Am I a closet liberal?

You do not examine legislation in the light of the benefits it will convey
if properly administered, but in the light of the wrongs it would do and
the harms it would cause if improperly administered. -Lyndon B. Johnson,
36th US president (1908-1973)

While I am no great fan of Lyndon Johnson, I agree completely with this statement. Sometimes I fear that my friends think that I am a liberal in disguise when I advocate restraint in a situation where they think that the government should intervene. I am reminded of the situation in New York a couple of years ago where a couple was living in an abandoned car but still having children to be paid for with state welfare money. A judge ordered the woman to have her tubes tied and the ACLU fought to have the decision overturned. I found myself in the odd position of siding with the ACLU. While I think that what the woman was doing was distressing, I reflected on what might happen in another Clinton administration if government was empowered to intervene in people's lives in this manner. About the same time, I remember a proposal that families on welfare should be compeled to take parenting classes if they recieved public assitance. Again, this sounds like a good idea but can you imagine what sort of content would find its way into these classrooms.

"No revolution was ever fought because government intervened too little into the lives of its people." Who said that? I did--and please feel free to quote me. "I prefer the danger of freedom to the security of tyranny." That came from Thomas Jefferson (and I don't remember the exact quote). Restraint of government intervention carries a price. Freedom creates a certain amount of danger that people will not act responsibly. I accept that. In the end, LBJ was right. Authority and power given to the government should not be entrusted without first identifying the damage that it can do along with the good.

Why we clash

I suspect that much rancor between people lies in a misunderstanding of the other, especially in ways that we do not even understand. I once wrote about vertical and horizontal thinkers. In addition to the ways we think, there are differences in our approach to time management that drive us crazy with each other. I am task oriented. My wife is time oriented. At the beginning of the day she will know what she has to do. If she has to be somewhere by 4:00 PM, she will know everything she has to do, in what order, and by what time in order to be where she needs to be when the clock strikes four. She gets everything done and does it on time. She is efficient. She gets things done at home. She is "time-oriented."

God bless my wife. She lives with me. I am "task-oriented." In my world, clocks and time do not exist. I wouldn't last a (fill in the blank with your favorite ambiguous time reference) at Federal Express. Put a task or a patient in front of me and the world shrinks to nothing more than what I am dealing with at the time. Time stands still. After a long while, I may get a sense of passing time. For the most part, the only thing that concerns me is doing whatever is necessary to fix the problem, diagnose the patient and formulate the plan of care, etc.

We used to drive each other crazy. I would be aggravated by her goading me along and she would be irritated by my lack of consideration of other tasks. I didn't care about the other tasks. When I finished what I was working on, I moved on to something else. I worked by a prioritized "Honey do" list and she worked by a timetable. My world is a vertical list and her world is a horizontal timeline. When I learned about the differences in working styles, the light dawned. I now understood the "beat the clock" mentality. (For those of you who have no awarenes of daytime game shows before the mid sixties, you will want to know that "Beat the Clock" was a game show built around getting contestants to do silly things under time pressure. Its name has survived as slang.) Now my dear wife began to understand my (seemingly) slothful approach to getting things done.

Things are now better at the Code Blue household. We each understand the leanings of the other (and our very different children). I try to meld my open-ended approach to the clock and my dear wife is more patient about the unstructured approach I take to doing things. There are many other landmines that we step on unknowingly. More about those in another post!

What lies beneath

Wasn't that the name of a movie from a few years ago? What does lie beneath the surface? Fifteen years ago, I was working as a sales rep for a medical device company and calling on a Veteran's Hospital nursing home. Been in a VA nursing home recently? They house the ancient of the ancient. The institutional halls were inhabited by wheelchair-bound old men whose dementia took their ability to speak or care for themselves years ago. It was a pathetic and depressing site to see the warehousing of barely-warm bodies whose sole purpose in life was awaiting death.

On the way out, I passed a wall in the lobby. Adorning the walls were pictures of young soldiers in uniform in various situations. They were the pictures that inspire the noble images we hold of brave, young men defending our nation. I asked the receptionist about where the pictures came from. I was stunned to find out that they were the World War I era pictures of the men I had just seen minutes earlier in their now ignoble condition. I could hardly believe that the subjects of those vibrant pictures could now possibly be the vain imitation of human existence I had just witnessed. I looked at those pictures for the longest time.

There is hardly a day that passes that I do not think of those veterans. I encounter on a daily basis the elderly and the infirmed. I see people who are old. I see people who are morbidly obese. Had I a chance to know these individuals before years and pathology took their toll, my image of them would be different. We do not normally have that luxury. When we see someone for the first time, we see them as they are then. When I look into the sunken face of someone who weighs 350 pounds, I try to imagine what they would look like if they were normal weight. When someone is disfigured by illness, I look at their face and try to imagine what that "person" was like before they became a "diagnosis."

"What lies beneath"? It isn't always easy to get past 200 pounds of "baggage," or the altered mental status of advanced years, or mental illness, but behind everyone we see like the old soldiers of the nursing home is someone who was once young and healthy. "What lies beneath" is the "real person" now obscured by time and disease. If I am lucky, I will live long enough for people to look at me and see me as something less than attractive and I hope someone will look beyond the surface with me.

The next time you see someone whose appearance causes you to change the focus of your attention, linger for a moment. Try to see that person as they once were. Try to see the person." It may not make you "fall in love" with them, but it is certainly an interesting exercise when you start to see below the surface.

Don't Shoot Taylor Hicks!

I followed with more interest than usual the crowning of our latest American Idol, Taylor Hicks. The gritty, southern bar singer with the Elvis Presley eyes snagged top spot in this year's competition. I believe that it was Paula Abdul who pegged the secret of his success. "No matter what song you sing, you always know who you are," she lauded on the last night of competition. That's it! I realized that my admiration of Taylor Hicks had less to do with what he sang than how he sang it. With each performance, my interest was more in his energy and the personal interpretation he brought to the song than the song itself. It wasn't the message, it was the messenger.

Pity the poor pundits on our local radio show who did not realize that. They made the mistake of saying that Taylor Hicks did not have his best performance the night they announced the winner. For this, they were vilified. Never mind that Taylor and Kathryn were both probably exhausted physically and mentally. Never mind that they spoke the truth. They said something less than flattering about Taylor. The audience was not defending the performance, they were really defending Taylor.

"Don't shoot the messenger," goes the old saw. We oft forget how closely the link can be forged twixt message and messenger. We are mindful of those who carry bad news. The soldier who brought the news of king Saul's death to Jerusalem paid with his life. We are less mindful of the fact that those who bear good tidings are just as likely to be looked upon favorably simply because of their message. Remember Philippides? Remember his message,"Nike!"? Legend has it that he carried the message of Miltiades' victory in the battle of Marathon to Athens. He reached the acropolis and uttered that one word before dying. His sacrifice to bring good news has beenmemorialized in the long-distance race ever since.

The corollary to both of these situations is the bearing that the messenger has on the message. Would you rather have a character reference from O. J. Simpson or Billy Graham? Can you see Ted Kennedy doing a PSA for MADD? Could Tom Cruise endorse Prozac? What if Einstein could endorse Sylvan Learning Center? Just as surely as a messanger can be shot for carrying bad news, a message can be deemed inherently good or bad based solely on our perception of the person who delivers it.

Roll on, Soul Patrol! We wish you the best. And as we watch you evolve from local boy to national star, let us pause to remember the lesson that you and the radio pundits taught us about the confluence of message and messenger.

Please forgive me if I misspelled it.

This is the word from the Greek that is the ancestor of our words "deacon" and "diaconate." The word "deacon" implies "servant." While most of us will never be formally inducted into the diaconate, we are all servants of God. If we are servants, what kind of servants are we? Words occasionally lose some of their meaning in the leap from one language to another. Diakonos means "through the dust" and implies more than our simple word "servant." The image conveyed by the Greek word diakonos is that of a servant who raises a great cloud of dust in his haste to do his master's bidding. Alas, were you to see my record as a servant, you would think that the best descriptor for me would a word whose Greek origin implies "collecting dust" in stead of raising it. Any time I think that I am really working hard, I think of the mental picture of God's idea of a servant and smile. ;-)

Perpetuating Abuse

This is a continued thought from my last two postings.


I am not an expert on abuse but there are some things I have learned. Abuse may not be genetic but it can be passed from generation to generation as modeled behavior and personality disturbance. I have talked to abuse victims who viewed the behavior in the home they grew up in as normal. Unfortunately, aside from just the modeled behavior, abuse can have a tragic impact on the mind of the victim.

Problems can start when the victim has two parental figures with extremely different interaction. The abusive parent creates an extremely negative self-image. The other parental figure may be worlds apart in their interaction with the victim and they will have some positive feelings about themselves. These polar images of themselves may be difficult to integrate into a single self-concept. As a consequence, the victim grows up not knowing who they are or, in some instances, wondering if they are even a person at all. This is the foundation of borderline personality disorder (BPD). The DSM IV criteria follows:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsively beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:


1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

4. Impulsivety in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

7. Chronic feelings of emptiness.

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

BPD rarely exists by itself. It is a common companion to depression and can easily be mistaken for bipolar disorder. I have spoken to several borderlines about their struggles. The things that have been told to me that stand out the most:

The mood swings that can send people into the depths of despair and anxiety.

Problems with controlling their temper. They sometimes know what they are doing when they do it but,"I feel so justified at the time," said one borderline. She, unlike some other borderlines, would feel guilty afterwards.

The "splitting." Just as they have extreme views of themselves internally, they tend to view the world through a prism of only black and white. Something or someone seems to be either all good or all bad. This view can change abruptly from white to black.

The lack of identity. Some borderlines aren't sure she they are or even if they really are a person. I asked one borderline who she thought she was and her answer came,"A very sweet person with a monster inside." She knew what she could be like when provoked.


We have all heard the stories that strain our credulity to the breaking point. Man beats wife. Man apologizes and says he really loves her. Woman goes back to man. How does this happen? Mix a borderline with a codependent and it is easy. The borderline has a mood swing or, for some other reason, sees his wife as suddenly going from white to black. There is an outburst and he physically abuses her (although a lot of verbal abuse goes on as well). The outburst passes. He really does love her and really is remorseful (though not always, but it can really happen this way). The codependent wife does not have the self esteem not to put up with this and is convinced that the violence was her fault and she continues in her relationship with the abusive husband.

This is not THE way it always happens but it is A way that it can happen. A child is abused. He (Most abusers are men but most borderlines are women. Men tend to be physically abusive and women tend to be guilty of verbal and emotional abuse.) learns abuse as a normal pattern of behavior but also develops a polar self-concept and evolves into borderline personality disorder. The pattern can then repeat to the next generation.

Many people in abusive relationships (both the abuser and the abused) do not even realize that there is a fundamental problem, let alone what that problem is. I hope this post helps someone recognize what is going on in their life or the life of someone close to them.

The Living Nightmares

There are things that haunt my dreams. My last post was on nightmares and my revelation as to just how prevalent abuse really is. I have heard patients say some amazing things over the years. I heard a patient who weighed six hundred pounds say that she just never thought of herself as being that fat. I heard a missionary with depression say that he doubted that even God could love him. A few months ago I had a woman sit in my office and tell me,"When I was in therapy, they told me that when my husband pushed me out of a moving car that I was being abused." Amazing!

After reading about abuse, a number of things stood out:

1. I am embarrassed to say that most of it is men abusing women or children.

2. Much unrecognized abuse is verbal and emotional abuse.

3. The abuser frequently does not recognize themselves as being abusive.

4. The victim frequently does not recognize themselves as begin abused.

5. The abuser frequently blames the victim for causing the abuse.

6. The victim frequently accepts the blame and feels like they deserve what they got.

7. The abuser has trouble setting limits on their behavior.

8. The victim has trouble setting limits on other people's behavior.

9. The abuser frequently grew up in a home where such behavior was modeled by a parent.

10. The victim has very low self-esteem and no sense of entitlement. They feel as though everyone else's needs come first and are uncomfortable when they do anything for themselves or some else does something for them. They frequently spend their lives pouring out their heart and soul into their family and their jobs. They find themselves disappointed that their spouse doesn't seem to return the effort that they are putting forth on their spouse. They feel like they are living the old joke about,"Marriage is a give and take relationship. I do all the giving and they do all the taking," and they wonder why the other person doesn't "get it." They keep trying harder and harder to make their spouse happy with the vain notion that one day they will win them over and their spouse will recognize them for who they are give them the love and validation that they need but aren't getting.

What I just described are traits of codependent personality. For an excellent discussion of verbal abuse and codependency, go to www.drirene.com.

Why do I write this? I write it in the hope that someone will see themselves and the revelation will come. After all, I am a nurse. I hate to see people in pain. I like to help people get better. There is help for codependent personality. The abuser and the victim can benefit from counseling if they are motivated, but recognition comes first. I am holding the mirror. What do you see?