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.

SEX ABUSE OF KIDS

SEXUALLY ABUSED KIDS
Last week I published a tongue-in-cheek response to an op-ed I had read in the editorial page of our local newspaper. The admonishment of the writer of the op ed that we should limit our talk about childhood sexual abuse stirred up some painful memories for me of patients who were attempting to overcome the effects of childhood sexual abuse.

A True Story
One case in particular comes to mind. This patient was an attractive young woman who came to see me with vague complaints and reported she had come because: “I just want something for my nerves.” After initial hesitation, she was able to give a more detailed history. Her general presentation confirmed my initial impression that she was suffering from clinical depression. She seemed shy and avoided eye contact until I asked if she worked, at which time she looked directly at me as if to assess my response as she hesitantly told me she worked as an “exotic dancer.” Apparently, I passed the test, for at that point, she unloaded in great detail how she had chosen such a career, and how she hated it.
She grew up in a blue collar family. Her father was a factory worker who forbade his wife from working. Her dad was a periodic, episodic alcoholic, and when drunk, was violent and abusive. When sober he was easily provoked. Mother was cowed, totally submissive, and seemingly helpless to protect her children from her husband’s rages. My patient (we shall call her Mary) along with her two older brothers developed strategies to avoid Dad when he was expected to come home drunk. As Mary grew into adolescence, her father began to take notice of her, and finally on the return from one of his nightly drunken forays came into her room and raped her.

But this was not the end of the abuse for the old man had the temerity to excuse his behavior by telling Mary that it was only because he loved her that he was sexually attracted to her. She accepted his advances as she was terrified at the thought of his beating her as he periodically did her mother.

Think it couldn’t get any worse?
Think it could’t get worse than this? Wrong. Soon her brothers emulated their father and to make matters even more unbearable bragged about having sex with her to their friends at school. As you might expect, this led to pursuit by many of the boys at school who were convinced that she was an “easy lay.” And where was Mary’s mother while this was going on? Mary was convinced she was aware, and attempted to convince herself that mother was so beaten down as to be rendered helpless, but she was also horrified to think that her own mother might have offered Mary up to her father in order that she would not be a target of his rages.
Emotional Extortion
Mary’s father had promised all kinds of dire consequences if Mary should ever breathe a word to any one about his behaviors. She knew that she would get no support from her mother were she to seek outside help. By now, even Mary’s teachers were convinced that she had become a problem as they heard that she was promiscuous. There was a reluctance to tell anyone due to the intense feelings of shame she felt about the incestuous relationships. There was also that long held custom of blaming the female in such situations, of which Mary undoubtedly was well aware.

The Spiral
The effect of all these prohibitions was made evident as she several times during the session asked for reassurance of confidentiality. In such a situation, the only sensible thing for her to do was run away, which is what she did. From then until the time of our session, her chronology was a bit hazy. I suspect that some pimp thought he had struck it rich when he discovered this beautiful little runaway. Although she did not admit to such, it seems likely she did engage in prostitution. In any event, at this point I felt it not necessary to probe deeper into her past for I had already seen enough pain to last for the rest of the day. It is enough to say that somewhere along the line she did find a way to use the only tool available for her to make a living in a semi-legitimate manner by swinging around a pole naked. Unfortunately, I never saw her again but noted the “men’s club” where she had been working was closed down by the sheriff. Her name was not listed among those who were arrested.

Sex abuse survivors suffer long after the abuse ends 
You may be thinking stories of this kind unusual, but they are not rare. It has been several years since that day I saw Mary, but I still think of her occasionally and wonder what her life is like now. I hope she found a good guy to marry has a couple of kids and is living happily ever after. But in my heart of hearts I know that is very unlikely. Those who have suffered such abuse usually have serious trust issues which interfere with the formation of meaningful relationships. Even though they know on a rational level that the abuse they suffered was not their fault, they often blame themselves by questioning whether the assault was brought on by their seductiveness, which is reinforced by the oft heard “she must have done something to bring this on.” They lack self-esteem, devalue themselves, and feel unworthy. When shown attention, they may be suspicious and distance themselves while others may become promiscuous, feeling they have nothing to offer other than sex. In their search for love, they find themselves in a series of abusive relationships a la the repetition compulsion which Freud so eloquently described.
Meanwhile, I continue to fuss over the op ed that I sarcastically commented on in my most recent blog. I was curious when I first saw the title of Ms. Flowers piece, but as I read on I became so angry that I could have had a Lindsey Graham type temper tantrum on the spot. I immediately wrote a rebuttal in my passive aggressive style, which Maggie thought was worthy of publication however; I feel the subject of child abuse deserves something more than a few smart-ass comments. I felt that Mary’s story speaks eloquently as to the effects of childhood sexual abuse. Fortunately, most cases are not so horrifying as hers, yet even less aggressive acts can have long lasting effects.

More light required
Yes, I was angry with the writer for her blame the victim tactic, and her concern about Kavanaugh’s “pain” but not one kind word about Dr. Ford. But the clincher for me was closing statement in Ms. Flower’s op ed in which she writes: “That we have now reached the point that assaulted children are considered appropriate conversational tender sterilizes the soul and induces a nausea that can’t be eliminated…”I submit that such an attitude is a major contributor to child abuse. For too many years as with Mary, most such vile acts which have robbed many children of their innocence often leaving them significantly impaired with a lifetime of suffering have been carried out in secret.
There has been some progress in shining the light on the problem e.g. there are now mandatory reporting laws in most states which require physicians, nurses, social workers, emergency rooms, psychologists, etc., to report their suspicions that a child is being abused, and yes that includes the sexual abuse which Ms. Flowers insists should not be a subject of “civil discourse.” It is also encouraging that many charged with caring and working with kids are being prosecuted, and that the veil of secrecy that has surrounded the violation of children by priests is being lifted. However, the National Center for Victims of Crime reports some very disturbing statistics which confirm sexual abuse of children remains a serious problem:

  • 1 in 5 girls and 1 in 20 boys is a victim of child sexual abuse;
  • Self-report studies show that 20% of adult females and 5-10% of adult males recall a childhood sexual assault or sexual abuse incident;
  • During a one-year period in the U.S., 16% of youth ages 14 to 17 had been sexually victimized;
  • Over the course of their lifetime, 28% of U.S. youth ages 14 to 17 had been sexually victimized;
  • Children are most vulnerable between the ages of 7 and 13.
  • 75% are abused by people they know and often those whom they trust
  • 23% of reported cases are perpetrated by kids under the age of 18
  • 40 to 80% of such juvenile offenders have themselves been victims

As we have witnessed in that infamous recent Supreme Court hearing, many of the old habits which allowed such awful acts to be inflicted on our children are still in place. The issue must not be swept under the rug as Ms. Flowers suggests but should be considered “civil discourse” of the highest order. Pedophiles do not feature a sign on their foreheads announcing their sexual proclivities therefore; those to whom we entrust our children deserve careful scrutiny. My own experience in that regard accentuates that truth.

Wolf in Sheep’s Clothing
He was a person for whom I had a great deal of respect. We first met when I was a psychiatry resident, and I was impressed with his knowledge and competence as a board-certified child psychiatrist with many years of experience in institutional practice with a University affiliation.

Upon completion of my residency, he invited me and a couple of other recent graduates to join him and form a group practice. Fortunately for me, I received another offer for later I was shocked to find he was sentenced to a lengthy prison term for child sexual abuse. He had apparently managed to abuse children, in most cases, who were residing in institutions, where complaints would likely be ignored. Of course, no one knows how many lives he may have ruined. In retrospect I realized I had missed all the warning signs.
Yes, it is my most ardent belief that the problem of childhood sexual abuse deserves serious attention and more “civil discourse” not less of it.

FAMILIES

FAMILIES

In previous blogs I have discussed the importance of relationships in our lives; however none are more important than our relationships with our family of origin. They will be a powerful influence as to how we view the world and other people.  More importantly, these experiences will be major determinants in the development of our personalities.  Those fortunate enough to grow up in nurturing environments will find it easier to nurture their offspring.   To feel loved is likely to protect one’s self-esteem, and allow one to experience the joy of loving others.  Our values are in many ways shaped by family for even if one is rebellious and rejects what he has been taught, his new found truths often originate from the nature of his family relationships.

Apprenticeship to Adulthood

We humans are unique among mammals in the length of time required for us to reach maturity. Not only is our rate of growth slow, but there is much to learn if we are to survive and thrive in a complex society.  Although much is determined by our genetic make-up, we learn behaviors and perceptions primarily by unconsciously mimicking others.  In that sense, growing up is much like an apprenticeship.

The 21st Century Family

An accurate definition of family is now difficult to pin down. There are no longer traditional roles for family members, such as were the norm in my generation.  Since most parents work, there are fewer stay-at-home moms.   We now see an occasional stay-at-home dad, something unheard of in my time.  Other than widows, single mothers were not nearly as prevalent during my youth as they now are.  Modern mobility has limited the number of nuclear families who can experience the support of extended family members.  Many of our children grow up barely even knowing the names of their cousins.  Blended families composed of his, hers and their children can face special challenges.

The Power of the Family Bond

In spite of these changes, the bonds between family members are among the strongest of all our relationships. This is evidenced by the fact that one of the first phases of recruitment by cultists is to alienate the prospect from family members, usually leaving siblings and parents confused and devastated.  The same tactics are used by those who would attempt to relieve the elderly and infirm of their possessions.  In both cases, they discredit the families of origin and attempt to break the bonds between the victim and the victim’s biological family.  Those in positions of leadership of all stripes realize the strength of familial relationships, and seek to provide an atmosphere in which a surrogate family can develop.  Street gangs likewise are said to provide family like bonds, which have been lacking in the lives of those they recruit.  The search for the type of relationships found in families seems to be a common human need.

“I found it difficult to remain therapeutic while feeling homicidal.”

Although families offer the best environment for rearing children, they can also be the scene of horribly abusive behaviors. I have had little experience dealing with such problems, especially when they involve children.  I generally avoided treating such cases as I found it difficult to remain therapeutic while feeling homicidal.  In like manner I find that the understanding of other cultural practices such as honor killings, genital mutilation and such to be way above my pay grade, and in spite of being paid quite well.  Consequently, I will confine my remarks to treatment of more mundane problems.

Who is the “real” patient?

Most families seeking help are usually concerned about the behavior or mental status of one of their members. They are often coerced into treatment by the identified patient’s therapist.  That term (identified patient) is useful in that one may find that the person in treatment may be the healthiest member of the family, and labeled as sick because he is out of step with the rest of the family (i.e., the identified patient is actually the most emotionally healthy of the group who is reacting to an unhealthy family dynamic).

The importance of family therapy

There are multiple reasons that I believe involvement of family is critical in the treatment process:

  1. Family members may be able to provide valuable information about the patient’s behaviors.
  2. It allows the therapist to view family relationships first hand and thus provide insights as to the stresses in the patient’s environment.
  3. Family members may provide a more complete family history
  4. It allows the therapist to assess the level of support available, and to encourage such support
  5. Perhaps most importantly, it is a mechanism in which the dilemma of providing family with needed information about their loved one’s illness without violating the confidentiality inherent in the doctor-patient relationship. This becomes even more important in those cases where there are paranoid tendencies, or there has been a great deal of conflict.

The Complexity of Family Relationships

Although the average family size has shrunk considerably over the last century, relationships between members can still be complex. It must come as no surprise that there are often conflicts within families.  Since it is difficult to walk away from one’s family, those conflicts are not easily resolved, and over time may escalate.  To be chronically angry can be debilitating and painful, and as such, blaming another for those feelings comes easily.

The Blame Game

As mentioned in previous blogs it is important that the therapist avoid joining in the search to establish who is at fault, for to do so merely perpetuates the problem. He must be able to analyze the problem from the outside looking in, that is, learn how to be a meta-communicator. Hopefully, the members will find it difficult to continue blaming each other if the therapist redefines the problem as blaming rather than defining the problem as identification of who is at fault.

The Power of Brevity

In order for the therapist’s comments to be effective, they must be brief if they are to be remembered. The importance of brevity as with most things in my practice was learned from a former patient during a chance encounter, during which he thanked me for having helped him several years previously.  He credited his recovery to one statement of mine.  He said: “The thing that helped me most was when you said ‘you think too much’ and now whenever I start to worry about all the things which could go wrong those four words come into my head and I am able to move on.”  I cannot take credit for any brilliant insights for I didn’t even remember the incident, but it is an example of how an offhand comment may be more effective than hours of therapy.  The same principle applies to our everyday lives, as the most memorable comments are those expressed in a few words.  The lengthy ones are often forgotten before they are completed.

Obviously there are many reasons for families to seek counseling other than to deal with hostility, but no matter the problem it is helpful to look at it as a communication system gone awry. Imbedded in many different behaviors is a message, and thus can be seen as a form of communication.  For example, what is the message being sent by a teenager who is acting out?  It could be that they are angry about limits set, unrealistic expectations from parents, lack of trust by parents, sibling rivalry, or resentful that not enough limits have been set, or for reasons which have nothing to do with the family.  Of course, the teenager is almost certain to be the last person likely to divulge such information.  Disclosure can many times offer a pathway to an understanding, which may be therapeutic.

Can’t see the forest for the trees

It was not my intent for this paper to be a treatise on family therapy; however I thought it might be useful to see how some of the concepts could be useful in understanding not only our own families, but relationships in general. As I mentioned in a past blog as with marital relationships, it is almost inevitable that one will be so caught up in seeing the trees that he will become oblivious to the forest.  That is, he will not realize what is going on even though he can hear the words.  This was brought home to me several years ago when following a party a colleague said “Smith I can’t believe how you treat your wife.”   I was shocked, could he be talking to me, the couples therapy and family expert?  After all, I had no doubt that I was among the world’s best husbands, but Barb later confirmed that my friend was correct in his assessment.  As has been said, “None are so blind a those who will not see.”

Reframing

For example though all have separate personalities, they also have different roles to play as family members. For example it is common for families to have a star and a black sheep.  Parents may lament that they don’t understand why the black sheep can’t be more like the star, and continue listing all of black sheep’s misdeeds and faults.  In such a case the therapist might address the black sheep kid by saying, “That is such a loving thing, doing all that stuff to make your sibling look good.” No matter the response the system is changed, and this is apt to open up some different dialogue. This is a process therapists call “reframing.”

Scripting

There are many roles that kids and parents may unconsciously adopt. There are the placaters or people pleasers, the mascot or clown, the lost child or withdrawn person, and as mentioned in the previous vignette the hero or achiever, and the black sheep or scapegoat, to mention a few.  Family roles may develop in order to fill a need or may come about by the process of scripting.  I mentioned previously the role families play in the development of our identity, and when they convince us we are a certain type of person, we are apt to follow that script.  Some have gone so far as to say if you can convince someone he is a homicidal rapist, he is apt to become a homicidal rapist.  Obviously, there are many influences other than our families which affect our identity; however, the opinions of our parents and siblings are undoubtedly the most powerful.

Disagreements

In this time of rapidly changing mores, it is not surprising that there will be frequent disagreements between we old folks and the kids. Of course disagreements between siblings seem to be written into their DNA, and disagreements between parents is certainly not unusual.  When family members cannot agree to disagree, an argument is likely to occur, and such arguments often lead to verbal or even physical attacks.  I don’t mean to suggest that disagreements are all bad for as Walter Lippmann famously said, “Where all think alike, no one thinks very much”.  When we tell our kids what to think while telling them we want them to learn to think for themselves it is little wonder they become frustrated for that is a classic double bind, or in today’s vernacular a no win situation.

Systems of Conflict Resolution

If a disagreement reaches the point that one feels threatened or under attack, either verbally or physically, he may respond in a variety of ways.

Attack/Attack system

He may retaliate in kind which is an attack-attack system. This is almost guaranteed to increase the level of anger, as each participant attempts to outdo the other.  These are the types of interaction which can lead to violence.

Attack/Placate system

The attack-placate system is often seen in cases of spouse abuse, when the abused attempts to talk hubby out of his anger by reassuring him and in other ways spreading oil over the troubled waters. This too usually fails as the abuser may feel patronized.

Attack/Divert System

Another type is the attack-divert system which as you might imagine can become rather bizarre. This might be effective in minor skirmishes, but simply changing the subject in the face of overt hostility is weird, and leaves the problem unresolved.

Acknowledge the Affect

For the best method to deal with such emotionally laden situations, I hearken back to my mantra of “acknowledge the affect.” In such cases, the message the attacker is trying to send is that he is feeling some kind of negative affect such as: anger, hurt, envy, jealousy, or fear.  Statements such as “I can see you really feel strongly about that” or “are you angry with me?” will often defuse the situation.  It is not necessary to change your opinion or point of view, but simply to communicate that you understand how he feels.  If your attacker’s affect is not available then one can use his own such as: “I feel …………” The concept has wider application, for in any emotionally charged situation it only makes sense to deal with the emotions rather than to ignore them.

What’s Next?

In my next blog, I plan to focus on child rearing. I am well aware there are probably hundreds of books written by people who are convinced they know better than you how you should raise your kids.  I don’t plan to do that since I have made plenty of mistakes in that department; although my kids all turned out well in spite of my screw-ups.   Rather than directions as to how one can raise perfect little people, I plan to provide helpful hints on how to screw up your kids lives: I call it “How to screw up your kids without even trying.”

Thanks for reading!

THE POPE AND I

No, I did not have an audience with the Pope. I confess that this title is a bit misleading, but you must admit it got your attention.

The Pope’s visit got everyone’s attention especially viewers of CNN, for their coverage was non-stop from arrival to departure. This must have made their bean counters happy, since I imagine their bottom line could be adversely affected were they to pay independent journalists to cover the horrors taking place in the middle-east and Africa, or the desperation of immigrants around the world.

You may be wondering why I didn’t change the channel to Fox and watch them trash democrats or MSNBC, as they did the same for republicans, or even to Sesame Street in case I wanted to learn something worthwhile. The problem is that Barb likes CNN.

Although I don’t wear a long white dress and beanie, I found his speeches interesting and even inspirational. At one point I nearly pulled a John Boehner and could feel a tear about to erupt. In most cases, his thoughts and opinions paralleled mine therefore; he must be pretty smart. In particular, his speech at the U. N. caught my attention when he talked about the need for people to bond and trust each other. I concluded that the Pope had much in common with this old Presbyterian. It occurred to me that our need to bond with each other seems to be universal and can have both good and bad consequences.

My understanding of Pope Francis's statement, which would result in people caring for each other, and in so doing to learn trust. There is little doubt that if such feelings for our fellow man were present in everyone, this world would be a much more pleasant place in which to live. Of course, this in not a novel idea. Many have espoused it for the past couple of thousand years, if not longer, but with minimal effect. In fact, religions both past and present, expect their members to meet and worship together. They usually encourage fellowship, and the experience of belonging to a caring group of people is fertile ground for the development of trusting relationships. The Pope must have felt there was a lot of bonding going on as millions flocked to hear his words and receive his blessings.

The Pope and I agree that bonding and trust are important. A very common complaint by my patients was of loneliness, and feeling a lack of connection to others. As a matter of fact, most of the perpetrators of the recent spate of mass murders are said to have been alienated from society. Notes they left reflect the anger they felt at being left out and alone. Group therapy has been a useful tool in dealing with such problems as it provides an opportunity to relate in an atmosphere where one can share in a safe environment, and learn to trust and be trusted. This need to bond appears to be so ingrained in our very nature that we sometimes look for other ways to satisfy the need. Those whose lifestyle or physical infirmities limit their relationships may find solace in a pet. There have even been instances reported in which prisoners who are isolated attempt to befriend the rats who visit their cells.

It is not clear when this need, so powerful that if unrequited may lead to suicidal or even homicidal behavior, became so ingrained in our psyche. There is evidence that earliest man  learned the advantages of close relationships. Indeed, it is likely that without such bonding, our prehistoric ancestors might not have survived, and could have become extinct as did other branches of the hominid progeny. Indeed, in a world where predators threatened their existence and competed with them for food, it would not have taken them long to realize there is safety in numbers. Likewise, as they developed carnivorous tastes they would have found that teaming with others would contribute to successful hunting. Such lessons learned were not unique to humans for many other mammals found that bonding with others of their species enhanced their chances of survival. With such a history spanning thousands of years, it should not surprise us that this need to bond would eventually become imprinted on our DNA.

There are some, myself among them, who are concerned about the ways in which our children are limited in developing relationships to which they can bond. Home schooling has become more popular and is likely to become more so as the digital world expands. I have long been concerned as I have seen the consolidation of small neighborhood schools to become institutions that are so large it is very easy for a child to be left out of the mainstream. Since K through 12 school is where children learn social skills, and develop much of their self-image, such feelings of alienation can have serious consequences. Parents face a great deal of stress sometimes working two jobs, and stay-at-home moms are less plentiful. It appears that kids spend much more time texting than talking. The rest of their free time is often spent playing video games. And, yes I know that a previous generation had the same concerns with the invention of the telephone, as my Grandson eloquently pointed out to me a few months ago. I agreed that the phone was a step down from looking one in the eye, but did preserve voice inflections and thereby we were not quite so insulated from the feelings of callers.

Most people would agree that neighborhoods are not as neighborly as they once were. The current generation prefers distance from their neighbors as witnessed by the current housing developments where larger lots are preferred and “houses are not jammed up against each other." Studies of large city apartment buildings indicate that many residents do not even recognize their neighbors. On the other hand, I did recently read that some companies are now eliminating the cubicles in which they isolated their employees, as they have decided that their workers were much more productive in an open office space. It was felt that the changes also resulted in feelings of camaraderie with coworkers, company loyalty was strengthened, and absenteeism was reduced. Such examples illustrate when barriers are removed, there is a natural tendency to bond.
Of course the ultimate bonds are those with our immediate families, but for most this does not seem to be enough. When populations grow so large that physical contact is impossible, they still find ways to bond. Witness any athletic contest and you will see groups sometimes numbering in the thousands banding together to cheer on their team and boo the bad guys. Though there are some loners among us, most seem to have a need to closely align themselves to a group or organization. There are lodges, fraternities, sororities, clubs, religious and political groups, reunions, and volunteer organizations to name a few. There seems to be an almost universal need to belong, to be attached in some way to others.

History tells us that nothing unites a group of people, whether it is a neighborhood, tribe, or country, like a common enemy. It makes little difference if the threat is real or imagined. Throughout history leaders of nations have been able to mobilize and bond their subjects by convincing them they have an enemy. Coaches have long known that their team’s success depends to a great extent on the relationships between their players, and their ability to function as a unit. Those who work in dangerous positions such as fire fighters, policemen, heavy machinery operators and such must depend on others to “watch my back;" consequently, trust is essential, and camaraderie is a prerequisite. Many religions bond together in their struggle against demonic forces of one kind or another.

Nowhere except within families is bonding more intense than in the military. Recruits soon unite by learning to hate their drill sergeant. The entire unit may be punished for the transgressions of one; thereby teaching him a sense of responsibility to his buddies. One may enter the service for a variety of reasons, but once in combat they report their allegiance is to those who fight beside them. The bonds formed are so intense that some experience grief after leaving their unit in spite of the dangers and horrors they may have faced. This sense of loss in addition to the survivor guilt often felt are undoubtedly factors which account for the epidemic of suicides by returning soldiers from our latest war. Some have volunteered for return tours of duty apparently hoping to recapture that which was lost.

It is true that relationships are not only pleasing, but probably necessary in order for us to maintain sanity. Indeed, one study from many years ago where volunteers were subjected to total isolation, all developed psychotic symptoms in as little as two weeks. It is also true that throughout the ages there have been the cunning and unscrupulous who have perverted this need of ours to service their lust for power. The mechanism as I mentioned previously is simply to convince a group of people that they have a common enemy and that they must unite to protect themselves or punish the miscreant for his alleged misdeeds. One need only to turn on the nightly news, and hear about the violence and chaos that persists throughout the world to see how successful these strategies have been as populations bond together to destroy their own version of the bad guys.

Although in the U.S. we moderns no longer have saber tooth tigers to fear, there are many who have no difficulty finding people to hate and whom we should fear. We have the white supremacists who are convinced we are in danger of being persecuted by blacks, the gun lobby who wants us to fear everyone, and other groups too numerous to mention. And let us not leave out our politicians as the republicans convince us we should fear the democrats and the democrats tell us the republicans are the ones who will do us in if given the vote. In other words, we are encouraged to choose sides, bond, and fight with each other. In order to fight we need a leader to save us, and there are always those who are gracious enough to be that person if only we will vote for him.

If I ever did have an audience with the Pope, I would enjoy discussing this bonding and trust stuff with him. I would probably agree that more bonding and trust is needed, but that in many instances those same qualities can also be used for nefarious purposes. In that vein, I can see myself saying, “Frank, be careful what you wish for” or in his case it would be more appropriate to modify the admonition by substituting the word "pray" for the word "wish."