Altimexis

I never heard of halo burgers either, but what about Coneys? Now when it comes to pizza, however, Detroit pizza can’t hold a candle to either Chicago deep dish pizza or New York thin-crusted pizza.

Finally, Jack is going to get the help he really needs. Adult psychiatrists aren’t really suited to the treatment of adolescents. Most of adult psychiatric practice is based on the premise that mental illness is related to chemical imbalances in the brain and can be treated with medication. Very few adult psychiatrists use psychotherapy in their practice. Indeed, insurance reimbursement isn’t sufficient to cover basic expenses of running a medical office. In the case of adolescent schizophrenia, characterized by auditory hallucinations, tangential thought processes and delusions, medical management is the mainstay of treatment, as it is in adults. However, Jack demonstrates none of the features of schizophrenia. Likewise for the affective disorders (mania, depression and manic depression), which also respond to medication. Yes, Jack is depressed, as is Nick, but depression isn’t the primary disorder. Medication does play a role in kids, but only as a stopgap to manage acute episodes. More than anything, Jack needs a psychiatrist who understands kids and knows how best to manage treatment. Jack needs to recognize that he’s internalizing the feelings imposed upon him by his parents. That’s a tough sell when self-hatred is a fundamental part of his very being. It could take years of counseling for Jack to realize he isn’t fundamentally flawed. Interestingly, the way Jack describes the unpleasant effects of his meditations is exactly the way many adults with mental illness describe the effects of their meds, and it’s one of the major reasons they stop taking their meds, even knowing that in doing so, they’ll lose touch with reality. BTW, Royal Oak is a very nice suburban town located to the north of Detroit, just past Ferndale, which borders the city. It’s one of a series of towns along the Woodward Avenue corridor, which is Detroit’s main street. Great chapter. I can’t wait for the next one.

Noooo! Nick's already too dependent of benzos to calm his anxiety. Add a stimulant to the mix and he could well get into a cycle of uppers and downers that would send him off the deep end. It could be even worse than what we saw with Jack. I don't want to imagine that! It's a real possibility, and not a laughing matter.

Another possibility would be a trip to Detroit, perhaps to see a Lions, Tigers or Pistons game in person. They could get into so much trouble in Detroit. There are some really cool places, like Midtown with its museums (I lived in a restored Art Deco building, next to the DIA), or Corktown, or the Eastern Market. Then there’s Greektown and the casinos. So much of Detroit is like something out of a dystopian novel, with miles of hollowed-out city. Just walking around in Detroit, even in the best parts, can be an adventure. You can’t walk a block on Woodward Avenue without being stopped by vagrants. I’d planned to walk the mile from where I lived to where I worked, until I realized it was a matter of when, not if, I’d be mugged. Yes, a lot could happen in Detroit.

Wow! So many possibilities. Where in Michigan is Harrison West? What towns is it near? Perhaps a trip to Mackinac Island? Might they cross into Canada at Port Huron or Sault Ste. Marie, and get detained at the border when they try to return to the US? How about a trip to Lansing or Ann Arbor, where they scope out the campuses of Michigan State or the University of Michigan, respectively? With Jonah along for the ride, they could get into so much trouble. On a more serious note, imagine a group of gay boys in Michigan Militia territory. That would be downright dangerous.

It seems this chapter finally has brought us to the meat of the story — dealing with mental illness. Nick is broken to begin with and has his own issues with unresolved grief, anxiety and low self-esteem. Jack, however, has a true mental health disorder brought on by the trauma inflicted on him by his parents. It's never good to make a diagnosis over the internet, but I feel that LB has brought us close enough to these characters that we can't help but see them as if we'd lived with them ourselves. Jack has classic symptoms of a dissociative disorder. I hate to resort to the rigid categorization inherent in the DSM-V, as Jack’s episodes have some features of partial multiple personalities, but there are definite signs of depersonalization. Either way, medications are of limited use as they only help to dampen associated anxiety and mood swings. The mainstay of treatment is intense psychotherapy which may last years, or even a lifetime. There's no undoing of the psychological trauma inflicted upon him in early childhood. Sadly, that trauma is a part of who he is. He needs to find a way to make peace with it and not let it define him. That's hard. I'm impressed by how Nick's Mom has truly adopted Jack and come to love him as her own son. At times, she's blind to the effect of Jack's illness on Nick and she expects him to act more like an adult, when even adults would have trouble with this. However, she's finally come to recognize that Nick needs counseling too. She really needs to push him in that direction. I can't help but wonder if LB has personal experience with this sort of thing. The depiction seems far too realistic to be invented, just from doing research in Wikipedia.

Jack’s meltdown harkens back to an episode near the beginning, when he tore up his room and Nick cleaned everything up while he was in the hospital. These are psychotic episodes in which he loses touch with reality. This isn’t schizophrenia, but it’s no less profound. The cutting reflects just how damaged his psyche is that he tries to punish the bad boy inside that his parents professed him to be. The seizure might have been psychogenic. I’ve read of such things, but never witnessed it myself. However, my money’s on a drug-related seizure, and I certainly dealt with a number of those. Jack was prescribed Depakote (valproic acid) as a mood stabilizer. Its primarily use is in treating absence seizures, and general seizures in children. Abrupt withdrawal can certainly cause seizures. My personal experience with Depakote was for another of its approved indications — the prevention of chronic migraines. I have a very healthy appreciation of what mucking with brain chemistry can do to a person. Effexor caused severe hypertension that didn’t fully resolve after stopping the drug. Topamax caused short term memory loss. Zonegran caused tremors, strabismus, dizziness and the inability to stand. Botox left me with permanent swallowing difficulties. I’ll never forget what Depakote did to me. From it, I learned what utter hopelessness feels like. I learned what it’s like to be suicidally depressed. Fortunately, as a doctor, I realized what was happening and with the help of those around me, was able to wait it out. As you can imagine, my migraines can be severe and frequent. That’s why I resorted to trying so many different medications, most of which did little to help and some of which had life-threatening complications. The treatments were worse than the disease. Thankfully, retirement has done more to reduce the migraines than any medication ever did. However, there are still some times when I have to retreat to a darkened room, put on noise-canceling headphones and listen to soft music. The one bright spot was that it allowed me to empathize with my patients in a way that few could. Sorry to digresses and personalize the discussion, but it demonstrates where I’m coming from when I talk about the risks of mucking around with brain chemistry. Medical management is a house of cards and Jack’s just fell down in a big way. Jack is a wonderful boy inside of a horribly damaged soul and it’s going to take a lot of patience to weather the storm. He really needs a lot of counseling. There is no medication that can substitute for that. The focus of this remarkable chapter, however, isn’t entirely on Jack. Nick is seriously broken too, and he has a lot of healing to do as well. It sounds like he had a classic schizoid personality (not to be confused with schizophrenia) and largely kept to himself, and then his father died. I’m a bit confused about when his father died though. I had thought I read that he was only nine, but this chapter makes it clear he was in middle school, which is a particularly bad time for a boy to lose his dad. It’s interesting to speculate as he did that had he let Tommy in, he might have weathered the storm. He might have even gone to his public high school. What a powerful chapter! LB, I can’t imagine what it’s like to live in such a dangerous place. However, with what’s happening in the US, I’m not sure we’re that much better off. Please, I hope you’re not involved in the drug trade yourself. A long time ago, we visited Mexico City with friends. That was before the kidnappings and crime of today. The friends had relatives in Polanco and when we visited them, there were armed guards on every street corner. Polanco is affluent but many of the rest of Mexicans live in poverty. In Manhattan, there are gleaming multimillion dollar condos next to housing projects (I live in neither), but there are no walls and in spite of the rhetoric, there is very little violent crime. Yet it only takes a few violent incidents to instill widespread fear. In any case, Lower Manhattan is doomed to be reclaimed by the sea, Mexico City will run out of water and I’m not sure what will become of Medellin.

Oh no! I used the pre-shredded reduced fat Mexican cheese blend tonight. I made mushroom quesadillas. They were delicious. How about pre-sliced cheese. Is that coated with an anti-caking dust to?

Regardless of her intentions, Nick's mom could have allowed the boys a little space before inviting Tommy. This was all new to Jack and I would have thought she'd see that he needed to acclimate before starting his summer. There's more than meets the eye, however, when it comes to Jack's jealousy of Tommy. Seriously, he forgave Jonah and invited him back into their friendship, but he can't accept Tommy? Not that jealously is ever rational, but his jealousy seems way out of proportion when compared to Jonah and Noah.

1. Yes, choosing east or west would give you 50% odds, since they aren't likely to be exactly the same and 'about the same' wasn't defined, but that in and of itself is a big clue. The two cities are within a degree and a half of each other, which is a difference of less than a hundred miles or 150 km as measured at the equator. On a planet with a circumference of a bit over 24,000 miles, that's statistically equivalent. 2. Correct. Columbia does cross the Equator, but Medellin is 450 miles north of the equator. That's very close! 3. I think you meant to write true. Most of South America is indeed east of Miami. Only the western-most portion of South America overlaps with the northeastern-most portion of North America. 4. You have a decided advantage there. New York is a bit further north than Lisbon, a place I'd very much like to visit someday. The vast majority of Europe is north of Boston. That's why if the Atlantic conveyor collapses as is expected from climate change, most of Europe will be thrown into a deep freeze. 5. That's very easy to look up. The earth's diameter is about 8,000 miles, which makes the circumference at the equator a little over 24,000 miles. Although the moon's orbit is not perfectly circular, the distance from the earth to the moon is approximately 240,000 miles, which is roughly ten time that of earth's circumference. Therefore, the string would wrap around the world about ten times.

Thanks for the acknowledgment. 😁 I’m a bit late to the party this time, so I won’t reiterate what has already been said. The description of finals week brought back some unpleasant memories. I don’t recall high school finals being that difficult. I went to a very good public school but it was huge and impractical to have such lengthy exams. The term papers were quite involved, however, and there was no AI around to help. Of course cheaters only cheat themselves. The only role for cheaters in real life is as president. Seriously, the section on finals reminded me a lot of the tension of exams in medical school. There, the competition was fierce and there was never enough time to study. In some ways, graduate school was even worse. Medical students rarely flunk out but in graduate school, where a C in your major was a failing grade, a third to a half of the students failed at least one course. Now, speaking of exams, here are some relevant questions: 1. Is Medellin east, west or at about the same longitude as New York? 2. Is Medellin in the northern or southern hemisphere? 3. True or false: Most of South America is east of Miami? 4. True or false: Most of Europe is farther north than Boston? 5. If you could extend a string from the earth to the moon and then wrap that string around the earth, how many times would that string go around the earth at the equator?

I’m not sure Nick is deliberately rewriting the history of the kiss as @Paladin suggested. Nick’s psyche is fragile and he may well have a selective memory of what happened for his own sanity. Even if Nick has deliberately altered the telling of the event, I’m not sure that’s necessarily a bad thing. After all, Nick did set boundaries with Jonah and it was Jonah who violated them. That’s sexual harassment. Nick didn’t have time to react to the kiss, even if his body did. The fact is that he did push Jonah away and he did tell Jack that the kiss lasted ten seconds. Ten seconds is a long time. What would have been gained by telling Jack that he kissed Jonah back?

As I stated early on, Nick has a lot of unresolved grief surrounding his dad's death. In his chapter, he tells how he tried to take over his dad's responsibilities because his mother was distraught and had tears of her own. I can relate to that personally, but I was sixteen when my father died. Nick, as I recall, was only nine. Nine year olds don't have anything close to the coping mechanisms of an adult, so much of that grief has become a part of his psyche. He put on a brave face and buried his grief deep in his subconscious. That grief has been coming out in anxiety and panic attacks ever since. My mother and I consoled each other. Nick's mother had responsibilities at work that couldn't be abandoned for long. As I suggested before, she probably threw herself even more into her work as an escape from dealing with her grief. Her son seemed to be fine, so that was one less thing for her to worry about. In the meantime, Nick lost his anchor in life — the man who gave him stability. His buried grief and anxiety, coupled with the insecurity all teenagers feel, has led to extreme self-doubt. A good adolescent psychologist or counselor could help him deal with that and work through the unresolved issues.

I'm not disagreeing with you. I'm just explaining why Nick's mom might not realize he isn't getting the care he needs. Remember, Nick was referred to a psychologist at Harrison West. What I don't understand is why Nick isn't still undergoing therapy sessions with that psychologist on a regular basis.

Good pickup. I forgot about that. Maybe she could help with Nick's tuition if the boys decided to go to Harvard, MIT, Stanford or Oxford.