Simone Biles: Re-modeling Mental Health and Female Self-Esteem

Listening to Simone Biles at Tuesday’s press conference, I was struck by how comfortable she appeared with her decision. Let’s be clear: Simone is not the problem. We are.

In our media-driven culture, where appearance is confused with substance and simple solutions are thrown at complex problems, Simone taught the country a lesson: mental health matters. Though she didn’t owe us one, Simone provided a sound explanation for her decision, knowing some wouldn’t understand. It was obvious she had learned a skill I teach everyday: how to self-validate. I can’t help but wonder if this is one of the reasons she excels at her sport.

Some of the headlines regarding Simone’s decision referred specifically to athletes. But this is about more than performance. As a former Army Social Work Officer and practicing therapist, I’ve seen first-hand the damage we inflict on each other due to ignorance and fear of mental health. Americans don’t know what they don’t know. They use labels, like Bipolar Disorder and PTSD, with little understanding of diagnostic criteria. They regard counseling as a sign of weakness or for “crazy people” rather than the complex and transformational process that it is. It’s not their fault. Society has failed to educate them.

Meanwhile, media outlets rarely discuss mental health and, when they do, it is limited to clinical conditions such as Major Depression, Panic Disorder or Anorexia. They don’t consult mental health experts like they do experts in other fields such as law, national security, politics, and medicine. And they don’t associate mental health with adjustment issues like stress and anger management, parenting and communication skills, relationships, self-esteem, generalized anxiety (worry) and problems on the job. In other words, the challenges Americans face everyday. This is the bulk of my work.

Why does our society compartmentalize mental health? We don’t do this with physical health. We don’t equate the word “medical” with “disorder.” We don’t discourage or shame people for seeking medical care. We don’t tell people they should be able to treat physical illnesses without medical intervention. We don’t assume we know as much as medical specialists. Mental health is as vital to our existence as physical health. Unfortunately, cultural norms have prejudiced us to place greater value on one over the other. Whether or not we acknowledge mental health, its impact on personal lives and society can be as destructive as the COVID pandemic.

But there is another reason why Simone Biles’ decision is relevant: the example it sets for girls. There’s an exercise I frequently do with female adolescent patients, called the “Inner Eye Exercise.”1 First, I draw a big circle on a large piece of paper. Second, I draw a small circle in the center of the big circle, creating a donut shape. Third, I draw lines to break the donut into four equal parts. And lastly, I draw an eye in the “hole” of the donut. Then I explain to the patient, “This circle is you, and this is your inner eye. It allows you to see inside of yourself.” A therapist can give each quadrant whatever label is clinically appropriate. I always label one quadrant “inner critic.” Then I ask the patient to write down messages from the bully in her head. The answers I receive are heart-wrenching: stupid; ugly; lazy; boring; annoying; untalented; worthless; and the like.

Is is any wonder that the Centers for Disease Control reports, a “51% increase in suicide attempts among teenage girls” last year, (not including suicide attempts that go unreported)? In fact, suicide, not physical illness, auto accidents, or drug overdose, is the leading cause of death among teenagers. While there are numerous reasons teenage girls experience depression, the common denominator is inadequate coping skills – remaining silent being the deadliest of these. Public schools could be teaching these skills: how to manage anger, anxiety and depression; resisting peer pressure; conflict resolution; problem solving; decision making; constructive communication; and self-esteem building.

Simone Biles is an athlete and celebrity, but the media’s portrayal of this as justification for her decision is exactly the problem. Why must there be an external justification for emotional discomfort? And why must external factors be severe in nature to warrant caring for one’s mental health? What constitutes stress? It means different things to different people. What about biopsychosocial history? For example, Simone Biles is a survivor of sexual abuse. If not dealt with, trauma can debilitate a person for the rest of his or her life.

Charlie Kirk and Piers Morgan called Simone Biles’ decision “selfish.” Kirk also observed that the country is “raising a generation of weak people.” Morgan and Matt Walsh mocked the idea of mental health as a reason for withdrawing from competition. (Ironically, Walsh uses Michael Phelps as an example, a celebrity athlete who has been very outspoken about his own struggles with depression.) While their concerns are valid, their sincerity is belied by name-calling. What is it they hope to accomplish by this approach? Furthermore, they have no expertise in mental health or child development. (They are welcome to invite me on their shows to address their concerns.)

You may argue what Simone did was selfish to her teammates and the country. This is a matter of opinion and we will never get everyone to agree. Far from selfish, however, the vast majority of girls (and women) are excessive people pleasers – to their own detriment. They second guess themselves, mind read, self-bully, compare themselves to their peers, anticipate others’ needs and put those needs before their own. All out of fear of rejection or failure.

We should be empowering girls to make their own decisions, to trust their instincts, set boundaries and assert themselves, to be as kind to themselves as they are to others. Women should be regarded as capable of making good decisions, whether or not others agree or understand (or, as I like to put it, without “looking for permission”).

Given what I know about women, I am confident Simone’s teammates told her the same thing.

PLEASE NOTE: for the purposeds of this article, I elected to focus on the events of this week. However, I wish to acknowledge and commend Naomi Osaka for asserting her needs under overwhelming social pressure and for raising awareness of mental health.

1 Sinclair, T.M. (1998). The Personality Pie. In Kuduson, H., Schaefer, C. (Eds.). 101 Favorite Play Therapy Techniques (pp. 72-76). Northvale, NJ: Jason Aronson, Inc.

2 CDC Reports 51% Increase in Suicide Attempts Among Teenage Girls – Foundation for Economic Education (

3 Drug Overdoses Killed A Record Number Of Americans In 2020, Jumping By Nearly 30% | KPBS

The strategy for beating Trumpism: Learn from the past and reach out to the future

This country was founded on two atrocities: the displacement and massacre of indigenous people and the abduction and enslavement of Africans. But this isn’t about “us versus them.” This is about us versus us. And Trumpism is America’s reckoning.

Joe Biden was right. The 2020 election was about the soul of America. We’ve been in denial for too long and it’s finally caught up with us. Many Americans were dumbfounded over Trump’s popularity, but I wasn’t. It was clear early on he was a vehicle for racial grievances.

As I often tell my patients, anger is a very empowering emotion. It prompts us to do things we otherwise wouldn’t. But anger is also a byproduct of other emotions. In this case, fear. It took a long time for mainstream media and the public to acknowledge what was obvious to others. Trump had tapped into something: many white Americans see their sense of identity – what it means to be “American” – threatened. This fear of difference is at the heart of our democratic reckoning. It is why millions of American’s are willing to ignore Trump’s incompetence, corruption, immorality, lies, and self-aggrandizement.

I live in a neighborhood that is at least 80% black and, yes, it sometimes feels uncomfortable. However, I’m healthy enough to take ownership of my discomfort rather than projecting it onto others. This is not the neighborhood I grew up in, but it is the neighborhood I chose. It is a neighborhood that confronts each other’s children when they are misbehaving, distributes COVID masks to every household for free, organizes a parade and puts together goody bags for high school seniors missing graduation, and sends gift cards to a family who’s house caught fire. It is a neighborhood with a sense of community like no other I’ve lived in, including a military post.

I attended public school with only a handful of students of color. Most of them were popular and active in extracurricular activities. I never regarded them as different but, of course, I don’t know how they felt. Fast forward to 2018, when I attended our neighborhood’s National Night Out. I’m not sure if I was the only white person in the room, but I certainly felt like it. I tried to strike up a conversation with a family who had a teenager my daughter’s age, but it felt awkward. Nevertheless, I recognized that I had only myself to blame for not being more active in the community. Plus, my daughter attends a different public school, close to her dad’s house.

As a psychotherapist, patients often ask me why, after so many years of ignoring a problem, they no longer can. They wonder what’s the point in “rehashing” the past when they can’t change it. I always share with them this analogy: imagine a child comes to you upset, would you ignore him? If you did, do you think he would walk away unphased, as though nothing happened? Of course not. What was bothering him would be compounded by your dismissal. Most likely, you would ask the child, “What’s wrong?” and help him problem solve. Our history is no different; it doesn’t go away because we ignore it. And what remains unresolved gets worse.

Many Americans are realizing that the monuments we’ve erected, museums we’ve built and speeches we make honoring our founding fathers are half the story. This identity we’ve created about the American spirit and democracy is only part of who we are. Rather than avoiding past atrocities, schools, public officials and the media should be talking about them. We must acknowledge that Native Americans and African Americans deserve credit for its founding.

After the congressional hearings about slavery reparations in June of 2019, I wrote an article comparing our dilemma to Germany’s.1 Most Germans living today did not participate in the extermination of 6 million Jews, but they understood their country did. According to an article by Greg Rienzi in “John Hopkins Magazine,” Germany invests an estimated $1.1 billion in reparations every year for World War II.

While the Republican Party remains in denial, there is a large overlooked constituency that won’t: young Americans. They have the most to lose from this existential crisis. They’re also the most receptive to Democratic messages of unity.

The next generation is more open and compassionate toward diverse thinking than any in history. As such, they are the most receptive to hearing about the atrocities of American colonialism. They are what some of us used to be in another age: full of energy, hope and ideals. They are also what most of us never were: plugged into a network of global activists determined to be heard. What they need is guidance and organization.

This is where the Democratic Party and its allies come in. Civil rights activists, historians, lawmakers and the media have an opportunity and obligation to reach out to young Americans. They don’t realize how powerful they are, and we have the know-how to show them. For its their energy and potential that will save this country.

The Most Dangerous Man in America: It’s Not Who You Think

Published December 2019

Some readers may remember Congresswoman Connie Morella. I grew up in her district. I used to quip she was a “Republican in name only.” She even voted against impeaching President Bill Clinton. Morella served eight terms before being defeated by then-State Senator Chris Van Hollen.

While I understood the Democratic Party’s desire to bolster its caucus, I thought it wholly unfair that a Representative who consistently put the needs of her constituents above party politics be penalized for having an ‘R’ by her name.

You might say, “That’s politics.” But is this what the Framers had in mind – that a Member of Congress who reaches across the aisle would still be treated as partisan? While I like Senator Van Hollen, his campaign to unseat Morella goes against everything the Founding Fathers intended. The system they created was working, but Maryland Democrats were hell-bent on going around it. This was the first time I voted for a Republican. 

Lawmakers have become so dependent on winning as a means of governing, campaigning now undermines lawmaking. As legislators rely more and more on conquering rather than compromise, is it any wonder money has corrupted the process of running for office and voters are abandoning both parties?

Perhaps there’s no better example of this dynamic than gerrymandering. Regardless of party, it is entirely wrong. The point of democratic elections is to hold legislators accountable. When politicians exploit democracy to ensure reelection, they are putting their needs above the needs of the American people. 

Democracy is more than a system of government. Its a way of life, a road map for coexistence guided by the principles of mutual respect and fairness. But it’s meaningless if not internalized. Democratic norms are not something you follow only when it’s to your benefit or to manipulate to your advantage. This mindset, “my way or the highway” breeds distrust and resentment, making it that much harder to work together.

It’s a cynical approach largely promoted by one person: Senator Mitch McConnell. There’s never been a more divisive figure in modern politics. McConnell’s actions are, simply stated, undemocratic. His efforts to block witnesses in Donald Trump’s Senate impeachment trial is a classic example of this.

I’ve heard McConnell only cares about one thing: remaining Senate Majority Leader. Despite being labeled the “do nothing Dems” by President Trump, the House has passed hundreds of bills, addressing myriad problems such as gun violence, pay inequality, immigration, climate change, and domestic violence. As Senate Majority Leader, McConnell has unilaterally blocked every one from reaching the senate floor for a vote.¹ Meanwhile, he oversaw the appointment of 102 conservative federal judges in 2019, more than twice the annual average over the past three decades.²

Democracy was never meant to be practiced this way. Consider the premise behind Congress. Senator McConnell represents one perspective in one state. His colleagues have been elected to represent other perspectives in other states. If for no other reason, McConnell’s Democratic colleagues deserve consideration because they are advocating for the wants and needs of fellow Americans.

Whether legislators like it or not, they have to want to work together more than winning. This may sound idealistic, but it’s actually quite practical. As Abraham Lincoln wisely said, “A house divided against itself cannot stand.” Since the Civil War, I can’t think of a more existentially perilous time for our country than now.

How hard can it be to lead this way? What kind of human being regards success as getting his way rather than building alliances? In reality, it takes more skill to seek common ground and build coalitions. Rather than being guided by democratic norms, McConnell treats them as tools he can take or leave. He blocks or selectively enforces regular order to suit his purposes.

As a psychotherapist for 27 years, I have come to appreciate how imperative good communication is, but also how complicated. When I work with families, I teach 15 different “principles” for constructive communication. Good communication requires skills, like driving, which must be learned and practiced.

Obviously, lawmakers appreciate the power of communication. (Otherwise, they wouldn’t talk so much!) Unfortunately, their’s is one-dimensional: all defensive. They’re either justifying their actions or trying to persuade others. This is not communicating. In fact, these are roadblocks to communication.

One of my principles is same scene, different script. The content of a discussion may change (i.e., gun reform; reproductive health; immigration) but the underlying dynamics – how people interact – stays the same. Members of Congress repeat the same dysfunctional patterns (scene) because they’re too busy arguing over policy (script). In Mitch McConnell’s case, the dynamic involves demonizing Democratic colleagues to gain power. 

To demonstrate my point, I’ve included a video of Dr. Fiona Hill, an expert in Russian and European affairs. It is a brilliant example of diplomacy, the art of negotiating while maintaining good will. You have to admire the delicate word choice, empathy, trust, and self-control it took to respond as Dr. Hill did to this Congressman – even though he tried to stop her from speaking.  

These are the skills Senator McConnell lacks, and the country is suffering mightily for it. Clearly, McConnell doesn’t understand the power that comes with trust, empathy and good will. Nor does he care about the strain his limited skill-set puts on his colleagues and the country. I know this because, if McConnell did, he’d  be putting these skills to use. 

America, take heed: changing the power differential will never be enough. The problems plaguing our country – war, climate change, healthcare costs, gun violence, opioid epidemic, suicide, poverty, declining education, unpaid leave for child/eldercare, loss of manufacturing jobs, election interference, illegal immigration and so on – will not improve until Congress fundamentally changes its discourse.

Unfortunately, that will never happen while Mitch McConnell is Senate Majority Leader. Of course, he’s welcome to prove me wrong. 





“America is Not a Racist Country:” The politics of semantics

We’ve watched it hundreds of times: the verbal chess match between reporters and politicians. One trying to corner the other into admitting something the audience already knows. The purpose of these interviews is less about substance and more about gamesmanship. As long as the politician keeps arguing – no matter how disingenuous or irrational the argument – the news media continues to treat him as credible. In turn, the politician is able to distract the public while legitimizing his position.

The comment by Senator Tim Scott and other Republicans that, “America is not a racist country,” is like saying humans beings aren’t violent. It is meant to provide an answer without addressing the substance of the question. If we look at America as a collection of ideals then, sure, you could argue it’s not inherently racist. However, in practical terms, the America we live in is not functioning according to these ideals. This is the politics of semantics – or “spin” as it’s commonly called, and it’s one of the main reasons why this country finds itself so divided.

The problem is not reporters, per se. It’s their model of reporting. The slow and methodical workings of the three branches of government – executive, legislative and judicial – don’t suit the demands of a 24/7 news cycle. So journalism has been turned into something that feels like news but isn’t. News outlets provide instant gratification in the form of insider information and political analysis. Contributors share cloak room conversations like gossip. Legislative progress is framed in terms of winners and losers. To what end? What can the average viewer do with this information except satisfy a curiosity? What does this incessant political analysis accomplish except (mis)lead us deeper into the abyss?

What’s the alternative? Well, for one, news outlets should stop giving airtime to guests that refuse to directly answer questions. They should either cut them off (which they do occasionally) or stop inviting them. News outlets should also stop reporting political soundbites as news. “So-and-so said this” is not news. It’s propaganda. Senator Mitch McConnell, for example, gets the best of both worlds when his comments make headlines; he gets to avoid tough questions while getting his deceptive messages into the public domain. If McConnell wants to promote a position beyond a right-wing audience, mainstream reporters should require an interview.

Throughout Donald Trump’s tenure, Republican lawmakers reportedly made fun of him in private while praising him publicly (as though their refusal to admit the obvious meant it didn’t exist). Nevertheless, not once did I see a reporter confront one of these Republicans for their hypocrisy. Nor did I see a single reporter ask Republican officials about Donald Trump’s obvious mental pathology. Under the guise of journalism, who were these commentators protecting except their own careers? This dereliction in reporting is perpetuated, I believe, because news programs have become political themselves. They’re afraid of being ostracized by their peers, losing viewers and ad revenue.

News should be about politicians doing the work of the American people. Except when covering campaigns, the news media should stop covering politicians who use their bully pulpit simply to retain power. Of course, this won’t happen until we, the viewers, stop accepting this as productive.

The Age of Ageism

Senator Diane Feinstein received a lot of criticism yesterday for calling the hypothetical retirement of Supreme Court Justice Stephen Breyer “a great loss.” She is quoted as saying, “My general belief is if a person serving with integrity and working hard and producing for whatever the constituency is, that’s what these jobs are all about.” At age 82, some Democrats are urging Breyer to retire now, just in case the Senate majority reverts back to Republican hands – namely Sen Mitch McConnell’s – in 2022. Fair enough. But others argue that Breyer, and Feinstein, should retire to “give their jobs to someone younger.” I wonder how these critics would feel fifty or sixty years from now if someone younger said this to them.

Perhaps I’m biased… My mom, an attorney for the federal government, did not retire until she was 79yo. Frankly, I never thought I would hear the words “retirement” come out of her mouth. But my mother had worked in the same office independently for 30 years, and suddenly a new, much younger solicitor was micromanaging her.

As a 55yo about to turn 56, I admit ageist comments sting personally. I think it’s safe to say most older adults don’t feel anywhere near the age they look. In fact, I often facetiously ask why everyone around me keeps getting older. Through no credit of my own, I happen to look younger than my age, but I still cringe every time I get complimented for it.

Older Americans may not appear as sharp as they used to be. Their movements may be slower. But consider the parable of the cracked pot: everyday, a woman carries two pots back and forth to the river. One is in pristine condition. The other has cracks in it, causing it to lose water. Over time, however, the side of the road that receives the water grows an array of beautiful flowers.

I think many confuse age with outlook. To assume that all older adults beat to the same drum is like assuming all young people think alike. Take Donald Trump and Joe Biden, for example. These two men couldn’t be anymore dissimilar than Cain and Abel! We are all a product of our experiences, not our age.

Like any other life challenge, how people respond to aging depends on their coping skills, but society certainly doesn’t help. Ageism is woven into our culture – so much so that Americans don’t recognize it. The only adults treated as part of the mainstream population are the ones able to keep up. The first time this hit me was when I was attending a wedding. There was an elderly couple at our table with whom no one was talking. My first thought was, “It’s as though they’re invisible!

I have a hearing impairment which requires wearing aids, so I took notice of a radio commercial which asks, “Do you avoid wearing hearing aids because they make you look old,” as though looking old is something to be avoided. Cosmetic commercials tout the benefits of this or that cosmetic for keeping skin “youthful looking.” Young people are increasingly seeking cosmetic surgery because they don’t like the way they look in selfies. Of course, Hollywood is one of the worst culprits of age discrimination, where youth is valued over talent. I suspect the reason is because they’re trying to establish an emotional connection with the audience and it’s easier to accomplish through superficial means.

Such cultural norms reinforce the dependency between youth and self-worth. Meanwhile, the US population as a whole is getting older.1 In 2019, the AARP wrote that “35 percent of the population is now age 50 or older.”2

So, what’s the solution? Well, to begin with, we need to acknowledge and normalize our fears of old age. You can’t solve a problem if you won’t admit you have one. Most Americans fear getting older means loss of independence and productivity, unemployment, poverty, poor health, loneliness, and/or irrelevance. Rather than ignore these fears, Americans need to identify what’s in our control to prevent these outcomes. As Mickey Mantle famously said, “If I knew I was going to live this long, I would have taken better care of myself.”

Recently, a family member was diagnosed with Parkinson’s. As he debated what to do, I inquired of his “worst case scenario.” Whether or not we admit it, we all harbor catastrophic fears. Through some probing, he admitted being afraid of “ending up in a nursing home, in a wheelchair with drool coming out of [his] mouth.” After assuring him we wouldn’t let that happen, we problem-solved what was in his control to avoid this: researching treatment options; enrolling in trial studies; utilizing his Medicare benefits. We now hold regular virtual meetings to monitor his treatment. In other words, by specifically identifying his fear, we were able to come up with concrete solutions to prevent it.

Americans also need to advocate for social change. We need to establish an infrastructure that supports an aging population, rather than forcing families to isolate their loved ones. We need to recognize the strengths that older Americans bring to the table and create incentives for employers to hire them. We need a national clearinghouse specifically to help older Americans find employment. We need to create opportunities for younger and older Americans to interact. We need to reject ads that stigmatize aging and demand more positive roles for older actors.

We all get old – if we’re lucky. To fight or deny this reality is not only individually self-destructive, it’s detrimental to our society. Despite many cultural messages to the contrary, self-worth doesn’t come from appearances. It comes from the way we treat others and the positive impact we have in the world.

1 The U.S. Population Is Getting Older, Richer and White | National News | US News

2 Age Discrimination Still Thrives in America (

Demonizing Joe Manchin

Take it from someone who worked on Capitol Hill: DC Statehood was always one of those causes every Democrat in congress would get behind knowing it had zero chance of passing. The question is if 2021 is any different.

With the momentum of the Black Lives Matter movement and increasing engagement of Black voters, along with a Democratic majority in the House and Senate, it is tempting to see possibility. It is also easy to see one US senator as the only obstacle. Even journalists who should know better are simplifying the argument.

When I got on twitter this morning and read all the hostile, even vile, tweets about Sen Manchin, the first thought I had was, “So this is why Republicans never cross party lines.” It is easy to see DC Statehood in black-and-white terms, literally and figuratively, to frame it as right vs. wrong. But if Americans want to see progress in Washington, they must see legislation, and people, in shades of grey.

Even if Sen Manchin voted for DC Statehood, Democrats would still need to eliminate the filibuster to pass it. There are some good arguments for doing this, but Democrats would do better to “break that glass” over more sweeping legislation, such as infrastructure, health care, or police reform. Keep in mind, these policies address inequality, too.

There are 34 Senate seats along with all House seats up for reelection in 2022. Republicans would like nothing more than to campaign on Democrats eliminating the filibuster and passing DC Statehood. They’re already trying to paint President Biden as a liberal in moderates clothing and hinge the election, once again, on race. If Democrats hope to accomplish anything, we must maintain control of both houses. In the current political climate, even a president with as much experience in congress as Joe Biden will not be able to breach the logjam.

While I’m furious over the hypocrisy, bigotry and outright lunacy of Republicans, Democrats must be careful how we channel our ire. Anger is a very empowering emotion. When channeled constructively, it can move mountains. But, as we’ve seen with Republicans, it can also enable destruction. Anger has the power to energize and embolden people to stand up for what they believe in. But it can also override rational thought and empathy. If we apply equal outrage to everyone who disagrees with us, we are being as unreasonable as Republicans. Not everyone who disagrees with us has bad intentions. Our beliefs, no matter how just, don’t preclude the possibility of righteousness in others.

When I help families with their communication skills, I tell them that the most important requirement is wanting to understand where the other person is coming from. You don’t have to agree with their perspective, just understand it. This is called empathy. People have good reasons for making even bad decisions: fear; frustration; helplessness; hopelessness; loneliness; feelings of inadequacy; concern; love; etc. The only way to avert a bad decision is to find a better solution to the problem.

I also help families avoid power struggles by separating the problem (e.g.; time; finances; parenting; chores) from the solutions. Racism, xenophobia, antisemitism, intolerance are solutions for people’s insecurities, albeit destructive ones. Education, emotional intelligence, and communication skills are healthy and constructive alternatives. (I urge Dr. Jill Biden and Sen Elizabeth Warren to push for adding mental health education to public school curriculum.)

I have listened to Sen Manchin’s arguments. While I don’t agree with all of them, I think his motives are about more than power and reelection. I believe his primary motive is bipartisanship – not just with congress, but with an eye toward the American people. Which is why I wonder how serious Democratic legislators are about passing DC Statehood in 2021. In fact, I wonder if Sen Manchin isn’t being used as a scapegoat to save some Democrats from themselves.

I have an expression, “You can win the battle but lose the war.” Democrats can’t want progress so badly that we undermine the progress we’ve already made.

Trump’s Insults Veterans: How this is different and why it matters

I joined the Army late in life, at the age of 42. In announcing this decision, the first question I’d get was “Why?” While I feared my answer would sound hokey, I told the truth: because I wanted to be part of something bigger than myself and to make a larger impact. It wasn’t until I entered the Army that I realized my motivation was not hokey at all, or abnormal.

As a clinical social worker, I have been writing articles about Donald Trump’s mental health for over two years. Nevertheless, when I read Jeffrey Goldberg’s report in the Atlantic Monthly, even I was shocked by the level of pathology of Trump’s remarks. It’s one thing to completely lack empathy. Given the obvious diagnosis of Narcissistic Personality Disorder, I knew that about Trump. But this was more disturbing. This was outright contempt for Servicemembers. I hardly slept that night.

Some will try to make this political. It isn’t. I love this country and what it stands for so much, it’s visceral. On TDY once, I remember watching other passengers waiting for our flight and thinking how blissfully ignorant they were. And yet, this is why men and women serve: so Americans can live their lives. Although my time in the Army was short, it remains one of the proudest and most defining experiences of my life.

Servicemembers don’t ask for praise because we’re not doing it to be acknowledged. We don’t ask for reward because the pride of serving our country is reward enough. But Veterans do deserve respect for their courage and sacrifice.

So I ask you this: how can someone who not only fails to understand but doesn’t even value the courage and sacrifice of Servicemembers be put in charge of deciding their fate? In interviews and in his book, Call Sign Chaos: Learning to Lead, General Jim Mattis describes a handwritten card he kept on his desk while serving as CENTCOM Commander at the Pentagon. It asked the following question: “Will this commitment contribute sufficiently to the America people to justify putting our troops in a position to die?”

In contrast, Donald Trump would apparently regard troops as suckers for risking their lives simply to protect the American people, and would regard them as losers if they returned injured or in a body bag.

When asked what is hardest about being President, each talks about the decision to put troops in harms way. Presidents have always understood that the lives of these self-sacrificing men and women were in their hands.

How can the American people ask these brave men and women – moms, dads, brother’s, sisters, husbands, wives, aunts, uncles – to put their lives in the hands of someone who regards their sacrifice essentially as a sucker’s bet? If nothing else disqualifies Donald Trump from retaining the duty of Commander-In-Chief, this does. Servicemembers deserve nothing less.

Police Brutality and the Art of De-Escalation

de•es•ca•late [de-es-kuh-leyt] verb (with or without object), to decrease in intensity, magnitude, etc.

As a Social Work Officer at Fort Bragg, my primary mission was the Family Advocacy Program, the Army’s solution for addressing domestic violence. When recounting a domestic incident, I was struck by how Soldiers described what happened. They never said, “I was just pissed off one day so I hurled one at her.” Rather, each Soldier had a story, a sequence of events escalating into a violent altercation. To the outsider, this may sound like making excuses, but the reality is violence doesn’t come out of nowhere.

In my anger management group with Soldiers, I called this phenomenon the “domino effect.” When you push on the first domino in a row, they all fall down. But if you take just one domino away, you interrupt the sequence. Most bad outcomes are the culmination of a series of choices. As we study the events leading up to police brutality, there are any number of decisions – some large, some small – that, if altered, can prevent tragic deaths like those of George Floyd and Rayshard Brooks.

At the outset, let me just say, it is the responsibility of local police to anticipate challenging outcomes. As a psychotherapist, I don’t expect every patient who comes to my office to be compliant and make good decisions. If I did, I’d have no business being a therapist. Law enforcement is no different. Having said that, police officers are human beings first. Emotional regulation, perception of events, physical reactions, and communication all play a role in the outcome of a call. This is to be expected. It’s how these four factors are managed that determines a good versus bad outcome. I discuss each of these briefly.


In order to become a police officer, a candidate must pass psychological testing, but what happens after s/he joins the force? Exposure to one traumatic event is extremely stressful for most human beings. It doesn’t take much imagination to appreciate the long-term effects of perpetual exposure to trauma. Add to that the pressure of working in a highly stressful, unpredictable environment. If I bang a tuning fork on a table, it will vibrate. While the vibrating will eventually stop on its own, this takes time. If I keep hitting the fork, the vibrating never stops.

Without exception, every single Soldier from the 82nd Airborne I counseled had a history of either psychiatric treatment, misdemeanors, substance abuse, or physical or sexual abuse. Each of these histories can compound the effects of trauma. While the medical portion of Military Entrance Processing (MEPS) was supposed to screen for this, I used to joke this was the real “don’t ask, don’t tell policy” of the military: if a candidate didn’t write it on the medical form, the doctor didn’t ask about it.

Such factors should not preclude police service. In fact, it would be impossible to enlist the necessary personnel if we ruled out every candidate who had a troubled past. But current events can trigger unresolved feelings from the past. Add to this any personal drama going on in an officer’s life: marital; financial; children; medical; substance abuse; etc.

Imagine a pitcher filled with orange juice, soda and coffee. When you pour out the soda, what happens to the orange juice and coffee? Officers must learn how to “empty their pitchers” and not allow feelings from the past to accumulate and mingle with the present. In recognition of these myriad emotional challenges, officer counseling should be normalized and mandated.


Any Mental Health Practitioner worth their salt is familiar with the “flight or fight response.” Our bodies are made up of the Central Nervous System (CNS), including the brain and spinal cord, and the Peripheral Nervous System (PNS) branching out to the extremities. The PNS is made up of the Sympathetic (SNS) and Parasympathetic Nervous Systems (PSNS). Anytime a person feels threatened, the SNS revs your body up to either confront a situation or escape it. The racing heart, rapid breathing, stomach upset, sweating, numbing, tingling, etc we associate with anxiety is really the SNS.

Of course, anyone who has ever felt anxious knows that the SNS sometimes overreacts. So, the more an officer understands the flight or fight response, the less likely s/he is to misinterpret its symptoms and the better s/he’ll be at managing them. If officers catch themselves early enough in a situation, they can employ behavioral techniques, such as deep breathing, muscle checking, and grounding, to reverse the effects of the SNS and activate the PSNS.

Other physical considerations include the impact of shift work on cortisol levels, sleep deprivation, poor diet and inadequate exercise.


The problems associated with dysfunctional thinking are rampant in our society. Distorted thinking leads to negative emotions (anger; anxiety; depression) which leads to destructive behavior. In addition to brutality, police suicides are at an all-time high, increasing from 172 in 2018 to 228 last year.

The gestalt of cognitive-behavioral strategies is as complex as it is abundant. Training would help officers identify their use of cognitive distortions as a coping mechanism, teach problem-solving strategies for work and personal life, and educate them on a variety of topics. Techniques commonly employed under this category are mindfulness, hypnosis, psychoeducation, Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Emotional Freedom Technique (EFT or “tapping”) and Eye Movement Desensitization and Reprocessing (EMDR).


The most important but least understood factor in de-escalation is communication. In fact, constructive communication is sorely lacking in all facets of our society: families; schools; work and (God knows) the US Congress!

In fact, patterns of problematic communication are so prevalent, I created a list of fifteen “Constructive Communication Skills” I teach my patients.* I tell them that good communication is like learning a different language. If it were easy, they would have figured it out on their own.

In Conclusion

Along with the above changes to police de-escalation training, we also need to update our public school curriculum to include emotional intelligence like conflict resolution, anger and anxiety management, and problem-solving. We also need School-Based Social Services for easier access and increased interface between families and school personnel.

You can’t build a house with just a hammer. Anger management or sensitivity training isn’t enough to address police violence (or domestic violence for that matter). If we want to solve the problems associated with local policing, we must embrace mental health in all its modalities.

The New York Times Versus the Truth: How the media giant shut down warnings of Trump’s dangerousness

Published April 28, 2020

I’m the last person in the world who believes in conspiracy theories. So if anyone had told me what I read in Joshua Kendell’s article, “Muzzled by Psychiatry in a Time of Crisis: The Man in the White Coat, The New York Times and The Stifling of the Public Debate about Donald Trump’s Fitness to Serve as President,” I would have politely called them paranoid. But here we are… in the midst of a pandemic, already exhausted from three years of chaos, and mental health professionals, like myself, are still trying to convince the country Donald Trump is unfit for office.

I’m not going to recount what is already a brilliant piece of journalism. Please read Mr. Kendell’s article. Rather, I’m going to tell you what it’s been like for a mental health expert to be held on the sidelines watching this spectacle knowing we can help.

I’m a former Army Social Work Officer with 27yrs clinical experience. I also served as the Executive Officer (XO) for the Medical Command for Afghanistan (OEF) in 2009-2010. For the last 3yrs, I’ve been doing the only thing I could think of to get through to the American people, writing articles and posting on social media.

When Donald Trump started to rise in the 2016 presidential primaries, I was as baffled as the press. Why would anyone be impressed with a candidate bragging incessantly about poll numbers and making sweeping promises a child could see through? The more I listened, the more concerned I became. For someone who’s been counseling people for 27yrs, it was obvious: Donald Trump had Narcissistic Personality Disorder.

On November 15, 2018, I published my first blog article – one that had been swimming in my head since before the election: “How Our Cultural Ignorance of Mental Health Helped Elect Donald Trump.” (I had originally submitted it to The Washington Post, but never received a reply.) It infuriated me every time I heard a politician or pundit express hope that Trump would “rise to the occasion” or “surround himself with good people.” I knew this was no more likely to happen than Trump willing himself back to health from Stage 4 prostate cancer.

To understand my certainty, you would need to accumulate years of training and experience. But some mental health experts did the next best thing: they wrote a book called, “The Dangerous Case of Donald Trump.” It contained essays from 27 (later 37) mental health experts and was edited by a Yale University psychiatrist, Dr. Bandy Lee, who happened to be female and of Asian descent. The goal of the book was singular: to warn the American people so they could do something to protect the country. It became a New York Times bestseller. I was sure once the American people were educated on what we saw, they would share our concerns. But then the chatter over the book dissipated.

Imagine sitting in a crowded stadium. Everyone has blinders on but you. You see fire and urge everyone to leave before it’s too late. But they can only smell smoke so they dismiss your warnings. That’s what the last 3+yrs have felt like for mental health experts.

My sense of urgency only increased the more Donald Trump remained in office. “If Congress acted early,” I thought, “they could set certain constraints to protect the public.” Yes, there were political forces at will, but the public was only hearing one side of the story.

Perhaps naively, I kept trying to do my part. I wrote two more articles in June 2019: “The Media’s Missed Opportunity,” addressing what seemed like naivete on the part of the press in covering Donald Trump; and “We’re No Different. Neither Are They,” comparing my Jewish heritage to the treatment of immigrants at the southern border. As the granddaughter of a Polish immigrant who lost his entire family in the Holocaust, I was in horrified disbelief over this policy.

Meanwhile, mainstream media was fixated on the Mueller investigation. I had no illusions the press would pay attention to my blog articles, even on an empty news day, but I was hoping I might spark something on Twitter.

Dr. Lee was also writing articles and granting interviews, but they were equally ineffective in generating media buzz. My frustration turned more and more toward news outlets. The raging sea that was the Trump administration rolled on, damaging democratic institutions, diplomatic relationships and long-term policy for reasons that can only be explained by Malignant Narcissism. Everything Mental Health Experts had predicted was coming true and we were rendered helpless to stop it.

In July 2019, reports surfaced that Donald Trump had approved a military strike on Iran, then pulled back the last minute. I started another article. I wrote at the time,”This breaking news, if true, should terrify everyone,” But the impeachment process was just getting underway and the incident was quickly forgotten.

If by now the America people felt they were being jostled from crisis to crisis, it was no accident – not because Donald Trump was deliberately creating them, but because he was impulsive, reactionary, disorganized and selfish. There was no “method to Trump’s madness,” only madness. There’s a term in psychotherapy called “use of self…” We all knew what was going on in Trump’s head because we’d been living it for the last 3yrs! Did any of this feel strategic to you???

The Fall of 2019 brought House impeachment hearings and, with it, a furious debate over how long the House should hold investigations. James Robenalt wrote an article for The Washington Post recounting the “drip, drip, drip” of revelations about Watergate. “In fact,” Robenalt recounted, “Bob Woodward and Carl Bernstein wrote relentlessly about the scandal [but] Americans were largely unmoved.” Meanwhile, I could see the political writing on the wall and churned out another article urging the House: “Hold All the President’s Men Accountable.” If Donald Trump was not impeached or at least sanctioned, I knew he would be even more dangerous than before.

By this time, one of the most troubling events of Trump’s tenure had occurred. Without consulting his Secretary of State, Director of National Security, Director of Defense Intelligence, military leaders or allies, Trump unilaterally withdrew US Special Forces from northern Syria. The weight of this news was crushing. As I thought about our country’s betrayal to thousands of Kurdish families, I felt I had personally let them down.

Still nobody in the media stratosphere was addressing the elephant in the room: Trump’s psychopathology. As impeachment shifted from the House to the Senate, I wrote my next article, “Impeachment: Right Idea, Wrong Remedy.” By now, I had come to the conclusion that the news media regarded Trump’s removal from office under the 25th amendment as a political non-starter and saw no point in even entertaining it. I, on the other hand, had a different take: while I knew Trump’s cabinet would never remove him from office, it was also unlikely the Senate would impeach him. There was still value in discussing Trump’s mental health. Congress could install limits on Trump’s powers, as they ended up doing after he ordered the killing of Iran’s General Qasem Soleimani. Also, didn’t voters deserve to hear from mental health experts before going to the polls in November?

Over the course of Trump’s presidency, news outlets solicited experts in law, national security, military service and, most recently of course, medicine. I was used to the stigma, even dismissal, of the mental health profession, but this was gut-punching. By now, Donald Trump’s mental instability was not only out in plain site, the country was reaping untold damage from it. Malignant Narcissism was the one common denominator. “Why,” I deliberated, “was Congress and the press still refusing to talk about it?” Was mental health held in such contempt that we didn’t deserve a seat at the table?

Which brings me to yesterday: when it all became clear. The American Psychiatric Association (APA), led by Jeffrey Lieberman, MD, had deliberately and strategically shut down Dr. Bandy Lee and the co-authors of “The Dangerous Case of Donald Trump.” And they collaborated with The New York Times to do it. As Joshua Kendell details in his article,

The New York Times lined up with the APA against Lee, publishing both an editorial in support of the new Goldwater rule and an op-ed by Lieberman in which he accused Lee of engaging in “clinical name-calling.”

Due to social ignorance of mental health, the public would not know enough to question the APA’s authority, but The Times should have.

First of all, the American Psychiatric Association (APA) is a trade association. While it can make recommendations to it’s members, it is there to serve them not dictate the scope of their practice. Like any professional association, a psychiatrist can choose to be a member of the APA to take advantage of benefits like trainings, guidance on best practices and to be a collective voice for the profession. As a social worker, I have the option of becoming a member of the National Association of Social Workers, but it is unfathomable that the NASW would interfere with my professional conduct. If I was engaging in unethical behavior, it is the state licensing board’s authority to issue sanctions against me.

Furthermore, the APA has no business dictating the practice of other mental health providers. We are a diverse community with varying skill-sets. Each discipline has unique roots, but there is also crossover in what we do. Unfortunately, we live in a society that equates credentials with expertise. The idea that a psychiatrist’s opinion should be given more credence than mine simply because he holds a medical degree is not only ignorant, it’s dangerous. It also smacks of old-school paternalism that should have been tossed out with the 20th century. Many psychiatrists today focus entirely on medication management. They have nowhere near my experience counseling patients.

How dare The New York Times make a unilateral decision to apply a trade association principal to all mental health professionals! The APA does not speak for Social Workers, Professional Counselors, Marriage and Family Therapists, Psychologists, Psychiatric Nurse Practitioners, or even all Psychiatrists. Nor does the APA have authority over anyone other than it’s members. If the American Orthopedic Association came to The Times demanding they write an op-ed that all mental health professionals should learn the parts of the skeleton before practicing independently, would they support that, too?

The New York Time’s capitulation to the American Psychiatric Association can be described only one way: as journalistic malpractice. Tragically, it’s the American people, not it, paying the ultimate price.

Donald Trump supporters don’t need him, but he can’t exist without them

Photo credit:

Magic mirror on the wall, who is the fairest one of all? – Brothers Grimm

A boy comes running home crying, “Daddy, I fell off my bike!” His dad replies, “Well, you should be more careful next time.” Not earth-shatteringly inappropriate, but consider the underlying message: the boy did something wrong and is incompetent. Now, imagine if the dad said, “That’s okay, everyone falls off their bike. I know you’ll get back on and do great.” While seemingly simple, this response sends a very different message: falling off a bike is normal and has nothing to do with the boy’s capabilities. It also role models how to cope with failure.

Psychotherapists call this dynamic mirroring. It is one of the most important roles of a parent. How you respond to your children – your tone of voice, your words, your body language – plays a crucial role in how they see themselves. Communication which normalizes a child’s behavior, supports his or her feelings and encourages problem-solving, fosters a child’s self-worth and confidence. On the other hand, critical or even inconsistent mirroring can seriously impair a child’s sense-of-self.

Perhap there’s no better explanation of how parenting impacts a child’s psychological development than German-American Psychoanalyst, Erik Erikson’s, 8 Stages of Psychosocial Development. Unlike Sigmund Freud, Erikson believed that personality development continued throughout the lifespan, marked by a series of existential crises around psychological milestones including trust, autonomy, identity and intimacy. According to Erikson, a child who does not successfully master a crises, will continue to have issues with trust, independence, identity, intimacy, etc into adulthood.¹

This is why it is crucial for parents to understand child psychosocial development: so they can respond appropriately to normal childhood behaviors such as temper tantrums, acting out, defiance, impulsivity, avoidance and more. Unfortunately, having a dysfunctional upbringing is the rule, not the exception. I often tell my patients about a cartoon I came across years ago depicting two adults – one man, one woman – each sitting alone in an empty auditorium with wide grins on their faces. Above them hung a banner which read, “Welcome Adult Children of Functional Families.”

To make up for dysfunctional mirroring from parents or guardians, many adults unconsciously rely on other people as mirrors, looking for validation they are worthy, competent, loveable, etc. As with all human behavior, however, it’s a matter of degree: how much their insecurity interferes with functioning and how much distress it causes them and others determines pathology.

Which brings me to Donald Trump. What the public sees as bragging, insulting, generalizing, contradicting and rationalizing, mental health providers recognize as defense mechanisms of a human being incapable of self-validating. He does not have the self-worth necessary to be open to self-improvement. Trump’s sense-of-self is reliant on the reflection of others. Every person he encounters is like a mirror to him. This is why he’s incapable of brushing off criticism and why he relishes political rallies. It’s also why Trump cares less about having real achievements and more about being recognized for achievements he doesn’t have.

Donald Trump is what I call “a cup with a hole in it.” No matter how much positive feedback you give him, he will keep needing more. Without it, he is empty.