Posts Tagged ‘psychiatrist’

trump12This blog entry is presented less as a political opinion than a medical opinion, but the political implications are staggering. I believe America has elected a sociopath as its next President, and, as a “mental health professional” that concerns me – in fact, it terrifies me.

What is a sociopath?

The current diagnostic term (per the new DSM-5) for the condition I’m referring to is “anti-social personality disorder” and, if you care to, you can go to the manual and read a long description of the symptoms. It all sounds like Donald Trump, almost comically so, from “inflated and arrogant self-appraisal” to “glib, superficial charm.”

I’m the first to admit there’s a worrisome aspect to mental health diagnoses, which is that they appear subjective. There’s no blood test, no pathogen you can stick under a microscope or obvious physiological indicator of disease. There’s just a description of human behavior and emotions. That hardly seems medical.

Nonetheless, the irregular human behaviors and troubling emotions that define mental illness – including sociopathy – are real and, they exist on a spectrum, so when they are severe, they can be very serious indeed. We all feel down once in a while, but if you witnessed the effects of catatonia in someone suffering from major depression, its severity might startle you. Likewise, knowing someone slightly “kooky” is different from encountering someone suffering from the hallucinations and delusions produced by severe schizophrenia.

Sociopathy is unique and troubling in part because of a peculiar paradox: the more severe the condition, the more difficult it can be to detect. It’s hard to see what isn’t there, and sociopathy, unlike schizophrenia or depression, is about the absence of normal controls on a person’s behavior. It’s easier to notice something new, that doesn’t belong in someone’s psyche, than something we take for granted that’s missing. And what’s missing in a sociopath is the very humanity that might make it hard for him to hide his condition.

So what is sociopathy, really? In brief, it amounts to the absence of a conscience. Whatever it is within us that we call empathy or caring or concern or connection to others, doesn’t exist in a sociopath.

My father, a psychiatrist who ran a secure ward at a state mental hospital, used to quip: “You know the true sociopath because he’s the one you lend money.”

What Dad meant was that the most severe sociopath is the one who can even fool a psychiatrist. And it really happened sometimes – my father used to recount in amazement stories about sociopaths talking their way right out of secure mental wards.

How do they do it? A sociopath has the amazing ability to tell you exactly what you want to hear. It’s as though they possessed empathy – astonishing powers of empathy – in the sense that they can intuit your desires, and sense what it is that you need to hear them say in order to produce a predictable emotional response. This creates a frightening ability to control others simply through insincere words and the inauthentic play-acting of emotions.

A moment after they tell you something – and this is the truly chilling aspect of sociopathy – a sociopath might be with someone else and say precisely the opposite of what they just said to you, with appropriate emotions displayed, simply because they sense that other person needs to hear something else and the sociopath wishes to control them, as well.

A sociopath will tell anyone whatever it takes, complete with apparently sincere emotions, to create the desired response in them, and thus influence their actions.

This phenomenon is sometimes called being a “pathological liar” and I’ve run into examples where the lying itself becomes the end goal – sociopaths who concoct stories to see how long they can fool people, then revel in being found out, as if that heightened the pleasure of the entire enterprise of deceit.

It’s been said that all criminals – at least, criminals with the intent to commit their crimes, perhaps not criminals who had to steal from necessity, due to poverty or desperation – are sociopaths. That’s because it is our consciences that keep us from doing things we know to be wrong. As members of a community, we sign on to a social compact, an understanding with other people, to care for one another, at least to the minimal extent that we agree not to commit acts we define as crimes because they hurt others.

The most dangerous sociopaths are the ones who are less concerned with fooling people or even stealing from people than they are with controlling people. They don’t want to be found out. They want the lies to go on forever so they can continue controlling those around them….

Which brings us to Donald Trump, our next President, and why I believe he’s a sociopath, and thus very dangerous, especially in his new role leading our nation.

First observation: Donald Trump tells lies without the least hesitation.

The lies are near-constant, and on their face, many are absurd. The lie about President Obama not being born in the United States could be disproven in a moment by posing the simple thought problem: Where would Obama’s mother, the teenage daughter of middle-class Midwesterners scraping by on modest salaries in Honolulu, fly to in order to give birth outside her own home country? Fiji? Japan? The Philippines? Chile? Any alternative, non-US locale she could have chosen (ignoring the question of why would she would go to all the trouble of choosing one in the first place and then somehow faking a US birth certificate) would involve an expensive, lengthy flight across thousands of miles of ocean just to place her near-penniless, American, teenage self for no particular purpose, outside the US. Likewise, the endlessly repeated lie that Obama is Muslim (particularly offensive, because it implies there is something wrong with being Muslim) is also flatly absurd, since Obama was raised by his Christian mother and grandparents and barely met, let alone knew, his Muslim father, a visiting graduate student from Kenya. It is absurd to imagine Trump actually believes such nonsense.

However, Trump knew those lies would produce the desired response in an audience of racist, anti-Muslim extremists who hated Obama, and so Trump told those lies. And these are only two of dozens and dozens of outrageous, hateful mistruths he initiated or perpetuated before, during and even after the campaign. Trump knew he could control people, excite them, fire them up, by telling them exactly what he sensed they wanted to hear. He continues to lie, and lie and lie and lie, in order to give whoever is listening to him a chance to hear whatever it was they want to hear and thus fall under his control.

Second observation: Donald Trump has no fixed values, morals or ethical precepts.



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Inevitably, a few times a year, a new patient refers to me as “doctor.”

I always flinch.

First of all, I’m not a doctor.  I don’t have an MD, which would make me a medical doctor – or even a PhD, which would make me a “Doctor of Philosophy” like a college professor.

Well, actually, I am sort of a doctor, kind of.  I have a JD, which makes me a Juris Doctor, or Doctor of Law – which means I’m a lawyer.  But I don’t think that’s what you mean when you call your psychotherapist “doctor.”

The fact is, people with a lot of different educations, backgrounds and degrees practice the art of psychotherapy.  Here’s the run-down of the most common professionals in my business, at least in the New York area:

1.  A psychiatrist. This is a medical doctor, who went to medical school and got an MD, and could, I suppose, probably remove your appendix.  In the mental health field, psychiatrists are the people who handle medication.  I occasionally refer one of my patients to a psychiatrist colleague when I think he might benefit from an anti-depressant or anti-anxietal or some other type of psychiatric medication.  Some of my patients get psychiatric drugs from their regular family doctor, but psychiatrists are the experts in this area.  They also work with patients who are very ill, such as those suffering from severe cases of schizophrenia, depression and bi-polar disorder.  Often these patients are seen in a hospital setting, due to the severity of their illness.

2. A Psychologist. A psychologist has a PhD, and many of them are affiliated with universities, where they may do research.  When you read an article in the newspaper on the results of a “study” – something like “people who have sex after 60 are more content with their marriages” or “teenagers who watch less television have higher reading scores” – that kind of social science study would be done by a psychologist.

Psychologists also work in Human Resources at corporations, advising on how best to manage employees, and they do psychological testing.  For example, if you want to give someone a test to see if they have Attention Deficit Disorder, you might send him to a psychologist for a set of tests.

3.  A Social Worker. This is the degree I hold.  Social workers are people who work with people in all kinds of settings.  “Clinical social workers” are social workers who, perhaps in addition to helping people navigate their way through social services, obtaining housing and so forth, also do psychotherapy with their patients.

It might seem like this is a list in order of quality.  After all, if you can get a “real” doctor – why settle for a mere PhD posing as a doctor or some measly social worker?

Freud was plagued by just such questions.  When his trusted protege, Theodor Reik, came to America and tried to practice psychoanalysis (which was more or less another word for psychotherapy), he was attacked by a group of medical doctors, who accused him of illegally practicing medicine.  Freud ended up, in 1926, writing an entire book in Reik’s defense, “The Question of Lay Analysis.”  In it, he said essentially that there’s no reason a psychotherapist needs to be a doctor, unless he’s doing something – like working with a severely mentally ill patient, or prescribing medication, which would draw on medical training.

I agree with Freud (which is convenient, I admit, since I’m a social worker.)

But there is a deeper issue here.

Anyone can do psychotherapy.  It is an art, and there are many different schools of thought regarding the details of how one works with a patient in a psychotherapeutic way.

The truth is I didn’t learn most of what I know about psychotherapy from Social Work School – I learned it from my own work with other therapists, both as a patient and as a student.  I worked with two excellent psychotherapists in psychotherapy institutes, which is where young therapists (psychiatrists, psychologists and social workers) sometimes go to train.  Both had doctorates, but (I found out later) one’s doctorate was in Theater and the other’s was in Education.

I guess my point is that it doesn’t matter all that much what education you have.  Psychotherapy is experiential – you don’t learn it in a classroom or from a book so much as from doing it yourself.

I also believe it is an innate skill, like playing the piano or being good at math.  At some level, you’re just born able to work as a therapist, or you’re not – and it doesn’t matter if you’re a dentist or a fireman – you might be a good therapist, or you might not.

Most of the degree and licensing stuff is pointless.  It would probably be better – as in the old days – to let anyone go to an institute, study with some therapists, and – if they feel the urge – hang a sign and practice psychotherapy.  If they’re good, they’ll flourish.  If they’re not, they won’t.

That might sound crazy, but that’s how Taoist fortune tellers get started.

A few years ago, visiting Hong Kong with a friend, we happened to wander into a Taoist temple, and he suggested we visit a fortune teller.  This is very common in Hong Kong – some people visit a fortune teller regularly, some just when there’s something troubling them that they want to work out.

First, you shake some bamboo sticks from a cup.  The ones that fall to the ground have numbers written on them.  Those numbers somehow guide the work of the fortune teller, who sits in the back of the temple in a special booth (there may be many fortune tellers working in a large temple.)

So, I shook my sticks, recorded my numbers and went with my friend for a consultation.  It was entirely in Cantonese, so my friend had to translate.  We paid a small fee (there’s always a small fee.)

The fortune teller turned to me first, eyed me curiously, and said “You are kind to your former lovers.”

I was staggered.  My first partner died young, many years ago.  I’ve always made it a point to reach out in affection and friendship to former partners, after having lost someone who was so precious to me.

Then he turned to my friend.  “You act confident at work, but you are not so confident inside.”  Of course, my friend had started a new job that month, with a major promotion.  He was demolished by this insight.  “How did he know?”  he kept asking for days afterward.  It was the first time he’d admitted to himself that he was feeling overwhelmed by his new responsibilities and needed support.

I had the clear sense that this “fortune teller” – an old man in a silk jacket at a Taoist temple – was a colleague.  Clearly a skillful psychotherapist, he was working in a different modality, but essentially doing what I do – observing, listening, and offering insights intended to create awareness.

He offered us longer, weekly sessions – for a slightly larger fee.  We had to decline.  I think we were both tempted, but we had to fly home the next day.

It doesn’t matter what degrees you have.  What I do – psychotherapy – is practiced in one form or another by fortune tellers, palm readers, priests, shamans and people holding every other crazy title you could imagine.

We’re all doing the same job, which is as old as humanity itself.

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