Saturday, February 18, 2017

Don't insult me by comparing me to Donald Trump

Many people find Donald Trump's actions... worrisome. I am one of them. Many mental health clinicians have decided to pathologize him as a psychopath or narcissist. I am not one of them.

Trump is a repugnant human being and unfit to be president. He may have Narcissistic Personality Disorder. But with or without NPD, he is unfit to be president. It's unnecessary to diagnose him. And it's insulting to those of us with a mental disorder who aren't total assholes to have clinicians harping on how "pathological" Trump is.

I got into a bit of a flamewar today on the listserv of one of my professional organizations. Someone had posted a link to a distinguished psychiatrist's op-ed in The New York Times. This psychiatrist thinks it's irresponsible of professionals to diagnose someone they've never met in person.

I agreed, and decided to post as well:

I think the rush to diagnose and condemn Donald Trump is the worst kind of stigma reinforcement. The most important social action we can take as mental health clinicians is to advocate that people with mental illness who engage in treatment and participate in their recovery are able to have meaningful lives and contribute to society. Writing a public letter or convening a grand rounds in the absence of any contact with the client is not only irresponsible, it reinforces the concept that mental illness renders people inferior to "normals."

Clearly Trump's behavior and judgment are appalling. He embodies the worst kind of white (orange) male privilege, selfishness, prejudice, narrow-mindedness, stubbornness, cronyism, etc. But to say that this appalling behavior must mean he is mentally ill and therefore unfit for office implies that many or all people with a mental illness are similarly "unfit for office," irrational, lacking judgment, etc. People with a psychiatric diagnosis who are NOT despotic, bigoted jerks are offended to be grouped with Trump.

All that is needed is a focus on his behavior--what he says and does--and holding him accountable, like the representatives in Congress who are pressing for further investigation into the Flynn treason. It's obvious that Trump's behavior renders him unfit for office and his deportment is not statesmanlike. There are many ways to resist this presidency (and advocate for those adversely affected by policy changes) without disparaging millions of Americans en masse by comparison with a bloated buffoon.

(I was so tempted to come out to the listserv like I did in the Bronx. Include myself among the mentally ill who disavow any likeness to Trump. But I'm job-hunting (my great clinical job turned to utter crap when they transferred me to an operations role), and as the next post will show, plenty of mental health clinicians are violently prejudiced against the mentally ill.)

A self-important psychoanalyst (SPA) disagreed with me.

Many in our profession, certainly not all , consider Donald Trump to be a dangerous psychopath aspiring to create a dictatorship, and feel a duty to warn in whatever way we can . Had we lived in the time of Stalin or Hitler., would we all be telling each other to stop talking? Those of us who feel the situation is much too close to these historical situations are doing what we believe is right and necessary . Those who disagree are free to do so as long as we continue to live in a  free  country. The concerted effort of the Trump administration to discredit the Free Press cannot go ignored by anyone interested in preserving democracy in this country . I am tired of being lectured by people telling me and others like myself to keep our mouths shut, something Steven  already told the Free Press to do. Sorry, it's not going to happen here.

He was so incensed, he wrote "Steven" without appending "Bannon." SPA authored a book about "traumatic narcissism," which apparently is related somehow to "subjugation." Clearly he believes he has a vested interest in all things narcissist. And I didn't tell him to shut up, just not to violate the Goldwater Rule. Another poster agreed with me:

I do agree with Ayelet, it is completely unethical to diagnose someone whom you have not met and done a complete intake exam, psychosocial, medical and  psychiatric history, etc. Where I also object is to the reinforcement and promotion for "hate," of any kind. I will not support it. 

I didn't see that before I posted this:

Then resist politically using democratic means. There are a million ways people are resisting and protesting this presidency. Don't try to diagnose somebody you have never met.

To be fair, I should include that a few people agreed with SPA, or at least said they did before agreeing with me (very diplomatic; I hear the State Department has dozens if not hundreds of available positions):

Agreer #1. Thank you for your posting.  I fully agree that we cannot, and must not, keep our mouths shut. 

I don’t believe an actual ‘diagnosis’ is the best idea.  For one thing, many of us may arrive at different diagnostic conclusions. More important, I think, is to for us to describe Trump’s multiple symptoms and talk about the risk of discounting information of this sort.  I also think we should think of having clusters of professionals as in the 80’s—eg., Physicians for Social Responsibility, Performers for…, Lawyers for….Such constituencies were very effective during the disarmament and anti-nuclear days; they worked together and separately and always collaborated when collective efforts mattered.

Agreer #2. Just want to say I appreciate so much your thoughts on this subject & how you have expressed them. (It doesn't surprise me, of course, from the author of Traumatic Narcissism.)
I believe we are confronting a situation that challenges our normally civilized attitudes & behaviors-- the habits of fairness, willingness to compromise, acceptance of those who disagree, yielding to majority   decisions, restraint re: 'off-site' or 'no-sight' psych evaluations-- all  valuable principles that yet can weaken our resolve to stand firm against truly unacceptable behaviors & positions and a genuinely dangerous threat to our democracy. Yes, surely there is a duty to warn-- even about the obvious.

I agree with Ayelet that it is not a stigmatizing diagnosis, but actual behavior, that shows him to be unfit for office. But the diagnostic label can offer a coherent way of conceptualizing the behavior, a lens for understanding it, and--together with history-- an alert to where it may lead.

However, do we really want to add confusion by conflating narcissism or even psychopathy with 'mental illness'?-- which to most people has a different set of connotations-- and in fact a different meaning. As well as different expectations of treatment outcome.

How did SPA respond? Well.... kinda like a wounded narcissist:

Then let's been all the books by Erich Fromm and Erick Erickson!

He didn't acknowledge the others who posted in accordance with some of what he said. Just fired off a shot. I assume he meant "burn" instead of "been," and remembers the proper spelling of Erik Erikson when he's not typing in a narcissistic rage. For the record, I think Fromm and Erikson have their place, but I really doubt he's earned a spot beside them.

I was tempted to point out his resemblance to Trump--they are both narcissists! and one of them wrote the book on narcissists!--since I was curious about how he'd respond to that kind of a poke. But again--I'm looknig for a new job, and I don't want to appear confrontational.

It is astonishing to me that in the 21st century they're still publishing books that psychoanalyze narcissists. I really need to get my act together and publish my book. Just as soon as I've made a few more gains in therapy. Which is going very slowly. I know that's the right way to do it, but I'm not a very patient person. I just want to remember what I've repressed.

Like the other serious boyfriend my mother had, when I was about 8 to 11 years old. Who lived in a farmhouse in a nearby town. And took me there--by myself, without my mother or sister--for at least one weekend.

I remember going on the weekend. I remember seeing a mouse in a big room filled with grain that was part of the barn. And that's all I remember. I loved him for a while. And then I hated him.

But I don't know why I started hating him. I eally have no idea, and that is bothering the shit out of me. Did he abuse me as well? Is that why he wanted to marry my mother? She accepted his proposal at first,. I remember him moving toward me, saying, "I want to hug my new daughter!"

And I shouted, "I am not your daughter!"

I was such an unhappy child. Ever since my father died. For decades, starting in college, I tried not to think about all those bad memories. And now when I need to know what happened to me, I can't access them. It's infuriating. I don't know why my mother didn't marry him. If it had anything to do with me.

But I doubt that. It seems pretty clear that my mother didn't recognize child sexual abuse when it was happening in her own house. Like so many other victims who go on to have children of their own. That's how it's perpetuated.

Are the secrets and keys to my current unhappiness locked in my own recalcitrant memory?
Copyright (c) "Ayelet Survivor"

Thursday, January 19, 2017

"I care about you, but..."

A person I've known since middle school created an anonymous profile on Fb where she could share her private thoughts and concerns. Kinda exactly like I did.

I guess at some point I stopped following her. Maybe I was going through too much and I couldn't take too much reading about other people's pain. If she emailed me, though, I responded. Back in 2014 she asked me to help her find a therapist for her daughter. I offered to post a query on my professional association listserv:

Ayelet: This is what I'm thinking: 'Seeking contact information for psychiatrists with a holistic approach and experience overseeing light box therapy. Issues are depression, child of narcissist, childhood emotional abuse, ADD, and other learning disabilities. She is a 19-year-old college student who has her own car and can travel a bit."

Alleged friend: Perfect. Thanks so much. I have been wondering: when were you first diagnosed with bipolar? When was your first major depressive episode?

A: Probably college, but I was diagnosed with clinical depression at 24 and bipolar at 25. Only took me 18 years to find a really good psychiatrist -- God willing, it won't take her nearly that long.

AF: What is it about college that messes people up so much?? I wish I knew how to help her more, but she wants to be independent, even though she isn't up to it. Sigh.

A: Your schedule is chaotic, your hormones are raging, you have so much independence that you don't know how to manage, and you think you're an adult & know everything even though your cerebral cortex is still not fully developed. If you'd like me to talk to her, I'd be happy to.

AF: Yep, guess that sums it up 😉 Gotta run. Hope you feel better!

Recently I tried to look at her private profile and noticed we were no longer friends. I wondered why and asked her. She responded:

AF: I removed you from this profile more than two years ago. Interesting that you just noticed.

A touch passive-aggressive. Somewhat patehetically, I asked her why and said that if I'd done anything to offend her, I was sorry. She responded at length:

You didn't offend me or hurt me in any way. But I think the fact that you didn't notice for over two years explains why I removed you. How did you not realize that you hadn't seen any posts from that profile the entire time my mother was in hospice and dying? While I was sitting shiva and mourning? Some major things have gone on in my life which were shared to some degree on my general page, but you didn't notice that you were no longer in the private loop.

I care about you, Ayelet, but I have observed you are very one directional in your use of Facebook. You want people to follow you and comment on your posts, but you do not reciprocate. Your interest in other people's lives, and sympathy for other people's ordeals, is minimal. My private Facebook page is for my inner circle, the few people to whom I confide my deepest thoughts. At some point I realized you haven't earned that position.

I was upset all day--I guess what she said hit close to home. Even though I remember sending her a condolence card, calling her, and trying to comfort her. I guess it wasn't enough.

I know I'm a narcissist. But I also know that I prove how much I care about other people every day. To clients as well as friends. And if someone is going to walk around with simmering resentment, then lash out and slander my character,  I can't trust someone who has such a vile opinion of me and claims to be my friend.
Copyright (c) "Ayelet Survivor"

Thursday, November 24, 2016

The introduction to my book

This is an incomplete memoir. I won't be delving extensively into my unhappy childhood, angst-ridden adolescence, or confused young adulthood. While I'll allude to seminal events and phenomena from those days—my father dying when I was five, being bullied in elementary school, sibling rivalry, college highs and lows, ten years of aimless career surfing after graduation, being diagnosed with bipolar disorder, a suicide attempt, and a dating life that makes Taylor Swift look like Gloria Estefan—I'm focusing primarily on personal and professional anecdotes from my life after I decided to become a mental health clinician in my mid-30s.

Having bipolar disorder has made me both a better and a worse clinician. On the plus side, I know many symptoms inside and out and can normalize clients' experiences very effectively. I know the side effects of many psychiatric medications because I've taken them. I can instill hope because I know treatment can work and recovery is possible.

The downside is that my own dysphoric mood and anger can impede my interpersonal effectiveness, both with clients and co-workers. I've learned that even if you're competent and creative, expressing anger or emotional chaos at work will get you fired—in my case, more than once. Behavior that appears out of control will get you dumped by even the most patient boyfriend—in my case, more than once.

While I've finally found an exceptional psychiatrist and therapist, having an excellent pit crew is only part of the battle. You won't win the race unless you hone your driving skills—you'll crash and burn. That's a NASCAR metaphor for emotional self-regulation, something I struggle with every day.

For about 10 years I wrote a blog under the pseudonym “Ayelet Survivor” that I taglined “My life as a single, Jewish mental health professional who suffers from bipolar disorder and a keen sense of irony.” I explored my experiences with graduate school, working, dating, sex, and my religious observance, which waxed, waned, then more or less collapsed. The personal anecdotes in this book are drawn from that source and from my twitter feed, which as of this day has about 230 followers. There are more than 1300 blog posts and 7000 tweets, so obviously I've picked and chosen selectively. Feel free to visit the blog (or @ayelet_survivor on twitter) for a window into my brain at any given time.

In April 2015 I was asked to contribute an article to a now defunct online e-newsletter (“CBT for schizophrenia? You don't know Jack”). After I posted it to my LinkedIn profile, I was pleased to note that more than a few people were reading it, and decided to start writing anecdotes about other clients. After about 10 posts, some of my friends started saying, “You should write a book. You're like the social work Oliver Sacks.” Well, one friend said it, and I was hugely flattered.

I was also asked to contribute to the Chronotherapy blog on, which gave me the first opportunity to merge my professional and personal writing. I detailed my experiences with insomnia and seasonal affective disorder, and also wrote about other individuals' struggle with insomnia and other circadian rhythm disorders.

I've always loved writing. My personal blog was a tremendous creative outlet for me as I adjusted to a clinical career after more than 10 years of publishing and editorial work. I wrote poetry, stories, and plays as a child and young adult, which developed both my skill with language and my conviction that my true milieu is nonfiction. Nowadays I write progress notes, employee evaluations, and reports. Occasionally I'll bust out a villanelle or free verse poem, and I'll include a few in here.

I'm also committed to advocacy. Even before I became a social worker, I've been trying to explain the reality of mental illness in order to diminish the tremendous stigma that accompanies most media depictions. For a while I wrote numerous letters to the editor, which the New York Daily News was often kind enough to publish. I've engaged with the National Alliance for Mental Illness's efforts to provide a counterbalance to stigmatizing movies, television shows, and news coverage. On my blog I tried to portray my struggles with a sense of hope that it's possible to have a decent, even good life while managing a chronic psychiatric condition.

Most recently, I've been entertaining my Facebook friends with a series of updates that explain what circumstances will cause me to reject a man's Bumble or Tinder profile. More than one has asked, “When's the book coming out?” So I decided to include those, along with other dating anecdotes from my blog.

I also learned recently that I'm a survivor of emotional incest. For most of my life I didn't know that existed or that my experience with it had traumatized me. I just knew I was an emotional mess, sometimes more than other times, and that despite psychotherapy and medication, my problems persisted. As I write this introduction, I've just started a new kind of therapy to address this aspect of my life. It's an evolving story.

Friday, October 28, 2016

Ayelet comes out. In the Bronx. Does that count?

On Thursday, October 20, I flew to California to participate in a weekend of healing for survivors of sexual trauma. It was amazing, and I can't really write about it. Too huge. Very glad I went.

I landed the next Monday morning and stepped into a whirlwind of activity. Classes, conferences, meetings, I was all over the place. And that Thursday, I went to a conference at the Bronx VA.

The topic was holistic mental health recovery. Attending were clinicians, veterans, and peer specialists--people with lived experience of mental illness who then work with other people dealing with mental illness. They spoke openly and frankly about their struggles, side effects, and experiences as patients in a system that thinks eliminating symptoms is enough.

It's not. Recovery is about having a full like you enjoy, with friends, a nice place to live, and meaningful activity (paid or voluntary). And the psychiatrist on the panel kept droning on about how people with mental illnesses need to take medication, some people who have bipolar or schizophrenia, they need medication, blah blah blah. The peer on the panel respectfully noted that psychiatrists minimize even quite draconian side effects.

I raised my hand.

"I'm a clinical social worker, and I've spent a lot of time discussing side effects with clients," I said. "Mainly because their psychiatrists haven't. We don't have perfect medications, but we do have more than one option. I take three medications, and they work--pretty well. But not perfectly. Psychiatrists need to maximize the client's quality of life. If they gain weight on Zyprexa, give them Haldol with Cogentin! Think outside the box!"

Did I just come out as someone with a mental illness?

I was exhilarated and terrified, which involve very similar physical reactions. My heart was pounding; my head felt light; my breath was quick and shallow.

Did I just tell a room full of strangers and clinicians and colleagues that I have a mental illness?

Fortunately, they were the second to last panel, and the last panel was brief. After the conference concluded, I went up to the organizer. He's been trying to get me to go to one of his events for a while; after having to cancel twice, I finally showed up. How would he react?

With warmth. And a smile, and a handshake with a slow firm clasp. "Thank you so much for coming today," he said meaningfully. "Will I see you at the event on November 4?" (Sponsored by a different veteran organization.)

"I'll be there," I said. He smiled again.

The reaction was similar from the social worker who runs the local VA's suicide prevention/crisis line. "I'm so glad you spoke up," she said.

"I felt like I needed to," I said. "The peers were so brave and honest, sharing their experiences. I felt like I needed be honest as well." She's also looking forward to seeing me on November 4.

I'm not sure who else I'm going to tell, or when. But when I publish my incest article, I will use my name and photograph. One of the other survivors on the weekend is also a writer. She introduced me to World Pulse. I can tell my story there.
Copyright (c) "Ayelet Survivor"

Tuesday, August 23, 2016

Presumptuous as Hell

When you work for city or state government, it's often perceived that your salary is decent, your benefits excellent, and your job security rock-solid. I'm happy to report that my salary is excellent, my benefits are decent, and my job security is pretty good for someone who's not in a union. I can state unequivocally that I love my job.

Either that love shines forth from my LinkedIn profile like a beacon or people see where I work and think, "I could do that." I get a lot of requests to find people jobs. Once the landlord of a newly housed veteran asked me if I had any positions open for a friend of his, a social worker who didn't like her job. (I had called him becaues he was having some issues with his tenant.)

"Does she have any experience working with homeless veterans?" I asked.

"No, but I bet she'd really like it," he replied. After a moment he added, "You know, I know another guy who's really smart. He's not a social worker, but he's very smart and capable. Could you use a guy like him?"

For what? was my initial thought, which I kept to myself. I wanted to stay on good terms with the landlord, so I let him know the drill: sign up for a list and wait, wait, wait.

Anyone who actually works for the city knows that getting a city job is never a simple matter, especially for unionized positions. It often requires getting onto a civil service list, which is a matter of timing and luck. And people on those lists might wait years to be called for a job interview. I was lucky: I responded to a job ad for a newly created position within a newly created department, and waited only 16 days between interview and job offer. (And then waited about five more weeks for my start date, which felt glacial to me but for government jobs is blinding speed.)

Apparently many people subscribe to the belief that if you're the recipient of good luck, you should pay it forward by helping them get a job. I don't think they intend to be rude, but it's rather presumptuous. The morning before I spoke to that landlord, an acquaintance on Facebook accosted me:

Hey! I'm looking for a job. You should just hire me it'll be fun

He's the brother of someone I used to supervise. We talked about getting together for a drink, but it never happened. He's cute, but not very bright. Even if I were looking to hire, which I emphasize I am not, I wouldn't hire this guy. But I'm working on my tactfulness, so I didn't overreact.

Not in a million years ;) You wouldn't like working for the city. Tons of bureaucracy

That's diplomatic, right?

Aww boo but ok. What agency are you with ?

Persistent little bugger. But I told him which agency. He responded:

In the Bronx? Why can't I handle that

Not in the Bronx, that was my last job, which he would have known if he were actually paying any attention to my Facebook feed. Still, I tried to be diplomatic, because karma.

My program isn't hiring right now. I'm not sure if the agency is looking for case managers, but you have to take a civil service exam and be on a list for years before they call you

I hoped that would discourage him, and it did. Haven't heard from him since.

At least this guy has met me in person a few times and we used to work for the same agency. Recently I got an email from someone whose connection request I had hesitated to accept.

I hesitated because he's fairly junior, and at this point, not to brag, I am not. I was wondering if he was just connecting so he could mine me for contacts and job prospects. Against my better judgment I connected anyway, and the next day he sent me this:

Good evening Ms. Survivor, I'm very interested in clinical work with veterans. I was wondering if you know of any clinical positions available. Thank you, {name redacted}

I don't think he realizes how incredibly rude this is. I don't know anything about him aside from what he's posted on LinkedIn. If I were going to recommend someone for a position, it would only be someone whom I know well and trust not to make me look like a bad judge of skill or character. I can't say that for him.

I'm genuinely happy to help people I know and trust. Recently a recruiter emailed me asking to discuss a position as Deputy Director of Behavioral Health, offering a six-figure salary. Even though I love my job, I figured I had nothing to lose by talking to him. Turns out the job isn't right for me, but it's perfect for a former colleague; I called her and sent her the recruiter's contact information.

But I don't know this new connection. I've never seen his work. I don't know if he's a good person. Why on earth would I risk my reputation to recommend him for a job? I thought about responding to him along the lines of,

Listen, this is not how you network. You don't send an email to someone who doesn't know you and ask for a job. You get to know a person, and they get to know you, and then if they feel comfortable recommending you, they will. You come across as horrendously unprofessional and presumptuous.

But it's not my job to fix him, and I think that just ignoring his request will send the right message. If it doesn't, I can always block him.

This should teach me not to accept connection requests from junior-level people I don't know. If that sounds horribly pragmatic, well, it is. I got another connection request a week ago from a psychiatrist who's worked with veterans for 25 years. Hells yeah I accepted! But no more brand new starting out unknowns.

I've been used by enough men in my time; I don't need to extend exploitation into my professional life.

Copyright (c) "Ayelet Survivor"