Mental Illness

Letter to a friend and former OSU medical school classmate. Asylums Anyone?

Note from Eshrink’s Editor: My father had a reunion with his classmates who graduated from the Ohio State University Medical School back in the 50s (1956 I think). Last month, one of the few classmates left in his class sent him and article from the Wall Street Journal. Here is the link to the article https://www.wsj.com/articles/its-time-to-bring-back-the-asylum-ec01fb2?reflink=desktopwebshare_permalink. I’ve included a PDF version at the end of this blog post.

This letter is my dad’s response.

July 31, 2023

Dear Jim, 

           Thanks for the WSJ article regarding asylums.  It resurrected memories of an incident which I wrote about previously (Passing the Torch) when during my residency my attending physician for whom I had a great deal of respect, invited me to share a cup of coffee with him.  This was a bit unusual, and my first thought was to wonder what I had screwed up.  Imagine my surprise when he announced that he would be retiring at the end of my rotation on his service and wanted me to be the first to know.  The casual observer would likely have seen Dr. Ristine as a tough old bird rather than as warm and fuzzy, yet patients warmed to him instantly.  He arrived daily at the hospital wearing a beret and driving a battered topless corvette which had lost the battle when he used it to pull out a stump on his farm. 

           Prior to his stint in academia, he had been assistant director of the department of mental health.  His face was flush with anger as he described his frustrations in that job.  He reported that he made occasional visits to the various state hospitals where he would often sit and cry as he witnessed what he saw in the “backwards.”  His efforts to secure more funding for their treatment went unheeded by the legislature, for as he said, “Severely mentally ill folks don’t vote,” and therein lies the problem.   It has oft been said that “you get what you pay for” and we pay very little considering the magnitude of the problem.  The National Institute of Mental Health reports 5.5% of Americans suffer from a serious mental illness.  Dr. Ristine seemed to be saying that it was now my turn to attempt to fix the problem, which was obviously way above my pay grade.  Nevertheless, I was touched by his openness and still fondly recall that coffee break.

           Surprise, surprise, more than a half century later, I must confess that I have also failed at fixing the problem, but Dr. Ristine had found the solution as had many more who had gone before.  As with most contemporary problems the solutions can be found by following the money or in this case the lack of it.  After the French Revolution Pinel unchained his patients, moved them out of the dungeons, and allowed them to exercise outside.  Unfortunately, such ideas which came to be called the Moral Treatment of Insanity, were rare, and it is estimated that more than 1,000 psychotic folks were burned at the stake. 

           The heroine of the movement was Dorothea Dix who became a tireless advocate for the mentally ill in the mid nineteenth century.  She addressed political bodies throughout the country and even convinced the Pope to launch an inquiry into hospital treatments of the mentally ill.  She was very successful and largely through her efforts a system of asylums was built.  These asylums were usually large attractive buildings with assurances that they would offer the latest in modern treatments.  Unfortunately, there was a lack of effective treatments for the more serious cases and most, if not all, became permanent residents.  It is difficult for us to imagine what it must have been like to deal with large groups of people so paranoid that they lived constantly in terror, and whose suspiciousness made it impossible for them to accept help.  Little wonder that caregivers were driven to try unproven and sometimes garish treatments out of desperation, and that the introduction of Thorazine was greeted with enthusiasm.  Within a year over 70% of psychiatric beds were emptied.  Finally, there was a medication with proven ability to affect delusions and hallucinations, and it was widely hailed as a possible cure for schizophrenia.  

           Mr. Oshinsky begins his piece with a series of instances of murders at the hands of mentally ill persons.   Such stories are real attention getters, especially the gorier ones, and will certainly get more press than articles about drunk drivers who kill.  They will also provide more grist for the NRA crowd’s message that it is the mentally ill not guns that are the problem and reminds us to be careful around those with psychiatric problems as you never know which one is a homicidal maniac.  In reality such assaults are rare and mentally ill folks are more likely to be victims rather than perpetrators of homicides.  Such attitudes do little to eliminate the biases suffered by the mentally ill.

           The author’s statement that our Mental Health system is a “mess” is accurate in my opinion, and it lacks provision for long term care, but the system has suffered mostly due to inadequate funding.  As his last official bill signing prior to his assassination in 1963, President Kennedy signed a bill authorizing the establishment of Comprehensive Mental Health Centers throughout the country.  The idea was to provide care in patients’ home communities.  Eligibility for funding required the provision of 5 essential services including: inpatient, outpatient, social services, medication management, and emergency services.  My hometown was the second in the nation to receive such a grant, and a decade later I was recruited to become its director.  I was exhilarated by a staff who were dedicated to the welfare of our patients, and frustrated by local politics, the difficulty of recruiting psychiatrists to a rural area, but most of all by the limitations of our budget.

           Kennedy’s bill was designed to provide operating expenses for a limited period of time, less than half the proposed facilities were ever built, Reagan eliminated the program as part of his budget squeeze, and now managed care pays for little more than crisis intervention with hospital stays averaging less than 2 days.  I agree that our laws regarding involuntary commitment need to be revised.  After all it is not unusual for such correcting laws to swing too far afield, and indeed in their zeal to “deinstitutionalize,” they failed to recognize there are still patients who require custodial care in spite of our best efforts.  It is also true that without corrective action abusers will find their way into the system and Nurse Ratchets, though rare, do exist, and a community-based system is likely to shed more light.  Which poses the question, without “One Flew Over the Cuckoo’s Nest” would we even be having this conversation. 

           The idea of asylums as he described them is attractive except for the fact that we already did that with poor results, and some would say to repeatedly do the same thing expecting a different result is the definition of insanity.  Many have also posited that the location of asylums for the insane have always been located in out of the way places with the idea that out of sight is out of mind while congratulating ourselves that they are not chained in a dungeon…but thousands are in jail. Though we no longer burn witches at the stake, the stigma of mental illness is alive and well.  I abhor the term behavioral health to describe mental illness which infers that behavior, not illness, is the problem.  Unfortunately, it is aberrant behavior which usually gets the public’s attention rather than its cause.  The term is widely used even by professionals including the mental health center where I last worked.  My efforts to convince the staff that although efforts to convince a psychotic person that a fireplug was not a urinal were laudable, it was unlikely to get to the root of the problem.   Medical insurance still offers minimal coverage for mental health problems.  Employers widely discriminate.  In many ways mental health problems are treated differently.  If mental illness is illness, why not treat it as we do other chronic diseases?  The answer of course remains the same as it was in Dr. Ristine’s day: it is too expensive. 

           The accomplishments of reformers back to the Middle Ages have always been short-lived by lack of adequate funding.  Bedlam, one of the earliest hospitals from the Middle Ages was designed by a famous French architect.  It was said to be a marvelous structure but eventually deteriorated due to lack of funds.  Understaffed and underfunded, their financial problems were solved by the sale of tickets to the townspeople to come watch the lunatics, and bedlam was added to our vocabulary as a word signifying chaos.

           Sorry about boring you with all that stuff, but sometimes when I get started it is hard to stop, and this diatribe will likely end up as a blog.  It was great to hear from you and reassuring that someone is beating the grim reaper.  I have no doubt that you will be around for another reunion.  Do you have any idea how many of us are still alive? It seems to me that almost all of the guys I really knew are gone.

We just returned from our family vacation at North Carolina Beach.  I think it might have been our 25th but the string was interrupted by the covid thing.  All the kids, grandkids and their significant others were there, and the trip was a gift to Barb and I from the kids in honor of our 70th anniversary.  We had a great time and I feel incredibly fortunate to have such a great bunch of people who actually care for a gimpy old fart.

           I agree that the world is a mess right now and I have grave concerns that our progeny may not experience many of the blessings we have enjoyed, but spending time with these kids gave me hope for I think they are smarter than we were and more capable of cleaning up the mess than were we.  Meanwhile, I see the buckeyes are rated #3.  I think it’s time for a national championship.

                                                       Love,

                                                       Smitty and Barb

Below is PDF of the WSJ article dad references.

Dads blog It’s Time to Bring Back Asylums – WSJ articleDownload

Responsible Gambling?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CHASING DEPRESSION

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

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

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

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

DEPRESSION of the AGES

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

The COMPLEXITY of DEPRESSION

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

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


A Little Shrink History

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

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


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

The Pharma Era

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

Depression and Pharma

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


No Silver Bullet

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

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


My Experience with the NEXT SILVER BULLET to TREAT DEPRESSION

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


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


Seeing is Believing

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


MAGNETISM

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


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

SAINT

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


SAINT: What it is

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


CAUTION: With Experience Comes Pragmatic Skepticism

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


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

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.

NEW ORLEANS, LA – JANUARY 01: Ohio State Buckeyes quarterback Justin Fields (1) is tackled by Clemson Tigers linebacker James Skalski (47) during the second quarter on January 1, 2021 at the Mercedes-Benz Superdome in New Orleans, LA. (Photo by Stephen Lew/Icon Sportswire via Getty Images)

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. 

Justin Fields | Quarterback | The Ohio State University

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]

WASHINGTON, DC – JANUARY 06: Pro-Trump supporters storm the U.S. Capitol following a rally with President Donald Trump on January 6, 2021 in Washington, DC. Trump supporters gathered in the nation’s capital today to protest the ratification of President-elect Joe Biden’s Electoral College victory over President Trump in the 2020 election. (Photo by Samuel Corum/Getty Images)

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.

Proud Boys leader Enrique Torrio at rally. Note: The Proud Boys was formed in 2016 by VICE Media co-founder, Gavin McInnes. In an op-ed in the far-right outlet Taki’s Magazine—notorious for its regular contributors, which included white supremacist Jared Taylor—McInnes announced the foundation of the group, describing its members as “Western chauvinists who refuse to apologize [sic] for creating the modern world,” and who “long for the days when ‘girls were girls and men were men.’” According to McInnes, the Proud Boys, whose name is taken from a song in the musical Aladdin, are a response and opposition to “politically correct culture. SOURCE: https://www.adl.org/proudboys


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.”























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.

The Way It Was| Part 10

   Being deeply loved by someone gives you strength.
While loving someone deeply gives you courage.
Lao Tzu

Editor’s Note: Above is a quote Eshrink found while doing research for this series of blog posts: The Way It Was (a glimpse into how he saw life growing up during The Depression and WWII). He said it might be his all time favorite quote so I decided to put it at the top of each post in this series as a reminder of the power of words and the power of love. Eshrink’s writing illustrates the power of both! In case you missed earlier posts in this series, I’ve provided links below.

EDITOR’S Note:

Welcome to Part 10, the final installment  of “The Way It Was” (Eshrink’s memories of WWII from his perspective as a young boy growing up in Ohio). 

2014-07-08_New_Deal_GI_Bill_Rights_03

President Franklin D. Roosevelt (FDR) signing the G.I. Bill in June 1944.

Our conquering heroes were treated as such. Many would return to their old jobs and families. But colleges, universities and trade schools were flooded with students as nearly 8 million veterans took advantage of the GI bill which paid for tuition, and living expenses for any approved college, high school, technical, or vocational school. Many universities found it necessary to erect quonset huts to handle the influx, while others opened branches in enabling some vets to commute (the latter allowed me to start college).

Low interest mortgages and business loans were made available, along with one year of unemployment compensation if needed. There were some who objected to the policy as being socialistic along with the prediction that it would encourage laziness. It turned out that this time the unintended consequences of a government policy were positive. Teachers and professors almost unanimously applauded the GI’s for their discipline, and dedication to their studies. Employers were recruiting rather than shunning veterans.

Sociologists and economists mostly agree that this massive educational effort contributed in a big way to the post war era of prosperity and to our becoming the dominant force in the world. We gained respect for not only our military prowess, but intellectual and artistic pursuits. For example, It would no longer be advantageous to study medicine in Europe, rather Europeans would now line up to study in the US. The ready availability of an educated workforce allowed us to move ahead of other countries in industrial and scientific research, and to mold our “swords into plowshares.”

Learning from History

Of course, we had a head start in the race for supremacy considering the fact that the rest of the industrial world was in shambles having suffered the brunt of the war’s devastation. In a rare display of good judgement, we seemed to have learned from past mistakes and decided to use our new-found prosperity to create the “Marshall Plan” which was designed to help rebuild and revitalize Europe including Germany and Italy.

This was in marked contrast to the treatment of Germany after the first World War, when they were severely punished. This was undoubtedly a major factor in causing WWII a mere 20 years later. The Marshall Plan, i.e., the general strategy of helping the countries we had just defeated, was roundly criticized by many who felt we were rewarding bad behavior. However, the rebuilding of Europe combined with a similar program for Japan has resulted in the establishment of democratic governments and prosperity for all, but most of all peaceful relations which have lasted for 70 years.

Those postwar years were full of the promise of peace and prosperity. The boys had come home, were going to school, or working better jobs. My Brother and my uncle as beneficiaries of the GI bill were the first in our family to have ever gone to college. As with millions of others, they were soon starting families, and the baby boom began. In 1948 I graduated from high school and worked briefly as a go-fer at an automobile agency, where there was a long list of people waiting to buy a new car. This was true of all kinds of items which had not been produced during the war. There was building everywhere, the economy was booming, and the future looked bright, but that euphoria was short lived when Joseph Stalin entered the picture.

War Makes Strange Bed Fellows

Stalin was at least as ruthless as Hitler, and is said to have executed millions of his political adversaries with even more dying in his gulags as his concentration camps were called. Nevertheless, he had been welcomed into the fold as an ally after he declared war on Germany. He called himself a communist but his definition of communism involved the presence of an all-powerful dictator.

Yalta Conference. Winston Churchill, Franklin

Left to Right: Churchill (PM of England); Roosevelt (President of the USA); Stalin (Leader / United Socialist Soviet Republic-aka: Russia)

At the famed Yalta conference called to decide the fate of post war Europe, Stalin was granted control of Eastern Europe after suckering FDR and Churchill into believing he would keep his word about establishing democratic governments in those countries. His duplicity marked the beginning of the Cold War which would become more frigid with Russia’s development of a nuclear bomb in 1949. This led to the policy of “mutually assured destruction” (a.k.a., a Mexican standoff) and the construction of backyard bomb shelters, air raid drills in schools, and teaching kids to sit under their desks…as if that would do any good in an atomic bomb attack.

air raid picture

air raid info

air-raid advertisement

Why?

It should come as no surprise that since I am a psychiatrist I might have some interest in human behavior, Although you could legitimately question if some of our world’s worst tyrants mentioned in this paper are really human. As a teenager during that great war I was subjected to a lot of news of the atrocities carried out under the direction of these people who at first glance would seem to be free of a mental illness. One of my friends had occasion to spend a great deal of time with Saddam Hussein following his capture. He was surprised to find him quite personable. In one of their conversations Saddam stated that he acted as he did because it was necessary to save his country. I am left to wonder if he really believed that, and if is such a rationalization is common among Tyrants.

After endless years of speculation as to what makes these guys tick, they remain a mystery to me. We psychiatrists are well versed in labeling various conditions, but not so good at finding causes. I am aware and concur that power corrupts, but still after those years of mental gymnastics I remain perplexed as to how these otherwise apparently normal people can do such evil deeds. Even more puzzling is how they are able to convince masses of people to follow their lead and participate in the torture and murder of others.

Nuremberg Trials

020419-nuremberg-trialWith the end of the war members of the Nazi hierarchy were rounded up and charged with “crimes against humanity.” I was 16 years old and found time to follow the trials in Nuremberg in spite having recently found the love of my life.

Nuremberg-trials-8

There apparently was some effort to learn something about these guys for I recently found they were all given Rorschach tests (these tests are now discredited by many). Herman Goering was second in command in Germany under Hitler, and I recently found a transcript of his testimony.  He was surprisingly open about the operation of his government and freely discussed the operation of the concentration camps and how adversaries were ordered to be killed by the SS or Gestapo. He was sentenced to be hanged, but managed to have cyanide smuggled in and killed himself.

goerring 1

Although, I knew the story of Goering’s suicide it was only recently that I learned there was a very interesting and strange sequel to the story. Goering had been examined by an Army psychiatrist by the name of Lt. Col. Douglas Kelly. He apparently shared some of my curiosity as to what made these guys the way they were. He is said to hope he would be able to identify what he called a “Nazi personality” which could be identified before such bad guys could come to power. From the story it sounds as if he was suffering from a serious mood disorder, which must have gone undetected by the army. In any event, after a minor disagreement with his wife he ingested cyanide and killed himself in front of his wife and children a la Goering.

True to the Biblical prophecies we have continued to “hear of wars and rumors of wars.” I was one of the lucky ones for my brief stint in the Navy was in between wars. It seems I will go to my grave with no understanding of why we do what we do to our own species. I have some ideas, but none seem to make sense. Perhaps we should add another diagnostic category called evil people to our diagnostic manual.

Thanks for the Memories

On this cheery note I leave you all to ponder those ways of the world which are beyond my understanding. I do want to thank Peter for suggesting this topic. The reminiscences have been fun, and as I have mentioned before that is the thing we old folks do best. It has also reminded me to be grateful for having been born in a time and place where I was loved, and for the good fortune that has accompanied me all these years.

 

 

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.