I knew something was wrong the moment I parked and saw old Red sitting at a table drinking coffee. It was evening, and Red always drank coffee in the mornings. A sixth sense started to itch.

Red was a mainstay of my local Starbuck’s morning crowd, not the evening. In the morning he would greet everyone, tossing out a friendly nod or acknowledging them with a gesture, like a glance over the top of his glasses as he read the newspaper.

I’d only spoken to him a couple of times over the years, but we knew each other by sight, if not by name. He was a small man, runty even, with a reddish complexion, hence the nickname. Looking at him now I could see he was forlorn, sad. His face was a dark mask, not like himself, usually a bubbling bubble of a man open and antic and without concern.

Old Red, the lucky retired guy who gets to sit and drink his coffee and read the newspaper while the rest of the world goes to work. Lucky guy. Lucky Red.

 Hey Red, I said, passing him by.

 Hey, he answered.

Like a switch flipping, his face erupted, exploded, and he was bubbly Red once again. This was in an instant. Then his chatter starts to flow like some rushing river that has escaped the dam.

Red has the ability to hold you in the moment, and he held me now with his words pelting me over and over like some hail storm that comes out of nowhere. What he says doesn’t really matter. He notes the weather, notes the cost of coffee, notes the state of the world in slight seconds, in sweeping drips of passing moments, stirring the air with crisp words strung together without periods or commas, but stabbing the air with exclamation marks every few phrases.

Since I’m in a hurry, I want to bolt now and get on with my evening. But I have to know.

Red, I say, everything OK?

Sure, he says, sure. Then he begins and I immediately know I was right to stop even while I wish I were elsewhere and not here. She died in December, his wife of some 40 years, he said, died after months of pain and agony. This is delivered matter of factly, yet there’s an edge in his voice. He left the house and came here to the coffee shop to see what he could see.

He is about a foot and a half shorter than me, and I put my hand on his shoulder only because it’s really all I can do. He is not himself, this Red. He is another Red, a man looking for something, searching for a way to mourn the passing of a partner of more than four decades. I realize that I am now a part of that process, and so I hold my place, despite a desire to get wherever I was intending to get. Instead, I listen to some more patter and realize the importance of merely being there for someone who’s wounded and hurt.

I realize that above all, these moments are ways for us to administer hope to others, to offer a hand, an ear, a heart. I realized, as he spoke non-stop, that he must have piled up his thoughts over many months and was finally getting to unleash them, not about death and loss and mourning but about nothing at all, the state of the world, the downside of retirement, cops, baseball, the newspaper.

I didn’t have to say anything, so I didn’t.

Fans gather outside singer Amy Winehouse's London home

Once again we hear about one of our young gods dying. Singer and songwriter Amy Winehouse was 27 when she was found dead, the same age as Janis Joplin so many years ago, both great voices stopped too soon.

Amy Winehouse’s music was a testament to rebellion, to female independence and to the twisted and tangled troubles often found within the complexities of love. For an artist, pain and suffering can be a path that leads to all sorts of lessons of the heart, and to lucrative and telling songs that speak of heartbreak. Great if you’re an artist with a healthy outlet, rough if you’re just a plain human being. Some people live life so high and so fast they burn out once they hit a certain stratosphere.

Amy, alcohol and my mom

Amy Winehouse was special to me because I was familiar with her struggles and always rooted for her to overcome her addictions. I grew up with alcoholism, but in her sixties, my mother somehow gave up alcohol and began baking bread and took up quilting. Quilts! This is a woman who was raised in New York’s Hell’s Kitchen, and I never saw her bake so much as a cookie. I found quilts hard to fathom. Yet, it was true. No more booze. Just like that. She later gave up cigarettes, too. To me, this was a magnificent example of how the human spirit can overcome its own demons, and more importantly, how recognizing the problem as your own is the first step in defeating it.

Interventions and enablers

I had fully expected Amy Winehouse to defeat her demons, and I damned the circle around her for letting her die. Yet, I once had a chance to get my mother off booze and I stumbled. My father called a family meeting, and we had an intervention. He wanted my mother to leave and was looking for a unanimous vote from my sister and me. My sister is tougher than me in many ways; so she voted in the affirmative, but I couldn’t do it. How was a 12-year-old boy supposed to vote his mother out onto the street? Of course, I learned later that my father was trying to make a point, but since I hadn’t read the script in advance, I gave all the wrong answers. So mom stayed at the house and continued to drink. I now know I was an enabler who might have acted differently and changed the course of my mother’s life much sooner. Or not.

This is the mindset I brought to Amy Winehouse. Her friends could save her. If they loved her, they could save her. Yet, we know this is not true. Individuals with addictions have to grow determined first and then they can get help. Keep in mind that Amy’s first album was released when she was 19 years old, a phenomenal achievement, and a vulnerable time to experience the intoxications of wealth, fame, love and heartbreak.

The road to rehab

Amy Winehouse in concert

Most of her songs were written by her, which offered her fans a glimpse inside her life. “They tried to make me go to rehab/I said no, no, no.” And yet she did go to a clinic and still could not find the fix she needed. This is not a criticism of the clinic. A patient has to accept his or her role first. It doesn’t matter how good a clinic is—if an individual does not become a part of the treatment, then there’s little anyone else can do.

Janis Joplin was the first celebrity who died that I cared for deeply,  and I remember how hearing the news rocked me. And now Amy Winehouse. Both women were 27, with world-famous unique voices, both full of rhythm-and-blues heartbreak, jazzy verve and great pop lyrics.

Alcohol has its place. Nothing wrong with it. But we moderate our consumption the same way we moderate our feelings, unless we can’t. My mother couldn’t. She drank despite the threat of being tossed out of her own house. She drank despite how she hurt the people around her. All these years later, I still quiver when I hear ice cubes being placed into a glass.

Amy Winehouse was rich, famous and troubled. Her lyrics are telling. Just as Aretha announced that she would have R-E-S-P-E-C-T, and we knew she meant it, Amy Winehouse celebrated a tortured view of love, something I thought was a measure of her low self-esteem. It made for great songs, but hard for living:

I cheated myself,
Like I knew I would
I told you I was trouble,
You know that I’m no good

When Janis died, I was quick to criticize the people closest to her for allowing her torment to get her so wasted she wound up dead, without a friend to intervene. I had a similar reaction to news of Amy Winehouse’s death. Then I recalled how I had failed my mother in many ways, and how she failed me, and yet eventually rose above her addiction and defeated it.

Being clear about responsibilities

We can’t be responsible for holding an addicted person to account. We want them cured. But they don’t share our timetable. They are often not ready yet to understand where they are and how much better it is not to be ruled by liquor or drugs or love or greed.

Our responsibility is not to bludgeon our loved ones with criticism over their addictions. Our job is to remind them from time to time that they are loved and if they loved themselves or wanted to, they would find help. Our job is to remind them that it is up to them to get help. It’s their job. That is the first step.

I tend to like the female singers – Aretha, Norah Jones, Alicia Keyes, Adele, great and unique voices with firm points of view. These are women who are doubly attractive to me. They have succeeded in a man’s world and they are the real deals; their music is not manufactured. Their music reflects the guts of life, the drama and passion of love.

In addition to their music, I am attracted to these singers on another level. In my little fantasy, I ask myself that along with loving their work, could I see myself sitting with any of them over a margarita at poolside dressed in my favorite Tommy Bahama shirt talking about life in general? Are you kidding? Yes, to all of them. A margarita is a happy drink and enjoyed by happy people. Healthy people can enjoy indulging in one. Yet, I could never have had that pleasure sitting with Amy Winehouse. How could I? I’ve learned that lesson. I don’t enable. I would walk away. It’s the least I can do.

As a forensic psychiatrist who worked in a jail for ten years, sometimes evaluating murderers and on one occasion a mass murderer, I have often wondered what we can do to mitigate or prevent disasters such as the tragedy that just occurred in Tucson.

I can think of no better answer than the letter written in a recent issue of the New York Times by a federal judge who is professionally experienced in the aftereffects of violence. His words speak both to the nature of the problem, and implicitly to our responsibility as psychiatric professionals. Here’s his letter:

To the Editor:

I disagree with the premise that attackers almost never telegraph their intentions ahead of time (“Real Threats Are Said to Rarely Give Warning,” news article, Jan. 12).

Reports that Jared L. Loughner’s bizarre behaviors were known to law enforcement, schoolmates, friends and, perhaps, his family should have raised a red flag that some form of intervention was appropriate before the attack on Representative Gabrielle Giffords.

I almost never had a child abuse case in Family Court that did not involve antecedents such as excessive absences from school, violence in the home or prior contacts with child welfare officials. Similarly, federal crimes are rarely spontaneous and may well be predictable, if not always preventable.

The challenge lies in connecting the dots and implementing appropriate measures before tragedy occurs, including raising public awareness about how to identify dangerous behaviors.

Richard M. Berman
New York, Jan. 12, 2011

Editor’s note: for more on the tragedy in Arizona, check out:

• To stop violence, we must start with ourselves
• Thoughts on a tragedy, with help from Jon Stewart and Dr. Walt Menninger
• Giffords shooting calls for measured, rational response

Sen. Robert F. Kennedy on the campaign trail

After reading Dr. Walt Menninger’s guest column in the Topeka Capital Journal, I read it again. He had the privilege of serving on the “Violence Commission,” a National Commission on the Causes and Prevention of Violence created by President Lyndon B. Johnson. The commission was created to answer many questions immediately following an assassination of a United States Senator some 42 years ago – Robert F. Kennedy, then running to become a candidate for president.

Dealing with reality

From June 1968 through December 1969, the “Violence Commission” explored “the causes and prevention of lawless acts of violence in our society including assassination, murder and assault; and the causes and prevention of disrespect for law and order, of disrespect for public officials, and of violent disruptions of public order by individuals and groups.” We were confronted with the reality that our country has a long history of violence. The tendency is to minimize the extent to which our past is replete with incidents of violent – crime, riots, assassinations, etc. – and by the pervasiveness of violence in our literature and entertainment.

As Dr. Walt reports, many reports were generated from the findings, including “Preconditions for Assassinations” and what can be done to address what they found.

Here we are 42 years later and what has changed? The names, dates, locations and some details. However, we are not free of violence in our society. We can change the players, locations, dates and maybe some of the rules by which we live and continue to have the same outcome. Until we begin to change the only thing over which we have control – ourselves – nothing will systematically change.

Soul-searching questions

Can I implement the suggestions from 42 years ago? Can I be less critical and more conciliatory toward others? Can I listen more and have less rhetoric in how I think and talk? Can I cut out inflammatory and demeaning thoughts and words? Can I celebrate our differences? Can I be more alert and tuned into who may be struggling with destructive thoughts around me and not depend on someone else to address those in need? Can I identify and appropriately respond to the pain of emotional vulnerability, lack of hope and access to the means which can lead to acts of destruction for those in my world?

Of course I can. Will I?  Will you? It is up to me and you.

Editor’s note: for more on the tragedy in Arizona, check out:

• Forensic psychiatrist praises judge’s letter to the New York Times
• Thoughts on a tragedy, with help from Jon Stewart and Dr. Walt Menninger
• Giffords shooting calls for measured, rational response
  

It’s been four days since Jared Loughner allegedly took aim at Congresswoman Gabrielle Giffords, critically wounding her and 13 others and killing six people, including a 9-year-old girl. Which means it’s been four days of non-stop news coverage and water-cooler conversation about the tragedy. Four days of what-ifs, whys and finger pointing.

Everyone seems to be trying to make sense out of something so, well, senseless.

My fear is that the effort, while noble and worthwhile, will be futile. I hope I’m wrong about that, and rest assured,  I appreciate those who try. Of all those sharing their opinions and thoughts, two–Jon Stewart and Walt Menninger, MD–have had a big impact on how I’ve been processing the events of last Saturday.

Jon Stewart (AKA Edward R. Murrow’s successor)

No, he’s not a mental health professional, a religious leader, a politician or even a poet laureate, but for my money, Jon Stewart claimed the moral high ground on Monday’s episode of The Daily Show. In his monologue, he put aside his usual humorous take on political shenanigans to speak from the heart about the shootings. He was eloquent, moving, thoughtful and thought-provoking.

I think he spoke for many who wonder if the state of our politics, which he described as “toxic” and “unproductive,” caused this young man to resort to violence. On the other hand, I wonder if we might be tempted to lay the blame squarely on mental illness and call it a day. If we do that, we give ourselves a pass to avoid reflecting on how our political rhetoric–whether left, right or center–impacts others. Which would be a real shame.

Stewart’s decision to acknowledge that “crazy is rarer than you think” was an important one. Research has shown that people with mental illness are rarely violent; so I’m glad he used his national platform to make that point clear. Plus, we need to make sure that this collective outrage and grief we’re experiencing leads us to make better decisions about how we as a society handle “crazy.” Maybe we’ll even be willing to devote more resources to mental healthcare as a result.

Walt Menninger, MD

First, we had Dr. Menninger’s New Year’s message, which I thought was a great way to start 2011. Then along came the horror of Saturday, which resulted in a great opinion piece by Dr. Menninger in the Topeka Capital-Journal. Not surprisingly, in light of what I know about him, it was an elegant and balanced testimony about our propensity for violence and what we can do about it.

I thought he summed up the debate we’re having about why this happened quite nicely:

“…media commentators focused on what they felt contributed to the event, with special reference to the inflammatory commentary that seemed to encourage aggressive action in the recent political campaigns. Some felt the commentary encouraged such action, while others exculpated inflammatory rhetoric as freedom of speech.”

As it turns out, Dr. Menninger knows his subject. Not only is he an eminent psychiatrist, he was one of 13 members of the National Commission on the Causes and Prevention of Violence established by President Lyndon B. Johnson following the assassination of Senator Robert F. Kennedy.

The commission undertook an extensive review of violence in America, and in case you didn’t know, there’s been a lot of it. And we’ve learned a lot about it, too, including what conditions can lead to violence, even of the political kind. One such condition, from a 1969 task force report, is described as: “a weakening of shared democratic values, or a crisis in which the democratic institutions are incapable of taking effective remedial actions.”

Referencing the last two years of political discourse in America, Dr. Menninger said:

“There has been a great deal of defamation and vilification by commentators on one extreme or the other who make sarcastic and demeaning observations about persons with contrasting opinions. There have been repeated references suggesting violent action as a way to deal with an opposing viewpoint. And there is no shortage of individuals who are both vulnerable mentally or emotionally to such rhetoric, and who have access to a means to take some action about it.”

So true and so sad.

As for the future

For me, the bottom line is this: when mental illness meets up with inflamed rhetoric, you don’t want to be around because no good can come of it. I’m not a clinician, and I’ve never met Loughner; so I can’t say if he really does have a mental illness at all. I also, like Jon Stewart, can’t draw a straight line from pundits’ public statements to shots being fired at innocent people.

But I would like to hope that we will all take greater care choosing our words when talking politics at the dinner table, around the water cooler and in the media. Doing so might just make this country a safer place in which to exercise our right to free speech. It also might give some other 9-year-old fascinated by politics the chance to grow up and actually vote one day. Wouldn’t that be nice?

Editor’s note: For more on the tragedy in Arizona, check out:

• Forensic psychiatrist praises judge’s letter to the New York Times
• To stop violence, we must start with ourselves
• Giffords shooting calls for measured, rational response

Knock knock.

Alyssa L. Miller photograph, courtesy of Flickr

Who’s there?

A bereaved parent.

(silence)

Knock knock?

Knock knock?

Knock knock?

Unfortunately, silence is often the response to a parent who has had a child die…silence or avoidance. The death of a child is something that hits too close to home; we don’t want to think that something beyond our control can happen that would destroy our world as we know it. For many people, the pain of a grieving parent feels too intense to even witness. “What could I possibly say?” we wonder. For our own peace of mind, we need to see bereaved parents doing well; we need to imagine that their world returns to normal fairly quickly. So we don’t ask, and we don’t see.

I’ve vacillated between writing this post for those who haven’t had a child die or for those who have: One side of me wants to write it for the former because it is a topic that needs a lot more understanding and awareness. There are a lot of grieving parents out there…every person who dies is someone’s child. Think about it like this: For every one death, there are probably two grieving parents, even though they may be as old as 80. We don’t stop being a parent just because our child becomes an adult.

But the other side of me wants to write it for the latter, in hopes that someone in this no-one-wants-to-be-here category will read it and be able to feel a small measure of comfort in knowing that what they are going through does not mean they are crazy, and that the pain can move from all-encompassing and suffocating to the kind that can turn us into a Velveteen Rabbit of sorts…our sharp edges softened by the buffeting and crashing and thrashing they take.

I’m aware that talking about pain so intense that it can ultimately soften us may lead many who have not “lost” a child (more on this later) to become even more fearful of reading on. I encourage you to stay with me, much as I have encouraged those whom I have worked with to stay with me…to not give up but to trust that we—because I want them to know they do not have to go through this alone—will walk through this together. That anything they have to go through, I will go through with them. When they can’t see the future, we’ll look through my eyes. That’s the message I want to give grieving parents. The message I’d like to give to everyone else:   It’s not a matter of doing, it’s a matter of being.

Words to live by

If you live, work or play with someone who has had a child die…no matter how long ago that child died…say the child’s name and invite the parent to talk about the child. I can assure you that in that parent’s heart, their child still lives. Many years after the death of a child, if you ask a parent about their child, one of the first things you’ll hear is “She’d be ____ years old right now.” They don’t have to stop to calculate the age: They have brought that child with them through the years.

Let me go back now to the word commonly used when a child dies: lost, as in “She lost her child.” Please take this word out of your vocabulary when you’re thinking about the death of someone’s child. The parent did not lose their child; she or he was not misplaced.

And don’t say anything like “He’s better off” or “It was God’s will.” As they used to say in the old West, or at least in my East Texas hometown, “Them thar are fightin’ words.”

Sew your lips shut if you think these words might slip out in your discomfort; if they slip out anyway, acknowledge your mistake. Let them talk, let them talk, let them talk.

Lost, but not alone

Any idea who does get lost? Very often, it’s the parent; sometimes it’s the couple’s relationship that gets lost. “I don’t know who I am anymore,” is often said. So I tell grieving parents, “What’s important to remember is that you can find yourself again only through grieving; your relationship can be recovered and strengthened through the grief.” And “grieving” means that they have to allow themselves to feel the anger and the guilt and the sadness and the fear. So the question becomes, do we let them go through this on their own, all by themselves? If I can’t take their pain, why would they even dare to hope that they can take their pain? If they can look in my eyes (or in your eyes), and see that I (or you) are not afraid of their pain, perhaps they will allow themselves to grieve. This means that ultimately they will heal.

As I’m writing this, I think back to the grieving parents I have worked with: I remember every single one of them. And if I remember the parent, that also means I remember their child. Parents fear their child will be forgotten; not so. Their child continues in every laugh and every tear and every good thing that happens. Grief is not to be feared; it is not ugly. The pain that I have seen makes every one of these moms and dads beautiful and real and made of velveteen.

So if a grieving parent is knocking at your door, please answer it. If they’re not, go knock on theirs.

Donna Lamb is a senior psychiatric social worker with the Hope Program for adults at The Menninger Clinic.