Re: "The Calm Before the Stormy"

3.21.18

To the editor

Frank Bruni (The calm before the Stormy, 3.21.18) problematically argues that President Trump's reluctance to attack Stormy Daniels is an extraordinary, if not unique, aberration for a man who so readily denigrates, bullies, insults and threatens others. Rather, as Frank Bruni observes, he is the 'tempered pacifist' perhaps fearful of what will be publicly revealed.

More blatant and infinitely more consequential is his treatment of President Vladimir Putin.  As reported in your lead story (President's call to Putin dodges talk of foul play), President Trump made a congratulatory call to Putin for his lopsided and undemocratic victory while withholding any criticism of Russia for its interference in our political process, its cyberattacks, or the poisoning of a spy living in England.

We have a right, a responsibility, to question President Trump's motivation.  A reasonably informed citizen should be skeptical of President Trump's treatment of Putin as it serves no clear political purpose and, in fact, runs counter to all the advice he has been given by his advisors.  As a citizen who is also a psychoanalyst, I question President Trump's motivation.  A logical speculation, and one can only speculate, is that just as he may be fearful of what Stormy Daniels may reveal, he fears the same with President Putin.  Based on the available evidence, this is a plausible hypothesis.  For this reason, Congress should take a clear and proactive step to ensure that the Mueller investigation is not undermined.

Respectfully submitted,

Larry S. Sandberg

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

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: "Trump: King of Chaos"

3.5.18


To the editor:

As a psychiatrist and psychoanalyst, it is remarkable to read Charles Blow's spot on description of President Trump's mental fragility and its impact on his executive (dys)function (NYT, 3/5/18, Trump: King of Chaos). Less blatant, but no less ominous, is the group psychology of members of Congress who are willing to turn a blind eye while Rome burns. They live in their own state of denial where they do not seem to realize that supporting this President out of self-interest will lead to self-immolation. 

It is our elected officials in Congress who must be confronted by journalists and constituents - including experts in mental health - to take the necessary steps to protect this country from an unfit President.

Respectfully submitted,

Larry S. Sandberg MD

Re: "No Country for Young Men with AR-15s"

2.18.18

To the editor:

Ross Douthat (No country for young men with AR-15s, 2.18.18) problematically frames our country's problem with gun violence as reflecting two moral visions - one pro-gun and one anti-gun - in conflict with one another.  I disagree. Responsible gun owners and those who favor gun control express a shared morality - the right to be safe.  Innocent lives are being lost to gun violence and, as a society, we have a moral responsibility to do something about that. The majority of Americans feel this way.

Power and money, not competing moral visions, are to blame for our tragic reality. The NRA's position and its lobbying impact on our elected officials are morally indefensible. The NRA's influence far outstrips that of citizens on both sides of the debate who support responsible gun ownership. The perverse 'right' of the pro-gun lobby is the right of self-defense; the right to ensure one's safety with military style weapons.  I have yet to hear a story of how these weapons saved lives. Only tragedy after tragedy. No, the political inertia that exists is not about competing moral visions.

It is convenient, but also morally reprehensible, to repeatedly blame mental illness for gun violence. Does it play a role?  Of course it does.  But we do not have more mental illness than other countries.  Banning semi-automatic weapons would decrease gun violence.  Politicians need to be held accountable for their shameless ability to rationalize their positions as morally based rather than self-serving.

Respectfully submitted,

Larry S. Sandberg

Re: "Is Your Child Lying to You? That's Good."

To the editor:

Mental health professionals have taken offense at likening President Trump's behavior to that of a young child viewing such a comparison as an insult and misunderstanding of normal childhood. Alex Stone's piece (1.7.18 'Is your child lying to you?  That's good.') describes the paradoxical finding that lying in childhood is a developmental capacity; conceptualizing and implementing deception is a sign of intelligence. Given President Trump's well documented tendency to prefabricate, some may feel inclined to once again assert that he is behaving like a 'child.  This would be a mistake.

All lying is not created equal. Stone reports that parents could not detect which children were lying. President Trump, on the other hand, is a terrible liar.  The effectiveness of a lie is in its power to deceive; most of President Trump's lies are so patently false as to be unbelievable. We are not fooled by his lies. On the contrary he looks foolish, unstable and, most worrisome, believing his own lies.  In other words, when he is lying he is often times engaged in self-deception rather than deceiving others.

He also engages in bullying behavior when he accuses those telling the truth of lying; the 'fake news' epithet being a prime example. Here President Trump is simultaneously lying and falsely claiming he and the public are being lied to. Most people see this as a transparent and desperate attempt to manipulate and rally his base; unlike the intelligent lying of childhood it speaks to a more sociopathic aspect to our President.

Respectfully submitted

Larry S. Sandberg MD

Re: "Sessions Denies Lying Over Ties to Russia"

To the editor:

The most generous conclusion one can make of Attorney General Sessions inconsistent remembering is that he is lying to himself while lying to others (Sessions denies lying over ties to Russia in '16, 11/15/17).  Last month, upon direct questioning he denied knowing anyone in the Trump campaign who had contacts with the Russians. With recent news reports including a photograph of his presence in a meeting with George Papadopoulos to assist he remains unclear what was said to him by Mr. Papadopoulos while certain how he responded.  

There is no neurological basis for this kind of patchy remembering.  Nor is there logic.  How can a man be certain of his response to statements made that have not been remembered? Only a psychological explanation makes sense.  When confronted with indisputable facts, the Attorney General falls back on 'not remembering' to defend himself against perjury but, when pushed, remembers just enough details to exonerate him from wrongdoing in the moment. 

If Attorney General Sessions spoke up as he said he did then he lied to Congress under sworn testimony.  If, on the other hand, he had no memory for the meeting that took place then there is no legitimate basis for his being absolutely convinced as to how he responded at the time.

Respectfully submitted

Larry S. Sandberg MD

Re: "A GOP Fix for Health Care"

7/20/17

To the editor:

J.D. Vance (NYT, 7/20/17, A GOP fix for health care) in arguing for government's culpability in the healthcare crisis likens its role to a speeding truck hitting an innocent man. As he says, government 'helped create' the problem and 'bears some financial responsibility' in fixing it.  I find the metaphor profoundly lacking in its emphasis on governmental activity, rather than inactivity, as the source of the problem.

I would suggest that Republicans have been asleep at the wheel and, having become the majority party, have shown themselves to be reckless drivers devoid of a moral compass necessary to effect change. Startled into wakefulness they have hit the gas pedal risking plowing down millions who have been helped under Obamacare.

Perhaps J. D. Vance’s piece will inspire some Republicans in Congress to move more wisely towards a bipartisan solution to this complex problem.

Respectfully,

Larry S. Sandberg

Re: "Where the Health Care Bill Fails"

6/26/17

To the editor:

Senator Ron Johnson (NYT, 6/26/17, Where the health care bill fails.) laments the health care bill before the Senate but for the wrong reasons.  He lauds the role of a free market economy and the place of the private sector to solve the health care problem in this country without recognizing that Obamacare was a response to the failure of such forces to solve the problem.  He denigrates the role of government in health care reform without recognizing that Medicare, albeit imperfect, is government run.  While he relies on his years of experience as an accountant in manufacturing to support his claims, he is unable to point to any country  successfully delivering health care to its citizens based on his naive assumptions.

Most egregious is his rejection of the pre-existing conditions clause that has brought peace of mind - and insurance - to millions who would otherwise be ineligible.  The inhumanity and arrogance of such a position is indefensible.  Mortality is our universal pre-existing condition and with that the likelihood we will all suffer with illness during our lifetimes.

Respectfully submitted,

Larry S. Sandberg, MD

Re:

To the editor:

The staged spectacle by President Trump of having members of his Cabinet praise his virtues while he engages them, the press, the public and, most of all, himself with hyperbolic statements should frighten all Americans regardless of party affiliation.  This would all make sense and be par for the  course in an authoritarian regime, not a democracy. 

President Trump's character flaws are not subtle.  A man whose self-esteem is so fragile that he needs a faux group therapy session to bolster his sense of self is not a person who should be President.  When such fragility requires the creation of an alternative reality we are all less safe.  How is he to effectively deal with the real threats facing this country when his first order of business - the pressing threat - is to his self-esteem? 

We may benefit from the comic relief offered by late night television that will no doubt have a field day with this material.  On the other hand, our elected officials, including Senator Schumer who parodied the meeting, should take seriously the threats presented by having such a psychologically fragile man in such a powerful position.

Respectfully submitted,

Larry S. Sandberg

Re: "The Axis of Selfishness"

To the editor:

David Brooks (The axis of selfishness, 6/2/17) in articulating the 'Trump plan' observes the central role of competitive advantage and selfishness as driving forces as opposed to our innate drive to cooperative with one another and to act from a place of kindness, altruism and righteousness.  As a psychoanalyst I think it is more accurate and helpful to speak of Trump's paranoid vision as an organizing principle. 

For President Trump the world is experienced as a threatening place where one is left attacking or being attacked.  There is no complexity or ambiguity in this vision nor is there personal responsibility - only victimization.  So President Trump is a victim of fake news or a witch hunt; our country is threatened by Muslims or Mexicans; NATO is taking advantage of us; we are laughed at by the world for signing on to the Paris climate accord as if we have shown our weakness. Facts, science - information that threatens this paranoid view - is either ignored ... or attacked.  Adding insult to injury the President creates his own echo chamber by surrounding himself with people who share his paranoid view.

The irony and danger is that this paranoid vision makes it difficult, if not impossible, to effectively manage the legitimate threats we face.  While I have faith in the durability of our country, our President has weakened us all.

Respectfully submitted,

Larry S. Sandberg

Re: "What the Republican Plan Gets Right"

To the editor:

Mark Siegel (5/6/17, What the Republican Plan Gets Right) makes an absurd argument to justify the Republican plan to charge higher premiums to some patients and not others.  He speaks of a patient who 'insists' on seeing him too frequently for her seasonal allergies and asks 'shouldn't a patient who continues to see me unnecessarily pay more?'  

No. The physician is not an indentured servant.  If his treatment is  'unnecessary' why is he delivering that care? And how is the insurance company paying for treatment that is not medically necessary? Dr. Siegel points to the patient's low copay supporting this misuse but he places too little responsibility upon himself for taking his time and the insurance company's money to 'reassure', apparently without success, his patient.

Patients with a tendency to over utilize the health care system often suffer from an undiagnosed psychological problem - typically an anxiety disorder or depression.  Perhaps if reassurance is not effective, Dr. Siegel should  suggest his patient see a physician who can more effectively treat her worry.

Respectfully submitted,

Larry S. Sandberg MD

Re: "Video Games Aren't Addictive"

To the editor:

Doctors Ferguson and Markey (NY Times, 4/2/17; 'Video games aren't addictive') point to a large scale study about internet gaming to prematurely conclude that video games are not addictive but a 'normal behavior' that for some may be a 'waste of time.'  In clinical practice, there are some patients whose gaming activities profoundly interfere with the work and social demands of living.  For some individuals it manifests itself as part of a severe depression, social anxiety, or incipient psychosis; that is, it is symptomatic of another primary psychiatric diagnosis. For others, it appears to be consistent with a pattern of addictive behavior. It seldom surfaces as a complaint by the individual. 

Given that tens of millions of people engage in gaming, one would not expect this behavior to be pathological for the majority who engage in it. Time will tell whether or not it makes sense to make gaming addiction a formal psychiatric diagnosis or to refine the diagnostic criteria so that it is more sensitive in revealing pathology.  It will also take more time to discern if there are adverse developmental consequences for young people whose game playing is increasingly in the virtual world.

While the research the authors report is reassuring, it is premature to make a definitive clinical judgment about the health effects of gaming.

Respectfully submitted,

Larry S. Sandberg MD

Re: "Why It's OK for Doctors to Participate in Executions"

4/22/17

To the editor:

 It is only with twisted logic that Sandeep Jauhar (4/21/17, Why It’s OK for Doctors to Participate in Executions) can argue that physicians have a rightful role in participating in the executions of convicts sentenced to death.

 It is absurd to equate the suffering of a terminally ill patient with a death-row inmate. The former is being destroyed from within; the latter by the state. Alleviating the suffering of a dying patient by offering end of life care is not the same as choosing to be a tool of the state. Such complicity not only violates the Hippocratic Oath to do no harm; it masks the barbarity and inhumanity of taking a life.

 A physician’s refusal to partake in enforcing capital punishment creates a necessary impediment to its implementation. Dr. Jauhar opines that more crude means of execution – like death by firing squad – may gain in popularity. If so, perhaps that will lead more Americans to ask why we are the only Western country to use the death penalty.

Respectfully submitted,

 Larry S. Sandberg MD

Re: "Trump Digs in on Wiretap, No Matter Who Says Differently"

To the editor,

President Trump's struggle to grasp reality should be of great concern to all Americans.  His reliance on unsubstantiated claims on Fox news that former President Obama wiretapped his phones using British intelligence shows that he is grasping at straws not the truth.  As you report, (NYT, 3/16/17, Trump Digs In on Wiretap, No Matter Who Says Differently) 'Much like his longstanding assertion that Mr. Obama was not born in the United States, Mr. Trump dismisses contrary information with undiminished surety.'  As a psychiatrist and psychoanalyst, I am in no position to offer a diagnosis of President Trump's underlying mental condition.  But this mode of thinking, whatever its cause, puts our country in harms way.  President Trump poses a risk to our national security and patriotic Americans, regardless of party, should speak out for love of country.

Respectfully,

Larry S. Sandberg, M.D.

Re:

To the editor

Allen Frances (NYT, 2/15/17), an eminent psychiatrist, contradicts himself by chastising those psychiatrists who have diagnosed President Trump from afar.  He asserts that President Trump while a 'world class narcissist' does not suffer from a personality disorder because one criterion, subjective distress and impairment, is not present. 

Not having examined President Trump personally, how can he exclude the presence of subjective distress?  Moreover, independent of President Trump's diagnosis, how can he exclude 'impairment' given the obvious trouble he has displayed in carrying out his functions as President?

Dr. Frances is correct that ultimately it is a political solution that is needed.  But it is neither stigmatizing to people with mental illness nor inappropriate for experts on the mind to offer their perspective and insight into the current turmoil facing this country.

Respectfully

Larry S. Sandberg MD

Re: "Bannon Says News Media Should 'Keep its Mouth Shut'"

To the editor:



Stephen Bannon (NYT, 1/27/17, Bannon says news media should ‘keep its mouth shut’) unsurprisingly fails to recognize and respect the crucial role of journalism in our democracy. His unapologetic contempt is chilling. What exactly does he mean when he says of the NY Times ‘They got it 100% wrong?’ Presumably he is referring to the polls predicting a Clinton victory.  What else?  What we are currently witnessing with President Trump is thoroughly in line with the in depth substantive reporting by the vast majority of news outlets, including the New York Times, leading up to the election.


The fact that so many Americans were uninterested in the facts, pinning their hopes on a motto of making American great again and informed by fake news says more about the electorate than journalism.  Our democratic way of life is being assaulted and journalists are in the front line fighting for our democratic way of life.



Respectfully



Larry S. Sandberg

Re: "A Lie by Any Other Name"

To the editor:



Charles Blow (‘A lie by any other name’, NYT 1/26/17) is right to insist that President Trump’s lies not be euphemistically downgraded into something more benign.  The problem is that President Trump believes his own lies. He seems unfazed by the fact that to most rational minds his false assertions are preposterous.  Rather than recognize that it is only the truth being spoken (albeit a painful truth), President Trump sees labeling his statements as lies as an attack against him. To bolster his misconception he orders an investigation as if that will legitimize his belief.  I think this is what Barack Obama had in mind when he deemed Trump unfit to serve.

I hope that patriotism will take priority over partisanship as members of both parties recognize their role in the balance of powers.  I hope the media will not be bullied and will flourish during these trying times. And I hope that Americans, including those who support President Trump, will make their voices heard and insist that the truth govern the important decisions that need to be made.



Respectfully,



Larry S. Sandberg

Re: "Meeting With Top Lawmakers, Trump Repeats an Election Lie"

To the editor:

Re. Meeting with top lawmakers, Trump repeats an election lie (NY Times, 1/24/17): I applaud the NY Times for calling President Trump out for lying in his assertion that he lost the popular vote because unauthorized immigrants voted for Hillary Clinton.  Unlike the sociopath whose lies are an intentional effort to manipulate others, all evidence suggests that above all President Trump is telling himself a lie because the basic facts are simply too painful for him.  He seems unfazed by the fact that to most rational minds his assertions are preposterous. 

I hope that patriotism will take priority over partisanship as members of both parties recognize their role in the balance of powers.  I hope the media will not be bullied and will flourish during these trying times. And I hope that Americans, including those who support President Trump, will make their voices heard and insist that the truth govern the important decisions that need to be made.

Respectfully,

Larry S. Sandberg

Re "Putin Led Scheme to Aid Trump, Report Says"

1/7/17

To the editor:

There has been too  much focus on the role of Russia in its covert efforts to influence the outcome of the past Presidential election while ignoring an inconvenient and worrisome fact (NYT, Putin led scheme to aid Trump, report says, 1/7/17). The Russians have a treasure trove of RNC emails that they can choose or not choose to leak at a moments notice. Hillary Clinton lost the election by a minuscule amount when looking at the three swing states that gave Donald Trump the election; we now will have a President in office whom Russia is capable of blackmailing at any time.

Respectfully

Larry S. Sandberg

Re: "Sorry Liberals. Bigotry Didn't Elect Trump"

To the editor:



David Paul Kuhn (Sorry liberals. Bigotry didn't elect Trump, NYT 12/27/16) cites numerous statistics to bolster his claim that bigotry, while more prevalent among Republicans, was not a cause of Trump's victory. He further suggests that to evoke such an explanation is to engage in stereotyping.

Bigotry, like implicit bias, impacts decision making often outside our conscious awareness. We are all vulnerable. The studies reported by the author do not eliminate bigotry as a 'cause' of Trump's victory. 

As hate crimes are on the rise and Trump continues with his divisive rhetoric we blind ourselves to the appeal of an 'us versus them' mentality at our own peril.

It is naive to conclude thatTrump won only because of bigotry. Trump won for many reasons. Appealing to man's - and woman's- more base instincts was one of them.



Respectfully 


Larry S Sandberg