Responsible Gambling?

A few days ago I received my copy of the PSYCHIATRIC NEWS wherein there was an article by Dr. Jon Grant, professor of Psychiatry at the University of Chicago entitled: Gambling Disorder Not Uncommon but often Goes Undiagnosed.   A couple of days later the following slick little brochure from the Ohio Lottery Commission showed up in my mail:

Play the Games and win the CASH that IS going to let you live like a KING

It even came with a coupon which could be worth $500 when turned in along with your latest “scratch off” ticket purchase.  With the aid of a magnifying glass, I was able to read the fine print at the bottom of the brochure and noted that 1 million such brochures were printed. I believe it is reasonable to assume that there would be one out of that 1 million who would get the 500 bucks if in the unlikely event all the coupons were actually turned in. 

There was also inscribed in that fine print the Lottery commission’s oft repeated oxymoron to “play responsibly.”  That phrase, which also accompanies their ads on TV, always takes my blood near the boiling point because I don’t believe my government should be in the business of promoting addictions.  I also believe that any behavior with the potential to do harm and even destroy lives should not be encouraged. Gambling is by its very nature irresponsible. 

Afterall, we don’t instruct people to take heroin responsibly.

Yet even Dr. Grant who is editor in chief of THE JOURNAL OF GAMBLING STUDIES , says: “When done responsibly gambling can be fun, thrilling, and potentially rewarding, yet hiding in plain sight are millions of people struggling  with gambling disorder.”   However, Dr. Grant does not share with us how we can be certain that we are immune from developing gambling disorder.  I doubt there are many gambling addicted people who begin gambling with the intention to gamble irresponsibly, or who start gambling with the intention to become addicted. 

During my career I saw many patients who admitted to having gambling problems, and probably many others whom I did not diagnose for those afflicted frequently focus on unrelated symptoms, embarrassed to admit to a gambling problem.  Others may admit to gambling, but deny it is a problem.   Related financial problems are written off as a string of bad luck and denial is expressed by the typical addict’s mantra of “I can quit any time”.  They may see their only problem as simply a string of bad luck which can only be overcome by continuing to gamble in order to recoup their losses. 

One patient who comes to mind was a very pleasant 40ish single mother whom we shall call Alice.  I had been treating her for depression for several months with little success.  She had gone through a nasty divorce from an abusive husband which had taken a toll on her self-esteem.  Alice had married young, had few skills, took a low wage job, and managed to barely survive financially with minimal and erratic child support from her ex-husband.  As is often the case with those of poor self-image she became involved with another poor choice long enough for him to introduce her to the joys of gambling by taking her to a casino where she became enamored with the slot machines.  Following the breakup of that relationship, she discovered the bingo games at her church and would often do 4 or 5 cards simultaneously.  Scratch off cards and lottery tickets consumed every dollar she could find.  There had never been any mention any of gambling until she arrived for a session one day, tearful and overwhelmed with guilt. 

She confessed that she had stolen money to gamble from her teenage son.  Her intent of course was to put it back when she won, behavior all too common with those who are addicted.  Alice was referred to Gamblers Anonymous, and continued in treatment for her depression until shortly before my retirement.  When last seen she was doing well, however relapses are common.  Alice was typical of those with a significant gambling problem in that she also had another psychiatric diagnosis which leaves one with the traditional chicken-egg controversy – did gambling cause the depression or was the depression the result of the gambling problem.  

It has been estimated that 1% of the population is suffering from gambling disorder as it is described in the American Psychiatric Diagnostic and Statistical Manual of Mental Illness (DSM), although accurate statistics are difficult since many cases go undiagnosed, and are often not discovered until a family crisis uncovers the problem as had occurred with my patient.   In addition to family disruptions, bankruptcies, and homelessness, addiction to gambling also carries with it a significant mortality rate.  Rates of gambling related suicide attempts have been rated as between 12% and 30%.  Such a variation suggests we don’t know the real number, and indeed we know suicide rates are underreported due to kind hearted physicians who wish to spare families embarrassment due to the social stigmata attached to the act and to ensure that life insurance policies will be honored.  

The gambling capital of the U.S. is also according to Michelle Trudeau of National Public Radio the suicide capital of the country averaging one daily.  She reported on a Harvard study in which residents of Las Vegas had a 50% higher risk of suicide than the rest of the country and that visitors to the city were twice as likely to kill themselves.  The coroner of Las Vegas ascribes this to the fast pace of life in a boom town and downplays the effects of gambling – surprise, surprise. 

According to our Attorney General we have four different commissions that regulate gambling in my state (Ohio).  When I was a kid, gambling was illegal with the exception of horse racing which could only be wagered at the track.  In 1973, the Ohio constitution was amended to allow a state lottery.  It was passed with a great deal of ballyhoo that the profits would be used to fund schools, and who could be against such a worthy cause? However, 50 years of the lottery does not seem to have done much to change financing of education.  At least I didn’t notice any decrease in my property taxes. 

10 years ago, our first casino opened.  The rational given for legalizing such facilities was that our neighboring state, Indiana, was attracting gamblers from Ohio consequently; would we not rather have them spend their money in Ohio?  Recently, our Governor signed a bill allowing betting on sports with no rationale I could find other than they are already doing it, so why not let the government in on the action?  

It seems that gambling of some sort has always been with us, and that fleeting euphoria which overtakes us when we beat the odds seems to be hard wired.   It may be simply another example of the “pleasure principle” which Freud talked about or perhaps a feeling of superiority for after all gambling is a kind of competition.   However, gambling has a significant advantage over other forms of addiction in hooking us.  B.F. Skinner demonstrated conclusively that behavior can be modified more effectively with what he called “intermittent positive reinforcement” which is the essence of all gambling.   His experiments with rats are replicated whenever someone plays a slot machine, for as did Skinner’s rats we wait for a reward each time we pull the handle.  He demonstrated that his rats were more highly motivated when the rewards were intermittent rather than when predictable, and that such was the case with all creatures tested including humans.  He also noted that the behaviors elicited in this manner were very resistant to being extinguished.  The same principal applies with gambling which is further amplified by increasing the possible amount of the reward. 

Prior to the time when I kicked my addiction to tobacco, I frequently stopped by a neighborhood convenience store to refill my stash of pipe tobacco.  On one such occasion, I was preceded into the store by a middle-aged man who appeared to be of modest means.  He had arrived in a pickup truck which had seen better days, and the state of his bib overalls showed signs that they had also endured some tough times.  His overall appearance and demeanor suggested this guy was a working man with emphasis on the type of work which tests one’s body.  It was Friday and I assume it must have been payday, for he grabbed a six pack of Bud light, asked for a pack of Marlboros and a scratch off ticket of some kind.  He scratched off the seal, threw the ticket down and asked for another one.  Meanwhile the line behind him which included me was stretching so he stepped aside.  As I was leaving he reinserted himself in the line and bought another ticket. 

That vignette of the sweaty guy in bib overalls throwing away money that was undoubtedly earned the hard way is replayed in my mind whenever I hear that those who gamble should “play responsibly”.  During the last few years of      my career, I worked in a clinic with patients mostly with very limited incomes usually through no fault of their own.  They often shared not only their fears, and troubles, but also their yearnings.  Perhaps, the most knowledgeable people about influencing human behavior are those in the advertising industry.  They know all about Skinner’s and other experts’ research, and I confess they hit the bulls eye with that cute little pamphlet I mentioned in the beginning of this diatribe, for who living on the bottom rung of the economic ladder wouldn’t like to have the “CASH that is going to let them live like a KING?” 

Madeline Albright | Freedom | War | Peace

Book cover of Madeline Albright book entitled THE MIGHTY and THE ALMIGHTY: A New York Times Best Seller. Madeline Albright was the first female Secretary of State for the United States of America

Yesterday I learned that Madeline Albright died. On my list of favorite diplomats, she was second only to George Marshall, whose policies were largely responsible for maintaining peace in Europe for 70 years and turned our enemies into allies. Her personal encounters with the evils which exist in our world have undoubtedly enhanced her appreciation for the freedoms afforded by democracy. Several years ago, during the post 9/11 years, we learned about the torture of our prisoners. Of course, the “T” word was never used to describe “enhanced interrogation, waterboarding, or even worse, rendition” which involved sending prisoners or kidnap victims to other countries to be tortured. She was asked to comment and responded that she felt the greatest danger to our democracy was the loss of our ideals.

It seemed clear to me from her comments that she felt the moral high road strengthened a nation and that we must be eternally vigilant and stay the course in order to survive. Her family had twice fled their native Czechoslovakia to escape totalitarianism. Although raised as a Catholic, later in her life she was surprised to learn that she had been born into a Jewish family and that many of her relatives had been victims of the holocaust, which must have further strengthened her resolve. She cautioned that since democracy was fragile it required constant vigilance, but in spite of what she saw as threats to our way of government, recently expressed confidence in its survival. The current political climate characterized by hate-speech, conspiracy theories, disregard for truth, and actual attempts to subvert democracy will certainly put that assessment to the test.

As if that were not enough, we now find ourselves between the proverbial rock and a hard spot with another testosterone-overdosed dictator deciding to kill a few thousand neighbors. Former president Bush had assured us that he had looked into Putin’s eyes, had seen his soul, and was reassured, while Albright had described his eyes as “cold almost reptilian.” Putin’s behaviors for the past few years have corrected that disparity, and we now face 2 unpalatable choices, i.e. directly intervene and risk nuclear war or stand by and watch the carnage of innocent people. So, here we go again with another stupid war. But then again, aren’t all wars stupid? World War II has been referred to as the “good war” although I find it hard to believe there is a lot good about 73 million deaths and only God knows how many injuries and how much suffering.

We now hear debate on the TV and social media about war crimes, yet isn’t killing people always criminal, or does permission granted by Putin or Biden make it OK? Was there a footnote somewhere that listed exceptions to the rule? I am told that there are some Bibles in which the phrase is thou shall not murder rather than kill which would refer to the legality of the killing, but is God actually a lawyer? Does the proverb I often heard my Grandfather use, “it depends on whose ox is being gored?” apply? During World War II Dresden was destroyed with incendiary bombs resulting in a firestorm which killed at least 35,000 people mostly women, children and elderly. There were no military targets. Likewise, Germany’s blitzkrieg of London specifically targeted civilian populations, but we got the prize by killing 226,000 people at Hiroshima and Nagasaki, and leaving other thousands behind to deal with all sorts of radiation caused illnesses.

Those who have been in combat will almost always say that “war is hell.” They often witness horrors they will never be able to forget and sometimes do things which leave them guilt ridden for life. I can see nothing good about any war, yet we continue to glorify it at the behest of our leaders. Were we to simply declare war illegal, it would greatly simplify the UN’s work at the Hague, although it would be quite stressful for those companies who build machines designed to kill people.

Madeline Albright being sworn in as Secretary of State by Vice President Al Gore in 1997. She was the first woman to hold the "top diplomat" position in the country's history
Madeline Albright was sworn in as Secretary of State by Vice President Al Gore in 1997. She was the first woman to hold the “top diplomat” position in the country’s history.

Learn more about Madeline Albright: This is link to an article in TIME Magazine

This is article from NPR

This is link to Wikipedia entry

HANG TOGETHER?

Tomorrow it will be exactly 70 years since, I sat in Mr. Davidson’s 5th grade class and listened to FDR’s speech over the Munson school P.A. system as he said December 7th was a date that would “live in infamy”, yet this day is half over and there has been barely any mention of that date. That day bonded the people of this country into a juggernaut totally committed to preserving our country’s freedom. To be certain, there was disagreement about many issues, yet in those few hours on an otherwise peaceful Sunday morning those differences became irrelevant.


Historians agree that the war was the bloodiest in history with so many millions maimed and killed that an accurate assessment is not possible. It was a terrible price to pay. Was it worth it? No doubt those liberated from the Nazi death camps would say yes. Patrick Henry is alleged to have said: “Give me liberty, or give me death” and thousands of our young people echoed that sentiment as they stood in long lines to volunteer while I was being mesmerized by Roosevelt’s speech. One could argue that the Pearl Harbor attack initiated the last war we have fought in defense of our liberty.


There is general agreement that we are now more divided than at any time since the civil war. Those we hire as a team to manage the country don’t even talk to each other, but rather talk at or about each other. One does not need to be a Psychiatrist to understand that without conversation differences can never be resolved, and anger ensues. When anger meets anger escalation follows, often culminating in rage – what has been called the Who’s afraid of Virginia Wolfe Syndrome.


Historians point out to us the fragility of democracies. They also tell us that when they fail, as they often do, it is from within. John Adams warned us about that in the very beginning of this saga, and seriously questioned how long his new democracy would survive. There are now unmistakable signs confirmed by our intelligence agencies that there are powerful forces plotting to undermine our government while we who care bicker with each other.


The latest death of a famous member of the greatest generation, Bob Dole, whom all seem to agree was a real patriot should inspire us to value what he and others like him gave us. I wonder if he shared the same feeling as did I on that fateful December day in 1941. Since then, there has been nothing like that sense of commitment to a righteous cause shared by millions of others. What a shame that it took the horrors of a war.


For years Pearl Harbor Day was a somber time for reflection. It was set aside to honor those who were lost, and to hear stories of bravery. It seems now to be treated as a mere footnote in history which makes me sad. It seems to me that we could use some inspiration these days.

CHASING DEPRESSION

Editor’s Note: One of my favorite shows right now is CBS Sunday Morning with Jane Pauley. They do such a great job at presenting interesting topics in a meaningful way. When I saw the spot about the promising treatments for depression, I thought of dad (eshrink) and knew it would be a great topic for eshrink’s blog. This post is a wealth of information on depression and Eshrink FINALLY weighs in on the TV program that prompted me to have him write it (that’s a little sarcasm that you’ll get when you read his blog) That’s just how we roll 🙂 Here is link to the spot that aired. SAINT: Hope for new treatment of depression – CBS

CHASING DEPRESSION
My slave driving editor who sometimes masquerades as a loving daughter has directed me to write a critique of a Jane Pauley TV show that featured information about a newly discovered treatment for depression. Maggie’s interest comes naturally since she had worked in my office as a receptionist when she was in high school, and her interest was undoubtedly enhanced by the presence of depression in our own family. There is no doubt that what we call Clinical Depression is a very common disabling and often fatal disease. Unfortunately, the word depression is also used for less serious mood deviations which often leads to a lot of misunderstanding. It is estimated that over 1 million people worldwide commit suicide each year and no ethnic group or race is immune from its paralyzing grip. Nearly all these victims are suffering from depression.

In 2017 there were 9.6 million people receiving treatment for depression, never mind the millions who were not treated. According to data from the 2017 National Survey on Drug Use and Health, 17.3 million adults in the United States—equaling 7.1% of all adults in the country—had experienced a major depressive episode in the past year.

There is said to be an alarming increase in suicide rates in the United States over the past decade however; such stats must be viewed with caution for in the past, coroners, who in order to spare family members the stigma of mental illness, would often rule suicides as accidental or from natural causes. Unfortunately, the stigma persists although there has been considerable progress towards classifying depression, the major cause of suicide, as a medical illness.

DEPRESSION of the AGES

It seems as if depression has always been endemic in human populations. There are multiple Biblical references offering solace to the despondent, and fables from even older times suggestive of unwarranted sadness. Perhaps the high level of consciousness afforded us by our massively complex brains has in some way contributed to our vulnerability. Throughout history, there have been endless speculation and theories put forth as to the cause of depression including: moral failure, demon possession, witchcraft, sinfulness, masturbation, or sexual deviancy to name a few. Most of these theories blame the victim, which further contributes to the self-loathing that typically accompanies the disease. To this day there are those well-meaning souls who unwittingly aggravate the depression of the one they are trying to help. In my practice, I had some patients with a strong spiritual orientation who become depressed,  sought help from their pastor who diagnosed the problem as lack of faith, and suggested they pray harder.

The COMPLEXITY of DEPRESSION

In medicine, as with most things, transparency minimizes speculation. There is little doubt in my mind that an understanding of the causes of mental illnesses would go a long way towards eliminating the stigma associated with psychiatric illnesses. There is also the maxim in medicine that prevention is preferable to treatment of a disease. It is my belief that since it comes in many different shapes and sizes, depression is not a single entity, but more likely a cluster of illnesses producing similar symptoms, much as we see the symptom of fever in many different types of infections. Depression also takes different forms as for example, some patients suffer from severe insomnia while others find escape from the horrible feelings of hopelessness by sleeping for days.

Although depression often occurs spontaneously, it can also be precipitated by extreme stress or loss. For example, grief presents with symptoms indistinguishable from depression. Seasonal affective disorder with its recurrent depressive episodes appears to be related to disturbance of circadian rhythms, and one could make a case for it having resulted from the migration of humans to temperate zones a few hundred thousand years ago. As a matter of fact, depression frequently accompanies a variety of mental health syndromes, not the least of which is bipolar illness in which a manic episode is frequently followed by extreme depression. There is even a separate category of bipolar illness where those afflicted only cycle to depression and don’t experience manic episodes.


A Little Shrink History

It has been my good fortune to have been involved in the shrink business during a time in which there has been more discoveries leading toward an unraveling of the mysteries of the mind than have happened since the beginning of time. For centuries a cure for what was called “the black dog” by the Roman poet Horace and later repeated by Churchill occupied the greatest minds to no avail. Hippocrates was the first to identify the brain as the major control center of the body. The pseudo-science of phrenology became popular in the 19th century, which was the idea that one could diagnose problems, estimate intelligence and diagnose personality types by measuring the size of the bumps on their skull. Although it was soon discredited, its proponent, Franz Gall, is credited for advancing the idea that there is localization of brain function. He identified 27 different areas of the skull which he said controlled different functions.

Franz Gall diagram that identified different areas of the skull that he said controlled different functions.


In the early 1900’s along comes a Viennese neurologist who would influence thinking about the entire field of psychiatry and psychology for a half century. Freud’s focus on sexuality, in a Victorian society in which even uttering the word sex itself was considered in bad taste, gained him much world-wide attention. He developed a form of treatment both lengthy and intensive which he called psychoanalysis. Even now that many of his theories have been discredited, many terms which he introduced have become part of our every-day lexicon.

The Pharma Era

Fast forward a half century and I was in medical school witnessing miraculous advances in medicine almost daily. Following Fleming’s accidental discovery of penicillin there had been a rush to develop antibiotics that might be effective in treating organisms refractory to penicillin. Among those was isoniazid which had proven to be effective in the treatment of tuberculosis. In those days total bed rest was required as essentially the only treatment for TB consequently; patients who were confined to continuously stay in bed for months at a time often became depressed. However, following the use of isoniazid, moods of patients in TB wards often brightened, they became more verbal, less angry, and even happy. This led to investigation of similar compounds and the first group of antidepressant compounds called Monamine oxidase inhibitors (MAOs) were developed. These drugs were effective for some, but not for all patients. They also required great care in their administration as they interacted with many other drugs and there were severe dietary restrictions.

Depression and Pharma

1956 was my junior year in medical school and it was a banner year for the pharmaceutical industry. It marked the development of broad-spectrum antibiotics, i.e., those effective against penicillin resistant organisms. Thorazine, the first drug to ever prove effective in the treatment of schizophrenia was introduced. Within a year more than 70% of patients in psychiatric hospitals in the US were discharged, and there would be no more barbaric lobotomies performed. A group of antidepressants called Tricyclics whose side effects were less onerous than with MAOs came on the market at the same time. The response to these antidepressants, even though understanding of their mode of action was largely theoretical, led to the development of what came to be called the catecholamine hypothesis of depression. It theorized that the symptoms of depression were due to defects in the transmission of chemicals called neurotransmitters which were necessary to transmit electrical impulses between nerve fibers.


No Silver Bullet

Despite all these treatment, relief from depression was still elusive for many patients. Electroencephalography had been around for nearly 20 years, and it had become more sophisticated and especially valuable in the treatment of seizure disorders. Before Freud, there was a guy named Bleuler who wrote a widely quoted book on schizophrenia. As a matter of fact, he is credited with coining the term. He noted that he had never seen schizophrenia and epilepsy coexist therefore concluded that seizures must protect against schizophrenia. With that in mind several people set out to induce seizures as a treatment for schizophrenia by giving drugs known to cause grand mal seizures. The problem was that response to the drugs was unpredictable and the mortality rate was too high even in a non-litigious time. They also noted that although seizures did not have any effect on schizophrenia except for those in a catatonic state, it did seem to be remarkably effective for those who were depressed.

In the 1930s Italians Cerletti and Bini found they could induce seizures by passing an electric current through the brain. This method allowed for better control, and proved to be remarkably effective in cases of severe depression. Electroconvulsive Therapy or ECT as it is called, was widely used throughout the world and I saw firsthand how effective it could be to treating depression that was resistant to drug therapy. It got a bad rap due to the type of complications that could accompany it, such as broken bones, and the movie ONE FLEW OVER THE CUCKOO’S NEST. Additionally, ECT was sometimes used in cases where it was not indicated, yet were we in the shoes of those guys would we not be willing to try it if it were our only tool? Recent developments of anesthetics and muscle relaxants have made it much safer and better tolerated, but it is still mostly reserved for antidepressant resistant cases, yet there are some cases of depression that don’t even respond to ECT, which has been designated the last line of defense.


My Experience with the NEXT SILVER BULLET to TREAT DEPRESSION

After years of research, primarily investigating the neurotransmitters, norepinephrine and dopamine, researchers had become interested in another neurotransmitter, serotonin, which eventually led to the breakthrough development of Prozac in 1987. I vividly recall the first person for whom I prescribed Prozac. He was a very depressed young man in his mid-20s who had been an outstanding athlete and valedictorian of his high school. Unfortunately, he had become severely depressed, and developed a disabling social phobia. He rarely left the home where he lived with his parents, except to keep his appointments, and requested to be allowed to come in via the back door of my office in order to avoid occupants of the waiting room. I had been seeing him for some time, but my efforts were to no avail. On this particular day, a drug rep had left a sample of this new drug called Prozac which had just been approved for general use, and I thought “What the hell, I ‘ll give it a shot!” Two weeks later, David (not his real name) bounced into the waiting room and with a broad smile announced to the receptionist that he had arrived. Indeed, he had. He was proud to inform me that he had just come from a theatre where he had enjoyed the first movie he had seen in several years. My first thought was, “Could I have misdiagnosed this problem, and this guy is actually bipolar?” but he continued to improve and said: “I have finally got my life back”. The last time I saw him he was a sophomore studying engineering at Ohio State University.


Needless to say, David sold me on Prozac. It proved to have a remarkably good side effect profile other than for occasional sexual dysfunction which most people thought was a small price to pay for relief from the horrors of clinical depression. There would follow, as always is the case, a number of other “me too” drugs all of which came under the heading of SSRI’s (selective serotonin reuptake inhibitors), and after prolonged usage would sometimes lose their effectiveness a phenomenon called Prozac poop out, but in my opinion they have remained heads above other treatments. Unfortunately, the SSRIs as with other antidepressants are only effective about 70% of the time, and psychiatrists are often forced to make use of the trial and error method of finding an effective medication.


Seeing is Believing

Other than the unraveling of the human genome, nothing has impressed me more that the development of scans. They always remind me of the STAR TREK physician Bones who could diagnose and simultaneously treat any problem by putting people in his scanner. I am in awe of those engineering types who figure out all this stuff. The Curie’s invention of the x-ray was monumental, but the enhancement of that technology with computers to produce a cross section view was over the top. It was called Computerized Axial Tomography (CAT or CT scan) and provided a much more detailed look at the brain. In addition to hundreds of other medical uses, it was a valuable tool for brain research and a straight forward way to eliminate brain tumors and other brain diseases which often mimic psychiatric syndromes, a problem that had bedeviled psychiatrists forever. It was not long (the late 70s) when along came the PET scan with which one could actually visualize brain function. Even more fascinating and incredulous to me was the MRI which use a powerful magnet to actually turn protons on end to produce an image from the energy given off when they return to their normal position. They produced amazingly detailed pictures especially useful to orthopedists.


MAGNETISM

There has long been interest dating back 200 years or so on the effects of magnetism on the human body. In 1989, after studies suggested that magnetic energy could be effective in the treatment of depression, the FDA approved TMS (trans-magnetic stimulation) as a treatment. It was a very benign procedure that involved placing a 2-pronged electrical coil which produced a weak magnetic field on the patient’s head. The procedure was simple, painless and without side effects, and could easily be performed in a doctor’s office. Analysis of effectiveness of treatments for depression are difficult due to the placebo effect, but double-blind studies (clinical trials in which some administrations are real, others shams, and neither the patient or the physician is aware of which treatment is real) demonstrated effectiveness in some patients, but not all. In general, responses were not seen as very robust, and it was used mostly as an adjunctive therapy along with antidepressants.


This paper is in no way meant to provide comprehensive review of past and presently available treatments of depression, but believe me they are numerous and sometimes bizarre. In the November 13, 2021 issue of PSYCHIATRIC NEWS, Charles Nemeroff MD, PH.D in his review of treatments for depression, notes there are currently 26 medications approved by the FDA for the treatment of depression and another 12 in the pipeline. There is one study published in the May 2020 American Journal of Psychiatry regarding the use of psychedelics like LSD and psilocybin in the treatment of depression. Who’d a thunk it? In addition to the many types of psychotherapy, there also are always a plethora of non-medical procedures touted to be effective. Lest I get carried away and in deference to my editor who is by now tearing out fists full of that beautiful red hair as she screams “When in the hell is he going to talk about the spot on the TV show?” I will proceed to offer my humble thoughts.

SAINT

After watching the Jane Pauley show about the Stanford Accelerated Intelligent Neuromodulation Therapy or SAINT (thank God for acronyms), I found the original publication that described their novel treatment of depression to be in the August 2020 issue of The American Journal of Psychiatry which I had discarded long ago. Since I am a lifetime member of the American Psychiatric association, I continue to be automatically subscribed, but I must confess that since my retirement eight years ago, I tend to scan rather than peruse journals in much detail. Frankly, because the rapid changes in the field with its increasingly complex technologies have left me often wondering what they are talking about. Nevertheless, the Stanford U website reported an astonishing 87% recovery rate in the treatment with this new procedure named SAINT. Even more impressive, was the fact that these patients had all failed on other conventional treatments. Dr. Nemeroff mentioned in his review that the effectiveness of SAINT had recently been confirmed by a double-blind study which lent even more credibility to the reports of its effectiveness.


SAINT: What it is

The procedure involved is a much more complex, powerful and targeted version of the TMS mentioned previously. The researchers (Dr. Cole et al) were able to direct a burst of very powerful magnetic energy to the dorso-lateral prefrontal cortex (you must look that up in an anatomy book if you plan to do this at home) of the brain for 5 minutes per hour for 10 hours daily times 5. They are convinced that their success is dependent on their ability to target that particular area of the brain which has long been suspected of playing a prominent role in mood regulation. The patients and their families who were interviewed on TV were absolutely euphoric in their endorsement of the treatments. They used the phrase “game changer” and one was convinced this procedure would change the world, and I guess it has changed her world. I agree that this treatment holds promise, but think changing the world may be a bit over the top.


CAUTION: With Experience Comes Pragmatic Skepticism

Members of my illustrious family have accused me of being pessimistic by nature, while I insist that I am simply a realist, and much too naïve to be a bona fide pessimist. In spite of this alleged cynicism, Maggie has asked me to share my opinion of this SAINT thing, and I do find it promising however; all those years practicing medicine have taught me that although all people are the same, they are also all different, or as Grandma used to say: “One size doesn’t fit everybody.” Time after time I have found the initial exhilaration associated with ground breaking discoveries in medicine are later tempered by experience. I do feel this may well be a large step towards conquering this dreadful disease.


Nothing that I have written here should be construed to mean that I believe pills or procedures alone are the answer to the problems of mankind. At best I feel that medications or other somatic treatments enhance the therapeutic benefit of human intervention. Pills are important, but so is the hand that dispenses them. I have been heartened by a trend towards more balance in the nature versus nurture debate which has persisted for generations, for in recent years neurochemistry has dominated the psychiatric literature. Those of you who have read some of my other blogs probably know that I have strong feelings about that subject. Again, one size doesn’t fit everybody, but the more tools (based on scientific research) that psychiatrists have to treat the black dog of depression, the better off the world will be. The brain is a wondrously complex organ and the acceleration of knowledge is promising indeed.

Drama at the Bird Feeder

An Oasis in the Backyard

It was a beautiful balmy summer afternoon and the gang was busy making preparations for granddaughter Emma’s surprise birthday party. There had been a temporary hiatus in the COVID warnings and such get togethers were no longer frowned upon.  I had escaped the chaos and responsibility associated with major decisions like whether the balloons should be tied down or allowed to escape to the ceilings by sneaking out to the back deck.  I settled into a comfortable chair hoping for some peace and quiet.  My favorite son-in-law (I can use that term without offending anyone since he has no competition for that honor) devotes nearly every minute of his spare time working in his yard.  The result is a carefully choreographed weed-free wonder of plants and flowers surrounded by patches of manicured grass in the front of the house, but my favorite place is the back yard which he has converted into a beautiful wildlife-friendly oasis.  It all began when he planted some shrubbery and small trees around his back lot line in order to provide some privacy.  As is his style, he soon immersed himself in learning all about landscaping, and the fence line around his backyard began to widen at the expense of the lawn due to the addition of more varieties of flora.  The diminutive pond fed by a trickle of water, at Jim’s behest, now got its fill from a more substantial flow which emitted a mesmerizing lullaby as it cascaded over a series of carefully placed stones into a small pool stocked with koi.                                                                                                                                                  

Indeed, as I settled into my adirondack chair, I felt at peace and somehow comforted. My knowledge about flowers, plants and trees is very limited, but I was impressed that all this stuff seemed to look as if it belonged.  There was all manner of shades of green in various shapes and sizes.  There were delicate ferns dwarfed and shaded from the assault of too much sunlight by their taller brethren who turned their leaves to face the sun’s rays head on, gratefully absorbing all they could get.  In the midst of this sea of green was the contrast afforded by those plants who seemed to compete for attention by showing off their ability to produce vividly colored flowers.  Presiding over this show was a backdrop of several varieties of tall trees silently dominating the scene. 

Let the Games Begin!

The quiet was soon interrupted as mother nature raised the curtain and the show began with the clarion call of a squirrel who was barking at me from his safe perch high up in a tree.  He was staring at me and his bushy red tail was swishing back and forth as he told me in no uncertain terms that I was invading his space.  This guy, I will call him Sammy, soon lost interest in me when a smaller version whom I named Freddy appeared on the scene. 

Freddy was aggressively attempting to access all those goodies in the bird feeder.   Never mind that the feeder was designed to be squirrel proof, Freddy was not to be denied.   He initially decided to attack from above and slid down the wire which suspended it, but with nothing to hold onto, slid off the top and fell to the ground.  Undaunted, he immediately was back up the tree.  Having changed to a strategy of frontal assault, he opted to leap from the trunk of the tree directly onto the feeder.  This time he appeared to have some success even managing to briefly reach paydirt by contorting his body around the feeder, but alas with nothing to hold onto and with the feeder swinging back and forth wildly he once again did a backflip and hit the ground.  However, his efforts had not been in vain for bird feed now littered the ground.  His good fortune was short lived however: as Sammy who had been preoccupied with my presence suddenly became aware of what was happening directly beneath him. 

Sammy had apparently decided that the immediacy of Freddy’s attempt to steal his cache of sunflower seeds and stuff represented a greater threat than did my presence consequently; he attacked poor little Freddy who was barely half his size.  Since I had been bullied as a kid, I had great sympathy for Freddy, and was rooting for him to kick Sammy’s butt, however Freddy was no dummy and took off running with Sammy in pursuit.  Their speed and agility was amazing as Freddy raced through the trees with Sammy on his tail.  Freddy’s diminutive size allowed him to leap onto small branches which would barely support Sammy, advantage Freddy. 

While those two were fighting, a flock of sparrows saw their opportunity and swarmed around the feeder determined to take advantage of the absence of those hair covered monsters.  In order to lessen the chance of being grabbed by some predator hawk or eagle, these guys opted to land, take a bite, and quickly fly away to seek refuge in the foliage of a tree.  Speaking of bullies, at this point a couple of blue jays showed up squawking and shoving the smaller sparrows out of the way, but it was not long before Sammy, after dispatching his adversary, was back at the bird feeder determined to reclaim it as his personal domain. This time he used his size to grab the birdfeeder with his front paws and somehow anchor his rear legs to the tree, thereby gaining access to the goodies.  It appeared to be a successful strategy until my little hero, Freddy, reappeared.  He slid down the wire and holding onto it with his hind legs was able to hang on since Sammy had stopped the feeder from swinging back and forth.  Needless to say, Sammy was a very unhappy rodent.  He reacted by attempting to reach Freddy, but in the process lost control and the feeder began swinging loose again.  You guessed it Sammy and Freddy both fell to the ground and took off running up, around, and through the trees.  They had barely disappeared from view when Charley the chipmunk showed up to clean up the spoils of war which had been left on the ground. 

Soon the sparrows who had been waiting unseen in the trees also showed up to share in the bounty.  Charley seemed to have no problem in sharing his find, and the birds seemed comfortable with him.  I guess they all felt there was enough for everyone.  I sat in place for a time waiting for Act 3 to begin, but neither Sammy nor Freddy showed up, besides it was time for me to return to my nest where I could participate in a different life drama which would be equally loud and raucous, especially following the arrival of the guest of honor.    

The Miracle of Life

The drama that I had witnessed on the patio merged with the realization that Emma the birthday girl was to be honored for 30 years of life, barely one third of the time I had been alive.  There was of course nothing new about this revelation, except that it awakened me from my usual lack of appreciation for the miracle of life in spite of the fact that our environment is teeming with it.  I believe most of us take our own lives for granted except for those of us who are more at risk of finishing our stint such as old men like me or those suffering from other possibly fatal conditions.   It has been said that awareness of our mortality leads to a more zealous appreciation of life, and my own personal experience confirms that to be true. 

In spite of endless speculation, observation, research, meditation, and spiritual inquiry, there is much about life that remains unknown or perhaps even unknowable.  There is not even agreement as to its definition.  I have spent nearly all of my life studying various aspects of life and the more I learn the more I become awed and humbled by its complexity.  We are told that life had its origins over 4 billion years ago, only a mere 250 million years after the earth was formed.  It is said to have originated from random chemical reactions to form amino acids which combined to form proteins. The proteins coalesced, and became encased in a semipermeable membrane.  Thus, the cell, the basic building block of life, was formed.   

Those “Why” Questions

Evolutionary biologists have provided extensive evidence as to how life has progressed from one cell to its current state of development, yet do little to explain why it all happened. Why questions only lead to more why questions and in the end can only be answered by God.  Reproduction is Job One for all living things, including the participants in Jim’s backyard drama, in order to assure the continuity of life.  An individual’s life is finite, but life goes on, at least it has on this planet. Since life began on earth there have been 5 cataclysmic events that have resulted in mass extinctions, but some type of life has always survived.  Some ecologists suggest that we are now entering into a human caused period of mass extinction. They base that conclusion on the large number of animals that are now seen as endangered mostly due to loss of habitat and climate change.  Some feel that all life including that of homo sapiens is at risk. 

No matter the current threats to our lives we need to remember Eleanor Roosevelt’s quote:

The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience.

Eleanor Roosevelt

To follow that admonition is likely to earn one the epitaph of a life well lived, but for millions throughout the world such reaching out proves to be very difficult.  Ben Franklin who had something to say about everything was only 40 years old when he wrote in POOR RICHARD’S ALMANAC: “Dost thou love life? Then do not squander time for that is the stuff life is made of.” When Ben wrote the almanac, the average life span was 33 years old so I’m sure 40 must have seemed old to him.  As a bonified oId guy, I can personally attest to the brevity of life and to the urgency one may feel as one’s time winds down. 

As a physician who wore many hats, first as a general practitioner and later as a Psychiatrist I have been witness to many deaths, all of which were sad, but perhaps none more so than those who died from suicide.  It is true that in spite of its wondrous qualities, life can present us with pain that can be so intense as to be intolerable.  There is also the recent phenomenon of the so-called suicide bombers who are conned into killing themselves along with others for political reasons. We Christians honor life, but ignore the Biblical commandment “though shall not to kill” by sanctioning executions and wars. 

In spite of its difficulties, life is a marvelous state of being as evidenced by the fact that even those whose lives we consider to be horrible cling to it.  As a matter of fact, during my stint as a shrink I witnessed so much unremitting pain that I was surprised there was not more suicide, but nothing was more satisfying than to see one who had suffered that torment return to experience joy in their lives. The human spirit is indeed resilient.

As for me, every morning I look on the wall of our kitchen and read a plaque which was given by a Grandson.  It is the best advice I have ever been given:

            THIS IS THE DAY THAT GOD HAS MADE

            LET US REJOICE AND BE GLAD IN IT

Downsizing is a BITCH!

DOWNSIZING IS A BITCH

Note from editor: HE'S BACK! I can assure you that eshrink is correct when he says his children are part of the solution to he and mom's downsizing. Enjoy the read...I'm sure we can all relate. 

It has come to my attention that some of you readers have questioned my absence lo these past few months. Although it is true that old bloggers suffer from the same rules of nature in that their life is brief, this one survives in spite of having flouted all the rules which are designed to promote longevity. Indeed, I am back following my latest misadventure.

It all began innocently enough when following a visit to my son and daughter-in-law’s new home in a neighboring community, Barb suggested that it would be nice to be closer to them and to downsize. It is true that we had discussed our lack of need for our “dream” house since we basically lived in only 3 of its rooms.


There was however, the problem of Floyd, who would limit our choices were we to check into one of those assisted living warehouses, for he had become persona non grata in the neighborhood due to his penchant for attacking any dogs who exhibited the audacity to walk on his street. You may recall from my previous accounts that Floyd had long ago defeated the underground fence, thus allowing him to exercise his homicidal impulses and explore the neighborhood and beyond.

Nevertheless; we decided to look around, and our son Peter arranged for us to visit a couple of facilities, one of which consisted of a couple of rooms about the size of a small chicken coop, and another which had no vacancies with approximately 200 people on a waiting list. You may be asking why they bothered to show us their place. My question, too! Realtors assured us that the shortage of housing in the U.S. was further accentuated by the fact that baby boomers were now looking to downsize. In short, we found nothing that even remotely fit us (and all of our stuff).

DESTINY or Google’s Artificial Intelligence at Work?

As a result of our fruitless search, we returned home having given up on the idea of moving while attempting to convince ourselves that it was probably best to sit tight. However, on the following day, I found myself trolling through some computer stuff when I noticed an ad for a condominium located in the area where we had been looking. It had recently come on the market. As a matter of fact, it had suddenly appeared while I was looking at the screen. Now, I am not a guy who is big on destiny and all that kind of stuff, but that picture on the screen seemed to be calling to me. (Note: Editor and daughter Maggie says that’s digital targeting–the power of AI). Consequently, I dialed the number and made an appointment to see the place the following day.

There’s Always A Price to Pay


It was located in a quiet secluded neighborhood within a few minutes of major shopping areas. The sign at the entrance announced that the houses populating the development were villas so I knew it must be a classy place. There were several people walking their dogs and they all waved as we passed. I wondered if they were really that friendly or if such behaviors were mandated by the condo association. I would later learn that there were rules about virtually everything else. Indeed, those rules were documented in 43 pages of small print along with 21 pages of amendments.
My family have accused me of being an impulse buyer which may be partially responsible for the accumulation of the huge amounts of unused stuff in our possession, although my marriage to a collector of beautiful and momentous objects certainly played a part. With that in mind I spent at least five minutes carefully inspecting the place, before saying: “I’ll take it”. I quickly qualified my comment after realizing that Barb might also have an opinion, but she agreed, our offer was accepted and we were on our way to our latest adventure oblivious to what we had begun.

We had discussed our next move and I had developed a simple game plan for our downsizing. We would move the stuff we needed into our new digs, turn the kids and grandkids loose to grab what they wanted, and have an auction for what was left. Yes, the plan was simple, but its implementation not so much.

Floyd Friendly?

Floyd the dog

Floyd remained an unresolved problem. On one of our visits to the new “villa” he jumped out of the car and after an extensive search was retrieved by Peter near a busy highway some distance away. Those condo association rules I previously mentioned had a lot to say about dogs and it became obvious that Floyd would find it difficult to comply, and make it even more difficult for Barb and I to control his exuberance, which is often misinterpreted as aggression. We saw many residents in the condo neighborhood walking their fuzzy little dogs, and it was doubtful that Floyd, the hyperactive disobedient mongrel with a rap sheet, would ever fit in.


Floyd and Barb had developed a very tight bond and she was reluctant to lose him. I must confess that I had also been taken in by the feigning of affection by those big brown eyes. After much weeping, wailing and gnashing of teeth, Barb relented when our yard man Steve, who is one of Floyd’s favorite people, offered to take him. She was partially convinced after Steve explained that he lived in the country where Floyd would have free rein.

The closing of the deal on the new place was uneventful. Fortunately. I took the advice of our realtor and insisted on an inspection of the place which resulted in the replacement of a defective HVAC. That thing about the best laid plans of mice and men turned out to be appropriate for the operation was largely down-hill from there.


STUFF

Our last move had been more than 35 years ago and we found that one can accumulate a lot of stuff in that period of time much of which has sentimental value. Some things were gifts, others items which had been bought as souvenirs or represented special times or places. There were what seemed like an endless parade of boxes of photos in albums, slides, framed or loose, some going back 5 generations or more. We decided to keep them all by promising ourselves that we would go through them all with the kids, identify all we could and digitalize them for safe keeping although in our heart of hearts we knew this would never happen. They now reside in 4 large boxes in our new garage.

Furniture however; presented a different problem for it goes without saying that 10 rooms of furniture do not fit very well in a 4 room house. Likewise, much china, glassware, figurines and all manner of doo dads had special significance to Barb, and there was no room for much of it. I wasted much time and energy fruitlessly arguing that point, (you would think that after 68 years I would know better).

As for me, I found myself emotionally attached to my tools. Through the years I had accumulated a lot of woodworking tools and all sorts of wrenches, pliers, screw drivers, and assorted gadgets along with the tools and materials to satisfy my favorite hobby of framing pictures which was one of the few hands-on activities in which I felt reasonably confident. I did move a few hand tools along with my 70 year-old collection of screws, nuts, bolts, washers and miscellaneous hardware which were categorized and labeled, my only feeble success at becoming organized.

Packing with a Twist: Paid by the BOX

In prior moves, Barb and I had packed up the stuff (correction: with major contributions by our four children…this detail was added by smith kid #4), but this time I decided to pass that chore on to the pros. I should have been prepared when the estimator told me that the guys who packed were paid by the number of boxes they filled. She had estimated that it would probably take 2 trucks to move our stuff, but we ended our move with 4 truckloads of stuff in the condo–most of which were in boxes. The boxes were stacked 3 and 4 high all through the place to the extent that there was no place to sit. There were so many boxes in the kitchen that it was almost impossible to unpack them. As we began unpacking the reason for so many boxes became obvious: paid by the box not paid to FILL THE BOX. Each box had wads of paper filling half the box and then just a few (sometimes ONE) For example, in one box I found a half-used candle about 4 inches long wrapped in a package about the size of a football. Those boxes disgorged enough paper to require 4 trips to the recycling center in addition to the truckload of cardboard boxes. Had we not moved, we would have saved not only a tree but a whole forest.


Naturally, it was frustrating enough to look for specific items hidden away in all those boxes and to get enough stuff unpacked to give us room to function at even a primitive level, but in the midst of it all Barb managed to complicate our problems further by having a very untimely heart attack. The roto-rooter guys (interventional cardiologists) unplugged and stented 4 coronary arteries one of which was totally occluded and the others more than 90% plugged up. The doctor said he was amazed that she had been able to even stay on her feet, but his prediction that I would not be able to keep up with her post-op proved to be fallacious for I have not been able to get a lick of work from her since the surgery.


Fortunately, the kids all helped out with some of the unpacking otherwise, rather than writing this I would still be trying to find my computer, wrapped in an armload of paper. In addition to the recycling center, there were multiple trips to Goodwill after we squeezed everything into our new house that it would hold. It has been over 3 months since the big move. Although we still have too much stuff for this place, It is cozy and we can now walk from one room to another without moving something.

Why is it so hard to let go of “stuff”

As for downsizing, that mission has been accomplished. The pain of “letting go” of treasured items was minimized by giving stuff to kids thereby burdening them with stuff which they will need to get rid of some day. We studiously avoided learning about how things went at the auction; although we know that some of that “valuable” stuff went for pennies. With an overstuffed 4 rooms and no basement or attic, whatever urges we may feel to accumulate more stuff are quickly extinguished.


Recently, I complained to one of my new neighbors about the pain of downsizing, and his response was “I know, we have all gone through it” referring to other neighbors in this 55 and over development. This started my thinking about why do we spend most of our lives accumulating stuff until it suddenly becomes a liability, then work hard to get rid of it. I asked Barb, a well known collector, why she collected stuff. Her reply was simply: “Because I like to look at it.” That shouldn’t have surprised me as Barb is a truly an “aesthetic” person at her core. She elaborated that all that “stuff” also reminds her of pleasant times in the past.

I presume there are other reasons that motivate us to accumulate and sometimes even hoard. There is that ego thing which says look at what I possess which is another way of saying look at me. Objects may stimulate intense feelings of nostalgia. I had a very special relationship with one of my grandfathers who was a carpenter. I still have some of his tools. When I look at them I visualize those gnarled hands working a piece of wood and I know that as long as I possess those tools I will never forget him. There is also the “I might need it someday” phenomenon which rarely happens. Although, I confess that I feel a special kind of exhilaration whenever I find the use for a screw or bolt in my collection.

Minimalists Anonymous!


Some millennials have advanced the idea of minimalism which would certainly eliminate the downsizing problem. Their philosophy is the less stuff the better. They would advise me to take a picture of Grandad’s tools, send it to the cloud and get rid of the tools. Advice that sounds like sacrilege of the first degree. I could no more experience Grandad’s tools in a picture than I could the Grand Canyon in a photo. Fortunately, the solution comes with having children whom you hope will not be minimalists, and will honor that stuff and the stories you tell about it. The minimalists insist that being bogged down with stuff hinders them from the enjoyment of more satisfying activities.


There are signs that this philosophy has taken hold by many. It seems as if reverence for old things has taken a hit as evidenced by the demise of the antique business. It makes me wonder if that same idea has fostered a disdain for longstanding traditions and ideals. Does it also prevent us from learning valuable lessons from the past? Minimalist ideas are also likely to have provided the impetus for the genesis of a “throw-away society” which is inevitable when people don’t want to keep anything, which contributes to the widespread pollution which surrounds us. It is true that the minimalist lifestyle does protect against the ravages of downsizing, and that their penchant for use of disposable products fits well into an economy in which consumerism is applauded. After all, the disposal of stuff means more stuff can be manufactured. We do glory in a burgeoning Gross Domestic Product, and wealth which is largely a measure of how much stuff a person has is generally admired and often envied, yet we profess great concern for the health of our planet.


As for me, I do not have enough walls for all the art I would like to hang, but I still have the tools and as I write this, I look at a knife hanging on the wall above my desk which has a scrimshawed drawing of a sailing ship on the handle. It was done by a close friend who is long gone from us. I get a warm feeling when I look up at it.

THE BIG LIE

My Mother frequently told me that dire things happened as a result of lying, and proved that to be true with the help of a switch cut from a weeping willow tree that was swiftly applied to my legs. The whole exercise was more ceremonial than painful, but was enough to convince me that indeed lying was a bad thing to do–unless you were sure you could get away with it. As with most things in life, lies come in all sizes. There are large lies, small lies and even white lies that are often meant to do good. When I was a kid, it seemed as if people made a big deal out of lying. Even white lies were considered troublesome, and lying was considered evil no matter the purpose. There was the traditional promise that doing something bad would result in punishment, but the lack of a confession when caught was sure to result in an even more painful backside.

Yes, in those days corporal punishment was widely hailed as an advocate for truth (“spare the rod spoil the child”), and truth was sacred. Little wonder that my generation is so screwed up. In order to keep my 4 kids in line, I had subscribed to this philosophy by fashioning a paddle. My oldest, Molly, who early on demonstrated her resistance to authoritarianism would later become a hero to her siblings by hiding it. When asked about the missing paddle, the kids denied knowing anything. It was years later after we lost Molly that they laughingly confessed to being part of the grand conspiracy. It was then that I realized the situation had been a win-win in that I didn’t have to follow through on my threats to whip them into shape and they suffered no physical pain. Although I did a bit of woodworking in those days, I never got around to making another paddle, nor do I recall fretting about its disappearance. As a matter of fact, I had no memory of that paddle until the kids brought it up while reminiscing about their childhoods. As Freud noted, our brain can be facile in the way it stores memories.

While sheltered in place by a pandemic and a blizzard, I recently decided to donate a week of my life to watching the impeachment proceedings. Since at my age every week is precious, I did my best to pay close attention to the proceedings only missing an occasional snippet for a potty break. I was very impressed by the prosecutors. Having experienced the pain of losing a child, I was amazed at the ability of the lead prosecutor Mr. Raskin’s performance only a few days after the death by suicide of his son. In spite of or perhaps because of such a devastating loss, he proved to be the most impressive of a group all of whom held my rapt attention. Their presentation was not only dramatic, but telling. The defense was erratic and mostly off the point-not surprising since they had been last minute recruits and relatively inexperienced at criminal defense. Beside that, the quality of the defense was irrelevant since the jurors had admitted to their bias before the trial began. Thus, the defense’s job one was to provide an excuse for a not guilty vote, and as expected, the republicans were left with the disproven premise that the entire proceeding was unconstitutional.

Few of us are as virtuous as little George Washington whom we are told could not tell a lie. We old guys are at a higher risk of becoming minor prevaricators. because we like to tell stories of our past exploits, and since our memories are spotty, we are often tempted to fill in the blanks. The problem with little lies is that when called on to defend them we usually add layers of more lies and those little lies can grow, but our liar-in-chief demonstrated a talent beyond the reach of us little liars by starting at the top with a really big lie. He began months ago, priming his adoring fans for the big lie that he could only lose the election if it was rigged, thereby sewing the seed for the biggest lie of all, i.e., that the election was stolen. Indeed, this lie was big enough to set in motion a frightening assault on the very foundation of our government.

capitol-riot-auschwitz-shirt

We only now are learning more about some of really bad actors in the invasion of the Capitol. The steady stream of videos shown by the prosecutors clearly showed the faces of many known to be involved in domestic terrorist activities to have forged ahead to lead the pack. Amongst the crowd were many Q-Anon signs, but to me the most repulsive of all was the creep who proudly displayed himself in a Tee shirt emblazoned with the sign: Camp Auschwitz. Nevertheless, it seems reasonable to assume that some of the participants were convinced that a coup had taken place and their government was about to be taken over by a shadow group of a secretive radical left-wing group who planned to assume dictatorial powers. With that in mind, it is little wonder that they saw themselves as patriots. Nevertheless, past experience confirms that when under the influence of mob rule, well-meaning people, especially those convinced of the righteousness of their cause, may find themselves participating in activities they would find abhorrent in any other situation..

Although it was difficult to watch as the rioters smashed windows and screamed violent threats, the outcome could have been much worse. For example, imagine the chaos that would ensue if those two pipe bombs later found in a parked pickup truck had been detonated in the house and senate chambers. Supposing Mike Pence had been captured. Did those guys who were shouting “Hang Mike Pence” really mean it? Would they have made use of the gallows they had constructed in front of the building? There was also the guy who was looking for Nancy Pelosi who said he would “tear her to pieces.” Was he just blowing off steam or was he actually homicidal? It appears that some of these guys are serious bad asses. According to the Washington Post, the FBI had picked up an online conversation calling for violence as follows:

“Be ready to fight’ Congress needs to hear glass breaking, doors being kicked in, and blood from their BLM and Antifa slave soldiers being spilled. Get violent. Stop calling this a march, or rally, or a protest. Go there ready for war. We get our President or we die. NOTHING else will achieve this goal.”


Remember the group who responded to Trump’s suggestion that they “take back their country” by storming the Michigan Capital and planning to kidnap the Governor? Supposing they had managed to trap the congress and hold them hostage. They are said to have been within minutes of getting to them before they were finally rescued. What would Trump have done? If he declared Marshall Law, how would the military and National Guard have responded?

Following the conclusion of the trial, Mitch McConnell, the minority senate leader displayed his versatility by with simultaneous conflicting messages of not guilty, and minutes later delivering a scathing condemnation of Trump insisting that he was actually guilty of all counts. He used the ploy that the trial was unconstitutional to explain his not guilty vote. It is little wonder that Mr. McConnell has survived and prospered all those years for such a talent for using both the left and right side of one’s mouth at the same time is a quality likely to be admired by many politicians. In this case the performance was designed to appease both the MAGA people and anti-Trumpers. Some cynics suggested it had more to do with encouraging the big money donors who had been scared off by public opinion polls.


Mitt Romney stated in a speech for the Congressional Record that Trump’s “Big Lie” took us to a “dark and dangerous place.” He was of course referring to Trump’s insistence that there had been massive fraud, and that the election had been stolen. As a matter of fact, one of the chants heard as the rioters attacked the capital building was “stop the steal”, and of course they had been invited to participate by Trump to go to the capital while the traditional counting of the electoral college votes was in progress. The term Big Lie was necessary in order to differentiate it from the several thousand ordinary lies which Trump had delivered throughout his career as liar in chief. Initially his lies had been characterized in the media as falsehoods, exaggerations, embellishments, or even jokes until the weight of their sheer volume resulted in a coarser representation. Now, with the exception of a few right-wing news outlets they are referred to in plain terms as lies.


Sadly, the big lie has not gone away. In the latest poll I could find, 76% of Republicans still believe Trump received more votes than Biden. Level of education mattered little for 71% of Republican college graduates concurred. [Link to article about poll] Meanwhile, the author, producer and director of this long running fiction has retired to Mar-a-Lago where he sits in judgement as to who is worthy to come and kiss his ring (or whatever). In a previous blog, I raised the question as to why people cling so tenaciously to lies even when they are proven to be untrue. I had quoted some research suggesting that repetition increased believability, but journalist, daughter, and editor Maggie (quite a load to carry) mentioned FBI director Comey’s note about how in his experience people often refused to accept they had been swindled.


There is little doubt that we do have difficulty admitting when we are wrong, especially when it involves other people. For example, in this country we have a long tradition of dickering over the price when buying a car, which probably hearkens back to the days when horse trading was seen as a competition which took the measure of a man’s expertise. I often hear friends say they got “a good deal” on their new car, yet I don’t ever recall anyone saying the salesman talked them into paying too much. It only seems logical that the more important the issue the more rigid we would hold on. Then I was reminded of what my old friend Sigmund Freud said on the subject. He who had something to say about almost everything sometimes said something that made sense, and a little over a hundred years ago coined the term “ego-dystonic” to refer to the instinctual need to maintain our self-esteem which makes it difficult to admit we are wrong no matter the evidence. Nevertheless, I find it remarkable that in spite of mountains of evidence which refute it, the number of Big Lie believers has changed very little.


It has been said many times that democracies are most at risk from forces within. In that vein, last September, Chad Wolfe, acting director of Homeland Security testified that: “Domestic terrorism has become the most lethal threat to the United States,” and FBI director Rae agreed. White Supremacist groups are said to be the best organized and most violent of all these forces, and recent information indicates there was careful planning and command control of the insurrection. The fact that they were able to enlist other antigovernment extremist groups along with the deluded Q-Anon Trump worshipers is indeed frightening. Our nation’s enemies although having shown no evidence of trying to affect the election results have done their part in supporting the Big Lie, which furthers their efforts to enhance the divisiveness.


Meanwhile, the Big Lie lives on. Trump continues to parrot it at every opportunity, and the faithful largely remain convinced that their hero is a victim. Many questions regarding the insurrection remain unanswered. It is obvious that those in charge of security were ill-prepared to deal with the size and violence of the mob. At the recent Senate hearing the capital police chief, the sergeants at arms of both the senate and house all deny ever laying eyes on the FBI warning which had been delivered to their offices prior to the attack. That such a dire warning escaped the attention of all three of the people who shared responsible for the security of the building, and the safety of those working there can only be explained as a result of gross incompetence or complicity. The other major unexplained issue was the delay by the Pentagon in sending National Guard troops after numerous pleas for help. Where are the conspiracy theorists when you need them?


Now, less that a month later, the whitewashing has begun. The latest theory is that the rioters were not Trump supporters, but rather Antifa members sporting Trump regalia. Even better was Senator Cornyn who read into the record a memo allegedly written by a participant in the march on the Capital in which it was stated that the mob was cheerful and pleasant until they were assaulted by the Capital police. Why not blame the victim? After all their leader has been victimized continuously for the past 4 years with vast left-wing conspiracies, witch hunts, and now the theft of an election. Poor fellow.

Expression of Fear

FEAR

Expression of Fear

            Fear is an emotion, without which we could not survive.  It alerts us to danger either real or imagined.  Sudden exposure to a fearful circumstance triggers the so called “fight or flight” mechanism.  Information about a threat to the organism is transmitted to the brain’s amygdala, which instantly sends signals to the hypothalamus.  It responds by directing the adrenal glands to secrete more epinephrine (adrenalin) which prepares us to take action against the perceived threat.  Our pupils dilate to enhance visual acuity, the heart rate increases to provide more blood to the brain and muscles, breathing quickens and the alveoli of the lungs open wider to absorb more oxygen.  Muscles tense and the famous “cold sweat” appears as a preparation to prevent over heating during the anticipated battle or flight.  Blood sugar levels increase to provide more energy, and there may be involuntary emptying of bowels and bladder (yes, the term “scared shitless” is for real).

            The process is automatic, nearly instantaneous and completed even before a decision can be made as to how to respond to the threat.  It can also be activated by fears for others, and most of us have undoubtedly experienced it when we are faced with a child running out in front of a moving automobile, and can even be provoked by imagined threats as in the case of those with phobias.  Many seem to be born with a hair trigger for initiating the response and for many it erupts without any stimulus at all, which we call Panic Disorder.  It is a common condition, said to account for 12% of Emergency room visits in the U. S.(link to article is here) Panic attacks frequently mimic the chest pain associated with heart attacks.  Panic disorder is amenable to treatment and in my experience a detailed explanation of the mechanism involved is helpful, as most are relieved to find they are not suffering from a life-threatening condition.  

The Physiological Response to Fear Was Key to Survival

            If the threat persists the endocrine system takes over and the amygdala stimulates the pituitary gland to produce adrenocortical hormone (ACTH) which further activates the adrenal glands to produce epinephrine, norepinephrine and cortisol.  This mechanism served Joe Caveman well allowing him to either climb a tree or stick a spear into the saber tooth tiger confronting him, but modern-day Joe can neither kill nor run from a boss who he is convinced is determined to destroy him, leaving today’s Joe chronically stressed.  Even minor stresses such as being stuck in traffic may lead to fears of missing an important appointment or attendance at his kid’s game.  Those hormones so eloquently designed to save the lives of his ancestors were not designed for long term use and their presence at high levels is analogous to keeping an engine revved up for long periods of time while it sits at the curb.  This phenomenon is felt to be a major contributor to a variety of medical problems, especially cardiovascular disease.   

Existential Fears

 Existential fears are not new to our planet.  The threat of natural disasters has always been present and persist to this day, but even though we now have a greater understanding of such phenomena, we are still helpless to deal with them in most cases, and find ourselves seeking divine protection from the big ones like earthquakes, floods, tornadoes, hurricanes, volcanoes, asteroids and the like.  I have vivid memories of fears of World war II during which invasion of the west coast by Japan was felt to be imminent following the bombing of Pearl Harbor.  Even in our small mid-western town there were designated bomb shelters as we were predicted to be next on Hitler’s list for invasion after they conquered England.

 I also recall the tears in my Mother’s eyes as we watched my brother board the train headed for training camp only a little over a month after celebrating his 18th birthday.  A few weeks later we received a call that he was “shipping out”, but he was not allowed to reveal his destination.  Nevertheless, there was some relief since the call came from New Jersey indicating that he was likely headed for the European theater rather than the South Pacific from whence came endless horror stories.  In the following months the fear for the family increased as more gold stars appeared in neighborhood windows, and the appearance of a Western Union messenger in the area would fill families with the worst kind of fear i.e. of reading “we regret to inform you…….”.

Since those early days of my life, in addition to a series of senseless wars, a a string of potentially apocalyptic events have occurred with some regularity with only brief periods in which there was nothing to fear on a grand scale. The development of the atom bomb was unique in that for the first time in history it gave the human race the power to destroy all life, and when Russia developed their version, backyard bomb shelters sprung up all over the place.  The worst of those fears came close to realization with the Cuban Missile Crisis in 1962.  In the 1970s, discovery of depletion of atmospheric ozone also resulted in fear of drastic consequences for mankind.  At the same time, there were also warnings about climate change which went unheeded, but now sow fear in many of us for our children, and their children. 

Fear & Pandemics

Fear is an unpleasant feeling.  It is understandable that we prefer to put it off if the threat is not imminent.  Such is the case of the source of our most recent global fear, i.e. the COVID-19 pandemic.  Viruses were discovered at the end of the 19th century, and 100 years ago a viral pandemic killed an estimated one third of the world’s population.  When I was a kid, polio was endemic, the world recently experienced a frightening Ebola epidemic, and for more than 50 years, scientists had been warning us of another pandemic.  In spite of all that experience and warnings we were woefully unprepared for COVID-19.  Now, more that 2.2 million people have died from it, and only the pandemic deniers are without fear.  As I mentioned in my opening statement, fear is protective, and sadly those who deny put themselves and others at risk. 

For many the fear of contracting the corona virus is superseded by more urgent fears such as: job loss, eviction, homelessness, or hunger.  There is also the sad fact that a primary concern about closing schools means that without the benefit of school breakfast and lunch programs many kids will go hungry.  It is estimated that 13 million kids arrive at school hungry and that 1 in five live with “food insecurity” (I wonder who is in charge of making up these kinds of meaningless terms, but I assume it means they don’t get enough to eat).  Yep, here we are, living in the world’s richest country where we pay farmers not to plant crops, but can’t feed our children.  Go figure!

The Fear Tactic: A Tried and True Motivator

Throughout the ages, leaders of all stripes have stoked fear in order to provoke the fight response as a motivator to followers not unlike the way our ex (thank God) president cranked up his followers on January 6 to storm the Capitol building.  They obeyed their charismatic leader when he told them they must “fight like hell” to save their country [link to video of Trump at Pre-Riot Rally].  During the insurrection they were recorded chanting: “fight for Trump.” The mob was a disparate group.  Among the most bizarre were the Q-Anon followers who were there in support of their leader (Trump), who they were convinced was destined to save the world from a secret cabal of Satan worshippers, who among other things, butchered children in order to drink their blood.  There were also groups of white supremacists, fascists, and anarchists, along with misguided patriots who had been convinced that the election had been stolen and that our democracy was about to be taken over by socialists.  Indeed, in subsequent interviews, some participants were proud of what they had done. 

Regardless of motivation, the mob’s behavior confirms the presence of a great deal of anger.  It raises the question as to from whence it came.  Did it arise from fear?  It does appear that they all were motivated by fear of something usually enhanced by misinformation.   We still don’t understand much about mob behavior, but I suspect that it must be exhilarating to be able to express suppressed anger when in the midst of like-minded people.  Why is it that when angry people congregate, anger tends to escalate, often ends in rage, and draws people into behaviors that they would never consider under ordinary circumstances?  Are they drunk with the mob’s power, or is it the need to belong?   Does group-think allow them to rationalize their behavior, or is it simply the thrill of acting out?   With the crowd shouting “hang Mike Pence’’ and hunting for other members of congress by name, the results of the insurrection could have been disastrous.  Unfortunately, the problem has not been resolved as polls indicate there are millions of citizens who still believe the election was fraudulent, the election was stolen, and vast left-wing conspiracies persist. 

Fear: The Seed of Hatred

Fear leads to anger, but long-term anger results in hatred, undoubtedly the most destructive force of any society.  We now have people in Congress who say they are afraid of suffering physical harm from their colleagues.  Some object to the prohibition against carrying a gun during deliberations.  They act as if it pains them to conform to the traditional decorum of the institution, and negotiation is a dirty word.  We now have large numbers of members of both political parties, each concerned that the other is a threat to our democracy. The Trump followers who invaded the Capitol were determined to destroy democracy in order to save it.  They continue to devour misinformation especially the “big lie” that Trump actually won the election.

In my early years I was also witness to other times in which right-wing political groups wrought havoc.  In the 1950s, Senator Joe McCarthy managed to instill fear into the citizenry with baseless allegations of communist spies having been recruited into important government and military positions.  This was in the early days of TV and his hearings were widely watched.  Many careers were destroyed as his House American Activities commission extended their “investigations” to include anyone of note, especially those in the arts since they were known to generally have liberal political views.  Later the John Birch society, a political group organized by John Welch, produced all manner of big lies mostly consisting of a grand conspiracy to take over the American government, the most outrageous of which was the accusation that Eisenhower, widely hailed as the one most responsible for winning world war II was actually a communist agent.  In both these cases the obvious goal was to create fear, but wiser heads in the Republican party intervened, whereas today’s Republican office holders fear going head-to-head with the exiled king Trump.   

Courage: The Antidote to Fear

Courage occurs when values overcome fear.  On January 6, 2021 small force of Capital Police courageously faced a mob of thousands in attempting to protect the occupants of the capital building.  Two died and multiple others were seriously injured, yet the news of the day was replete with inferences that there may have been some who were complicit in the insurrection.  To this day there has been very little mention of the other four souls known to have died that day as a result of anger gone wild.  Are they not also victims?  And what of those millions of others who have been convinced that the government of which they were once proud is now corrupt, and now fear the consequences? 

Active Listening: The Antidote to Divisiveness

The saber-toothed tiger is long gone and we humans have gained dominion over all our enemies except for those darn viruses – things so small we can’t even see them.  Now that we have destroyed most other critters, we are so secure in our dominance that we now try to save those who are left, and we find that our only enemies are each other.  We talk a great deal about our divisiveness, but do very little to correct it.  Back in the days when I was practicing my craft, I saw many couples who were deeply divided.  In nearly all those cases it was apparent that they did not listen to each other.  Oh yes, they heard each other loud and clear but did not listen.  Listening involves more than words.  To listen one must be attentive, and hear not only the words but the music i.e. the feelings.  To acknowledge those feelings provides validation, a feeling which affirms one’s humanity.  For example, to say to a true believer that he/she is crazy for believing the election was stolen is unlikely to be helpful to either party.  On the other hand if one responds with something like: “I don’t believe it was rigged, but since you do I can understand that you are pissed off”, you might go on to a meaningful discussion.  You might even find that person wanting to know why you were not a believer.  God forbid, but you could even end up respecting or even liking each other.*

Since we all have our fears, I can’t finish this thing without once again mentioning my favorite quote on the subject of courage. 

TO BE LOVED DEEPLY GIVES US STRENGTH, TO LOVE DEEPLY GIVES US COURAGE

P.S. This was a difficult paper to write because I continue to ignore the advice of my high school English teacher Miss Higgins who said that most authors select topics that are too broad in scope, and consequently do not do justice to their topic.  Some of us are just slow learners

*Editor’s Note: I recall an interview with former FBI Director James Comey after the election and prior to the holidays. When asked for any advice regarding the holidays and interactions with those who were upset about the election results or even believed the false accusations that the election was rigged. I thought Comey’s statement was interesting and relevant to eshrink’s blog subject this week. Comey talked about people’s fear of being wrong…their fear of being duped. He talked about the countless cases he had seen where people had been defrauded of their life savings and/or their retirement by unscrupulous “investors” who promised their money was safe. To his shock, many of these victims would not only refuse to testify against the accused shyster, they sometimes would testify on the shyster’s behalf. Oftentimes, the fear of being wrong or the fear of being “taken” trumps everything else. Victims of these crimes had a belief that they could “see through” a fraudster and they had a deep seated belief that the shyster was a good business person. His advice was to understand the person’s thinking from the lens of fear.

Justin Fields Quarterback for the Ohio State Buckeyes

The Power of LOVE

The new year began with me finding a new hero.  He happens to be a marvelously gifted athlete, but that is not my reason for choosing to honor this young man. His name is Justin Fields. It is true that I am proud of his exploits on the football field, and in particular his thrashing of the enemies of my treasured Ohio State buckeyes, but it was a single comment made following his sustaining of a potentially very serious and obviously painful injury on the field which I deemed heroic.

During the recent New Year’s Day game with Clemson, when sliding to the ground at the end of a run, my hero, Justin, was struck in the right lateral rib cage by the helmet of a 24-pound linebacker who dove into him as they both were running all out.  The force of the blow doubled him over and left him writhing in pain.  The force applied and location of his injuries left me concerned that the damage could be life threatening.  Although quarterbacks usually wear padding on their torsos, I couldn’t imagine him surviving this trauma without sustaining a few broken ribs or lacerating his kidney. Consequently, I was amazed to see him walk back on the field after sitting out one play, throw a touchdown pass, and be escorted into the treatment tent (more about that later) shortly before the first half ended. 

This game had received more than the usual amount of hype. It was the semi-final game in the quest for a national championship, but also was a repeat appearance of both contestants in identical circumstances.  The prior year’s game was won by Clemson with a last-minute score, and my Buckeyes had been forced to look at a poster showing the final score of that game every time they entered their practice facility.  If that were not enough motivation, there was also the fact that Ohio State was considered the underdog, and best of all, there was a recorded quote from the Clemson coach that they should not have been ranked high enough to be selected to play in the tournament as there were at least 10 other teams better than Ohio State.  He would be widely criticized (especially by the Clemson fans) for motivating an opponent, especially after losing by 21 points.

At half-time the OSU coach, Ryan Day, when asked as to the condition of his quarterback responded with the following non-answer: “He’s got the heart of a lion, and he’s gotta play for 30 more minutes.”  I would have been more comfortable with reassurances that he had been examined thoroughly by the team doctor who determined that it was safe for him to play.  I was shocked to learn that there were no X-rays taken, or what, if any, procedures were done to determine his fitness to play.  It seems to me that such an injury warranted rib films at the minimum.  I dare say that in most any other situation an X-ray would be routine, and the neglect to do so would be considered malpractice. 

At his post-game interview Justin was a model of humility. Link to YouTube Video and Link to Google Search of all Interview Results.  When asked the inane question as to how he felt about the win, he responded that he felt blessed.  He heaped praise upon his teammates, his God, and his coach, whom he said treated him like a son.  When asked how he felt about the Clemson coach’s disparaging comments, he simply replied he didn’t want to talk about that. 

However, it was the answer to the question about motivation leading to his setting sugar bowl records, that got my attention.  He mentioned that his team had been beset by disappointments throughout the season due to the pandemic, and that he was happy for them because “I love those guys.”

Deeds of valor have been favorite subjects for authors and poets throughout history.  There have been instances when soldiers have thrown themselves on hand grenades in order to save the lives of their comrades.  Soldiers who request return to combat following injuries usually do so out of concern for their buddies.  As a matter of fact, nearly all episodes of heroism arise out of concern for other people.  Psychiatrists, psychologists, philosophers, and self-endowed experts of all kinds have discussed, analyzed, and categorized the phenomenon of love ad nauseum, which usually means that they don’t have a clue.  When I was a kid, I was taught that love was a word that should be reserved for use when describing a human relationship with the possible exception of feelings for the family dog or God, but now we profess love for food, music, cars, clothing, and all kinds of inanimate objects.  We were taught to love our country, certain ideals and core values all of which had something to do with mankind.  Although love had not the exalted status of the F word or the N word, it was treated with respect. I now find the definition in the Google dictionary to include “affection for someone or something.”

My favorite definition of love is: caring for another as much or more than for oneself, but then I am a person who likes to simplify.  There is little doubt that there were multiple factors which contributed to Mr. Fields’ remarkable performance, but I was struck by his demeanor and his use of the word love.  As with most emotions, love is a word that defies description.  It can cause euphoria and unbridled pain when taken away, but is an effective antidote to hatred.  Love heals and hatred destroys.  We have all heard testimonials of people who have suffered grievous injuries at the hands of others relate how they could only find peace by forgiving those who had harmed them or their loved ones. 

My Favorite Definition of LOVE

The power of love has been recognized by the ancients, even before Jesus Christ, whose philosophy of love was first learned about by me in perhaps the most quoted of the scriptures ………THE GREATEST OF THESE IS LOVE.  It was enhanced by a quote from of all people, an ancient Taoist philosopher, Lao Tzu, who long before Christ is alleged to have said:

TO BE LOVED DEEPLY GIVES YOU STRENGTH, TO DEEPLY LOVE GIVES YOU COURAGE”

Lao Tzu

He also said: “LOVE OF ALL THE PASSIONS IS THE STRONGEST, FOR IT ATTACKS THE HEAD, THE HEART, AND THE SENSES.”

Can the power of love be misused in unscrupulous ways?

Ironically, it was while writing this little essay that I heard about the assault on the Capitol.  Perhaps that is more timely than one might think, for it illustrates a thought that had occurred to me about how the use of love is often used as an unscrupulous way to influence others to do bad things.   Although these insurrectionists were involving themselves in a hateful enterprise, most of them would undoubtedly report they were doing it out of love for their country and in many cases for their revered leader who had directed them.  Their thought processes have been so distorted by the lies of Trump and his sycophants that they refer to themselves as patriots.   After all, they were simply following the instructions of the commander in chief.  Such strategies have long been the bread and butter of charismatic cult leaders. 

Indeed, Trump misused the sentiment of love in his taped message during the siege on the Capitol.

“Go home. We love you, you’re very special,” he said as the rioters attacked the legislative branch of our government, our sacred institution of democracy, and the “thin blue line” that loyal Trump followers had previously and consistently supported without question–even when police blatantly killed citizens of color without cause.

These rioters were willing to check all of their principles and values at the door for one man. Fortunately, for us, our founders knew the danger of allegiance to one man, to a king, and set up our Republic to keep that in check. Therefore, each public servant, swears an oath to The Constitution of the United States of America, not the President. Democracy is messy, often inefficient (by design in some respects) and while ours is not a perfect system of government, it is exceptional and has always been the model for countries around the world who fight for the rights these rioters obviously have taken for granted.

To the best of my knowledge, there are no anarchists or militia groups operating in this small midwestern town of mine. Nevertheless, our local paper reported a busload of 67 of our citizens heeded Trump’s call and traveled to Washington to join in the “demonstration.”

These followers heard their Dear Leader encourage them to walk down to the Capitol and fight. Unfortunately, some of Trump’s followers take him at his word….led by one man who has tapped into their anger, their need to feel important, their need to find an excuse for all of their problems, their hatred…all for “the love of Trump” which they translate to their love of country.

Link to 3-minutes of video from Trump’s Address to his followers at pre-riot rally January 6th. [Video in full is at the bottom of this post]

Who Could Have Imagined the Danger A Narcissistic Power-Driven Trump Could Cause as POTUS?

It has been a little over 3 years since I used this blog to express my opinion about what I considered to be the serious mental problems of our President when I posted the blog entitled Trump’s Mental Health. I was not alone for I was joined by approximately 80,000 other mental health professionals who shared my concerns, and published an open letter on the subject.  There had been blowback from our parent organization, The American Psychiatric Association, that decided following a lawsuit many years ago, by Barry Goldwater, that to express such opinions without a one-on-one evaluation was “unethical.”  I had predicted that when cornered, Trump was apt to decompensate and become psychotic, which indeed seems to have occurred since losing the election, as rumor has it that there are a number of indictments that await him once he leaves office. There is also the fracture of that fragile ego as he watches his cadre of sycophants abandon him.    

The assessment from those who have met him recently that he has become “unhinged” is borne out by his incitement of riotous and what some say is treasonous behavior in a direct assault on his own government.  Dr. Lee, the psychiatrist who wrote the criteria for narcissistic personality disorder in the diagnostic manual insisted that Trump did not fit that diagnosis because he suffered no distress as a result from his aberrant behaviors.  I wonder what he would think now, and does he still believe that as psychiatrists we have no “duty to warn” when we see the so-called “leader of the free world” is dangerously deranged with a high probability of becoming psychotic.  (Sorry, but I couldn’t resist doing an “ I told you so thing”).

In addition to the serious damage done to this country which may take decades to overcome, there is also the loss of 5 lives at last count.  (By the way why have we not heard who they are other than the murdered policeman or of anything about the circumstances of their deaths).  Trump’s brainwashed followers are not likely to be deterred at least for a long time, the experience of this assault is likely to whet the appetites of the really bad actors of this bunch.

Can We Heal?

In spite of all this doom gloom and despair, I was able to grab onto a glimmer of hope this morning as I tuned into my favorite guy on CNN, Fareed Zakaria.  He did an in-depth interview with Colin Powell, the guy who was conned into delivering false information about Saddam Hussein’s alleged weapons of mass destruction which led to the Iraq war.  In spite of the long list of problems caused by Donald Doofus and his assault on democracy he was hopeful.  Although a lifelong Republican, he was convinced that Joe Biden was the right man for the job of pulling us out of the messes created by Trump.  As for the divisiveness we now experience, his answer was simple.  “always tell the truth and love each other.”

To finish where we started…O-H…

I-O…GO BUCKS!

Editor’s Note: The italicized text was written by me when the author suggested I add information about Trump’s declaration of love to his followers during the siege on the Capitol.

Links of Note:

Eshrink’s Blog Post December 2020; It’s Not Over Yet: The Last Days of Trump

Eshrink’s Blog Post September 2020: An Attempt to Understand Trump Fans (Cult Followers)

Eshrink’s Blog Post: April 2018 | Trump Fatigue

Eshrink’s Blog Post: Feb 2017 | Trump’s Label

Eshrink’s Blog Post: August 2020 Is Our Republic in Danger?

Eshrink’s Blog Post: Let’s Learn from Our Past | The Most Dangerous Man on Earlth

WORDS MATTER. Transcript of Trump’s Speech at Rally that Preceded the Assault on the Capitol

Members of Hate Groups Identified at the Capitol Riot. Article by Frontline and PBS

Link to Video of Trump Speech at Rally Prior to Capitol Riot

Link to Entire RALLY held prior to Trump Speaking is below.

Floyd the dog

The Annual Christmas Letter

Editor’s Note: The holidays are typically so busy, I intentionally decided to post Eshrink’s Christmas letter AFTER Christmas. Yes. That’s it! I didn’t forget to post it. I’m not suffering from menopausal A.D.D. or anything like that. I decided Eshrink readers deserved a good laugh to end this crazy year of 2020.

Dear Friends, Family and Christmas letter afficionados,

We are living in another one of those times which “try men’s souls”.  In our case both our souls survive in spite of the isolation imposed by this damnable virus, and we remain in possession of all necessary body parts.   Our efforts to avoid the bug have included cancellation of the annual Smith vacation, and Thanksgiving by Zoom.  It is not looking good for Christmas either.  The kids did conspire to throw a big outdoor family party for the old man’s 90th B-day complete with balloons and posters, but lacking in hugs.  When I am not hobbling around the house with my cane complaining about my aches and pains in fruitless attempts to elicit sympathy, I can usually be found at my desk writing a blog, a stupid Christmas letter, updating my obituary, or dealing with Floyd the devil dog. 

That latter activity has become a full-time job.  Those of you who have visited us have undoubtedly met Floyd whom we rescued from our local dog pound 3 years ago, for he is a very gregarious outgoing mut of undistinguished lineage.  As a matter of fact, his welcomes can be overwhelming at times, as it was for a rather staid elderly widow who after seating herself on our couch was enthusiastically greeted by Floyd via his leaping over the coffee table to land directly in her lap (did I mention he is very athletic?).  His other favored method of greeting a visitor can be even more problematic.  Some who read this may have been conned into helping Floyd exercise his fetish of having his belly rubbed without realizing that when he enters into that state of ecstasy his bladder sphincter also relaxes and the one who rubs will find themselves in the direct line of fire.   

In a previous letter, I believe I mentioned some of Floyd’s past exploits.  I could tolerate his digging up a well-manicured lawn, constant barking, burying our newspapers, and even the embarrassment of his leaping into the mail truck, but those behaviors are minor compared to his more recent attempts to kill me.  He is quite capable of feigning affection while possessing the heart of a cat killer (another story).   He has even attempted to break up my marriage by refusing to allow me to even come into contact with Barb.

Floyd’s bona fides as a devil dog were confirmed by his ability to make Barb and I the neighborhood pariahs.  Although he is in many ways very gregarious and welcoming to other dogs, he has decided that they are not to be allowed to walk on our street, and he routinely stands guard barking at the many dogs that are walked past our front yard.  Until last Memorial Day he was contained by an underground electric fence but on that day which will live in infamy he decided to brave the shock to run through it and launch a vicious attack on a neighbor’s dogs.  Needless to say, our neighbor was not happy.  A week later, in spite of my cranking the fence shock level up to the max, he again attacked the same dogs – this time drawing blood.  I learned that the middle of a dog fight is not a good place to be nevertheless; I managed to pull Floyd away from his victims but ended up flat on my skinney butt holding onto his collar.  I barely had time to get up off the ground when an ambulance arrived followed minutes later by two cop cars and the dog warden.  The ambulance guys seemed disappointed that I was not hurt, the sheriff deputies were amused, the neighbor was only mildly homicidal, and the dog warden gave me a serious lecture and a ticket to appear in county court.  All the players in this little drama were unmasked, by the way. 

Peter, always the good son, insisted on accompanying me to the court appearance even though I assured him I would be allowed a phone call before they locked me up.  The court appearance was an illuminating experience.  The room was packed with fellow criminals, but I decided to play the gimpy  old geezer card and made sure my cane was on full display as I hobbled up to the podium to plead guilty.  I was surprised to learn the judge had a rather comprehensive description of the events leading up to my appearance, and was impressed that I had paid my neighbor’s vet bill ($242.90).  I assured him that we were lo longer depending on the underground fence and were in the process of hiring a dog walker.  He seemed impressed and suspended my sentence and told me I would only pay court costs of $50.00, but when I checked out I was told I owed $98.00.  I didn’t complain out of fear that I might be charged with contempt of court or something equally disgraceful.

Floyd’s absolute favorite activity is riding in a car, and a recent episode in which he attempted to engineer my death explains why.  With the covid thing, Barb and I have spent time exploring some of the less traveled back roads of the county.  Though he feigns ignorance when convenient, Floyd seems to be electronically gifted for he learned some time ago that he could lower the car window by tramping on the button.  On this one particular trip I neglected to set the window lock button, and when I slowed to turn off the road, he was instantly out the window and racing down the middle of a heavily traveled 2 lane country road.   As soon as I could turn around, I succumbed to Barb’s pleas by going after him, but when I caught up, he turned and ran in the opposite direction.  I turned again, and this time he had stopped to investigate something in the middle of the road.  With deep ditches on each side of the road, I was forced to stop in the traffic lane.  Barb got out to retrieve the scoundrel, but found we did not have his leash.  It was obvious that a gimpy old fart like me would be of little help, but as I attempted to extricate myself from the car, I was saved by a guardian angel.  This person was not your stereotypical angel.  He had no wings, but of course you can only know an angel by what he does, not by how he looks.   He stopped his pickup truck in the lane opposite mine, and stepped out – a man mountain with biceps the circumference of my thighs.  Meanwhile, cars were backed up in both directions, but amazingly no one was rear-ended.  I knew this angel must be heaven sent when he got his female boxer dog out of his truck,  Floyd found her irresistible.  When the devil dog approached to check her out, my angel scooped him up, dumped him in my car and drove away before I could even thank him.

The angels who look after my family have also done a good job.  Barb is still a delightful companion (most days) and everyone has escaped the ravages of the covid virus except for Emma whose case was mild.  Caroline’s roommate has contracted the disease and Caroline is in quarantine but so far remains negative.  Everyone is gainfully employed in spite of the pandemic.  Barb and I remain perplexed as to how we managed to end our lives surrounded by such a marvelous group of people, and what I have done to deserve the longevity with which I have been blessed.  We can only assume divine intervention was involved.  Therefore; with love for all and in the spirit of the season Barb and I  WISH FOR YOU THAT YOUR ANGELS WILL KEEP YOU SAFE AND BLESS YOU WITH THE MERRIEST OF CHRISTMASES AND THE HAPPIEST OF NEW YEARS.