Re: "GOP Faces Another Midterm Threat as Trump Plays Shutdown Card"

To the editor:

While it may make for laughs among his loyal supporters, President Trump's texting about the media's being driven insane by their  'Trump Derangement Syndrome' (GOP faces another midterm threat as Trump plays shutdown card, 7/30/18) is yet another example of his disturbed mind as he attempts to manipulate and deceive by perpetuating the use of a pseudo-condition that creates an impression that such a psychological condition is real and can be given a name; one that labels as pathological journalists who are committed to the truth.

As a practicing psychiatrist and psychoanalyst I can attest to the fact that many of my patients are suffering with heightened anxiety, insomnia and feelings of powerlessness in response to President Trump's relentless attack on reality. And some worry they are losing their minds - not because of Trump's policies - but due to his relentless attack on facts themselves.

It is undeniable, yes a fact, that President Trump uses deception as a major mode of relating to world; it is hard to know the degree to which he engages in self-deception though some of his lies (the size of the inaugural crowd, for example) beg the question.  Regardless, I applaud the media for their arduous work in being committed to the truth and helping to keep American citizens sane during this difficult time.

Respectfully

Larry S. Sandberg MD

Re: "Trump Says he Got Only One Word Wrong"

To the editor:

When someone is telling the truth he has only one story to keep straight in his mind. This is not  a complicated intellectual task; the story does not change over time because the events that comprise the story - remembered and part of history - have not changed.  We hope to learn from history but do not engage in revisionism - either for ourselves or others. Our well-being, our sanity, requires that we grasp reality and tolerate it especially when painful. If not, important judgements as to how to deal with reality cannot be made.

President Trump (NYT, 7.19.18, Trump says he got only one word wrong), with help from his inner circle, repeatedly changes his stories though his true sentiments often reveal themselves. He is a confabulator-in-chief who creates stories that suit his audience and his own emotional needs. In Helsinki, Vladimir Putin was his audience.  Back home, his audience became Americans and his story shifted accordingly. He constantly seeks to dismiss news stories not to his liking by creating his own story - 'fake news' - manipulating the minds of his supporters.

The multitude of confusing and contradictory statements of 'fact' are comprehensible only through a psychological lens: President Trump will say or do whatever he has to based on his internal emotional needs. Whether this is based on a purely psychological problem, a problem with past behavior he is trying to conceal, or some combination of the two is impossible to know at this point. Regardless, deception including self-deception, appears to be a frequently used coping mechanism.

When neurological patients confabulate it is poignant to see how they fill their gaps in memory with more pleasant stories than are warranted by their state of illness.  When the President of the United States repeatedly makes things up we are dealing with an emergency.  To view it otherwise is to collectively deny reality.

Respectfully submitted

Larry S. Sandberg MD

Re: "Trump, At Putin's Side, Questions U.S. Intelligence on 2016 Election"

To the editor:

The American Psychiatric Association, wedded to an outdated concept of ethical conduct, refuses to make any public statement concerning the mental health of President Trump because he has not been personally examined.  In staying silent, they do a disservice to their membership and to a population desensitized, numbed or terrifed by the current state of affairs. President Trump's conduct over the last several days - with our allies in Europe and England and today with Vladimir Putin - is a reflection of mental instability regardless of diagnosis. 

Today (Trump, At Putin's Side, Question U.S. Intelligence on 2016 Election, 7.23.18) the President of the United States, in avoiding rebuking Russia and more importantly in equivocating in his support of our intelligence agency, laid bare is unfitness to govern.  He does not trust the agency whose function is to keep us safe.

Given President Trump's ability to spin reality, hail fake news as real and real news as fake, and manipulate the minds of a vulnerable public, we need the American Psychiatric Association and other professional associations invested in the well-being of our country to step forward and make a statement - any statement - that serves as a reality check that what we are witnessing is not normal and a threat to our national security. 

Respectfully,

Larry S. Sandberg MD

Re: "Trump's Magical Fantasy World"

To the editor:

David Brooks (NYT, 5.25.18, Trump's magical fantasy world) opines we are being seduced into President Trump's fantasy world 'like puppets on a string' dominated by the Trumpian 'soap opera.'  He is misunderstanding, in my opinion, the reality of many Americans.

As a psychoanalyst I hear many of my patients describe the feeling of living in a waking nightmare in a reality that is both terrifying and terrorizing because reality itself is under constant attack.  This leads, not to seduction, but hypervigilance in an effort to manage a constant feeling of threat. My patients do not feel they are engaged in a 'soap opera;' rather they feel this is like a soap opera (albeit a bad one) and one they should be able to turn off. But they wake up in the morning and ... it is still going on!

I have urged many of my patients to respect their need to be informed without compulsively monitoring the news in a failed effort to reassure themselves they are safe. The evening news does not make for good bedtime reading. For many people some form of activism, an antidote to feeling paralyzed with fear and helplessness, is crucial.

Many mental health experts have argued that President Trump's problem staying in reality impairs his ability to make decisions and raises questions as to his fitness to serve.  We are witnessing a metaphorical train crash in slow motion.  History will not be kind to those who blindly or knowingly joined our President for the ride.

Respectfully submitted

Larry S. Sandberg

Re: "10 Dead in Shooting at High School"

5.19.18

To the editor:

As the details of yet another tragic school shooting unfold (NYT, 10 Dead in shooting at high school, 5.19.18), a predictable narrative, highlighting with '20:20 hindsight' the mentally deranged state of the shooter, Dimitrios Pagourtzis, will likely follow.  The signs are already there: wearing a 'Born to Kill' t-shirt, an apparent attraction to music adopted by neo-Nazi groups and the alt-right. He will be demonized and there will be calls for improved mental health services; an unobjectionable idea in principle that cynically shifts attention away from gun control.

We have failed as a society to keep our children safe but the threat is not the conveniently often scapegoated, untreated mentally ill or the fringe, disenfranchised 'troubled' youth.  There will always be segments of the population who are deeply troubled who do not seek treatment.  The upsurge of nationalism and neo-Nazism in parts of Europe has not lead to the mass violence we have in the United States.

Our politicians have sold their souls with blood money from the NRA.  They have abdicated their responsibility as elected officials; shamelessly invoking God during each tragedy.  I have no faith that today's politicians can do what needs to be done.  But children across this country and across all demographics - rich and poor, Democrat and Republican, conservative and liberal, black and white - are growing up. Their courage to speak up and come together due to their shared history of trauma from gun violence may create the necessary common ground to effect change.  I hope so.

Respectfully

Larry S. Sandberg

Re: "Trump's Lizard Wisdom"

To the editor:

David Brooks (NYT, Trump's lizard wisdom, 5.11.18), in a striking display of wishful thinking, describes President Trump's actions as based on lizard wisdom. He seeks to reassure us that behind President Trump's erratic, impulsive, self-centered, paranoid, grandiose behaviors there is something of evolutionary value in his conduct.  Lizards are typically sit and wait predators that adapt to their environment through anti-predatory behaviors like camouflage, playing dead or reflex bleeding as a chemical defense. These behaviors are well suited to their environment. One can say the President can learn a thing or two from lizard wisdom.

Humans have adapted more sophisticated brains to create, survive and flourish in a more complex world.  Wisdom involves forethought; reflex gives way to introspection; impulsiveness gives way to restraint.  President Trump possesses none of these traits. Yes, some of his actions may have favorable outcomes. After all, even a stopped clock is right twice a day. 

It is a serious misunderstanding of the man - and the lizard - to equate his conduct or thinking with anything resembling wisdom.  I would suggest the more apt metaphor is that President Trump is like a bull in a china shop attempting to destroy valuable, albeit delicate, international agreements on peace relations, trade and climate change and, of course, the domestic achievements of President Obama.

Respectfully submitted,

Larry S. Sandberg MD

Re: "Trump Tells Macron the U.S. Will Withdraw from the Iran Nuclear Deal"

To the editor:

Mental health experts have been expressing concern  that President Trump's ability to make sound decisions is impaired because of his trouble staying in reality whatever the underlying cause.  Withdrawing from the Iran nuclear deal (NYT, 5.8.18, Trump tells Macron the U.S. will withdraw from the Iran nuclear deal) is the latest and perhaps most consequential illustration of this problem.  He has managed to surround himself with the few like minded radical thinkers who back him while rejecting the advice and guidance of moderates in his own party and our allies.

President Trump has a long history of failed business ventures many ending in litigation or bankruptcy.  But in today's decision he has made the world a less safe place.  We  have not only a reason but an obligation to question his motivation. His behavior must no be normalized.  And we should expect our elected officials to speak out; silence is complicity.

Respectfully submitted

Larry S. Sandberg MD

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

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: "The Antidepressant Withdrawal"

To the editor:

(Re. 'The antidepressant withdrawal', 4.17.18) Psychotherapy is a credible, evidence based treatment for mild to moderate Major Depression and a valuable adjunct to medication for severe Major Depression where suicide is a distinct risk.  There are many reasons anti-depressants have been over prescribed.  As you report drug companies have historically played an important role with aggressive lobbying efforts, direct to consumer advertising and funding academic research in ways that biased outcome.  Diminished stigma to mental illness has been a complicated factor making treatment more acceptable to people who have shunned care.  Most important, from my perspective, has been the cultural trend to value the quick fix, devalue talk therapy (really conversation in any form) and to have an insurance industry that is largely antagonistic to the legitimate role of psychotherapy to treat mental illness. 

Respectfully

Larry S. Sandberg MD

Re:

To the editor:

The murky perils of quitting antidepressants after years of use (NYT, 4.8.18) reports on the prevalence of withdrawal or discontinuation symptoms when antidepressants are stopped.  These medications can be lifesaving for people with severe depression; a condition which tends to be chronic and recurrent. When a decision is made to taper an antidepressant vigilance is required to monitor for relapse as well as withdrawal.

Not only should a patient be aware of the risks of taking any drug at the outset; she should also be aware of alternative treatments.  Psychotherapy for mild to moderate depression is an effective and evidence based approach that alters brain chemistry without side effects or withdrawal symptoms.  And, when effective, its benefits can be long lasting.  Individuals seeking treatment for depression should discuss drug treatment, psychotherapy and combined approaches with their physician before embarking on any course of treatment.

Respectfully

Larry S Sandberg

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