Saturday, July 17, 2010

Black and White on Romance ...and Other Things in Life

I'm stealing a post from Jay at Two Women Blogging----which is interesting because it's written by three women blogging and you'd think that three bright women could count (maybe even up to five), but okay.... Here is their stolen post and I'll discuss it below. I think they'll be okay with my stealing, and here's a shout out to Tigermom.

Was Harry Right?
~by Jay

Bluemilk got me started thinking about this. I first heard Harry's thesis advanced by the resident I worked with on my med school psych rotation. She assured me that while I might think I had platonic friendships with men, the men didn't see it that way. I was pretty sure they did see it that way. I wasn't naive - I was engaged to be married and had done my share of dating and flirting; I knew what it felt like when a man was interested in me sexually and I knew the difference. I still know the difference, and I still have men friends. For most of my life, my closest friends have been men.

I had a best girlfriend growing up, but we weren't together very much - she lived in a different neighborhood and had a lot of afterschool activities and we weren't usually in the same class at school. We didn't trade sleepovers and call each other to check our outfits and have long closed-door talks like Eve does with her friends. My day-to-day best friend, the person I hung out after school with and rode bikes with and watched TV with and waded in the creek with, was the boy across the street. We were inseparable until he moved away when we were ten.

During that same psych rotation, we had a lecture on child development in which I learned that "all children" had a same-sex best friend during latency. I asked the lecturer afterwards what would happen if a child had an opposite-sex best friend during that period, and she said "gender development would become abnormal". Perhaps that explains it.

I started to seek out and cultivate female friendships when I was in med school, but I find I still gravitate toward friendships with men. I am blessed, now, with wonderful women friends, and I'm deeply grateful for them, but I still think my psych resident - and Harry - were wrong.

I picked this post to blog about because 1) I liked having the When Harry Met Sally clip in it and 2) because these kinds of black-and-white statements about How Life Works come up all the time in therapy. In the case above, the teacher tells the student that during latency one must have a same sex best friend. Must. If not, the person grows up to be "abnormal" in their gender development. Show me the science. Oh, first define for me "normal" in terms of gender development? And who out there has "normal" gender development? What's the goal? Martha Stewart? Barbie? Elana Kagan? J Lo?

What comes up more often in therapy is the question of can you be friends with an ex-girl/boy friend? An ex-husband or wife? I tend to think that it's usually hard, but there are people who do it, so counseling: "you can't be friends with an ex" or "you can't be friends with a member of the opposite sex" or pretty much any absolute, seems, well, not evidence-based. My personal favorite piece of advice-- to give-- along the 'absolute,' non-evidence based line is to tell people to stay away from the person they are so painfully breaking up with for a good long time, at least until all parties are no longer in love and have moved on with their lives. Now all I need is a movie scene.


moviedoc said...
This comment has been removed by the author.
moviedoc said...

Dinah: You're a physician who treats mental illness with "therapy" and the pressing question is whether you can be friends with an ex-? And our health insurance premiums should pay for this?

What am I missing here?

Dinah said...

MovieDoc, I have no idea what you're missing. When people come to therapy, they talk about their relationships. If romance isn't going well, they talk about that. If they've heard from an ex-lover (recent, long gone, still in love-with, long-forgotten) they talk about ex lover. If they've had a fight or a makeup, or they are having trouble getting over a relationship, this is what the therapy revolves around.
What would you prefer: "I realize you're devastated about this break up but let's limit the conversation to your OCD and how many times you washed your hands yesterday?"
Angst over romance seems to be a reason for much distress and suffering. You're opposed to using insurance for maladaptive patterns of functioning that interfere with a person's ability to function, or to love...
I guess limit it to med checks and you don't have to hear much about romance.

moviedoc said...

Dinah: I never said I was opposed to anything. I am raising the question of what we can afford to pay for when 40k died for lack of access to primary care. We need more dialog about where we draw the line. Now it happens by default. I'd like to see us make a decision. Do the triage. Sure it's gratifying to help people with life problems, and of course even a PCP will end up talking to patients about everything from hobbies to hubbies. We have limited $. Are you willing to let John go without treatment that will allow him to live so Joe can have treatment that will allow him to love better?

Dinah said...

A complicated issue.
1) people kill themselves over romantic distress....I don't know the exact line where.
2) Do we only offer treatment to those with fatal illnesses because let's see-- you have OCD or panic disorder, but those aren't usually fatal and John needs a kidney.
3) Shouldn't we offer more intense treatments to young addicts to prevent future morbidity and improve their quality of life so they can pay more taxes (it's about $$, right?) rather than 3 day detoxes and 30 day rehabs to those who can afford to shell out upwards of $20K since the best rehabs don't take insurance and are only available to the rich.
4) Somehow, I don't see my willingness to let people talk about their lives in therapy (many of whom pay out of pocket and are poorly reimbursed) as translating into someone else living longer. It would be nice to think it's the same pool of funds, but it's not. In our state, state beds were cut way back---oh, but it will be okay, there are community services, outreach and crisis beds. But somehow, in the next breath, the outreach services diminished.
I suppose I could service more people if I saw 3-4 patients/hour and kept it just on the "illness only, ma'am" version of psychiatry, but a) I'd retire momentarily and b) patients are unhappy with this treatment.
If someone comes in and wants to talk about upsetting issues in their relationships, it seems like a perfectly valid thing to talk about in psychotherapy. It might be nice to think that cutting them off and shoving them out the door means that someone else will live, but prove that to me.

Sunny CA said...

Regarding the post: Some platonic friendships with men do have a slight sexual "tension" to them. Slightly flirtatious without crossing the line into a sexual relationship. Some don't because there is absolutely zero basis for attraction.

I agree with your comments about those "black-and-white statements about How Life Works". They were jarring when I read the original post and I thought the same thing: What is normal? What studies show effects of friendships during latency?

Moviedoc: You have never been in therapy I guess? What gives you angst in your personal life? My relationships are major in mine and when my primary relationship was ripped out from under me, it was a time I needed mental health help. I think mental health is equal to physical health in importance and both deserve equal allocation of resources.

moviedoc said...

Sunny: If I sought help for personal angst, I would go to a marital and family therapist, not a psychiatrist, and I wouldn't ask for a prescription or expect your insurance premium dollars to pay for it. Equal allocation sounds good, but the devil is in the details. And people with minor physical symptoms probably waste as many health care dollars as those with overtly psychiatric symptoms, probably because of angst.

A psychiatrist can treat a thousand or more patients with serious mental illness with those pejoratively labeled "med checks" compare to a psychoanalyst "treating" 10-20 "patients" who want to talk about whether they should pursue a relationship with their ex-. It's all legitimate. The question is who pays for it.

Anonymous said...

moviedoc, I find myself wanting to leap to dinah's defense -- there's a very cogent argument readily available about strengths-based counseling and I have several cases from which to furnish illustrative examples -- however, I find myself caught in a conflict of interest. I'm a mental health counselor. If you psychiatrists wish to collectively convince yourselves that you're much too precious to waste on doing talk therapy, and leave it to us masters level clinicians (oh, and the psychologists) that would be dandy as far as I'm concerned.

Anonymous said...

Dinah, one of the unexamined assumptions here is that one cannot be friends with someone to whom one is sexually attracted, that sexual attraction or desire "ruins everything". I am a woman with several close straight male friends. As far as I know they all find me at least somewhat sexually desireable -- I've spoken explicitly about this with some of them, and there's no guessing there. Heck, two of my ex-boyfriends and I maintain(ed) good friendships (once the dust settled which took several years in each case), and that despite both of them making it crystal clear that they still desired me quite strongly.

So the answer is also, "Depends on your relationship to desire: your ability to manage erotic feelings of your own without acting on them or being eaten by them, and your ability to tolerate others' erotic feelings towards you that you don't reciprocate or don't intend to act on." Not everybody can handle that -- but not everybody can't, either.

Sunny CA said...

I am one of those "patients" you refer to, who my psychiatrist is "treating"(the quotes are yours!) via psychotherapy. I do talk about my relationships with him, except I did not go to him to talk about relationships, I went to him because I ended up in a psych ward, psychotic, and held against my will for more than 3 weeks. He does not do "med checks for thousands", thankfully, he does talk therapy. I did not go there to ask for a prescription, I went there ON meds and he suggested I go off them, which I did very successfully by working with him just talking, mostly about relationships (not just with romantic partners). He is a LOT better than the marriage and family counselors I saw in the past and way, way better than the psychologist who was supposed to be providing the "talk therapy" component of my care. My life is SO much better as a result of seeing my psychotherapy oriented psychiatrist. The psych meds left me with seriously impeded short term memory and lack of emotions. I felt like a robot. Functional to accomplish work and get things done, but emotionally dead. Also I had no creativity and I worked in a creative field and I lost my sense of humor. My husband said that I had become "just like everyone else": stupid, forgetful, and non-creative. Some way to live a life! It felt as though my life and everything I valued had been taken from me. Thankfully my brain came back off the meds (after about 6 months) as did my feelings, creativity, and sense of humor. I can't understand why it is superior to drug people than to help them work through their problems so they don't need to be drugged.

Anonymous said...

Moviedoc - I suppose your point is that we triage medical care paid for by insurance companies and the government, and that some instances of psychotherapy may be significatly less important than other illnesses. But like Dinah pointed out, there are a number of flaws with your theory. It's not all the same pool of money; we don't have a government-run, government paid for health industry. How can you determine which psychotherapy is important and which is not? Just because someone speaks of a relationship sometimes does not mean that there are more serious issues. But like Dinah said, under your theory we should triage based on who could become the most productive member of society. That person dying of cancer? Let's cut off the treatment because the money could be better spent on someone we could absolutely save.

The issue is not limiting the coverage people already have, it's expanding the coverge to people who do not have it. In the end it's a question of allocating resources - do we spend the money on a war or roads or education or health care or something else.

Sarebear said...

I supposedly had a best friend, a girl, when I was four and five, but I don't remember when I was that age at all. When I was older, I didn't have any friends at all. I got whipped with jump ropes with the plastic thingies on, and stuff (those thingies should be used for torture, they're horrible).

I didn't have any friendships. So I guess that makes me "screwed up". Lol.

Maybe I can have a relationship with a jumprope? heh. More like a nightmare.

When we moved to a different state when I was fifteen, I didn't know how to interact with other kids my age, I had no basis for socialization. So it was beyond awkward. It was very horrible, even though it was a much nicer place, no whippings or anything.

Sarebear said...

Oh, and what's latency? And when is it?

Jay said...

Dinah, thanks for the shout-out - I don't mind at all (and thanks to TigerMom for the heads-up. Trackbacks...need to figure that out...)

As I carefully step around the moviedoc derail, I agree with you about the absolutes, and I wish you'd been my psych professor instead! What is "normal", indeed?

I also agree with the anonymous commenter who said that it depends, in part, on how you're affected by desire. I also have friendships, still, with men to whom I am attracted, and that doesn't ruin everything - or even anything. It's kind of fun and no, I don't think I'm playing with fire, because I'm really clear about what's not going to happen, and so are they.

Men are not slaves to their libidos, really, they're not. Neither am I.

Nikki said...

This was a fascinating post + comments. I'm so happy to have found this blog.

Two things I'd like to add. Firstly, I think it's very important that psychologists/psychiatrists continue to engage patients on the discussion about angst caused by romantic love. Not having an outlet to address the psychological anxiety caused by romantic extremes (whatever those may be for an individual) can cause lethargy, depression, etc. In order to address moviedoc's points, perhaps to cover what he views as frivolous (this is my interpretation of his comments), maybe you create higher premiums for psychologists/psychiatrists to address these types of issues. Or take a look at Kaiser Permanente in California. My recent trip to a psychologist at Kaiser resulted in that doctor telling me to pay out of pocket to discuss my romantic angst issues with a private psychologist. He said that the psychiatry services at Kaiser were only to be used for more severe head cases. I imagine that under the newly reformed healthcare system, this is very much the type of system that we're heading into where treatments are doled out based on regulations designed to keep costs low.

Moving on to the post itself, I wanted to ask Dinah about the challenges with gays/lesbians to maintain friendships with one another without out having it breach romantic grounds. In my experience as a lesbian, I very rarely have strong lesbian friendships. It always seems that one of the partners is interested in more (or less) and that deflates the whole experience. But, I also see many lesbians hanging around each other in the guise of friendship much more so than I see men and women constantly seeking "friendship" when they're seeking something else. I think part of this is because gays/lesbians still feel like a minority and associate with one another in order to find commonality. However, this often leads to drama because everyone in these groups has the potential to be attracted to each other. I'm curious if you've seen anything on gays/lesbians and their ability to create friendships with one another, and how that might differ (or be the same as) the heterosexual examples that you and your readers referenced.