Tuesday, October 31, 2017

Brainwashed!

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 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).

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, for most people.



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 younger children play by themselves (or with siblings) in their rooms, and let older 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 or a parent had an untreated disorder.

Sunday, September 24, 2017

What is Co-Dependency?

I've discovered many people do not know what the word "co-dependency" means.  It's a somewhat complex clinical term.

"Co-dependency" was coined in the addiction treatment field to describe a phenomenon observed among family members of alcoholics and addicts. Treatment professionals and others noticed that spouses of addicts and alcoholics frequently were high-functioning individuals, but that they often helped the addict/alcoholic cover up their addiction and "enabled" the addiction through "caretaking." These "enabling" and "caretaking" behaviors sometimes allowed the addict/alcoholic to continue their addictive behaviors past the point where they might have been forced to change, had they been on their own. These observations led to a belief among treatment professionals and others that family members of addicts needed their own treatment.

"Enabling" and "caretaking" can take a variety of forms. The spouse/partner might make excuses for the addict/alcoholic to employers, "explaining" that the person is "sick" and can't come to work, for example. If the addict/alcoholic is fired from employment, the co-dependent may take on additional work to make up the difference, instead of demanding that the addict/alcoholic stop the addictive behaviors and find a job.  The co-dependent in some cases may even facilitate the addiction by keeping alcohol in the home or by driving the addict/alcoholic to social events or perhaps even the liquor store. Why do people engage in these behaviors?

A theory began to emerge that the co-dependent was "dependent" on the spouse's addiction the same way that the addict/alcoholic was dependent on the substance. By comparing her/himself to the addict/alcoholic, the co-dependent could feel superior. The care-taking behavior was seen as making the co-dependent feel important. In some cases, the co-dependent behavior led to a "martyr complex," in which the co-dependent believed that he/she was a valiant and long-suffering individual. Underneath  these behaviors and beliefs there is typically a lack of self-esteem. Treatment for the co-dependent involves helping the person get in touch with his/her feelings of low self-worth, and guiding the person to finding productive ways to raise their self-esteem instead of through comparing themselves to a dysfunctional person whom they need to remain dysfunctional in order to fulfill this purpose.

Because so many alcoholics and addicts are men, for a long time the stereotype of the co-dependent was that of a wife. However, it's been my observation that more men than women have co-dependent traits, and that these traits are often normalized in men--the "White Knight" who rescues a damsel in distress, or the man searching for an "Angel with a Broken Wing." We are so familiar with these characterizations that we may think of this as normal male behavior. Needing to feel superior is a sign of low self-esteem, and just because it may be common in men doesn't mean it isn't pathological.

Even though the co-dependent may "help" the dysfunctional partner or family member, the relationship doesn't serve anyone's interests. It enables the dysfunction and stresses the co-dependent. The dysfunctional person often starts to resent the co-dependent, sometimes sensing consciously or unconsciously that the care-taking behaviors are a form of control.

Anyone who has a close relationship with an alcoholic or addict should seek their own counseling. Any man who searches for an "Angel with a Broken Wing" as a partner should take a serious look at his own feelings of insecurity and inadequacy.

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 to 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:
https://www.mcsweeneys.net/articles/greeting-cards-for-your-online-trolls