I’m Glad that I’m Sick

Who in the world would say such a thing? Who in the world would want to be sick? Surprisingly, many people would. It’s not that they actually want to be sick. Rather, they want to have a reason for why they feel so bad. Having a reason why your stomach hurts answers the questions, “What’s wrong with me?” So when your stomach hurts (or your leg, or your chest, or your back), you want to know what is wrong. That seems reasonable, but the reason part of reasonable gets lost when it encounters our present healthcare system that focuses on what is wrong rather than focusing on what is right. I frequently have people tell me that they have some sort of back problem, usually described as a “herniated disc” or a “slipped disc” or some kind of twist in their spine. Unfortunately, they don’t feel any better physically, but somehow knowing what is wrong helps them understand why they hurt so much. Remarkably, it is very possible for two people to have the very same spinal abnormalities with one of these people having intense pain and the other one having no pain whatsoever. Why is that? The answer to that question is yet very illusive.

I felt compelled to write this blog because of an experience I had a few days ago. A man came to see me in my office who has been suffering from what he described as “OCD” (obsessive compulsive disorder), and has been in intensive hospital-based treatment for this alleged disorder for months. Furthermore, he has probably suffered from OCD-like symptoms and other symptoms for years. He told me that he had been making some headway with this very challenging difficulty under this intensive treatment. More recently, however, he said that his wife and he had come across the diagnosis of Asperger’s Disorder (AD), read about it extensively, and began to think that he may really be suffering from AD, either primarily or in addition to his OCD. He asked me if I could test him for AD to determine whether this diagnosis would be an answer for what was “wrong” with him. In fact, Jack (I’ll call him Jack) was quite hopeful that I would diagnose him with AD, thinking that such a diagnosis would lead to some kind of effective treatment. In a sense, he wanted to have Asperger’s Disorder, odd as that sounds. But it isn’t really odd because he just wants an answer to his distress. Can’t blame him for that. Unfortunately, finding a diagnosis like AD does not give him an answer. He might find symptoms consistent with AD, but that doesn’t mean that he has this disorder. Furthermore, many people who have AD-like symptoms are not suffering from Asperger’s just the same as how people can have the very same physical condition with one person suffering immensely while another person with the exact same condition does not suffer. Why is that?

The reason one person with a very specific physical difficulty has great pain compared to another person with the same difficulty with no pain is…we don’t know. In fact there is certainly more that we don’t know than we actually do know. We don’t know, for instance, how cancer starts. We know where it starts, like in the liver or the colon. We know what seems to be some of the reason it started in the first place. We know, for instance, cigarette smoking tends to lead to lung cancer. But what about those people who smoke for 75 years and never have cancer? We don’t know why they seem to be immune to it. We know a lot of things about physical illnesses in the way they progress, like liver cancer tends to progress fast, while lung cancer progresses at a slower pace. But we don’t know why cancer starts in the first place. And we don’t know why cancer starts because we don’t really know why a cell grows and multiplies into two cells. If we really understood why cells tend to multiply, we would know why cancer cells grow too fast and create too many cells. We know a lot about the physical body and how it functions, but we still don’t know everything. In fact, we really don’t know much about how the body functions. Thank God we know enough to correct some of the diseases that infect humankind. Yet, even though we don’t know much about the cause, the course, and the cure for many of these diseases, people still rely on their doctors to tell them what is wrong, why it is wrong, how long it will be wrong, and what can be done about it. Most of us have heard our good doctors say something like, “I am not sure” as an answer to these questions. Physical problems are just too complex to give exact answers to these questions.

We know even less about psychological difficulties, and as a result, there are even fewer answers to the why, how, and when questions although we have a few answers about the what questions. We know for instance what depression is. For instance, we know that depression has certain symptoms, namely disturbances of sleep, appetite/eating, and energy. When people are depressed they usually have sleep problems in the form of insomnia or hypersomnia (sleeping too much). Even more importantly, depressed people have low energy or motivation that we call anhedonia. We also know what anxiety is, but perhaps a bit less. We know, for instance, that people who suffer anxiety worry about the future in a variety of ways, that they can’t overcome this worry with rational thinking, and that they suffer some kind of physical symptom of anxiety, usually chest pains or shortness of breath. There is some neurological evidence that suggests that the brain operates differently with depressed and anxious people as compared to people who don’t suffer these maladies.

We know a bit about the symptoms of depression and anxiety, but we don’t really know why people get depressed or seriously anxious, how they suffer these problems, or when they start to suffer. There is a good deal of theorizing about the causes of depression and anxiety leading physicians and others to talk about a “chemical imbalance” in the brain that can theoretically be corrected with one or more medications. Unfortunately, these so-called chemical imbalances are not well understood in themselves, not universally agreed upon, and only rarely corrected with medication. Certainly, there are brain changes when someone suffers from anxiety or depression, but this is not the magic bullet people want it to be. Informed physicians will say that antidepressant medication helps about half the people who suffer from depression, but we also know that a placebo will help nearly a third of that same group. The difficulty with the medical-cure theory of depression and anxiety is that it certainly does not cure these ailments. Medications help treat the symptoms of such difficulties, but not the problem. Most people know friends and family members who have gone from one medication to another, and sometimes from one on top of another, all with minimal assistance, and certainly with no cure. And on this matter of cure there is fierce debate.

The oddity of this matter of the what, when, why, and how of so-called mental health difficulties leads people to find the magic bullet even though there is no magic in this vastly diverse field of psychology. I have previously written about the magic associated with mental health treatment: magical diagnosis, magical treatment, and magical cure. There is no such thing. There is no magic in what effective therapists do in their offices, and sadly there are not too many effective therapists in the first place. There are many therapists who are very good people, and very often well trained and intelligent as well as truly compassionate. But we often find that therapists these days are more familiar with identifying what is supposedly wrong with people than they are in finding out what is right with these people. There is even a burgeoning subcategory of psychology called “positive psychology” that purports to examine the right things about people. We have studied much of this positive psychology literature and find it valuable, if quite incomplete. And very few therapists of any stripe and degree are even familiar with any sort of positive psychology. Helping people overcome the difficulties in their lives, requires a depth understanding of psychology, certainly the mental health difficulties like depression and anxiety, but more importantly, the strengths and abilities that people have. It is these strengths and abilities that get us into trouble, much more than the so-called diagnoses.

After hearing from Jack who “wanted” to have Asperger’s Disorder, I told him (with his wife present, by the way), that I thought there may be a different way of looking at what was wrong without thinking that there was something wrong with him. This, by the way, is a statement I say to patients on a daily basis and sometimes on an hourly basis:
“There is nothing wrong with you. Furthermore, there is nothing wrong with the people you work with or the people you live with. And there is nothing wrong with the world. There is something wrong with the interface between you and people, work, and the world. For some reason, you don’t seem to fit. So you have concluded, unfortunately that there must be something wrong with you, work, people, or the world. There is nothing wrong with anyone.”

There are, however, grave difficulties between people just as there are between countries, denominations, and political parties. There are even greater difficulties between tribes of countries that are more tribal than America. It is hard for Americans to grasp the profound differences between Sunni Muslims and Shitte Muslims that has been violent for centuries and has led to the creation of ISIS and other fundamentalist groups in the world. ISIS and its cousins have taken the stand that their philosophy or theology is right…for everyone. So we have these terrible atrocities that ISIS commits in the name of Allah because they know that they are right and everyone else is wrong. Believing that nothing wrong with someone is very different from thinking that there is nothing wrong with what that person does or says.

It is easier to believe that I am right in what I believe than it is to consider that there is nothing wrong with me. Importantly, no one is always right all the time. But you can believe that there is nothing wrong with you as a person while also seeing that you say and do things that are wrong. It is easier to believe that there is something wrong with me or something wrong with the world than it is to admit that I might be wrong with what I said or did. But this is not a distinction that most people make, and it is a distinction that is the hallmark of personal maturity. The more one firmly believes that he or she is not a wrong person or a bad person, the more one can admit to errors of words or actions. Believing that you are a good person at heart, truly believing that, gives you the opportunity to see mistakes you make, misspoken words you uttered, and misunderstandings you created. And then apologize. But you are not apologizing for being a bad person. You are apologizing for failing to communicate, for hurting someone unintentionally, or for neglecting to gather all the facts before you shot your mouth off.

How does all this philosophizing help Jack who came to my office “wanting” to have Asperger’s Disorder? I needed to be quite careful with Jack because he had found some important hope that he could conquer the difficulties in his life by finding an exact diagnosis like Asperger’s. I explained what I do and how I do it, namely finding people’s strengths first and then finding the limitations and excesses of these strengths that cause problems. Within a couple of hours, we were able to come to an understanding of a different way for Jack to look at himself, one that looked at these strengths and limitations that led to his life’s problems. This is a beginning, a new beginning, a way that looks for hope in the positive and healthy rather than the negative and unhealthy. Now comes the hard work of helping Jack sees both his strengths and limitations and find ways to enhance these strengths and acknowledge his limitations in order to make a life for himself. But this is hard for Jack as it is for everyone. If I seek to replace the magic bullet of some kind of mental health diagnosis and replace it with a strengths-based “diagnosis,” I then have to help the person face the limitations of these strengths in order face the even harder task of seeing the opportunities of making the world a better place. For the moment at least Jack is excited about finding and enhancing these strengths than in finding a way to cure him of some magical disorder with some kind of magical treatment.

Further Reading
 My previous blog, The Magic of Psychotherapy
 Our current book, The Positive Power of Sadness (Brock and Johnson), Praeger Press.
 Articles and books written on Positive Psychology (Seligmann and others)

America Depressed and Distressed

It is remarkable that the popular media has properly identified President Trump as a person with a narcissistic personality disorder. Sadly, this is certainly an accurate diagnosis for Mr. Trump although I prefer avoiding all such diagnoses because they just look at what is “wrong” with someone, which is never helpful. Instead of identifying someone with some kind of psychological diagnosis it is more valuable to understand the mechanisms with which someone operates and possibly the causes of these operations. Then it is important to know how to relate to those people. Diagnosing someone does not help us understand how to relate to people. Diagnoses only tell us what is supposedly wrong with someone. Let me propose to identify the psychological mechanisms that Mr. Trump uses in life, how they affect us as Americans, and how we might survive and thrive over the next four years.

President Trump most certainly fits the diagnosis of narcissistic personality disorder, or we might say he is “narcissistic.” Ultimately, we should be thinking about how we might be affected by what he says and does instead of simply calling him names and giving him a diagnosis. People with so-called narcissistic tendencies seem to act in selfish ways, and they seem very self-centered. But this is only their surface functioning. Inside such people is a much different operation. Selfish self-centered people do not have a sense of “self” inside. They are focused on external things, i.e. outside of themselves, instead of internal things that are inside of themselves. Sometimes we say that people with a narcissistic personality disorder, or any of the other personality disorders, lack a “core” of what it means to be a person. Lacking this “core” or “self”, people who act selfishly need these more from the external world because they don’t have a solid internal world. There is a deep psychological hunger inside people who are selfish. Because they feel “empty” inside, they need to “fill” up with as much external “food” as possible. Their hunger is insatiable; they are rarely satisfied. Furthermore, when they don’t get constant refreshment from the outside, they feel this deep hunger and become afraid. In a way, they are afraid of dying. They feel like they need to be “fed” by external rewards to keep them alive.

Narcissistic people, or more accurately selfish self-centered people, feed on many things that are “external,” mostly other people’s approval. Because they do not approve of themselves at a deep psychological level, they need almost constant approval from other people. The result of this constant seeking others’ approval works when everyone approves of them, but it doesn’t work when even one person disapproves of them. This constant demand for 100% approval from all people is what we see with people like President Trump. It is painful to see such a brilliant and successful person as he obviously is find it impossible to admit that everyone didn’t vote for him. His recent ludicrous assertion that there was some kind of conspiracy of “voter fraud” with millions of illegal immigrants voting against him is almost delusional. I think that if there had been only one person who voted against him, he still would be upset because he is not capable of managing the disapproval of anyone. He is deeply “hungry” inside and craves constant external rewards of some kind.

There are other ways that typify people who are narcissistic, but they all have the element of being external to oneself. People find different ways of attempting to satisfy their deep hunger. Hoarders are people who have found a way to feel satisfied only when they keep everything, whether of practical use or not. Many obese people have found excessive food to satisfy this deep psychological hunger, but only briefly. Extraverted people with this lack of inner core tend to talk too much and demand constant social engagement hoping to keep from feeling this internal hunger, while introverted people feel marginally satisfied only when they say nothing and keep to themselves. Working and dreaming are both good elements of life but if people are deeply “hungry” inside, they might work all the time to avoid feeling this hunger, and dreamers might dream all the time for the same reason. All addictions are essentially outgrowths of narcissism and the accompanying feeling of emptiness. Addictions include chemical (alcohol and drugs) as well as behavioral (sex, gambling, buying, exercise). All of these addictive elements are natural and useful, but when they are used to satisfy deep inner emptiness, they fail. An important aspect of an addiction is that the individual needs more of the substance or behavior to reach the same level of satisfaction.

Allow me to describe the cause of narcissism, that deep seated hunger that many people, like President Trump, suffer. Simply put, selfish narcissism in adults derives from natural narcissism in early childhood. Think of it this way: when I am an infant, or approximately until I am about two years old, I get most of what I want. It is a challenge to take care of infants’ demands and needs but infants get most of what they want because they don’t want much more than food, clean diapers and a bit of physical contact. But from about the age of two, things are very different. Because they can now talk, walk, and run, they see that the world is much bigger and there is much more interesting. Their wants now multiply by a hundredfold. They want more than they can have. If children of the ages two through about six receive good parenting, these children are routinely limited. They should hear “no” a hundred times more than “yes” because they simply want 100 times more than they can have. If children are not given their basic needs, they remain deeply hungry, sometimes for the rest of their lives. More common, however, is that children in these toddler years are given too much, and given to, rather than limited. This creates the 4-8-12 child that I have discussed elsewhere.

Narcissism is natural for children of the ages two through six: they want everything and feel “hungry” for everything. The task for parents during these years is go give to their children what they need but not much of what they want. Parents and children who have migrated these challenging years well lead to these children understanding that they do not get everything they want. If they learn this important lesson during the toddler years, they are then prepared to engage the social world during the elementary school years where they learn how deal with other people. They learn the importance of sharing, and the intrinsic value of giving. Most importantly, they learn to care about other people because they have been cared for and they care about themselves. If they do not adequately get through the toddler years, they lack self-care and certainly care for others.

No one gets through the early childhood years of natural narcissism unscathed. As a result we all suffer some remaining narcissism, i.e. wanting more than we can have. This adult narcissism shows itself in undue anger when we don’t get what we want, selfishness, and jealousy of what others have. It is very important to understand that we all have at least some of this leftover childhood narcissism if we are to deal with the narcissistic self-less people in our lives. It is not just President Trump who is narcissistic. We also are all narcissistic to some degree. And we know plenty people who suffer from the same lack of development. Being around anyone who is narcissistic is a challenge. Children who are psychologically undeveloped are a challenge because they throw fits when they don’t get what they want. Adults throw different kinds of fits. You can deal with a four-year old’s natural narcissistic demands by saying “no” and taking the consequences: he hates you. But it is much harder to deal with the adult who wants everything, whether your time, your property, your money…or your vote.

Mr. Trump wanted my vote. And he is angry that he didn’t get it. He is throwing a temper tantrum because he didn’t get what he wanted: everyone’s vote. He will continue to be angry. He will continue to be demanding. He will continue to be selfish and self-centered because he does not have a good sense of self and personal core. We will hear him whining about one thing and another, all of which amount to the fact that he can’t have everything and he can’t have everyone like him. There will be more tweets and public statements, the substance of which will be how he isn’t getting everything that he thinks he deserves. He is not capable of accepting loss, disappointment, mistakes, and people’s disapproval. And he will be in our faces about it. He is a man of 70 who has a brain and life experience that is certainly well beyond those years. But he has the emotional structure, and hence the social ability, of a four-year old. We need to accept this phenomenon, which I called the 4-8-12 phenomenon in another blog. But the real task is how to feel, what to think, and what to do over the next four years dealing with his four-year old temper tantrums without being angry or afraid. This is no easy task. It will be distressing. It already is distressing. It could easily be depressing.

If we are to avoid the anger that is the essence of depression, and the fear that is the essence of anxiety, we need to attend to how we really feel. That feeling is sadness. Narcissism, like its cousins anxiety and depression, is contagious. When I am around a depressed or anxious person, I will tend to become depressed or anxious. When I am around a narcissistic person, I will tend to become narcissistic. It is something like, “He is getting everything he wants. I want to have everything I want.” This is real dangerous. It is dangerous enough to be angry at him all the time; it is more dangerous to be afraid all the time of what he might do; but it is much more dangerous to become narcissistic, i.e. become more selfish, self-centered, and self-less. We can do better.

My suggestions for your mental health, your social health, and your physical health:

  • Note the incipient narcissism that occurs in you when you are confronted by Trump’s narcissism. I could say, “Don’t stoop to Trump’s level,” but that would be wrong because it would suggest that you are superior to Trump.
  • I prefer to say, “Be mature in the face of immaturity,” “Be honest in the face of dishonesty,” “Be generous in the face of selfishness,” and “Be yourself. Don’t let yourself be dragged into thinking and feeling that is childish.” You are a mature, honest, and generous person. Be that way. Stand tall.
  • Be sad. It is sad that Mr. Trump has been elected. It is sad for me. It is sad for many people. It is sad for the country. It is sad for the world. If you can continue to feel sad, you will avoid the tendency to be angry and anxious, which are simply the result of repressing the feeling of sadness.
  • If you are a person of faith and prayer, do as Jesus said: pray for your leader. If you have a different philosophical perspective, you may profit from meditation and personal reflection. If you are a person of wit, use it carefully and constructively. If you are one who writes, write. If you write poetry, write. If you sing, sing. If you dance, dance. Be yourself. You will be well. Stay well.

Further reading:

  • “Narcissism as Evil” by R. Johnson and D. Brock. In the three volume set on Evil edited by J. Harold Ellens published by Praeger
  • The Power of Positive Sadness by R. Johnson and D. Brock to be published in March, also by Praeger
  • The 4-8-12 blog, and the forthcoming book

Tough Day as a Child

Veteran’s Day a long time ago. It was scary. We were home from school because, back then, the honored were honored with a real holiday.

It is funny, in a weird way, how the brain registers such major passage events. I haven’t thought of my mother’s first brain hemorrhage in years and years, and yet this weekend, I realized “oh, Monday is Veteran’s day, that was the day mom fell down on the kitchen floor screaming “my head, my head”. I sometimes query, if or not, when such long ago recall comes into mind, if the deceased isn’t wandering back through “my side of the universe”. Just in case my query is accurate, I try to always appreciate the individual in recall and say “thank you” to them.

We were just kids playing on a day off from school when mom abruptly jumped up from her sewing machine screaming, holding her head in her hands as if she could somehow contain the cerebral explosion. While I can’t recall if all of us were at home that day, my memory sees my brother kneeling down on the floor with mom and him yelling at Phyllis and me to run to the neighbors for help. We did run to Francis’s house. She wasn’t home, or if so she was too drunk to open the door. We ran to the next house, no one there, another house, no one. We reached the house on the corner which designated the upward economic shift in the small community. We had never been to that house before and only briefly wondered if we should go before our childhood panic swiftly dismissed protocol. How wonderful when a lady, opening her door to two breathless, terror filled girls, babbling about their mommy screaming and hurt on the floor, confidently rendered assistance.  It wasn’t long then that the ambulance arrived down the street where my mother’s brain was bleeding.

I think we were kept from going back into the house from the time we began our desperate door knocking and when they lifted the gurney on which my mother was strapped into the ambulance. The man who shut the door to the ambulance patted me on the head and said something like, “she will be okay little girl.” I savored his hand on my head transmitting some current of comfort, unknown, unexplained, yet confident. That was very nice of him. I remember that part as clear as seeing mom on the floor and the woman opening her door.

This time around, with so many years having passed, in my queried appreciation of those who have “gone on” and might be floating back by, I should say “thank you” not only to my mom for her lingering memories, but to the ambulance attendant and to the neighbor woman who called him. Their kindnesses were indeed heroic to a young child lost in the terror of her mother’s personal warfare that day.

Tender thoughts,