On Misbehaving

1.14.22

To the editor:

David Brooks (NYT, 1.14.22) feels himself helpless to answer the question he poses: 'Why are so many of us behaving so badly'? He is not alone in feeling helpless. A pandemic that is entering its third year, a climate crisis ravaging the globe, a dismantling of democratic guardrails in our country. Oh! I forgot to mention the large number of people who actually believe Donald Trump should be president. Or persistent racial injustice. Or economic insecurity. Or ...

This tsunami of stressors contribute to feelings of helplessness. Many people are feeling overwhelmed, scared, and incapable of taking effective action. 'Misbehaving' is, by definition, ineffective but should be understood (at least in part) as an effort to deal with painful feelings of helplessness in the setting of overwhelming stress. What Brooks describes can be thought of as impotent rage; failed efforts to feel in control that unfortunately only makes matters worse.

Respectfully

Larry S Sandberg

Putting Lives At Risk To Save Trump's Ego

6.12.20

To the editor:

Donald Trump made the outrageous claim a lifetime ago that he would lose no supporters if he were to shoot someone on Fifth Avenue.  Given all that he has gotten away with during his presidency, I can only admire his prescience in understanding the blind support he garnered.  Among the vulgarities of the present moment is Donald Trump's plan to hold a mass rally that knowingly will put peoples lives at risk.  To feed his narcissism  and fire up his base he is symbolically pointing a gun at the very people he claims to care about.  And the coup de grace is that attendees must agree not to sue should they become sick ...or if loved ones die.  In this regard, President Trump is more cult leader than President knowingly putting people in harms way and abdicating all responsibility for doing so. This is insanity. I feel sad for those who will risk their lives and angry that local officials lack the moral fortitude to do the right thing.

Sincerely

Larry S. Sandberg

The Public Needs To Understand Narcissism

4.17.20

To the editor:

By focusing on President Trump's 'brain', Jennifer Senior (NYT, 4.16.20, Trump's Brain: A Guided Tour) draws attention to the prefrontal cortex; a region of the brain critical in complex decision making.  While I agree that President Trump displays deficits in problem solving, thinking of the material 'brain' as dysfunctional is less helpful than understanding that President Trump's mind - his psychology - is the problem. 

We tend to think of the major psychiatric illnesses (depression, mania, schizophrenia, PTSD, for example) as causes of impairment in functioning.  Donald Trump is a case study in severe narcissistic pathology - personality dynamics - leading to catastrophic damage to our country, world and environment.  His constant need to manage his self-esteem interferes with his ability to solve basic problems.  For example, his inability to tolerate criticism fueled his decision to withdraw support of the World Health Organization during a pandemic. I believe the public benefits from understanding that severe narcissism is real, and really dangerous, when possessed by the most powerful person in the world. 

Respectfully submitted

Larry S Sandberg

Nikki Haley's Pitch To Be VP

4.8.20

To the editor:

When the debacle that is President Trump passes, history will look at the complicity of self-serving Republicans, like Nikki Haley, and the judgement will not be pretty.  Haley (NYT, 4.8.20, Focus on you governor, not Trump), in highlighting the importance of local and state government during a crisis, completely ignores how President Trump's failings impacted governors' abilities to take appropriate action.  Exhibit one: the unavailability of testing.  Haley is self-congratulatory in giving herself credit for her work as governor when Barack Obama was in the White House.  If only Obama were in charge now.  She finds curious the pleas for a strong unified response from the federal government when many consider President Trump authoritarian.  Insofar as this is odd it is only because there was some desperate hope that he could use his authority to save lives. Haley's piece should be seen for what it is:  a pitch to be his vice presidential nominee this Fall.

Sincerely,

Larry S. Sandberg

Republican Complicity

4.6.20

To the editor:

Jennifer Senior writes persuasively about the devastating impact of President Trump's narcissism on his ability to lead the fight against the pandemic (NYT, 4.6.20).  The Dangerous Case of Donald Trump, a compilation of essays written by mental health experts in 2017, was a foreshadowing largely ignored by the public and criticized within academic psychiatry as an unethical excursion into the public domain.  It was prescient, the proverbial canary in the coal mine.

It will take time and distance to establish a postmortem on how President Trump's narcissism contributed to the unnecessary loss of life. But ultimately group, societal dynamics must be acknowledged.  Too many good people knew all too well the truth of Donald Trump. Why are we in this mess?  Republicans in the Senate acted selfishly  rather than speak truth to power.

Respectfully

Larry S Sandberg

President Trump to New York: Drop Dead

3.24.20

To the editor:

As Governor Andrew Cuomo, implores the Federal government to rapidly deliver thousands of ventilators that are now available but in storage, I am reminded of the Daily News headline a lifetime ago - during NYC's financial crisis in 1975 - 'Ford to City: Drop Dead.' While this headline was meant metaphorically, we are now in a situation where the inadequate mobilization of available ventilators  by President Trump is quite literally telling New Yorkers to drop dead.

Members of Congress, especially those who support President Trump, should bring this reality home to him.  His self-interest in inextricably tied to averting  catastrophic and unnecessary loss of life in my city.

Respectfully

Larry S. Sandberg

President Trump's Narcissism ... Again

To the editor:

3.20.20

David Brooks (NYT, 3.20.20) speaks of the crucial role of solidarity during this unprecedented time but only hints at President Trump's repeated efforts to destroy the very cohesiveness demanded by this crisis.  He insists on using the xenophobic taunt of the 'Chinese' virus.  He makes the mind-boggling statement that the Federal government is 'not a shipping clerk' in response to the shortage of necessary supplies for health professionals.  He uses repeated falsehoods to defend his self esteem rather than attacking the real threat of a pandemic. President Trump has repeatedly illustrated how severe narcissism is antithetical to the solidarity needed to fight this challenge successfully.

Insofar as we are coming together as a country, it is in spite of President Trump not because of him.  I hope that on election day there will be a resounding rejection of his destructive brand of politics, an opportunity for renewal by embracing a solidarity, not against the virus, but against a President who has threatened the fabric of our society and the world.

Respectfully

Larry S Sandberg

President Trump's Narcissism and Covid-19

To the editor

3.9.20

Jennifer Senior (NYT, 3.9.20,  President Trump is Unfit for this Crisis. Period.) convincingly argues that President Trump's narcissism profoundly interferes with his capacity to fulfill his obligations to keep America safe in light of the multiple threats linked to the coronavirus. While for many of us this is a painfully old and familiar insight, one can wonder whether it will be any different this time around for those who support Trump?  Maybe.

President Trump has characteristically tried to bolster his self-esteem - and rally support - by demonizing others.  Fake news, immigrants, Obama ... the list goes on and on.  Cultivating paranoia - a polarizing 'us versus them' mentality - has been a tool to sustain his narcissism. Bit it is hard to demonize a virus; it is apolitical and impersonal. Successfully fighting it requires humility and confronting one's own limitations - characteristics lacking in this President. His effort to manage the threat to his self-esteem caused by the virus has interfered with his ability to manage the very real threats posed by it.

Perhaps this crisis will have the unintended consequence of unifying our country in recognizing  the real existential threat President Trump poses to our country by virtue of his psychological limitations and tendency to confuse real from imagined dangers.

Respectfully

Larry S. Sandberg

Spineless and Shameless

2.5.20

To the editors:

Senator Robert Portman (NYT, 2.5.20) will not be spared history's judgement by simply rationalizing his decision to oppose removing President Trump from office.  He may ease his own conscience by stating that what the President did was wrong but he, along with other Republicans, has abdicated his responsibility to put country before party. As Senator Patrick Moynihan famously said: 'Everyone is entitled to his own opinion, but not to his own facts.'

What are the facts? The majority of Americans favored calling witnesses to get at the truth. President Trump continues to believe his behavior was perfect.  The proceedings in the House were hampered by the President's lack of cooperation and contempt for the process.This is the same political party that believed a President's lying about sexual misconduct warranted removal from office.

What is my opinion?  The lack of bipartisan support was evidence, not of a weak case, but of the sad state of affairs of the Republican Party.  President Trump had it right when he said during his campaign that his supporters would be fine with his shooting someone on Fifth Avenue.  I didn't realize at the time he could be referring to members of Congress.

Respectfully,

Larry S. Sandberg

Fake News and Journalism

12.27.19

To the editor:

It doesn't make sense to describe sociology rather than events as driving politics (Brooks, The Media Is Broken, 12.27.19).  Are 'events' not sociological in the first place?  We need to appreciate the 'lenses' through which we take in the news, [but] David Brooks overlooks how most Americans get their news in the first place; that is, the role of non-journalistic media as a primary source.  Journalism is a noble profession and foundational for our democratic process. But journalism is constantly under attack. There are constant efforts, from within and outside our country, to manipulate the very content of the 'events' that are reported. The sociological, political result is that we are living in a polarized world of alternate realities where the very 'events' reported are in dispute.

Respectfully

Larry S Sandberg

Michelle Goldberg: Democracy Grief is Real

12.15.19

To the editor:

As a psychiatrist and psychoanalyst, I agree with Michelle Goldberg that many people are experiencing a kind of grief and despair about our country unlike other times in their lives (Democracy grief is real, 12.15.19).  This includes one elderly patient, born in the 1920's, who has seen a lot of life! 

Soon after President Trump was elected many people focused their anxiety, anger, depression and fear onto him: Donald Trump was THE problem. But over time, many people (myself included) have been confronted with a more  ominous reality.  Donald Trump has destroyed the Republican Party. Many, if not most, Republicans think like him  and act like him: Trump is  victim of a 'witch hunt,' Ukraine interfered with our elections, the Mueller report was a waste of taxpayers money ... on and on.  It is as if an isolated cancer, with the help of Vladimir Putin, infected our democracy and it has now metastasized destroying our two party system and life in a fact based world. Many patients look to the 2020 election cycle in an effort to remain hopeful while terrified by the prospects of  Democratic loss.

Respectfully

Larry S. Sandberg

Trump's Pathological Narcissism

To the editor:

Perhaps it was in an effort to appear balanced that you chose to publish a letter (10/20/19) that offered a counter-argument to the the prevailing view that Donald Trump has severe narcissistic pathology. But quoting an expert, Allen Frances, and then taking his words out of context is misleading at best. What Allen Frances wrote two years ago was that there were, in essence, exclusionary criteria that precluded making a diagnosis: 'he does not suffer from distress and impairment required to diagnose a mental disorder.'

Is there anyone observing President Trump today, supporters and non-supporters alike, who would conclude that President Trump is not in distress? That he doesn't grasp the source of distress as his own psychopathology is, by definition, a narcissistic perspective. But reports of his distress are in the news on a daily basis and evident in his tweets. Can one honestly look at President Trump's decision making and conclude there is no impairment? Even Republicans have been up in arms about Syria and the G7 fiasco.

Ironically, and sadly enough, President Trump hits the ball out of the park when it comes to narcissistic personality disorder. Only five of nine characteristics are needed to make the diagnosis; he has all nine! Legitimate differences of opinion exist as to how to handle an unfit President. But the public should understand, without doubt, that they are witnessing the unraveling of narcissistic pathology in the most powerful man in the world.

Respectfully

Larry S Sandberg

Trump's Lies and His Lying Accomplices

10.26.19

To the editor:

Jennifer Senior (NYT 10.26.19) points out how President Trump's attack against the truth has been sustained by self-serving Republican politicians and by media that profit from packaging and disseminating lies. A large number of Trump supporters believe these lies.

This historical moment reflects a profound betrayal of the public trust. At the end of the day, no one likes being lied to. As the impeachment inquiry moves forward, patriotic civil servants - with unimpeachable integrity - will come forward in public hearings to literally speak truth to power. Will President Trump's political cronies engage these brave men and women as truth seekers? Or will their political agenda demand they attack and discredit? I suspect the latter. Either way, I am hopeful that more and more Americans will recognize they have been fed a steady diet of lies and ultimately repudiate this President for degrading our country and the office he holds.

Respectfully

Larry S Sandberg

Trump, Narcissism an His Inevitable Fall

10.11.19
To the editor

While Jennifer Senior (NYT 10/11/19) persuasively argues that President Trump suffers from a narcissistic personality disorder, it is his impaired judgement that makes him unfit for office and a distorted sense of reality that he attempts to forcibly impose on the public that can be crazy making for those who see through him.

The challenges of the Presidency are infinitely more complex than running a real estate business. It’s obvious he’s been in over his head from day one when he lied about the size of the inauguration crowd. He has been a wrecking ball to our country, the international order and the environment. As the damage grows day by day the reality of his unfitness will overwhelm his lies and conspiracy theories.

I don’t know when President Trump will fall but his fall is inevitable. Sadly, mental health professionals who spoke out early on were ignored or denigrated rather than taken seriously. We’re all paying the price.

Respectfully
Larry Sandberg

Nancy Pelosi and Hate

12.8.19

To the editor:

As is often the case, President Trump's supporters use as a line of defense an accusation that more accurately applies to the President rather than his critics (Hating the word 'hate', Maureen Dowd, 12.8.19). While gender issues may have played a role in why Speaker Pelosi was asked if she 'hated' President Trump, I would suggest the power of her response - 'As a Catholic, I resent your using the word hate ...' - was not because she was like 'John Wayne, minus the racism and colonialism.' Rather, her response, in effect, transcended gender. She was speaking as a Catholic, embodying her faith and touching on a universal value for believers with unquestionable authenticity. This stands in stark contrast to President Trump where faith is a political calculus to his conservative base rather than an embodiment of religious values.

Respectfully submitted

Larry S Sandberg

Pain As A Symptom

2.17.19
To the editor

Regardless of whether we consider pain a sensation or an emotion (Haiter Waraich NYT 3/17/19) it is a symptom with many causes. Opiates are no more a cure for pain than Tylenol is a cure for febrile seizures. The underlying condition must be addressed.

This point was driven home to me many years ago when I treated a man with intractable back pain who made a suicide attempt. Electroconvulsive therapy treated his depression and eradicated his pain. Fifteen years later his wife called me after failed back surgery - his depression had returned.

This case illustrates, albeit dramatically, the link between mind/brain and body.

Attention to the psychological and social dimensions of pain - not only the concretely physical symptoms -- are necessary for all patients complaining of pain.

Respectfully submitted
Larry S Sandberg

Climate Change and Catastrophic Thinking

2.17.19

To the editor:

In his powerful piece on climate change (2.17.19, Time To Panic), David Wallace-Wells makes frequent reference to the value of 'catastrophic thinking' as a way to mobilize appropriate action to fight global warming. But what he is describing is realistic thinking rather than catastrophic thinking - at least as the term is commonly used within psychology. Catastrophic thinking is distorted thinking based on excessive worry. Learning to reign in such thinking is key to managing anxiety. Decision making often becomes frozen or problematic in such states.

If catastrophic thinking is not the solution to the cognitive biases that - in Wallace-Wells words - lead to 'delusion' and 'self-deception' then what is? An insistence on the legitimacy of scientific facts, that our elected officials believe in such facts and that denial - turning a blind eye to reality - is an unacceptable response to the real catastrophe, the frightening catastrophe we all face. We need to be able to think about the catastrophe in order to face it, not think catastrophically.

Respectfully submitted,

Larry S. Sandberg MD

Gun Violence

To the editor:

Jaclyn Corin (2.14.19, Would congress care more if Parkland had been a plane crash?) writes powerfully about the toll of gun violence in our country and the willful indifference of politicians to deal with it as the crisis it is.  Sadly, I think the answer to her question as to why more is not being done is as simple as it is shameful: follow the money.

Why did a Russian operative insinuate herself into the world of the NRA?  Because they know full well the influence and power they have in the political realm.  Money talks and money is used to silence critics of the NRA and to silence the consciences of politicians who do nothing while our children die.

Respectfully

Larry S Sandberg

In Favor of Impeachment Proceedings

To the editor:

In an effort to strategize how to defeat President Trump in 2020 (4.21.19, How 2020 Democrats are Gaming Out Trump Impeachment Quandary), Democratic candidates cynically miscalculate as they shy away from calling for impeachment proceedings in the wake of the Mueller report. The rationale is three-fold: the electorate is uninterested in impeachment, the votes do not exist in the Senate to remove President Trump and his base will be energized with such efforts.

Our democracy has been weakened by Russian interference and by a President who attacks the very institutions we depend upon as the bedrock of society. Lies, creating false narratives, have infected the minds of many Americans leading to a pervasive atmosphere of paranoia. But resisting calls to impeach gives in to the very paranoia we need to fight. It reinforces the notion that speaking the truth and doing the right thing will result in harm; that illuminating the facts will hurt the truth tellers as if we exist in an authoritarian world rather than a democracy.

It is worth remembering that President Trump won by a slim margin with Russian support in a country that voted Barack Obama into office twice. There is a strong case to be made to those swing voters. Impeachment proceedings, in addition to clear policy statements, are a critical part of that case.

Respectfully

Larry S.Sandberg

President Trump's Impact On Our Bodies

11.29.19

To the editor:

David Brooks (NYT, 11.29.19, The Wisdom Your Body Knows) writes about how our bodies express our emotional states and are the nexus between our thinking minds and the world around us - especially our relationships. He gives as an example the physical response to the bully on the playground: quickened heart rate, rapid breathing and the urge to fight, take flight or freeze.

But what does this look like when living in a world where 'emotional granularity' is lacking; when the 'bully on the playground' is the President? As a psychiatrist and psychoanalyst, everyday I see the detrimental effects of physical bodies activated - constantly primed for danger - while feelings of helplessness and powerlessness complicate defining constructive action. In this situation, it is important that individuals can define modes of engagement (protest, political involvement) that feel purposeful while, at the same time, mindfully getting out the 'playground' by detaching from the 24/7 media attention our President commands.

Respectfully

Larry S Sandberg