Sunday, December 24, 2017

Snap Shots: The Holidays, and More As We Wrap Up 2017

It's over, Chanukah. but it was fun. 

It's traditional to wish people Happy Holidays  this time of year. Knowing we get at least a day off, we ask one another what is happening, how do we celebrate? Will there be a big turkey dinner? A ham, perhaps? 

It happened just last week. I have a new friend who swims at the same time I do each day, and she asked what I do for XMAS. Big dinner XMAS eve?

So I told her that no, we don't do that. But it brought back a very old memory. My brothers, me, and my parents, seems like it was always a Wednesday on December 24. The store, my father's store, finally closed for the holiday. This is before online shopping, so retail shops on the streets thrived in November-December. A family could eat all year on the profits for the season alone. So it was a celebration, and we DID have a big dinner, even if it was in the middle of the week, simply celebrating the end of the retail season and so much work. And it was great. 

Sometimes it would be on Chanukah, too, but not always. Because the Jewish calendar is lunar, the dates of our holidays are different each year.

And guess what? Chanukah is over, and yet people still want to know: 

What do you do on Chanukah? 

Why bother telling them it is over? Instead I tell them we can work during the day, but not at night while the lights are burning. Maybe we go to a Chanukah party with family or friends, but it isn't a big deal. This isn't a soul searching holiday, not one commanded in the Five Books of Moses, rather it is a celebration that we're still here. They tried to kill us. We won. Let's eat! 

But it is more, of course, and the irony is that most Jews who skip out on the Sabbath (much more important) celebrate Chanukah religiously. Their parents assimilated, they are, too, and nobody told them that this is the anti-assimilation holiday. It is a victory over forced assimilation. We should call it the DIVERSITY holiday of the Jews, a celebration of differences. The Greeks said: Give up your Sabbath, close down your mikvah, burn your Torah--or face certain death. Not unlike the Spanish Inquisition! 

If we caved back then, would we even be here right now? Probably not. Jews don't go to war over nothing. 

lasagna, mock meat
potato latkas, the traditional kind
So anyway, getting back to what we do on ChanukahWe valiantly try to get home a little early on Chanukah nights to light candles (or an oil menorah, see above) at sundown. We add one flame each night, say a prayer, then settle down to a meal that is always too high in calories, usually with cheese, something oily, hence the latkas (potato pancakes). 

Do we give presents? Sure, to the kids, or money. Most of us don't even know where that tradition came from. If anybody knows, shoot me an email.   

2.  XMAS 

The gifts can get out of control, I hear. In family therapy they are described as a tremendous source of stress. 

There's a Moth podcast about a woman who feels compelled to buy an expensive wedding dress, even though she isn't a real "wedding dress" kind of gal. It's worth hearing, if spending money for the holidays makes you sick. Find Jesse Klein on The Moth Radio Hour for that. 

But three patients, the same day, three, tell me they have to give it up, the work of this holiday, Xmas. It is too hard. All the decorating, all the shopping. Enough is enough. One even said, "I'm telling people I'm Jewish," (meaning exempt from all the bother). 

But she has to be told. It has to be discussed. She's exhausted, she's depressed. The holiday is work, sure. But this has nothing to do with the work, not even with the materialism, or even comparative religion. It's all about grieving those people who are gone, the ones who showed the example, who did the work without complaint, who aren't here anymore, who probably should have just done less, but couldn't disappoint the kids. These holiday troopers are missed, more than ever, on those silent, holy nights, even with those complicated relationships that haunt us, looking back. And they aren't missed for the gifts.

Yeah, grieve them.


After we squirt out a few tears in a visit like that, I find myself asking my grumpy patients, "What about New Years? Is that fun?"

(To an observant Jew, January 1 is a pagan holiday. Most of us don't revel.)

And every one of them tells me what I already know, because I know them: "Nah, we never did that. For what? Why would we do that, go out with all the crazies who drink too much, risk getting into a car wreck? The streets aren’t even safe, and there’s plenty to watch on television. We're just going to stay home, maybe play some cards, eat popcorn."

Me, Too.  

Well, that's all the time we have for today, friends, for this year, probably.  May your holidays be happy. May you resist over-working (your mother didn't work outside the home, just a hunch). Do what makes you happy, as long as it isn't invading someone's personal or even psychological boundaries, and if you decide you want to take off and go to the movies rather than open another fruit cake with Aunt Martha, just do it. She's probably using Truvia by now, anyway, it will last forever in the freezer, or she bought it at the bakery or the local Jewell. She doesn't have much time or energy, either.


Friday, December 15, 2017


No, not my usual post. But this stuff has been bothering me, and this is how I'm working it out. I feel badly for making Mr. Franken an example, he was a champion, is the truth. But we're learning that if you can't be a mensch, a human being who is careful with other people, you're likely to lose more than a few fans.

It's the end of the year, and what a year it has been. Distressing, in a word. But just when you're about to give up hope, something wonderful happens, like Roy Moore loses! So on that note, let's get started with what might prove to become an annual post. 
Chris Sacca, the only mensch


1. Worst Loser Award

Roy Moore, congratulations! 

Just in time for the celebration of Chanukah, we hear that the man who thought nothing of taking a fourteen year old girl to his house to get acquainted, lost election for Congress. Going in he was ahead at the polls, but thanks to the African American vote of intolerance, he lost by 20,715 votes. That's a lot of votes! 

Yet, at this writing, Moore refuses to concede. He believes that God might still save the day. Well, Roy, God works in mysterious ways. Even Donald Trump is saying, Let it go, fella. Roy Moore gets the Worst Loser Award for not only refusing to see himself as imperfect, but for not resigning when he probably should be behind bars or in therapy, or both. That's what we call a serious chutzpah

II. Worst Parting Shot After Losing Your Job Award

Tom Ashcroft gets this one. He's a National Public Radio host (I always liked him.) The allegations are that he talked "creepy" sex talk, gave  unwanted hugs, neck and back rubs. Eleven mostly young men and women who worked with him on the show reported the abuse that surely constitutes a hostile work environment.

 Ashcroft, informed that he had to go, sent the following text to the station, the line that earns him the Worst Parting Shot award:

"I am sure that once the facts come out that people will see me for who I am-- flawed but caring and decent in all my dealings with others." 

Translate this into therapy-speak and what he means is: Who me? Must be some misunderstanding. I'm awesome. One day they'll know. They'll be sorry.

Oh, we already know more than enough, Tom.

Onto the next award!

III. Most Creative Use of Office Space Award  

Matt Lauer, hands down. Lauer is said to have installed a panic button in his desk that allowed him to lock his office door from the luxury of his chair. Women can get in, but they can't get out! This is called creative narcissism, but it isn't the good kind. Do not pass Go, Matt. 

IV. And Two Awards, Two, go to a  our politician who is not a President  of the year (and that's a tall order)
       1. Best, if Second-Rate Entertainer in Politics Award 

and 2.  First Place Swine at the Fair Award

Al Franken, yes.. Franken couldn't be with us tonight, so therapydoc thought it a good time to use this public forum to accept the award for him and have a little talk together.
Here's the thing, Al. I've been holding in a lot of rage about you for a few weeks, at least. Your behavior, like Harvey Weinstein's, just isn't Jewish. It'is embarrassing to all of us who light candles or oil menorahs tonight. You get this award, however, not Weinstein, because you claim to be a man of the people, elected by the people, and a true champion of women's rights, and you let us all down. And another thing.

I NEVER LIKED YOU ON SATURDAY NIGHT LIVE! I'm just not much into the smug act, that superiority bit you did so well on Weekend Update. I thought, wow, his father is probably this way, you don't get this material out of thin air, it is so convincing. Then, at some point I thought, IT'S NOT AN ACT!  and stopped watching because an unfunny skit went on so long. It was the one where you ended every sentence with your name, the tag line  ME, AL FRANKEN
And NOW, Me, Al Franken, as a United States senator, you're called out for touching women inappropriately while taking pictures with them, and even though we can't see it, it is assumed that you are smiling! This is very offensive, Al. These women, who once admired you, now think you are a disgusting excuse for a human. There's another allegation, too, that you asked at least one of ex-voter to join you in the bathroom after you had already humiliated her with that grabbing thing you do. It is said that before you went into politics you did this grabbing thing and said it was your right  as an entertainer (forget that you didn't make me laugh). 

Your defense, dear, is so terribly weak, too. Rather than apologize, even try to empathize, you say,  I DON'T REMEMBER DOING THAT!  Al, this isn't something you forget. You have a body memory, just like she does. Stop lying. It further cheapens you. 
The apology, too, such a poor excuse for an apology: If I did make some women uncomfortable, I'm really sorry.   IF you did something to make some women uncomfortable? Use "I" language. I did things.  
Champion stuff, there. Deliberately shaming a woman, or humiliating her, publicly, this is worse than narcissism. It is sociopathic. Now there's a third award. Most sociopathic politician. But there are so many contenders, it is too hard too choose. 

Just so you should know, readers, this kind of conceit is the underbelly, the ugly side of narcissism

Side bar. If a man doesn't tell us his history, why he does these things, because he knows, deep down in his heart, what drives him, then people will assume the worst, the sociopathic, the ugly narcissist. I'd rather hear an apology like the following than nothing at all:
"When I was a kid it was a really cool thing, grabbing women, it made you feel like a man, you see, and we all did it and we laughed, and the girls hated it but you sort of wondered, Did they like it? I think they did! And some guys, like me, don't give up their frat boy years so easy. It was funny then, but it isn't funny now, and I'm an idiot, and I have a lot of thinking to do, intend to take women seriously, and I have to stop lying, begin owning up to what I've done." 

You've been so lucky so far, Al, they'll probably accept that.   
V. Best Friend Award
and the winner is . . . Garrison Keillor!
We'll never have to listen to Keillor's dopey Prairie Home Companion again. (Okay, I loved him for years, even listened to the poetry, but his show, and his droopy voice, got old over the years). He no sooner defended Franken, blamed Tweeden (seriously, who blames the victim anymore) than NPR fired him. But before his crimes came to light, he  defended Franken's honor (the expression, thick as thieves comes to mind) calling the women liars, these victim who had witnesses to their stories, who told on him immediately to spouses and friends, after he groped them, cried about the feeling (this is never acknowledged by these guys, the feeling) how horrible it was for them. BEST FRIEND! Cellmates!

VI. Funniest President Ever Award

and the winner is. . . George H W Bush!
Al Franken got nothing on me, HW might say, admitting to having grabbed too many women to count during photos. (This is a thing, who knew?)

People are trying to be kind about it, saying he suffers from senility, that's why he did it. Could be. But it still gives new meaning to the expression photo op

Bush excused himself by telling the woman a joke before he flexed his wrist.  
"Do you want to know who my favorite magician is? David Cop a Feel!"

Now that's really funny.

If you're twelve.

Let's pause for a song, because nobody, with the exception of VC Chris Sacca, the only one in the scores of sexual misconduct apprentices knows how to apologize (I HAVE MORE WORK TO DO, he writes). 

As the wonderful, if drunken Dean Martin might croon: 

Everybody says they're sorry sometime, everybody has to look inside. Somewhere in my heart I'm certain, I've something to hide.Everybody knows he's guilty sometime, everybody's face gets red sometime, Why is it that out of nowhere, what's hurt is my pride. 
That's all the time we have for today, friends. 

Oh! And if you happen to be thinking, Hey, I probably ought to apologize to Susie, or Mary, Janice, Heather, Debbie, Bob, Jim, Spike, Sylvia, whoever, take a deep breath, and for God's sake, just do it. Call, or write first, don't show up at the door. Do expect to be called a few choice words, and when she finishes say, "And? There has to be more. Let me have it. I'm so sorry."


Tuesday, December 05, 2017

What I Wanted to Put on Twitter But Just Couldn't

If President Trump talked to #therapydoc
Hi out there! It has been a super busy "holiday" season, meaning people touch base in therapy as holidays approach, so I'm scrambling to stick to regular hours (working too much at a stressful job can be bad for your health). So I haven't posted in awhile, But this one, hopefully, will make up for that. It is a conversation between me and our President, therapydoc and Donald Trump, about NPD, narcissistic personality disorder.

On Twitter sometimes people have these long, connected, stream of consciousness posts, not exactly lectures, but opinions. If there's one thing you probably guessed about therapydoc, (s)he loves to express her/his practice wisdom, which is an educated opinion. Loving attention, thrilling to the sound of my own voice, you would think that it would be a perfect venue for me. 

But honestly, this one features the President of the United States, or #POTUS, and I don't want to suffer retaliation of any kind, were he to be insulted, having read something tagged #POTUS. I wouldn't want him to interpret it as anything other than a caring, truly worried conversation, if a conversation can be worried. We all have our neuroses, and one of mine is being found out, discovered, trolled, annihilated. There's a fear of annihilation, and I have it. 

So I pulled back from Twitter, knowing that hashtags draw attention, and that the President loves Twitter, in favor of running this conversation by my friends, those of you who still read Everyone Needs Therapy

So here goes! You can read it from top to bottom, which you can't do on Twitter! Yay Blogger!

December 5, 2017

Dear #POTUS: I know that many journalists don’t like you and don’t agree with your politics. They are saying that you have #narcissisticpersonalitydisorder, or #NPD. That has to hurt. I cringe when they make fun of you, but sincerely want to discuss it, because it doesn’t have to be that way. You can prove them wrong about the #NPD. 

Dear #therapydoc: You have a lot of nerve even thinking that there is something to discuss. I do not have #NPD, have never had #NPD. That is #FakeNews. Nothing to discuss.

Dear #POTUS: Are you sure there’s nothing to discuss? Everyone is a little narcissistic but they can't all tweet and get the attention they deserve. We get it from family. It isn't easy growing up. We're just responding to how people treated us (although that could be unconscious, it is in the worst cases). We don’t even know, half the time, why we say what we say, do what we do. We’re on auto. 

Dear #therapydoc: I know you are, but what am I! I’m not trying to be funny. You might be on auto but I think about everything I say and it is all correct.

Dear #POTUS: No disrespect, because you are the COMMANDER IN CHIEF! How awesome is that? But it is kind of conceited to say that everything you say is correct. Everyone is wrong once in awhile. 

Dear #therapydoc: I might be wrong sometimes and when I am I tell everyone, and everyone is listening because, in case you forgot, I AM the President of the United States.

Dear #POTUS: That’s great to know, that you apologize, because we all have to apologize sometimes. Like the name calling thing. IS it okay? Let’s talk more, seriously. 

Dear #therapydoc: #RocketMan does not deserve respect. He is aiming his rockets at us. But we have bigger and better rockets. He should know that. We're bigger than he is.

Dear POTUS: Of course we do, of course we do. This is America, the greatest country on earth, and you are the PRESIDENT! That must be an amazing feeling. I mean, if anyone ever teased you as a kid, or even as an adult, it’s like, Who’s crying now right?

Dear #therapydoc, Do you even know who you are talking to? 

Dear #POTUS: I am sorry. You occupy what is the most respected, revered, awe-inspiring, yet terrifying position in the world as #POTUS. I’ll take a step back. Let’s go back to this idea that they, the #fakenews people are calling you names, the idea that you have #NPD, or #narcissism.

#THERAPYDOC!!!! Really? Only liberals and CNN would say that about me. You better watch your step. 

Dear #POTUS:  Did I ever call you that, even once? 

#therapydoc: Now that I think about it, no, you did not. But I think YOU are a narcissist, probably, seeing them in your sleep.

Dear #POTUS: Actually, you’re right, I do see them in my sleep, I am a mental health professional and we see quite a bit of unhealthy #narcissism. I have some, too, and it eats me up, I feel terrible when I think I’m better than anyone, even for a minute. Did you know, however, that in the research there’s evidence that we all do that? We all think we’re a little superior and it helps us be better, more creative people. Even leaders!  Crazy, right?

Dear #therapydoc:  If you don’t love yourself, who will love you? I don’t listen to anyone because I know, in my heart, I’m right. 

Dear #POTUS: Exactly.  When you’re right, you’re right.

Dear #therapydoc: And I AM, mostly right if not always.  

Dear #POTUS:  Can we talk more about the difference between healthy and unhealthy narcissism?  

Dear #therapydoc: Mine is healthy, just so you should know. I think you know that.

Dear #POTUS: Well of course you are right, because if you weren’t healthy, how could you have been elected President of the Free World! Or is that not a thing. President of the United States, I mean. The people trust your instincts. Or at least they did on election day. Is it possible you have lost their trust? I hope not.

Dear #therapydoc: Now you are sounding like the liberal media. Don’t be ridiculous. The people love me. Have you seen how #SarahHuckabeeSanders repeats every word that comes out of my mouth? She always respects me and she is a beautiful woman, a beautiful person, beautiful. SHE gets me. She will keep her job. 

Dear #POTUS: Does she ever try to give you advice? See, that would be proof that you aren’t narcissistic. If you can listen to other people and validate their advice, then you’re good. 

Dear #therapydoc: HA, HA, HA! They listen to me. BELIEVE ME, they listen to me. 

Dear #POTUS: But you don't tune people out when they talk to you, right? You would never do that, just space out, drum you fingers, and go, La, la, la, la, la. 

#therapydoc: You’re an idiot. I would never do that. 

Dear#POTUS:  That’s what I thought. So you could technically respond to the naysayers that you have healthy narcissism, the kind that gets people ahead in the world, inspires them to be creative, inspires them to be leaders. 

Dear #therapydoc: I don’t like that word, narcissism. 
Dear #POTUS: Then what should we call it? 

Dear #therapydoc: Let’s call it BLESSED. I’m gifted, and blessed. 

Dear #POTUS: A good start, Mr. President, a good start.  


Thursday, November 16, 2017

Roy Moore: Why We Should Believe the Victim

Leigh Corfman, 14-Roy Moore, 32 
Roy Moore, a judge of questionable character

Roy Moore, always smiling 

First, a quick story. Yes, a #MeToo.

I'm fifteen and am visiting a friend I haven't seen in a long time. We were once best friends, but when we hit high school, no classes together, we didn't keep up. But for some reason I'm there, in her house, and so are about a dozen others. I haven't made it past the kitchen when her father, in a big blue bathrobe, appears. He is a very tall, imposing man, and he's all smiles, very happy to see me, especially. He takes my hand into his, and proceeds to pull it under his bathrobe.
I pull free and spit out these words. I cannot believe, to this day, that these words came to me: Go jag off in the john!
Then I ran home and told my mom, who told me: Don't tell your father. He'll kill him.
So I didn't, and I didn't tell anyone, not for another 20 years.
Because that is how long it can be for a person to process an event like that.
When I think about it, if I had told people, they might have believed me. My friend is probably a survivor of incest. He likely did that to her, and much worse. It makes me very sad but explains why she distanced from me after that, has never seemed very comfortable in my presence. Who knows what he told her. There were witnesses. Who knows what the other kids believed. 
One thing I know, for sure. That man was a sexual predator (he's probably dead by now).
And being one who preferred adolescents, the technical label is ephebophile. 

But he could have started with his daughter when she was younger. I hope not.

And that story? It is a nothing story, compared to the many that we hear in therapy. And now, you're hearing them, too.

First hand accounts of what sexual predators have done to women, men. Professionals like myself wonder: Are the numbers going down? That statistic that tells us that one woman is raped every minute, has it change? Unlikely, because those tend to be international statistics. The Harvey Weinstein story might not be heard in impoverished patriarchal societies without Internet. Not everyone has a computer or can afford to be a news junky; not everyone is informed.

But if you're reading this, you've heard it all. It would have been hard to miss the Weinstein story, the one about Kevin Spacey, Louis Ck, etc. So many others, mostly in entertainment. And now, Roy Moore.

Mr. Moore has adamantly denied that he forced young adolescent girls into sexual acts, or coerced any of them to be his "girlfriend." He has everything to lose if he is vilified as a sex offender. Which is why Mrs. Moore stands at his side. It is bad for her, humiliating. So she will deny knowing, and indeed, may not have known.

I have a friend, a professional who after doing some research into sexual assault on campus, decided to go into sexual assault/harassment prevention as a sideline. She developed workshops and tried to worm her way into big corporations and schools, even got as far as talking to a lawyer for the NFL, and a proposal for them. But she wasn't hired anywhere but in schools that worried about Internet predators. 

She tells me that it is because exposure could cost a company millions of dollars in client revenue, and if there is a problem it is handled within, by HR, and that most human resources complaints are about sexual harassment, and they fall on the floor (like some of my claims to insurance companies).

In corporate it is exceedingly difficult to get taken seriously with allegations, and the EEOC, flooded with complaints, vets them, too, and there are wait times of years between the complaint and the action. By then the complainant has lost her job, expected retaliation by the company, and she suffers survivor fatigue. After awhile, you live with it.

But it shouldn't be, as we all know. Post traumatic stress, the almost inevitable consequence of violence of any kind, isn't necessary in a person's psyche. We could all do very well without it.


Why believe the victims who come forward, as opposed to the alleged perpetrators?

1. Because it takes tremendous courage to do that, to tell everyone (because everyone will hear) that you have been coerced into a sexual relationship, have somehow found yourself (victims say stupidly) in a sexual situation that you didn't want or understand.

There are different methods of coercion, but regardless the type, when the victim is still a minor she cannot legally say yes to sex with an adult. Minors can't grant informed consent. So they feel horrible and guilty when they are subject to sexual assault. Confrontation takes strength and confidence.

2. Because it means confrontation, just speaking up, comes with potential public humiliation, embarrassment, and future references to sexual experience. The perpetrator is likely to deny the accusations, so one's future, a woman or man's reputation is at stake.

One who comes out as having been sexually assaulted or harassed risks their own good name, Stories follow people. Getting hired, even getting into certain schools, can be harder when there are Facebook references to sex, especially when one is reputed to be a whistle blower, a person who is likely to complain about future offenders.  (We wouldn't want that at the company).

3. Because of the fear of retaliation, even fear for one's life or safety. When a woman, or a man, comes forward and accuses another of a sexual crime, there's that risk. Who would do that if it weren't worth the risk, preventing the perpetrator from future crimes?

4.  Because of the precariousness of mental health, we prefer to be symptom-free. Mental health is a terrible thing to lose, and assault and harassment are associated with depression, anxiety, post , traumatic stress, and a host of other diagnoses, not to mention pregnancy and sexual transmitted disease. In the process of exposure and reporting, women (and men) report re-victimization, re-traumatization or secondary trauma, disbelief and difficulty with work relationships.

5. Because of the culture of disbelief. Men believe, have been socialized to believe, that if a woman (or a girl, man, boy) dresses a certain way, or drinks too much, that this is an invitation to a sexual response, sexual behavior, that it is wanted. Even if the victim said No, it is thought she meant Yes.

Sexual assault prevention professionals, like my friend, don't believe that. They say that NO MEANS NO. That No really in truly, means no.

That is all based upon research findings. Although sexual assault victims rarely get the help they need (it is unfortunate, but true), and they aren't likely to volunteer as research subjects, sexual assault counselors and researchers confirm their stories. So there are hundreds of counselors who have seen thousands of victims and their thinking, the thinking of the counselors and protection agency professionals is that, actually. . .

Women Do Not Ask For It. And that they guy, well, he probably did it.


Friday, October 27, 2017

Me, too

It isn't a new story, not to me. Not a new thing, sexual assault, rape, harassment, but having listened to dozens of victims (fine, survivors) tell their stories over dozens of years, surprisingly it never gets boring.

A man in his thirties talks about his experience as a young boy, age six, and a rabbi (rabbi!) who took his youth. You see, it is not only the priests, this is cross-cultural.

Or a woman in her twenties. She writes the details in long-hand, cannot talk about what happened to her. She is married now, hates sex.

Another man is introduced to porn and sex as a schoolboy, an older cousin. My patient cannot maintain a relationship, cannot finish what he starts, hardly ever initiates. He is addicted to online porn.

A prostitute tells me that she's had sex with hundreds of men, was told that it was all she was good for. She believed it for the longest time.

A mother brings in her daughter, says that incest is in the family and she fears that her daughter has been molested repeatedly by an uncle, her brother. The daughter will not talk about it. The mother discusses her own trauma, the abuse she suffered from him.

A young woman in her early thirties tells me that she has a choice. She can "date" her boss, or she can look for another job. There's a company retreat, required attendance, and she knows he will force the issue there.

A college student on break for the summer comes to therapy to get over an acquaintance rape. She'd been drinking. He walked her home.

Another woman recalls the tragedy of her life, a violent rape. He slit her throat, left her to die in the snow. She was under the influence, blamed herself for years.

Now there's #Me, too.

Women are opening up the proverbial can of worms, telling their stories to anyone who will listen. We are telling the world on Twitter and on other social media sites, screaming to other women that we are not alone. This happens.

Who doesn't have a #MeToo story? Find me that woman and I will tell you that likely she's (a) been very lucky or (b) she can't remember, lives in denial, head in the sand (this happens). Prove me wrong, tell me how a little girl, a young woman, a little boy, a vulnerable man, can avoid this abuse of personal boundaries. Because rape happens even if you wear long sleeves, long skirts, wear a bag over your head. It makes you all the more of a challenge, is all.

Therapists have to work out their own Me Too.  Most of us, by a certain age, have told our story countless times. We do it in classes via the small group, designed to be intimate, set up to smoke out our interface. We've had our own therapy, encourage our patients to speak with us about their experiences. Better out than in, purge it. Now this opportunity is available via social media, so much support for the survivor, no blame any longer for the victim.

This is something phenomenal and unexpected. That women would come out, one after another, after another, a seemingly endless chain of stories, amazing. That it is the rich and the famous are in the spotlight as predators, all the more incredible, but it comes as no surprise.

We might grieve that #Bill Cosby got away, a hung jury, and that #Bill O'Reilly has somehow crawled under the rock he came from. But #HarveyWeinstein has not escaped an unrelenting public eye. He will likely go to jail. And from there he'll make the movie about himself, ugly and shocking, like him. If he is smart all of the proceeds will go to the international fight against sexual assault

I'm not sure in the ten years of blogging anonymously that I've ever done a #MeToo.
Now would be the time, no? Being female, I have more than one (I think I counted four, including the father of a friend, I was 16). Here's the least emotionally damaging:
In college, a junior. I have an apartment in a co-op, am resident advisor. I accept a date from a man I know peripherally on campus, not even from class. He walks into the little apartment, closes the door, puts his hands on my shoulders and attempts to push me to the floor.
My adrenaline is greater than his, and maybe my anger, and I wrest myself free, push him out the door, lock it. Collapse. I kept the story a secret for years. It is why, to this day, FD tells me that he pities the man who tries to assault me.
This is no joke, however, having to fight off sexual assault, and it is something that I fear, as do most other women when they go out, even to their cars to go to the store in the evening, and men, too, who have been the objects of sexual assault.

That story, however, is hardly a #Metoo.  It is a survivor tale, not a victim story, and I never had him charged with attempted battery or assault. We could call it a Not me! in fact. In the treatment of rape Not Me is what we're after, but it is rare, this transition from victim to survivor, and placing the blame where it belongs, on the perpetrator, not ourselves. But that was sheer luck, pushing him out the door. If he had a gun or a knife, would I have been so bold?

There's a post on this blog, first steps toward treating rape, and it is far and above the most read on this site. Because most of the time we don't get away, and we're searching for those first steps in recovery, if not for ourselves, then for a friend, a relative.

Rape (the preferred legal designation is sexual assault) is a 1 out of 3 phenomenon for women, 1 out of 8 for men. It is possible there is even more of this crime now, or maybe less, I'm not sure. But it should be a 0 out of 3, 0 out of 10. No means No is not a new mantra.

Sexual assault begins as a violation of physical boundaries, and as such, has far reaching emotional consequences, several likely diagnoses will present soon after the event. A short list:
post-traumatic stress, 
sexual dysfunction, 
addiction to alcohol and drugs, 
intimacy fears, 

The body memories, the pain, the pregnancy and disease that go along with the trauma, these physical manifestations magnify the emotional pain.

But still, most telling is that the stories we are hearing now have been the dirty little secrets for years, feeding self-blame and anger, embarrassment, stigma, marginalization.

We might compare the experience of sexual assault to a different type of crime. Consider the man who has been a victim of frequent muggings. He tells his therapist that he this happens often, probably because he isn't a big guy. He appears vulnerable, and he is. But he tells everyone when his wallet is surrendered to a masked fellow with a gun on the street, near the alley. It doesn't even faze him anymore that this happens. He's learned to carry only one credit card.

When you read a MeToo story in the coming weeks and reflect upon your own, think about finding a way to share it, even if it anonymously. Even if it is a where do I begin, kind of thing, as it is when it comes to how many times we women are molested in our lifetimes, or approached for sex that we don't want, coerced, physically forced. We are vulnerable, and when we are young or old, unarmed and disempowered, we don't know what to do, so we do nothing.

What should we do? Tell someone, preferably a rape victim advocate, even years later. Or call the state coalition against sexual assault. Ask for someone trained on the crime at the emergency room, if it just happened. Make sure to ask for a rape kit, too.  And get some therapy, even if you think you don't need it.

Last night I listened to an interview on NPR. A female lawyer who specialized in defending sexual assault victims said that she wasn't sure that on the job sexual harassment training really does any good.* She said that the online training offered at most jobs with over fifty employees is sometimes good, never great. And she wasn't sure that any training, honestly, made any difference in the corporate world, where promotions are dangled, demotions expected. I always suspected as much, and after the prevention workshop phase of my life ended, segued to treating known perpetrators.

The lawyer's message, that prevention efforts haven't been shown effective, and that maybe it is impossible to eradicate sexual assault, seems terribly dark. But she ended on an upbeat note:

When well-respected, affluent men are outed for sexual assault, when the producers at Amazon, the managers at Fidelity, the Harvey Weinsteins, Bill O'Reillys, and even past Presidents (George H. W. Bush) must apologize, we are making progress. These high profile men influence the decisions of other high profile men, and if they go to jail, all the more so.

We can only hope.


*You might remember that I developed a series of these, offered them to corporations and schools. Online training made me obsolete and I abandoned the initiative.

Wednesday, October 11, 2017

Steven Paddock's Mental Illness

Stephen Paddock talks about is happy-go-lucky self

Unusual, isn't it, that mental health professionals aren't chiming in with a diagnosis for Stephen Paddock? We usually do. I usually do. No small crime, massacring 58 innocent people, injuring hundreds more. 

People died for doing nothing more American than listening to country music. 

Yesterday's New York Times

The Las Vegas police believe Mr. Paddock may have had a secret life. 

More accurately, he didn't advertise his intentions. We all have secret lives, and he was particularly private. But he could be friendly. He went on a gun shopping spree in October, 2016, and the salespeople found him pleasant enough.

Reports from his brother Eric Paddock:

From an early age, he focused on gaining complete control over his life and not having to rely on anyone. He cycled through a series of jobs he thought would make him rich

“He went to work for the I.R.S. because he thought that’s where the money was, but it turned out the money wasn’t there,” the younger Mr. Paddock said. “He went to the aerospace industry but the money wasn’t there either. He went to real estate and that’s where the money was.”

Which only tells us he wasn't into being poor. He went to work at the postal service, too, where his father's picture stared down at him: MOST WANTED, a doubtful coincidence.

with two failed marriages, both short and childless. Stephen Paddock started gambling. Some who met him described him as arrogant, with a strong sense of superiority. People in his life bent to his will, even his mother and brother. He went out of his way for no one

“He acted like everybody worked for him and that he was above others,” 

We can understand why the marriages didn't last.  But narcissism, loving only one's self, isn't necessarily a predictor of sociopathic behavior. It might help, certainly functions to put people off socially, distance from others (protection, exposure avoidance). The son of a psychotic bank robber, Stephen Paddock had to work hard to project an image of normal, ended up shooting for better than, superior. Feeling superior beats the alternative, masks feelings of inferiority by trying to make it so. Fool them and you can fool yourself, too. 

“I would liken him to a chess player: very analytical and a numbers guy,” 

 Mr. Paddock cherished his solitude, his brother said.

He knew that he was smart, could succeed in business, even at poker, and at the slots (there are ways to beat the house). In that cold, analytic, unemotional fashion, he could plan the logistics of a mass murder. It becomes a game, how many guns would it take, how long would he have before they discovered him, etc. The detachment from reality that tells him he's superior, different, enables him to murder. Most of us love other people, want to be a part of their world, admire how they look, how they smile. Not Paddock. If they don't admire him, serve him, he has no use for them.

A 1969 newspaper story described him as a “glib, smooth talking ‘confidence man,’ who is egotistic and arrogant.”

That's about Stephen's father, Benjamin Patrick (Hoskins) Paddock, who had a long rap sheet, bad checks, stealing cars, robbing banks.  

Benjamin Paddock was arrested when Stephen was 7 years old. If he didn't know why his father disappeared, it is likely he knew that he was a criminal, and at some point found out. It is possible his father even contacted him while on the lam, when he evaded law enforcement after his escape from prison. 

For certain Stephen knew he would have to rely upon himself, that his mother needed help. In school in California, wanting to win a contest, he apparently cheated. Others accused him. He merely smiled, as if to say, I can do that, I'm above those rules, better than you. Make it so. 

Investing in real estate in Los Angeles made him a millionaire. But he personally attended to the buildings, treated tenants well, wanted them to be happy. So he wasn't detached from people who depended upon him, who could see him as somebody. I would bet he tipped well at the hotel.

a midlevel high roller, capable of losing $100,000 in one session, . . . Mr. Paddock may have lost that amount at the Red Rock Casino in Las Vegas within the last few months.

This could be when he began to lose his sense of self, shake up those manufactured feelings of superiority that kept him going, provided him a reason to love himself.

The story skips to Paddock's total detachment, social isolation from his neighbors in Nevada.  

Mr. McKay (a neighbor) yelled out, “Merry Christmas!” Mr. Paddock kept walking. “He said nothing,” Mr. McKay said. “Not a word. No eye contact.”

It may seem that I'm making a case here for personality, narcissism or schizoid (below) but there are other diagnoses that apply. When we diagnose there are two types of diagnostic categories, one personality, the other the primary disorder, like alcoholism, or depression. Briefly, let's look at the options based on that short narrative.

(1) Gambling addiction

He stopped working to gamble full time, compulsive behavior that makes a rich man poor. But having nobody home waiting for him, the addiction wouldn't come to anyone's attention.  

Gambling, like using cocaine, can lead to crime to recoup one's losses. That he might be reduced to that, become like his father, might have stressed him. He took comfort in making money legally.  

If we might think he had a grudge because of his losses, then we would think he would act out on a casino, not innocent people, perhaps bomb the hotel. But his state indicates that the human race is the target, specifically happy people going to concerts. They're happy, he's not. Been there, done that his whole life. 

So far, calling Paddock's problem a gambling addiction doesn't explain much, but another diagnosis might 

(2) Bipolar Disorder

Mania is the "high" end of the bipolar spectrum, and it presents as excessive energy, no need for sleep, excessive everything, irresponsible spending and behavior. The "low" pole, depression, is vegetative. That Paddock gambled for very high stakes indicates a preference to excessive and a need for stimulation, what some people call an alcoholic personality (no surprise, there can be an association between the two disorders). Paddock wanted an even better win. An exceptionally big win.

So many lives.  An exceptional number of lives.

(3) Depression

The father, a bank robber, had suicidal thoughts, one of the symptoms of depression, and at the end of his life, the son completed the act, killed himself, along with the others. 
 I'll take you all down with me. 
He might have thought that, likely wasn't the cocky, cheery man he liked to present in public. (But who is?) Certainly plausible for a depressed man with no children who ultimately couldn't control his life, could fail at the casino and at online poker, couldn't keep a wife. Wasn't enough to keep a father and lost him at a vulnerable age, seven. 

neighbor suggested that Stephen Paddock did seemed depressed. And quirky. One of the features of depression is avoiding socialization, presenting as irritable, unapproachable. There are many different diagnoses, all types of depression, and again, it is the opposite pole in bipolar disorder.

So maybe we're back to bipolar disorder.. 

But depression, remember, is often a secondary diagnosis, can be caused by all kinds of disorders, like alcoholism, eating disordersattention deficit disorder, high functioning autism, borderline personality disorderobsessive compulsive disorder, the list goes on and on.  

(4) Schizophrenia

We would be remiss if we didn't look at schizophrenia, at its worst a type of psychosis, unmanageable without medication (like bipolar disorder). Maybe he heard voices in his head that screamed: 

People are evil. You are evil. Kill many, as many as possible, and kill yourself. Tell no one about us (the voices). 

The voices only come out at night, when he's about to go to sleep. So he stays up and gambles to have something to do, to keep them at bay, sleeps during the day to avoid the pain and torture of these demons and their escalating, damning voices. Voices in the head can wear a person down. A man might cave.

And his brother mentioned that he seemed tired, not himself. Perhaps he couldn't fight the voices anymore.

(5) Social phobia/anxiety

He didn't speak with classmates as a child, kept to himself, and apparently ignored neighbors as an adult. A
 solitary man who played solitary games, slot machines. No desire to join a neighborhood poker games drinking beer with friends (loved online poker), or go to a Dodgers playoff game, perhaps, just to be with people, to be a part of something. 

But this doesn't mean he had a fear of people, or that he wanted to be with people, just lacked the confidence to initiate friendship. People with social phobia come to therapy because they want to join in, want to connect with others. 

We're not feeling that with Stephen Paddock. If he went to therapy for social skills training, we would have already heard about it.

(6) Schizoid personality disorder 

Here the pattern of detachment from social relationships, deliberate, is by definition the most salient feature-- no desire to be with people, not even family. The disorder is marked not only by the dearth of relationships, but indifference to praise or criticism and a palpable emotional chill or flat  personality affect. 

And little interest in sexual experiences with others, yet we hear Paddock hired prostitutes. And more important, he was nice to his tenants, the people who needed him, who admired him.

Also, the symptoms of schizoid disorder cannot concur in another, such as bipolar or schizophrenia, depression with psychotic features, or autism spectrum disorder. So it is a tough call, and we rarely see them in an outpatient clinical population. If we do, engaging the patient is extremely difficult. When he doesn't return we suspect premorbid schizophrenia, might even reach out to an emergency contact on an intake form. 

(7) Narcissistic Personality Disorder

That grandiosity, wanting himself to be better than everyone else, special, and the feeling that he has that he is unique, gifted, works to enhance low self-esteem. Sufferers of NPD are fragile emotionally, and lack empathy with others, are described as self-centered, arrogant, manipulative and demanding, harboring fantasies of success. They seek admiration and attention, are intolerant of criticism, suffer "narcissistic injuries" when criticized, are antagonized, angry, irritable and vengeful.

Enough said.

(8) Antisocial Personality Disorder

This is the one commonly referred to as sociopathic, or psychopathic. Features include a pattern of disregard for others, or violations of their rights; failure to conform to social norms with respect to lawful behavior; deceitfulness, conning; impulsivity; irritability; reckless disregard for the safety of others; consistent irresponsibility; lack of remorse; evidence of conduct disorder before the age of 15; and that the occurance of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

One need not have them all. Paddock tied up many of them in one day. 

Now you see why everyone's so reluctant to put a ring on the diagnosis? 

There are life circumstances, reasons these disorders unfold as they do, although it is tempting to blame genetics. Therapy in early childhood for someone like Stephen Paddock might have gone a long way. But the family didn't have resources for that. The boys drank powdered milk. And he didn't seek therapy when he could afford it. If he did, we can predict he would be the type of patient that if we failed to flatter, and continue to flatter, would lash out at us, threaten to sue us, or otherwise make us feel like a fool. .

What happened to bring out the very worst in this man? 

A boy has a father who is above the law, takes from others, ruthlessly. A Most Wanted man, and a fugitive. The father is incarcerated when the boy is 7, but escapes. He is in hiding for six years before capture. The boy theoretically knows none of this, but we don't know if he hadn't been contacted, sworn to secrecy. 
Tell no one we talked.
Now they are in collusion. 

His mother has moved the family to a small community, a place where people don't know her. She struggles, has no money, like most of her neighbors. Her eldest son is aloof, seems arrogant to classmates. Like his father, he doesn't play by the rules, either. He has no friends. He's learned that he needs to depend upon himself if he'll ever get out of that place. 

He tries various jobs, finds a niche in real estate, invests in properties that sky rocket, ensures an early retirement for his mother and his brother.  Somebody had to do it, and it is important to him that he be somebody. Maybe somebody other than a man like his father.

We call this conflict in therapy. Do I make it legally, or as a conman, like my father. My feeling is that he synthesized the two, found ways to beat the house, but played the slots legally (more on this in that article cited above).

Either way, he's socially detached, maybe because of the shame of having an incarcerated father, a failure, a pariah, a psychopath. And this is fifty percent of his DNA. He went to school, he knows this. He has to keep his father a secret, too. It isn't something you can brag to people about. 

There's trauma beyond the shame, perhaps intrusive thoughts about the man's methods, waving guns, behaving in a violent fashion (we should have included Post Traumatic Stress Disorder above). PTSD is one of those diagnoses that coexists, causes depression and other anxiety disorders, especially hypervigilance (wanting to own guns, perhaps). 

But maybe also identification: My father, myself. Larger than life, a man on the run, a cloud covering everything. A black mark. Or, at some point, admiration. A genius. I'm like him. People are tools.

At some point he tires of real estate, retreats to the casino because he's good at this, gambling. He's systematic, counts cards, hogs the slot machine. It is a happier place, the casino. But nobody wins all of the time, and inside he's still harboring very real negative feelings, jealousy and envy toward others, people who have normal lives, normal fathers. 

He can change that, even the score with one formidable, unthinkable act of violence. 


Better Things-- Seeing Ghosts