Archive for the ‘Mental Health’ Category
I feel the need to write this open letter to express my thoughts given the current situation in our country. I am not a political person. That does not mean I don’t have strong political opinions, it means that I don’t get involved in politics and don’t enjoy the machinations necessary to succeed in politics. Up until last weekend, the only protest march I have ever been in was against the Vietnam War, a march that my older sisters took me to since I must have been only 7 or 8 years old. I wonder if they remember. Last weekend I marched from Queens to Manhattan, along with about 1000 others, to protest the positions that Mr. Trump has taken and the values he appears to hold. The people of Queens, where I was born, wanted to make a statement that while Mr. Trump may also have been from Queens, where he was born, he is not of Queens anymore and doesn’t represent the values they hold. As I am sure you know, Queens is likely the most diverse place in the country with something like 169 languages being spoken and every culture you can imagine, and some that you can’t, being represented there. It is a wonderful place, a place where people roll up their sleeves and get it done. Melting pot doesn’t really describe what it is like there, it is more like an enjoyable cacophony.
Now, I am not one who likes to paint swaths of people with a broad brush as that is never accurate, but broadly the supporters of Mr. Trump have me very worried about the future of this country that I so love. I spent a good deal of my childhood in upstate New York, the Southern Tier as it is called, a piece of New York that shoots out west along the Pennsylvania border. For virtually as far back as I can remember it has been an economic basket case. Endicott Johnson, which was the shoemaker to the world, and shod nearly every WWII solider, is a distant memory. It was a company whose workforce was largely powered by immigrants and there are local stories told that when an immigrant from certain parts of Europe got off the boat in New York, the only English they knew was “Which way EJ?” Singer Link, which started by making sewing machines and rose to become a technology powerhouse, was destroyed by corporate raider Paul Bilzerian, who bought up the company and then sold it piecemeal to make a profit. (He later served prison time for fraud). IBM, whose hometown is Endicott, and which seemed to have whole neighborhoods of employees at one point, is now and has been for a long time nothing more than a ghostly presence. Other companies, such as Corning, Lockheed and BAE still form valuable economic anchors in the region as do several major Universities. I remember as a kid riding my bike down the main street, past empty factory building after empty building, buildings which used to house economic powerhouses for the region and storefront after boarded-up storefront. I understand in my core what economic uncertainty looks like, I grew up with it, and I have seen its effects on an entire region. While it was deeply frustrating to me, and I recognize has shaped me to some degree, I don’t hate immigrants or minorities, I don’t hate government, I don’t hate businesspeople, I don’t hate because of it.
It is of course impossible to completely walk in someone else’s shoes. John Rawls, the noted philosopher on Justice described his veil of ignorance, a method to help put you into someone else’s shoes, but thought experiments only go so far. The coal miners in Appalachia? I think I get it. The factory workers in Michigan, Ohio and Illinois? I am pretty sure I understand. Family farms displaced by factory farms in Iowa, Nebraska, Missouri, Kansas and Indiana? Yes, I understand the pain. It is painful not only for those directly affected, but also for the entire communities those jobs and people supported. The shops and restaurants, the dentists, doctors, school teachers and other professionals who see their neighbors, customers, clients and patients at first suffering, then disappearing. Towns become places where there are only old people left with few children and young families. Once thriving communities are filled with empty homes.
Today Trump supporters are using this tale, which is the tale of late 20th century middle America, to point fingers at the “other”, whether the other are immigrants, minorities, government, cheap labor or weak environmental and other regulations abroad, or Wall Street to say they are the source of our problems. They are saying, if only we didn’t have these immigrants, regulation, or vocal minorities, if only we could go back to the way it was, when times were “good”, they would be “good” again.
There is an old Russian saying, “You cannot cross the same river twice”. Things change, whether it is technology, the economy, the workforce, or the water flowing in a river, things change. Going back to the good-old-days is a fantasy, for the good-old-days never really did exist for many. Those coal miners? They had good paying jobs, but they also had high death rates on dangerous jobs and ended up with diseases like black lung and cancer. After relatively short careers in physically demanding jobs they retired, and then struggled to get by, supported by various government programs. Generation after generation felt that they had no choice other than to work the mines. People felt trapped. The technology of strip mining, which required many fewer workers, accounted for the majority of the lost jobs, not the often cited regulation or labor costs. The factory workers? Automation and efficiency gains did away with many of their jobs. America today manufactures something like 3x what we did in 1985, but we do it with 1/3 fewer workers. This is not to say that the workers of today should not be fully employed with livable wage jobs. It is to say that specifically what those jobs are will change, hopefully for the better, and the workforce needs to adapt and be ready if they want to hold those jobs. As a society we need to help people adapt, not hold out false promises that things can return to a time that never was. This is a lesson that we might have to learn the hard way at this point.
A good portion of the Republican animus towards President Obama is pure racism, recognized or not, and we are still a long ways away from minorities being protected as they should be and having the rights that everyone deserves. Black Live do Matter, not because other lives don’t matter, but because for so long, and today still, the day-to-day treatment of blacks indicates that many don’t feel that they do. And in terms of walking in someone else’s shoes, it is impossible for those flying the Confederate flag on their cars, in their homes or over their state houses to know the pain that the flag causes those whose ancestors were enslaved or whose civil rights were abused under that very flag. Just as Trump’s white supremacist supporters may not know the significance of, or the pain caused by the Nazi salute they give in their meetings. Yet again, they might.
Everyone needs to be given the opportunity to fulfill their humanity, to have a dignified existence with a level playing field, let’s call that pro-lifespan. Any babies being born into this world, regardless of their skin color, religion, ethnicity, or sexual orietation must be given the life-long tools that they need to prosper. Benjamin Franklin knew for instance that education for all was a key for having a successful democracy and he knew that the availability of high quality public education was an absolute requirement. That now seems to be in jeopardy. School vouchers which promote private and religious schools in the place of public education will be a significant step backwards. And going backwards to a time of Jim Crowe or when LGBTQI folks needed to hide is an abhorrent thought, but one that we may now face or have to face down. Just the other day on CNN one Trump supporter wondered out loud, on the air, if Jews were people, or perhaps they were simply soulless golems. A golem being a fairy tale creature whose existence rose out of some of the darkest moments for Jews in eastern European history as a protector of children, now cast by a neo-Nazi on CNN as a Jewish source of evil. Why is this person on CNN? The American public was fed a continuous stream of false news, surrounded and amplified by false hopes, false promises and outright lies by the Republican candidate. Mr. Trump knew that people are rarely searching for the truth, but rather they are searching for information that supports their existing point of view. Whether it is truthful or not matters less.
Mr. Trump’s personal issues also seem to mean nothing to the electorate, whether those issues are ethical, behavioral or mental. Not being a clinical psychologist I will let others speak to his mental state, but from what I can see I am truly alarmed.
As an organizational psychologist, it is quite clear to me that resorting to blaming the “other”, people who are somehow “different” from us, a group either internal or external to “us”, or tribalism has been a method that has been repeatedly employed through millennium for certain people to seize or retain power and control. Putin of course is a regular user of blaming the “other” and so were figures like Hitler, Mussolini, Stalin, al-Assad, Pol Pot, and Osama bin Laden. The fighting between the Shia and Sunni at its core is about power, and each blames the other as being “other”. The Spanish Inquisition and the Crusades were powered by the same principles. The list is endless and now we can add Donald Trump and his supporters to that list. His whole campaign was based on playing to people’s fears about the “others” and then denying his statements through the use of slight nuance. A pattern is evident at the beginning of in-human times, excuses are made, appeasement attempted Chamberlin-like, apologist spokespeople appear explaining how we misunderstand them, denials are made, but then the full-throated horror becomes evident, usually too late to stop without great cost.
Humanity survived into a more civilized state after the atrocities of WWII only because the United States, as imperfect as she is, was there as a bulwark. What if that bulwark is now the one threatened by this tribalism? Who will return us and the world to the realm of sanity? I made a promise that I would do my part. I may not be able to affect the whole world, but I will do my best to positively affect the pieces that I touch.
It is no surprise that former white nationalist and former Trump supporter, Derek Black, who had an opinion piece in the New York Times this morning, described how he moved away from white nationalism by being welcomed by, and seeing how “others” were not the demon-like characters as they are portrayed and that he is now a graduate student majoring in history. To understand where we are going you first have to understand where we have been. We can only hope that this episode in our nation’s history is akin to umweg behavior, a concept out of Gestalt psychology which means detour, that in order to achieve a goal you sometimes must first move away from it.
I simply can’t believe what I see when I look at the candidacy of Donald Trump. How has the Republican Party, a main-stream political party devolved to reach such a low as to nominate a candidate that has the Klu Klux Klan, the American Nazi Party and other assorted racists and white supremacists advocating for its candidate? A candidate who numbers among his supporters a former KGB leader, Vladimir Putin, an autocrat and dictator running a corrupt kleptocracy, whose political and otherwise perceived opponents mysteriously disappear or die, who thinks nothing of bombing hospitals, and who actively supports Trump’s bid for the USA’s highest office with espionage.
Other support from the world of national leaders comes from Kim Jong-un, the missile-firing dynastic despot who kills people for “not showing the right attitude” during meetings, or for being perceived as a threat to his rule and from the Iranian hard right who want to dismantle the treaty that reduced their nuclear capability. So 2/3rd of George Bush’s “Axis of Evil” support the current Republican candidate. With this kind of support and role models it is no wonder that Trump threatens to imprison his political opponents, to make it easier to go after critical journalists and who constantly states that they only way he can lose is if the system is “rigged” against him. While it is easy to despair about the candidate, calling into question not only his policy positions but also his mental fitness, it is even more disappointing that he has garnered any support, let alone significant support from a proportion of the American public. This is not who we are or at least, based on the ideals of the founding fathers, not who we are supposed to be.
But we have been here before. Previously during times of economic and demographic transition the country has lurched toward populism, nativism, protectionism and the fear-mongering that we are currently seeing. And while as a national movement these periods have been relatively short-lived, there always has remained an undercurrent of baser populism by people who feel threatened by change or are simply racist, misogynist and xenophobic.
John Adams, perhaps the most religious of the founding fathers, signed a series of laws collectively called the Alien and Sedition Acts in 1798, which made it harder for an immigrant to become a citizen, allowed for the imprisonment and deportation of non-citizens deemed “dangerous” or were from a hostile nation, and criminalized the making of false statements against the federal government. The argument was made that these laws were required to strengthen national security during a time of uncertainty.
The rise of the Know-Nothings in the mid-1800s, which began as the American Republican Party then became the Native American Party, and then later simply the American Party, came about because of a fear of the immigration of large numbers of Germans and Irish Catholics. A California chapter opposed Chinese immigration. This anti-immigrant party, whose base was protestant men, saw conspiracies everywhere they looked and when members carried out various criminal acts and were questioned their response was “I know nothing”. Abraham Lincoln despaired about the No-Nothings: “As a nation, we began by declaring that ‘all men are created equal.’ We now practically read it ‘all men are created equal, except negroes.’ When the Know-Nothings get control, it will read ‘all men are created equals, except negroes and foreigners and Catholics.’ When it comes to that I should prefer emigrating to some country where they make no pretense of loving liberty – to Russia, for instance, where despotism can be taken pure, and without the base alloy of hypocrisy.”
And more recently, after the surprise attack on Pearl Harbor by the Japanese, during the spring of 1942, well over 120,000 Japanese Americans were forcibly relocated to internment camps because of fears over their loyalty. Reviews of this policy later on could find little to no evidence of disloyalty among these citizens and the motivations for this forced internment were identified as institutional racism.
While it is easy to say that these episodic periods of populism were economically driven, and to an extent they were, they are also driven by some basic human tendencies towards tribalism and to see “otherness” as a threat rather than a benefit to society. But the evidence is incontrovertible, immigration rather than being the threat that these movements perceive has powered this country to the heights of economic prosperity and to be a leader in scientific and industry innovation. After all, except for a very few of us, we are all immigrants.
From a business and organizational health standpoint prosperity is not achieved by walling yourself or your organization off from the rest of the world, but by embracing it. Ronald Reagan who is often used as the ideal icon of the Republican Party stated in his farewell address to the nation: “I’ve spoken of the shining city all my political life, but I don’t know if I ever quite communicated what I saw when I said it. But in my mind it was a tall, proud city built on rocks stronger than oceans, wind-swept, God-blessed, and teeming with people of all kinds living in harmony and peace; a city with free ports that hummed with commerce and creativity. And if there had to be city walls, the walls had doors and the doors were open to anyone with the will and the heart to get here. That’s how I saw it, and see it still”. You have to wonder what Reagan would say about what his party has become.
“Neurotics build castles in the sky, psychotics live in them.” My professor for a course called abnormal psychology made that statement as a way of remembering the difference between these two classes of mental illness. While the thinking around many aspects of mental illness has shifted and continues to evolve since that statement was made, that stark difference between people with neurosis who fantasize, sometimes as an escape from reality, and psychotics who can’t tell the difference between fantasy and reality remains.
While people talk about mental illness as some sort of all-encompassing disease the term mental illness is not at all precise, nor is it very useful. From the Mayo Clinic: “Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. Many people have mental health concerns from time to time (emphasis added). But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function (emphasis added).”
Very often when someone is labeled mentally ill, that label and the stigma it brings sticks for life. Once mentally ill, always mentally ill. Mental illness, it was thought, unlike a cold, infection, or broken bone, was not something you got over or recovered from. And mental illness is also associated in people’s minds with violence or unpredictability making people steer clear of those with the label.
The stigma of mental illness is nothing new and historically the term “insane” has been used as a weapon or as justification for brutality and slavery. In the early 1800’s entire populations of African Americans in many southern towns were classified as “insane” by the census, a classification which had nothing to do with actual mental illness. And absurdly one physician created a mental illness called drapetomania, a label given to slaves whose illness was trying to escape to freedom. According to Samuel Cartwright the physician who came up with this illness the cure was “whipping the devil out of them” and the removal of both large toes to make running impossible. This makes it very clear who the insane person was, and it was not the slaves.
Recent research implies that some mental illnesses are transient and over time people can overcome them. And certainly some of the medications now available as well as other improved treatments helps people cope better with the mental illnesses they do have.
Today, as we operate as more of a service economy, there is less tolerance for mental illness at work. In service oriented economies there is more direct interaction between individuals and if mental illness is present it is more obvious. A person laboring away on a farm could be a little “off” and no one might notice, or the illness might have little impact on their job performance. But a person with a mental illness who is cleaning your teeth or serving up your favorite coffee brew will much more noticeable.
The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) is the latest attempt by the American Psychiatric Association to classify the various mental illness to which a human can be subject. Prior versions of DSM classified mental illness into 5 categories or Axis as they were called. This new version does away with that classification as it was deemed too categorical and that many mental illnesses actually cut across these artificial boundaries. It is a big, thick book full of small print. But just because a book is big and thick doesn’t mean that it has all the answers and interrater reliability between two diagnosticians utilizing the DSM to classify a mental illness is relatively low.
One distinction I want to draw is the difference between mental illnesses and human bias and judgement errors and how math enters into the picture. We all fall victim to bias and judgement errors. One bias for instance is to give additional credence to evidence that supports your pre-existing point of view and to dismiss information that contradicts your closely held beliefs. But at some point when faced with incontrovertible proof that a closely held belief is wrong, refusing to modify your belief crosses the line from “normal” human bias to mental illness. Exactly when this occurs is defined by society and not a medical reference book or textbook. This point also shows the connection between mental illness and math, or statistics. Normal can be defined as being within 1 or 2 standard deviations from the mean on a trait. So there is a “normal’ level of fastidiousness which can cover quite a range. But if you are out a few standard deviations from the mean in either direction you would have people who would have difficulty functioning within society, for instance extreme hoarders or extreme cleanliness obsessives/compulsives, who meet the definition of mental illness by their behavior.
What is the mean score for our various human traits and characteristics? We decide that as a society. If we were all extreme obsessive/compulsives that would be the mean and would be considered normal. I am reminded of a Twilight Zone episode, #42 – “The Eye of the Beholder”, where a woman undergoes repeated plastic surgeries to her face because she was deemed hideous (of course by society). When the final bandages come off and she looks in a mirror she screams as her hideousness remains. As the camera pans out we see that by our definitions she is quite beautiful, but everyone else attending to her in the hospital room is quite hideous. Society determined the definition of beauty. And if our society becomes fractured with diametrically opposed groups, then the definition and determination of normal in each of those sub-groups can become different. Is racism, or tribalism normal or abnormal? Is xenophobia, misogyny, or a belief in some higher power directing your day-to-day actions normal or abnormal? The answer is not in a medical textbook but rather in what society defines as normal and what it defines as abnormal.
One newly emerging way of looking at mental illness is through the lens of Bayesian statistics. The Bayesian approach is one of probability. It assumes that the brain is always assigning probabilities as it is processing data based on our internal heuristics or rules-of-thumb. How likely is a certain outcome or a “thing” given past experience, assumptions I have or new incoming information? It has been shown that people with at least certain kinds of mental illness struggle to assign the correct likelihood probabilities. In schizophrenia for instance it has been shown that people have trouble connecting new incoming information to their expectations. (And hence are less susceptible to optical illusions). And autistics don’t update their expectations regarding how the world operates, and use only incoming information rather than expectations to navigate the world. This was demonstrated in one experiment when those with autism performed just as well in remembering nonsense syllables as strings that formed complete sentences. (Science News, May 13, 2016).
While it is of course not possible to cover even a smidgen of the mental illnesses that people experience in a blog post, or the ones that occur in a work environment, there are some important points to be made.
First, some information from Harvard Medical School:
- “Low treatment rates imperil workers’ careers and companies’ productivity.
- Mental health problems affect many employees — a fact that is usually overlooked because these disorders tend to be hidden at work. Researchers analyzing results from the U.S. National Comorbidity Survey, a nationally representative study of Americans ages 15 to 54, reported that 18% of those who were employed said they experienced symptoms of a mental health disorder in the previous month.
- But the stigma attached to having a psychiatric disorder is such that employees may be reluctant to seek treatment — especially in the current economic climate — out of fear that they might jeopardize their jobs. At the same time, managers may want to help but aren’t sure how to do so. And clinicians may find themselves in unfamiliar territory, simultaneously trying to treat a patient while providing advice about dealing with the illness at work.
- As a result, mental health disorders often go unrecognized and untreated — not only damaging an individual’s health and career, but also reducing productivity at work. Adequate treatment, on the other hand, can alleviate symptoms for the employee and improve job performance. But accomplishing these aims requires a shift in attitudes about the nature of mental disorders and the recognition that such a worthwhile achievement takes effort and time.”
The most common mental illnesses manifesting themselves in the workplace include:
- Depression (estimated at 6% of the workforce at any given time)
- Some signs: Increased irritability, much lower levels of productivity
- Anxiety (estimated at 6% of workforce at some point in career)
- Some signs: Often require constant reassurance regarding performance and are commonly undiagnosed
- Bipolar disorder (1% of the workforce)
- Sime signs: While the person may accomplish a lot in the manic phase, during the depressive phase will have lower productivity
- ADHD (3.5% of the adult workforce – while often thought of as a child’s issue it equally affects adults)
- Some signs: Disorganization, failure to meet deadlines, problems with instructions and work prioritization, argumentative
While these mood disorders may be the most common mental illnesses in a large workforce, special mention needs to be made of other personality disorders, such as borderline personalities, while potentially not as widespread, but that have the ability to inflict high levels of damage to other people and to organizations, especially when they are present in management.
The Dark Triad. This is a combination of traits that often show comorbidity that is they tend to travel together and include psychopathology, narcissism, and Machiavellianism. These traits are fundamentally malevolent in nature. In other words people who express these traits are likely to cause harm to others. There is a well-researched, extensive and heavily referenced article on the Dark Triad in Wikipedia. Here is a very brief definition of each of these characteristics from that article:
“Psychopathy – Considered the most malevolent of the dark triad, individuals who score high on psychopathy show low levels of empathy combined with high levels of impulsivity and thrill-seeking. The similarity between psychopathy and antisocial personality disorder have been noted by some researchers. Psychopathy has been found to correlate with all of the Big Five personality factors…
Narcissism – Individuals who score high on narcissism display grandiosity, entitlement, dominance, and superiority… Narcissism has also been found to have a significant correlation with psychopathy.
Machiavellianism – Named after the philosophy of Niccolò Machiavelli, people who score high on this trait are cynical (in an amoral self-interest sense, not in a doubtful or skeptical sense), unprincipled, believe in interpersonal manipulation as the key for life success, and behave accordingly.”
While it can take extensive observations and assessment to determine if someone has one of these personality disorders some of the more common traits of those with these pathological issues are:
- Exploitive, opportunistic, can be successful in life, but often that success is short-lived
- They can be charismatic and persuasive
- Pay a lot of attention to their appearance, with a desire to look attractive
- Aggression, racism, bullying is often evident
- Assertiveness, dominance, self-importance
- Limited self-control, higher risk taking, short-duration marriages and multiple spouses or multiple affairs
- Low scores on honesty and humility with high scores on greediness
- Psychopaths are notorious for a lack of emotion and empathy, the ability to understand right from wrong or to understand the emotions that someone else is feeling
- And, those with these traits generally lack self-awareness – the ability to see how their behavior is perceived by others.
One study found that narcissists, people with an “overly grand view of themselves” found it difficult to impossible to apologize for any of their actions or words (Scientific American, Nov. 2011). Or as Elton John composed, “Sorry seems to be the hardest word” – especially for narcissists. Now, just because someone has a tendency to be concerned about their appearance or seems to be opportunistic does not mean that they are afflicted with the Dark Triad or a component, but a consistent pattern of behavior over time, while exhibiting many of these characteristics in combination, would be an indication that the person needs psychological care.
How does the Dark Triad affect people at work? In “Snakes in Suits”, Robert Hare, a researcher in the field of criminal psychology and developer of the Hare Psychopathy Checklist, indicates that there seems to be a higher proportion of psychopaths in management than exists in the general population. While the incidence rate is still very low (around 1%), management positions seem to fulfill at least some of the needs of a psychopath. And interesting, while many psychopaths function somewhat normally in society, about 25% of the males in federal prisons are estimated to be psychopaths.
Hare, in an article in Scientific American describes psychopaths as: “Superficially charming, psychopaths tend to make a good first impression on others and often strike observers as remarkably normal. Yet they are self-centered, dishonest and undependable, and at times they engage in irresponsible behavior for no apparent reason other than the sheer fun of it. Largely devoid of guilt, empathy and love, they have casual and callous interpersonal and romantic relationships. Psychopaths routinely offer excuses for their reckless and often outrageous actions, placing blame on others instead. They rarely learn from their mistakes or benefit from negative feedback, and they have difficulty inhibiting their impulses.”
Is there a cure or treatment for psychopaths? Many mental health experts would say no. The general feeling is that people who are psychopaths “can be treated or managed but not cured” (Dr. Nigel Blackwood, Psychiatrist at King’s College London).
So where does all this lead us? It has not been possible to cover even a fraction of the mental health issues that might show up in the workplace in this short piece. But the important point is that they are there, present in the organization. And more importantly, many people who suffer from these issues can benefit from an enlightened approach to mental health treatment. The benefits that accrue will benefit not only the individuals within the organization but the organization itself.