Category Archives: Medicine

Is Trump Crazy?

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According to one survey, nearly half of American households has someone who has had psychotherapy, and more would do so if it weren’t for the cost or lack of insurance coverage. People who have experienced psychotherapy often become familiar with the various diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Perhaps that is why so many people–from the ordinary man or woman, to journalists, to talk radio and television personalities–have engaged in amateur psychoanalysis of Donald Trump. I always thought that it was considered unethical for psychotherapists to diagnose people without having personally examined them, but I read somewhere that analysis of one’s mental health via television is now acceptable. My view is that almost all public personalities carefully cultivate a public image that may or may not be what they are really like. I have to ask, are all these real and amateur psychoanalysts diagnosing the public image of Trump or the real Trump?

The persona Trump presents to the public is that of a flamboyant New York billionaire who lives in a flashy apartment, has constructed lots of fancy buildings and resorts, and has acquired beautiful, sexy wives. He wants to be known not only as a fabulously wealthy entrepreneur, but also as a talented television personality, and a generous philanthropist.  He has been for years a celebrity with a capital c. He is The Donald.

During the campaign and since taking office when his profile has been at its highest, Trump often has been profane, untruthful, insulting, vulgar, obsessively combative, inconsistent and more. Yet, ninety percent of Trump voters are optimistic about the next four years with Trump as president, found an Economist/YouGov survey of American voters, conducted on the eve of his inauguration. Is Trump really that person described above or is his persona since he began campaigning for the presidency merely a facade? Some journalists and psychiatrists claim to know, the journalists from having covered him over the years and the psychiatrists and psychologists, as I said, from observing him on television. However, I think any fair person (if there are any left in today’s environment) would conclude that it is actually impossible, except for those close to him, to know the real Trump.

One example that Trump’s image may be fabricated has to do with his refusal to release his tax returns. Some believe that the tax returns would reveal illegal activity that might then be grounds for impeachment. Although I am sure the returns would reveal that he took advantage of every deduction and loophole the law allows (as most people do), I think it highly unlikely that he did anything illegal. Trump is just the sort of public figure the IRS  loves to go after, and Trump and his accountants certainly know it. I would guess (yes, it’s only a guess) that Trump refuses to release his tax returns because they would reveal that he is not really a billionaire, only a multi-millionaire. Being one of the relatively few billionaires in the country is perhaps, in Trump’s mind, an integral part of his image. However, (if it’s true) that doesn’t mean he’s crazy.

If Trump’s image has been a carefully constructed facade, he would certainly not be a unique figure among most other famous people, even among former presidents. When Harry Truman was in office, he had a public image as a profane former haberdasher. His supporters called it “plain speaking.” Much was made of his lack of a college education, which meant to many of the educated middle class that he was ignorant. I doubt that Truman’s image was one that he created; I think he was a president who didn’t care about such things. Years later we learned that Truman was an avid reader of serious books, despite his lack of a college degree. Author and professor Thomas Sowell speculated that, despite Democratic presidential candidate and former Illinois governor Adlai Stevenson’s (perhaps contrived) image as an intellectual, Truman probably read more widely than Stevenson.

As I wrote in a former post, President Eisenhower, wishing to return the country to normalcy after the cataclysmic events of the first half of the 20th Century, appeared to be a relaxed executive. In truth, he was deeply concerned about the Cold War and avoiding another hot war, a war that would probably result in a nuclear exchange.

John F. Kennedy has often been called the first president to skillfully use television to project an image that was painstakingly fabricated. Kennedy was supposedly the embodiment of good health, youth, and vigor, whereas in fact, in historian Robert Dallek’s words, he “suffered from colitis, prostatitis, and a disorder called Addison’s disease, which affects the body’s ability to regulate blood sugar and sodium. He also had osteoporosis of the lower back, causing pain so severe that he was unable to perform simple tasks such as reaching across his desk to pull papers forward, or pulling the shoe and sock onto his left foot.”

Dallek also reveals the drugs Kennedy took:

The medical records reveal that Kennedy variously took codeine, Demerol and methadone for pain; Ritalin, a stimulant; meprobamate and librium for anxiety; barbiturates for sleep; thyroid hormone; and injections of a blood derivative, gamma globulin, a medicine that combats infections.

During the Bay of Pigs fiasco in 1961, and the Cuban Missile Crisis in October 1962, Kennedy was taking steroids for his Addison’s disease, painkillers for his back, anti-spasmodics for his colitis, antibiotics for urinary tract infections, antihistamines for his allergies, and on at least one occasion, an anti-psychotic drug to treat a severe mood change that Jackie Kennedy believed was brought on by the antihistamines.

This deluge of drugs often had side effects, including grogginess or even depression. To treat this Kennedy took more still anti-anxiety medications.

Kennedy also cultivated the idea that he was a brilliant intellectual, but his Harvard grades were mediocre and his favorite author was Ian Fleming, the creator of James Bond.

I believe the public images of Johnson, Nixon, and Ford pretty much corresponded to who they really were. Jimmy Carter cultivated the image of the common man by carrying his own luggage and wearing a sweater when addressing the public on television. Reagan played the cowboy who rode horses and cleared brush from his ranch.  Some historians consider Reagan’s real personality to be a puzzle, that it was impossible to know what he was really like. The public persona of the first Bush was genuine as, I think, was his son’s. I suspect Clinton’s image corresponds closely to the real man. He was known as a philanderer before he took office and being president didn’t change him. On the other hand, Obama, it has been said, is a brilliant thinker, writer, and speaker who is so intelligent and learned that, according to one presidential historian, he is the most intelligent president ever to have held the office. To me, that is utter nonsense.

And so we come to President Trump. As I have said in previous posts, Trump, I believe, created an image of a brash, plain-speaking, confrontational candidate who was nothing like the carefully coached politicians who never utter a word that hasn’t been vetted by focus groups and professional political advisers. Trump’s voters supported his proposals, his willingness to say what he really thinks, and his aggressive approach to the news media, which they consider biased as well.

I ask again, are the real and amateur psychoanalysts diagnosing the genuine Donald Trump or the fabricated, public Donald Trump?  The father of a relative of mine, an electrical engineer, actually worked for Trump on many of Trump’s buildings in New York. The other day, when I asked her what her father thought of Trump as an employer, she replied:

He liked him because he always paid him on time. He was very straightforward and could talk to anyone from the construction worker to the architect. He was the one who told my father he needed a hearing aid because my dad would ask him to repeat things in meetings all the time. The people who work in his office were very kind. A few of them came to the shivah for my Dad. They all had nice things to say about my Dad.

That doesn’t sound anything like the public Trump we have come to know. He comes across in my relative’s description as a responsible, personable, knowledgeable, and caring employer. He appears to be just the kind of employer one would like to work for.

Which Trump is the real Trump? My guess is that it’s not the Trump you see and hear on television.

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My Experience With Depression

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In yesterday’s post, I mentioned my experience with depression a couple of times. I’d like to write about a few aspects of my experience that I hope will be helpful to others who have depression or might experience it in the future. And I hope it’s not too depressing. Also, I promise not to write about it again.

First, the psychiatric medicines. My first experience with serotonin reuptake inhibitors (SSRIs) was about 17 years ago. I’d asked a doctor to recommend an internist, a family doctor. I didn’t have one at that time. At my first appointment, I expected nothing more than a general physical examination; but after the examination, he said, “You know, you look a little depressed.”

I knew that I wasn’t an easygoing, worry-free kind of guy, but I didn’t think I was depressed. Furthermore, the office visit took place after a day of teaching high school English in one of Philadelphia’s public schools. I am sure I looked tired and somewhat stressed, and besides, doctors make me nervous. He offered me a prescription for Zoloft, one of the new miraculous SSRI drugs at that time. I hadn’t heard of Zoloft, but I had read about Prozac, which supposedly had the magical power to correct a chemical imbalance in your brain and thus transform you into the real you, the person you were meant to be – happy, relaxed, intelligent, and likable. Some asserted that if everyone took Prozac, peace would break out the world over and everyone would be happy.

I hesitated to accept the prescription at first, believing that it was probably not a good idea to take a pill to cure an illness you didn’t think you had. But then I thought it would be like taking a mental vacation, and I never thought I would take it long term, so I filled the prescription.

Within days, I really did feel like a new man. Things that used to upset me now rolled off my back. And I really enjoyed the new me.  I didn’t worry about the idea of taking a pill every day, for this pill (I said to myself) merely corrected an abnormal condition in my brain and thus made me “normal.”  What could be wrong with that?  In addition, there were no unpleasant side effects that I could detect.

After a while, my internist sent me to a psychopharmacologist because he didn’t want to prescribe such drugs anymore. The new doctor, an expert in antidepressants, continued prescribing  Zoloft, saying that if I stopped taking it, my depression would return. I forgot that I hadn’t thought I was  depressed when I started on Zoloft, and that if I was depressed, it was a very mild depression. After all, I seemed to function satisfactorily before Zoloft. I managed to graduate from college, earn a graduate degree, stay married to the same woman for more than 30 years, help raise two wonderful children who now have families of their own, and function pretty well in a highly stressful job. But I couldn’t think of a reason to stop taking Zoloft.

Then, one day the Zoloft stopped working. I had heard about “Prozac poop-out,” but neither the internist nor the psychopharmacologist offered to talk about it. I remember asking the psychopharmacologist about it, and he said it wouldn’t happen. When it pooped out, I felt at first intermittent anxiety that, after a while, became almost constant. Clinical, major depression followed, and no other drug helped very much.

According to reports, one in ten Americans is on antidepressants. I assume that many of those people are not clinically depressed. One person I know takes Zoloft to fight what she calls “irritability,” which, to my knowledge, is not a disease or illness. Many who take antidepressants feel fine most of the time, but take the pill because they want to feel even better. Also there are lots of people on SSRIs who function normally but are mildly depressed, meaning they often feel unhappy. Should doctors promiscuously prescribe antidepressants to such people?  From my experience, I think not.

These people, I believe, should be advised to talk to a psychologist, psychiatrist, or even, if they are religious, their pastor. I know many doctors move patients on to another drug before the original drug stops working. But there is no guarantee that the new drug or any of the others will work.

Another problem one must deal with is doctors. I’d advise patients to be very assertive with their doctors when they prescribe antidepressants. My experience is that doctors can be less than forthcoming about a drug’s side effects. Demand to know all of the possible side effects, and ask your pharmacist to give you a list of them before you start taking a drug. Don’t be surprised if a doctor gets very annoyed by your questions. A lot of doctors can be arrogant and patronizing when questioned. A favorite comeback of my first internist was, “What medical school did you go to?” My psychopharmacologist has a repertoire of condescending insults.  Once when I complained about a drug’s very unpleasant side effects, he came out with “I’m biting my tongue,” which I assumed meant, “How dare you question me, you moron.  I’m dying to tell you what I really think of you and your inane questions, and I’m doing my best to restrain myself.”

I would also ask therapists if they have ever experienced depression. A skillful therapist who has actually experienced depression would be ideal, but probably hard to find.

Finally, stay away from hospital psychiatric units unless you are on the brink of suicide. One day, on my birthday it turned out, I went to a local hospital ER because I was feeling panicky about something and I thought an ER doctor might give me something to relieve it. Unfortunately, I had gone there a couple of days before with the same complaint. The first time, they gave me a tranquilizer, and I went home feeling better. The second time, a social worker was called in. I would advise anyone who goes to the emergency room for anything having to do with depression and/or anxiety to beware of social workers. She was there to interrogate me and her subject for the day was suicide: Did I ever think of suicide, did I have a “plan,” and had I ever attempted it? I stupidly responded that, yes, I had thought of suicide. The fact that I said, no, I didn’t have a plan and, no, I’d never attempted to do it didn’t matter to her. I cannot imagine that anyone with clinical depression doesn’t have thoughts of suicide; indeed, many, if not all of the drugs prescribed for depression can cause suicidal thoughts. From my experience, I would conclude that social workers are not trained in the skill of separating those who think of suicide from those who are likely to do it.

So the social worker strongly urged me to go to the psychiatric ward. As I understand it, they can keep you for only 72 hours and only if you sign off on it. She also described the psych ward as a small, homey place, sort of like a spa.  I remembered seeing ads in Philadelphia Magazine (probably in some doctor’s waiting room) that touted the intensive treatment provided  at the psych ward of this hospital . The way I felt, I thought, Why not? It’s only for a few days and I would get intensive therapy from experienced psychiatrists. So I signed the paper and was off for a few days of helpful therapy, I believed.

Almost as soon as I set foot in the ward, I knew that everything the social worker had said was a lie. My wife was also horrified by the place and we told the resident Nurse Ratched that we had changed our minds.  But the doors were locked.  No, she said, you signed the paper, you’re not going anywhere.

I was shown to my room where my roommate was snoring away in the middle of the day. He was obese, and when awake, walked around the place wearing too small pajamas with weird designs. The room next door held a young woman who screamed and cursed both night and day and argued with people who were present only in her mind.

Next they took away all my possessions, including my belt, shoelaces, and even the little strings that held up pajamas. I know they believed that this was a necessary precaution, but it was still demeaning and disheartening.

I spent the next 3 days sitting in a sort of common room trying to read, which was difficult because of the drugs I was given. Still, I was able to observe what was going on. I did see a few doors with psychiatrists’ names on them, but I rarely saw an actual psychiatrist. The only time I saw one was in the morning when they came in, wrote something in a loose-leaf binder, and left.  The only times I talked to a doctor was on the first day “intake” evaluation and the day before I left for discharge. Nothing that took place between us could be defined as treatment. And we met outside in the common room where everyone could hear what was being said. I never saw any doctor take an “inmate” into a private office for treatment.  Needless to say, I was amazed by their unprofessional behavior.

So most of the day, the inmates (mostly the younger ones) socialized with each other and at night watched television. Yes, there was something called “group therapy.” Out of boredom, I attended two such sessions. The first one was a group “project” in which we were supposed to make a truck or something out of pieces of cardboard. I stayed about 10 minutes. In the other one we sat around a table and were asked to identify and discuss our most “positive” experience. During this “group therapy,” the woman next to me continuously drew with her finger imaginary circles in the air. I left after 5 minutes. And that was it for three days, and I cannot get those days out of my mind. It was worse than prison; in prison at least, you are permitted to go outside daily for some fresh air.

So beware of social workers and other “mental health workers” who want to send you to a psych ward. And the ward in which I spent 3 days is reputed to be the best in the area!

To be fair, I have to say that there was one member of the staff who treated me like a real human being. His job was to order and dispense medicine to the inmates, but he did much more. He did everything he could to make me and others as comfortable as he could.  He understood that this was a very unpleasant experience for me and let me know that he didn’t think I belonged there.  He also asked me once why I was doing this to myself. An interesting and, I think, an important question that was the closest I came to therapy during my stay.

A lot of the time, nowadays, I am feeling better. I do things that I avoided before, like going out, talking to friends, and traveling. Writing this blog seems to be therapeutic as well. Still, it has been a rough ride.