join in that effort, please take the time to explore the resource links below. Change is possible if we all pitch in.

Wishing you all Happy Mother's Day.

MomsRising.org and Collaborating Organizations
Over 85 organizations have signed on to be aligned with MomsRising. They are some of the nation’s strongest women's organizations, family advocacy groups, mother’s organizations, child advocacy groups, unions, health care organizations, parenting groups, and faith-based organizations all of which have the goal of improving the lives of mothers and families.

Top 10 Organizations that Help Single Mothers
Here is a list of organizations that can benefit single mothers and their children to lead a peaceful, decent and a healthy social life without hunger and poverty.

The Mother Dance: How Children Change Your Life
Lerner's own experience taught her the basic lessons of motherhood; that we are not in control of what happens to our children, and that this fact needn't stop us from feeling totally guilty and responsible, that matters of life and death turn on a dime, and that most of what we worry about doesn't happen (although bad things happen that we fail to anticipate). Lerner shows us how kids are the best teachers of life's most profound spiritual lessons.

Oxford American Writer's Dictionary

Grief: The Simple Truth

One year ago today I learned that a dear colleague had died. One month ago today I visited a dear friend whose memory is failing. One week ago today I was with my mother in her new assisted living residence, where many are still lively and active but where others are rapidly approaching a final passage. And sitting here tonight reflecting on aging and dementia and death, I have been reminded of a conclusion made years ago when I first encountered these realities working as a nurse: Grief is a mysterious process and, even with the best laid plans, loss catches us unawares.

The truth is we can never be adequately prepared for any of life's loss milestones, slow moving or sudden.  And while a literature search would harvest numerous theories and road mapseven the authors of those guides remind readers that the journey of loss is unpredictable and rarely linear. Grief is singular and personal. Grief is raw and fluid. Grief can conjure gratitude and laughter just as readily as tears and regret. Grief takes our breath away, leaves us wondering if we will ever breath easily again. Grief opens our hearts, clears our vision, wake us up. 

Grief need not be solitary however. Grief often appreciates company. Presence the only gift required. The holding of a hand. The bearing witness to pain. The willingness to listen and not judge. The courage to sit with powerlessness. The determination to see beauty in the full range of human age and functionality and decline.

I miss my colleague in ways never anticipated. I yearn for the rich and insightful conversations I once shared with my friend. I stumble in my attempts to offer useful support to my mother. But I am grateful for the years and the memories and the lessons learned. And I have come to accept the simple truth: 
Grief is a mysterious process and, even with the best laid plans, loss catches us unawares.

Resources:
Help Guide: Coping with Grief and Loss
Grief Net: Email Grief Support Groups
The Healing Center: A Seattle Grief Support Community

growing wiser: the practice of sanity in a bombastic world.

Beyond our ideas of right-doing and wrong-doing, there is a field.
I will meet you there.
  
Rumi

I do not want to talk about Charlie Hebdo. I want to stay close to home and hone in on what's relevant to mental health, yours and mine, in the safety of our daily lives. 


There is always a temptation for us to detach ourselves from the headlines. It's an understandable tendency. Tragic events remind us of the limits of our power. And those of us who do actively respond to a particular crisis usually do so as a call to collective action, not as a call to personal growth.  As Leo Tolstoy noted, "Everyone thinks of changing the world, but no one thinks of changing himself."

Yet a consideration of how we might change as individuals in the face of world terror is the primary path to sanity. Cries of justice and rights and honor come readily. Reflection and insight, the cultivation of wisdom, is harder earned. Smarts alone do not get us there.

Smart: quick-witted, brainy, savvy, quick on the uptake.
Wise: discerning, discriminating, judicious, insightful.*
Smarter is a challenge. the darling of satire, the muse of planned obsolescence.
Wiser is an invitation, the product of patience, the true currency of all whose prophetic words we have so twisted or ignored through eons of time.

You may know smart people. You may consider yourself a smart person. You may know people who can speak their minds or stand their ground or preach their cause. You may feel you can do the same. But who in your circle of friends or colleagues or family do you consider wise? More importantly, how do we ourselves grow wise? 

I do not want to talk about Charlie Hebdo. But I do want to reference an ancient wisdom, a set of three questions that will serve us steadfastly in the most challenging of situations, if our intention is constructive:

Is it true? Is it kind? Is it necessary?

The origin of this litmus test of the quality of our speech or action has been blurred by time. It has been attributed to multiple spiritual disciplines and sages. It has been quoted in multiple writings from 19th century poetry to modern day parenting guides. But whatever or whoever the original source, the call to wisdom remains pure and clear. And let's face it, most of what we say and do in the course of our daily lives falls short of the mark.

I do not want to talk about Charlie Hebdo. I do not want to add to the clamor of lash and backlash, of terror perpetrated by bombs or disrespect perpetrated by words. But I do want to hold the possibility that each of us might, in the course of our ordinary lives, grow wiser along the way.

Additional resources:
Constructive versus Destructive Language
Wisdom from a career in technology.
Encourage Dialogue to Open Communication
The Extrodinary Team Blog

Words Can Heal
Consider taking the pledge.
The Center for Nonviolent Communication


* Oxford American Writer's Thesaurus

Prescription Medication: Are you paying a higher price at your pharmacy?

The high cost of medication in this country is a concern for us all. Yet when we are acutely ill or burdened by chronic illness, adequately researching competing information and savings claims can prove an arduous task. As a result, when it comes to filling a prescription many of us default to habit. If your budget is tight, you may want to reconsider. Here are a few resources and tips that may help save you money:

Pharmacy Pricing Varies Widely: 
In May of 2013 Consumer Reports published a survey regarding the cost of a months supply of 5 common generics from 11 different pharmacy retailer groups. In all five cases, CVS was the most expensive and Costco* the least. The range was considerable. A 30 day supply of escitalopram 20 mg tabs (generic for Lexapro) was $17 at Costco vs $150 at CVS. The cost was $85 at Target and $105 at Walgreens. 

To confuse matters further, some pharmacies utilize 'lost leaders' in their drug marketing. For example, while one of your medications may fall under a retailer's "$4 Generics" pricing, you may be paying more for your other medications at that same location. Just as many of us purchase groceries at 2 or 3 locations to access better price points on particular items, accessing different pharmacies for different medications many reduce your out of pocket expense substantially. (If you decide to access your medications from more than one pharmacy, be certain to provide your full medication regimen to all retailers so that potential drug / drug interactions are monitored.)

Does My Copay Represent a Cost Saving?
Not necessarily. Recently one of my patients switched to Costco to fill his antidepressant script. He paid cash. Doing so saved him money as the price was LESS THAN HIS COPAY when utilizing his insurance prescription drug benefit. After passing that information on to other patients, I have heard many examples of patients saving money by bypassing their insurance. David Belk, MD, states it plainly: "Close to 80 percent of the prescriptions filled in the U.S. now are for generic medications. So using your insurance to buy many of these medications isn't saving you money, it's costing you money."

May I Mail Order My Drugs From Outside the USA?
Not if you live in the USA. Not legally.
Statistics vary but overall the cost of brand name medication in the USA can be 40% or more above the price paid for the same drug from the same manufacturer when purchased in another country. Yet to "reimport" your medication from another country remains "unequivocally" against the law.  Notably, many individuals and companies opt to do so anyway. Per WebMD: "Governments of the states of Wisconsin, Minnesota, Illinois, Vermont, as well as many city governments and private employers have turned north [Canada] for lower-cost prescription drugs." 

Online Prescription Drug Savings Sites:
There are numerous online sites that claim to provide competitive pricing on medication, just as Kayak or Expedia and the like offer comparisons and/or savings on travel. Some (e.g.: Pharmacy Checker) simply list competing suppliers. Others offer coupons (e.g.: GoodRx) or "free membership" (e.g.: LowestMed) and provide a card. These alternatives may be a good option for some people, though I would exercise caution as from my limited searching the prices were not always less and/or discount reliability could not be confirmed.

Ultimately, what retailer we chose may be based on variables aside from cost. Supporting a local business or geographical convenience may be of a greater priority for you than cost savings. And if your insurance coverage is extensive, your copays may be low and vary minimally. If, however, your budget concerns are great and your insurance benefits are limited, I strongly encourage you to explore the resources above and target reduction of your prescription medication costs today!

* Costco Pharmacies are required to be open to the public; you need not be a member.

Culture, Gender and Your Mental Health

In the aftermath of Satya Nadella's (Microsoft CEO) misbegotten comments on women and their right to advocate for a raise, and subsequent apology, media organizations are weighing in. Some, such as FastCompany, are guiding the conversation toward greater gender equality. Others, such as Forbes, are deferring back to a dated, and conveniently reinforced, misunderstanding that working women value interpersonal connection over adequate pay. In the end, as Maria Klawe aptly reminds us, the positive here is that we have been provided a rich opportunity to promote dialogue and champion change.

Archaic mores around gender hobble us all, men and women, young and old, across race and religion and country. And that hobbling has a direct impact on our collective mental health. Men are pummeled with mixed messages; be violent but be compliant; wield rage but practice empathy. As The Representation Project asserts, we are a culture failing our boys. Women are tyrannized by messages underestimating our intellectual capacity and reducing our value to body. As Taylor M. Chapman explains, we are living in a culture of misperception. Whether female or male, our sense of self, our sense of competency and our capacity to effectively engage in the world are compromised by these misconceptions.

We have the power to shift this reality. We have the potential to be agents of progress. If you are a man, consider exploring organizations such as the Mankind Project, whose mission is the "building and supporting of emotionally mature, accountable, and compassionate male role models that our communities need." If you are a woman, consider exploring organizations such as Lean In, whose action plan is "packed with practical advice for women on how to believe in themselves, pursue any goal and take a seat at any table." If you are a parent, sit down with your children and watch stereotype exposing films such as Miss Representation. If you are a reader and have arrived to this point without opening any of the links provided, go back. Open them. Read them. Discuss them with your peers.

If you believe you are immune to these stereotypes, that your relationship with your co-workers, with your friends and family and with yourself are not impacted by gender bias, think again. Much of the conflict in partnership, in the workplace and in our own self-esteem arise from these discrepancies, discrepancies that exact a price on our mental health. Educate yourself. Value yourself. Challenge yourself to cultivate equanimity in yourself and in the world around you.

Panic Attacks: They're Not For Wimps.

Several weeks ago I attended a wedding in NY. It was a delightful family affair, with the added bonus of getting to spend three days with my two sons and their wonderful partners. All went well, from the weather to the ceremony, and on the day of my departure I stepped out of a cab and into the JFK airport with a full and contented heart.

Minutes later, while waiting at the gate, I found myself in the throes of panic. I had never had a panic attack before and was stunned and confused at the timing. Where was this coming from? Why now? What did I miss? I was even more surprised, in hindsight, that despite my 25 years experience as a stress disorders consultant, I was unable to call on my own skills training and evoke the quieting reflex. I felt flooded and overwhelmed and, quite honestly, as if I was 'going crazy.' This last conclusion Patricia A. Farrell, PhD quite correctly identifies in her article, Under Pressure: What is a Panic Attack, as "the worst" symptom of all.

With the luxury of time and reflection, I have some notions on what might have triggered my state of escalated panic that day. But whatever the source, I have three solid bits of wisdom I am carrying away from the experience that I'd like to share with you here:
1) An increased empathy for my patients who suffer chronic issues with anxiety and/or panic attacks. As my header acknowledges, this disorder is not for wimps! Please be patient with yourself or anyone else in your world who has to contend with this affliction.
2) The quieting reflex is something that needs to be practiced regularly. Only then will we have stored a calming strategy to which our mind and body can default 
when a moment of escalated panic occurs.
3) We do not always have to go it alone. That fateful day I called my older son and he kindly and compassionately stayed on the line with me until the event had passed. It's okay to occasionally turn to a loved one for help.

If you have an ongoing problem with anxiety and/or panic and these symptoms continue to significantly interfere with you ability to function despite your use of relaxation and self-quieting strategies, there are medications that may be of benefit to you. As with any illness, sometimes pharmacological intervention is an appropriate option.

Here's wishing you all an anxiety free day.

Domestic Violence: You're not alone; You're not immune; You're not exempt.

In the wake of news surrounding the NFL and Ray Rice, domestic violence is once again front and center in our national conversation. I encourage all of us to keep that conversation going. And if you want to be inspired to do so. I encourage you take 36 minutes and 9 seconds out of your day to listen to this particular conversation, which aired on KCRW's To The Point:
The NFL Takes a Hit: NFL Fallout and the Domestic Violence Discussion

In the meantime, here's what I want you to know about domestic violence:

YOU'RE NOT ALONE
"
Domestic violence is one of the most chronically underreported crimes. Only one-quarter of all physical assaults, one-fifth of all rapes, and one-half of all stalkings perpetuated against females by intimate partners are reported to the police."
National Coalition Against Domestic Violence 
There is help. There is no shame. You're not alone.
Washington State Domestic Violence Shelter, Programs and Advocacy Services

YOU'RE NOT IMMUNE
Domestic violence is a continuum. Before you next confront a friend, a colleague, a loved-one, even a stranger, ask yourself this about the words you are about to speak: Are they true? Are they constructive? Are they necessary? If not, and you speak them anyway, you too are fueling the flames of violence.
Anger can become a habit. Conflict can become a pattern. You're not immune. 
Love is Respect

YOU'RE NOT EXEMPT
For any of us to claim that we do not have any personal responsibility for domestic violence in this country is comparable to any of us claiming we do not have a personal responsibility for racism or pollution or poverty. If we're not out there actively trying to make a difference then, like it or not, we are complicit. And making a difference begins with educating ourselves on the core issues compromising the character of our nation. Domestic violence is one such issue. 
Face the facts. Take a stand. You're not exempt.
Hey NFL fans: Ray Rice Isn't the problem. We are.