Re: "Your Dreams Tell You Who You Are"

11/11/18

To the Editor:

It came as a surprise to me to read that 'conventional wisdom' supports the idea that dreams are 'silly little stories, the dandruff of the brain' that should be ignored and not reflected upon (Alice Robb, Your dreams tell you who you are, 11.11.18).  While it is true that some neuroscientists adopted an antagonist view to the idea that dreams were meaningful and motivated, I do not believe this was ever a conventional or wise perspective.  It not only defied common sense for those who reflected upon their dreams; it begged the question as to the evolutionary adaptive value of dreams.

Sigmund Freud famously said that dreams were the royal road to the unconscious.  Our dreams, whether they become conscious or not, literally and metaphorically help guide us into the future.  Many patients in psychotherapy or psychoanalysis find their lives and self-understanding enriched by reflecting upon the meaning, including the hidden meaning, of their dreams. Often times, this involves uncomfortable truths that one prefers not to confront making the therapist an important partner or vehicle in its exploration.

Respectfully submitted,

Larry S. Sandberg MD

Re: "Breaking With U.S. Intelligence"

10.20.18

To the Editor:

In what seems an eternity ago, then candidate Trump opined that he could shoot someone on Fifth Avenue and not lose a single vote. This boast will now be put to the test, figuratively if not literally, in the brutal killing of Jamal Khashoggi.

President Trump (Breaking With U.S. Intelligence, Appears to Accept Saudi Explanation of Journalist’s Death, 11.20.18), unbelievably though unsurprisingly, finds credible (or pretends to find credible) the Saudi fabrication that Khashoggi died during a fight in the consulate putting Trump on the side of a government that killed a U.S. resident, journalist and father while visiting the embassy to get papers in order for his marriage.

President Trump’s absence of a moral compass and grasp of his responsibility to our country is revealed in his bizarre comment: “This one has caught the imagination of the world, unfortunately … It’s not a positive.” He sees the problem not as the murder itself but the world’s response to it. The video of Khasshoggi entering the embassy is haunting because we know – we do not need to imagine - what ensued. We experience moral outrage and the need for justice. For President Trump, always the self-serving businessman, the problem is the imagination of others rather than the misdeed.

I hope that Republicans in Congress and his base of supporters do not let him get away with this degradation of life and denigration of moral outrage as ‘imagination.’

Respectfully submitted,

Larry S. Sandberg

Re: "When a President Believes he is Entitled to his own Facts"

To the Editors:

Maggie Haberman (Re. When a President believes he is entitled to his own facts, 10.19.18) illustrates the profound threat posed by President Trump's idiosyncratic relationship with objective reality.  Young children make up things all the time; 'pretend play' is a normal aspect of childhood and a source of great pleasure precisely because one's imagination is given free range.  Most of us outgrow this phase and are capable of discerning when we are engaging our imaginations and when we are observing the external world. Yet the most powerful man in the world is perversely engaged in the acrobatic juggling of reality and facts to suit his inner emotional needs.

How can he get away with this?  It is only because he has others who are willing to play along with him.  This includes members of Congress who are complicit in their silence and, as Haberman points out, a Republican base that uncritically plays along infusing Trump with the power of a charismatic leader . Robert Jay Lifton, a psychiatrist and scholar on the effects of war and political violence, speaks of the danger of 'malignant normalization' when threats to the safety and fabric of society are no longer perceived as such.  It is unfolding before our eyes.

Respectfully submitted

Larry S Sandberg

Re: "Saudis Now Plan to Say Journalist was Killed by Mistake in Inquiry

10.16.18

To the Editor:

(Saudis now plan to say journalist was killed by mistake in inquiry, 10.16.18): We are witnessing the creation of 'fake news' before our eyes between the President and Saudi Arabia. Rogue killing, seriously?  Is the world so beaten down and numbed by relentless attacks against reality that it is to be expected that we accept silently such deceit? Is this how little our 'pro-life' President values human life? How many more moral lines must President Trump cross before those who support him stand up and say no more?

Respectfully submitted

Larry S. Sandberg

Re: "The War of Words on Abortion"

1.10.19

To the Editor:

 Charles C. Camosy (The War of Words on Abortion, 1.10.19) argues that being identified as ‘anti-abortion’ rather than ‘pro-life’ is a manipulation of language that serves to obfuscate what is really at play; i.e., his concern for vulnerable populations.  But these two points of view are not contradictory.  Rather they fit logically; the flip side of the proverbial coin.  This in not the case with regard to Camosy’s own wordplay.

He laments, following Pope Francis, our  ‘throwaway culture’ and conflates racist and prejudiced attitudes towards immigrants, minorities, the disabled, the elderly, and prisoners with individuals who support a woman’s right to choose abortion.

Camosy wishes to be understood as pro-life rather than anti-abortion and cautions against dehumanizing language in the discourse around the abortion issue.  Is it not dehumanizing to categorize those who differ with his position as expressing a ‘throwaway’ mentality?  I think so.

Respectfully submitted

Larry S. Sandberg

Re: "Trump Repeats False Claims about Trade with Canada"

3.16.18

To the Editor:

President Trump is painfully transparent in exhibiting his unfitness for office and risk to our country (NYT, 3.16.18, Trump repeats false claims about trade with Canada).  He tells Republican donors in a private meeting that he was ignorant of the most basic details of the trade balance between the U.S. and Canada.  Aware of his ignorance, he asserts to Prime Minister Trudeau what he wishes to be true (i.e., that a trade imbalance exists with Canada) in an apparent effort to manipulate the Prime Minister.  He then flaunts this behavior to Republican donors in an effort to impress them and garner their financial support for a Senate candidate. His press secretary, as expected, comes to his defense by manipulating the facts.

As a psychiatrist and psychoanalyst, I am troubled not only by this undeniably pathological behavior.  I am troubled by the lack of outrage, the deafening silence of those in elected office who turn a blind eye and embrace denial putting their self-interest before country.  Moderate Republicans should be ashamed of themselves for their complicity and moral abdication of responsibility. I am troubled because this story is buried in the pages of the Times as if this is trivial news. Or so typical as to not be particularly newsworthy.

It is crucial that citizens do not become numb or see our current reality as the 'new normal.'  We must insist that our elected officials do the right thing.  If not, we will do the right thing at the ballot box next  November.

Respectfully submitted

Larry S. Sandberg

Re: "Why Trump Supporters Don't Mind Lies"

4.28.18

 To the Editor:

 Daniel Effron (4/28/18, Why Trump Supporters Don’t Mind Lies) cites research that supports the idea President Trump’s lies are tolerated by his supporters because they can be regarded as plausible and hence less unethical or immoral.

He describes as a ‘subtle psychological strategy,’ for example, Sarah Huckabee Sanders responding to Trump falsely claiming that a Muslim had committed assault by saying ‘Whether it’s a real video, the threat is real.’ 

As a psychoanalyst, I hardly find this subtle.  However effective, language has been manipulated to say, in effect, the truth does not matter.  The focus is progressively moved away from the false statement about a video to a ‘threat’ that makes the President’s lie irrelevant or, perversely, illustrative of the threat.  The truth is twisted.

I suggest that President Trump’s core supporters are not expending too much energy thinking about his lies or, worse his being a ‘liar.’  They will rationalize his statements as ‘white lies’ as long as they believe his policies address their concerns.  It is deeply ironic that his biggest lie – his urge to help those truly in need – goes undetected by his core supporters.

Respectfully submitted,

Larry S. Sandberg MD

Re: "In Therapy Forever? Enough Already"

 4.22.12

To the editor:

Jonathan Alpert (4/22/12) presents a caricatured picture of long-term psychotherapies and trivializes the suffering of patients whose illnesses require more than an  'aggressive prod' to get them better.  Insight oriented therapy is not passive, but involves a kind of activity that encourages mobilization through self understanding - often by apprehending unconscious motivations. The effectiveness of this approach is supported by research (Leichsenring and Rabung).

He suggests that anxiety and depression are not severe psychological disorders compared to schizophrenia.  These mood states can be part of syndromes that are life threatening.  For example, Major Depression has a lifetime risk of suicide around 10% and Panic Disorder can be incapacitating.

While some patients may be in ineffective therapies, many more lament the inadequacy of their insurance coverage as it limits access to psychotherapy.  Others are encouraged to take medication because it is expedient rather than it necessarily being more effective.  The problem of the perennial patient pales in comparison to these contemporary problems.

Respectfully,

Larry S. Sandberg MD

Re: "The End of Intelligence"

4.29.18

To the editor:

Michael Haydn (The end of intelligence, 4.29.18) powerfully argues about the risks posed to our country when objective reality and truth are devalued, ignored or manipulated.  But it is not, as he suggests, that facts exist in opposition to emotion.  President Trump appeals to base emotions of fear, paranoia and mistrust and he provokes moral indignation in those who oppose him and his effort to render reality irrelevant. 

There is a basic reality that psychoanalysts and psychiatrists all know: decision-making requires an intact capacity to parse out reality from fantasy.  While one cannot definitively say why President Trump has this problem without a comprehensive psychiatric examination, the very presence of this symptom – regardless of diagnosis – should worry all of us. Turning a blind eye, denying this reality, is its own complicity. 

Like a malignancy that has metastasized, President Trump has mobilized Republicans in Congress, Sarah Huckabee Sanders, Fox News and, of course, his base to engage in a folie-a-deux (sharing and perpetuating of false beliefs).  This, too, should worry all of us.

It is only through a passionate embrace of the truth that the tide can be turned.  The excitement and energy amongst Democrats going into the midterm elections is a hopeful sign.  The fact that many recent special elections have been won by Democrats also suggests that the cancer may not be fatal.

Respectfully submitted,

Larry S. Sandberg MD

Re: "When Fiction is a Fact of Life"

3.18.18

 To the Editor:

 ‘When fiction is a fact of life’ (NYT, 3.18.18) highlights President Trump’s ignorance about basic details of trade with Canada, his knowingly lying to Prime Minister Trudeau and his boasting to Republican donors that he lied.  I thank the Times for deeming this newsworthy and protecting us from what Robert Jay Lifton has called malignant normalization. This must never be normalized.  What parent hearing of her child behaving like this would not be deeply concerned?  What psychiatrist or psychoanalyst would deem this behavior non-pathological?

What White House press secretary would be complicit with this dangerous behavior? Sarah Huckabee Sanders is astonishing in her straight-faced effort to normalize President Trump’s behavior. As reported, she acknowledges that President Trump fabricated a story about the Japanese dropping bowling balls on American made cars to curtail imports and then asserts how this false story illustrates ‘creative ways some countries’ block U.S. imports.  In other words, President Trump’s lie becomes truth telling.

We should be troubled by the lack of outrage, the deafening silence of those in elected office who turn a blind eye and embrace denial putting their self-interest before country.  Moderate Republicans should be ashamed of themselves for their complicity and moral abdication of responsibility.

It is crucial that citizens do not become numb or see our current reality as the 'new normal.'  We must insist that our elected officials do the right thing.  If not, we will do the right thing at the ballot box next November.

Respectfully submitted

Larry S. Sandberg

Re: "Diagnosis Goes Low Tech"

OCT. 16, 2003

To the Editor:

Re ''Diagnosis Goes Low Tech'' (Arts & Ideas, Oct. 11):

Many patients feel that they are not given the time they need to feel either cared about or well cared for. High-tech studies have not only supplemented but also replaced clinical acumen, and concerns about lengths of stay exist on the first day of admission. Physicians feel rushed and patients do, too -- the latter not only by the medical community and managed care but also by unrealistic expectations that technological advances should afford them the quick fix.

While technology has been responsible for profound advances in our ability to care for patients, we must not lose sight of the low-tech role of listening as an essential ingredient in healing. In our fast-paced world, this point of view has become devalued. I am glad to see within medical education that the pendulum is beginning to swing.

LARRY S. SANDBERG, M.D.

New York, Oct. 11, 2003

Re: "Shrinking Hours"

OCT. 14, 2013

To the Editor:

Richard A. Friedman laments the fact that a therapy “hour” is typically less than 60 minutes, suggesting that this is an ominous sign of our times (“Shrinking Hours,” Sunday Review, Oct. 13).

What is remarkable is that a typical psychotherapy session has changed little, if at all, for so long. As a practicing psychiatrist and psychoanalyst for 25 years, I have always kept my psychotherapy sessions at 45 minutes, a time that is by and large typical of most practitioners.

In other words, despite the hyper-focus on efficiency in our culture and the devaluation of intimate conversation, given the intrusion of modern technology, psychotherapy remains an invaluable modality precisely because its practitioners value time.

What is ominous is that giving patients adequate time — within psychiatry and other branches of medicine — is increasingly rare.

LARRY S. SANDBERG
New York, Oct. 13, 2013

The writer is a clinical associate professor of psychiatry at Weill Cornell Medical College.

Re: "Going Home Again"

To the Editor:

Re “Going Home Again” (column, March 21): David Brooks, in talking about Sting’s TED talk presentation, writes convincingly about what he calls “historical consciousness” and the creative aspects of “going back.”

This is the essence of an insight-oriented psychotherapy, in which the emotionally alive process of reflecting on one’s past liberates the individual in living a more fulfilling future.

It is precisely because the process of looking back can feel painful or overwhelming that it is often fended off. The psychotherapist, a benevolent guide, serves to catalyze that process.

LARRY S. SANDBERG
New York, March 21, 2014

The writer is a psychoanalyst and a clinical associate professor of psychiatry at Weill Cornell Medical Center.