Category Archives: Writing

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Writing

The Dialectics of Diagnosis at MFPE in Belgrade

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Waving

Today I’m in Bozeman on my way to present to the Montana School Counselors in Belgrade, MT. As my friends at the Big Sky Youth Empowerment Program like to say, “I’m stoked!” I’m stoked because there’s hardly anything much better than spending a day with Montana School Counselors. Woohoo!

My topic tomorrow is “Strategies for Supporting Students with Common Mental Health Conditions.” That means I’ll be reviewing some DSM/ICD diagnostic criteria and that brings me to reflect on the following. . . .

Not long ago (July, 2019), Allsopp, Read, Corcoran, & Kinderman published an article in Psychiatry Research, not so boldly titled, “Heterogeneity in psychiatric diagnostic classification.” Hmm, sounds fascinating (not!).

A few days later, a summary of the article appeared in the less academically and more media oriented, ScienceDaily. The ScienceDaily’s contrasting and much bolder title was, “Psychiatric diagnosis ‘scientifically meaningless.” Wow!

The ScienceDaily summary took the issue even further. They wrote: “A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders.”

Did you catch that? Scientifically worthless!

In an interview with ScienceDaily, Allsopp, Read, and Kinderman stoked the passion, and avoided any word-mincing.

Dr. Kate Allsopp said, “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”

Professor Peter Kinderman, University of Liverpool, said: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”

Professor John Read, University of East London, said: “Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.”

In contrast to the authors’ conclusions, nearly every conventional psychiatrist believes the opposite–and emphasizes that psychiatric diagnosis is of great scientific and medical importance. For example, the Midtown Psychiatry and TMS Center website says, “A correct diagnosis helps the psychiatrist formulate the most effective treatment that will result in remission.”

No doubt there.

In addition, although I literally love that Allsopp, Read, and Kinderman are so outspoken about the potential deleterious effects of diagnosis, I think maybe they take it too far. For example, “Shall we pretend that we should provide the same intervention for panic attacks as we provide for conduct disorder, autism spectrum disorder, and gender dysphoria?”

That’s me talking now . . . and as I discussed this with Rita, she amplified that, of course, if you have a student who’s intentionally engaging in violent acts that harm others, we’re not treating them the same as a student who’s suffering panic attacks. Obviously.

Psychiatric diagnosis is a great example of a dialectic. Yes, in some ways it’s meaningless and overblown. And yes, in some ways it provides crucial information that informs our treatment approaches.

This leads me to my final point, and to my handouts.

What’s our School Counseling take-away message?

Let’s keep the baby and throw out with the bathwater.

Let’s de-emphasize labels – because labelling, whether accurate or inaccurate and whether self-inflicted or other inflicted, are possibly pathology-inducing.

Instead, let’s focus on specific behavior patterns, as well as abilities, impairments, stressors, and trauma experiences that interfere with academic achievement, personal and social functioning, and career potential.

In case you’re interested in more on this. My handouts for the workshop are below.

The Powerpoints: MFPE 2019 Belgrade Final

Managing fear and anxiety:Childhood Fears Rev

Student de-escalation tips: De-escalation Handout REV

Why Kids Lie and What to Do About It

 

 

Personal Reflections, Politics, Writing

In My Great and Unmatched Wisdom

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One Wipe Charlies

In my great and unmatched wisdom I hereby proclaim that today is Opposite Day.

Never mind that Opposite Day is a fictional children’s holiday and that it’s officially celebrated on January 25. Just because today’s not January 25 and I’m not a child, doesn’t mean I don’t get to say opposite things. I get to say opposite things because I’ve said I get to say opposite things.

When my nephews were little, we never waited for Opposite Day. Instead, we’d suddenly start playing the Opposite Game. It’s just like Opposite Day, but spontaneous. We’d say hello when we meant goodbye. I’d say things like, “Tommy, you’re the smartest person I know!” Or, “Paul, you’re one good looking guy.” I was totally hilarious, maybe the funniest uncle ever to exist on planet Earth.

Sometimes our spontaneous opposite games got a little out of control, but that was the point. One time, when grandma showed up and Tommy and Paul rolled their eyes and said, “It’s terrible to not see you” she looked hurt. We had to call time-out and explain the game to her. Even after the explanation, she didn’t seem to get it.

Funny thing, even when you’re playing at saying things that are the opposite of the truth, sometimes people don’t catch on. People get confused. For example, if the media happened to be listening to us, they might get confused and literally report things we said, even though we meant the opposite. That’s especially funny. When that happens, whether it’s by accident or on purpose, the correct response is to say, “I was only joking.”

After a while, if you intermittently play the Opposite game and mix it with being normal, people won’t know when to take you seriously and when to not take you seriously. For example, the other day I made a phone call, it was a perfect phone call. I said, “Hey dude, I’ll bring you over some of that medicinal plant you’re needing for nausea. It really sucks to feel sick, and I want to help. I’d like you to do me a favor though. If you could spontaneously give my boss a call and tell him how much you appreciate my great and unmatched wisdom, that would be nice.”

To be certain that I’d communicated perfectly, I ended the conversation by saying, “I’m only joking you know. I’m quite the humorist. Never mind what I said before. You look really good today.”

The best thing about being in charge of the opposite game is that it keeps everybody else off balance. In comparison, I’m always on my game, because I’m the only one who knows when the opposite game rules are in effect. Sometimes I forget whether I’m playing the opposite game or not. Hey, not really. You and I both know I’m the most self-aware and evolved person ever to inhabit the planet. Me forgetting? Not possible. Or, maybe it’s possible, but I’d never forget the important things.

I remember how me being in charge of the opposite game worked with my nephews. At the end of the day, sometimes I’d hug them and yell, “I hate you.” They knew what I really meant.

Oh, and BTW. Thanks for reading this. I value you as a person and I hope you love yourself. You know one thing that might help. If you’d just keep this blog post to yourself. Don’t share it. Seriously. I’m joking.

 

Clinical Interviewing, Personal Reflections, Writing

Hacking Affect and Mood in 325 Words

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Rita Wood Surfing

Affect is how you look to me.

Affect involves me (an outsider) judging your internal emotional state (as it looks from the outside). Whew.

Mood is how you feel to you.

Mood is inherently subjective and limited by your vocabulary, previous experiences, and inclination or disinclination toward feeling your feelings.

Independently, neither affect nor mood makes for a perfect assessment. But let’s be honest, there’s no such thing as a free lunch, and there’s no such thing as a perfect assessment. Even in elegant combination, affect and mood only provide us with limited information about a client’s emotional life.

Our information is limited and always falls short of truth because, not only is there always that pesky standard error of measurement, also, emotion is, by definition, phenomenologically subjective and elusive. Emotion, especially in the form of affect or mood, is a particularly fragile and quirky entrepreneur of physiology and cascading neurochemical caveats. Nothing and everything is or isn’t as it seems.

As an interviewer, even a simple emotional observation may be perceived as critical or inaccurate or offensive in ways we can only imagine. Saying, “You seem angry” might be experienced as critical or inaccurate and inspire the affect you’re watching and the mood your client is experiencing to hide, like Jonah, inside the belly of a whale.

Oddly, on another day with the same client, your emotional reflection—whether accurate or inaccurate—might facilitate emotional clarity; affect and mood may re-unite, and your client will experience insight and deepening emotional awareness.

As a clinician, despite your efforts to be a detached, objective observer, you might experience a parallel emotional process. Not only could your understanding of your client deepen, but ironically, because emotional lives resist isolation, you might experience your own emotional epiphany.

Rest assured, as with all emotional epiphanies—including our constitutionally guaranteed inevitable and unenviable pursuit of happiness—you’ll soon find yourself staring at your emotional epiphany through your rear view mirror.

*************************************

Just for fun, below I’ve included a link to a brief clip of me doing a mental status examination with a young man named Carl. A longer version of my interview with Carl is available with the 6th edition of Clinical Interviewing. https://www.youtube.com/watch?v=1lu50uciF5Y

 

 

 

Happiness, Personal Reflections, Suicide Assessment and Intervention, Writing

On the Road from Suicide to Happiness: Please Send Directions!

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IMG-5436

Buddhists often say that life is suffering. Some days, for many of us, that feels about right.

But on other days, the inverse also rings true. Life is joy. Joy is the dialectical sunshine that intermittently breaks through clouds of suffering to interrupt our melancholy.

Don’t worry. Even though there’s currently a September Winter Storm Warning happening in Montana, I’m not going all weather on you. Besides, there’s not much I love more than clouds, rain, and winter storms. Also, to be fair, Buddha and the Buddhists recognized long ago that there’s a road we can take to get away from storms of suffering.

Maybe it’s my penchant for bad weather that’s drawn me, for the past two years, deeply into the professional monsoon of clinical depression, suicide assessment, and suicide interventions. What’s odd about that is that I don’t believe that depression or suicidality should be as pathologized as they have been. I’m a proponent of the right to die. I also find light and hope in the existential perspective that encourages us to embrace and integrate our darker, depressive sides, so we can emerge more whole and, as the existentialist Kirk Schneider likes to say, experience a Rediscovery of Awe.

For the past two years, focusing on suicide has felt very important. Our society isn’t very good at discussing suicide in an open and balanced way. All too often, suicide gets inaccurately conflated with illness or shame or moral weakness. These inaccuracies have inspired me to talk openly about suicide whenever given the opportunity.

But, to be honest, talking and writing about suicide—even from a professional perspective—isn’t all that fun. Those who know me know how much I like to tell funny stories. For years, I’ve had an untreated addiction to showing Far Side and Calvin and Hobbes cartoons during presentations. You wouldn’t believe how hard it is to find suicide cartoons that are workshop-worthy. When I show my cartoon with the white rat in the cage hanging itself and the lab scientist saying, “Looks like discouraging data on the antidepressant” if there’s any laughter it’s a painful and strained laughter, at best.

I do have one amazing depression cartoon; it’s a Gary Larson Far Side scene of a sad looking man on a bed in a messy room with the caption, “The bluebird of happiness long absent from his life, Ned is visited by the Chicken of Depression.”

But let me get out of my addiction and to the point. In my work on suicide prevention and intervention, I’ve slowly realized that we need to paddle upstream. I won’t stop talking about depression and suicide, but I want to more explicitly acknowledge that disabling depression and tragic suicides are often the inverse of well-being or happiness turned upside down. To address this effort at integration, I’m preparing materials to teach and present on the science of happiness. This is where I need your help. Yes, please send more suicide and depression cartoons, but even more importantly, send me happiness cartoons! I’m expanding my focus, and getting ready to spend more time talking about how we can all live happier and more meaningful lives. One way I’m doing this is by teaching a new “Happiness” course this spring at the University of Montana.

As background, I should let you know that I’m familiar with the Yale Happiness Class, the Penn Positive Psychology Center, and other popular resources. Although I’ll use this mainstream material, I want to do something different.

Here’s how you can help.

I’m looking for lecture material and happiness lab activities. Examples include,

Lecture content

  • Video clips
  • Songs with meaning
  • Demonstration activities
  • Quirky/meaningful stories

Lab activities

  • 30-60 minute specific experiential activities that can deepen student learning
  • Evidence-based experiential activities that demonstrate how to counter depression or embrace meaning

Because I’ll be delivering the course to undergraduates, as you contemplate sending me a map with directions to happiness, please put on your 19-year-old hat and help me find destinations with academic substance, but that will still appeal to the college-age generation.

As always, thanks for reading. I wish you a weekend (and life) filled (at least intermittently) with the sort of happiness and joy that’s palpable enough to sustain you until the next bluebird of happiness lands on your shoulder. And if you live in Montana, be sure to stay warm in the winter storm.

John S-F

Personal Reflections, Politics, Writing

Without a Trace of Shame: Looking Back at Trump’s Personality

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IMG-5443

Donald Trump told another joke today. Problem is, his jokes frequently include death threats. I recall back in the day when he implied that his 2nd amendment supporters might want to stop Hillary from appointing Supreme Court justices. He played that off as a joke. Today the joke was about how America used to treat spies.

Like most things Donald Trump, what he says is usually half-impulse, half-informed, half-truths, half-ass, but wholly designed to trumpet his dominance.

The focus right now is on Trump’s Mafioso-like negotiation with Ukraine’s President. The press and politicians call it a “quid pro quo.” I think they’re using their fancy Latin to refer to a shake-down, which, if you read the transcript is obviously happening. To be more accurate, the Latin refers to “this for that.” But the Urban Dictionary might put it clearer with, “I want something, you want something. You give me what I want, I’ll give you what you want.” Even better, if you want to really know what’s going on, check out Urban Dictionary’s definition for “Quid pro quo-job” (which, because of my PG-13 rating, I’m unable to share here).

Some people act surprised that Donald Trump’s behaviors are so reminiscent of the Godfather. I’d say Mafioso, but Trump’s not Italian and consequently cannot qualify . . . which is probably at least partly why he’s acting so much like he’s trying to gain Mafioso status without having it. As Alfred Adler would say, that’s the way psychological compensation works.

If you’re a conscious and sentient being, there’s nothing particularly surprising here. Trump was being Trump. To review (which us academics do all the time, mostly because we’re forgetful), let’s look at the personality traits I wrote about in Slate Magazine last year around this time.

The following descriptions are summarized or paraphrased from the famous personality psychologist, Theodore Millon. Millon’s work was immense and immensely interesting. Read the following descriptions and contemplate two things:

  1. Do they fit Trump?
  2. What might the future of a Trump Presidency hold?

As I said last year, Trump has virtually all the qualities of someone with narcissistic personality disorder. But that’s not particularly interesting because most big-time politicians, media personalities, and rock stars have at least some narcissistic qualities. What’s unusual (and dangerous) is that Trump also has antisocial personality traits.

Generally, Millon summarized antisocial personalities as:

“Driven by a need to . . . achieve superiority.” They act “to counter expectation of derogation and disloyalty at the hands of others,” and do this by “actively engaging in clever, duplicitous, or illegal behaviors in which they seek to exploit others for self-gain.”

With that general description as backdrop, here are specifics.

Impulsive Imprudence. Antisocial personalities are “. . . shortsighted, incautious, and imprudent. There is minimal planning, limited consideration of alternative actions, and consequences are rarely examined.”

Blaming Others for Shirked Obligations. Antisocial personalities “frequently fail to meet or intentionally negate obligations of a marital, parental, employment, or financial nature.” This is the equivalent of a personal philosophy in direct opposition to President Harry Truman’s, “The buck stops here.”

Pathological Lying. Millon wrote, “Untroubled by guilt and loyalty, they develop a talent for pathological lying. Unconstrained by honesty and truth, they weave impressive talks of competency and reliability. Many . . . become skillful swindlers and imposters.”

Declarations of Innocence. During times of trouble, antisocial personality types employ an innocence strategy. “When . . . caught in obvious and repeated lies and dishonesties, many will affect an air of total innocence, claiming without a trace of shame that they have been unfairly accused.”

Empathy Deficits. Antisocial personalities are devoid of empathy and compassion. Millon called this “A wide-ranging deficit in social charitability, in human compassion, and in personal remorse and sensitivity.” He added that “many have a seeming disdain for human compassion.”

Counterattacks. Millon noted that antisocial personalities are hyper-alert to criticism. He “sees himself as the victim, an indignant bystander subjected to unjust persecution and hostility” feeling “free to counterattack and gain restitution and vindication.”

Moral Emptiness. Antisocial personalities have no ethical or moral compass. As Millon described, they “are contemptuous of conventional ethics and values” and “right and wrong are irrelevant abstractions.” Antisocials may feign religiosity—when it suits their purpose. But the moral litmus test will always involve whether they stand to gain from a particular behavior, policy, or government action.

Whether you think Donald Trump’s personality is captured in this short list of descriptions probably depends on your politics. I should also add that it’s perfectly possible for someone to have all these qualities and still have positive qualities as well. We’ve known—probably since the beginning of time—that people with antisocial personalities can be quite charming and charismatic. What’s crucial, and also intuitive, is that we the people recognize that despite his intermittent charm and charisma, Donald Trump is not to be trusted . . . which is likely why one of his favorite lines is “Trust me.”

My perspective is precisely the opposite. Please don’t trust me. Do the work, think about Trump’s pattern of behavior. It’s about far more than this latest incident regarding Ukraine. Take a look at the long list of behaviors that are consistent with Millon’s criteria. And then decide where you stand on a future with Donald Trump.

*********

The views expressed here are my own. They’re not representative of anyone else. They’re also not part of a quid pro quo.

For the whole long version of the Millon and Trump’s personality article, go here: https://johnsommersflanagan.com/2018/09/03/the-long-version-of-the-trump-personality-slate-magazine-article/

Personal Reflections, Suicide Assessment and Intervention, Writing

When Happiness Ran Away: Thoughts on Suicide and the Pursuit of Happiness

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Elephant

Several days prior to driving across the state to a party with her family, a friend met up with Rita and me. We talked about happiness. She said she liked the word contentment, along with the image of hanging out in a recliner after a day of meaningful work.

Following the party, she wrote me an email, sharing, rather cryptically, that her party planning turned out just okay, because,

“Sigh. Some days happiness runs so fast!”

I loved her image of chasing happiness even more than the image of her reclining in contentment.

As it turns out, being naturally fleet, happiness prefers not being caught. Because happiness is in amazing shape, if you chase it, it will outrun you. Happiness never gets tired, but usually, before too long, it gets tired of you.

In the U.S., we’ve got an unhealthy preoccupation with happiness, as if it were an end-state we can eventually catch and convince to live with us. But happiness doesn’t believe in marriage—or even in shacking up. Happiness has commitment issues. Just as soon as you start thinking happiness might be around to stay, happiness suddenly disappears in the night.

Maybe our preoccupation with happiness is related to that revered line in the U.S. Declaration of Independence about the right to life, liberty, and the pursuit of happiness. Grandiose words indeed, because, at this point in the history of time, I’m not so sure any of us have an inalienable right to any of those three wondrous ideals.

But don’t let my pessimism get you down. Even though I’m not all that keen on pursuing happiness, I believe (a) once we’ve defined happiness appropriately, and (b) once we realize that instead of happiness, we should be pursuing meaningfulness, then, (c) ironically or paradoxically or dialectically, happiness will sneak back into our lives, sometimes landing on our shoulders like a delicate butterfly and other times trumpeting like a magnificent elephant.

Another reason not to feel down is because next Tuesday, October 1, I’ll be in Red Lodge, Montana as the speaker of the month for the Red Lodge Forum for Provocative Issues.

How cool is that?

My Red Lodge Forum presentation is: Suicide, Suicide Prevention, and the Pursuit of Happiness.

Just in case you’re passing through Red Lodge or happen to know someone in the general vicinity, below I’ve pasted the promotional email for the event. Please come if you can. There will be a fancy dinner, which inevitably involves a full stomach, which, even though I’m talking about suicide, might provide you with a twitch or two of happiness.

Here’s the promo:

From: Red Lodge Forum <redlodgemtforum@gmail.com>
Sent: Sunday, September 22, 2019 2:13 PM
To: ‘Red Lodge Forum’ <redlodgemtforum@gmail.com>
Subject: Tuesday October 1st Forum for Provocative Issues. Dinner reservations open

Forum for Provocative Issues

Suicide, Suicide Prevention, and the Pursuit of Happiness

Tuesday, October 1

PROGRAM

Beginning in 2005, death by suicide in the U.S. began rising, and despite vigorous national and local suicide prevention efforts, suicide rates have continued rising for 13 consecutive years. Depending on which metrics you prefer, suicide rates are up from somewhere between 33% and 61% from their levels at the turn of the century.

In Montana, we have the dubious distinction of the highest per-capita suicide rates in the U.S., at about 29.0 per 100,000 Montanans. Why? What is so peculiar about Montana?

But suicide is about much more than numbers. Join us on Tuesday, October 1 when Distinguished Professor at the University of Montana, John Sommers-Flanagan talks about what contributes to suicide, why Montana’s rate is so high, what’s wrong with suicide prevention efforts, and how we should talk with friends about suicide. Although suicide is a difficult, emotionally charged, subject, John will explore emotions that can create and sustain happiness.

FORUM CATERER CHANGE

In the next section, you will notice our caterer has changed. Martha Young, who has faithfully served our delicious meals for eight years, first at Café Regis, and more recently at the Senior Center, is unable to caterer our October meal. Prerogative Kitchen, an outstanding local restaurant,  has agreed to stand in.

DINNER RESERVATIONS NOW OPEN

Dinner at the Red Lodge Senior Center (13th St and Word Ave) will start at 5:30 pm and our program shortly after 6. If you plan to have dinner, email RedlodgeMtForum@gmail.com (no text or calls) with:

  • your reservation request,
  • your general meal choice (meat/fish, veggie, non-gluten), and
  • your cell number

If you don’t receive an email confirmation of your request promptly, please resubmit it. When I know specific dinner choices later this week, I will ask you to confirm your choice.

If you plan to attend the forum but not eat, come around six but donate $5 to help defray room rental and other expenses.

The price for this  dinner is $18. Please bring a check written prior to your arrival to Prerogative Kitchen for $18 per person. It will reduce traffic at the door, seat everyone faster, and make our cashier’s job easier.  If you want to leave an additional gratuity, simply leave cash on the table. Do not include gratuities in your check.

If you have friends who are interested in attending the forum, feel free to forward this message.

HAS YOUR EMAIL CHANGED?

If you change your email address and want to continue receiving forum notices, remember to send the change to RedlodgeMtForum@gmail.com.

INFORMATION ABOUT UPCOMING AND PAST FORUMS

For quick access to all news about upcoming and past programs, become a member of our Facebook group page, which supports FPI programs.  To access the page, simply search “Forum for Provocative Issues.”  This is an open group, but we carefully screen applicants to avoid potential problems by asking three simple questions.

USE OF FORUM EMAILS

I never share the emails of forum members. However, I have on occasion sent information about community issues and events that I think members will find valuable.

FORUM SUGGESTIONS

If you have an idea for a forum, email it to RedlodgeMtForum@gmail.com.

FUTURE FORUMS

The dates for our 2019/2020 season follow. Mark them on your calendar now to avoid conflicts.

  • November 5, The Future of Nuclear Energy, Redfoot
  • December 10, Japanese American Internment Camp Conditions in WWII, Russell
  • January 14, Fighting Fires, Saving Homes, Trapp
  • February 4, Apollo 8 and the Race for Space, Dragon
  • March 3, Subject TBD, Darby
  • April 7, Dark Money in Politics, Adams
  • May 5, Genetics and the Future of the Human Race, Gunn

 

 

Personal Reflections, Suicide Assessment and Intervention, Writing

The End of Suicide Prevention Week

6 Comments

Chair

The September 12 edition of the New York Times included an opinion piece titled “What Lies in Suicide’s Wake” by Peggy Wehmeyer. Ms. Wehmeyer previously worked as a correspondent on ABC’s “World News Tonight.” In the opinion piece, Ms. Wehmeyer shared experiences following her husband’s death by suicide in 2008.

Wehmeyer’s account of widowhood by suicide grabs you by the throat and brings you to your knees. If you’re a suicide survivor, read it with caution, because it will bring you anger, sadness, pain, and guilt.

Wehmeyer’s story also made me want to take action. I wanted to do to her what Robin Williams did to Matt Damon in his role of the therapist in Good Will Hunting. Williams looked at a file on Damon’s history of abuse, and then stood in front of him, saying,

“All this shit. This is not your fault. Look at me son. It’s not your fault.” Then Williams repeated “It’s not your fault” until Damon collapsed crying in his arms.

Some burdens are too big. I want to take Ms. Wehmeyer in my arms and tell her she’s taking on too much. Her former husband chose suicide. That’s a tragedy. But it’s not her fault.

After a suicide, shame and guilt spread like warm butter on hot toast, seeping into crevices, muscles, joints, and neurons. Guilt stabs you in the heart and then pummels your brain with the most obvious, most painful, most important, and most impossible question, “Why?”

Why . . . is a stupid, impenetrable, devious, and unhelpful question. But suicide survivors can’t stop themselves from painfully ruminating on, Why did this happen? If I were the god of suicide recovery, I’d cancel that question from the genetic blueprint. After a suicide, the question Why is pointless and unanswerable.

I’m a psychologist and a counselor. I’ve got plenty of friends in the mental health professions. Many of my friends, being of the post-modern or existential ilk, like to exclaim, usually with intellectual delight and breathless discovery, that “Humans are meaning makers!!” Well, duh.

Of course humans are meaning makers. Basically, that’s all we do. We make up shit all the time in an effort to explain our existence and our experiences. Let’s say your romantic partner breaks up with you, if you’re like most humans, you’ll wonder “Why?” And then you’ll painfully exfoliate your soul until you corner yourself with some irrational bullshit like, “I must be unlovable” or “I’m defective” or “I’m undesirable.” Or, if you’re inclined the other direction, you’ll quickly conclude, “He was an asshole” or “She’s defective” or “I hope my ex gets hit by a train.” And there are the new-age explainers who repeatedly wax philosophical, saying, “It wasn’t meant to be” or “The universe is telling me that it’s not my time for a romantic relationship.”

Asking why shit happens (and then answering yourself) is simply not helpful; it’s not helpful because you will, being human, come up with dozens of stupid, irrational, and unhelpful explanations for terrible things that happen. In the aftermath of suicide, if you’re like Ms. Wehmeyer, and many of us are, most of your stupid, irrational, and unhelpful explanations will involve blaming yourself. You’ll think things like, “I should have loved him better” or, you’ll embrace the ultimate piece of bullshit, that, somehow, as Ms. Wehmeyer wrote, “I missed those [suicide] signs until it was too late.”

No she didn’t. Wehmeyer didn’t miss the signs. And neither did you. Predicting suicide is impossible for even the best suicide researchers on the planet. Like Robin Williams said: It’s not your fault. You’re not the god of suicide prevention. Things happen. Shit happens. People kill themselves. Suicide started eons before you were born and it will continue for eons after.

Accepting tragedy sucks. It sucks more than nearly anything else we can think of. But tragedy strikes. And most of the time, tragedies are outside our control. Does that mean you should stop trying to prevent suicide and save lives? Of course not. Do what you can when you can. Does it mean you should stop blaming yourself for actions and choices that other people make and that are beyond your control? Hell yes!

In case you missed it, National Suicide Prevention Week is just ending. All week we’ve been encouraged to watch for warning signs, to follow up on our concerns by directly asking friends, family, and colleagues how they’re doing, and if they’ve been thinking about suicide. All this is great stuff. But, along with the many educational messages we’ve heard, somebody has to point out the cold, hard truth.

Sometimes you track the warning signs, you ask all the right questions, and you love people with all your heart, and they’ll still die by suicide. If that happens, it doesn’t mean you missed the signs or that you weren’t lovable enough. If suicide happens, you need to take care of yourself; you need to talk about your sadness, pain, and regrets. But you need to add one more thing. You need to listen to Robin Williams (who also died by suicide) and forgive yourself, because . . . All this shit. This is not your fault. . . . It’s not your fault.

****************************

Resources for help

  • National Suicide Prevention Lifeline: Call 800-273-TALK (800-273-8255)
  • Crisis Text Line: Text HOME to 741741
  • Bozeman Help Center – 24-Hour Crisis Line: (406) 586-3333

 

Personal Reflections, Writing

Eight Tips for Coping with Writing Rejections

9 Comments

SheepWriting is hard. I know you already know that.

Reading is hard too, especially if you have to read bad writers, which is why I hope you haven’t already started thinking, “Reading this blog is hard. . .”

My point is that putting words on a page and hoping they pile up and turn into clear, coherent, and meaningful prose (or poetry) is so difficult that it creates self-consciousness and worry and other neurotic thoughts and emotions linked to being judged and rejected. And just in case you feel tempted, you don’t have to tell me that good writers never write, “My point is. . .” because my other point is that I’ve been getting lots of rejections lately.

I’d rather not admit anything about my writing rejection rate; I’d rather have you think that everything I write gets published. There have been thousands of pages, eight books, and 100+ professional articles—all published, but that’s NOT the point (I also know that using ALL CAPS is bad form, like shouting while writing, and that no one but Dave Barry, former humor columnist, GETS AWAY WITH ALL CAPS).

This summer, not unlike last summer and the summer before that, and other ad nauseam summers of my life, was a summer of writing rejections. I like to say, “There were a plethora of rejections” because I like the word plethora. But let’s not go into the details because one year I tried to count up all my rejections and it was like counting cloudy days and I got depressed and I vowed to never count rejections and instead to only count acceptances and publications and successes and smiles and sunshine, and I also vowed to write long sentences if I feel like writing long sentences, because as far as I can tell, that’s what Sigmund Freud did, and he got a couple things published.

Instead of numbering the rejections, let me share just one.

This summer I wrote a proposal for a trade book on Suicide in American. It was supposed to be a proposal for a trade book on Suicide in America. But the first version of the proposal managed to include an extra “n.” How that typo slipped in there after 43 readings, including my traditional oral reading before submitting—I cannot say.

Anyway, just remember this, Suicide in America is not the most fun topic, but it’s even a worse topic when you make a typo in the first line. After experiencing the horror of seeing the typo and correcting it, I sent the proposal out to a dozen or so agents and got a dozen or so rejections. Not the most fun outcome. However, not to be deterred, I stole some of my sample chapter material and used it in a continuing education course that I DID GET PUBLISHED (notice the ALL CAPS, BECAUSE, YES, I AM YELLING).

I thought about sending all the agents who rejected my book proposal a copy of my first check from the CE company, along with a photo of my finger, but that belongs on this list of tips and sage advice for all you writers who will inevitably need to cope with rejection.

  1. Even though you want to, don’t write a snarky email or letter back to the person who rejected your wonderful work. No doubt, the snarky email will feel good in the moment, but you could regret it later. I speak from experience. Being at conferences with people who have received photos of my finger is awkward. Instead, vent to your friends and colleagues, and thank the person who rejected you for considering your work.
  2. Listen—sometimes. Lots of trade book agents and publishers tell you in advance that they plan to ghost you, so sometimes there’s nothing to hear. But on occasion, there’s this thing that happens called feedback. You can take it or leave it, but if you want to develop your writing skills, take it—or at least take some of it sometimes. The corollary to this is that reviewers can be nasty. This is especially true of academic reviewers, many of whom have come to believe that it’s their responsibility to shame fledgling writers. My advice on that is simple: Ignore the reviewer’s tone because he/she/they likely have poor social skills and are compensating for their loneliness by trying to make you feel bad, or something like that. Ignore the tone, but listen to the content.
  3. Go Big or Go Home. Being that you’re an amazing person with fantastic ideas, don’t, as former President George W. Bush might say, misunderestimate yourself. Feel free to submit pieces to the New Yorker or the New England Journal of Medicine or other fancy publications that begin with the word New. Then, get ready to be ghosted, rejected, and humiliated. If—odds are low here—you get something accepted, you’ll be like Rocket Man.
  4. Find a Small Pond. Going big or going home is a broken philosophy, unless you finish the guidance with go home and find a small pond where you can submit your work, become a big fish, and find the positive reinforcement you crave. Publishing a short comment in your neighborhood newsletter is better than having nothing published. Look at me. I’ve got a blog. I publish here all the time. The best part of the deal is my publisher loves my work.
  5. Turn it Around. Rita and I have an academic friend who says we academics should live by the turn it around in 24 hours rule. He says that as soon as he receives a rejection letter/email from a professional journal, he starts his timer and submits the manuscript to a different journal in 24 hours or less. Never having achieved that, Rita and I try to live by something more like a 24 day rule. Either way, push yourself to revise and resubmit to someone, like my blog publisher, who’s likely to love your work and publish you yesterday.
  6. Mingle. If you’re sitting around feeling sorry for yourself, you need to get out more because, duh, you’re not alone. If you find them, you’ll discover that most writers are mostly sitting around feeling sorry for themselves most of the time. So mingle. Share your sorrows. Maybe form a writing group or a book club or a knitting clutch. Embrace the Hegelian dialectic that, although you’re plenty special, you’re also simultaneously not really all that special.
  7. Write More. There comes a time when you need to get right back on that bus that bucked you off. Nobody becomes a better writer without writing. Visualization is good for golf and relaxation, but not so much for writing. Reading is good for writing, but only if you’re also putting fingers to keyboards and digits on screens. Somebody said this already: Read, write, repeat.
  8. Practice CBT on Your Neurotic Writer-Self. Albert Ellis liked to say, “Don’t be a love slob.” What he meant was to not be too needy. He would ask his clients things like, “What the holy Hell are you thinking?” He drove home the idea that you can perform badly at lots of things, get rejected, fail, and still have, what he called, “Unconditional Self-Acceptance.” In other words (which is another phrase my editor hates), Ellis is saying you shouldn’t confuse your performance with your SELF. Let’s say you get rejected. You’ll likely feel sad and disappointed. That’s normal and healthy. But don’t use your Vita to measure your SELF.

I’m hoping you find this list of tips for handling rejection helpful. If it’s not, feel free to let me know. I’ll be sad and disappointed But I’ll get over it. I plan to keep writing anyway. I hope you do too.

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Suicide Assessment and Intervention, Writing

Suicide Myths — Part Two

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From M 2019 Spring

This is part two of my “Four Suicide Myths” blog post. If you read part one, you probably noticed that it ended abruptly. Apparently, that’s how I do two-part blog posts. Thinking back, I should have added something like, “end of part one.” 

And so, as an introduction, here’s the beginning of part two . . .

Myth #2: Suicide and suicidal thinking are signs of mental illness.

Philosophers and research scientists agree: nearly everyone on the planet thinks about suicide at one time or another—even if briefly. The philosopher Friedrich Nietzsche referred to suicidal thoughts as a coping strategy, writing, “The thought of suicide is a great consolation: by means of it one gets through many a dark night.” Additionally, the rates of suicidal thinking among high school and college students is so high (estimates of 20-40% annual incidence) that it’s more appropriate to label suicidal thoughts as common, rather than a sign of deviance or illness.

Edwin Shneidman—the American “Father” of suicidology—denied a relationship between suicide and so-called mental illness in the 1973 Encyclopedia Britannica, stating succinctly:

“Suicide is not a disease (although there are those who think so); it is not, in the view of the most detached observers, an immorality (although . . . it has often been so treated in Western and other cultures).”

A recent report from the U.S. Centers for Disease Control (CDC) supported Shneidman’s perspective. The CDC noted that 54% of individuals who died by suicide did not have a documented mental disorder. Keep in mind that the CDC wasn’t focusing on people who think about or attempt suicide; their study focused only on individuals who died by suicide. If most individuals who die by suicide don’t have a mental disorder, it’s even more unlikely that people who think about suicide (but don’t act on their thoughts), meet diagnostic criteria for a mental disorder.  As one of my mentors used to say, “Having the thought of suicide is not dangerous and is not the problem.”

Truth #2: Suicidal thoughts are not—in and of themselves—a sign of illness. Instead, suicidal thoughts arise naturally, especially during times of excruciating distress.

Myth #3: Scientific knowledge about suicide risk factors and warning signs allows for the prediction and prevention of suicide.

In 1995, renowned suicidologist, Robert Litman wrote:

At present it is impossible to predict accurately any person’s suicide. Sophisticated statistical models . . . and experienced clinical judgments are equally unsuccessful. When I am asked why one depressed and suicidal patient commits suicide while nine other equally depressed and equally suicidal patients do not, I answer, “I don’t know.” (p. 135)

Litman’s comments remain true today. Part of the problem stems from the fact that suicide is what is referred to as a low base rate event. When something occurs at a low base rate, it becomes mathematically very difficult to predict. Suicide is a prime example of a low base rate event. According to the CDC, in 2017, only about 14 of every 100,000 citizens died by suicide.

Imagine you’re at the Neyland football stadium at the University of Tennessee. The stadium is filled with 100,000 fans. Your job is to figure out which 14 of the 100,000 fans will die by suicide over the next 365 days.

A good first step would be to ask everyone in the stadium the question that many suicide prevention specialists ask, “Have you been thinking about suicide?” Assuming the usual base rates and assuming that every one of the 100,000 fans answer you honestly, you might rule out 85,000 people (because they say they haven’t been thinking about suicide) and ask them to leave the stadium. Now you’re down to identifying which 14 of 15,000 will die by suicide.

For your next step you decide to do a quick screen for the diagnosis of clinical depression. Let’s say you’re highly efficient, taking only 20 minutes to screen and diagnose each of the 15,000 remaining fans. Only 50% of the 15,000 fans meet the diagnostic criteria for clinical depression.

At this point, you’ve reduced your population to 7,500 University of Tennessee fans, all of whom are depressed and thinking about suicide. How will you accurately identify the 14 fans who will die by suicide? Mostly, based on mathematics and statistics, you won’t. Every effort to do this in the past has failed. Your best bet might be to provide aggressive psychological treatment for the remaining 7,500 people. However, many of the fans will refuse treatment, including some of whom will later die by suicide. Further, as the year goes by, you’ll discover that several of the 85,000 fans who denied having suicidal thoughts, and whom you immediately ruled out as low risk, will confound your efforts at prediction and die by suicide.

To gain a broader perspective, imagine there are 3,270 stadiums across the U.S., each with 100,000 people, and each with 14 individuals who will die by suicide over the next year. All this points to the magnitude of the problem. Most professionals who try to predict and prevent suicide realize that, at best, they will help some of the people some of the time.

Truth #4: Although there’s always the chance that future research will enable us to predict suicide, decades of scientific research doesn’t support suicide as a predictable event. Even if you know all the salient suicide predictors and warning signs, odds are, in the vast majority of cases, you won’t be able to efficiently predict or prevent suicide attempts or suicide deaths.

Myth #4: Suicide prevention and intervention should focus on eliminating suicidal thoughts.

Logical analysis implies that if suicidal thoughts within an individual are eliminated, then suicide will be prevented. Why then, do the most knowledgeable psychotherapists in the U.S. advise against directly targeting suicidal thoughts in psychotherapy? The first reason is because most people who think about suicide never make a suicide attempt. But that’s only the tip of the iceberg.

After his son died by suicide, Rick Warren, a famous pastor and author, created a Youtube video titled, “Rick Warren’s Message for Those Considering Suicide.” The video summary reads, “If you have ever struggled with depression or suicide, Pastor Rick has a message for you. The pain you are experiencing will not last forever. There is hope!”

Although over 1,000 viewers clicked on the “thumbs up” sign for the video, there were 535 comments; these comments mostly pushed back on Pastor Warren’s well-intended message. Examples included:

  • Are you kidding me??? You’ve clearly never been suicidal or really depressed.
  • To say “Suicide is a permanent solution to a temporary problem” is like saying: “You couldn’t possibly have suffered long enough, even if you’ve suffered your entire life from many, many issues.”
  • This is extremely disheartening. With all due respect. Pastor, you just don’t get it.

Pastor Rick isn’t alone in not getting it. Most of us don’t really get the excruciating distress, deep self-hatred, and chronic shame linked to suicidal thoughts and impulses. And because we don’t get it, most of us try to use rational persuasion to encourage individuals with suicidal thoughts to regain hope and embrace life. Unfortunately, a nearly universal phenomenon called psychological reactance helps explain why rational persuasion—even when well-intended—rarely makes for an effective intervention.

While working with chronically suicidal patients for over two decades, Dr. Marsha Linehan of the University of Washington made an important discovery: when psychotherapists try to get their patients to stop thinking about suicide, the opposite usually happens—the patients become more suicidal.

Linehan’s discovery has played out in my clinical practice. Nearly every time I’ve actively pushed clients to stop thinking about suicide—using various psychological ploys and techniques—my efforts have backfired.

Truth #4: Most individuals who struggle with thoughts of suicide resist outside efforts to make them stop thinking about suicide. Using direct persuasion to convince people they should cheer up, have hope, and embrace life is rarely effective.

Starting Over

Individuals who are suicidal are complex, unique, and in deep distress. Judging them as ill is unhelpful. Believing that we can successfully predict and prevent suicide borders on delusional. Direct persuasion usually backfires. Letting go of the four common suicide myths might make you feel nervous. At least they provided guidance for action, right? But just like having the female on top to prevent pregnancy, clinging to unhelpful myths won’t, in the end, be effective. How do we start over? Where do we go from here?

All solutions—or at least most of them—begin with a clear understanding of the problem. As someone who has worked directly with suicidal individuals for decades, there’s no better person to start us on the journey toward a deeper understanding of suicide than Dr. Marsha Linehan.

Dr. Linehan is the developer of dialectical behavior therapy (DBT for short). DBT is widely hailed as the most effective evidence-based approach for working with chronically suicidal patients. To help her students at the University of Washington better understand the dynamics of suicide, Dr. Linehan begins her teaching with this story:

The suicidal person [is] trapped in a small, dark room with no windows and high walls (in my mind always with stark white walls reaching very, very high). The room is excruciatingly painful. The person searches for a door out to a life worth living but, alas, cannot find it. Scratching and clawing on the walls does no good. Screaming and banging brings no help. Falling to the floor and trying to shut down and feel nothing gives no relief. Praying to God and all the saints one knows brings no salvation. The only door out the individual can find is the door to death. The task of the therapist in this situation, as I always tell my clients also, is to somehow find a way to get into the room with the person, to see the person’s world from his or her point of view; to get inside the person, so to speak, and then together search again for that door to life that the therapist knows must be there.

Efforts to understand someone else’s reality are destined to fall short. You can’t always get it right, but that’s okay, because empathy is more about being with and feeling with others, than it is about perfectly understanding them. Trying to understand the inner world of others is an act of courage and compassion. Thus, our next step is to suspend judgment and begin our descent into that small, dark room with no windows.

Personal Reflections, Politics, Writing

The Brain-Based Truth of Donald Trump’s Social Dominance

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Snowy Sunset

Although everyone is arguing with everyone else about everything—especially everything involving presidential politics, no one argues about whether Donald Trump can work a room, work up an audience, and dominate a news cycle. Love or hate him, Trump has a special talent.

But what is that talent? How can it be that despite clear evidence of Trump lying at unprecedented rates, despite the small blue wave that swept the House of Representatives this past November, and despite substantial evidence that his policies are not benefiting rural Americans, Trump’s approval ratings continue to hover at around 40%. Given his flirtation with the Russians, his legal problems with the Department of Justice and in the Southern District of New York, and his incessant outrageous and vulgar tweeting, why don’t his approval ratings dip even lower?

Perhaps even more puzzling is the apparent inability or unwillingness of previously powerful republicans to push back on Trump’s wanton disregard for family values and morality. Many of Trumps tweets are, at best, rated PG-13. The fact that Googling “bullshit” and “circle jerk” takes us to commentaries about Trump’s tweets is a testimony to his ubiquitous disrespect for whatever moral codes republicans have retreated behind.

Never mind the well-documented porn star payments, “shithole” references, and stories about bullets dipped in pig’s blood. Unless they’re still commenting on Obama, the Clintons, or other targets designed to distract from rational argument, the collective chorus of outrage among republican politicians is no louder than you’d expect from a band of Buddhists practicing mindful acceptance at a silent retreat.

Sure, Mitt Romney and a few others have occasionally (and carefully) expressed their sickened feelings. And although Bill Kristol and other #neverTrumpers have held forth—even purchasing political advertisings to counter Trump rhetoric—to date, no current republican office-holder has publicly confronted Trump and provided an alternative leadership narrative. What’s up with the formerly assertive republican leaders? Whether we’re watching blank looks from Chris Christie, John Kelly, or Rod Rosenstein, republican power brokers appear frightened, intimidated, and only a meek shadow of their former selves.

What’s the best explanation for Trump’s stable approval ratings and the continued shriveling of republican leadership? You might be inclined to consider favorable economic indicators, or the Fox News phenomenon, or some other rational explanation. But I’m leaning a different direction—toward a theory to explain the irrational.

Like all dangerous populist politicians, Trump is a master manipulator. He can bend minds like psychics bend spoons. Although many—including my father—refer to him as a run-of-the-mill con man, Trump is much more than that. Trump is no expert on the art of the deal; but he’s a wizard at the art of mass hypnosis.

Among others, two Canadian academics, Drs. Erik Woody and Henry Szechtman, have written about how mass hypnosis works. They say it involves the activation of a particular evolutionarily-important part of the brain. They’ve labeled this neural network in the brain as the “security motivation system.” Essentially, the security motivation system is an ancient part of the brain that scans for “hints, inklings, whiffs, and foreshadowings” of danger. The problem, as Woody and Szechtman put it, is that contemporary human brains are now connected to the internet, and the internet is filled with perpetual news, Facebook forwards, Russian bot activity, and political messages. Much of this instant information has hints and whiffs of danger and those hints and whiffs activate the security motivation system. The louder the call of dark, scary, danger, the more activated our collective security motivation systems become. And what do our collectively activated security motivational systems want? Action! Specifically, action leading to safety. All this can direct us to embrace politicians who offer big actions that will hypothetically protect us from danger. Woody and Szectman wrote: “. . . support for politicians promoting bold action [like building a big, impenetrable border wall] is itself an action . . . which may help” de-activate our heightened security motivation.

In contrast to Reagan’s message of the late 1970s and early 1980s, Trump’s message has been consistently about doom, gloom, and danger. His speech at the 2016 Republican National Convention was a bleak frightening portrait of America. But, in contrast to Trump’s portrait of America as under attack from Mexican rapists, Muslim terrorists, and international commerce, he simultaneously promised (and continues to promise) to make America great again with big, albeit unrealistic and unfounded, actions.

For a substantial minority of Americans, Trump is a charismatic speaker. He ramps up crowds to an emotional fever-pitch. He combines extremes. On the one hand, America is under attack from Mexicans, Muslims, and Democrats. On the other hand, he—and only he—can offer a future filled with beauty, safety, and financial success. As he speaks, he sometimes riffs like a hypnotist employing a specific hypnotic induction procedure called the “confusion technique.” When he employs this strategy, Trump’s words barely make sense. He offers a rhythmic narrative absent any real content. Take this example from the 2016 campaign trail:

You are going to be so proud of your country. Because we’re gonna turn it around, and we’re gonna start winning again! We’re gonna win so much! We’re going to win at every level. We’re going to win economically. We’re going to win with the economy. We’re gonna win with military. We’re gonna win with healthcare and for our veterans. We’re gonna win every single facet.

We’re gonna win so much, you may even get tired of winning. And you’ll say, “Please, please. It’s too much winning. We can’t take it anymore. Mr. President, it’s too much.” And I’ll say, “No, it isn’t!”

We have to keep winning. We have to win more! We’re gonna win more. We’re gonna win so much.

Ashley Feinberg of Gawker, described this verbal dispatch from Trump as: “His best Howard Dean impression if Howard Dean had been given a whole lot of cocaine and also a thesaurus with just the word “winning” followed by the word “winning” again in progressively larger fonts.” Not surprisingly, Woody and Szechtman described it differently, noting nuanced differences between the oral and written word:

Through repetition, this type of communication stays “on message,” almost to the point of caricature. More importantly, it presents no line of argument or supporting material whatever that would call for higher thought. Such communication, which can be effective in person, is similarly effective when replayed on media as video [or audio]. By contrast, it becomes ineffective in print, where its paucity of intellectual content is painfully obvious. (p. 14)

Most observers agree, Trump is best when on the stump. When it comes to governing or foreign policy or role-modeling moral behavior, Trump is less effective. On the stump Trump uses other hypnotic methods, beyond the previously mentioned confusion technique. He continually pounds away messages about current dissatisfaction, combined with an orientation to the future. Under him, future life will always be better, more beautiful, a Shangri-La for the masses. He uses the words “believe me” and “trust me” like a mantra. Even though nearly every rational person in the U.S. knows they should quickly run away whenever a salesperson (or con-man) says “trust me” Trump’s hypnotic reverie has weakened the rational mind to the point where the words believe me and trust me actually work. As Roger Cohen opined in the New York Times,

Tolstoy wrote of “epidemic suggestion” to describe those moments when humanity seems to be gripped by a mass hypnosis that no force can counter. . . . We find ourselves in such a moment.

But there is a countering force. There always has been. And there always will be.

Let’s go back to Woody and Szechtman, and their ideas about the brain’s security motivation system.

When activated, the security motivation system directs humans toward actions that enhance safety. When looking for safety, nearly always, humans follow their evolutionary noses. And where do their evolutionary noses point . . . toward the person with the most social dominance.

Think about it. Who can keep us safe? Then, think about Trump’s hulking figure looming in the background as Hillary Clinton speaks in one of the televised debates. Then, think of what he has (wealth and property) and think of what he offers in his hollow narratives (winning, beauty, and safety, so much winning).

Republican politicians are cowed like never before. They can’t match Trump’s verbal skills and hypnotic persona. They can’t match his wealth and connections. And republicans have historically been motivated by fear. Trump’s presence activates their security motivation systems. On their own, most White, male republicans fear immigration. On their own, most White, male republicans are drawn to wealth and power. For them, Trump stokes their fears and activates their security motivation system in a way that goes back to primitive human thinking: “Save yourself” . . . is the irresistible unconscious motive that weakens republicans. Open conflict with Trump is too dangerous. Alone, individual republicans don’t have the verbal or financial prowess to compete with Trump. So, they slink into the background and do what frightened people have done since the beginning of time—they follow a socially dominant and powerful leader.

The answer to the problem of Trump is simple, but not easy.

There are two roads to countering a socially dominant, hypnotically adept bully. Both roads necessarily include an alternative socially dominant discourse. How to get there? Republicans, if they can find their courage, might band together to push back against Trump. This would be risky. And the outcome is dicey.

The other road is to latch our trailer to an alternative socially dominant political figure. The hazard here is we could end up jumping from the socially dominant frying pan into the socially dominant fire. Consequently, we need to be very careful when selecting the socially forceful leader who can take on Trump and win. Perhaps of greatest importance, along with powerful messaging, to ensure safety of all Americans, our new leader needs to have two characteristics that Trump lacks and that make Trump dangerous. We need a leader who can be a team player (and not just deputize family members) and we need a leader who is able to experience and express compassion.

Methods for resisting and awakening from a hypnotic trance exist. They begin as all things begin, with awareness. Now is the time to wake up. Listen closely as I count backward from five to one. When I get to the number one, you’ll awaken, you’ll stretch, look around, and realize that finding an alternative socially dominant and yet compassionate leader is urgent.

5

4

3

2

1

You can wake up now. If you stay asleep, you face a greater danger. If you stay asleep, you may act in ways that are incompatible with your deep values. If you stay asleep, you may need forgiveness, because although you will act, you . . . will . . . know . . . not . . . what . . . you . . . do.