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.

It’s Not Over Yet! The Last Days of Trump.

Those of you who have read any of these blogs may recall that I have had a lot to say about the mental health of our President, or more specifically the lack thereof. I described him as being quite fragile, and at risk of decompensating into psychosis with the right triggers. Unfortunately, there are signs, that prophecy may now be coming true, and we may be stuck with a crazy President for the next month or so. There is little doubt that his behavior has been even more erratic than usual, leaving the pundits to spend a great deal of time attempting to discern his strategy.

It was no surprise that he would insist the election was fraudulent for he has been telling us for months that if he lost, it would be because the election was fixed. Of course, he only complained about the states won by Biden. He has maintained a surprisingly low profile since the election and info leaked from the White House paints a picture of an angry brooding person subject to fits of rage directed at anyone who suggests it is time to concede. One of his earliest and most faithful supporters has characterized his quest to have the election overturned as “an embarrassment.” He has apparently been shocked to discover that even those federal judges whom he nominated have chosen to follow the law rather than the dictates of our dear leader. Some have even shown the temerity to chastise his attorneys for alleging fraud without evidence to support the charges.

Theories Regarding Trump’s Behavior in “Defeat”

There have been a variety of theories raised in an attempt to explain what is often seen as self-defeating behavior as he excoriates those who have been his most staunch supporters. Some see the parade of lawsuits alleging fraud as merely a fundraising ploy ($207 million dollars so far) as he sets the stage to start campaigning for the 2024 election, or as a means to finance his own propaganda machine a la Fox News, and there is the problem of the $300 Million bucks he is said to owe to a mysterious benefactor, yet his retreat from the public eye is beginning to erode the support of dyed-in-the-wool Trumpers. There are even a few frightened senators who are whispering disapproval of his conspiracy theories.


There seems to be general agreement among the more expert Trump watchers that except for his continuing fund-raising efforts, his behavior doesn’t make much sense. Many of us in the field have concluded that his mental state is precarious, and that when under stress he is at risk of decompensating into psychosis. As a matter of fact, a few thousand of us signed a letter attesting to that opinion some time ago. Although diagnostic labels in psychiatry are not precise (more about that in a subsequent blog) most agree that the diagnosis of Narcissistic Personality Disorder with Sociopathic features best describes Mr. Trump. He has spent his entire life attempting to prove to himself that he is a superior human being in order to shield himself from deep seated feelings of insecurity and inferiority, which explains his bullying, lying, bragging, self-aggrandizement, and continual need for praise. It is the latter quality which has led him to surround himself with a group of sycophants and has appeared to influence even his foreign policy decisions as other world leaders learn how to use that vulnerability. His preoccupation with protecting his fragile ego leaves no room for empathy or concern for others, and those who threaten to expose his deficiencies are subject to his rage and punishment.

The Truth Will Set You Free but The Lies Fan the Flames of the Discontented Sheep

Much has been made of Trump’s lies with the Washington Post reporting thousands (I couldn’t find the current number). EDITOR’S NOTE: This link goes to the Trump Lies Database (as of Oct. 16, the tally was over 26,000). Goebbels, Hitler’s propaganda minister, is quoted as saying that if you tell a lie often enough people will accept it as true, which a recent study covered in Scientific American tends to confirm. However, I am not aware of any research which focuses on the effect of such repetitive falsehoods on the one who delivers them, i.e. does the chronic liar come to believe his own lies if he repeats them frequently over a long period of time? This brings up an interesting philosophical point – is one who has convinced himself that his lies are true still a liar?

However, in the case of one whose entire being is dominated by a need to convince himself of his superiority to other humans, truth is irrelevant for the ultimate goal is to convince himself that falsehoods are truths. When one begins with a lie the only proof that can be offered is another lie which is how conspiracy theories are born. In Trump’s case, he has been unwilling to even consider the possibility of fallibility in any aspect of his life. He always uses superlatives to describe himself or his performance, never just good but always the best as in the “best economy ever” or “the biggest crowds ever.” He took pains to insure his loss of the election would be due to fraud rather than admit that he wasn’t the greatest President since Lincoln or maybe even before. He continues to insist in spite of evidence to the contrary that the election was stolen from him and that lie has been repeated by him hundreds of times in the past month.

Could it be that he actually believes those lies he constantly mouths as do many of his followers. A recent Reuters poll concluded that 52% of Republicans believe the election was rigged while other polls show the percentage to be even higher. Thus, it seems Trump’s admonitions to his followers that they should only believe him and not the “fake news” purveyors has been effective even though there has not been a shred of evidence of significant fraud. In a recent blog (LOYAL TRUMP FANS) I quoted Michael Cohen, Trump’s former lawyer and fixer, who described the Trump organization as a cult. I thought comparison of Trump to a cult leader seemed an exaggeration until I read this article in Psychology Today by Joe Navarro, a retired FBI agent. who wrote in his article about about dangerous cult leaders:

“ Having studied at length the life, teachings, and behaviors of Jim Jones (Jonestown Guyana), David Koresh (Branch Davidians), Stewart Traill (The Church of Bible Understanding), Charles Manson, Shoko Asahara (Aum Shinrikyo), Joseph Di Mambro (The Order of the Solar Temple a.k.a. Ordre du Temple Solaire), Marshall Heff Applewhit (Heaven’s Gate), Bhagwan Rajneesh (Rajneesh Movement), and Warren Jeffs (polygamist leader), I can say that what stands out about these individuals is that they were or are all pathologically narcissistic. They all have or had an over-abundant belief that they were special, that they and they alone had the answers to problems, and that they had to be revered. They demanded perfect loyalty from followers, they overvalued themselves and devalued those around them, they were intolerant of criticism, and above all they did not like being questioned or challenged. And yet, in spite of these less than charming traits, they had no trouble attracting those who were willing to overlook these features.”

By Joe Navarro, Psychology Today, Dangerous Cult Leaders Dangerous Cult Leaders: Clues to what makes for a pathological cult leader

Sound familiar?

Cults and The Company We Keep | Hate Groups. Domestic Terrorists. White Supremacists.

If those thousands of attendees at His rallies are members of a cult, it is a large one, yet not unprecedented for many consider Scientology for example to be a cult. My experience with cults has been in treating family members of those recruited into cults. What I have read indicates there are varied reasons some are vulnerable to being recruited, and that there are a surprising number of apparently well-adjusted people who are willing to surrender their beliefs to a charismatic figure in spite of his obvious flaws.

It appears Trump is running out of legal challenges designed to steal the election for himself which begs the question as to what is next for Trump and his followers, the vast majority of whom believe whatever he says. Unfortunately; there are also many who support him out of fear for their political future. His son in law, Kushner, said in an interview that Trump had succeeded in executing “a hostile takeover” of the Republican party. Indeed, we have seen a continuous string of supports by elected officials for, or pathological tolerance of, his nefarious activities out of fear they will be primaried. Consequently; he continues to spit on The Constitution with impunity, most recently by filing suit in the Supreme court to nullify the votes of millions of people.


Meanwhile more drama appears to be forming as Trump’s buddies, The Proud Boys are no longer adhering to the order to “stand back and stand by” as ordered by Trump during the Presidential debate. As a matter of fact, they have been an active presence during the current demonstrations for Trump in Washington. Their leader, a gun toting dude by the name of Enrique Tarrio, was seen visiting or maybe casing the White House, but the administration assures us that this was not at the invitation of the President, and we know we can always trust every word we hear from that source. Nevertheless, during a lull in the attempts to foment rioting Mr. Tarrio later addressed the troops and said: “We have come a long way”. Another hero to speak was recently pardoned General Mike Flynn who extoled the virtues of his benefactor for keeping him out of the slammer. All in all, it was just another day in the swamp.


There has been a great deal of speculation as to what Trump will do in order to attempt to save face or better yet to mete out punishment for those who refused to praise him. Some have suggested that his recent replacement of key personnel at the Pentagon with know nothing sycophants is a backup plan to use the military to engineer a coup d’etat since his hand-picked supreme court was disloyal to him and decided instead to follow the constitution. There was also the trial balloon arranged by Bill Barr during the Black Lives Matter demonstrations when he raised a secret militia composed mostly of federal prison guards, but that didn’t work out so well.

It has been assumed that the torch if passed would be flame first, and that Trump likely will not attend the inauguration. There are lots of possibilities as to how the swearing in could be disrupted. One rumor has it that Trump will arrange for a giant rally and use the occasion to announce his intent to run again in 2024. It seems nearly certain that he will not be able to tolerate watching Biden get all the attention. It is expected that there will be many pardons passed out which will get him noticed along with various other gimmicks designed to make governing difficult. With a little help from the Donald it may be possible for some of those wacked out militia groups to infiltrate the inaugural crowd and stir up trouble, but hopefully the COVID thing will keep crowds to a minimum.

Top Reasons for Trump Would Refuse to Cede Power

There are several reasons Trump may be more reluctant than the average guy to cede power to another:

  • It is a dream job for the pathological narcissist who lives to be the center of attention.
  • It presents multiple opportunities to cash in, e.g. the $175,000 a day charged to the inauguration committee for the use of Trump’s DC hotel ballroom.
  • The title of President lends credence to whatever con job one wishes to pull off, which is the greatest joy for any sociopath.
  • The power to make or break individuals helps to validate the self- imposed myth of infallibility.
  • The office offers some protection from indictments, and rumor has it that Trump may be facing serious legal problems as a civilian. Here’s a link to the list of current law suits Trump will likely face as a civilian when the office of the President of the United States can’t protect him anymore..

Today, Biden was certified as President elect, but I was happy to hear that Trump said he would not give up on overturning the election. Yes, I was pleased because I thought as long as he is occupied with such activities, he is unlikely to engage in even crazier behaviors. Hopefully, even when hope is lost, the lure of all those donations to his “legal “funds will keep him going for a while.

However, as the end of his fun time draws nearer, I am concerned that his paranoia may progress to the point that he might do something really crazy. His support for or simply lack of commentary about the proud boy agitators’ recent activities could be seen as a go-ahead signal which could rapidly escalate into a major crisis – his parting gift to Biden. In the event that Trump does come to believe some of those conspiracy theories which he espouses, there is no limit to the crazy behaviors which could make sense to him, and even on his best days his legendary fits of rage seem to overwhelm judgement.

The Proud Boys claim they aren’t a hate group. This T-Shirt was recently removed from Amazon. The term is well-known term proliferated about the Holocaust and stands for “6 Million Weren’t Enough”

The 25th amendment to the constitution provides a mechanism to remove a sitting President who is disabled, but according to my reading, section 4 states the President has a right to appeal such decisions in which case Congress must be convened with 48hours to debate the issue. The most powerful man in the world can do a lot of damage in 48 hours. As a matter of fact, if he is angry with the world, he has it within his power to destroy it. But that is even too horrible for an old cynic like me to contemplate.

There is hope however as today the long awaited vaccine is being distributed at the same time a new administration is voted in to office. I am reminded of my long ago departed Father-In-Law who, although he was a registered Republican, admitted that he always voted against the incumbent because he figured the best thing you could do for the country was to “keep turning them over.”























How to Survive Loss

Life can be defined as a finite period of time characterized by continual change. Consequently, since nothing is permanent, we all experience losses. Some are trivial, others are devastating. We are now living in a time of great turmoil with millions of people subject to losses beyond their control. Thousands of homes and businesses have been destroyed by the effects of climate change with fires, floods and storms throughout the world. Many more have been displaced by wars and political upheavals with thousands having lost their homes, possessions and way of life, but the most immediate and tangible threats are due to the COVID-19 pandemic where in addition to the loss of over a quarter million lives, several million remain unemployed, and self-imposed isolation has taken a toll on mental health.

According to the CDC, 8 out of 10 deaths from the virus have been in those over age 65, but they noted even those in their 40s and 50s are at higher risk than younger folks. Many studies have documented that widowhood carries with it a mortality rate of well over 30% during the 1st 90 days of bereavement and 15% thereafter, powerful evidence that loss of loved ones has serious consequences for survivors. The pandemic has limited traditional mechanisms of dealing with grief since last goodbyes are often denied due to isolation policies, and funerals, wakes, and life celebrations are limited. Time will tell if their lack will result in an increased prevalence of unresolved grief.

Grief | Loss due to death vs Loss due to breakup

Meanwhile, we are still subjected to the ordinary losses associated with the process of living. Much of my time as a psychiatrist was devoted to helping those afflicted with the pain of losses, as I am sure is true for most clergy, counselors, social workers, psychologists and bartenders, etc., but it is only recently that the Board of directors of the American Psychiatric Association has recommended that unresolved grief be considered a diagnostic category. Although death of a loved one may seem the ultimate loss, in some ways it is easier get over than the termination of a relationship via other means, such as divorce or breakup of an important personal relationship. The finality of death encourages one to move on, but when the object of one’s affections is alive a relationship real or imagined will persist. Thus, Don Jackson, a renowned family therapist said there is no such thing as divorce. Or as I have often said: divorce is like a death in the family, but you can’t bury the corpse.

Our nature requires relationships. Relationships help to define our identity, i.e., who and what we are. For example, I am often introduced as Barb’s husband which provides considerable information about me. Our identities are also shaped by those with whom we associate even the organizations to which we belong or those we choose to lead us. Long term relationships invade one’s personal space to the extent that we often absorb some of the involved person’s personal characteristics to the extent that they become part of who and what we are. Consequently, their loss may result in what I call a psychological amputation. Thus, in the face of such losses, one is left with the feeling that a part of one’s self has been taken away.

As with the loss of a physical body part, a psychological amputation can result in myriad feelings and reactions in addition to sadness. There may be anger, at times even rage, directed to whomever one blames even him/herself. Instances in which rejected suitors have stalked, assaulted, or even murdered, are unfortunately not rare, which naturally leads one to question the nature of such alleged love. There may be feelings of betrayal at the deceased for being abandoned or for behaviors thought to have hastened his/her death. God is often a target for anger, especially in deaths, and in such instances the Biblical quote: “the Lord giveth and the Lord taketh away” rarely provides solace. Although I have found that referral to the patient’s pastor or Rabbi is frequently helpful.

GUILT

Anger may also be self-directed resulting in guilt. In such cases, the patient may spend endless hours ruminating over what he might have done to prevent the loss or even worse how he could have caused it. A close friend of mine, who shall remain nameless, continues to have pangs of guilt over her Grandmother’s death nearly 80 years ago because as a child she had “sassed Grandma” shortly before her sudden death.

There are instances in which survivors may feel guilty for not grieving enough. One case from many years ago, which has stayed in my mind, involved an elderly lady who was referred to me by her family doctor with the complaint that she had lost the strength in her right leg. An extensive workup had not yielded a diagnosis and the referral appeared to be a hail Mary. She walked into the office unassisted. Although using a cane, she appeared to walk quite well. Her story was that her husband of many years had recently died following years of a debilitating illness for which she had been his primary caregiver. She reported that she rarely left the house during all that time, having obviously taken seriously the vow about “in sickness and in health.” Shortly after her husband’s death, she was excited to visit a friend in a neighboring village whom she hadn’t seen since her husband became ill. After starting her car, she was unable to move her leg to the accelerator in order to drive away -a classic case of conversion reaction, resulting from the guilt she felt over enjoying her new found freedom.


The Affect of Death on Children’s Development and Attachment Theory

It has long been noted that children who become orphaned are at risk for significant relationship or mental health problems later in life. (This is a relevant post from Psychology Today). Konrad Lorenz’s studies of imprinting demonstrated the importance of relationships in young animals, and Bowlby, with his Attachment Theory, came to similar conclusions regarding humans. When the process of attachment is interrupted prematurely it may leave the child lacking in skills necessary to develop healthy relationships, and leave them impaired for life.

Much has been written about the stages of grief. However, I have not found that concept particularly helpful, for in my experience people do not always follow a particular pattern of behavior when they have lost something or someone, though I have found that denial is frequently present especially when the loss involves another human life. Although at a conscious level there is realization that a person is gone, a survivor may behave as if expecting them to return. In such cases there are frequent slips in which the deceased person will be described in the present rather than the past tense. There is resistance to disposing of clothing and other personal effects, or to removing the voicemail greeting from the family phone. Frequent trips to the cemetery are common and may involve imaginary conversations with the deceased. The survivor may be said to have “held up” surprisingly well during the burial proceedings.

Perhaps, the most painful loss of all is the death of a child, and in my experience the most likely to result in denial. Although at a conscious level the parent knows their child is dead, they may continue to insist that their room will remain untouched as if they are waiting for him/her to return. Deaths by suicide usually introduce a series of unanswered questions which further complicate the healing process, often leaving survivors blaming themselves.

It goes without saying that it is very difficult to resolve a problem without acknowledgement that it exists, and in my experience, denial following the death of a loved one is quite common. It is usually the first hurdle that must be overcome in order to find resolution of grief. There are numerous exercises which may be ordered to help one achieve acceptance. My favorite is to arrange a visit to the graveyard with a close friend or pastor, simply say goodbye, and have a good cry. For those in denial, there is usually a great deal of resistance to using that word, and the mere suggestion to carry out those instructions is often met with tears.

Loss of Relationship by means other than death can be even more complicated.

The break-up of young lovers, especially first loves, is complicated not only by the level of passion involved, but their lack of experience in dealing with loss. They should be taken seriously as such losses can result in serious suicided attempts especially in teenagers. But for anyone the loss of a love object can be devastating for with it go dreams of an idyllic life with the hope of loving and being loved. It may result in sadness, depression, anger, or even violence.

How to Survive Loss

Hope is invaluable with the loss of things which are replaceable for it inspires one to action. The streets of our big cities are littered with homeless people most of whom have lost hope, while those who have lost their homes in fires or other calamities, although saddened and depressed by the loss of all their possessions, need hope if they are to replace that which has been lost. However, with abandonment by a loved one hope can hinder resolution. It goes without saying that one cannot live in the moment if they are stuck in the past, which happens when we continue to dwell on recovering something which is beyond reach.

Recovery from loss is simple but not easy.

We must “let go” if we are to “move on.”

We let go by grieving. Grieving is the process by which we allow ourselves to grapple with and purge intense disabling emotions following a loss. Grief can be initiated by the loss of anyone or anything to which a person has a personal attachment.

Cultures have developed various traditions which seem designed to promote resolution of grief following deaths. In a previous blog I have written about those I experienced in a rural midwestern village 75 or 80 years ago, but my favorite funeral celebration is the traditional New Orleans jazz funerals in which the funeral procession is led by a brass band to the graveyard while playing a funeral dirge, then following interment the band marches back toward the decedent’s home playing a lively Dixieland tune. The message could not be more evident. There is acknowledgement of the sadness of death followed by the celebration of life, a perfect example of letting go and moving on.

Other Types of Loss

In addition to the loss of loved ones, since the word pandemic entered our lexicon, we have been subjected to losses of some of our most precious possessions. It has been said that you don’t fully appreciate the importance of something until it is gone. Granted, it has been catastrophic for those who have lost jobs, housing, or businesses, but the isolation and cumulative effect of the loss of activities which we previously would have considered mundane have also taken a toll.

On a positive note, if there is one, perhaps we have learned to know the value of some of those things we previously took for granted. There is also hope that constriction of our social activities may result in more family cohesion. Who knows? Maybe kids and parents will even start talking to each other. Losses of all kinds are bound to get our attention, and there is often a lot we can learn from them, especially those we create by our own mistakes for failure is the great educator.


CATHARSIS

Although in rare instances, loss may result in a sense of relief, in nearly all cases, there will be strong feelings elicited as previously mentioned. Such emotions are disabling and must find expression, a process which we call catharsis. It is not a good time to do the strong silent thing when consumed by grief.

As I have mentioned many times, we are herd creatures, which is hardly a new concept having been the subject of John Donne’s poem, “NO MAN IS AN ISLAND” written in 1624. As such, we are dependent upon others whether we like it or not. In the face of intense emotions we can become overwhelmed and confused. In such times more than ever, we need validation, i.e., someone who we trust to listen, be supportive, and reassure us that our feelings are rational. Indeed, the process of attempting to communicate those feelings verbally helps to organize one’s thoughts, and a recent study in the American Journal of Psychiatry, has confirmed what we already knew, which is that confiding in others helps prevent depression. After all, that is how I made a living.

Surviving Loss is a PROCESS

Usually catharsis is not a one-time thing and there will be triggers that will resurrect some of those feelings in milder form from time to time, but most will learn to let go of past traumas by focusing on the road ahead. Hopefully, they will come to understand that to look back over their shoulder will likely cause a stumble, and that they must let go of the past in order to move ahead.

With millions all over the world facing serious losses, we are not only “all in this together,” but we are also very much in need of each other and there has never been a better time for us to be our “brother’s keeper.”

LONELINESS

Many years ago I treated a patient who was suffering from a near fatal case of loneliness.

 

No, I am not exaggerating for this person would later confess that she had come to me in a last-ditch attempt to resolve her problems while promising herself that if I couldn’t help she would hang herself. She was a 20-something attractive and very modestly dressed woman who did indeed look very despondent with the psychomotor retardation and furrowed brow characteristics of clinical depression. When I asked her why she was there to see me, she hung her head, stared at the floor, and tearfully responded that she had been shunned.

 

She went on to tell of how her infraction of the church’s rules (one that most of us would consider a minor infraction) had resulted in her being officially designated as one with whom the entire church should have no contact whatsoever. You may be thinking: “Big deal go find another church.” But her story was more complicated. She had grown up attending this church. It was the center of not only her spiritual, but also her social and family life. Since the church doctrine insisted that only members of their church were true Christians, the members were warned about the dangers of consorting with people outside the church, apparently convinced that sin was contagious. Thus, when alienated from the congregation, which to make matters worse, included her entire family, she found herself totally alone.

 

Such stories are not new as evidenced by Nathaniel Hawthorne’s tear-jerker, THE SCARLET LETTER, but give witness to the importance of relationships and the pain of loneliness. Many religions have used banishment of varying degrees of severity to punish wayward members. The Catholic Church’s policy of excommunication appears to be less stringent and is viewed by the church as a means to save souls whereby one can return to the fold and regain salvation by repenting. Such tools are powerful and their use can have long lasting effects. For example, I recently discovered that my Great, Great, Great Grandfather was shunned and ejected from the Quaker church. It occurred to me that if he had toed the line, I might be a Quaker.

 

AND YOU THOUGHT SMOKING WAS BAD

Solitary confinement has long been used as a means to enhance the discomfort of imprisonment, and is agreed by many to be a form of torture. In a previous blog, WHAT’S LOVE GOT TO DO WITH IT? I contended that our need for relationships is encoded in our DNA, having evolved long ago as a major contributor to the survival of our species. If one were to accept that premise, it would be logical to assume that loneliness could be a major problem for us. Indeed, according to Vivek Murthy, M.D., the former Surgeon General of the U.S., loneliness has become “a growing public health crisis.” He has said that loneliness is a more effective agent in reducing longevity than obesity, and that its toxic effects are worse than smoking 15 cigarettes per day. Recent research into the prevalence and effects of loneliness tends to confirm Murthy’s assessment. Last year Cigna released a report on a study of 20,000 people age 18 and over as measured by the UCLA loneliness scale.

 

Nearly half reported loneliness as a problem, but even more concerning was that 27% felt no one understood them, and 43% admitted they felt their relationships were not meaningful. One in five felt they rarely or never felt close to others or that there was anyone they could talk to. It was also noted that Generation Z (those born after 1996) were the loneliest of all the generations measured.

There have been a number of studies which confirm the effects of loneliness on physical and mental health. It is not surprising that it could result in affective disorders such as depression, and may help explain the increase incidence of suicide as mentioned in my previous blog, but there is also evidence that loneliness can cause or aggravate innumerable maladies including: hypertension, coronary artery disease, dementia, inflammatory diseases such as arthritis, impairment of immune systems, and even some malignancies to name a few.
A study in the Archives of Internal Medicine sponsored by the National Institute of Health followed 1604 people over the age of 60 (average age 70) for 6 years and measured their physical decline and mortality rate. Their stark conclusion was: “Among participants who were older than 60 years, loneliness was a predictor of functional decline and death.” Need I say more about our need to engage with our fellow man?

 

WE ARE NOT THE ONLY LONELY

It turns out that we are not the only nation where loneliness has become a problem, both from a public health and productivity perspective. Great Britain’s parliament has recently appointed a commissioner to investigate remedies for what has been called a silent epidemic after a study showed that 20% of Brits reported they were lonely most or all of the time. It appears there are similar studies in progress in other European countries. It would be helpful to know if loneliness is a worldwide problem or peculiar to our culture.

NOTHING ELSE TO DO

If one accepts the premise that loneliness is a significant problem, the question arises as to how did we get this way and what can we do about it. Prior to the industrial revolution, multi-generational families provided a sense of belonging. Relatives galore, including parents, siblings, cousins, grandparents, aunts, and uncles usually lived in close proximity. With the switch from an agrarian to an industrial society, there had been a migration to cities where houses were built close together, which resulted in the development of neighborhoods usually composed of people with common interests. There was the inevitable clustering of children who interacted with only minimal adult supervision, and stay-at-home moms who could relate to each other in a very personal way. Neighbors were evaluated based on certain standards including friendliness and mutual respect. The lack of air conditioning and television made front porches very popular especially on hot evenings, and provided an opportunity for informal socializing. The only taboo subjects were sex, religion, and politics.

 

BETTER THINGS TO DO?

Soon after World War II ended, front porches began to disappear from neighborhoods, and there was a wild rush to the suburbs where large green lawns were treasured and families had fewer opportunities to be “neighborly.” On hot summer nights, it became more comfortable to be inside the house (with air conditioning) than outside. There were also new-found entertainment devices available – first radio, then TV, movies in the VCR and then DVD Player, video games, and then the internet which gave us social media and streaming. One could go for months or longer without ever having face-to- face contact with one’s neighbors. There was no longer danger of an errant foul tip sending a baseball through someone’s window. Privacy became important, and it was no longer considered a snub to build a fence between houses.  There were no kids playing hopscotch on the sidewalks, as a matter of fact, there often were no sidewalks in these new neighborhoods.

Competing Schedules and Activities

As more mothers joined the workforce and children were exposed to more structured extra-curricular activities, long-held family traditions changed. There was concern about the “latch key children” so named because they would come home to an empty house. The evening meal, often the only time in which the entire family came together, was often disrupted due to conflicting schedules. This led to the so-called crock pot families where the family meal was available to all who passed by…making it easy to just grab a bite and be on your way without any hassle (or conversation).

Forced Socialization in the Pew

Another effective defense against loneliness was the weekly church service. Traditionally, religious institutions encouraged socializing (and in some cases, demanded it). However, attendance at religious institutions has declined in recent years (one study says church membership in the U.S. has declined from 70% in 1999 to 50% in 2018).

 

WHY SO MUCH LONELINESS?

It is ironic that in this digital age when we have vastly improved modes of communication, that we would identify loneliness as a problem. Facebook’s founder, Mark Zuckerberg, insists that he saw his invention as a tool by which relationships could be fostered throughout the world and help dispel feelings of loneliness and dissention, but it appears that it has done more to promote divisiveness and distrust.

 

With the invention of the telephone we gave up non-verbal cues in our conversations, and the trade-off for its convenience seemed like a good deal. Now kids have largely given up talking on their cell phones in favor of texting. Voices from the internet, news media and politicians all conspire to promote divisiveness and paranoia to the point that it is almost impossible to have a rational conversation about many of the issues of the day.

 
Today people are marrying later and living longer. As reflected in the census figures of 2012, 32 million or 27% of Americans lived alone which was up from 17% in 1970. As you might expect, widowhood is likely responsible for many single occupant households, and in another study it was found that 47% of women over the age of 75 lived alone. With aging, comes the inevitable debilities and limitations. The National Institute on Aging reports that nearly half of all people over the age of 75 have hearing loss, which can be a major impediment to any meaningful social interaction resulting in withdrawal from friends and family.

 

It has been said that Americans are losing faith in our institutions, and our political leanings are often shaped by who we hate rather than who we like. Political discourse has hit a new low. Muck raking is no longer good enough, and has been replaced by personal insults a la grade school rants. Respect for contrary opinions has now gone out of fashion. Divide and conquer is the new strategy, and a tactic that seems to have even been adopted by the news media (Matt Taibbi has written an entire book about it, called “Hate Inc.”). We lack heroes. We frequently hear the term “disenfranchised” these days, a synonym for “left out” and to be an outsider is lonely for any herd critter.

ALL IS NOT LOST (stay with me…a little break from “downer” time)

There is some evidence that there may be some efforts underway to deal with the loneliness issue. I was pleased to see a recent article in Psychiatric News suggesting that psychiatrists are focusing more on loneliness as an underlying psychiatric problem (don’t know why it took so long to figure that out). A former president of the American Psychiatric Association has suggested that assessment for loneliness be part of any evaluation or perhaps become a diagnostic category in the DSM 5 (the shrink bible). There is also a growing awareness of a worldwide suicide epidemic which most would agree loneliness all too often plays a part.  Lonely lifestyles also frequently seem to be common with mass murderers.
lonely quote

LONELINESS VS. BEING ALONE

Proximity to other people is not necessarily a solution for loneliness, for it is not unusual to feel lonely in the midst of a crowd. Obviously, some type of emotional engagement is necessary to dispel lonely feelings. Ordinary discourse involves much more than words. Unfortunately, in our digital world many of the nuances of communication are lost. Not only are the tone, rhythm, volume, and timbre involved, but there are multiple non-verbal cues which can modify or even completely change a communication. As a matter of fact, some very significant interactions may occur without any words spoken. In that vein a text hardly measures up to a face to face encounter as a means to communicate feelings.

 

Emotional tone is less relevant, for even an argument can dispel lonely feelings.
Although, until recently, there have been few attempts to measure the extent of loneliness, there is definitely a consensus among sociologists and mental health professionals that there has been a definite increase. Employers have taken note of recent research which has shown that employees are more productive when they are encouraged to interact with each other. As a consequence, in many cases the traditional office cubical arrangement has been scrapped in favor of a more open environment, teamwork is encouraged, and brief chats at the water fountain are less likely to result in a dirty look from the boss. Since most workers spend nearly half of their waking hours in the workplace such changes could be very beneficial for large segments of society.

 

GO TEAM

The needs for engagement with other humans has long been addressed by the formation of millions of organizations that bring groups of people together with myriad goals, but which also provide an opportunity to relate to others. The sense of belonging to a group is a powerful antidote to loneliness. Young people who feel neglected or alienated are more likely to join street gangs (easier to radicalize for terrorism and/or recruit for “religious” cults*). Athletic events and concerts attract millions, most of whom “show their colors” and cheer as one. One of my all-time favorite TV shows was Cheers which identified the locus of the show as the place “where everybody knows your name.” Organizations of all kinds including sports teams, military, and political groups or for that matter any group of people with a common goal make use of the need to belong which at the end of the day is an antidote to loneliness.

THEY NEED EACH OTHER

AARP sponsors a very interesting and apparently successful program called “Experience Corps” in which volunteer over 50 are enrolled in a program where they are trained to help children develop literacy skills. They spend 6 to 15 hours per week working with K-3 students with spectacular results including as much as 60% improvement in reading skills, fewer behavior problems, improved attendance, and increased graduation rates  The AARP foundation at last report had 2,000 volunteers throughout the country serving over 30,000 students. However; it appears the volunteers may be benefiting more than the kids from the program. A University of Michigan study reported a statistical decrease in depressive symptoms and functional limitations among the volunteers after two years involvement in the Experience Corps. There may also be a secondary benefit in that some kids may learn to venerate rather than denigrate us old folks. (Score 1 for the Old Farts!)

 

BE CAREFUL WHAT YOU WISH FOR

None of this should be interpreted as an attempt to diminish the value of solitude. Certainly, this need to relate can be overdone, and in some cases become pathological. In many cases of marital therapy, for example, too much togetherness can be identified as the problem. In testimony before Congress, Prof. Julianne Holt-Lunstad defined loneliness as ” the perceived discrepancy between one’s desired level of social connection and their actual level of social connection.”  She explained that some people who are socially isolated don’t necessarily feel lonely, and some people who are lonely are surrounded by people who make them feel more alienated.

 

One’s work may require so much contact with others that it can become oppressive, and some personalities may cause anal pain of the worst kind!  Nevertheless; before you make plans to spend the rest of your life on a deserted island or join an order of non-verbal monks, be careful what you wish for. Time-alone can be refreshing, relaxing and creative, but as with most things in life, it can be overdone. Alone can be good, but lonely can be very bad. In this time in which we are all mutually dependent, it has become even more necessary to have relationships than we did in those days when we needed help to bring down a woolly mammoth. It is difficult nowadays to survive in this world as a loner. We face enormous problems including an increased global population, competition for resources, and degradation of our environment. It is once again time for us to hang together or hang separately.

WHAT MAKES THEM TICK?

The ability of the human race to relate to each other has allowed us to survive and to thrive.  We need to exercise that talent now more than ever.  As I finished writing this, once again two hate-filled young people described as loners committed horrible atrocities within hours of each other. It goes without saying that we need to take logical steps to limit access to those instruments designed to kill people, but the prevalence of these kinds of behaviors also require us to learn more about the milieu in which they occur.  For example: are there genetic influences involved, does our society in some way generate such hatred, are certain personalities more easily recruited to violent organizations, is shyness a precursor, and finally does the hatred cause the loneliness or vice versa?  We need to understand more about how these people end up the way they are if we are to have any success at solving the problem.

What’s Love Got To Do With It?

If you have read any of my recent blogs, you may have noticed the following quote from Lao Tsu, an ancient Chinese philosopher: “to be loved deeply gives you strength, to love deeply gives you courage.”

 

The wisdom of those words explain much about behaviors I observed and attempted to treat as a psychiatrist. Feeling unloved was indeed a common complaint and the cause of a great deal of pain and misery.  Without the experience of feeling loved one is weakened, and thus may lack courage to face even the ordinary demands of life.  This may progress to a conviction that one is not only unloved but unlovable, resulting in self-loathing, depression, thoughts of harming oneself, and according to Anthony Storr, may generate violent aggression which he says is: “a complex mask for a repressed longing for love.”

WHY DO THEY DO IT?

There seems little doubt that we are now in the midst of an era of increased incidence of depression and unsanctioned violent aggression. Mass murders by otherwise ordinary people of all ages are now occurring at a level never before seen in the U.S.  Most perpetrators have a history of relative anonymity.  Neighbors usually describe them as quiet and unassuming, a person to whom they would speak to in passing but never engage in conversation.  Acquaintances when found describe their relationship as superficial, and express profound surprise that the person was capable of violence.  There is little evidence of any closeness let alone intimacy in their lives.  Could such horrible deeds be as Storr said: a result of anger over the lack of love in their life?

THE THIRD MOST COMMON CAUSE OF DEATH

There has been an alarming increase in the number of kids diagnosed with clinical depression which is not limited to those who are disadvantaged or abused.  A recent Center for Disease Control and Prevention survey of young people between the ages of 10 and 24 years resulted in shocking statistics. They report 4600 lives lost each year by suicide (most experts feel the actual number is higher due to a tendency for many to go unreported), and that rate has nearly tripled since 1940.  Emergency rooms throughout the country report 157,000 young people treated for self-inflicted injuries each year.  In their Nationwide survey of high school students, the CDC reported 13% admitted to seriously considering suicide, and 8% actually made an attempt to take their own life.  The report goes on to list a number of risk factors however; at a time in their lives when they are dependent on others to establish an identity and self-worth, it seems to me that relationships deserve to be at the top of the list.  Indeed, many teen-age suicides do implicate such problems as precipitating factors.

MORE OF THE SAME, ONLY WORSE

Rollo May in his 1960’s book LOVE AND WILL, says  “Our culture pushes people toward becoming more detached and mechanical,” but that observation doesn’t come close to what we see now that the digital age has enveloped us.  The addiction of our children to cell phones and other electronic gadgets contributes to their alienation.  Consolidation of schools and overcrowded classrooms have made it easier for kids to fall through the cracks.  Social media has become a convenient vehicle through which kids can be disparaged or bullied.  They are often attacked where they are most vulnerable i.e. their lovability consequently; the common theme “no one likes you” can be devastating to developing minds.  Now we hear there has been a dramatic increase in suicides in recent years among not only teenagers but pre-teens.   Although there is no proof of a link to feeling unloved, logic suggests there often is.

DON’T CARE? SURE YOU DO

There is ample evidence that we are herd animals, consequently; it is not surprising that I spent many hundreds of hours listening to patients with relationship problems, for when people are so very important in our lives, dysfunction can present problems.  Although we often attempt to comfort ourselves by professing to not care what others think, in truth we usually do care more than we would admit.  During all those years I spent in the shrink business I must have seen hundreds of people who were contemplating suicide or had actually made serious attempts.  Although there are obviously many factors that may lead one to seriously consider killing oneself, I recall often hearing: “Nobody cares.”

DO WE KNOW WHAT IT IS?

It would indeed be presumptuous of me to attempt to explain what love is all about.  It has certainly been a popular topic for poets, philosophers, musicians, theologians, and artists, through the ages.  The stories of wonder, ecstasy, and tragedy associated with love resonate in pop culture to this day. There have been myths, and legends and attempts to define love by categorizing it (erotic, agape, filial, spiritual, etc.), but the force responsible for this peculiar phenomenon remains a mystery to me.  My favorite definition of the term is from psychoanalyst Harry Stack Sullivan, as follows:

The validity of such explanations is confirmed by the intense love relationships experienced by warriors throughout the ages.  The myriads of reports of heroic efforts put forth by battle hardened veterans to protect their comrades, even risking or forfeiting their lives in the process gives credence to Sullivan’s ideas.  Indeed, when questioned as to why those who would in other situations have been considered unlikely heroes are questioned about their behavior, they will acknowledge that it had nothing to do with military or political beliefs, or patriotic fervor, but rather their devotion to their buddies (“No greater love hath man……”). That phenomenon has not been lost on those charged with training the military, consequently; camaraderie is encouraged and interpersonal dependency guarantees bonding.  One cannot wonder as to the part that the loss of relationships, solidified by the heat of battle, factor in the alarming rate of depression and suicide among our veterans.  Many report they worry about their comrades who are still fighting which may  also account fir the significant number who volunteer for additional tours of duty with their old outfits in spite of the known horrors they will likely confront.

WORTH THE TROUBLE?

Obviously, love has been a major contributor to the success of the human race.  Humans isolated from their kind rarely survive.  Sullivan posits that love is caring for others as for oneself and the old Chinese dude says as a result of love for each other, man gained the strength and courage to take on woolly mammoths and those guys in the next village who were trying to muscle in on their territory.  It is the latter part of that statement that has caused a lot of problems.  We seem to know a great deal as to the effects of love, but little about from whence it comes.  The neuro-physiologists and brain mappers continue to look for specific love loci, and geneticists will likely say that it is in our DNA, but I doubt that CRISPR will ever be able to install a love gene.  It would be great if such could be done, for we currently have little treatment for those who seem incapable of love, i.e. psychopaths.

I KNOW IT WHEN I FEEL IT

It may be that love is like the dark matter of our universe in that we know it exists and feel its effects even though we are unable to see, hear, smell or touch it.  Could it be that love is simply a product of evolution?  If so, how could we have survived long enough for natural selection to kick in?  The creationists insist that God snapped his fingers and we instantly appeared on the scene fully equipped.  Atheists on the other hand think the whole thing was an accident.  Others see love as spiritually endowed.  There are 4300 religions in the world with Christianity leading the pack and Muslims close behind.

WHAT ABOUT RELIGION?

Since I have been reared as a WASP, I have very little understanding of the other religions of the world or in particular where they stand on the love thing, but am pleased that love is at the core of Christianity.  When it comes to Biblical scholarship, I am a dunce, but I do find inspiration in those first few pages of Corinthians which are all about love.  The first 2 of the 10 commandments are also about love, and love is said to be the greatest of all, never fails, and is even better than faith or hope.  There is also that thing about loving your enemies and turning the other cheek, but most of all were the teachings of Christ who was all about love.  Of course, many see an inconsistency in a loving God who lets crappy things happen in spite of being all-powerful.  Since Christians are people it is not surprising to find they have found ways to subvert the love philosophy, and resort to violence with all sorts of rationalizations.

Loving others as much as oneself is a great idea, but very difficult to implement on a grand scale.  Excessive cheek turning is guaranteed to result in a lot of broken jaws.  Nevertheless, there have been many attempts to use love as a mechanism to provide peace and tranquility, which has been met with success in some instances.  In a rare instance of wisdom, our government eschewed the policy of gathering the spoils of war after WWII.  Instead they initiated a policy aiding even our enemies to rebuild their virtually destroyed countries which lead to their becoming our closest allies.   Of course, I was also around during the “love ins” of the sixties.  Although they seemed to have emphasized the erotic rather than agape version of love, they did call attention to long neglected human rights issues and war mongering.  There was also Nelson Mandela and Martin Luther King who both emphasized reconciliation and learning to love each other.

We certainly could use more love in this world, but the chances of EVERYONE following the Golden Rule seem to be unrealistic.  Nevertheless, when I look back on our history it seems there has been some progress in the love department with more emphasis on inclusivity and acceptance.  Although it may seem that love is in short supply, it is alive in well and we can only hope the day will come when The Golden Rule is ever present. Even as millions of our fellow humans face horrors each day, there are millions of people who devote their lives to helping others individually and through organizations, which gives credence to the dictum that love never fails.

Corinthians 13:4-8 gives tells us everything we need to know: “Love is patient, love is kind. It does not envy, it does not boast, it is not proud.  It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs.  Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres. Love never fails…”

The High Life | Marijuana and Us

It appears that Marijuana use has now become a socially acceptable practice. Not only are states falling in line to legalize recreational use (I don’t like that term for it seems to equate smoking weed to working out at the gym), but I was surprised the other day when I happened on to an interview with Liz Post who is the great granddaughter-in-law of Emily Post, the etiquette guru.  Liz has taken up the etiquette banner and continued as director of Emily’s foundation for the last 30 years. She has written her own books of etiquette, this latest of which caught my attention. It is titled Higher Etiquette, and is all about proper behavior in marijuana involved social situations.

A few days later, I was confronted with a full front-page spread in our local newspaper about our county’s latest industry, a facility for growing marijuana on a large scale. It was hailed as a major success for the area and projected that it would eventually employ more that 100 people. Image result for marijuana

The story featured a half-page picture of the interior of a huge greenhouse inhabited by large plants. Apparently, since the owners realized potheads would see the photo as their idea of heaven on earth, they assured us that the facility would be heavily guarded. Medical marijuana (whatever that is) was legalized in our state in September 2016.

Image result for marijuanaThe new law only authorizes the use of cannabis orally or topically in the form of pills, elixers, tinctures, and lotions etc. Dispensaries were licensed by the state and product can be obtained with a note from a licensed physician confirming that the person is suffering from one of a list of 21 maladies; although the state medical board is authorized to add diagnoses to the list as they see fit. The law prohibits home growing of weed and smoking it, but allows inhalation through a vaporizer. (I would anticipate there will soon be a brisk business in vaporizers). Not only does this and similar laws across the country violate federal law governing the use of marijuana, it appears to me to bypass Federal Drug Administration procedures which require extensive testing for both efficacy and safety before any drug can go on the market.

Efficacy of Cannaboids

There is a great deal of anecdotal information concerning the efficacy of cannabinoids for a variety of medical problems. In the early 1800s an Irish physician found cannabis extracts helpful in relieving stomach pain and nausea in people suffering from cholera, and recently the FDA approved 2 drugs containing THC, Marinol and Syndros, for treatment of nausea and anorexia in patients undergoing chemotherapy for cancer. It is also said to be useful in the treatment of refractory epilepsy, chronic pain problems, glaucoma, and various neuromuscular diseases such as multiple sclerosis to name a few. Prior to the dawn of modern pharmaceuticals, cannabis extracts were widely sold as a treatment for stomach ailments. Now, nearly 200 years later we don’t know much more about them than we did then.

Other Naturally Occurring Plants in Medicine

This is not the first time that a naturally occurring plant would be found to be useful in treating medical conditions. For example, back in the dark ages when I was a general practitioner, digitalis, which was extracted from the foxglove plant was the treatment of choice for a variety of cardiac problems. More recently, taxol, a substance extracted from the bark of the Pacific Yew tree has proven effective in the treatment of ovarian cancer.

The Problem with Pot

The fact that THC is a mood-altering drug complicates the issue of doing the proper research to discern its effectiveness, side effects, and dangers both in the short term and with prolonged use.

There is also the possibility of an enhanced placebo effect. Does drug-induced euphoria tend to mask symptoms, and if so is that bad thing?

The more significant reason for the lack of knowledge as to the effects of marijuania on the human body is due to Federal Drug Administration’s reluctance to allow scientists to possess it in order to evaluate it properly.

In 1970 Nixon signed into law The Controlled Substances Act which listed marijuana as a Schedule 1 drug along with heroin, LSD, and other dangerous and /or highly addictive drugs. This was during the time of the War on Drugs, and the FDA was so uptight that they refused to allow possession of any of these drugs for research purposes. Of course, as usual they zigged when they should have zagged for this was a time when new tools were becoming available to researchers with which to evaluate the effect of drugs on the brain, and an opportunity to learn more about the drug was lost. With such information, they could have been in a position to inform us as to the possible consequences of their use, and perhaps more specifically define how or where they might be useful or harmful.

Follow the Money

With one foot firmly planted in the door with the medical thing it is not surprising that the Marijuana Rights and Regulations Amendment will be on this fall’s ballot. It would legalize the use, possession, and sale of marijuana for persons over the age of 21, and would allow the Ohio General Assembly to enact a tax on its retail sales. As nearly as I could tell there are no proposed restrictions and if passed, potheads can rejoice at their new found freedom. Likewise, entrepreneurs would like to see some of that drug cartel money stay right here in the US of A, and why shouldn’t stoners throw a few bucks into state coffers for the privilege of getting high? Those who grow their own (in limited amount) will pay $50 for a license which is not a bad deal when one considers a cigarette smoker pays $1.97 in taxes for a pack of carcinogens.

If one follows the money, it would seem that the proposed bill would pass, and become law. According to one PR organization (ABCD Inc.) the potential profits are nothing to sneeze at. In their 2018 Cannabis Price Index, they project that in New York city alone 77.44 metric tons of pot was consumed in 2018 with a revenue of well over $8oo million, and if taxed at the same revenue as cigarettes $354 million for the city. I have no idea how they came up with those figures, but if true it is little wonder there appears to be an active campaign espousing the virtues of cannabis involving not only established stoners, but big business and politicians as well.

History of Pot

According to the DEA Museum, the oldest known written record on cannabis use is from the Chinese Emperor Shen Nung in 2727 B.C. There is some evidence that its psychoactive qualities were known then. However, the plant was used primarily for its fibers, which were used to make rope, cloth, and a variety of other products, and is thought to have been low in the concentration of psychoactive chemicals. Although hemp and marijuana are of the same species, i.e. cannabis, it is thought that one variety was developed over time with the goal of increasing the levels of tetrahydrocannabinol (THC), the chemical responsible for its mind-altering effects.

A Higher High

The process of increasing the potency of weed has continued and has accelerated during the last 20 years – not surprising since users are always looking for the “good stuff.” One study found the average potency in Europe and the U.S. to have nearly doubled between 2008 to 2017. The THC levels had gone from 8.9% to 17.1% with one variety reaching 67%.

This same study compared rates of psychosis between areas with different levels of cannabis potency and found that indeed those cities with the more potent stuff reported more psychotic episodes. As a matter of fact, those who had used higher potency stuff were twice as likely to eventually have a psychotic episode compared to those who had never used. Even more worrisome was the stat that daily users of high potency weed were four times more likely to experience psychosis. This raises the question as to whether THC may have long term side effects. This is not at all surprising; after all THC has long been categorized as an hallucinogen even though until now a weak one.

Pot and the Teen Brain

With the frightening (to some of us), statistics as to the prevalence of pot smoking among adolescent and even younger children has come realistic concerns as to the effect of pot smoking on their brains. This has become increasingly worrisome with recent discoveries of the so-called “plasticity” of the developing brain i.e. the effect that various stimuli may have on its structure and function. Such changes may not become readily apparent until years later and to that end the National Institute of Health has instituted The Adolescent Brain Cognitive Development Study that will follow 10,000 children through adolescence hoping to find what sort of factors, including drugs, affect their brains. Unfortunately, it will take many years for the study to be completed.

Not So Fast…

Although such information is incomplete, I feel it is premature to judge cannabis to be an innocuous substance, as many would have us believe. I recall similar reassurances regarding cigarettes, e.g., that they were not addictive, harmless, and simply a relaxation aid. It was true those people on billboards, in the magazine ads, and the movies looked really cool with one between their fingers. I was one of those gullible slobs who tried looking cool for 50 years, and was rewarded with a couple of cancers. I was also left wondering how much damage I had done with all that second hand smoke. Of course, I knew that I was not addicted for I could quit anytime I wanted, it was just that I didn’t want to (the same words I have frequently heard from my pot smoking patients).

We’ve Been Down This Road Before

At the beginning of the 20th century, cocaine was toted as a wonder drug with the potential to cure a potpourri of illnesses including drug addiction. Its health benefits were even extoled by adding small amounts to a soft drink which in honor of the presence of cocaine was named Coca Cola. Two of the best-known pioneers in their respective fields of medicine became addicted as a result of their experiments with the drugs. William Halsted who is credited with devising many of the surgical techniques still in use today became incapable of functioning due to his addiction as did Sigmund Freud who likewise became addicted by testing the use of cocaine for psychiatric illnesses. In the 1960s along comes Timothy Leary a Harvard psychologist who promoted more potent hallucinogens as treatment for depression, to increase awareness of otherwise untapped spiritual states of being and other kooky stuff. He was eventuallyHe was eventually disgraced when he was found to be using prisoners as subjects for his experiments.

Why?

Whenever there are discussions with anti-dopers about mood altering drugs, the question frequently arises as to “why they do it.” Freud attempted to answer that question with his “pleasure principle” theory, an idea which was a couple of thousand years old having previously been described by the Greek philosopher Epicurus. This was the idea that the pursuit of pleasure and avoidance of pain are the essence of life, and therefore all behaviors can be explained by this instinct, furthermore conforming to societal norms is simply to delay gratification of those instincts.

Addiction

The term addiction is not easily defined as it seems to be used in different contexts, but it is clear that the more pleasant the effects of a substance, the more likely it is that one moves on to an insatiable craving. With prolonged use physiologic changes occur as our body adjusts to the presence of the new substance and bad things happen when it is suddenly withdrawn. The extent of its effect on our body/brain is called its potency. A 2- pack-a-day cigarette smoker is apt to have some headaches and grumpy days for a week or so, but a very heavy use of alcohol over a long period of time can result in delirium tremors, a condition which carries a significant mortality rate when untreated. It appears that in some heroin users, the passage from craving to addiction is almost instantaneous.

Of course, the foregoing description of addiction is woefully simplistic for it is a very complex subject with much disagreement among the experts. My point is that without some regulation governing potency of cannabis we may be in for some unpleasant surprises. Having over the course of my career seen large numbers of marijuana smokers, I am convinced that it is by no means innocuous. I also question the conclusion of pot supporters that it is in no way addictive. I believe that it is especially dangerous in children and that many who are exposed at a young age may be permanently damaged.

So, What’s the Answer

Many of you may be thinking: “OK smarty pants, if it is such a big problem, what can be done about it?” The answer is not much. It is clear that the current situation has not worked except to provide opportunities for criminals to make a buck and for addicts to sell in order to finance their habits. Apparently, we did not learn our lessons from the results of prohibition. As with alcohol, cannabis is easy to produce in most any climate and even more difficult to control than opiates, which must be imported. There are some steps I think would be helpful in minimizing the problem:

  • For the states to continue to have their own laws about pot causes confusion. The federal government should legalize the stuff.
  • The FDA should set standards and monitor compliance.
  • It took 100 years for the realization that tobacco companies were spiking cigs with extra nicotine, we should test cannabis for potency.
  • Anyone who gives or sells the stuff to kids should spend significant time in the slammer (I have seen instances where pot smoking is a family affair).
  • Many organizations saved lives with an all-out effort to make smoking uncool, let’s give marijuana the same treatment.
  • With legalization will come more use, encourage NIMH to make research into the drug a priority
  • Please, please, no advertising. Think it couldn’t happen? That’s what the temperance union thought following the repeal of prohibition.

After pushing pills and other remedies for well over a half century I have concluded that there is usually a downside to whatever chemicals we put in our bodies regardless of their positive benefit. In spite of rigorous evaluations, clinical trials and such we often see unexpected side effects…sometimes years later. The current practice of prescribing cannabis based on anecdotal information without benefit of rigorous clinical testing is in my opinion irresponsible.  Nevertheless there is little doubt we have a serious drug problem, and the consensus is that cannabis is safer than most other street drugs. Prohibition offered further proof that “the pleasure principle” thing would not be denied no matter the consequences. Legalizing alcohol did not solve the problem, but it was not as bad as the alternative, and following that model seems to me to be the more sensible approach in dealing with cannabis.

 

 

 

 

 

 

 

A brief interruption of the “The Way It Was” Series as we return to “Shrink Stuff” | Personality Disorders 101

PERSONALITY DISORDERS

The other night while dining with friends, I was asked for my professional opinion as to the mental health of our President.  My response was not very professional as I responded “I think he is nuts!” There is a caveat, especially important in our business, that one must carefully consider any pre-determined bias before rendering a diagnosis, and my response suggests that I had violated that rule.

In retrospect, I realize that my friend was asking for a less flippant answer to his question.  Anyone who owns a TV (or uses Twitter) would probably agree that Mr. Trump’s behavior is different from what we are accustomed to seeing in our politicians.   His detractors suggest this is evidence of significant mental disorder while his supporters applaud him for being earthy and “unconventional.”

I have previously written (click this link to read that post from 2016) about Mr. Trump in not very flattering terms concerning his mental status, and the non-position taken by the American Psychiatric Association of which I am a lifetime member.  Those mental health professionals who insist that Trump is mentally impaired and therefore unfit to hold office in most cases make a case for the diagnosis of Narcissistic Personality Disorder.  After the conversation with my friend, it occurred to me that most people might be unfamiliar with what signs and symptoms might lead to such an impression

In the first place, it may be helpful to explain what we in the shrink business mean by the term personality disorder as people sometimes overuse a term and its true meaning from a psychiatric standpoint gets watered down (for example: a person who might say upon having a bad day or disappointing day, “I’m so depressed” when in reality they aren’t clinically depressed, just a little down).

Personality Disorders | Definition by Psychiatrists

The general criteria listed in the American Psychiatric Association’s Diagnostic and statistical Manual of Mental Disorders or DSM which is now in its fifth edition. The definition of personality disorder as summarized in DSM IV is “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture” (not caused by such things as drug abuse, or other medical problems).  Unfortunately, for me the criteria as listed in DSM V are more complex, and since I am a simple-minded person I will stick with DSM IV in my discussion (but perhaps more to the point I am reluctant to invest a hundred bucks in another 900 page dust collector for my bookshelf).  In either case, it is clear that those who suffer from a personality disorder are very different.

Signs & Symptoms of Personality Disorders

Signs of personality disorders characteristically have been present for long periods usually from childhood.  These patients are difficult to treat.  Although some psychotropic medications may be helpful, the gold standard remains long-term intensive psychotherapy, a commodity which is in short supply these days.  The symptoms usually serve a protective function. Consequently, patients in treatment have difficulty giving them up.  An even bigger problem is that in many cases people who need treatment most are those lacking in insight. Consequently, they are convinced there is nothing wrong with them.  This is especially true in cases of narcissistic and sociopathic personality disorders.  They believe they are perfect in every way so why in the world would they need a psychiatrist?

Narcissism | Signs | Symptoms | Cause

The term narcissism is from the Greek myth about Narcissus who fell in love with his image while gazing into a pool of water.  This did not work out too well for him for he eventually committed suicide when he realized his true love was himself.  A bit of narcissism is not a bad thing…as a matter of fact most therapists would probably report that low self-esteem is one of the most common problems they see and that they spend a great deal effort trying to help their patients learn to like themselves.  But as with most things in life, it is the extremes which cause us problems.  We all know people who are arrogant and self-centered, but those with a narcissistic personality disorder take that to the level where their self-image is so far removed from reality that it approaches the delusional.

He/she of the narcissistic personality disorder is the master of the superlative.  He is never simply good at something, he is the best.  Others are not bad, they are the worst.  Everything in life is measured against the perfection that only he possesses.  The need to maintain this distorted image of himself dominates his life and leaves no time to consider the needs of others.  He is convinced he is special, and deserves special treatment.  He courts admiration or subservience in relationships, and is pathologically intolerant of criticism.  This preoccupation with self, frequently distorts perceptions and may affect judgement.

As with many mental health problems, the causation is up for grabs.  There may be some abnormality of brain function, environmental factors, or both.  Some postulate that excessive adoration by parents is the cause, while others feel the opposite, namely that excessive criticism is the culprit.  Whatever the cause, most agree that such extremes of narcissism serve the purpose of protecting a very fragile ego.  His need for attention is never satisfied.  Indeed, the tenacity with which the narcissist holds onto and nurtures these false opinions of himself leads one to suspect an underlying desperation at the core of his being.  The most readable synopsis of narcissistic personality symptoms I have found lie in a pamphlet distributed by the Mayo Clinic as follows:

  • They have a sense of entitlement and require constant excessive admiration
  • Have an exaggerated sense of self importance
  • Expect to be recognized as superior even without achievements that warrant it
  • Exaggerate achievements and talents
  • Preoccupied with fantasies of success, power, brilliance, beauty or the perfect mate
  • Believe they are superior and can only associate with equally special people
  • Monopolize conversations and belittle or look down on people they perceive as inferior
  • Expect special favors and unquestioning compliance with their expectations
  • Take advantage of others to get what they want
  • Have an inability or unwillingness to recognize the needs and feelings of others
  • Be envious of others and believe others envy them
  • Behave in an arrogant or haughty manner, coming across as conceited, boastful and pretentious
  • Insist on having the best of everything (for instance the best building, golf course, yacht, wife, etc.–the examples are my words NOT Mayo Clinic’s example–they used car and office)

Narcissism & Trump

So, there you have it – all you need to make a diagnosis.  You Trump watchers have certainly observed enough behaviors to decide if the shoe fits.  If you conclude that the diagnosis of Personality Disorder fits, you should be concerned as to the fitness of POTUS to handle the job.  Those so diagnosed are prone to react in irrational ways when their distorted view of themselves is threatened and consequently are very sensitive to any kind of criticism, often reacting with over-the-top rages.   Mistakes are never acknowledged for to do so would shatter the myth of their perfection.  They react poorly to stress and to change, and there is no doubt that POTUS must be under mountains of stress considering all the investigations currently underway with many of his former supporters on their way to jail.

While in the midst of writing this, I was directed by one of the friends I mentioned in my opening statement to a YouTube presentation by John Gartner, a Ph.D. psychologist at Johns Hopkins. Dr. Gartner is convinced that Trump is demented.  Gartner is adamant in his diagnosis and convinced that he should be removed from office.  In spite of Gartner’s intensely verbalized political views, he does make a good case for an Alzheimer’s type dementia.  However, I believe the evidence he presents is not unusual for one afflicted with a narcissistic personality disorder who is under threat of losing that shield, which protects him from facing the reality of his deficiencies.

Narcissism Exposed (“s#@t hits the fan” time)

As I have mentioned in previous blogs, my major concern is that the current investigations will turn up things which he will not be able to deflect with his usual strategies of denounce, deflect, or deny.  Recently, he has seemed less rational with a 2- hour long rant at the Conservative Political Action Conference, and the strange attempts to demonize John McCain months after his death.  In the so-called Twitter storm from last week, he seems enraged at everyone within range.  It appears that his only respite is the campaign rallies at which he is able to bask in the attention accorded him, confirming to him that he really is “The Greatest.”

Some say our President is “crazy like a fox”.  It is true that he has turned self-promotion into a very successful career, even becoming the world’s most powerful man.  Those same talents have served the additional function of satisfying insatiable ego needs.  I believe that Trump’s narcissism governs every aspect of his life, and explains the “crazy” things he does and says.  I believe that he is psychologically vulnerable and likely to demonstrate irrational and impulsive behaviors if his defenses are destroyed.  With that in mind, I hope all these investigations do not burst the President’s fragile ego for that could be disastrous.

Editor’s Note: I was slow on the editing of Eshrink’s post and so much has happened since he originally wrote this article. The Attorney General released a 4-page summary of the Mueller Report on a Sunday while many of us were watching our brackets bust during the NCAA basketball tournament.  I kept asking why the full report wasn’t being released to the public (the taxpayers paid for it, as POTUS continues to remind us in the context of money wasted) or at least released to Congress (it seems Nancy Pelosi wonders that, too.) However, Eshrink’s post about Narcissistic Personality made me think maybe the inner circle knows more than we think about the stability of POTUS and his psychological vulnerability that could lead to an even worse outcome. History will tell the tale… I’m sure those working inside the Oval Office will have plenty of great material for books once this crazy time in our republic’s history is behind us–if the Republic survives that is. God Bless America. We need all the help we can get!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Looking for trees? Check my mailbox.

Our mailman does not seem to like us although Barb and I both consider ourselves to be as likeable as the next guy. Whenever I meet him at our mailbox, he doesn’t respond to my characteristic jolly greeting, but simply hands me my mail, grunts, looks straight ahead and drives away. Old habits die hard and this old psychiatrist still tries to understand aberrant behaviors. Consequently, I have attempted to understand what may have precipitated his apparent animus.

 

The Investigation: Why does my mailman hate me?
It is true that I forgot to leave his traditional tip in the mailbox at Christmas time, but of course that was several months ago.

There was also the Floyd incident, but I wouldn’t anticipate his blaming me for my dog’s exuberant behavior. Floyd loves to ride in the car and isn’t choosy about the type of vehicle or driver. Consequently, when the mail truck pulled up to mailbox one summer day, Floyd seized the opportunity. He leaped into the mail truck with excitement with big plans to accompany our mailman on his route. Unfortunately, in the process Floyd was forced to run through a gauntlet of boxes and crates of mail resulting in the rearrangement of their contents. However, the mailman was remarkably calm throughout the incident and accepted my apology, although I did note that he was muttering to himself as he restored order to the crates of mail.

 

My Epiphany! It’s not me. It’s those damn catalogs.
After all of these deliberations, I have concluded that the ire exhibited by my mailman has the same genesis as my own.

You see, just yesterday he delivered 23 catalogs in addition to two magazines and multiple solicitations from organizations, some of whom I have never heard of, and this was only a routine day. If history is any guide, the volume will increase as the holiday season approaches. Instead of emptying my paper recycling bin once a month, I now must empty it every few days. No wonder my mailman becomes frustrated since he must stuff all that stuff in my mailbox daily.

 

Nothing unites like a common enemy.
His pain is my pain! I sympathize with my mailman’s frustration. I get angry each time I have to unload that mailbox, cursing as I sort the scams from the legitimate mail. As a bona fide card-carrying curmudgeon I must tell you that I remember the day when if one wanted a catalog they asked for it. Today, if you order something  from a catalog, you will soon be buried in an avalanche of slick pictures of beautiful people wearing cool clothes and hawking gadgets I’m sure I need but know I’ll never use. Not only do I resent their audacity of sending the catalog without me requesting it, I resent that they believe they can convince me that I look as cool in those duds as the suave handsome dude who models their stuff.
Some of these catalogs feature stuff way beyond my pay grade. For example, I do not ordinarily shop for $1500 leather jackets, $600 sweaters, or $750 shoes. One such high end catalog featured of all things a $250 pair of jeans faded in all the right places to make them look old. I do occasionally browse and sometimes find interesting inventory. For example, one which featured home health aides also had a two-page display of dildos. I was surprised to find they came in so many different sizes, shapes, and colors. Barb vigorously denies having ordered the catalog, but I have my suspicions.

 

The good ole’ days of face-to-face relationships
It is no secret that there is a flourishing market for names and addresses of potential customers and that these catalogers have no hesitation in selling us to the highest bidder. I recall the time of the mom and pop stores when the relationship between customer and seller was built on mutual trust and therefore personal. The storekeeper was more interested in customer loyalty than making a sale, trusting that if his customer was “treated right” he would come back. Likewise, the customer trusted the salesperson to give an honest representation of the product sold. In many cases shopping was as much of a social event as a series of business transactions. I suppose that now as even we former Sears catalog devotees fade-away, we will become even more depersonalized as we become numbers in Amazon’s super computer. Our computers will order from their computers, our orders will arrive untouched by human hands, and one more avenue of human interaction will close.
Shopping: Art, Science, Disease, or Therapy?
Enter my beautiful, charming, and aesthetically gifted wife. She is a former shopkeeper one of the last to conform to those qualities I mentioned, and whose store continues to receive rave reviews from former customers. Among her other talents she is a world class shopper. As our daughter Molly (now deceased) said regarding her Mother’s shopping prowess: “when Mom gets the scent, you better get out of her way.” For Barb, Christmas shopping is not a project, it is a mission. She scoffs at the idea that it would be much simpler for her to give the kids money and insists on finding a gift (or unfortunately–gifts…plural) which are perfect for each one whether they realize it or not. Things to be considered include: hair and eye color, stature, personality, and consideration of their known personal preferences unless those preferences are in extremely poor taste.
Within the past year the last department store as well as the last men’s store in our town closed their doors. I recall a time when our main street hosted three department stores and multiple specialty shops which have all folded as the big boxes took over. Having fought and lost the good fight with the big guys, and since she places online shopping in the same category as those big box adversaries, the best Barb can do is to reluctantly shop via catalogs even though she disapproved of the one featuring dildos. I presume this change in her shopping habits is responsible in large part for the appearance of our names on a few hundred mailing lists.

 

The List Contagion: It’s a real thing
It’s not only the merchandisers who will pursue you. Barb is a sucker for those tear-jerking ads on TV, which has resulted in reams of solicitations for real and non-existent charities. I wonder if they make more money selling my name and address than from my feeble contributions. In my zeal to become a good steward of my government, I once made the mistake of contributing to a political campaign online. Now, I start my day by deleting pleas to contribute to this or that political cause or candidate. They assure me that without my contribution a worldwide calamity is immanent or that I will be to blame for the extinction of the white rhino.

 

Privacy?
On a more serious note, it has been said that with a few key strokes one can know more about me than I do about myself. This is undoubtedly true e.g. I don’t know where I ate a year ago but that info is available somewhere. Our privacy is said to have been eroded, but it is probably more accurate to say it is gone. Now, as more DNA results are collected not only will more be known about your behavior but your body and your relatives. Nevertheless, the blatant disregard of our rights to privacy as this little essay illustrates is only one small example yet enough to piss me off big time.

 

Ground Zero
Maybe my overzealous anger about the catalogs goes beyond the senseless time spent sorting and recycling and even beyond the invasion of my privacy. Maybe it’s a symptom of something bigger that concerns me. A change in our society that is worrisome. While many say technological changes make it easier than ever to connect with one another, it seems we are more disconnected than ever. Less human interaction. More loneliness. Clicking the chat button as you order gifts on the internet, or even talking to a live person when you order from one of the thousand or so catalogs, is a poor substitute for the process of old-fashioned shopping at the aforementioned brick and mortar establishments where you talked to retail clerks, shop owners, and even fellow shoppers.

 

A little over 100 years ago, a sociologist name of Emile Durkheim coined the term Anomie which he used to describe situations where societies in large measure feel a sense of alienation because their only feeling of attachment is to the system in which they don’t believe or feel a part of. He thought this came about due to division of labor (this was in the midst of the industrial revolution) and rapid change from a traditional society to a modern society.

 

The pace of changes which Durkheim witnessed were trivial compared to the last 50 years, and it change continues to accelerate at a speed almost beyond our ability to comprehend. Yesterday, I awoke to hear news of the second mass shooting in less than two weeks. I believe it noteworthy that most of the perpetrators of these horrible acts were described as people with few if any acquaintances and no one who was willing to call them a friend. They were described as quiet and uninvolved in their communities, in short: alienated.

 

It also seems noteworthy that in spite of relatively good economic times, suicide rates in the U.S. have increased 24% from 1999 to 2014. Likewise, murders increased 8.6% in only one year (2016). According to the non-profit that tracks gun violence in the USA, (www.gunviolence.org) incidents have increased each year since they started tracking statistics in 2014. Conventional wisdom is that our current President was elected and continues to have widespread support from those who feel they have been “disenfranchised.”

 

Who is the patient?
This all suggests to me that we need to look farther than individuals with mental illness as the major factor in gun violence. It may be that it is our society that is ill, and in need of treatment. Human connection, kindness, and compassion might not help cure all of society’s mental illnesses, but it can’t hurt.

 

P.S. Catalog UPDATE
By the way, I just now picked up today’s mail and there were only 18 catalogs, but an armload of solicitations for money, some bills, and a letter from my only friend who still writes via snail mail.  Remember to be kind to your mailperson (especially this time of year).  There may be other Floyds out there and I’m sure there are even more catalog targets like me and Barb on every mail carrier’s route.  (Break for reminiscing): When I was in college a couple of centuries ago I worked as a mailman during Christmas breaks, and occasionally someone would invite me in for a cup of hot chocolate on the coldest days.  I wonder if that happens anymore.

Editors Note: While editing eshrink’s blog, I found this non-profit whose mission is to help us cancel unwanted catalogs: Catalog Choice . However, I haven’t told eshrink yet because I don’t want to rain on his curmudgeon complaint parade…he’s on a roll and I think it energizes him! Love you dad.

Transitions

This title was chosen by my son for reasons which will soon be obvious. His youngest has just left home, this time for good, and he and Sue are now presiding over the proverbial empty nest. It is a frequently quoted truism that if you truly love someone you will let them go when it is in their best interest to leave. I was reminded of this last night as I watched Casablanca…one of my favorite movies in which that theme was paramount. Though it is a noble act to let go of those you love, separation is painful, and usually results in significant changes in our lives.
We experience multiple types of transitions during our lifetimes, but since we are at heart social beings, or to put it more crudely, tribal in nature, changes in our relationships are apt to generate the most intense feelings. It is something of a paradox that as the world gets smaller, we find so many people of whom we care to be geographically farther away. Yes, indeed we are able to communicate with ease yet Facebook is a rather poor substitute for a next-door neighbor, or a relative living in the neighborhood. Prior to the industrial revolution, one’s cadre of friends and relatives was unlikely to change very much, and most people were born and died in the same place, often even in the same house. Now neighborhoods are in a constant state of flux, and there is a lower expectation of lifelong relationships.

STUCK WITH THEM
No wonder our children are among the very most important people of our lives. Since humans require nearly 2 decades to reach maturity and carry our DNA, we tend to form very strong bonds. We are often identified as “Johnny’s” father or mother. We live vicariously through them and share their triumphs, failures, joys, and sorrows. In many ways they are our second chance at life as we attempt to steer them away from repeating our mistakes. As the years go by our intimate involvement in their lives blurs with our own–they become part of us and in doing so shape our identity, i.e. who we are.
GRIEF WITHOUT A CORPSE
With all that in mind, it is not surprising that separation anxiety is a common affliction. When the kids grow up and leave, something more than their presence is missing. It is as if a part of ourselves is gone. Not only is the nest empty, but we feel an emptiness within ourselves, a kind of psychological amputation. In my experience, this emptiness is most profound when the youngest one leaves  for with it comes the realization that nothing will ever be the same. This time they are leaving to build their own nest.
THE FUN TIMES
Life is an ever-changing process. We begin as totally helpless and dependent creatures and experience a myriad of transitions during our lifetime all designed to produce an individual capable of building and presiding over that nest. Some of those changes are more dramatic than others. There are the first steps, the first words, the first solo bicycle ride, the first day of school, the first sleep over and a few thousand other adventures all with a goal of achieving sufficient independence to allow them to face the world on their own.
WHY DID I GET INTO THIS?
But it is not all sweetness and light. There is the messiness, the lack of discipline, the terrible twos, the out of bounds phase, the adolescent rebellion, the sleepless nights, and the continued testing of limits to name a few of the frustrations inherent in the child-rearing business. Those little buggers are also expensive. According to the USDA the average cost of rearing a child in 2016 was over $245,000 which does not include costs for higher education (but for the kids, I could have been a millionaire). Considering all the chaos they generate it is little wonder that we don’t occasionally wish them to be grown up however; one should keep in mind the maxim to “be careful what you wish for.”
BEGINNING AND END
According to the Bureau of Labor Statistics 67.3 % of high school graduates enrolled in college last year (2017). It seems safe to assume that most of these kids would leave home while in school, but retain a close connection to their old familiar environs. In many cases the college transition is a prelude and training for that final fly away. The days when we dumped kids and their gear off to a strange new environment were certainly memorable to Barb and me.
Our first experience with the off to college scenario was painful for all involved. Molly, our firstborn (now deceased), who suffered from serious medical and emotional problems was unable to complete that transition. Next in the line of succession was Peter, who was much too macho to display his feelings, but I was already missing him by the time we pulled away from his dorm. After a four-year hiatus, it was Trudy’s turn. Trudy, the adventurous one, was on the phone almost immediately, tearful and very upset to find beer being consumed at the sorority rush parties that she attended. We had no idea where this came from for temperance had never been emphasized at home. As you probably already suspect. her distress was short lived and as was her habit she soon became involved in everything.
THE LAST ONE STANDING
Of course, those separations were painful, but none so telling as Maggie’s departure for we were now returning to a house inhabited only by Barb, myself and Grover the dog. Maggie was one who had insisted on an out of state school, for she was eager to assert her independent status. She wanted distance from childhood connections. Her reaction to the college transition was a convincing testimonial for that “be careful what you wish for” thing. Permanently engraved in my memory is the sight of that sobbing, skinny little red-haired girl who stood there all alone in that huge empty parking lot making feeble attempts to wave goodbye as we pulled away. Barb wanted to go for one last hug, but I insisted she had already had several last hugs. We were later told that she cried for the next month and lost 20 pounds. [See an earlier blog post about Separation Anxiety + Mental Health}
NOT ALL SWEETNESS AND LIGHT
In case you are thinking this gang of mine is the Partridge family incarnate, think again. It is true that to date we have come through our transitions relatively unscathed, but not without trials and tribulations. In spite of their best efforts some families are overwhelmed by circumstances beyond their control. Barb and I are indeed fortunate that in spite of our screw-ups we have ended up with 2 generations of exceptional people, and the beat goes on.
STILL AT IT
It so happens that this month marks the beginning of significant transitions for every one of my Grandchildren which of course they will undoubtedly handle better than do their parents (or Grandparents for that matter). My three oldest grandchildren are already emancipated and starting new and more challenging jobs. Another is off to her first year in college, and our youngest is entering high school. As mentioned in my opening statement, Carter’s room is empty, and home is now in another city far away. Trudy’s is the only nest still occupied.
LIFE GOES ON
Whatever distress the kids may feel from leaving those years of memories behind is apt to be short lived compared to that of their parents. There is hope for Mom and Dad however. In return for enduring the vicissitudes of child rearing God has rewarded us with grandchildren. Thus, we have an opportunity to get all the goodies and none of the crappy stuff ,which leaves me wondering what it would be like to be a great grandparent. Stay tuned for the answer!