Thursday, September 24, 2009

When the good guys are doing us wrong

Detective Robert Goren said it to Nichole Wallace on Law & Order: Criminal Intent. Sara Sidle said a version of it Gil Grissom on C.S.I. And Herman Meville probably would have said it to Sigmund Freud.

"Sometimes, a whale is just a whale."

I am as big a fan as anyone of tough regulation of pharmaceutical companies, but it seems in recent months that the Food and Drug Administration has continue the drive off the cliff of logic that they leap a few weeks back and have landed in the gorge of patient destruction - at least when it comes to mental health medications.

In May 2007, the F.D.A. ordered a "black box warning" be placed on the packaging of all antidepressants to warn people of an increased risk of suicide related to the medications. Earlier this year, the F.D.A. reversed itself and ordered a "black box warning" be placed on anticonvulants, including those used to treat depression and mania in bipolar disorder and mood swings in other psychiatric illnesses.

The F.D.A. argument seems to make sense on its face. People on these drugs commit suicide at a higher rate than the general population. But, unlike the formal logic that development experts say is grasped by 8 year olds, the F.D.A.'s conclusions forget that correlation does not, indeed, equal causation, especially when three is a much more likely reason for people on antidepressants and mood stablizers to commit suicide. The illnesses they have, both mental illnesses and neurological illnesses, have a higher than average rate of suicide than the general population, especially when not treated with psychoactive medications.

Yet, as a result of litigation, politics and factors, people who most need psychoactive drugs are warned away from them because of the high rate of suicide associated with the drugs. If I could have a quarter for person who has come to me this year with a prescription from their doctor for an anti-depressant who has told me that they do not want to take it because of the rate risk for suicide - "Look right here, Jayson!!!!! It says so on the box."

I pull out a paperback copy Kay Redfield Jamison's "Night Falls Fast," a scholarly and narrative book on suicide, and, then, I explain to them how the F.D.A. concluded that the drug they now don't want to take has a high risk of suicide.

It's goes a bit like this (and I am making up the numbers):

People taking antidepressants commit suicide at a greater rate than the general population, so, the black box logic goes, that antidepressants cause suicide.

It's predicated on that a person who is taking antidepressants is more likely to commit suicide than a person who is not. Really, Sherlock? Could it be because they are depressed.

What's next? More people who take antidepressants have depression, therefore antidepressants cause depression.

The logic for mood stabilizers is even scarier and takes off from the bad conclusion of the previous decision, but I'll spare you.

It would be easy to laugh at the F.D.A.'s logic and "black box warnings" if the labels did not have an impact on people whose lives are at risk and who are already unlikely to comply with taking medications because of their real side effects.

An article in The Journal of Psychiatry points out that "FDA warnings have contributed to the increase in the number of youth suicides" and that if the "recent expansion of the FDA black box warning to young adults decreases overall SSRI prescriptions by 20%, there would be an additional 3,040 suicides in the United States over a 1-year period. Its a shame that their logic is much better than the F.D.A. black box approval process. It has also had an impact on the prescription of more heavy duty drugs with even more serious short-term and long-term side effects, such as antitypical antipsychotics.

The F.D.A.'s black-box warnings on suicide are about as logical as one of my favorites that Detective Goren delivered in explaining the thought process of a schizophrenic witness who would not take his medication: Sick people take meds; I'm not sick, so, therefore, I don't take my meds because meds make people sick.

They make about as much sense as the Consumer Product Safety Commission warning against airbags because more people get killed when airbags are deployed than when they are not. Airbags are deployed when people are at serious risk, and so are anti-depressants.

We all know that's silly. But before we get there or somewhere equally dangerous, the F.D.A. should consider a different set of standards, one that respects the difference between a relationship with something -- or a correlation -- and the cause of something. In these cases, the whale was just a whale but the F.D.A. has turned them into Moby Dick.

I'm the first to admit that pure logic would be a dangerous thing; but a little would be nice.

Sunday, September 20, 2009

The best coaches in life, and athletics

The “Perfect” Coach For Your Boy*

Maggie Avedisian, Ph.D.

Clinical Child Psychologist

This is the first post in a series of guest contributions on coaching children by Dr. Maggie Avedisian sees adults, couples, children and adolescents as a psychologist in private practice at Ashburn Psychological Services. With doctorate and post-doctorate specializations in both clinical and developmental psychology, Dr. Avedisian is also the proud mom of two athletic superstars. She can be reached at (703) 723-2999 or by email.

As each Fall athletic season begins and boys are recruited into (or placed onto) various school and county leagues, my voicemail and e-mail Inbox receive an inevitable bombardment of concerns from pare nts about the “best coach.”

Parents often have the same concern season-upon-season: “My sons’ coach is mean and I don’t think he can succeed with someone mean;” “His self-esteem is being harmed;” and of course, “What should we do?” I rarely hear from the parents who love their sons’ coaches: obviously, they have no complaints.

In an effort to address the question of what makes a “perfect” coach, I turned to parents who love their sons’ coaches, talked with coaches, looked at the recent research on the effects of athletic coaching styles on boys, and sought the advice of a life coach (*I should note that while there are many similarities about coaching boys and girls, the differences illustrated in research literature are strong enough to separate the topics, and focus on only coaching boys in this article.)

The first goal of my journey was to address the complicated question of how to best coach boys in team athletics sports, the second was to identify the responsibilities of parents, and, finally, to get some understanding of what works to motivate young boys.

Boys generally from age five (but as early as 18 month olds) are often placed into organized sports. Some parents have the high hopes that their son is a potential superstar. Some say they just hope for a little exercise. Others say they hope their children can develop meaningful friendships through team activities. Parents, regardless of their reason for placing their son on a team, want the “perfect” coach for their son. What is the “perfect” coach for parents?

Coaches also have various hopes when they take on the commitment of training boys. Some coaches are fathers who want to spend more time with their children. Others want to impart a love for the game. And, still, some want to provide leadership for boys. Most coaches, regardless of their hopes for winning, want to be good coaches (note: not "perfect" coaches). The qualities of a good coach are often listed in psychology and other research literature as patience, leadership, and love of the sport.

A coach is defined as someone who gives instruction, tutors, trains and directs the people who are working with them. In examining the broad picture of coaching in general, I spoke with Jayson Blair, a prominent certified life coach in Loudoun County, Virginia, who works with adolescents and young adults who struggle with motivation, self-esteem, direction, attention, organization, interpersonal relationships, realistic expectations and social skills. He says that, in many ways, these are the same issues that athletic coaches have a chance to help at an earlier stage.

Coaching kids in any arena of life - be it athletics, teaching, or life coaching - is a huge responsibility, and Blair says coaching is a process of teaching skills, helping to develop intuition, self-awareness, building character and modeling the real world in a safe and encouraging environment. Some of the primary techniques that help make good athletic coaches, according to Blair, are to understand and motivate players and to help them grow through a safe process that will be strikingly similar to the not-as-safe world they will face beyond 18. Winning can be important, Blair says, "But it is in making mistakes, losing and losses that we learn the most about ourselves and have the greatest opportunity to grow."

Coaching a team, Blair says, requires special characteristics.

Blair points out that the being able to provide each individual with both positive and negative feedback can be difficult to manage in a team situation. But the challenge, he says, goes far beyond equity of attention.

"The challenges each child brings to the setting can be a good basis from which to find ways to motivate them individually and teach them how to work together," he says, "but coaches must also work to understand each player and attempt to tailor approaches individually while taking into consideration the broader needs of the group, and how each individual approach impacts the larger ecosystem that includes the players, other coaches and parents. In this, they are teaching young people how to be responsible in a broader world beyond just themselves."

Blair sees the most valuable qualities in coaches, when excluding the role that the understanding of the sport itself, are strong powers of observation, intuition strong enough to make smart decisions and intelligence and strength that allow them to solve complex interpersonal equations. Blair says coaches need to understand and modify their coaching styles to individual players, while managing the collective impact on the team's ecosystem, in order to develop skills and character both on and off the field.

Parents reasons for placing their children in competitive athletics is often based on their understanding that team sports is important developmentally for socialization, leadership, understanding how to take direction and discipline to enhance character. Coach Bowman, a well respected coach for Loudon County, Virginia football team, includes in that array, a child’s desire to be on the field. He emphasizes that a children’s desire to be there is a big part of the mix of things going right on all levels. Thus, as the old adage goes, “you can lead a horse to water…”

With all the best intentions for their children, parents often forget (or neglect) their children’s desires. There is no doubt that there are many “wannabe” fathers who hope their sons “make it” because they did not.

This is not a myth. Mothers come to me frequently stating their sons (regardless of ability level) have no real desire to play the game, but do so because their fathers push them. Ask your child and talk about their desire to participate. Know what your child desires. Ask your sons coach what they think. By encouraging this dialogue you will find that some should not be on the field. Most parents know these truths about their own complicated motivates, and often use the excuse that the coach is not doing what is needed to keep their son motivated.

Maybe the weakest link is not coaching style, maybe the weakest link is the child’s desire to be in competitive sports and the refusal of some parents to see this apathy in the name of their vicarious redaction of their own youth. It seems, in this area, that above all else, coaches need understand the desires of parents, but not cave them, and, instead to learn to place oneself in the shoes and eyes of their players and act in their best interests.

"A parent could come to a soccer coach and say that they want their child to be a forward just like a parent might walk into my office and say that their child might need to work on managing their finances," Blair says.

"In reality, as a coach, I need to listen to the parent, but I also need to get their child working on what's the best opportunity for them grow, whether its playing as the goalie or learning organization and empathy first, before finances and academics."

Parents can akin coaches to teachers. There is no perfect teacher or perfect coach. One child adores the teacher and the other finds them intolerable. The same happens on the field. I find that often in both situations children adapt better than their parents do. I also find parents fueling fires that do not exist for children. Needless to say, but I will…do not talk badly about teachers or coaches to your children. It is very disconcerting to a child to have their parents belittle the authority of a coach or teacher, and then be expected to perform for that person.

The juxtaposition is cognitively and emotionally disabling for children, and often gives the children a real world example of hypocrisy from their own homes, as parents talk down coaches behind their backs and openly praise them and encourage their children to listen in front of the coaches faces With that said, this article was not intended to address the extreme end of abusive coaching, which is best dealt with swiftly and decisively by removing your child from the situation.

Results of a recent study by Coatsworth and Conroy (Developmental Psychology. Vol 45(2), Mar 2009, 320-328), showed that competence and self-esteem reflected perceived competence provided by coaches. In other words, when coaches provide praise, children seem to perceive themselves as more confident and capable of performing.

In this study, children did seem to think they could do better when coaches gave them praise. However, this does not suggest that children will do better, it suggests they “think” they will do better, which, in and of itself, is an important part of the battle. Does thinking positive lead to actions? The answer seems to be, sometimes. Positive self-image and belief in one’s ability can be the beginning of changing actions and behaviors. “I think I can”, “never give up”, “try and try again” are examples of how we hope to train children to stay motivated. In competitive athletics, the lines are blurred and the studies are nearly non-existent.

Should coaches provide false praise for children who are trying, but not really doing well athletically? As a developmental psychologist, I have absolutely no doubt that praise can provide a basis for developing positive self-esteem. The line of what's too much or too little in this regard can be drawn, in many respects, when looking children at different ages and stages of development and athletic competition. Feedback is crucial to personal growth on the field. While clinically I know that the presentation of feedback is important, studies in on this topic are lacking. We know that negative feedback, when handled wrong, can be devastating.

So, should coaches not lie to children, but give only positive feedback? Joe Russo, a longtime coach of boys Lacrosse in Vienna Virginia (and highly respected by the parents on his teams) stated it like this “I try to establish a high level of player accountability early each season. This sometimes requires being strict and demanding.

Finding the proper balance of discipline and fun can be challenging. He goes on to say that “insincere pep talks” are not how he prefers to challenge his teams. A good coach, he stated, is willing to help a player by pointing out and teaching how to improve his game.

Since I believe that lying to children at any age is wrong, the question for coaches might very well be how to impart corrective messages or negative feedback in a way that helps the child learn, does not obscure the truth and teaches them that necessary losses and mistakes are the way that we learn and we grow. In other words, the goal, it seems, from a clinical perspective, is not too much unlike being a psychologist: helping people build their self-esteem so they honestly accept their strengths and weaknesses, and know that it is the strong child that can look at something that they are not doing well and tackle it with enthusiasm.

It should be noted, however, that if a child thinks that they can do better and doesn't, it provides coaches what Blair likes to call a "teachable moment" where young people "can learn that their effort and improvements are important no matter the end result, that friends do not abandon each other when things get rough, that someone has to lose and how to do so with the same grace and understanding of the victory." Most importantly, he says, "you won't believe how many clients I have who come to see me as young adults and say that from their childhood on they have never felt someone truly believed in them."

Parents who love their sons’ coaches tell me that the greatest quality they found in a coach was the ability to connect with their sons in order to help the youngsters improve skills. That connection is not readily quantifiable, although there is no question that the connection they speak of is not limited to athletics. It ranges from a high five, or a simple “good job”, “to try it this way.” They appreciate direction, attention and pushing their sons to the limit.

Yelling does not seem to bother most parents, and most parents who love their sons coaches are not too phased by some uncomplimentary names their sons may be given by coaches or teammates (my favorites are “Sleepy” and” Dopey”). While many parents use the line “I just want my sons to have fun,” they also do not like it when their team loses. That apparently is not fun, at least not for parents. The whole coaching package is quite a feat: providing individual attention, making the game fun, and developing a winning team.

I end this brief blog with Coach Russo’s quote that parents ability to align with the coaches philosophy is an important aspect of his ability to coach. “I consider it a great responsibility and privilege to coach young people and I see it as my duty to ensure that they play the game as it was meant to be played," he states. "Parents and players who are aligned with this philosophy make coaching much easier.”

Note: This is a first in a series of posts on coaching children in athletics. Part II involves interviews with children and looking at their perspective on what makes a good coach. I would also like to thank Coach Bowman and Coach Russo for their time and thoughtful consideration of responses. Both coaches give of their time and energy without having sons on their teams. They do so for the love of children, and the game.

Thursday, September 17, 2009

Minatours, Medusa, Icarus and logic in parenting

I tripped across a recent newspaper column in The New York Times that ran under the headline "When Parents Say 'I Love You,' Means 'Do as I Say.'" It made me think of three young adult clients whose parents have struggled with setting up systems of rewards and punishments that were balanced with the notion of helping their children stay safe, improve their judgment, develop and mature, become independent and take ownership over the choices they make in their lives.

The piece was one of those that just seemed destined to be brilliant in its contrainism. In reality, it ended up only being contrary.

The logic of the piece went a little like this: (a) unconditional love is a good thing; (b) some parents put conditions on attention and affection; (c) therefore, conditions and unconditional love could not co-exist; (d) therefore systems of punishments left children feeling resentful and anxious, and (e) negative reinforcement systems left children feeling resentful, anxious and unlikely to comply.

"Even if we did succeed in making children obey us," the article asks, "through — say, by using positive reinforcement — is obedience worth the possible long-term psychological harm? Should parental love be used as a tool for controlling children?"

No, it concluded.

Throw it all out. Create a system "autonomy support" by including their in decision-making, encouraging them and explaining the reasons for the rules.

And! They had research to prove it!

Studies showed, the article said, that adult children who thought their parents love was unconditional did not like their parents very much, were resentful, anxious, did not take ownership over their behaviors and lives and were destined for more unhappiness and anxiety than those of us, like me, who felt their parents love was unconditional.

This all makes sense -- well, if you are into false choices, faulty logic, and you are willing to believe that a pot of gold and the end of a pretty rainbow is in the last room of the Labyrinth, as opposed to Medusa, the Minotaur and a freshly imprinted set of Icracus wings.

Unconditional love is probably a good thing. But it is hardly mutually exclusive from putting conditions on behaviors. Would it be worth it, given the frustration and hardships on children, to have a system of conditions designed to create obedience? Perhaps. But this isn't boot camp. Parenting is not so much about obedience as it is creating a safe environment, where children can learn, grow, develop, mature, prepare to make decisions on their own and learn that actions often have consequences, both good and bad. So, in many ways, creating systems of rewards and punishments are a most loving thing to do. It's what the real world is like.

Next, what about this notion of autonomy support? Once again, when did the idea of including children in decision-making, encouraging them and explaining the reasons for the rules become mutually exclusive of the idea of punishment and rewards systems? In this idea, in fact, we find the brick that makes this "house of new parenting" come crumbling down - completely, utterly, totally. Punishment and reward systems provide the opportunity to explain the reasons for rules to children, gives you a chance to encourage them, dissuade them from poor decisions and to involve them in decision-making that affects them. In fact, the best punishment and rewards systems, to a reasonable degree and individually tailored to each family and child, include some elements of all of these ideas.

The failure in the author's logic and extrapolation of the studies is monumental in its simplicity. It assumes that the feelings of children who felt that their parents love was conditional is a measure of whether positive and negative rewards systems work. Since all the children in the studies felt that their parents love was conditional, perhaps the problem was that their parents love was conditional or that their parents were not able to communicate that their punishment and rewards systems were designed because of the fact that they did love their children enough to help guide them as they tried to allow them to develop more independence and autonomy. In fact, I think most people who give it much thought would agree that it is quite loving for a parent to make the effort to punish, reward and help their children to develop. Sometimes that love has to be delivered in some tough ways -- and the toughest love of all to deliver is the two-word kind: no.

This point could be illustrated by the dozens of cases I get involved with each where parents are struggling over creating boundaries with loved ones who have serious mental illnesses -- in the name of their sanity and not enabling adult children to avoid treatment. This point could be illustrated by the parent who takes a step back in their financial support because they know that a drug or alcohol problem is being enabled by their actions. This point could be illustrated by the treatment providers and parents who force psychiatric hospitalizations on clients, knowing that while they might get better and might be safe, that enormous harm is being delivered to their relationships.

None of these cases are examples of love that is conditioned, but they are examples of loving someone so very much that you are willing to put conditions on your relationship that would help the person you love even if it ran the risk of losing them (to you, at least, even if they do get better). Still, more benignly, but perhaps more accurately, illustrating the point are the cases of young adults in need of motivation who do not have serious mental illnesses.

So, back to the three clients I mentioned above. To varying degrees, each client is an example of loving and structured parenting that has lead to dramatic improvements in the lives of the clients. One client talks fondly to me now about a punishment system his parents put in place a little while ago - finances while in college were conditioned on a sliding scale of academic performance, which had slipped. He remembers the anxiety of coming into my office at 8 in the morning to figure out, among other things, what he was going to select as major, how he was going to improve his grades and going over budgets to determine how he was going to pay his bills if he did not get the necessary grades. He just knows that his parents tough move helped motivate him, and, he never doubted that it was the most loving thing his parents could have done at that point.

The other two clients are in the middle of it as we speak.

One client's parents had legitimate concerns that cutting off his financial support would send him a message, in a life already filled with many emotional disappointments, that their love was conditional. After going back and forth over the topic of connecting money to performance, combined with some system of accountability, reinforcement and support, we tripped across something that has, so far, worked smoothly. When we backed off a bit out of collective frustration that followed an outburst from the client, he began taking ownership over many things that he did not seem to be willing to do for years. He was doing them for himself now. He told me recently, "My parents could take all the money away from me, I know they would still love me," echoing a point that most of us already knew. "I just needed you all to get out of the way so I could do this for me." Things are not perfect, but they sure are better than they have been in some time. He's taking care of elements of self-care and getting excited about things in a way haven't seen since knowing him.

The other client is very intelligent (I mean, ridiculously intelligent), although she concedes, when asked the question of how old she is emotionally, that she's "about sixteen" in maturity. Before we ever met I had heard that she struggled with motivation and direction, and in our second meeting she flat out said that she knew that she needed her parents to stay on top of her to even do the things that she wanted to do for herself, much less the things that she did not agree with.

In her case, the difficult part -- okay, one of the difficult parts -- was coming up with systems of rewards that she could not manipulate (she's smart, after all), punishments that would not leave her with the message that love was not unconditional, that would foster personal responsibility, help her with direction and allow her to actually decide what she thought was important for her, as opposed to us didactically dictating that to her (which there was a temptation to do because of her emotional immaturity, and would have been a disaster because of her intellectual superiority).

I can't be sure whether she doesn't have us all around her little finger, but my best guess is that all of our goals have collided -- her parents want her to mature and have direction, she wants to as well, while preserving some parts of her that are youth like and creative in a positive way. Her parents have settled on giving her responsibilities without conditions, adjusting support without conditions or rewards, and we've implemented a rewards system that she helped design, is fully aware of and because of open communication knows is being done because she is loved (not a condition of that love) that is predicated on doing things she wants to do: volunteering in a professional setting, succeeding and learning in her classes, staying involved in groups she has in the past and following her social, academic, occupational and creative dreams. She seems much more motivated and directed now, and is plotting her own course, making her own choices - not ones that we are forcing upon her.

Each client has loving parents and I have no doubt that each of them believe that their parents are unconditional. Each client has had their parents do some things that they don't like in the name of motivating that, and I have no doubt that when I talk to each client in years future, they will view what their parents did as the loving thing, as the caring thing and as a necessary thing that has improved their lives. If either of the three thought this was merely about obedience, I'm sure they would be resentful and even more frustrated (and, in fact, on the issues where they feel it is just about obedience, they have no problem pointing it out and working with me and their parents to either understand the lesson or adjust the program). Not to mention, of course, that punishments and rewards safely and lovingly model the real world's system of doing business.

So before we throw out "conditional parenting" for "autonomy support" alone, we might want to look at combining parenting with negative and positive consequences, with support for independence, development, decision-making and taking ownership, and a host of other notions.

Otherwise, we might as well hand our kids those Icarus wings and tell them to learn too fly to close to the Sun on their own.

(Note: The article also hoists a notion of "encouraging without manipulating," which does seem like a mutually exclusive proposition, since encouragement inherently motivates -- positively or negatively -- no matter what your intentions are. This could also get me onto one of my pet peeves -- the false choice between manipulation and motivation, but I will save the philosophical case for manipulation in the name of love for another day, one in which I have not made you all suffer so much already via the hand of my writing).

(Additional Note: My ire at this article was inspired by reading it, but this post was inspired by Dr. Al Jerome, an excellent psychologist I work with in private practice. I'm sure he would not endorse all my ideas, but his critique of the article inspired me to write. Dr. Jerome has a blog at; he can also be reached at

Monday, September 7, 2009

Athletic coaches as life coaches

My friend and colleague, Dr. Maggie Avedisian, a clinical psychologist, recently asked for some thoughts on what makes a good athletic coach. Since I work with a number of teenagers, I gave Dr. Avedisian this advice for a blog article she's writing for parents on identifying good coaches and for athletic coaches on how to improve their work with their students:

A good coach should recognize that winning is not everything and that the process of trying is where young people develop, build their self-confidence, recognize their talents and learn to cope with their weaknesses.

Coaching is a process of teaching skills, helping people develop intuition and self-awareness and building character. Coaches should seek to understand and motivate their players. In a one-on-one setting this is easier to do, but in a group setting coaches can teach people to lead and should help their players coach each other.

The best coach teaches life skills along with sports skills.
Motivating begins with understanding the kids you work with, putting yourself in their shoes and coming up with ways to help them accomplish their goals, see their potential and get to know themselves better. These are the tools that help them learn to motivate themselves.

The temptation for those who coach a large group of people is to focus on a few players, the most talented, their favorites and the ones who are most like them. Some coaches also fall into the trap of attempting to motivate players through yelling at them and putting them down. This is generally a failure in the coach at truly spending the time to identify what motivates their players. Intuition, analytical abilities, leading by example, being able to model healthy relationships and positive motivation are the most important skills for a good coach -- not to mention being able to laugh and have fun.

Friday, September 4, 2009

To think, that which makes me great

Sitting here waiting for my dinner date, I was thumbing through a copy of the latest edition of Vanity Fair when I came across an article about The Washington Post called "Post Modern." While thumbing through the well-written could-this-be-the-one-newspaper-that-survives stories because of my interest in journalism, I stumbled across this passage that made me think that Michael Wolff, the author, at least sort of got the tempo and the upsides and downside of the days untreated bipolar disorder (née manic depressive illness). Unparrelled productivity, energy, ideas and risk-taking that pays off, followed by psychotic paranoia and sad consequences:

He’s also seriously bipolar. He turns the paper into a powerhouse, consolidating its position by buying the morning competitor, the Washington Times-Herald, in 1954, trouncing the afternoon Washington Star, and adding Newsweek to the stable in 1961, as well as a group of high-profit TV stations, before turning on his father-in-law and family with anti-Semitic rage, and then killing himself, in 1963. - "Post Modern" - Michael Wolff in the October 2009 Vanity Fair

It did not hurt that Wolff, as he described how Phil Graham miraculously built a media empire in such a short amount of time, summed all of Graham's successes and descent into one manic-sentence following the phrase "He's also seriously bipolar." It would be easy to view what happened to Graham as successes and then a descent into madness. But what we know from great researchers like Kay Redfield Jamison is that the success was probably just as much a part of the madness as the decent was. Just two different versions. One was admired and socially acceptable; one just wasn't and had great destructive potential. It's also easy to understand why Graham may not have been taken aback by his friends who tried to warn him off of the anti-Semetic views he later developed. After all, those were probably the same types of things he was hearing when he was coming up with some of the most risky, yet successful, business ideas for The Post a few years earlier.

Although manic depression and these types of dramatic, mind-binding and obstacle-clobbering rises are most often associated with artists, we have seen this story before with captains of industry who have been bipolar. Phillip Merrill, the former publisher of The Annalopis Capital, former head of Capital-Gazette Communications and the namesake for the University of Maryland Phillip Merill College of Journalism, is another example. The philanthropist, owner of the Washingtonian, former counselor to the Undersecretary of Defense and former head of the Export-Import Bank, committed suicide by tying a small anchor around his ankles and shooting himself with a shotgun while standing at the edge his boat in the Chesapeake Bay. He fell in the water and was not found for more than a week. Ted Turner, the founder of CNN, former Turner Broadcasting owner, former Atlanta Braves owner, former husband to Jane Fonda, former husband of two other women, former vice chairman of AOL Time Warner and buffalo rancher and buffalo restaurateur, is a living example. I wonder, with no true evidence, whether captains of industry with bipolar are attracted to the more creative side of the business world.

This notion of the thing that makes you great becoming and being your Achilles heal is what I call the Virginia Woolf syndrome -- the same thing that makes you so great at what you do contributes to the madness that attempts to consume you. Ms. Wolff's suicide note provides a powerful glimpse at what its like to be on the tail end of that which makes your mind do great things turning on you. John Nash, the Nobel-prize winning mathematician whose diagnosis lands somewhere between bipolar and schizophrenia, according to his biographer Slyvia Nasar, sums it up in the opening pages to her biography of him A Beautiful Mind:

[George] Mackey, [a friend of John Nash and a Harvard professor] finally could contain himself no longer. His voice was slightly querulous, but he strained to be gentle. "How could you," began Mackey, "how could you, a mathematician, a man devoted to reason and logical could you believe that extraterrestrials are sending you messages? How could you believe that you are being recruited by aliens from outer space to save the world? How could you...?"

Nash looked up at last and fixed Mackey with an unblinking stare as cool and dispassionate as that of any bird or snake. "Because," Nash said slowly in his soft, reasonable southern drawl, as if talking to himself, "the ideas I had about supernatural beings came to me the same way that my mathematical ideas did. So I took them seriously."

So, devastating to think, that which could make you so great could also undermine you. What cruel a trick, one that deceives you by using the certainty of your goodness to make you believe in the certainty of your madness.

The Gift of Fear (or the Gift of Intution in Protecting Yourself and Lie Detecting)

A friend was recently on the phone with me walking down a New York street and she noticed a man starring at a street pole, and it didn't make her comfortable. Now, as the boys at Matchbox Twenty would put it, this is from a woman who makes friends with shadows on her wall, hears voices telling her that she should get some sleep, takes to herself in public and dodges glances on the train. What, on Earth, could bug this woman out?

After first she dismissed her reaction. Could it be because the man was black and she racial stereotyping was making it worse? No. She lives in New York, and sees blacks all of all ethical and moral stripes and sizes every day. Could it be the neighborhood? Nah. It was familiar too her. Maybe something was different about the street lights? That could be it. Eventually, I said, "Who cares, why? If it doesn't feel right, just move, move."

Gavin de Becker, a personal security professional, received acclaim for his book "The Gift of Fear" that was -- on its face -- about how fear can be your friend, your personal warning system. A psychiatrist suggested it to me -- he had given it to one of his children who was headed off to college -- after I was mentioned I did not want to fully medicate my fear and anxiety away, because, as long as they were not paralyzing my ability to function, they could be my friends in figuring out that something was wrong, even when I had not processed all the factual evidence in front of me. "The Gift of Fear" is really about The Gift of Intuition.

Intuition is the ability to acquire knowledge without inference or the use of reason. Lacking deductive reasoning, intuition gives us a sense of what's right or wrong about a person or a situation even before our minds have begun to process all the facts its absorbed and before our analytical muscles can devour the details and come to some fact-and-reason-based conclusions.

As William Patterson's character Gil Grissom put it so masterfully on the television show CSI, “You’re a primitive man on the savanna. You see something move out of the corner of your eye. You assume its a hyena. You run. You live. If you assume its the wind and you’re wrong, you die. We have the genes of the ones who ran. We’re genetically hardwired to believe [in] living forces that we cannot see.”

Intuition is one of those things that we believe in that we cannot see, although research suggests that intuition is based on thousands of pieces of evidence that move into our minds too fast for us to process and put together a full picture. And if you try to sit down and process all those bits of information, instead of act on intuition, the same thing that happened to the man who didn't run in Grissom's story can happen to you. No matter how smart you are -- you're eventually going to get eaten by the hyenas. Anxiety and fear can be your friend in that right doses.

In spite of the truth in Grissom's quotation, there is also a part of each of us that wants to be able to justify and explain our intuitive reactions. My friend in New York did not want her reaction to be based solely on racial profiling, and in the intellectual and moral debate she was having inside herself she was missing the fact that something inside her, something intuitive, something based on an accumulation of fairly accurate information she had acquired over her 50-plus years, was telling her that things were unsafe. If she took the time to debate whether she was being motivated by racism or whether her experience in journalism provided her enough accurate, fact-based information about crime to know that it was a dangerous situation on its merits, it would have been too late. She got out of there, and I'm glad, whatever the reasons.

Intuition can lead us astray if we have bad information, but, as deBecker puts it, "Intuition is always right in at least two important ways: It is always in response to something. It always has your best interest at heart ... Denial is a save now, pay later scheme."

Reliable intuition is founded on having good information in your head before you ever have to use it. DeBecker makes this point in a seminar by describing the key signs that a Kangroo will attack. He talks about how they will give what appears to be a wide and genial smile (they are actually showing their teeth); they will check their pouches compulsively several times to be sure they have no young with them (they never attack and while carrying young) and they will look behind them (since they always retreat immediately after they kill). After these three signals, they will lunge, brutally pummel their victim, and then gallop away. He asked the auidence member to repeat the signals and then asked if they were prepared to react quickly and intuitively if a Kangaroo attacked. Their brains were now wired this with information and if they were ever face-to-face with a Kangaroo they would know the signs of a attack. The only problem was that deBecker had made up those pre-incident indicators.

"In our lives," deBecker writes. "We are constantly bombarded with kangaroo facts masquerading as knowledge, and our intuition relies on us to decide what we will give credence to."

I was recently reading the work of a reputed expert in the field of lying. He discussed those magical physical signs you could see if a person was lying: their eyes pointing toward the creative center of the brain, twitching, sweating and so on. Try that on someone with ADHD or an artist and see how well that lie detecting works for you. The easiest way to tell someone is lying is to know them when they tell truths and pick up on when they are lying. In lieu of that, intuition, backed by a wide breadth of accurate knowledge, is your best friend.

After reading deBecker's book, I gave a copy to one of my client's who was about to break off an emotionally abusive relationship and was concerned about violence. My message and the message of the book: trust your instinct, trust your intuition and jettison these silly ideas about the signs that you are actually in danger for the ones that are fact-based and will serve you best when intuition needs to kick in and takeover. Trust that intuition.

I gave my next copy of the book to a psychologist who has, on occasion, had me consult when she believes a client is lying to her about something important for their therapy. I would come in to talk to the person and get an intuitive feel for their truthfulness, backed up by my fact-based understanding of the typical reactions (and reasons for atypical reactions) for people in certain circumstances. My message to her: Trust your intuition. You probably have a good idea of the answer by the time you picking up the phone to call me in.

What "The Gift of Fear" offers, in addition to its promotion of intuition, is the personal safety facts that can inform you prior to a situation where your intuition is needed and it debunks myths that can be fatal, such as the statistics that suggest a likelihood of greater violence (not to mention handing them a map of where you are going to be, including for court hearings) when you obtain a restraining order against an intimate partner or stalker. It's a must read.

Yes, I know. The concept is not a welcomed one for those who want a simple system to pick up lying or signs of violence. But if it were simple, we would have been living in a truth-telling panacea a long time ago.

Bunnies, Butterflies and Care Bears Too

It was our nightly conversation about relationships.

"Have you never had a fantasy relationship," my friend in Inwood who has been through a series of relationships with men on the Internet, and just broke off her second one in the last year. "Have you never met someone on the Internet and fallen in love? Have you never fantasized about a summer romance continuing even though you knew it wouldn't?"

"No," I said. "When I was kid, I fantasized about being the executive officer -- note, not the captain -- of a ship. I was there on the couch, falling asleep, on call for when we ran into the submarines and battleships. My fantasies have always related to work."

I'm not sure which one of us was more sick. Today's topic, suggested by my friend in Inwood: Fantasy relationships as a way of escaping, and, so I can relate, steady as she goes, we'll include fantasy relationships with care bears, jobs and 48,000-ton ships.

Fantasy relationships can be more exciting than real ones. They can end with less of a crash, especially since they really only involve one person (although my journeys - affairs? episodes? ordeals? - with Folie à deux haven't been that bad either). Fantasies can be healthy distractions. They can also be ways of starring at the butterflies floating by your window as the house burns down. John Mayer would call that Slow Dancing in a Burning Room.

I use fantasy in my work, particularly in guided imagery. On a recent trip with a client who was feeling depressed, we visited an island that was so beautiful and waters that were calm. We noticed that there were people floating around her boat in the water -- they were close and none of them were talking. That made her feel good. I don't think any analysis is necessary. We also realized that as beautiful as the island was, she did not want to go to it (no analysis necessary there either) and that her worst fear was to float far in the opposite direction, where she could not see the island (hmmm, wonder what that could mean?). Fantasy can be a tool for all of us, whether we are a 14-year-old high school student in Virginia writing stories about Pretender-like prodigies or my friend in New York with her online "boyfriends." They help with our anxieties; they help make our dreams sweeter and they help us sort through complexities and get a glimpse at what we really want in life.

Sometimes, however, those fantasies reach a tipping point, and, by that, I don't mean the generally good ones that Malcom Gladwell writes about. Those fantasies can take over your life and impair your functioning (like the teenager I know who once told me that everything in her life would be alright if she could just marry an amine character). Or even worse when you are like my friend in Inwood who begins to see and turn those relationships built on fantasy into something real, something that can never live up to the magical expectations. Or, you could be like me, or my other friend from Ashburn, who just skip the fantasy part and try to make every ridiculous thing that happens in life real.

Fantasies can be your friend. They can help guide you, calm you and see paths to happiness in real life. But, well, when you begin to believe you can fly -- or, at times, in my case -- never really thought the idea of human flight was all that ridiculous, you might want to pause, and take it easy (And if you actually see a Knight in shinning armor galloping toward you on his white horse, with his sword and his shield, runnnnnnnnnn ...)

Update: Christine asks, "What if its not a knight in shining armor but Aladdin on a magic carpet who wants to take you for a ride?" The Knight Rule applies to boys on magic carpets, beasts who walk on two legs and think you are a beautiful brown-eyed belle, talking teacups and little mermaids who sing about being a part of your world. Unless, of course, you are at a Broadway play. Speaking of which, I've got to run ...