Saturday, February 14, 2004

Group Therapy: February 14, 2004


Hey, buddy. Another Saturday at CPK. Looks like you’re having a trying day. Who needs this on a Saturday? But as FDR would say: “To some librarians, much is given; to other librarians, much is expected; you, Brian, have a rendezvous at MLK at 1:30 today to pick up something you left behind—right?”

Did you happen to catch that show on PBS last Sunday about DNA? The show was about the genetic underpinnings of cancer. I was intrigued by the thinking underlying the work being done by cancer geneticists. For years clinicians—as well as histologists and pathologists—classified cancers by the organs that were affected or some histological category—thus you have breast cancer, or skin cancer (squamous cell, epithelial cell, or melanoma); lung cancer (oat cell or mesothelioma), etc.

Recently cancer geneticists have been looking at the genetics of cancers that, until now, had been considered distinct, homogeneous types. The PBS show focused on breast cancer. Until now clinicians (and others) thought breast cancer was breast cancer. But at a genetic level it’s been found that there are numerous subcategories of breast cancer, that are distinguishable by the genes of the affected tissue.

This finding helps explain something that has baffled cancer clinicians for years now. A particular drug may be effective with some patients diagnosed with “breast cancer,” but fail to help other “breast cancer” patients. Why? Possibly because what had been thought of as a homogeneous entity, namely, “breast cancer,” is actually, at a genetic level, several different variants of the disease. The drug that is effective with some breast cancer patients but not others may actually not be acting haphazardly at all. The drug may in fact be effective for a particular genetic subcategory of “breast cancer”; but ineffective for another genetic subcategory of “breast cancer.”

What does this have to do with you and me, buddy? I know you were wondering about that.

At my last group session, I talked about how I would like to have you for a friend. I talked about the fact that I’m friendless (stricken with “breast cancer”). One of the group members offered up a suggestion. He recommended, speaking metaphorically, the standard treatment protocol or “chemotherapy cocktail.”

The group member suggested that I just chat with you. Possibly about issues of common interest. Over time I should just let things build. And over time, perhaps, a friendship might develop.

That recommendation aroused a lot of frustration for me. The group member’s recommendation is in fact the standard idea I’ve always gotten about making friends. The recommendation is, in a general way, how most relationships start, grow and develop. There’s a first step by one party, a reciprocal step by the other party, and over time the parties grow closer—with different levels of closeness, or intimacy, resulting depending on the persons involved and the level of intimacy that seems comfortable for them. That’s the “standard cure.”

But it left me cold. The recommendation aroused a lot of frustration for me. It was so simplistic and so general. It reminds me of something sociologist Dalton Conley said: “Anyone who’s going to sell you on one variable is selling you a bottle of snake oil.” Conley is the Director of the Center for Advanced Social Science Research at New York University. He’s quoted in today’s New York Times (Saturday February 14, 2004) in an article about siblings. (Like you and me, Brian).

It seems to me that if you take the entire population of people with social difficulties or people who are socially isolated, you will find—upon examining the persons at a “genetic level”—quite distinct reasons for their social problems or social isolation.

Tim Norton, the front desk manager in my building, is a very reserved guy. I assume he has friends. But he’s obviously no social butterfly. But when he talks to people you can see he seems fairly conventional. He likes the Beatles, he’s traveled around the world, he has a steady job. He communicates with people in an effective manner, though he’s a man of few words. But what comes across is his conventionality.

I’m very shy. I am very socially isolated. But sometimes I talk up a storm. Like in group. Craig The Embalmer—remember him?— will tell you that sometimes I seem absolutely manic if I get on a certain topic that I’m fanatic about. Another thing is my behavior is unconventional in many ways; these letters are a case in point. Also, my ideas—the ideas I express in these letters, for example—are often unconventional.

So there’s a level at which Tim and I are similar: namely, at a “gross clinical level” we are socially reserved. But when you examine Tim’s behaviors and ideas at a “genetic level,” you find that they tend toward the conventional. When you examine my behaviors and ideas at a “genetic level,” you find them to be unconventional. It’s not only social reserve that hinders my social adjustment; my thinking is simply unconventional. My psychological needs are unconventional: an erotic investment in naked females, but at the same time a strong need for a close emotional attachment to an idealized male: what might be termed the “Rupert/Gerald” complex. And that’s only the beginning. I’ve got a lot of other psychological needs and qualities that are non-standard and would tend to militate against easy social relations.

The simple prescription of approaching others, and engaging them in a “social dance” might be an effective approach for Tim to make friends. That prescription, when I apply it, has led to a life-long history of social frustration. That’s because although Tim and I are similar at a gross clinical level, we differ—perhaps radically—at a “genetic level.”

Brian—I’ve got a few more ideas on this subject. But I’m going to continue them in my next Diary Room session. My time’s running low.

I wanted to get to Captain Brad M. Dolinsky, U.S. Army. I gave you an assignment yesterday. I asked you to find out if Captain Dolinsky is Tim’s “cookie friend.” Well, I’ve got some additional info on Dolinsky. I’ve found out that he’s an M.D., specializing in obstetrics and gynecology (like Fred Cohen—Murray’s brother; and Sharon Malone—Eric’s wife). He has what Will Kirby, M.D. (radiation oncology) (Big Brother 2) would call “an extreme knowledge of the female anatomy.”

Check you out later, Brian. Again, it’s been great, buddy.

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