Supporting Veterans Beyond the Uniform: Mental Health, Housing, and Hope

Last May, I was honored to be appointed a board member for the Midwest Shelter for Homeless Veterans. This opportunity has deep personal meaning, as my own family history includes grandparents and cousins who have served. The Midwest Shelter provides essential services for veterans and their families across Chicago's western suburbs, and they are currently expanding to build a larger housing unit in Wheaton.

Many veterans face ongoing challenges that extend beyond the battlefield. Recently, I spoke with a man who was shot down over the Philippines long after the Vietnam War officially ended. Even 46 years later, the weight of this experience continues to shape his life. His story is one of countless veterans who struggle silently, burdened by the emotional scars of service.

Veterans from Beirut to Kosovo to Iraq report feelings of isolation upon returning home, sometimes masked by the initial celebration of their return. But beneath the surface, they often grapple with complex emotions, including disillusionment, regret, and trauma. Many describe moments of moral ambiguity in their missions, compounded by media narratives that fail to capture the nuances of their experiences. For some, these unresolved conflicts lead to avoidance behaviors, substance use, and financial instability, increasing the risk of homelessness.

This Veterans Day, let’s honor our veterans not just with words but with action. Please consider donating to the Midwest Shelter for Homeless Veterans. Every contribution helps provide crucial resources, mental health services, and safe housing for veterans who have given so much. Together, we can offer a path to healing, hope, and stability for those who served.

If you or someone you know is a veteran in need, please don’t hesitate to reach out. And for those looking to make a difference, a donation to the Midwest Shelter for Homeless Veterans is a powerful way to show your support. Visit our website to learn more and donate today.

Embrace the Magic of Halloween: Dr. Michael Pica’s Guide to Spooky Fun and Nostalgia

It’s official—Halloween is coming! One of my favorite holidays and times of the year. Soon, neighborhoods will be filled with spooky décor, and the promise of eerie evenings ahead. I often reflect on the Halloweens of my childhood in the 70s and 80s. I remember dressing up for school as a hobo, werewolf, or pirate—simple costumes, but always fun. I was amazed by the intricate costumes my friends and their parents created. Back then, when things felt safer, we roamed freely through the neighborhood for trick-or-treating. It’s unfortunate that times have changed, but safety always comes first.

As a haunted house enthusiast, I encourage you to visit one this season if you dare! Or try other festive activities like Scarecrow Fest or a haunted trail. If staying in is more your style, Halloween is also a great time to gather with family and friends. Watch movies—from cartoons to scary classics—and enjoy the fun together. Growing up, it was always It’s the Great Pumpkin, Charlie Brown for me, with Dolly Madison commercials in between. I’m aging myself, but those were the days! As I got older, my movie picks became Halloween, The Omen, and if I was feeling particularly brave, The Exorcist.

I have fond memories of sorting through my candy on the floor after trick-or-treating, trading away the Baby Ruths and Mounds Bars because I’ve never been a fan of nuts. Later on, Halloween became all about parties and themed dinners. No matter the tradition, Halloween has always been a time of fun and celebration—just remember to stay safe.

These days, time seems to fly, and we all get caught up in busy schedules. However, I encourage everyone to slow down and allow the child in you to enjoy this season. Make memories with your family and friends. At the office, we dress up every year with a fun theme—past themes have included The Flintstones and Scooby Doo. This year, we’re going with mythical creatures, and I’ll be dressing as Anubis, the Egyptian God of the Underworld. If you’re free on the Thursday before Halloween, feel free to stop by our office, or check out the photos we’ll be posting!

Above all else, have a wonderful, safe, and fun Halloween!

Embracing Change: How Fall Reminds Us to Live Fully and Break Free from Stagnation

As the weather turns cooler, the experience of fall begins to settle in. Slowly, the leaves change colors, and the days grow shorter. I encourage all my clients to be open to this natural process and remember that, just as the seasons change, many aspects of your life can also transform—if you allow yourself to be open to the process of living.

Fall offers a unique opportunity for personal growth and change. By making intentional choices, we can move forward in ways that align with our true desires. Existential theorists propose that, as human beings, we have a significant degree of choice in shaping our lives. Yet, often, we are held back by a fear of the unknown, keeping us stuck in familiar routines. These ruts trap us in dysfunctional behavioral patterns and unhealthy choices, leading to increased anxiety, depression, or, as we grow older, what Erickson termed a sense of stagnation.

With the arrival of fall, I encourage everyone to take a moment to assess their current situations and embrace something new, even if it’s a small change. Whether it’s going for a walk and enjoying the vibrant fall colors, visiting a pumpkin patch, decorating for Halloween, or completing a project you’ve been putting off, these little moments of action can help shift your perspective. Sip on a cup of coffee on a crisp morning or enjoy seasonal treats—it’s all about slowing down and being present.

Engage in these activities with friends and family, sharing experiences that can spark deeper conversations and strengthen your connections.

As for me, I’ll be taking Chomsky on long walks, tracing leaves, and enjoying fall foods and baked goods from local farms. I hope to see you out and about, embracing the beauty of this season!

Unlocking Insights: The Power of Psychological Testing at Pica & Associates

At Pica & Associates, we offer comprehensive psychological testing services designed to provide clarity and insight into a wide range of mental health and developmental concerns. Whether you're seeking answers for Attention Deficit Disorder (ADD), learning disabilities, early education needs, giftedness, or autism, our testing process can help you understand the root cause of your concerns and guide effective treatment.

Our testing services cover a variety of needs, including:

• ADD/ADHD evaluations

• Learning disability assessments

• Early childhood education screening

• Autism evaluations

• Giftedness assessments

• Mood vs. personality disorder diagnosis

• Suicidal risk assessments

• And more

What to Expect During Psychological Testing

Despite the word "testing," the process isn’t just about answering questions. Our approach includes a clinical interview, reviewing any information you or other sources provide, and administering a variety of hands-on tasks. These might include assembling designs with blocks, coding symbols, or responding to prompts such as sentence stems or story cards.

The specific tests we use depend on the reason for referral, and sessions usually take between three to five hours. Sometimes, the process may be split over two days to allow for breaks and maximize focus. We often recommend testing be done in the morning, when individuals are more alert and able to concentrate.

The Report and Recommendations

Once testing is complete, the evaluator carefully scores and analyzes the results. This analysis forms the basis of a comprehensive report, which includes a working diagnosis and tailored recommendations. The report can be shared with other professionals, such as therapists, physicians, psychiatrists, or school systems. After the report is complete, we meet with you to discuss the findings in a feedback session. The entire process, from the initial interview to the feedback session, typically takes about eight weeks.

Why Psychological Testing Matters

Psychological testing allows us to view the individual with a depth and precision that often isn’t possible in standard therapy sessions. It provides a clear roadmap for treatment, diagnosis, and recommendations that can be used more effectively by therapists, medical professionals, and educators.

Is Psychological Testing Covered by Insurance?

Many insurance plans cover psychological testing, but it's essential to verify your coverage to understand any out-of-pocket costs.

The Power of Breathing: Techniques for Everyday Calm

In my personal and clinical experience, I've observed how easily we underestimate the significance of our breathing patterns. Often, when we become anxious, we suddenly notice that our breath becomes shallow and rapid, confined to the upper part of our chest. This hyperventilation can trigger panic, and in those moments, we forget one of the most basic yet powerful tools we have at our disposal: deep, mindful breathing.

Breathing, when done with conscious awareness, can serve as a grounding force. It helps reorganize our body's arousal levels, allowing us to remain steady and calm. Proactively practicing deep breathing not only calms the vagus nerve, which is essential for regulating our body's stress response, but it also fosters a lasting sense of tranquility. Those who regularly practice yoga or meditation will recognize the profound impact that mindful breathing can have.

Here are some basic breathing techniques that I often recommend to my clients. Incorporating these practices into your daily routine can lead to significant improvements in your overall well-being.

1. Basic Deep Breathing:

   • Find a quiet spot and sit with your feet flat on the floor.

   • Close your eyes and take a slow, deep breath in through your nose. Hold it for a few seconds, then slowly exhale through your mouth.

   • Pause briefly, then repeat this cycle six times. Afterward, switch to breathing in through your nose and out through your nose for another six cycles.

2. Guided Imagery:

   • Start with a few deep breaths to relax your body.

   • Then, visualize a safe and peaceful place. Engage all your senses—imagine the sights, sounds, textures, and even smells of this place.

   • Choose a calming word or phrase to repeat to yourself as you continue to breathe deeply. When ready, slowly open your eyes and take a few more deep breaths to ground yourself.

3. Progressive Muscle Relaxation:

   • Begin with deep breathing to center yourself.

   • Focus on one area of your body at a time. For example, clench your fists tightly, hold for a few seconds, then slowly release. Repeat this twice before moving to your arms, shoulders, neck, and so on, working your way down to your feet.

   • After tensing and releasing each muscle group, notice any thoughts, feelings, or sensations that arise. Conclude the exercise with another set of deep breaths.

Incorporating these simple exercises into your daily routine can help you slow down, manage stress, and cultivate a peaceful state of mind. Whether you're dealing with anxiety, stress, or simply the demands of daily life, mindful breathing can be a powerful tool for maintaining emotional balance.

Understanding Self-Injury: The Persistence of Cutting in Teens and Adults

A topic that came up in one of my recent supervisory sessions involved self-injury, specifically a client who engaged in repeated cutting. The phenomenon of self-injury, particularly cutting, has its roots in the mid-1980s, where it was commonly linked to individuals with histories of childhood trauma or severe depression. For those with trauma, cutting often serves as a means to escape psychological pain by inflicting physical pain. In cases of deep depression, it acts as a reminder that they are still alive, with the sight of blood serving as proof of their existence.

Around the early 2000s, I observed what seemed like a minor epidemic of cutting behaviors among teens. During this time, cutting often served as a socialization or identity function, a way for teens to connect with one another. While the prevalence of such behaviors has decreased somewhat over the years, self-injury, particularly cutting, remains a persistent issue among both teens and adults.

For many who engage in these behaviors, there is often a connection to unresolved trauma or an inability to cope with overwhelming stress. In some cases, particularly among teens and young adults, self-injury becomes a way to signal to others that they are in crisis and in need of help.

For parents, addressing this issue can be challenging, as many teens are reluctant to share. Many cut in places that are not visible, such as areas covered by clothing, making it difficult for parents to detect the behavior. In some cases, I have observed clients switch from cutting to other forms of self-injury, such as drawing excessively on themselves or burning their skin with erasers, without others noticing.

Regardless of the specific behavior, parents should take any reported or observed self-injury seriously and either seek help or contact the teen’s therapist as soon as possible, even if the marks appear superficial. Parents should also be aware of subtle indicators, such as a teen wearing long sleeves in the summer, shavers going missing, or broken plastic items found in the teen’s room.

When approaching this sensitive issue, I advise parents to respect the delicacy of the situation, considering the shame and guilt often associated with self-injury. In more severe cases, parents might consider enrolling their teen in a self-injury day treatment program or consulting with a psychiatrist. Linden Oaks Hospital in Naperville/St. Charles is one option for those seeking more intensive care.

Back-to-School Success: Tips for Families to Transition Smoothly

As summer fades, the start of the school year brings a time of transition for both students and parents. The relaxed pace of summer often gives way to the hustle and bustle of school routines, which can create tension and stress within the family. From my experience as a psychologist, I've observed a familiar pattern: families start strong, but by mid-September, the demands of school, extracurricular activities, and expectations can become overwhelming. To help ease this transition, I recommend the following strategies:

1. Establish Structure Early:
Begin the school year with a solid routine. This includes setting consistent sleep schedules, managing homework, and limiting screen time. For those involved in sports or extracurricular activities, it's essential to balance these commitments with academic responsibilities. Remember, hard work during school hours allows for well-deserved leisure time later.

2. Prioritize Teamwork and Balance:
Parents should work together to manage time effectively. While keeping children and teens busy is important, too much activity can lead to stress and conflict. Strive for a balanced schedule that supports both family harmony and individual well-being.

3. Get IEP and 504 Plans Ready:
For children who require special accommodations, it’s crucial to have Individualized Education Plans (IEPs) and 504 Plans updated and ready before the school year starts. Early communication with the school ensures that all necessary supports are in place.

4. Set Healthy Expectations:
Both parents and students should maintain realistic expectations for the school year. For those applying to college, it's important to involve parents in the process without micromanaging. The goal is to create a collaborative relationship that can continue as students transition to college life.

Remember, resources are available to help with various challenges, from school refusal programs to counseling services. By staying prepared and working together, families can navigate the school year successfully and make the most of the opportunities ahead.

The Priceless Value of Lifelong Friendships

Just the other day, I reached out to an old friend with whom I had not had much connection over the last few years. He was my best friend during my internship year in 1999, an artistic sort who went on to develop a one-man show on diversity. His intuitiveness, genuine empathy, and dark sense of humor were most appreciated. With him living on the east coast, it became more difficult to see him outside of when he traveled to the Midwest for his show. And such as life, time moved on, and our lives became busy.

A rather private individual, I had most recently learned he had been diagnosed with prostate cancer, which had resulted in him undergoing treatment with potential for surgery over the Summer. We reconnected and caught up like it was yesterday. This particular conversation brought me back to 1999. All the laughs and inside jokes and his understanding of me as a person. He knew me when and gave me exactly what I needed. I found myself back in touch with many pieces with which I had let slide over time. And he too, he noted, felt the same way.

Rather than allowing myself to get lost in the regret of time passed, I saw it as an experience much needed for each of us. I thought about the times ahead and our need for one another during this new developmental period in our lives. I was led to think about the importance of friendships over the lifespan and the much-needed magic that can take shape through such reconnection. Now in our early fifties, there is so much more to connect around and share as we are both faced with some new vulnerabilities.

The message: some friendships are priceless. They take us through long-faded memories and aspects of ourselves that have been stripped away through the course of everyday living. Maybe there is a friend out there to give a shout. Do not minimize the importance of maintaining and redeveloping your social support network.

Revisiting Freud: The Timeless Relevance of Defense Mechanisms

Say the name “Freud,” and it strikes like a lightning rod, or projective measure for that matter. Whether you love him or hate him, he was an innovative pioneer from which countless theories, research, and schools of thought have been drawn. Often misunderstood or taken too literally without considering the historical context in which he wrote, some of his theories can be misinterpreted. That being said, I do not want to come across as a Freudian apologist. Like the rest of us, he was prone to his vices and stances, some of which could be considered politically incorrect in today’s world.

So, with that being said, I would like to touch upon his introduction of defense mechanisms and the concept of repetition compulsion. Freud introduced the concept of unconscious defense mechanisms such as denial, repression, projection, intellectualization, and reaction formation, to name a few. I see them in use throughout my sessions and in my personal relationships. People have an uncanny way of living in unconscious denial to the point that they do not allow themselves to see that a molestation has occurred in the family, a family member is homosexual, has a blatant eating disorder, or that the parent they idealized was quite sociopathic or interpersonally destructive. Their unconscious motivations keep them living in ongoing denial around the issues, resulting in intrapersonal and interpersonal dysfunction. However, the denial maintains one’s self-preservation in that seeing the reality of a situation could result in psychological devastation.

Another regular use of a defense mechanism relates to the use of projection. Projection allows us to displace our own unwanted feelings onto those around us. For instance, “my brother has just always been so jealous of me” may serve as a projection of one’s own jealousies toward the brother. Intellectualization, on the other hand, functions to separate cognitive thought from feeling, allowing the individual to more safely navigate through the world without dealing with vulnerable feeling states.

Repetition compulsion refers to the unconscious need to repeat early attachment disruptions in the hope of correcting the early relational problems with an abusive father, or invalidating mother, and so on and so forth. Of course, it never works out well. Patients are surprised when I connect the dots to their relationships, wondering how it is that they always seem to find someone who invalidates them, for instance.

I could go on and on about Freudian concepts, such as his developmental stages. However, that is not the point of this blog. Despite what you think of him, some of his concepts are timeless and play out on a regular basis. As a brief psychological exercise, you may want to think about what patterns you repeat or what defense mechanism you unconsciously rely on. Just some food for thought.

The Unseen Treasure: The Wisdom of Our Elders

I was recently invited to participate in a podcast and was asked what led me to become a psychologist. Among other things, I thought about my grandfather, who immigrated from Italy to the United States in 1955. He served as a POW for six years during World War II, captured by British troops while serving in the Italian army.

After coming to America, he worked two jobs. His second shift was as a custodian for Marquette University. From as far back as I can remember, he pushed me to go to school. Despite my teenage rebelliousness, I kept his message in mind and got accepted to Marquette. From there, I embarked on my journey to becoming a psychologist. I used to visit him and my grandmother on weekends since they lived near the campus. She would load me up with pasta and meatballs, which I’d bring back to the dorm and share with my friends.

Reflecting on my childhood, I was fortunate enough to have had both sets of my grandparents until I was 17. Not only that, I was able to see them regularly and absorb their many colorful stories and words of wisdom. They were always there for me, in many ways my biggest cheerleaders. To this day, I carry a soft spot for the elderly.

I think about my younger patients and the extent to which their grandparents and the elderly play a role in their lives. I find it unfortunate that many lack regular contact and involvement with their elders, often due to geographic considerations, health issues, death, family dysfunction, or a general devaluation of the elderly. There seems to be a growing estrangement. Once seen as the wisest members of the family or tribe, their roles have become trivialized and diminished. To this, I ask: where will this next generation get their wisdom, learn their family histories, or experience the unconditional love that comes from a grandparent, great aunt, or uncle? What happens to tradition?

For many of my teenage and young adult clients, I encourage them to maximize the time they have with their elders. For those who do not have grandparents, whether they are teens, young adults, or middle-aged adults, I encourage them to pursue contact with the elderly through volunteer work or, at the very least, simple conversation when the opportunity arises, be it at church, the gym, or somewhere safe in the community.

I think about my friend Bob. He is 79 and suffering from Parkinson’s Disease. We speak weekly, sometimes for a few minutes, sometimes for 30. It makes him feel relevant. It makes him feel like he still matters. It gives me perspective, often grounding me with his stories and experiences. At his age, he is uncorked in his words. He says it like it is. He always makes me laugh and think.

So in this hectic and overly committed way in which we live, take some time to reflect, immerse yourself in the memories and the messages, and reprioritize your perspective on those who have lived, learned, and served.

Understanding Extended Adolescence: Preparing Teens for Adulthood

The world is constantly changing, and with it, psychological life-span development is ever-evolving. These days, individuals live well into their eighties and early nineties. People do not necessarily retire at 65 anymore, often remaining active in their careers well into their seventies. This is not to mention how individuals get married and start families later in their lives. In terms of adolescent development, many do not often enter into young adulthood until their mid-twenties, whether or not they go off to college.

Speaking specifically to the topic of adolescent development, I have found many teens going off to college and returning within the first semester or year of college. In most cases, though cognitively ready, they were not emotionally mature enough, able to regulate themselves, or deal with adversity. Similarly, individuals who do not leave for college may find their own setbacks entering into the adult world. This does not mean they are lazy or entitled, which unfortunately is the automatic assumption that some of us make.

I attended a conference a few years back where myself and others in the audience voiced questions concerning this phenomenon referred to as extended adolescence, and no, I do not mean “Peter Pan syndrome,” but a definitive extension of the entry into psychological adulthood.

The presenter, a neuroscientist, reminded us that the brain develops from the back to the front. In the days of the Boomers, Millennials, or older Gen X’ers, the lack of a bombardment of media and technological information resulted in the dorsolateral prefrontal cortex of the brain reaching adult maturity between ages 18 and 21. Today’s brain, he explained, takes much longer to mature given the vast amount of information required to process and absorb. By this account, he explained that the brain does not necessarily reach maturity until the age of 25, give or take.

While outliers exist, it makes sense that this current cohort of adolescents enters adulthood with a neuropsychological burden. Stated differently, they may not be neurologically ready despite high levels of intellect or stated goals. Throw in a pandemic, and it creates quite the recipe for disaster.

In the case of college, I am not saying that adolescents should not apply/enroll after high school. What I am saying is that parents may need to be educated and encouraged to prepare the adolescent to deal with social, emotional, and adverse situations that they may otherwise have taken for granted. A psychologist, mentor, or life coach might prove key in this regard. Others opt for gap years, or community college as a means to facilitate preparation, self-regulation, and emotional maturity. Whatever the case, I think the common goal is to allow the necessary training that our adolescents need to succeed. This can prevent the self-esteem blow associated with failing out of college and potential anxiety or fear of ever returning.

Until next time, stay curious and keep growing. — Dr. Michael Pica

Navigating Extended Adolescence: Preparing Teens for Adulthood

The world is constantly changing, and with it, psychological life-span development is ever-evolving. Nowadays, individuals live well into their eighties and early nineties, often remaining active in their careers well into their seventies. Many people get married and start families later in life. In terms of adolescent development, many do not enter young adulthood until their mid-twenties, regardless of whether they attend college. This shift in contemporary adolescent development is where I'd like to focus today.

In recent years, I've observed a significant number of teenage patients going off to college, only to return home within the first semester or by the end of their freshman year. Despite being cognitively and intellectually prepared, they often lack the emotional maturity and self-regulation skills to cope with adverse circumstances. Beyond college, many late teens face similar setbacks when entering the adult world. This does not mean they are lazy or entitled, a common but mistaken assumption.

At a conference a few years ago, I and others discussed this phenomenon, often referred to as extended adolescence. A neuroscientist explained that the brain develops from back to front. In the days of Boomers, Millennials, or older Gen X’ers, the absence of constant media and technological bombardment allowed the dorsal-frontal part of the brain to reach maturity between ages 18 and 21. However, today's adolescents face an overwhelming amount of information to process, delaying brain maturity to around age 25.

While exceptions exist, this explains why current adolescents may not be neurologically ready for adulthood despite their intelligence or goals. Adding a pandemic into the mix only exacerbates this challenge.

Regarding college, I’m not suggesting that adolescents shouldn’t apply or enroll after high school. Rather, parents should be educated and encouraged to prepare their teens to handle social, emotional, and adverse situations that might previously have been taken for granted. A psychologist, mentor, or life coach could be crucial in this preparation. Others might opt for gap years or community college to help adolescents develop self-regulation and emotional maturity. The common goal is to provide the necessary training our adolescents need to succeed, preventing the self-esteem blow from failing out of college and the potential anxiety or fear of returning.

Exploring Addiction Through the Lens of Gabor Mate's "In the Realm of Hungry Ghosts"

For today’s blog, I would like to share some thoughts on Gabor Mate’s profound work, “In the Realm of Hungry Ghosts.” Hats off to Dr. Gluzerman who introduced me to this insightful book.

Gabor Mate is a Canadian physician born in 1943 in a Jewish Hungarian ghetto. The Nazis invaded his town when he was an infant, resulting in the loss of his grandparents and the internment of his father in a work camp. These early traumatic experiences shaped his pre-verbal attachment style, a concept he explores extensively in his work, particularly in his decades of experience with Canadian drug addicts and substance users.

Mate's central thesis is that addictive behaviors are rooted in preverbal development, beginning in utero and lasting until about the age of three, around when memory consolidation starts. He posits that disruptions during this critical period—marked by trauma, anxiety, neglect, or inconsistent caregiving—impair an infant's ability to form a cohesive self-structure, a sense of trust, and the capacity for intimate attachments. As a result, individuals may seek external stimuli to fill an internal void, manifesting in behaviors such as substance abuse, excessive eating, gambling, shopping, overworking, and more. Mate himself admits to an obsessive addiction to work and collecting classical music, to the point of missing significant life events.

Mate’s perspective offers a humanistic framework for understanding addiction, fostering empathy for addicts often stigmatized or punished by society. He provides a new lens for addicts to understand their behavior as rooted in attachment issues, encouraging a focus on developing an internal self-structure to achieve fulfillment.

Throughout his book, Mate shares numerous case examples of heroin addicts discarded by society, seen as self-centered and manipulative rather than as individuals deprived of early affection and relational consistency. This loss of self is poignantly described by Claudia Black as "becoming what they are not."

Amidst these insights, it is crucial to maintain hope. Whether you are struggling with addiction or dealing with someone who is, set and maintain your boundaries, but strive to understand the underlying issues with empathy.

The book delves deeply into the neuroscience of trauma and addiction, but I encourage everyone to explore its case narratives for a profound and humane examination of addiction.

P.S. Don’t let the size of the book intimidate you.