May 2026

Coping with Uncertainty…

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Entitlement

So, what does entitlement mean? In Europe, people held titles such as earls, barons, or lords. The main idea was that they enjoyed special privileges because of their titles. They lived in specific places, ate certain foods, and received priority over people without titles. This was the English tradition for centuries and remains so today. The best example is the King and Queen. Do you think they have trouble getting tickets to Wimbledon? Probably not.

When the unhappy colonists arrived in the United States, they were committed to creating a society where all men are equal. They grew tired of the privileged few ruling over them and controlling their actions. They were revolutionaries, focused on their fight for independence.

Although the New Americans abandoned traditional European titles like baron and lord, new titles quietly entered American culture. On the East Coast, where I grew up, people take pride in claiming descent from those who arrived on the Mayflower. They believe this grants them a pedigree and a special status in society. It’s funny because the folks on that ship were probably rebellious, rough-around-the-edges people. They weren’t high-society types.

Over time, new ways to assess status and titles emerged in the United States, even as society broadly valued “you are what you do.” Privilege persisted for those who attended certain prestigious schools. Owning a business or living in specific neighborhoods also indicated your social standing. Living in Newton, Massachusetts, held a different social meaning than residing in city housing in Roxbury or Dorchester.

There are many reasons why people believe they are special. They might be attractive, smart, or athletic. They could be a doctor, a lawyer, or a professor. Perhaps they grew up with limited resources and now feel entitled to what they perceive as their rights as adults. Whatever the reason, many people believe they deserve special privileges. They don’t want traffic tickets and want to go first in line. They don’t always follow the rules that the rest of us do.

One of the benefits of aging is realizing that symbols of superiority don’t matter. Feeling comfortable with yourself and finding a meaningful path brings peace. It is like the salmon swimming its own route upstream to its home: mission accomplished.

Gathering the Threads

We come to you with threads undone—
of guilt that will not be released,
of loneliness that chills the bone,
of trauma’s echo, never ceased;

we bring the shock of sudden grief—
a parent gone, a child unwell,
a friend’s betrayal without relief,
and sleepless nights we know too well.

We lay before you all we’ve stored,
this bitter gall, this inward cry—
torn shreds of sorrow, scattered, worn,
a cloth that cannot hold or lie.

And you—
you take each trembling, broken thread,
not rushing what has long been bound;
with patient hands and presence spread,
a shelter safe for all that’s said.

How shall we name the splendor of your art—
this quiet loom, this patient heart?

You do not force, you do not bind,
but sit beside our searching minds;
and in that space, both wide and still,
new colors come, new shapes of will.

A tear you do not ask us to hide,
you see it—and let it abide;
in silence deep, a reverent space
where cleansing finds its time and place.

One day, in distress, we will gather these threads,
though once we could not see their hand;
you showed us how the scattered strands
could form a stronger, steadier band.

And what was once so torn apart
becomes the fabric of our hearts—
a quilt of memories we can wear,
stitched firm with loss and tender care.

You have helped us weave this story,
with patches stitched in truth, not blame;
but hands that hold the child in us
and gently call a kinder name.

For in this sacred, shared exchange,
the seeds of love have now been sown…
what once we received in quiet grace
becomes the strength we’ve grown.

A life renewed we’ve come to live,
beyond the loss we once had grieved;
and so the cloth we have received
becomes the one we learn to give.

© Dick Millspaugh

Dick Millspaugh is a retired Board Certified Hospital Chaplain ordained by the United Methodist Church. He was previously Chief of Chaplains at the VA San Diego Healthcare System. Dick and his wife currently reside in Scripps Ranch. He enjoys writing poetry, woodworking, ceramics, and playing Bocce Ball.

Grief and Loss Among Older Adults

“It was an amputation.”

“I don’t think I’ll ever get over losing my wife.”

“I can’t stop thinking about the things I didn’t say to her as she was dying…”

“It’s really okay that he died.”

“I haven’t moved anything. I don’t leave the house. His jacket is still hanging over the back of the chair in my living room.”

“Everything seems pointless.”

“I am lonely. I have no one to go through things with me anymore.”

“He died in my arms. It was so traumatizing.”

“I’m lonely. I miss having someone here to talk to about politics and interesting things.”

These quotes represent a range of thoughts and feelings expressed by bereaved seniors in my clinical practice. Their words speak for themselves. The experience of loss and grief among older Americans is a topic that is under-researched and minimally discussed in the literature and in our culture. It deserves our time and attention.

Wendy Tayer, Ph.D. is a geriatric psychologist and associate professor of psychiatry at UC San Diego Senior Behavioral Health. She is a long time member of SDPA and its Aging Issues Committee.

Creativity in Retirement: Jon Nachison

Jon Nachison is a retired Past President of SDPA. The creator of Stand Down, Dr. Nachison is a talented musician and photographer.

Psychosis in Older Adults

In the most recently revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR; American Psychiatric Association, 2022), psychosis is indicated as a cluster of “psychotic features” which generally include a loss of touch with reality, delusions, hallucinations, disorganized thoughts, specific behaviors, and negative symptoms such as blunted affect, alogia, and avolition (American Psychiatric Association, 2022; World Health Organization, 1992). Late-onset psychosis, defined by the onset of a psychotic episode after the age of 40 (Howard et al., 2000), is more prevalent than many would guess and causes significant distress to those afflicted and their caregivers.

Current estimates suggest that older adults have a 23% risk of developing psychotic symptoms in their lifetime (Reinhardt & Cohen, 2015). This does not typically include mild cases of psychosis that are easily missed or patients in nursing homes and hospitals, because these individuals are not usually included in population surveys. Individuals who develop psychosis in late life outnumber those who had longstanding, early-onset psychotic disorders and aged into late adulthood (Tampi et al., 2021). Psychosis in late life is also associated with elevated morbidity and mortality (Talaslahti et al., 2015).

Legacies: John McCarron

John McCarron, Ph.D. was a former president and fellow of the San Diego Psychological Association. He was a kind and caring man who left a mark on our community. Along with his significant psychological expertise, he was also known for his outdoor accomplishments. He climbed all the fourteen-thousand-foot mountains in the Lower 48, rafted wild rivers, and was an expert skier. He moved to Telluride in the 90s to fulfill a lifelong dream of living in the Rocky Mountains.

John had a great sense of humor, and he often called me from the chairlift in Telluride, daring me to guess where he was. Pete Libero, Vicki, and I skied with him several times in Telluride, which was always a challenging experience. If he said, “You will love this run. It is a bit dicey but it’s nothing you can’t handle,” the translation was, get out of the area immediately. It is an impossible run!

John made a significant contribution to the Telluride community. He proved to be a versatile clinician who handled a variety of problems in his small mountain town. When you skied with John and his wife, Jane Reldan, the town physician, it was like being in the presence of celebrities in the best sense of the word.

John passed away from a brain tumor in 2003 at age 54. His loss was a significant blow to his friends, family, and Colorado community.

Battling Capitis

When I lived in Massachusetts many years ago, it was common for people to retire in Cape Cod. The Cape was bustling in the summer with thousands of tourists visiting ice cream shops, seafood restaurants, and the beautiful beaches all along the Cape. In the winter, things slowed down. Shops closed, and the Cape became a quiet, rural area with a smaller population.

Capitis was a term used to describe what almost seemed like an illness among retirees on the Cape. As life slowed down, so did the people. They took their responsibilities less seriously and drifted from one event to another during the day. Planning went out the window, and residents on the Cape learned not to expect timely responses from workmen and others. It was as if a fever swept across the Cape from November through April.

Capitis can strike retirees anywhere. With unlimited time and responsibilities ahead, retired people might relax too much and not accomplish much. Is there anything wrong with that? No, not really, but often people feel unhappy because they believe they’re not making their time meaningful. We’ve all grown up in a society that encourages and rewards productivity and achievement. That won’t suddenly change just because someone is retired. Assuming most of us want to be productive in some way, here are some strategies to handle the unavoidable struggle with Capitis.

Oltre Mare

An Italian couple from Milan runs Oltre Mare, an outstanding Italian restaurant on Cass Street in Pacific Beach. The building is modest, and the interior has a clean, efficient look. The decor is simple, with tables spaced at a comfortable distance from each other, and it’s the kind of room you might put in your own home.

I’ve been to this restaurant several times, and I love the homemade pasta, warm service, and excellent appetizers and desserts. Last night, we had pasta vongole with fresh clams, preceded by burrata with tomatoes soaked in virgin olive oil. For dessert, I had tiramisu and a cup of espresso. The restaurant does not serve alcohol, but they are very open to guests bringing their own bottle of wine. The pasta is always homemade, and though the menu is somewhat limited, the dishes I’ve had are outstanding.

HBO Max: The Pitt

The Pitt, a new HBO Max show, is in its second season. The series features an ensemble cast starring Noah Wylie, who, as a young man, starred in ER (1994-2005), one of the original medical dramas. The Pitt, which takes place in a fictional Emergency Room in Pittsburgh, has become very popular in a short time.

It’s easy to see why the show has become so popular and highly praised. It’s a fast-paced, clever series that accurately depicts real emergency room events. Like a well-coordinated basketball team moving down the court, the cast interacts smoothly while using complex medical terminology throughout. The emergency room characters showcase a wide range of personalities, making the show engaging and intriguing.

Noah Wylie as Dr. Robby is the glue that holds the show together, and he has a powerful presence around which the drama unfolds. A new chapter of The Pitt airs on HBO Max every Thursday evening.