Tuesday, October 31, 2017


Over the past year I had been experiencing the pervasive sense that large numbers of people in the US were going crazy. From neighbors, colleagues, patients and random persons on the internet I heard statements that sounded extreme in their despair, fear and rage. At times the statements entered the realm of clinical paranoia. I was told by left-of-center persons that America was full of Nazis, and by persons to the right that the "Left" was engaged in a purposeful campaign to destroy the Constitution and install a totalitarian regime. I blamed the media and our two main political parties for the incessant drumbeat of hysterical "news" stories, inflammatory language and demonization of others that fed this mass hysteria. But it turns out that the real story is even weirder: It was the Russians.

Why do people succumb to propaganda and why can't they see that they are being manipulated? There are many factors:

Conformism: Humans are social animals and want to "belong." If a group of people with whom someone wants to associate insists on a shared belief system, many people will adopt the beliefs even though those beliefs have no basis in fact. The strong need to "belong" will override logical thought processes.

Displacement: Persons with histories of abuse or neglect in childhood deal with anxiety, anger and even outrage, but may be unable to connect those emotions with their childhood experiences due to wanting to protect the images of their family members. Instead, they direct their fear and outrage toward public figures or groups or imagined groups. It is emotionally convenient to fear and hate those you don't personally know.

Self-esteem: Many people revel in a belief in their own moral superiority. By aligning themselves with what they see as a virtuous or righteous position and condemning others who disagree, they feel better about themselves.

What can counter these dangerous tendencies? Here are some tips:

1. Learn history. The better educated and older people I know demonstrated less susceptibility to the propaganda, and not just because they don't use Twitter. It's that they (we) have seen it all before, and what we haven't seen personally we have read about. Propaganda and popular hysteria are nothing new. There have been waves of mass hysteria throughout history, often with atrocious, catastrophic or genocidal results.

2. Use logical analysis to assess claims made by groups, including established groups. It doesn't matter who made the argument or published the news story if it doesn't make sense.

3. Listen to your gut instincts. If something seems fishy, it probably is. If you can't put the pieces together, maybe it's because they don't fit. Ask yourself: Is something missing from the story? Does the story seem too bad or too good to be real?

4. Live a healthier lifestyle: Acknowledge your childhood traumas, build your self-esteem in healthy ways and seek friends who don't demand that you agree with their political beliefs. Talk to different types of people and listen to them.

Tuesday, October 24, 2017

Harvey Weinstein Heads to Rehab

Yesterday I read that Harvey Weinstein is checking into a facility for treatment of "sex addiction." Is repetitive sexual harassment or sexual assault a form of sex addiction? 

Sex addiction, like any addiction, is a repetitive, compulsive behavior. The hallmark of any addictive behavior is that it is experienced as being outside of the person's control. A common self-test for addiction is to try to stop the behavior for a period of time. If you find that you are engaging in the behavior after you told yourself you wouldn't, this could be a sign of an addictive disorder. Simply making something a habit is not itself  a sign of addiction. If the behavior is under the person's control, an addiction has not been established regardless of how dysfunctional the behavior is.

Sex addicts typically either frequent prostitutes, pick up random strangers for sex on a regular basis, or spend hours masturbating to online pornography. Some also compulsively attend peep shows and strip clubs. Eventually they start to realize that they are spending enormous amounts of time or money (or both) on their sexual activities, and perhaps endangering their health or even their lives. At this point an addiction has been established, and sometimes, people seek help.

Based on the publicly reported evidence, Weinstein appears to have exercised great control and planning in his harassment activities. Subterfuge and the assistance of allies appear to have been involved in the various scenarios that have been reported. The cost of hiding the behavior appears to have been calculated. This type of planning and execution is rare in addictive behaviors, because, as I said, the hallmark of addiction is that the behavior has spun out of control. In addition, on a deeper psychological level, addiction is about a regression in which the person unconsciously grants power to a substance or behavior, enacting a dominance/submission dynamic in which the addict is the submissive. In Weinstein's case, it's obvious that the dynamic went the other way in his encounters with young actresses and models.

If it's not an addictive disorder, is it possible that Weinstein has a different clinical disorder? It's possible and perhaps likely, but it may be one that it is extremely difficult to treat. Pleasure in exercising control and dominance over others is sadism, a psychological phenomenon that is rarely treated because sadists don't seek help. I'm not aware of any standard treatment protocols for sadism except perhaps psychoanalytic therapy to resolve early childhood traumas and conflicts, but, as sadists are rarely interested in such treatment, there isn't a lot of evidence regarding outcomes. Sadism is often a component of antisocial personality disorder (also called sociopathy or psychopathy) and this disorder is notoriously difficult to treat. Confrontation and limit-setting may be the only ways to address sociopathic behavior. People, like other animals, respond to negative consequences for behavior.

Wednesday, October 18, 2017

Mass Culture and the Normalization of Pathology

Yesterday I wrote a post about the psychological defense mechanisms often used by trauma survivors and others, and how these defense mechanisms might prevent awareness of traumas and crimes. But are psychological defense mechanisms the only reason why people don't address sexual harassment, sexual assault, and related issues? Of course not. Our culture supports the minimization and rationalization of sexual harassment and violence against women and normalizes the oppression of women People don't complain about, or sometimes don't even notice, what they consider "normal."

Repetitive presentations of violent or degrading images in tv shows, movies, video games and in online pornography trigger the use of the defense mechanisms I noted in yesterday's post. Today's youth (I'm using "youth" expansively to mean persons under 45) have grown up with pornography, reality tv shows in which people are deliberately humiliated, and violent imagery in television that wasn't permitted or just didn't exist 40 years ago.  Repetitive viewings trigger dissociation, separating the viewer from his or her emotions. The viewer stops experiencing the normal feelings of disgust and fear that these images would otherwise generate.  Unfortunately, the use of these defenses then becomes a habit. The individual who routinely uses dissociation in order to view tv, video games or pornography without disgust and fear then becomes unable to recognize violence and humiliation perpetrated on others in real life. Violence and humiliation become "normal." The dissociation doesn't just destroy empathy for others; it can also lead individuals to deny their own victimization, because they are dissociated from (disconnected from) their own emotions.

The notion that women's bodies are a commodity for men's entertainment has been normalized, including in persons who don't view online pornography or violent films. The commodification of women is an old practice and has only gotten worse in recent decades as it has become more generally acceptable and out in the open. As a psychotherapist who works with men and women, I hear things that most people don't, and have come across more than a few examples of how people who would generally be considered liberal or worldly or even feminist still can accept the notion that women's bodies are for men's entertainment. Here are some vignettes, all from the past 8 years:

1. A man who worked in sales told me team meetings were sometimes held in strip clubs. I pointed out to him that this was done to exclude women or make them feel uncomfortable. He looked surprised. This hadn't occurred to him. He didn't disagree with me; he simply hadn't thought about this possibility.

2. I was working with a man who I thought might have a problem with online pornography. I decided it might be important to find out what type of porn he was viewing. It turned out he mostly looked at women giving men blow jobs. I pointed out that these images represented a woman doing something for a man. A look of horror came over the man's face; he considered himself a feminist and didn't want to think of himself as someone who thought women should serve men. Yet he hadn't noticed the pattern in his choice of pornography and pondered what it might mean.

3. A man told me workers at the social service agency where he was employed had a get-together at a local Hooter's. I found this odd considering that many women work in the social services field. Apparently, women are now so dissociated from their own femaleness that they can watch other women degrade themselves in a low-wage job to obtain tips, and not feel uncomfortable.

The reality of women's oppression is also obfuscated by the invention of euphemistic phrases or new definitions of words. "Casting couch" and "sleeping her way to the top" have now been revealed to mean "raped and silenced with job offers." For decades women and men alike have been brainwashed by these euphemisms to believe that women initiated these encounters or at the least agreed to them in advance.

More recently, the word "choice" has been confused with the word "empowerment." The words aren't synonymous, as many choices are not empowering. I find that when I point out examples of internalized oppression or capitulation to oppressive systems, the person to whom I am speaking sometimes will tell me that the behavior can't be an expression of internalized oppression or defeat because the person "chose" to engage in the behavior. But people also "choose" to commit suicide. They choose to shoot heroin. These aren't examples of empowerment. In addition, many so-called choices are not made freely. The 12-year-old girl in East Africa who "agrees" to be genitally mutilated is not making a "choice." And yet, I found out recently that the ACLU--supposedly an organization that supports freedom--supports the "right" of persons in the US to "practice" this form of torture and disablement because it is their cultural "choice." We are well into the realm of Orwell's "1984" with this type of re-definition.

The overwhelming presence of mass media and entertainment media in people's lives has been a boon to those who want to entrench sexist notions. Media and entertainment companies are still mostly run by men, and these men have used media to shape and alter people's emotions and perceptions. Through the control of images and the manipulation of language, violence and oppression have been normalized.

Tuesday, October 17, 2017

Normalization of Pathological Behavior, Part One: Psychological Defense Mechanisms

Since the Harvey Weinstein revelations, I've been thinking about the normalization of pathological behavior. This is a common phenomenon in our society and in most societies.

This article in The New York Times summarizes the reasons why women often don't report sexual harassment--mainly, that they fear retaliation. There are other factors, however, that make people in general turn a blind eye to harmful and pathological behaviors. These include psychological defense mechanisms such as denial, rationalization and dissociation, effects of mass culture, and deliberate propaganda by vested interests that uses rhetorical tricks to minimize atrocities. I'll address psychological defense mechanisms today.

Psychological defense mechanisms serve to ward off anxiety by distorting reality. In rationalization, the mind invents "reasons" why something happens that aren't really logical, but serve to distract from an unpleasant or frightening reality. In dissociation, consciousness is altered so that an experience isn't perceived at all in daily consciousness, but may be acted out unconsciously, or remembered while in an altered state (such as hypnosis). Denial is a phenomenon in which "the existence of unpleasant realities is disavowed; [it] refers to keeping out of conscious awareness any aspects of external reality that, if acknowledged, would produce anxiety" (Kaplan and Sadock, "Synopsis of Psychiatry," 2007 edition). Denial and dissociation are closely related.

The mind resorts to defensive maneuvers in order to preserve physical health. Overwhelming stress can cause great damage to the body--altering hormones, damaging the immune system, interfering with sleep and worse. The survival instinct will undermine the mind's ability to accurately perceive reality in order to avoid the physically damaging effects of overwhelming fear.

People who have been victims of rape or other traumas not infrequently experience dissociation. Aspects of the trauma may be blocked from conscious awareness.

Sometimes trauma survivors invent "reasons" why the incident occurred (rationalization). As the general population is made aware of behavior such as Weinstein's, others may also engage in denial or rationalization. People don't want to believe that another human could be that horrible, and perhaps especially, when that human is the same gender as they are. It's too frightening.

The way to overcome denial, dissociation and rationalization is to speak about the crimes and traumas. Overwhelming evidence eventually destroys the use of distorting defense mechanisms, in all but the psychotic.

Wednesday, October 11, 2017

Raising Resilient Children

There have been a plethora of books and articles written in the past few years about the lack of "resilience" among members of "Generation Y" (people born from approximately 1985 to 2000), what has caused it and what to do about it. But now, the millenials are starting to have their own children. How can they avoid the mistakes of their parents? Here are some tips:

1. Have more than one child and make sure that siblings aren't more than 3 or 4 years apart in age. I know this might not be feasible for all parents, but it is worth mentioning, because the advantages of siblings outweigh the negatives, and the advantages are significant.

 Although some studies in the past indicated that only children have higher achievement, some studies also found a greater incidence of drug addiction among only children.

People who grow up with siblings learn crucial skills of negotiating, sharing, advocating and taking turns, earlier and more consistently than only children do. More importantly, a sibling close in age is a "buddy" who provides peer identification, which is important for personality development. Only children often feel lonely because school friends and play dates aren't a substitute for a sibling, and worse, when the parental marriage is dysfunctional, an only child can become a parent's best friend, an unnatural situation that interferes with personality development and in the worst cases leads to incest.

Although I've heard stories of dysfunctional sibling relationships (including abuse), the majority of my patients who have siblings have benefitted from those relationships. Siblings too far apart in age often don't function as siblings, however, with the older sibling often taking on a quasi-parental role that may not be appropriate.

2. Allow your child to engage in unstructured, unsupervised play. It really is true that hovering parents interfere with a child's developing sense of autonomy. Let young children play by themselves (or with siblings) in their rooms, and let school age children play by themselves in the backyard, if you have one.

3. Send your child to sleep-away camp if you can afford it. Do this when your child is 11 or 12 years old. Sleep-away camp can be a way for only children to get some of the benefits that children with siblings get. A good sleep-away camp offers challenging outdoor activities that build confidence.

4. Remember that academic achievement alone doesn't guarantee success in life. The Unabomber went to Harvard. Prestigious academic degrees don't guarantee mental health or social functioning. I have found that many of my patients who are the children of immigrants were kept home after school to study, study, study. The end result is often anxiety disorders and worse. Just today I read an article in The New York Times about the skyrocketing rate of adolescent anxiety disorders, with one teen profiled  taking 3 Advanced Placement classes as a high school junior. I don't understand why this is allowed by the school, much less by the parents.

5. Be a role model of mental health. The best way to be a good parent is to be a healthy parent. Parents with untreated depression or those who engage in substance abuse tend to have emotionally disturbed children. Nine times out of ten, when I worked with children, I found that there was either abuse or neglect going on or a parent had an untreated disorder. Unfortunately the media sometimes give the impression that children's emotional disorders are purely genetic, purely socially constructed,  or unfathomable, and this isn't true.