Stop Worrying FOREVER!

If you struggle with anxiety, you’re not alone. It’s rampant. Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States, ages 18 and older, every year. Although anxiety is highly treatable, only 36.9% of those suffering receive treatment.¹

One of the biggest misconceptions about anxiety is that it’s interchangeable with worry. Not so. Anxiety is an emotion. Worrying is a thought process. Anxiety is a normal reaction to feeling out of control. Worrying is a coping strategy, albeit an ineffective one. Anxiety is unavoidable. Worrying is a choice.

It saddens me that so many struggle with incessant worrying, interfering with sleep, disrupting their productivity, making them depressed. It’s so unnecessary! You probably don’t believe me. You probably think I’m selling you “a bill of goods.” But I have conquered worrying and teach others everyday how to do the same.

You may have heard of the “fight or flight” response. The sensation you know as anxiety is your body revving up to protect you from a threatening situation. Yes, it’s uncomfortable, but so is touching a hot stove. It’s there for a reason. It’s how most people cope with anxiety that is problematic.

Anytime we feel out of control, we experience anxiety. This is particularly true when we’re emotionally invested in the outcome. For example, if you’re going on a job interview, you would likely feel anxious about making a good impression. If you start getting severe headaches, you would likely feel anxious until you got answers from your doctor. If you’re going on a first date, you would likely feel anxious until you got past the awkward introductions.

Through my years of practice, I have found anxiety is the result of three fears: harm to self or a loved one; rejection; and failure. Most people worry because they mistakenly believe it gives them some measure of control. By anticipating the worst, they are more likely to avoid it and less likely to be disappointed. But if you lay in bed worrying all night what are you accomplishing? You’re not doing anything to fix the problem.

In order to avoid whatever you’re anxious about, you have to identify what’s in your control and then follow through. Once you’ve done everything in your control, worrying serves no productive purpose but to make you miserable.

Furthermore, when we worry, we’re either anticipating something bad happening or rehashing something that’s already happened. In other words, our minds are preoccupied and not focused on what we’re doing in the moment. So not only is worrying a waste of energy, it also undermines our happiness. You cant be happy if you cant be present!

(This is an excerpt from a book I’m writing: Mantras for Managing Anxiety. Let me know what you think!)

¹ Anxiety and Depression Association of America: Facts& Statistics https://adaa.org/about-adaa/press-room/facts-statistics

What an American Superhero Looks Like

Spiderman

At 5yo, I vividly recall sitting on the floor in front of our living room TV watching Spiderman. I can still recite the theme song. And even though the TV was black-and-white, I remember the show in color. Perhaps this says something about a child’s imagination or revisionist history, but I’ve always wondered why this particular memory?

It may have something to do with our culture. The American ideal of the omnipotent and indestructible “superhero” dates back to the era of the Depression and WWII. It should come as no surprise that classic superheroes like Superman, Wonder Woman and Captain America came out of the minds of children of Jewish immigrants escaping war-torn Europe – artists like Stan Lee, Jack Kirby, and Jerry Siegel. Who else would hold such high ideals of America than people deprived of them?

But as movie technology has made superheroes into a huge entertainment industry, they have become increasingly unrecognizable from their quaint origins. I wonder what impact these depictions have on our ability to recognize hero powers among us. For who would recognize themselves among these fantastical depictions?

I thought about this as I watched the Mueller hearings yesterday. One common theme among superheroes is their secrecy. They loathe attention. They don’t care about accolades. Their reward is knowing they are making a difference. (As a therapist, I can definitely relate to this!)

Superheroes have special abilities (or supernatural powers), but they never use them for their own benefit, only to help others. This makes them particularly vulnerable to exploitation or destruction by those with selfish intentions.

When not helping others, superheroes are unrecognizable from everyone else. Even though they have remarkable skills, they are otherwise like you and me. They experience the same feelings, struggle with the same personal issues and have some of the same vulnerabilities. This may be disillusioning for some and an excuse for others to question their abilities, but they don’t feel a need to prove themselves.

Superheroes have a set of values that never falter – no matter how much they are criticized or how hard others try to stop them. Their mission is not based on what is popular or easy, but what is the right thing to do. It doesn’t change under peer pressure or fear of failure. And it is bewildering to them how a person could behave any other way.

Superheroes are not as elusive as you think. Despite appearances, be assured they are among us today. Just don’t expect them to tell you.

For additional information on the history of superheroes, see: https://www.humanities.org/blog/how-american-history-created-the-american-superhero/

 

A Letter to Mitch

Dear Mitch,

I’m not Black. I don’t know how it feels to be Black. But I am Jewish. And no matter how much time elapses between past and present, Jews will hold Germany responsible for the Holocaust. No matter how many generations pass, my family will feel a kinship with my Polish grandfather, who lost his family during the Holocaust.

America is not just a geographic location. It’s an identity. We are “Americans.” Your wife is a Chinese immigrant and she’s an American. You can’t point to a specific flag in the Capitol and say, “This flag on this pole is the American flag” because it’s a symbol.

You and I will die one day but America will still be responsible for slavery. I don’t know if your justification against reparations stems from ignorance, racism or political convenience, but there’s no excuse.

Most Germans living today did not participate in the extermination of 6 million Jews, but their country did. In his article for John Hopkins Magazine, Greg Rienzi describes the history and conditions of Germany’s ongoing reparations for World War II. According to his report, an estimated $1.1 billion in compensations is made every year. Of course, there are economic and political advantages for Germany to do so, but Jews would expect it regardless.

The culture of slavery and its predecessors are gone, but it’s legacy lives on. “Who would reparations go to?” you facetiously ask. How about places where racism has been institutionalized: e.g; public schools; law enforcement agencies; the justice system; housing; education; and healthcare?

While we’re at it, voters should “clean house” of relics like you who ignore slavery’s stain on the country.

Greg Rienzi’s article, Other Nations Could Learn from Germany’s Efforts to Reconcile After World War II, can be found here:

https://hub.jhu.edu/magazine/2015/summer/germany-japan-reconciliation

The Debate Myth: Advice from a therapist

2020 presidential debate

Attention Democratic Presidential Candidates:

You’ve studied the issues, honed your policy proposals, reviewed videos, consulted political experts, prepared remarks and practiced with surrogates. But have you talked to a psychotherapist?

Naturally, you will be anxious. Any time you feel emotionally invested in something (eg.; a job interview; medical diagnosis; first date) and you don’t have complete control over the outcome – which is pretty much always – it’s human nature. Don’t even try to talk yourself out of it. However, anxiety can be compounded by unrealistic expectations.

Which brings me to the point of this article. Hyping up the “2020 Presidential Campaign Debates” makes for good ratings, but puts unnecessary pressure on candidates, particularly with ten competing at once for air time. Debates should be about informing the public and contrasting ideas, but they’ve morphed into political theatre. The media is fixated on performance and tussles between candidates. It reminds me of reality TV, creating conditions destined to cause drama.

Some of you (like me) are old enough to remember when Party conventions were more than pageants. They served a practical purpose. Platform policies were leveraged in exchange for votes from delegates. The position of Vice-President was a prize for working hard and galvanizing a lot of voters. Being a “political insider” was not a dirty word. Although way too homogeneous, at least they had expertise and a familiarity with the candidates. I can’t think of a single Presidential candidate who survived that process who didn’t at least have a command of the issues and experience governing. And, because the candidates had insider support, they actually did have “all the best people” wanting to work in their administration. Under this process, I have a hard time believing the GOP establishment would have nominated Donald Trump.

The idea that a good debate performance has bearing on who makes a good president is ludicrous!So stop accepting their exaggerated relevance! You are enabling a process that is harmful to our country.

I know you want to win, but it should never be at the country’s expense, but that’s exactly where we are. Politicians are so fixated on winning, they start wars, misappropriate funds, twist laws and circumvent democratic procedures to do so. This idea that you have to be in-charge to implement change, is why Congress is so dysfunctional. It also explains how the Office of the President has accrued so much executive power.

If you go along with this charade, youre equally responsible as Trump for our dysfunctional government.

So take advice from a psychotherapist: be honest with the American people. Tell them “soundbites, zingers and ‘gotcha’ moments are superficial and unimportant.” (They’re also a lazy way to pick a president, but I know you can’t say that.) Hold Americans responsible for learning more about you. Remind them debates are one of many steps to choosing a candidate.

Since I have no faith the media will frame debates this way, it’s up to you. Push back on efforts to label and simplify complex issues. Challenge reporters who ask about political theatrics when they should be asking about policy. Wait until you’re one of three or four candidates before debating. Tell the networks, “Thanks, but no thanks,” to debates, “but I’m happy to do a town hall.”

We’re no different. Neither are they.

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There was a time when I thought Americans were above this, that we were special. I thought what happened in WWII Germany could never happen here. “We’re not that naive,” I thought, “not that dispassionate.”

As an American Jew, I grew up learning about the Holocaust; this is what happens when “good men do nothing.” I learned, if Jews wanted cultural acceptance, we’d have to stand up for it. If we wanted to survive in a hostile world, we’d have to create our own safe haven.

My family’s story is a common one among Jews. My maternal grandfather escaped Poland and moved in with extended family in NYC. At some point, he stopped receiving letters from his parents and siblings. He never heard from them again. After the war, he researched vigorously to find out what had happened. He was never able to.

My grandfather was a very religious man. As a child, I had mixed feelings about his visits. On the one hand, my mom brought home “treats,” like bagels, lox and cream cheese, halvah and wafer cookies – you know, the kind that taste like cardboard on the outside but have that sugary pink cream in between?

On the other hand, I was not allowed to watch TV or be driven anywhere Friday through Saturday. My mom had to leave one gas burner on at all times to cook, and lights were kept either on or off. Once my grandfather scolded me for using scissors.

This was how my mother was raised. Even though she lived in Brighton Beach, she was not allowed to go swimming on a Saturday. Years later, she would enviously recall passing children on the beach while on her way to schul. Nevertheless, she was very proud of her Jewish heritage and even worked as a Hebrew school teacher early in her career.

As was common of his generation, my grandfather worked with his hands, making leather goods. My mom went on to become one of the first female attorneys of her generation. She stayed home with my brother, sister and I until I started school. For most of her career, my mom worked for the US Department of Interior, retiring at the age of 79.

My mom did not live to see her daughter join the Army, (which was probably for the best). Like most moms, she was worried about me being in harms way, so we agreed-to-disagree. While my siblings and I held vigil at the hospital, I was going through the process of commissioning at the age of 42.

My family’s potential would not have been evident to the Nazi’s. They never gave Jews the opportunity to demonstrate otherwise. They wanted an easy “solution” and a place to vent their anger. Demonizing and dehumanizing Jews provided a scapegoat for Germany’s economic woes.

Once I joined the Army, I discovered many Soldiers did so for the same idealistic reasons as I: to make a difference and be part of something bigger than themselves. (Imagine my surprise when I heard these exact words on an Army commercial!) I saw how military men and women are taken for granted. But I think this is exactly the type of luxury they’re fighting for.

As a clinician, I understand it’s human nature to get caught up in the routines of daily life. But Americans have become so self-consumed and fixated on the trivial, we’ve lost our sense of civic duty. America was not designed for a passive, reactionary citizenry. As Thomas Jefferson said, “If we are to guard against ignorance and remain free, it’s the responsibility of every American to be informed,” and, I would add, be involved.

It is also human nature to feel more than one way about something (or someone). Unfortunately, people have a tendency to ignore some of their feelings.

Why? It’s easier – less messy, less complicated, less anxiety-provoking. Responding individually to each situation (or person) takes effort. It requires insight and a variety of coping skills, which most people don’t have. This is the cost of a society that stigmatizes mental health: you can’t expect people to make good decisions if they haven’t been taught how.

There are no simple solutions, but I recommend updating school curricula to include training in life skills, conflict resoution, problem-solving and emotional coping. I also recommend neighborhood improvement projects that bring together people of different backgrounds or roles in the community (e.g.; police officers and residents).

We may be Americans, but we’re human beings first. Without community engagement and mental health awareness, another holocaust is always possible.

The Media’s Missed Opportunity

Trump-Media-Reporters-

After his sterling performance at the 75th Commemoration of D-Day, the news media pondered if Trump really meant what he read from the teleprompter. When asked about this, one legislator even suggested Trump seemed emotionally moved by the experience.

I understand holding out hope Trump will change – just as I understand why a battered spouse keeps returning to her abuser. But to expect Trump to change after one event is like expecting a person w/ cancer to cure himself by sheer force of will. If it was that easy, Trump would have changed already.

I wish the news media understood how such untrained observations can discourage people from seeking help. Sadly, only 37% of people w/ a mental illness seek treatment. By suggesting that Trump could emotionally pivot in one day, insinuates he’s capable of change if only he tried harder. Many of my patients get accused of this, which leaves them feeling unsupported, misunderstood and inadequate. Then they start second-guessing their symptoms. The news media’s amateur psychoanalyses also feeds the misconception anyone can be a psychologist. If reporters with no medical training regularly hypothesized about Trump’s physical health, I expect they’d be fired.

The mental health field is constantly working against stigma and minimization to reach people. Silence and misinformation lead to increased isolation which leads to increased suffering. The consequences include a rise in teen suicides, a drug epidemic, increased violence and irresponsible policy.

Cluster B personality disorders, which includes Narcissistic Personality Disorder, develop over years of dysfunctional rearing (and, in many cases, trauma). Naturally, it takes years of therapy to unravel the effects. Plus, at his age, Trump’s brain is hard-wired to think the way he does. Often there is a comorbid diagnosis with a personality disorder. Some contribute to the formation of a personality disorder, such as ADHD or a learning disorder. Others can be a byproduct such as chronic depression, anxiety, or substance abuse.

Trump’s conduct over the last 2 years has provided ample opportunity to explain his behavior to the public. The news media could have brought in “panels of experts” in mental health just as they’ve done with lawyers and security analysts. These experts can differentiate between psychosis and maladaptive behavior, explain how psychiatric disorders are diagnosed and what treatments are effective with what diagnoses. They need not prognosticate, (which is what many legal or security analysts do).

Rightly so, the news media takes its role of speaking truth-to-power very seriously. And there’s no doubt our democracy is safer for it. But shouldn’t that include the issue most responsible for our current state of affairs: Trumps mental instability? Don’t Americans deserve this information before returning to the voting booth?

By doing so, the news media will also legitimize and destigmatize mental illness for millions of Americans.

How Our Cultural Ignorance of Mental Health Helped Elect Donald Trump

mentally speaking trump flag

Leading up to the 2016 presidential election, I repeatedly heard politicians, pundits and voters predict or at least express hope that, if elected, Donald Trump would “rise to the occasion” or “surround himself with good people.” It infuriated me. As a mental health practitioner, I knew this would not happen. More than his policy or populist rhetoric, it was Donald Trump’s instability I feared. It was disconcerting how few people did.

People assume that psychiatric diagnosis is a subjective science open to interpretation, but this is far from the case. Human behavior operates on a continuum. In many cases (but certainly not all) it’s a matter of degree and frequency that separates abnormal from normal. When taking Abnormal Psychology in college, we were warned of psychiatry’s own version of “medical student syndrome.”

Perhaps this is why it’s easy to justify Trump’s deviances. It’s when you take into account the totality of his behavior that you see a troubling pattern. In the mental health field, practitioners rely on the Diagnostic & Statistical Manual (DSM) to differentiate normal from abnormal. The DSM, now in its fifth revision, outlines specific criteria which must be met before a diagnosis can be made.

After intake, a patient will sometimes ask, “So, do you think I’m crazy?” My usual response is, “If you were, you wouldn’t have asked that question.” I believe this fear is the main reason why the mental health field is so stigmatized. What most people call crazy, we call psychotic symptoms: auditory or visual hallucinations (hearing voices or seeing figures that aren’t there) or delusions (an unshakeable, and usually irrational, belief despite irrefutable evidence to the contrary). But psychotic symptoms apply to just a fraction of mental health disorders and are usually of neurological or pharmacological origin.

Most distorted thinking has nothing to do with psychosis. It is a maladaptive form of coping. One of my favorite mantras is, “People have good reasons for making bad decisions.” This is why people repeat the same self-defeating, and even self-destructive, behavior no matter how much you try to reason with them.

I tell my patients, “There are plenty of people out there happy to give you advice. I’m here to empower you to make your own decisions.” Until you understand a person’s motives, identify his ambivalence (conflicting thoughts and feelings), and help him develop new coping skills to replace old ones, he will not change.

So, when the same people who hoped Donald Trump would change now express bewilderment over his behavior, I am not surprised. You cannot make sense of Trump except in the context of a personality disorder.

The DSM-V defines a personality disorder as a long-term and rigid pattern of thinking, feeling and behaving that adversely affect all aspects of a person’s functioning. The most relevant aspect of a personality disorder is the consistency and pervasiveness of the person’s behavior. This is why I knew Donald Trump would not change.

Consider the DSM criteria for Narcissistic Personality Disorder (NPD), indicated by five or more of the following symptoms:

1. has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
4. requires excessive admiration
5. has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
6. is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
7. lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
8. is often envious of others or believes that others are envious of him or her
9. shows arrogant, haughty behaviors or attitudes

When a group of mental health professionals came out with the book, The Dangerous Case of Donald Trump, some questioned the ethics of attaching a diagnosis to a person they had never treated. But Donald Trump has provided more evidence than could ever be gleaned from weekly office visits.

Another relevant aspect of a personality disorder is that it can’t be treated with a pill. It requires long-term therapy. Sometimes it can be augmented by medication if a patient has comorbid symptoms such as depression or anxiety.

After outlining the criteria for NPD, a friend asked me about an interview she read with Dr. Allen Frances, the self-described “author” of Narcissistic Personality Disorder in the DSM. He claimed that Trump didn’t have it. I had to shake my head over the irony.

The Diagnostic Manual was created to provide clinicians with an objective and universal measurement of mental disorders. If I needed Dr. Frances’ or any other author’s interpretation, it would cease to be the stand-alone resource that it is.

Dr. Frances, who is a long-standing skeptic of the DSM, based his argument on his (apparent) impression that Trump does not experience distress. While Trump’s anger outbursts and paranoid rants tell a different story, this is beside the point. There is nothing in the DSM criteria for personality disorders that requires internal distress.

I wonder if Dr. Frances is referring to the fact that most people with personality disorders do not seek treatment unless distressed – usually due to a crisis in their personal or professional lives or to comorbidity (depression, anxiety or substance abuse). Otherwise, it is very difficult to convince a person with a personality disorder to seek treatment. Unfortunately, once the crisis is abated or the emotional discomfort wanes, they usually stop going.

To further justify his argument, Dr. Frances points out that Trump has been rewarded for his behavior. While Trump may not have reaped major negative consequences for his behavior – yet – lying, cheating and breaking the law, are dysfunctional behaviors, consequences or no consequences.

Lastly, Dr. Frances warns against generalizations. Rightly so, he argues that this should not disqualify someone from the Presidency. Abraham Lincoln and Winston Churchill are believed to have had mental illnesses (Major Depression and Bipolar Disorder, respectively). But this is my point.

If a Presidential candidate is diagnosed with high blood pressure, voters would not automatically deem him or her unfit as long as the condition is being treated. However, if a Presidential candidate was diagnosed with dementia, there would be valid cause for concern. The impact of mental illness on a person’s functioning is no different. Many are manageable with therapy and/or medication, and need not significantly interfere with a person’s performance or functioning. The degree of impairment depends on the diagnosis and prognosis.

Rather than shying away from labels, we should be talking about what the labels mean. You may accuse me of bias, but there is nothing more essential to human progress than mental wellness. How we behave is inextricably linked to how we think and feel. To paraphrase the Spanish philosopher, George Santayana, until we learn to understand this link, we are condemned to repeat our mistakes.