Tuesday, August 8, 2017

If Psychotherapists Ran the World

If psychotherapists ran the world, it would look a lot different.

Let's start with the U.S. We would have universal healthcare, because all psychotherapists know that the patchwork system we have doesn't work and isn't fair. We work every day, in one capacity or another, with the healthcare system, and as most of us are self-employed, we know from personal experience that the current system is unworkable for self-employed individuals. Obamacare helped many people, but didn't resolve many of the underlying problems.

We would require large businesses to have onsite daycare, because psychotherapists know that there's no substitute for an early parent-child bond. All businesses would be required to offer both maternity and paternity leave.

We would have a different foreign policy. All psychotherapists who have worked with children or with dysfunctional families (all of us) know that the cardinal rule of behavior modification is "ignore the negative behavior." Paying attention to negative behavior rewards the behavior, and the child (or adult) is encouraged to continue or even to escalate the behavior. Responding to provocative behavior and threats from other world leaders by making threats in kind and engaging in provocative rhetoric is exactly the opposite of what you want to do.

Should I run for office?

Saturday, July 22, 2017

When You "Assume"...

There used to be an old saying about assumptions: "Never assume; it makes an "ass" of "you" and "me."" This piece of wisdom seems to have fallen by the wayside.

Assuming can lead to social bloopers. But it has worse effects: It can lead one into dangerous situations. One of the most common assumptions, in my observation, is the one held by many women that if a man seems like a nice person, he is a nice person.

Women are socially trained to be "nice" and accommodating and to not be "critical." Although many women don't adhere to these norms and stereotypes, all women are to some degree affected by this social conditioning.

Even with my decades of professional experience and training, I don't always know in the first session that a patient I'm working with is a sociopath or a dangerous person. Sometimes such individuals reveal themselves quickly, but others mask their dangerous traits--in a psychotherapist's office, the disguise is in the form of other symptoms. In real life, the disguise is in the form of charm, sociability or verbal skills.

Both men and women can be sociopaths. In women, being pretty can be the "disguise" (disguises aren't necessarily deliberate). There's been research showing that physically attractive people are assumed by many people to be morally superior. This assumption--like most assumptions-- isn't based on facts.

Making assumptions won't make you popular with other people. It might sound like a compliment to say to someone, "But I thought you were much younger!" but depending on the person, it might not be heard as a compliment. It might also make you look like you're not very observant or that you are being dishonest.

People respond more positively to  questions and interest in the responses. Most people, particularly women, are attracted to others who show interest in finding out who they really are. The generic compliments some men give women on dates might puff up the self esteem of a woman who is insecure, but a woman with better self esteem responds more positively to questions about who she is and what she likes.

Professionals, including mental health professionals, aren't immune to assumptions. An amusing (or not) example is the following experience I had while working in a residential treatment program for men with mental health and substance abuse problems, in the 1990s: One of my tasks was to write up summaries for patients' post-discharge housing resources. I scanned the initial assessments of one such patient, and saw that the psychiatrist and other professionals had consistently described the patient as "white" or "Caucasian" in their assessments. I didn't know the patient well as I didn't do individual counseling at that job, but I had been trained to never make assumptions and to never go by another clinician's assessment. "How would you describe your ethnic or racial background?" I asked him. He looked confused. "I'm black," he responded. I decided not tell him that he had been assumed to be white by numerous persons.

I don't assume I know people's race, their age, or even their gender, unless the facts are extremely obvious. I certainly don't assume I know their personalites just by looking at them. It's always better to act from the standpoint that you don't know than to assume you know things about people based on outward appearances.

Sunday, June 25, 2017

Snappy Answers to Stupid Questions (or Comments). Or, How to Defuse Conflicts Without Really Trying

When I was 10 years old, my favorite reading material was MAD Magazine. For those of you who don't know, it was (is?) a humor magazine that's somewhat lowbrow, although nothing I read in it in those days was offensive. One of my favorite features was called "Snappy Answers to Stupid Questions." Unfortunately, I can't remember any of the snappy answers I read in MAD more than 40 years ago. But, I've come across gems of snappy answers over the years. These type of retorts serve to defuse potential conflict through humor, a useful skill.

Probably the best snappy answer to a stupid question of all time was voiced by Mohandas ("Mahatma") Gandhi, India's national liberation leader: A journalist once asked him: "What do you think of Western civilisation?" He replied "I think it would be a good idea!" (For those of you who don't understand this, read up on the history of the British Empire).

Another of my favorites comes from Pablo Casals, the famous cellist. When in his 90s, he mentioned that he still played the cello, and someone (another journalist, I think) asked him: "Why are you still practicing at this age?" which is an ageist and clueless remark. Casals replied,  "Because I think I'm making progress!"

Obese people have told me that they've had experiences of being in a fast food restaurant when another customer said to them something like "You shouldn't be eating those fries." A standard retort: "It's true I'm fat, but I could lose weight. Unfortunately there's no cure for stupidity/bad manners." (That may not be completely true, as people can learn better manners, but they usually don't).

A sense of humor is considered an important psychological strength by psychotherapists. In fact it is classified as an adaptive defense mechanism.

I've noticed that despite a plethora of comedy on tv and in movies, many people today are taking themselves too seriously, are easily offended, and at the same time are often afraid to use the type of snappy answers I've cited above because they are wary of offending others. But snappy answers can be a way to put people in their place so that you are standing up for yourself without arguing or throwing a temper tantrum. They are more likely to be heard than direct reprimands or lectures.

There are times when it's best to hold one's tongue, such as when dealing with your boss at work. But in most cases it is better for one's mental health to respond to offensive remarks. Practice some snappy answers to the type of insults that you encounter so you'll be prepared for the next time.

Addendum 7/15: And for my patients who work in media, I found the following:

Sunday, May 28, 2017

How to Argue

After last November's election, I saw a number of media articles about disastrous arguments that had erupted among family members and even between couples. There used to be an old saying, "Never discuss religion and politics" in conversation. But today, people sometimes have difficulty finding non-controversial subjects to discuss, partly because the media likes to enhance controversy and division, and partly because entertainment has become so splintered many people aren't watching the same tv shows or movies as their friends or family. To make matters worse, many people today don't know the rules of debate. The rules of what used to be called rhetoric certainly are not modeled by our politicians or  by the media. Here are some of the basic rules:

1. Arguments must be supported by facts. Facts are pieces of information that are demonstrably true. Something isn't true based on the number of people who believe it. A billion people could believe something and it could still be false. Many beliefs throughout history have been believed by the majority of the population of a country or region yet were found later to be utterly false. Truth is supported by observable evidence. The evidence might only be observable with an electron microscope, or it might only be indirectly observable (psychotherapists can observe the workings of psychological defense mechanisms, even though the mechanisms themselves are caused by brain patterns that we haven't yet been able to pinpoint, for example) but there must be observable evidence to support the argument.

2. Arguments and positions must be evaluated on their own merits, rather than being judged by who did the arguing or who holds the position. This is the classic distinction between an "ad jure" and an "ad hominem" attack. An ad hominem attack is a personal attack. For example: Sen. Smith supports a controversial bill. Someone argues against his position by saying "Sen. Smith cheated on his wife who divorced him." This is an ad hominem attack. The problem isn't so much that the attack is personal, the problem is that it is irrelevant. Sen. Smith's marital history is only important if one is planning on dating him or marrying him. It has no relevancy to the legislation he supports, even if the legislation concerns marriage. The validity of the legislation has to stand (or not) on its own merits. The personal attributes of its sponsors have no relationship to the validity of the legislation.

3. Guilt by Association is a smear tactic and should not be used. Guilt by association is often used as part of an insinuation or innuendo. For example: "I saw Sen. Smith talking in a parking lot with the Grand Wizard of the Ku Klux Klan." Unless we know what transpired in this conversation, this is an irrelevancy. Even if the Grand Wizard of the Ku Klux Klan endorsed Sen. Smith for public office, this does not mean that Sen. Smith holds the same views as the Klan, unless Sen. Smith asked for an endorsement from the organization or its leader. Although one might assume that an endorsement is done because of similar beliefs held by the endorser and endorsee, that may not be true. The important question is what does Sen. Smith believe and support? Sen. Smith's political positions have to be evaluated based on their own merits or lack thereof.

4. A "Straw Man" argument is an innuendo/insinuation that manufactures a controversy; it is a dishonest tactic that should not be used. Wikipedia has a good entry about Straw Man arguments:

5. Sources cited must be credible. Here are some basic rules for sources that I learned as a journalist in the 1980s, before the profession sank into the mud: a) Information should come from more than one source, especially information that is politically sensitive, incendiary etc. The standard rule for reporting sensitive stories is that the same information must come from two independent sources, in other words, two sources who aren't in collusion with each other  b) Sources must lack bias. In other words, they cannot have an ulterior motive. c) Sources cited as experts must actually be experts. Having an opinion does not make one an expert. Experts are persons with extensive training and/or professional experience in a given field.

If one reads many of today's news outlets (many of which are not actually newspapers or magazines but agenda-driven websites) one can find stories written based on only one source or based on sources with bias. The most notorious recent example was the Rolling Stone magazine campus rape story that was retracted. It was almost entirely based on the account of the victim with no corroboration. For other examples, look for news stories that quote agenda-based organizations on the same topic that the organization promotes or attacks. Anything such sources claim should be taken with the proverbial grain of salt. Just because their spokesperson is being quoted in a newspaper does not mean that what the spokesperson says is credible.  In fact their bias discredits them. Many news stories try to sidestep this rule by printing "opposing views." They publish (or broadcast) two persons' views that are in opposition to each other. But both viewpoints could be false, if they aren't based on facts. If the subject is technical or scientific or requires professional expertise to understand, the viewpoint is only credible if the person is an expert.

Many ordinary people when arguing a point will base their argument on what they read in the media. Unless the media source you are citing follows the above rules, your argument may be based on false information.

If ordinary people followed all five rules I've cited above, arguments would be less volatile. Because they would be fact-based, the opponent may catch on that listening is an opportunity to learn. If the opponent has no facts, he or she may discontinue the argument and head to the library to find some. Both parties might learn to have more respect for each other, because we tend to respect people who know facts and who avoid insinuations and personal attacks.

Saturday, May 13, 2017

Reading Fiction for Better Mental Health

Does reading improve mental health? There's evidence that it does.

It's long been known that reading improves overall cognitive ability. Studies have shown that there's a correlation between early literacy in children and higher IQ scores later in life, and that reading in older adulthood delays cognitive decline to some extent. Reading involves the decoding of symbols (letters) and forces the brain to interpret words in context--perhaps the brain requires this exercise to stay fit. Pictures don't have the same effect, because understanding them doesn't use the same brain functions.

But what about emotional health? There are several ways reading may improve emotional well-being. This rather long article in The New Yorker http://www.newyorker.com/culture/cultural-comment/can-reading-make-you-happier
on bibliotherapy cites some studies indicating that reading fiction improves the capacity for empathy and also, can be a "mindfulness" activity (see my previous post on mindfulness).

This brings up the issue of what type of reading we're talking about: Any type of reading may increase general cognitive function, but reading fiction, particularly the best fiction, may have special benefits: Good fiction convinces the reader, temporarily, of the "realness" of the characters, setting and events (thus inducing a trance state that removes the reader from his/her real-life troubles). Good fiction also includes well-developed, multi-dimensional characters and immerses the reader in the character or characters' inner and outer worlds, helping the reader see through their eyes. It's easy to see how this could increase the capacity for empathy.

The best writers portray villains who perhaps weren't always evil, and heroes who are flawed. These nuanced explorations of human nature may especially help readers with personality disorders. Persons with Borderline Personality Disorder in particular typically divide the world into polar opposites: Good v. Bad people, and simplistic or extreme interpretations of events. These tendencies are found in people with Borderline Personality Disorder even when the person has a high IQ, because these distortions are caused by dysfunctional ego defenses, not by low intelligence (see my previous post on Borderline Personality Disorder from Oct. 14, 2015 ).

Reading fiction might also help persons with depression: The characters in the best fiction grapple with conflicts and make mistakes, even when they are the novel's "heroes."  Reading about their struggles might help self-critical persons moderate their self-criticism.

In short, reading is important, but it matters what you read. Many of the opinion essays,  Facebook posts etc. that I come across on the internet are nothing but recitations of popular slogans and catchphrases. They often demonize opponents by using hyperbolic language. They often promote a code of "correct" language that is remarkably reminiscent of the "newspeak" of Orwell's classic dystopian speculative fiction novel "1984." The purpose seems to be to increase fear and hatred of opponents,  as well groupthink and submission to self-promoted "authorities." These are the tools of authoritarianism and totalitarianism. This type of reading can have a negative effect on mental health by increasing anger. It might even negatively impact overall cognitive functioning by encouraging simplification.

I've noticed over the years that although reading complex novels doesn't prevent mental illness, my patients who read fiction often seem to cope better with their disorders, including serious disorders.

To increase general knowledge, I recommend reading reputable non-fiction books written by academic experts or by reputable journalists who are basing their works on facts and research, not on opinions. To increase emotional well-being, I recommend reading  fiction (in any genre) that includes multi-dimensional characters. Maybe a book club is a therapy group!

Wednesday, April 12, 2017


The word "mindfulness" is coming up more and more in the popular vocabulary. What does it mean?

"Mindfulness" means simply a state of being aware. The practice of mindfulness is an element of Zen Buddhism that has been incorporated into some Western treatment programs, especially Dialectical Behavior Therapy. I can't comment on mindfulness as a spiritual practice because I am not Buddhist, but I can explain the ways it works psychotherapeutically: Focusing your attention on something stops anxious ruminations. Focusing for a prolonged period of time can induce a trance state, which is relaxing  and also is a component of hypnotherapy. In addition, mindfulness can increase appreciation for the world around you.

Mindfulness is an essential part of meditation.

Marsha Linehan, the founder of Dialectical Behavior Therapy, developed a series of mindfulness exercises to help persons with Borderline Personality Disorder manage their emotions. Mindfulness is a component of DBT, along with interpersonal skills training and elements of cognitive therapy. Since Linehan developed DBT in the early 1990s its use has expanded and DBT is now  used to treat people with anxiety, depression and PTSD. Here's an excerpt of a mindfulness exercise from Linehan's DBT workbook:

" `Awareness Exercises' 1. Awareness of the Positions of the Body: This can be practiced in any time and place. Begin to focus your attention on your breath. Breathe quietly and more deeply than usual. Be mindful of the position of your body, whether you are walking, standing, lying, or sitting down. Know where you walk, stand, lie, or sit. Be aware of the purpose of your position. For example, you might be conscious that you are standing on a green hillside in order to refresh yourself, to practice breathing, or just to stand. If there is no purpose, be aware that there is no purpose."

Another excerpt: "Awareness While Making Tea or Coffee: Prepare a pot of tea or coffee to serve a guest or to drink by yourself. Do each movement slowly, in awareness. Do not let one detail of your movements go by without being aware of it. Know that your hand lifts the pot by its handle. Know that you are pouring the fragrant, warm tea or coffee into the cup. Follow each step in awareness. Breathe gently and more deeply than usual. Take hold of your breath if your mind strays."

Mindfulness can help anxious or depressed persons get out of their inner world in which they may be dwelling on negative thoughts. Obsessive preoccupations are common in anxiety disorders and also for some persons with depression. These internal experiences often become disconnected from external reality. Mindfulness exercises can help re-connect the anxious or depressed person with the greater context of the world around them.

People who play sports or engage in artistic activities often practice mindfulness without realizing it. Perhaps that's why those activities are referred to as "recreation" (re-creation).

Too often we mindlessly engage in our daily activities. Eating mindlessly not only leads to weight gain but also denies oneself the pleasure of flavor, aroma and other sensory experiences of food. Many people walk through parks without fully appreciating the natural world around them.

On a vacation last year in Vermont I spent an hour in the afternoon doing nothing except sitting in a grassy area by the woods. I focused on the touch of the grass, the dark mystery of the woods, the blue sky, some unidentified plants and an occasional butterfly. I sat alone, which allowed me to experience the natural world without the distraction of conversation. I had the sensation of being in a timeless place in existence apart from daily life. In hypnotherapy, we often teach people to mentally escape to a "safe place" in their minds. But I believe real-life experiences may be necessary for many people to be able to imagine a safe place.

Anyone can benefit from mindfulness exercises and perhaps we all need them as an antidote to our frantic, distracted contemporary lifestyles.

Saturday, January 14, 2017

Winter Blues

Some people get depressed in the winter, and in the 1980s this was identified as an illness called Seasonal Affective Disorder. Today SAD isn't used as a diagnosis per se, but is described as an aspect of a mood disorder for some people. It's been theorized that reduced exposure to light in wintertime triggers depression for some people (perhaps by increasing sleep?).  But could there be other reasons  why people get depressed during wintertime?

Another possible reason for winter blues could be wintertime respiratory infections. Being sick isn't fun, and also, the body's immune response involves inflammation, and inflammation has been linked to depression (see my post "Can Vitamin D Improve Your Mood" from June 29, 2013).

Many people don't pay attention to infection control, and in a city like New York, this can be dangerous. It's important to wash your hands after taking public transportation--or, wear gloves. 

The most recent issue of Eating Well magazine suggests a few dietary tricks to reduce wintertime colds: Cinnamon has a property that inactivates viruses according to one study.  Try putting it in coffee instead of sugar, and mix it with unsweetened applesauce. The article also recommends Shiitake mushrooms, which have been found to improve immune cells (possibly because they contain selenium and other minerals and vitamins). If you don't like mushrooms, you could take supplements.  Probiotics may also be helpful, so regular yogurt is a good idea.

Perhaps another reason for wintertime blues is that people spend more time indoors during cold weather. Exposure to nature has been found to be beneficial to mental health. The Japanese sometimes practice a therapy they call "Forest Bathing"--which just means spending time in the woods (a wooded park is probably just as good). It's been found to reduce stress. This makes sense, because for millions of years before modern humans evolved, our ancestors found safety in trees. In addition, trees may give off organic compounds that promote health.

The way we live in New York City isn't  natural. Dark apartments, fluorescent lighting, overcrowded public transportation and lack of contact with nature all promote ill health. But infection control measures, good dietary habits, and perhaps taking a winter vacation to someplace like a national park in a warmer state or a Caribbean or Latin American rainforest could help.