Requiem for a State Hospital

by Tory Butterworth

It’s been coming for a long time, but the final announcement was still a bit of a shock.

Perhaps, between presidential campaigns and other natural disasters, you missed the story. Mayview State Hospital will be closing at the end of next year.

Mayview was built by the City of Pittsburgh in 1897 and served as a home for the poor until 1941, when the Commonwealth of Pennsylvania took over its operations. The patient population reached a high of 3785 in June of 1967. There are slightly over 200 patients there now.

In the early 90s I had a job coordinating evaluation efforts for Unified Systems, a program where state funds were diverted to the county to pay for services that would, hopefully, help Mayview residents leave the institution. The basic question underlying this research was whether it was better for Mayview residents to live in a large state institution or the community.

Mayview became a state hospital in the era when the chronically mentally ill where placed in large, full-service institutions far from city limits. Many of these institutions encouraged residents to become involved in gardening, farming, or even operate small businesses. Directors often lived on the premises, adding to their insular feel. A friend of mine's brother who is schizophrenic still talks of his time in one state institution as, "the good old days."

Among mental health service providers, talking about closing Mayview can generate intense feelings. Some feel strongly that the state is “dumping” their responsibility for these patients, that many will end up in jails or living under bridges. Others look at a state hospital as the most restrictive and therefore least desirable form of care. The psychiatric medication available today allows many to live independently who couldn't have 40 years ago.

As an evaluator, I was expected to come from an unbiased position. I have to admit my one visit to Mayview didn’t leave me with any great love of the institution. And our data on community residences did seem to show more freedom there.

On the other hand, those still at Mayview are the lowest functioning of a very low-functioning population. Is moving them to smaller, community-based residences an improvement?

I think that part of the shock of Mayview’s passing is that it represents the end of an era. Nostalgia for the “good old days” can have a profound impact, even in mental health.

What do you think about Mayview closing?

The Power of Prayer

by Tory Butterworth

A friend of mine saw a cartoon posted on someone's door. It shows a speaker at a convention of clergyman saying, "And now, let us pray. And for you Unitarians out there, do whatever you Unitarians do . . ."

I was raised a Unitarian. For those of you unfamiliar with the religion, not all Unitarians are atheists, but some of them sure are. My mom and dad were both agnostics, which meant (for them), "I'm pretty sure there's nothing out there but I'm not willing to stake my life on it." My mother's mother, on the other hand, was a tried-and-true atheist. She was damn sure there was no God!

I was taught as a child that Jesus was a great man but not the son of God, any more than we are all (metaphorically) sons and daughters of God. Comparisons with other great men, such as Ghandi and Martin Luther King, Jr., then ensued.

But around 30 I began questioning my agnostic upbringing, and after much personal inquiry, decided I did believe in God. And I pray. And I see results of my prayers.

I sometimes pray as the "treatment of last resort" with my clients. What do I find? That God sends answers, but his/her/its ways are still mysterious, and that they rarely work out exactly as we expect.

A case in point.

One woman, very shortly after becoming a client of mine, decided to have gastric bypass surgery (colloquially known as stomach stapling.) I have to admit, I am not able to maintain my usual professional detachment about this procedure. Among my friends, I call it, "surgical bulimia."

Still, it's not my job as a therapist to make a decision for my clients. I merely encouraged her to take her time, allow our work to progress, and consider her alternatives before she engaged in this irreversible procedure.

No go. The woman was going under the knife.

The week before the procedure, she had a big fight with the friend who was taking her to the hospital and said she was going alone (a typical pattern for her.) I spent most of a session trying to suggest alternatives, but she was adamant.

Having used up my other resources as a therapist, I prayed. I was hoping that her insurance would not approve the surgery. But God had other ideas in mind.

Three days before her surgery, my client attended her class in publishing children's books. The professor brought in a speaker to talk about the book she had written on, get this, her own gastric bypass surgery. My client later commented, "Even I saw this as a sign from God."

My client talked to the speaker after class, explaining she was having the same surgery later that week. The author asked who was going with her. When my client said, "No one," the speaker announced, "I'm going with you!"

Whenever I tell this story, people always ask how it "ended." My client completed the gastric bypass, with more personal support than she had anticipated. She lost a large amount of weight (I think it was close to 100 pounds.) This enabled her to get into a very dysfunctional romantic relationship, and she started blaming all her problems on her partner. When I suggested her own behaviors might be causing some of her problems, she ended therapy with me.

Like I say, the ways of God are not our ways . . .

Do you believe in prayer?

Lessons from Reality TV

by Tory Butterworth

Okay, I'll admit it. I do it, at least once a week. And I'll bet I'm not the only one who reads this blog who does it, too. I bet most of you out there have done it at least once. At least I'm willing to admit to it, openly on a blog.

I watch reality TV.

Worse yet, I'm almost beginning to believe it has something to offer, above and beyond temporary mindlessness. I'm starting to learn lessons from reality TV.

Pretty scary, eh?

On "Hell's Kitchen," at the end of each show Chef Gordon Ramsay sums up why the contestant who's leaving didn't make the cut. About one contestant he said, "She's got leadership ability, but her cooking ability doesn't match up."

A week or so later, I was having a discussion with some friends at work about why a supervisor didn't like a former employee of hers. One of my friends said that people naturally followed the staff member, even when she wasn't seeing the "big picture." Chef Ramsay's words came to mind. Some people can lead others, but take them in the wrong direction!

When I watched, "The Bachelor: An Officer and a Gentleman," I wondered how he'd chosen between the final two bachelorettes. Both had given him gifts on their final pre-decision date: one a wrist watch, one a scrapbook of their times together. He mentioned the scrapbook was an important part in making his final choice.

I was in a training on, "Intentional Families," when I realized the significance of this decision. The training advised parents to take time creating "rituals" with their kids, everything from bedtime to playtime. By creating jokes, games, and activities unique to your family, you also create a sense of bonding.

The bachelor chose the woman who gave him a memory of their time together, showing how important it was for her. No "pre-packaged" gift could ever be as meaningful. Their scrapbook created a bond between them that lead to a proposal of marriage!

Come clean, now. Do you watch reality TV? What lessons have you learned?

Better Than Nothin'

by Tory Butterworth

When I first started in community mental health as an outpatient therapist, one of my clients had waited three months for his first session. This is part of what motivated me to take up the challenge of co-facilitating Newcomers' Group, where new patients got to be seen by someone (admittedly in a group) within a week of their initial assessment. To say it was a hard sell was an understatement, but we persisted, and the concept continued even after I'd left.

One of the things that kept my co-leader and I going on those difficult days when patients, staff, and mental health regulations seemed to conspire against us, was our motto. "After all, it's better than nothing," I'd repeat to myself or my co-leader. And despite its lacks, Newcomers Group gave help quickly to people who desperately needed it, and allowed us to keep an eye on the patients at greatest risk. It was better than waiting six to eight weeks to see someone individually.

After leaving that therapist job, I let go of our motto, hoping I would never need it again. When you're doing training, you have time to prepare in advance, right?

So much for wishful thinking.

Just as I was leaving work Monday, my boss approached me, looked me in the eye, and told me, "I need help." New boss, new job, not the sort of request you want to turn down. This week our organization is hosting the "Crisis Intervention Team" training for police officers, and someone from a collaborating agency dropped the ball and left us a presenter short. I was given a powerpoint on assessing suicide attempts and asked to present it the next day at 8 a.m.

As I was busy assessing whether I could politely refuse, our Newcomers' group motto came to mind. The trainees had already left for the day, so it was too late to ask them to come back at 9 a.m. rather than 8. My presentation, as inadequate as it was, was still better than nothing. I agreed and managed to make it through the presentation the next day more or less unscathed.

Based on audience reaction, if I had to do it again I would have organized the presentation differently. But, even if I had time to prepare, would I have figured that out before the event? I guess I'll never know.

I tell my perfectionist clients, "Some things need to be done right, others just need to be done." All I can say is, it was done.

Any mottos that get you through the day?

What People Want

by Tory Butterworth

So, I have a new job. I'm back in community mental health, but one step up. Now I'm training employees in mental health, rather than working the front lines. I’m excited to be there.

My first task is to come up with the mental health training calendar for 2008. My boss gave me a list of people to contact, to ask about their training needs. As far as I'm concerned, bopping in on meetings I'll never have to go to again and chatting with people I don't know is the fun part. I feel like an anthropologist in a strange land. Where do they come from? What are their customs? What are their beefs?

Of course, at some point the fun exploration stops and the real work begins. In my case, that means coming up with titles and descriptions of trainings employees will want to come to, and then conducting them.

One of the Training and Development department's biggest beefs is that employees ask for certain classes, and then don't register. They've checked out the best days and times. Still, no interest. I can't say I have any crystal ball into this phenomenon, but it does make me wonder about asking people, "What trainings do you want for 2008?" Do people know what they want?

As a psychotherapist in private practice, I have to give clients what they want or they don't return. In therapy we ask, "What brought you here?" That's called the presenting problem. For ongoing complaints we ask, "Why now?" That's called the precipitating event. One supervisor of mine suggested that if you give the client what they want, you often have some room left over to help them with something they need, but haven't yet recognized. That's called diplomacy.

My favorite inspirational speaker, Marianne Williamson, suggests that the most boring question you can ask in bed is, "What turns you on?" She believes the real answer is, "Surprise me!" I'm not sure that's true even in bed, but is it true other places?

Most novelists I know don't go around and ask people, "What do you want to read?" (or, "What turns you on?" for that matter.) An idea comes to them, and they try to mold it into something people will like. Sounds to me a lot like therapist diplomacy.

What about picking out a novel in a bookstore? Do you know what you want? Or do you like to be surprised?

I'll let you know over the next few months how my efforts go at figuring out what trainings employees want, and whether they like to be surprised. In the meantime, in terms of books, do you know what you want?

Girls Gone Stupid II

by Tory Butterworth

Lisa's last blog reminded me that I, too, submitted a story to the anthology, "Girls Gone Stupid: Dumb Things Smart Women Do," which never happened. Like her, I thought it was a great idea and, like her, I never found another place to submit it. So, here's my stupid story . . .

* * *

I have a degree from MIT and a PhD on top of that, so I’m not exactly dumb. But when it comes to cars, I’ve always felt really, really stupid. Particularly around car dealers, even those without any degrees.

My seven years of graduate school delayed my independence from my family of origin, and it was in my thirtieth year that I decided to move from Michigan to Pittsburgh, PA to start a new life. I was driving my mother’s Chevrolet Citation then, and had been told by a car-savvy friend that it would probably last until I settled in with a job. “Just don’t expect to get anything for it when you trade it in,” he’d advised. The Citation proved my friend wrong by dying a month after I moved, and I was jump-started into buying my first motorized vehicle.

With a “General Motors family” discount and a substantial down payment from my mother, I somehow managed to wangle a car despite not having a job. At that point, I wasn’t picky. I took whatever was on the lot.

She was a white Chevy Nova and I named her Bonnie. Things officially settled down two months later when I got a job and was able to afford her payments without any financial subsidies from my mom.

Bonnie wasn’t a bad little car. She did have an annoying habit of going through mufflers like nobody’s business. And she gave me a big scare shortly after her last payment, when she needed a new oil pan. I wasn’t sure at the time whether to put her down, but I made the right choice for radical surgery and she lived another four years after that. All in all, she got me there and back again through nine years, 160,000 miles, and sixty small monthly payments.

She did have one peculiarity, though. Her radio reception was lousy. Of course, taking what I could get at the time, I had reconciled myself to no tape deck or cruise control. So I attributed this trait to her inexpensive sound system, manufacturer installed, or perhaps the Pittsburgh hills that made reception difficult.

Still, eventually even Bonnie’s life expectancy came to its end. I was standing in the parking lot of a Subaru dealer with my friend Judy, looking for her replacement, when I complained to the salesman about, “miserable radio reception.” He casually reached over and extended her antennae, which had remained dormant in its black plastic sheath since her christening. No words were needed to express the shock on the faces of either me or my friend.

Judy and I laughed about this incident all the way home. Bonnie’s radio sounded great for the next three weeks, until I traded her in.

Anyone else feel stupid around cars?

'Tis the Season

by Tory Butterworth

Well, it's that time of year again. I'm not speaking of violets and rhododendron in bloom, or shedding coats and boots and being able to wear shorts again. I'm talking about the time of the year when television shows are wrapping up their seasons.

Maybe, with my writing hat on, I'm more critical this year, but does anyone else dislike what many of the shows are doing at the end of this season?

I'm not talking about the shows that you know the premise is lousy and the writing is uneven, but you watch anyway because it's your area of interest or your spouse is watching or you enjoy seeing a good train wreck.

I'm talking about the shows that had decent to excellent writing all year, interesting plots, good character development, and in the last few episodes it's like the writers are on speed.

And maybe they are. I've never written for a television show, so maybe it's like finals. By the end of the season you're so sleep-deprived you'll put anything on the page just to get it over with?

And I guess not only do writers have to think about how to wrap up their current plots and subplots but also how to keep viewers interested enough to want to tune in next season.

But still, why do they think we like cliffhangers manufactured out of thin air?

And here's the thing. If the season comes to a satisfying conclusion, if it ties up loose ends, if I breathe a sign of relief like I do at the end of a good novel, that's when I'm going to be tuning in again next year. If the writers' drop a bombshell, turning everything I've taken for granted upside down and making it a whole new show, then I'm going to think twice about sticking with it.

But maybe I'm in the minority. What about you? What will get you to tune in next fall?

Psychotic

by Tory Butterworth

I don't know about you, but I'm not a big believer in the, "Not Guilty by reason of insanity," plea. I've worked with many clients from dysfunctional families, including sadistic and/or abusive parents. Some of these clients are the nicest people you'll ever meet, with a great capacity for empathy with others' pain. Of course, some sadistic and/or abusive people also come from such backgrounds. Still, it proves to me that there can be many different responses to the same dysfunctional environment.

I was reminded of why we need the insanity defense when I met a patient I'll call Joe (not his real name.)

Joe believed the FBI was chasing him. He got on a bus and rode across the country, exiting somewhere in Utah. Scared he was being followed, he stole the nearest car, and in due time was caught and arrested.

Now, I don't know about you, but if I thought the FBI was chasing me, I might well have done the same thing. The problem, of course, was that the FBI didn't have anything to do with it. It was all in Joe's head.

Joe complained that the people next door where listening in on his thoughts. He said he wanted to move to Minnesota to get away from it. I asked him how it would be different for him in Minnesota. He said, "In Minnesota, if they're listening, they don't talk about it!"

This is what clinicians call, "psychotic," being out of touch with reality. A number of conditions can cause psychotic symptoms, including dehydration, severe lack of sleep, and abuse of certain substances. Several different psychiatric disorders, including bipolar disorder and depression with psychotic features, can also cause psychosis.

The most common cause of psychosis, however, is schizophrenia. Epidemiologists estimate one in 100 people in this country are schizophrenic. Average people sometimes use "schizophrenic," to mean having a split personality. The mental health diagnosis, however, is part of a much broader disease that can lead to progressive mental disorganization.

To follow up on the, "Creating Believable Villains," theme of my last few blogs, I believe that psychotic people can make sympathetic villains, if the author can show how their actions arise from their distorted thoughts. However, it is usually difficult to disguise psychosis (most people can tell that someone who's psychotic is acting weird, even if they don't understand why) and so it may be difficult to make it a surprise that this type of villain committed a crime.

Any of you crime writers out there considering making your villain guilty by reason of insanity?

Personality Disorder

by Tory Butterworth
In fiction, when we think about, "character," we think about the unique traits that make one person distinct from another. These include mannerisms and ways of speaking and also, on a deeper level, characteristic ways of thinking, feeling, and acting. In psychology, such traits are considered, "personality." There is an entire branch of psychology devoted to studying it.

In therapy, there is something called a "personality disorder," when a patient's personality is their basic problem. This brings up an interesting question: when does someone's personality help them and when does it get in their way?

The DSM-IV, the list of diagnoses from the American Psychiatric Association that is used by most mental health agencies, defines a personality disorder as, "An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture." In other words, it's when someone's personality does not fit with their environment.

I would take this one step further. For me, a personality trait becomes a personality disorder when it is so rigid that the person can't modify it to fit the situation they find themselves in.

Think about the trait of stubbornness. Many times this is a good thing. Stubborn people stick with problems long after others have given up, and so they may solve a problem which others don't. However, all of us have the "Vietnam wars" in our lives, times when we need to let something go. Ordinary stubborn people do this reluctantly. People with a personality disorder may never let go, even if it hurts their life and relationships.

All good traits have their dark side. A sense of humor is usually a good thing, but we all know people who take this too far, who crack jokes at inappropriate times and in inappropriate ways. Intelligence is valued in our culture, but goes too far when someone relies on it to the exclusion of their feelings.

I'd like you to try an experiment. Think of something you like about your spouse/ child/ coworker/ friend/ neighbor. Doesn't that trait, at the wrong place and time, annoy you? My next door neighbor is a very friendly person, but his mindless chatter with his friends on his back deck (right next to mine) can bug the hell out of me when I'm writing.

Let me know what you come up with.

The hardest traits to see, of course, are our own. Do you have any personality traits you'd like to be able to "turn off" at certain times?

Impulsivity

by Tory Butterworth

Here's one of the comments I got on my last blog, "Why People Do Bad Things." (Thanks, Annette!)

". . . there was one guy who my husband and I thought was a friend. Very charming, very personable, BUT he then started luring other friends into money schemes in which he always came out ahead, but others lost their life savings . . .

The end result: he ended up going to prison for shooting an employee in the back during a fit of rage."

As a psychotherapist, what stands out for me in this example is the concept of impulsivity.

Impulsive people do things, well, on impulse, in the spur of the moment, without thinking ahead to their consequences. As little kids and then teenagers, most of us were more impulsive than we are now. The school of hard knocks teaches us the expected consequences of our behaviors (e.g. if I get drunk, I'll have a hangover the next day.) As adults, most of us think things through before making major decisions, sometimes too much. Even when we'd rather not, we imagine the horrible consequences of everyday actions (e.g. slicing our hand rather than the bread with a sharp knife) and hopefully take steps to prevent future physical or psychological injury.

But some people just never seem to learn. I have clients like that. My more impulsive clients are, like the "villain" mentioned here, charming, spontaneous, personable. However, it is a struggle to help them develop what therapists call, "psychological insight," the ability to understand why they keep repeating the same costly behavior.

Did the villain above, while he was raising the gun on his employee, think, "Well, if I do shoot him, I'm likely to end up in jail for many miserable years?" Probably not. He acted in the moment, and may still be suffering the consequences.

Most impulsive people have certain areas of their life that they are impulsive in, and others they are not. So, some impulsive people tend to get involved in physical risks (e.g. extreme sports), others sexual risks, others financial risks, and still others risks of violent behavior.

As an author, if you have chosen an impulsive villain, you'll need to both establish that this kind of risk-taking is in his or her character, as well as the specific precipitating events that lead the risk-taking to get out of hand.

Any of you know chronically impulsive people? Where do they get themselves in trouble?

Why People Do Bad Things

by Tory Butterworth

On Saturday Gina's blog, "Skyscraper Cones and Motivation," discussed how seldom people ask the question, "Why is a person doing that?" I agree that too few people ask this important question. As a psychotherapist, however, I spend much of my professional time speculating on people's reasons for their actions.

As a writer, I think there's no place more important to consider motivation than in creating our villains. In order to make villains believable, we need to give them reasons for their actions. However, in order to make them villains, they need to be motivated to do things that your average person sees as at least morally incorrect if not reprehensible.

In May, I'll be presenting at the Pennwriters' conference on, "Creating Believable Villains: Why People Do Bad Things." I thought I'd use my blog space over the next two months to outline different types of villains in psychological terms.

I've decided start with the most "extreme" villains: psychopaths, people lacking any moral conscience.

Most people not only believe that certain actions are right or wrong, they also viscerally feel that they are. When people who are not psychopaths behave badly, they feel guilt or shame. Psychopaths lack these emotions, and so choose behaviors merely as means to ends.

Not all psychopaths are criminals. If they can satisfy their desires in law-abiding ways, they may choose to do so, simply because they don't want to risk ending up in jail. However, they wouldn't be bothered by doing something most people would consider "wrong" if they believed they could get away with it.

Unfortunately, psychopaths don't usually make the best villains from a fiction standpoint. They're very rare. Few people have met one, and if they have, they may not get close enough to them socially to realize what they were seeing. (Psychopaths don't have great desires for personal intimacy.) To make a villain work, the character needs to at least remind a reader of someone he or she knows.

So, the first question to ask when you are considering why your villain is doing bad things is: Do they have a moral conscience? Are they literally unable to recognize right from wrong? The second question is: Will they interest my reader? Then again, maybe you should reverse those.

Who are the "villains" from your own personal life? I'd love to hear about them!

Autonomy and Ecstacy

by Tory Butterworth

When I work with clients in psychotherapy, I try to help them find themes for their work. By repeating these back to them, it helps make sense of their daily struggles as dealing with a particular set of issues, rather than a series of random events. It can help them see how they are coping with the same issues more effectively as they progress in their work.

As a writer, I try to find a core theme in my work, allowing the plots and subplots to develop different aspects of that theme. My hope is this will give the work an integrated feel, as the collection of people and events fits together into a greater whole, moving towards a satisfying resolution.

One of the themes that comes up a lot with my clients is the search for autonomy. Autonomy is about developing a sense of oneself as separate from others and complete in oneself. Healthy autonomy allows people to follow their own interests and meet their own needs. A person with healthy autonomy can answer the question, "Who am I?"

One of my favorite stories of a quest for autonomy is from The House At Pooh Corner by A.A. Milne, "In Which Tigger Comes to the Forest and Has Breakfast." Pooh asks Tigger, "Do Tiggers like honey?" Tigger responds, "They like everything." However, after actually tasting honey, he realizes Tiggers like, "Everything except honey."

Tigger then tries haycorns, thistles, and many things in Kanga's cupboard, and realizes he doesn't like any of them. Finally, he tries extract of malt and realizes, "So, that's what Tiggers like."

The reason I like this story so much, and quote it often to my clients, is that while people are working through their autonomy issues, they may only be seeing all the many things that they don't like and losing track that they will ever find something they do like. I try to help them realize that they're turning down dates, jobs, or projects in the pursuit of finding something that truly fits with who they are.

Autonomy themes appear frequently in literature, not just in Winnie-the-Pooh. Classic tales of men choosing between their love and the sea (in which, as my high school English teacher once quipped, the sea always wins.) Love triangles, like Scarlet O'Hara choosing between Ashley and Rhett. Protagonists making choices that define who they are (and not just what they like to eat.)

When you look at the books you like, do any particular themes stand out? Is there a way those relate to your life?

What's Your Excuse?

by Tory Butterworth

For those of you who pay attention to our blog schedule, I’m subbing for Annette today. Her father passed away on Sunday and the funeral was today. Annette wrote a really sweet piece on him (it made me cry) in her blog.

My dad used to say, “There’s no excuse!” when he was referring to some behavior that made him mad. But I think, “My father died,” is an excellent excuse. My father died a few days before taxes were due. Definite excuse to file an extension. My mother died a few days before Christmas. This was an excellent excuse for not sending out Christmas cards that year.

My mom hated Christmas. Every year she asked us, “Can we skip Christmas and go to Mexico this year?” My dad hated taxes. You can’t convince me, the psychotherapist, that my parents’ unconscious wishes didn’t play a role in the timing of their deaths.

My dad was cremated. My mother, for some reason, wanted to “see the body off,” (really the casket, praise the Lord) as it was headed towards the flames. I couldn’t see her doing this alone. I had a class the morning this was scheduled, and as I’d missed class the week before I wanted to go to this one if I could.

The professor of the class in question was a self-important psychoanalyst (that is, orthodox follower of the practices of Freud.) He conducted the only 8:30 a.m. class in the entire psychology department and reputedly showed up after having seen his first patient of the day. Let’s just say that “rigid” was his middle name.

The week before my dad’s passing I had asked him for a copy of a paper a friend of mine, since moved to Massachusetts, had written for the course the year before. I knew that if I didn’t catch him that day, it was likely the paper would be lost forever.

I stood in the line of other students after class, waiting to talk to the professor. He and the student before me were engaged in an animated conversation. The minutes ticked by, and I imagined not getting to the crematory in time.

I attempted to briefly interrupt him, expecting I could get the paper, run, and he could return to his conversation. “Excuse me,” I said, as politely as I could.

He turned and glared at me. “What, young lady, is your hurry?”

Damn, you don’t get handed those sort of lines often enough. I’ve always regretted that I didn’t tell him. At that age, I was too timid. But I still think, “I’m late for my father’s cremation,” would have made an excellent excuse, even for a rude interruption. And one I can never use again.

What’s on your top list of best excuses?

Serious Talks with Cats

by Tory Butterworth

I used to post a Silvia cartoon on my office door titled, "Serious Talks with Cats." Unfortunately, I lost it when I left my last job, so I'll have to paraphrase. It pictures a woman eating a hamburger with a cat looking on hungrily. She says, "It appears you have problems with personal boundaries, distinguishing what is yours from what it mine. Have you ever considered intensive psychotherapy?"

I'll admit it, I have serious talks with my pets. A few nights ago, just as I had gotten into bed, I heard a crash downstairs and then a strange brushing sound. As a single woman living alone and a mystery writer, this type of noise tends to put me in mind of burglars invading my premises. I'm proud that I managed to convince myself it was Thora and fall asleep nonetheless.

The next morning I looked around to find what she had pushed over, and discovered a metal glasses case on the floor with the glasses, thankfully unharmed, a few feet away. The case had also contained a pair of clip-ons in a velveteen sleeve. I searched the downstairs and the basement, to no avail.

"Thora," I said, mustering my serious cat talking-to tone, "I understand that you find my glasses much more fun to bat around than the twenty-odd cat toys I've supplied you for that purpose. I know cats need to keep busy and active, and I appreciate your mischievous nature. But I really need those clip-ons. Where did you put them?

What do you know, half an hour later, I once again heard that strange brushing sound. Thora was pawing the bottom of the refrigerator. Investigation with a long, thin stick under the fridge revealed the clip-ons, still in their case.

Score one for human-feline communication!

I had a less productive talk with Thora regarding our weekly adventures in "clipping butt." As neither of my Persian cats will let me brush them, weekly knot clippings are a necessity. Pansy tolerates them, looking forward to her canned salmon reward. Thora has taken to hissing and growling when I get too close to her rear end.

"Thora," I say, "I understand that you take my desire to clip your knots as a personal affront. However, if you don't let me near you, you will soon become one big dreadlock. Not only will this destroy your impressive good looks, but the knots will pull and ruin your playful disposition. Will you let me proceed?"

Score for the week: one for the humans, one for the cats.

A friend of mine once told me about a child-rearing book that deeply influenced her experience of motherhood. "You don't have to win all the battles," it said. I'm hoping the same is true for cat motherhood.

Fess up, how many of you out there have serious talks with your pets? Is it the same with dogs as with cats?

Bipolar

by Tory Butterworth

These days, bipolar disorder seems to be all the rage. This fall, I watched several TV dramas which diagnosed a character as "bipolar." Many of the patients at my community mental health center job described themselves as "bipolar." My co-leader and I used to come up with slogans for our orientation group. Hers was, "Teaching Pittsburgh they're not bipolar, one client at a time." On some days, that's how it felt.

I can't say I understand this societal phenomenon. Bipolar is a hell of a disease, and I wonder if patients knew how devastating it is, whether they'd choose to label themselves that way.

Bipolar used to be called manic-depression. People with bipolar disorder are constantly on a roller coast ride between severe depression and mania. On the depressed end, this can include feelings of worthlessness, excessive guilt, changes in eating (over- or under-), changes in sleep patterns (can't go to sleep or can't wake up), and recurrent thoughts of death.

On the manic end, bipolar people experience feelings of grandiosity, believing they're capable of things nobody can do. At this end of the spectrum they often sleep very little, their thoughts race, and they can't stop talking. They tend to get involved in risky activities, such as unrestrained buying sprees, sexual indiscretions, or foolish business investments. Some feel more angry than expansive in their manic phase, or when they're on their way up or down.

As mystery writers, we might tend to think of characters with bipolar disorder as our villains. When they are on the manic end of their cycle, these people are more likely to behave impulsively and commit arson, theft, take drugs, or engage in reckless driving. Most patients with bipolar disorder have little capacity for insight into themselves and what motivates them, and so they are frequently a pain in the ass to deal with.

Still, the majority people with bipolar disorder are law-abiding citizens. I might suggest a few other ways to integrate bipolar characters into your stories. One of your suspects could be bipolar, as he or she wouldn't think to cover their tracks. Someone in their manic phase could easily become the victim of a villain, as they are often impulsive and "out there."

In the TV show ER, writers used a bipolar character to provide back story. They introduced the bipolar mother of ER resident Abby Lockhart, played excellently by Sally Fields. She helped viewers sense the frustration and unpredictability of Abby's life as a child as well as to empathize with Abby's intense need for control as an adult.

So, what other ways might you use a character with bipolar disorder in your writing?

All in Their Heads

by Tory Butterworth

As a psychotherapist, I try to get inside people's heads. As much as possible, I want to know how my clients see themselves. While I'm not omniscient, I like to believe that I know a little more about people's internal experience than your average Joe.

As a pet owner, it is tempting to assume I have these same skills with my two Persian cats. What does go on in their furry, little brains, anyway?

At times I feel like I do understand. Cats evolved from cave dwellers. As a result, they feel safe in dark, small places that make most humans claustrophobic. Conversely, the bright, open spaces us humans prefer make them nervous, because they're just the sort of spots where large, winged predators can swoop down unexpectedly.

Ever put a cat in a pillow case? A friend of mine recommended this for trips to the vet or short moves. From a human perspective, it reminds us of death by strangulation. However, anyone I know who's ever tried it with their cats notices how calm they get. Sometimes they even purr!

Then, there's other times, when I realize my intracranial feline perspective is all an illusion. I bought my cats some raw food last year: raw chicken meat ground up with vegetables. Little did I know that health food can be as hard a sell for cats as it is for humans.

Thora (name not changed to protect the innocent) wouldn't try the stuff. Well, that's Thora, she hates anything new. But Pansy wouldn't try it either. So I coated it with a canned, "chicken in broth" cat food. Broth, my foot! It's should be named, "chicken in strange gelatinous substance." That didn't stop Pansy, she loves the stuff.

Thora, despite the fact that she didn't want any, didn't want to be left out. While I fed Pansy, I put food out for Thora with a closed door in-between, so Pansy wouldn't steal Thora's food. After a few minutes, I opened the door and Pansy got whatever Thora didn't eat.

Here's the strange part. Pansy licked the canned food off her plate, but left the raw meat untouched. However, when I opened the door protecting Thora's identical breakfast, Pansy ate everything, canned food and raw meat alike.

So I moved Pansy's unfinished dish next to Thora's. And suddenly she licked her platter clean! What DOES go on between those furry ears?

Here's my advice. Live with them, love them, cuddle up with them at night or in the morning. But don't kid yourself that you really understand what's going on in their heads. You probably don't want to know.

I'm not a Forensic Psychologist

by Tory Butterworth

A couple of weeks ago on the TV show, "Criminal Minds," a profiler was approached by a High School student who was afraid he would murder someone. Later in the show, a different profiler evaluated this young man and said, "In my opinion, it's not if he'll kill, it's when."

This episode illustrates one of my quandaries in writing this blog. I've been considering blogging on diagnoses such as "bipolar" and "schizophrenia" which get bandied about on TV, often incorrectly. I've hesitated because I'm afraid readers will assume I'm someone who specializes in criminal minds. As a therapist, I work with the mentally ill. As a group, the mentally ill are somewhat more likely to be violent than people who are mentally healthy. However, most mental patients (90% or so) aren't violent.

In the orientation group I co-led at a community mental health agency, we quickly learned to screen out the criminal population, sending them to the forensic treatment unit. I discovered that in establishing a therapeutic alliance, I assume a basic truthfulness from the client. If someone told me the FBI was after them, I wouldn't necessarily believe they were being chased, but I would assume the client thinks he or she is. With forensics clients I learned to assume they were lying in order to pull off a scam. My first job when working with them was to figure out what they were trying to get away with.

Forensic patients are masters at scoping out a group, identifying like-minded individuals, and forming alliances to help them undermine the authority of the group leaders. Amazingly, they were often able to pull this off in a single two-hour group session. The bulk of patients who come more or less willingly to community mental health, not forced there by a court order, were focused on their own pain and didn't have much attention left for others in the group. Most of them lacked the social skills to form a rebellion even if they wanted to start one.

Getting back to the "criminal minds" episode, the profiler who performed the evaluation didn't realize the mistake he was making in predicting future behavior. His job starts with a past act, a murder that's already happened, and he works backward to identify who did it. He rarely meets the 100 to 1000 people that match his profile who haven't killed anyone. He doesn't collect data on what differentiates them from the killers.

The fact this young man, frightened of his own impulses, was looking for help before he'd killed anyone, speaks to me of something in his character that differentiates him from those who take out their sadistic fantasies on others. Clients who are successful in therapy have to look at their own pain, rather than blaming it on others or covering it up with unhealthy behavior. This act of moral courage often differentiates those who remain sick from those who get better.

As a therapist, I'm predicting I could work with him.

The Mind of a Scavenger

by Tory Butterworth

One thing I've noticed at my new job, there's a lot of free food floating around. It seems like several days a week there's a free lunch being offered at some function, and the leftovers sit on a cart in the hallway for the rest of the day.

Whenever I see free food, I think of a client of mine from my community mental health days. I'll call him Tom, though that's not his real name.

Tom first attracted my attention in our orientation group. His hair was slick-backed and he wore a navy jogging suit without a shirt underneath, the top unzipped to show his hairy chest.

I remember the time Tom and I were standing in front of the agency during a fire alarm. I had reached the limits of my ability to keep up a conversation without revealing confidential information to the forty or so other people also standing in the parking lot. Tom, picking up the conversational ball, pointed to a hotel a few blocks away. "They have a pretty good buffet there." I nodded, too tired and disaffected to wonder where he was going with this. "Let's go over there," he suggested.

"I've already had lunch."

"No," he insisted, "We can get free food. They don't really check, you know, if you've paid. You just wander in, act like you're supposed to be there, and you get something to eat."

Over the next few months Tom taught me how he crashed events and stole from public places. One restaurant he mentioned still gives me the creeps. Tom had several hiding places staked out there where he could stash his "booty."

I can't say Tom left therapy a changed man. I began to question working with him when I realized that I was helping him become a better thief, not a better human being. Just for the record, he was one of only a very few clients who I don't feel like I helped in some constructive way.

Now, seeing all this free food reminds me of Tom. I wonder if there's a reality TV show in it: "Survivor" meets "Hell's Kitchen." Can contestants create haute cuisine from food scavenged in public buildings? Tom could be both instructor and judge. I'm sure he'd like that.

Communication

by Tory Butterworth

I resisted it as long as I could.

I'm talking about cellphones. I actually bought my first one many years ago. As a single woman, I have a fear of my car dying in some God forsaken place without any means of communication. So I bought a cellphone and didn't give anyone the number. I've never been stranded (not since I bought it) but it did prove useful for checking my phone messages during traffic jams and calling in pizza orders on my way home from work.

Five weeks on my new job without a phone in the office made me decide I'd have to change my policy and use the cellphone for incoming calls. Well, only if I wanted to get any work done.

There are now seven ways to reach me electronically: my home phone, my work phone, my private practice office phone, my cellphone, my home email, and my work email. Checking all of them, I figure, takes about an hour (on a good day.)

It occurred to me when I was stranded in a phoneless office (my cellphone having just run out of juice) that, in typical American fashion, we have worked so hard at increasing the quantity of our communication, we haven't noticed how its quality has been reduced.

I have two psychotherapy clients who have moved out of town and continue to have phone sessions with me. I've been surprised how effective these are, and how few times I wish I was seeing them in person. But I do notice a big difference between sessions on a cellphone and on a landline. Cellphones tend to reduce subtle cues of tone and inflection that give us information about the emotional state of the caller. Sometimes we lose the essential word in a sentence.

So, you ask, what words of wisdom do I have about improving quality of communication now that its quantity has increased? Being willing to listen, developing empathy for another person, and having the patience to say things many different ways till our meaning gets through haven't changed with technology.

It's just that now, we're so busy checking our messages, we don't have time for any of that.

Trick or Treat

by Tory Butterworth

Now that we've officially moved on from Halloween to All Saint's Day, I feel I have license to complain about the holiday without spoiling it too much for anyone else.

I don't have a very good relationship with Halloween. Apparently it started before my birth.

The story my mother tells is that one faithful Halloween night she was pregnant and threatening to miscarry. She was under strict doctor's orders to remain horizontal. My Dad had a bad case of the flu. He was on the phone with his mother when he passed out.

My mother described crawling around on the floor, trying to get a blanket over him. Meanwhile, the neighborhood kids arrived in a steady stream chanting, "Trick or treat, trick or treat!" I guess the good news was that Dad recovered, Mom had her baby, and undoubtedly the children's health was improved by one less treat.

My own personal Halloween story happened at age thirty, while moving from Michigan to Pittsburgh. That morning I awoke to a sign: bloody entrails strewn across my bedroom floor. A heart here, a liver there. It was my cats' present of a mouse (I think it was just one.)

My original plan was to start driving before six and arrive by noon. At a rest stop off the Ohio Turnpike, I tried to fill my gas tank and the liquid poured onto the pavement. That was my second clue that the day was not going as expected.

After a four-hour detour into farm country to get a new part, I once again resumed my journey. I got into Pittsburgh at rush hour. Lets just say I wasn't used to those narrow, windy roads, particularly driving a moving van. I did okay until I turned into the driveway of my new apartment and the van's bumper wedged into the wheel well of a parked truck. It was positioned such that moving my van forward or backward was likely to turn minor damage into major body work.

My frantic search for the truck owner was punctuated by shouts of, you guessed it, "Trick or treat, trick or treat!"

This fiasco was not without its up side. Two friends of mine were coming to help me unpack, but lost the address of my new place. One remembered it was in Bellevue and called the local police department, who reported an obstruction created by a moving van on Sprague Street.

Any other Halloween horror stories out there? Or is it just me?