​Why We Sleep:
Sleep is not an option. It is a necessary and vital dimension of what is essential to keeping ourselves healthy and alive. As we age, we generally need less of it. On average, newborns require 16 hours of sleep every day and the fact that infants and children need more sleep is evidence of its important role in promoting growth and health.  Still, the average adult over 65 to remain optimally healthy requires seven hours of sleep each day. 

The Effects of Sleep Deprivation:
The specific reasons we sleep are to restore equilibrium to our bodies and minds. While we are sleeping our brains are eliminating  proteins such as amyloid beta that build up throughout the day. In postmortem analyses an abundance of these proteins has been associated with certain kinds of dementia such as Alzheimer’s Disease. Sleep is vital to maintaining a healthy immune system and as most of us know from personal experience insufficient sleep compromises our mental functioning such as alertness and memory, our mood, and our motor equilibrium and coordination.

There is more. Over time insufficient sleep increases our risk of developing cardiovascular disease such as heart attack and stroke and its effects on our alertness increases our proneness to accidents. For example, drivers who get six hours of sleep or less are 33% more likely to have an accident on the road than those who get seven or eight. 

The Causes of Sleep Deprivation:
Despite its importance to our functioning, sleep can be disrupted or deficient for various reasons, stress, travel, anxiety, depression, physical illness or chronic pain, life transitions and the demands of our daily lives. In today’s world, especially here in the United States, sleep deprivation has become increasingly prevalent. Here are some facts cited from The Center for Sleep Medicine (www.sleepmedcenter.com): 
 
(1) 40% of Adult Americans and 70% of adolescents are sleep deprived.
(2) The average American sleeps less than seven hour a night Monday through Friday. 30% of all working people in the U.S. sleep less than six hours a night.
(3) Fifteen million Americans work the night shift and 40% of them get fewer than six hours of sleep per day.
(4) “Short sleepers” eat 500 calories more per day and are likely to eat more fatty foods and carbohydrates than normal sleepers.

The reasons for this growing problem in our society are a product of several factors, economic, cultural, and technological. Today’s families in the United States rely on income from both heads of the household in order to meet the demands of trying to maintain a lifestyle commensurate with their dreams of success, or worse, just to make ends meet. On average, Americans work 137 hours more every year than Japanese workers, 260 hours more than British workers, 394 more hours than German workers, and 499 more hours than the French. Some of this disparity may be explained as the general decline of the American middle class as more and more American adults find it difficult if not impossible to keep up with the standard of living they grew up with in their parents’ generation. 

Sleep deprivation may also be explained as a function of a cultural heritage that regards sleep as tantamount to laziness and lack of ambition. As such sleep is devalued for fallacious reasons as being a relatively unimportant part of life that stands in the way of success.

Finally, we live in a world rife with technology, stores that stay open all hours of the night, television whose hours of operation at one time conformed to the normal schedules of daily life broadcasting programs all hours of the night, and electronic devices such as computers and smartphones with unlimited access to text messages, the worldwide web, and social media anytime of the day or night, projecting sleep-inhibiting wavelengths of light from these devices.

Sleep Disorders:
It is normal for sleep to be disturbed or disrupted for various reasons but when these disturbances become persistent they can have deleterious effects on our well being. When this is the case, intervention might be necessary to treat what is known as a “sleep disorder.” Here are some of the most prevalent kinds of sleep disorders: 

(1) Insomnia: It is estimated that anywhere between 10% and 60% of adults suffer from chronic insomnia. People who are most susceptible include older adults due to chronic pain or medical conditions, social isolation, or medication, adolescents, and pregnant women. Some people with insomnia have difficulty falling asleep. The most prevalent causes are stress and anxiety, caffeine or stimulants, or irregular sleep habits.  Others have difficulty maintaining sustained sleep which is often associated with chronic pain or medical conditions, restless leg syndrome, or sleep apnea, and some tend to wake up prematurely, often a sign of clinical depression.

(2) Obstructive Sleep Apnea: It is estimated that one in fifteen adults has sleep apnea and only 15% who have it have been diagnosed. Common signs include excessive drowsiness during the day, snoring, and irregular breathing patterns during sleep. Sleep apnea is associated with obesity and Type 2 diabetes, and is imputed as a possible cause of heart disease. A referral to a sleep specialist is needed to diagnose this condition which is usually treated with a breathing device known as a CPAP machine. 

 (3) Circadian Rhythm Sleep Disorder: Adenosine is a neuromodulator in the brain that plays an important role in regulating our normal sleep/wake cycle, known as circadian rhythms. The sensation of drowsiness is a function of adenosine building up during the course of the day. Ingestion of too much caffeine or late in the day can interfere with this process. When our normal cycle is disrupted we may have difficulty falling asleep or feeling sufficiently rested when we normally get up. The most common causes for this disorder include jet lag, shift work, a mood disorder, medication, pregnancy, or chronic pain. Adolescents are often susceptible because of a delay in the brain’s production of melatonin which otherwise promotes sleep and older adults who have a tendency to nap during the day.

(4) Restless Leg Syndrome: This disorder is described as sensations of crawling, tingling, itching, or muscular cramps that are sometimes relieved by getting up and walking around. It can be inherited but often is caused by medical conditions such as diabetes, iron deficiency, and peripheral neuropathy, or by prescription medication. The most common onset for this disorder occurs in middle age. Women are twice as likely as men to develop restless leg syndrome which is usually treated with medication and sleep hygiene.

(5) Parasomnias: These are unusual behaviors that occur either while asleep or while transitioning in or out of sleep. Parasomnias, characterized as incomplete awakening and responsiveness to other people while in a sleep-like state, can originate from different sources. There are two types, NonREM and REM-related. NonREM parasomnias include confusional states of arousal, sleepwalking, and night terrors most often found in children. They may also include sexual behavior, talking, eating, which can be dangerous if it involves cooking or ingesting harmful substances, and even driving! REM parasomnias include REM sleep behavior disorder characterized by excessive, violent movement while dreaming that most often occurs in older adults, sleep paralysis, a prolonged period of paralysis while falling asleep or upon awakening, and recurrent nightmares often brought on by psychological stress or trauma. 

Other parasomnias include “exploding head syndrome,” in which the sleeper experiences a loud noise or bright light upon awakening, sleep-related hallucinations, and nocturnal enuresis, or bedwetting, the latter most often found in children. Parasomnias can be brought on by stress, trauma, certain medications, irregular sleep schedules, and certain neurological conditions such as Parkinson’s disease. When they occur in children they are likely to be transitory and neurological in origin though they can also be induced by stress. A parasomnia should be diagnosed by a specialist in sleep disorders and the treatment may include medication or cognitive-behavior therapy.

How to Sleep Better:
Here are some general guidelines to help you get a better night’s sleep if you are suffering from a temporary sleep disruption or a sleep disorder. If the condition persists, you should seek consultation with a sleep-disorder specialist:

1) Reduce the stress in your life if possible and, if not, learn how to live with stress better, such as with exercise, meditation, and cognitive therapy.
2) Practice meditation or autogenic training on a regular, if not daily, basis. Learn how to tame those runaway, worrisome thoughts.
3) If you have difficulty falling asleep, read a relaxing or boring book. Your focus should be on relaxing instead of trying to force yourself to sleep.
4) Exercise on a regular basis. Aerobic exercise such as running or walking improves mood and creates a calming effect.
5) Practice good sleep hygiene. Go to bed and get up on a regular schedule, don’t engage in stimulating activities the last two hours before you go to bed, engage in rituals that prepare you for bedtime, avoid bright lights, turn off electronic devices, including television before bedtime, reserve your bedroom for sleep or sex only, make your sleep environment conducive to sleep, i.e., sufficiently dark, free of noise, cool temperatures, a firm mattress, and aromatherapy scents such as lavender.
6) Limit your intake of caffeine, stimulants, or alcohol.
7) Avoid late night meals, sugary foods or spicy snacks.
8) If you have a circadian rhythm sleep disorder, try getting up earlier each morning and consider taking melatonin an hour or two before you go to bed.
9) Avoid napping during the day.
10) Get as much sunlight during the day as you can. If the sunshine is limited where you are, consider getting a sunlight-simulating lamp.

The late, curmudgeonly comedian, George Carlin, once gave a humorous skit on what he thought of the “me” generation and its absurdities. According to Carlin, in today’s world everybody has to be “special” but if you think about it if everyone is special, the word, “special,” no longer has any meaning. Some experts believe the profession of psychology itself, here in the United States has, ironically, contributed to this trivialization of “specialness” by unwittingly fostering a sense of entitlement and a malaise of self-esteem issues it supposedly has been designed to treat.  According to the psychologist, Philip Cushman, the affluence of post-World War II America created a burgeoning market of psychotherapists promoting self-help books and services that promised to cure all that ails us in our emotional lives by helping people build self-esteem. This enterprise, paradoxically, has created instead for consumers of psychological services a greater sense of insecurity because it has either neglected to heed the superficial and narcissistic way the self is conceptualized in our consumerist society which fails to support healthy self-esteem or, worse, exploited this condition for their benefit. 

Building on Cushman’s critique, it isn’t the emphasis given to self-esteem per se as an important aspect of mental health that is the problem but rather how the self and its epiphenomenon, self-esteem, are understood. The well-known cognitive therapist and former president of the American Psychological Association, Martin Seligman, has admonished parents of children of the so-called “me” generation not to shelter their children from the experiences of failure, disappointment, and averageness that parents mistakenly might believe are the bane of developing self-esteem. To expect oneself always to be special or the best, to win all the time sets children up for disappointment later in life and the complications that growing up with a sense of entitlement eventually creates. The key to building healthy self-esteem instead depends on the ability to take risks and, when matters don’t end well, those disappointments aren’t taken to heart as signs of what is deficient in oneself. Self-esteem is predicated on positive expectations of   oneself which in turn relies on achievements which cannot be accomplished without the ability to take risks.

Where Does Self-esteem Come From?

As with most matters psychological, our earliest influences are often the most crucial. A healthy self is fostered within a secure and emotionally supportive environment that balances sufficient attention and unconditional love with expectations and responsibilities that encourage a child to grow beyond the safe confines of its home and all that concerns oneself alone. Perhaps how self-esteem develops may be better explained by walking this backward: In order to have self-esteem or positive expectations of oneself one must succeed in life but in order to succeed one must take risks and assume responsibility, and in order to do these things one must accept oneself implicitly so that failure and disappointment don’t crush one’s spirit. For many, unfortunately, one or more of these elements is missing. When it is, low self-confidence, learned helplessness and resignation, and resentment and blaming others or life in general are likely to ensue, all cardinal signs of low self-esteem.

The Building Blocks of Self-esteem

William James, one of the founders of modern psychology in the United States, suggested that self-esteem is the function of a simple ratio between what he called sympathy and stoicism. "Sympathy" is the degree to which one grows beyond oneself through one's accomplishments, generosity, and capacity to empathize with others. "Stoicism" is the degree to which one is able to relinquish one's pretensions or to realize what one doesn't need in order to be happy and successful. Self-esteem, therefore, is a function of (1) Accomplishments. In order to achieve one must be able to take risks and, once again, in order to take risks one must not personalize failures and disappointments, in other words, to accept oneself as less than perfect, (2) Growing in dimension as a person with empathy and generosity of spirit as opposed to selfishness, jealousy, and envy toward others, and (3) The ability to let go of things one doesn’t need such as unrealistic expectations of oneself, others, and life. Although the Dalai Lama emphasizes in his book, How to See Yourself As You Really Are, that self-knowledge is the key to happiness in life, in order to know oneself one must first be able to accept oneself, a building block of self-esteem. Self-acceptance depends on one’s ability to accept disappointments and relinquish unrealistic self-expectations.

Unhealthy Self-esteem

It might seem a bit of a paradox to have unhealthy self-esteem but it does exist. When one or more of the aforementioned building blocks are missing, self-esteem is predicated on a shaky foundation, and what presents as healthy self-esteem belies elements of low self-esteem underneath. For example, those who maintain unrealistic expectations of themselves might seem confident or highly accomplished when deep inside they suffer from the anguish of never feeling good enough. Others who are arrogant and self-centered in nature, such as narcissists and sociopaths, may appear supremely self-confident but deep inside may suffer from a lack of depth and inadequacy about which they are likely to be unaware and adept at hiding from others. When not all the building blocks of self-esteem are working together, psychological problems are likely to develop, such as depression, anxiety, substance abuse, and problems of intimacy, and often these can be outgrowths of a personality disorder associated with problems of self-esteem.

How to Build Self-esteem

Here are some tips on how you can build self-esteem:

1. Identify the positive things in yourself. Make a list of them and review them regularly.
2. Stop comparing yourself to others in a negative way and learn to “find your own voice.”
3. Practice self-compassion. Learn to forgive yourself for your mistakes, develop a sense of humility and a sense of humor about your foibles and shortcomings.
4. Learn how to distinguish a criticism of your behavior from an attack on your person.
5. Take on new challenges, learn new skills, and take some risks in life.
6. Speak up for yourself; be assertive and learn to be a self-advocate.
7. Set goals in life, both short-term and long-term, and a time-frame to achieve them. Be accountable to yourself and others to achieve them.
8. Be clear about your values and relinquish values you once adopted for reasons that are either no longer or never were valid for you.
9. Build and/or nurture relationships that nurture you. 
10. Be charitable and generous to others.
11. Contribute time to making this world a better place.
12. Exercise, eat healthy, and take good care of your body.
13. When all else fails, ask for help.

 ​I’m dating myself by reciting a favorite story told by the late comedian, Myron Cohen. A man comes home to his wife and upon opening the door smells the odor of cigars and asks, “Since when did you start smoking cigars?” Her puzzled response prompts him to say in an accusatory voice, “Well then there must be a man in the house.” He immediately proceeds to bolt through the house opening one door after another and lo and behold, upon opening the bedroom door, as a man appears, the husband blurts out, “And what are you doing here?!” to which he replies with a shrug, “Everybody got to be someplace.” In each and every place that there is a person, there is not just any person but A person. As much as there is a place that each of us occupies at any given moment it is our place and no one else’s at that moment. Each of us is a singular entity that no one can replace.

The Objective and Subjective Self

What is the self? And who are we? Up until the 19th century it was generally accepted that what makes us unique is our soul, or psyche, something immaterial that transcends our earthly existence. However, at about the same time that psychology became a science of its own, the self was understood instead as manifest from our interpersonal relationships. The early developmental psychologist, James Mark Baldwin, posited, for example, that children identify themselves in relation to others in their world through observation, imitation, and empathy, as well as through conflict and assuming complementary roles. Through “reflected appraisals,” according to the psychoanalyst, Harry Stack Sullivan, children learn to see themselves as their parents see and treat them. So, who we are is a sum of our experiences from our relations with other people, especially those such as our parents to whom we are closest and most deeply influenced early in life. Later in childhood and thereafter others can serve as mentors who help further guide and serve as “role models.”

How we see ourselves, or what we commonly call “identity,” is sometimes referred to as the “objective” or reflected self. However, there is another part of who we are that probes more deeply into our essence that has to do with agency. The psychologist, Gordon Allport, called this part of the self “the proprium.” This is the part of us that organizes our experience, that says to ourselves, “This is me, and no one else.” It is also the part that makes decisions, carves a path to follow in life, and that creates meaning from experience. The philosopher, Immanuel Kant, had a word for this he called the “transcendental ego.” Without it we are merely the sum of our memories like going through a photo album of our lives. An album says a lot about who we are yet something deeply fundamental is missing without a narrator. Pictures and memories tell a story about a life, but the “self as agent” lives a life that has purpose, understanding, and intention.

Western and Eastern Notions of The Self

Conceptualizations of self historically have differed between Eastern and Western civilizations. Here, in the West, with our traditions in freedom and self-reliance identity is more individualized, whereas in the East a more collective sense of self prevails.  Buddhism with its lessons about the destructive illusions of the ego is a good example. The psychoanalyst, Carl Jung, created a model of personal development that fits the Western notion of the self within Eastern philosophy’s broader framework. According to Jung, the ego or Western conception of self is just a small part of who we are. We must integrate all the existential dimensions of what it means to be human, such as “the shadow,” and “the syzygy,” which refers to our relative masculine and feminine aspects, over a period of a lifetime in order to “self-actualize” or reach our full potentials.

The Bounded and The Ensembled Self

For Carl Jung, the self of the West is more individualized and egoistic whereas the Eastern notion of the self is broader and collective in nature. In Buddhism, the self disappears altogether as just an illusion. The Western psychologist, Edward Sampson, has proposed a distinction between these two ways of conceptualizing the self he calls the “bounded” and “ensembled” notions of the self. While a bounded self has served Western civilizations by promoting self-reliance, autonomy, and free enterprise, an ensembled notion of the “self” tempers the hubris, unbridled avarice, and willful ignorance to which an ego devoid of its collective conscience may be susceptible. A collective consciousness also can assuage the existential dread of alienation and finiteness living in a world without meaning and purpose can bring. It is through our collective identity and by discovering the limits of our ego that spirituality is born at a personal level.

The Harmonious versus the Disordered Self
​
These and other influences from my life, clinical work, and education have led me to propose that a healthy “self” is reliant on a harmonious and integrated relationship between these two fundamental aspects of the self that is both bounded and ensembled in nature. As a corollary to this proposal, when this relationship is antagonistic instead, as in a zero-sum game, problems in living ensue that parallel what mental-health professionals in the West call disorders of personality. For example, a healthy person is a person with strong self-esteem but only when the foundations of that strength do not have disastrous ramifications for the welfare of others. By the same token, generosity and compassion enhance our sense of self and security but not when they eventuate in destructive ways to our sense of autonomy and ability to advocate for ourselves when necessary.

The concept of the self has been and perhaps will always remain a mysterious and difficult idea to pin down. It isn’t something we can see with our eyes and feel with our fingertips yet it has emerged in human history as one of the most fundamental notions that demands attention as we humans endeavor to understand who we are and what makes us tick. As the psychologist, Raymond Cattell, who was known for his fondness for studying the human personality through psychometric analyses once observed, our attitude toward ourselves is the most powerful factor in determining who we are.

They say a vampire does not prey upon its victim unless he is invited. Narcissists, sociopaths, con men and the power they possess to create destruction in the lives of others rests within their ability to win your trust.  Like a Trojan Horse their success depends on winning your trust in order to bypass your defenses. It is only after the cloak is removed and the disguise is revealed that the full force of their predatory nature and intent is likely to be unleashed. 

What is a “Trust Vampire”? The Grifters:

A “trust vampire” is anyone who exploits your willingness to take a risk or expose a vulnerability. In the world of commerce and consumerism a grifter is someone who exploits your gullibility to purchase whatever he is selling you. As described in The Distinctly American Ethos of the Grifter, by Ligaya Mishan, The New York Times, September 12, 2019, the cultural ethos of the grifter in the United States for example is fostered by an economic system that promises social mobility and limitless possibility that is, unfortunately, confined by a disillusioning reality beyond which a meritocracy alone cannot take you. According to Mishan, our society ostensibly endorses an ethic of meritocracy while cultivating a culture of opportunism and disavowing the advantages privilege affords to achieve success. Hence, its populace is “grifted” into endorsing a deceptive “social contract” that, with the exception of those either with an a priori economic advantage or who are highly adept at exploiting others, is highly unlikely to pay off.  When it doesn’t pay off, blame is cast on those who either were persuaded and failed (too stupid?) or simply failed to invest (too lazy?) in its promise, the “so-called” American Dream. This “bait and switch” ploy followed by gaslighting is one of the hallmarks of the “trust vampire.” To make matters worse, in a world dominated today by social media and highly politicized news platforms, the divide between reality as it is presented and reality as it is has become evermore present and problematic. Who can we believe and who is truly blameworthy?

The Narcissists and Sociopaths:

At a more personal level, we associate those who prey on our trust as having character traits of narcissism or sociopathy. These are clinical terms thrown around loosely today that generally refer to people who are self-serving, exploitative, and lacking in empathy. While there is much overlap between these two types there are important distinctions as well. A narcissist is a person who seeks attention and needs to feel superior or entitled. A pathological narcissist is someone who possesses these qualities at the expense and well being of others. In other words, he or she might disparage you or minimize your qualities or achievements because, like a zero-sum game, your assets are judged by adverse comparison to their own. Because of the importance they give to self-image, they are vein and very sensitive to criticism. On the other hand, many narcissists are very charming and use flattery to win you over until, mission accomplished, their true colors show through. Narcissists, paradoxically, can be very generous, until, that is, your interests are at odds with theirs. For a narcissist, it eventually always boils down to a philosophy of “Me First!” For this reason, narcissists can indeed be cruel and uncaring. 

A sociopath, unlike a narcissist, is driven not by a mission to validate the self so much as simply to gratify the self. Here self-centeredness arises from a more primitive way of being, a world in which survival is paramount and therefore no one can be trusted. Survival depends in turn on power through force or deception. Rules, morals, and laws serve only to constrain the guileless and weak. 

In his YouTube series, “The Dark Triad,” psychologist, Todd Grande, describes a third type of “trust vampire,” called the “Machiavellian,” named after a famous 15th century author who wrote a book about power and how it is used. Machiavellians, like narcissists, are driven to achieve power and status, but like sociopaths, they use guile and deception, particularly emotional manipulation, such as playing on your guilt and plying your weaknesses to get what they want. A Machiavellian is likely to be shrewd, cunning, and scheming, and thus more subtle and, for this reason, often more successful than the narcissists or sociopaths for whom these qualities are not so predominant. 

The Cult Leaders:

Perhaps the most malignant of the group because of the magnitude of destruction they can foment, cult leaders stand at the top of the list. These people are the Antichrists, those who promise a paradise to the masses but deliver hell instead. They are invariably very charismatic and possess what can be a ruthless lust for power. At a national level, these are the dictators masquerading as populists whose message is to convince their followers of their deep convictions about the plight of the common man, the dejected, and the oppressed. 

In popular culture, some of us may remember Jim Jones and the infamous Jonestown where an entire “colony” of followers were persuaded to drink the fatal “Kool Aid” for the sake of a better world in the afterlife, David Koresh who preyed on girls and young women, known as the Branch Davidians, whose compound was destroyed and members incinerated in a botched invasion by the U.S. Attorney General’s office, and more recently Keith Raniere, of NXIVM, the founder of a sex cult masquerading as a personal development  organization in upstate New York for whom a recent television series was broadcast. In all cases, these are pathological characters who prey on the trust of people who are susceptible to their gift for grift for a variety of reasons, vulnerability at a certain time in life, disillusionment or disappointment, a broken home or marriage, seeking something or someone to believe in, a person who seems to care enough to listen to their troubles. 

What Creates a “Trust Vampire”?

No one knows for sure. Statistical research suggests that as with most aspects of who we are, both physiologically and psychologically, there appears to be a fairly even split between nature and nurture. There are among us those more talented at reading other people, planning and executing strategies. Some of us are more prone to take risks. Life experiences and opportunities shape these talents and predilections accordingly to make us who we are. Exploitative behavior may also arise from trauma and neglect, a lack of good role models or the prevalence of bad ones, and the quality of our education and community in which we grew up; all play a role in the degree to which we cultivate empathy and responsibility toward those among us. Who we care about depends on who we identify with and who we identify with depends on our families, our community, and our society, the extent to which we are loved and esteemed as well as the responsibility we are assigned to others when we are youth. 

Many who are exploiters are able to inflict harm without compunction because of the primitiveness of their psychological defenses. In his book, Being of Two Minds: The Vertical Split in Psychoanalysis and Psychotherapy (1999), author Arnold Goldberg paints a clinical picture of individuals who lead double, often Dr. Jekyl and Mr. Hyde, kinds of existences, a feat enabled by the more “primitive” psychological defenses such as denial, disavowal, and splitting. In my clinical experience with individuals with Cluster B personality disorders, the “dramatic” types, who invariably include those who prey on the trust of others, their psychological defenses resemble those with addictive disorders.  Rationalization, denial, projection, and minimization are used to enable their transgressions. For example, when someone calls them on their misbehavior, they might disavow it while simultaneously accusing their accuser of jealousy or the same qualities of which they are both guilty and fail to see in themselves. Many rely on a victim mentality to justify their actions, some a cynical philosophy of life. 

How Do I Deal with a “Trust Vampire”?

Vampires of trust are clever and charming so while at first you might not be able to identify them, they soon begin to reveal their true character. Here are some signs to watch out for:

1.  Look for the charm and flattery. If it seems excessive or a bit much, be wary.
2. “Trust vampires” prey on weakness and vulnerability and they are masters at discerning where these qualities exist in other people. In David Mamet’s film, “House of Games,” the protagonist who is a con man explains to his foil that the “con” stands not so much for the confidence they seek to gain from you as the confidence they offer you in exchange for the power doing so gives them to gain control over you.
3. “Trust vampires” usually are domineering personalities. Eventually, therefore, they will either try to violate your boundaries or manipulate you to breach your own. Don’t be kowtowed or intimated; be assertive and confront them when they have violated yours.
4. When a “Trust vampire” believes they have you in their power, there will no longer be reason to use charm to win you over. What soon follows is devaluation, and controlling and abusive behavior. The key of course is never to give them that much power over you but if they believe they have put a stop to it immediately.
5. “Trust vampires” rarely apologize. If they have insulted you or violated your trust, insist they accept responsibility for their behavior and if it continues consider the wisdom of the price you are paying for continuing the relationship.
6.  Watch how they treat other people, especially those in a servile role or of lower stature. Realize that the victim they are treating is likely to be you someday.
7. Pay attention to whether your needs are being met in the relationship. If you find yourself always the one to give in or compromise or if you begin to feel ignored or neglected it is time to speak up and assert yourself.
8. “Trust vampires” are masters of lying and gaslighting. At first they will try and convince you of their impeccable honesty and trustworthiness. When they begin to violate your trust you will experience so much cognitive dissonance you won’t believe your senses. When you catch them in a lie or an incongruity in their behavior, they will challenge your memory and disavow their behavior or true intentions. 
9. Trust your gut. Do you feel safe in the relationship with this person? Does this person seem entirely different than the person you once thought they were? If your answer to these questions are “no” to the first and “yes” to the second you are probably in a relationship with a “trust vampire.”

When we think of what human emotion binds us to one another, the first that might come to mind is the emotion of love. This certainly applies to our relationships with our children or our pets, those who are or who have been dependent on us for their survival. Our unconditional love and devotion create a bond that is likely to last forever. However, a more fundamental emotion is necessary for love to develop when we are vulnerable. In other kinds of relationships, such as between lovers and spouses, friendships, partnerships, and in the case of children in relation to their parents or caretakers, there is an element of risk involved. In these kinds of relationships the emotional bond that develops into love is more complicated. Trust must be established before a stable bond can unfold and love can spring forth and flourish.

Where Does Trust Come From?

As with most every basic emotion of human development, trust begins within the matrix of the bond that forms between infant and caretaker. “Good-enough mothering,” a term introduced by the English psychoanalyst, Donald Woods Winnicott, refers to the nature of the relationship between mother and infant that promotes healthy emotional development. In order for a child to feel secure, his mother needn’t be perfect yet must be sufficiently reliable and responsive to the child’s needs. At the same time an anxious or overly protective caretaker conveys to the infant that the world is a dangerous place beyond the child’s capacity to learn to manage on their own. According to the psychoanalyst, Erik Erikson, in his landmark book, Childhood and Society (1950), trust is the fundamental stage of human development upon which the eight stages of man, such as autonomy, identity, intimacy, and living a productive life are dependent. 

Distrustfulness as a Personality Trait

When trust fails to form as it should in early childhood, dysfunctional attachment patterns are likely to emerge in personality development that may be characterized by separation anxiety or anxious, clingy, insecure attachment, avoidant or emotionally distant personality characteristics, or disorganized or ambivalent attachment styles that can lead to unwittingly sending mixed signals in relationships. 

As Theresa Miller discusses in her book, Anxiety in Relationship (2019), a self-help book to help people who are overly anxious in relationships, problems such as excessive jealousy, obsessive attachment, fear of abandonment, and controlling behavior can ensue from an anxious attachment style. Anxious attachment can also manifest from low self-esteem. Healthy self-esteem is necessary to build a healthy relationship. 

Knowing and Trusting Ourselves

One of the pioneers in the study of trust in relationships, Sidney Jourard, in his book, The Transparent Self (1971), pointed out how intimacy requires transparency which in turn requires honesty and courage. According to Jourard, in order to be in a relationship one must also be able to enjoy being alone, a time necessary to know in a deeper sense what one’s truer values are. Consistent with the 18th century romantic philosopher, Jean Jacques Rousseau, who was a proponent of loving oneself when it was a heretical idea, Jourard discussed how living in a social world can squelch expression of our true selves in order to avoid criticism and ostracism. While Jourard was writing during an era in American history when self-exploration and self-expression were in a renaissance his caveats still ring true today. In order to be authentic in a relationship, a necessary condition for trust to develop, one should be as open as possible to oneself. And as David Richo in his book, Daring to Trust (2013), reminds us, in order for us to be able to trust others it is equally important that we learn to trust ourselves.  

Eight Principles to Building a Trusting Relationship

Here are some tips I have learned from my professional practice and from personal experience that will help you develop a healthy, trusting relationship:

1.  Relationships are like a dance. When establishing a new relationship, you have to take risks but the when and “how much” of those risks you take should be determined by how much is reciprocated by your partner.
2.  Be attentive. Show your partner you are genuinely interested in knowing who they are, what they think.
3.  Be responsive. Pay attention to the reactions the things you say and do elicit in a relationship. Make adjustments when they are called for unless they are inconsistent with your basic morals or values. 
4.  Be empathic. Listen to your partner’s concerns and treat them with due respect even when they are presented during an argument or disagreement.
5.  Communicate. Work on being transparent with your partner, sharing your day, your feelings and sentiments, your joys, disappointments, and grievances. Check in periodically with your appraisals of the relationship, its strengths and challenges, and where it is in relation to where you want it to be. My blog, Finding that sweet spot dealing with conflict in relationships: The ergotropic complaint, offers tips for finding the right time and place to have these discussions.
6.  Accept responsibility. When disagreements come up, refrain from deflecting or blaming. See it as an opportunity to learn more about yourself, be a better person, and perhaps most importantly gain your partner’s trust.
7.  Be reliable and loyal. Being true to your word and your promises is golden. As the saying goes, it takes a long time to build trust, but just one betrayal to knock it all down. 
8.  Be supportive. While it doesn’t mean you have to agree with every point of view your partner takes, it is important that you show them that you “have their back,” to demonstrate the loyalty and sanctity of your partnership.

Life is about change. This is a cliché; yet as unsettling as it is, it is an incontrovertible truth about existence. It is normal to become attached to all in life we love, especially those whose closeness we cherish, even though we are aware at the same we will someday suffer their loss. Some of us have suffered the misfortunate of losing a loved one early in life which in some cases, such as the loss of a parent, sibling, close friend, or pet, can be a traumatic experience. Eventually, however, we will all share the pain and sorrow of this profound aspect of existence. As much as we might dread this fact, we must ask ourselves then how do we manage to reconcile this reality so it doesn’t become a tragedy in our lives.

Is There a Normal Way to Grieve?

The answer is yes and no. There is no one way to grieve that applies to everyone. The grieving process depends on how we as individuals deal with stress and change as well as the nature of our relationships with those whose lives we’ve lost. Joan Didion in her award-winning book, The Year of Magical Thinking (2005), described in detail how by revisiting the loss of her husband each time unveiled more questions about his death, what could have been done to prevent it, the distortions in her thinking designed to deny the reality of it, and how it was complicated by crises she and her daughter had to confront occurring at the same time. In Helen MacDonald’s award-winning memoir, H is For Hawk (2014), the author recounts how she coped with the sudden death of her father by raising a goshawk and how through this experience she gained a relationship, qualities such as patience she learned from her father, and a sense of mastery that enabled her to recover from her grief.

There is no one way to grieve and the course of grieving does not follow a linear path. In the late 1960’s the famous psychiatrist, Elisabeth Kubler-Ross introduced the idea that grieving takes place in five stages, denial, anger, bargaining, depression, and acceptance. While this model has been generally understood as applying to the natural progression of grieving the loss of a loved one, they actually were intended to describe the experiences of those who have been diagnosed with a terminal illness. Kubler-Ross herself later observed that her model was not intended to apply to everyone because grief is an individual process that follows no set pattern.

Are There Different Kinds of Grief?

Freud, in his monograph, Mourning and Melancholia (1917), identified two kinds of grieving processes that are specific to the nature of loss. Mourning, which is less complicated, entails the actual loss of a loved one and for which a period of grieving naturally follows. By comparison, melancholia involves a complicated relationship with the lost object as would more likely be found in situations such as a breakup of a relationship or more vague losses of a personal nature not so easily identified. In these instances, grieving is complicated by the narcissistic wound or rejection that results in self-loathing, what might likely be rage toward the lost object turned inward. 

While this distinction is clinically valid it belies how complicated and individual the grief process actually can be in either case. Notwithstanding it is important to identify qualitative differences in how one grieves that can point to distinctions between grieving that unfolds toward recovery and that which deteriorates into a clinical state of depression. Those distinctions are listed on the Hospice Red River Valley website entitled, “Grief vs. Depression: What you need to know and when to seek help.” In normal grief, for the bereaved person, closeness to others is comforting, self-esteem is likely to remain intact, and thoughts of death are related to wanting to reunite with the deceased loved one. Those suffering from depression, on the other hand, are more self-focused, less capable of enjoying life and engaging with others, and more inclined to feel worthless and guilt-ridden.

How Can We Overcome the Anguish of Grief?

We must first acknowledge that bereavement is a process that cannot be hurried in a deliberate fashion. Letting go unfolds naturally and in its own time if we take the necessary steps to allow it to do so. In her blog, psychologist and motivational writer, Michelle Roya Rad, lists “7 Steps for Dealing with Loss and Grief.” They include:

1. Sharing your feelings with others, such as a friend, a counselor, or family, journaling, meditating, prayer, or joining a bereavement support group.
2. Taking steps to fill the void such as developing a new relationship, volunteer work, or recreational activities.
3. Learning how to grow from the loss, such as developing resilience, gaining insights into your strengths, and finding greater meaning from your loss.
4. Learning how to gain a greater perspective of life and approach life with a greater sense of gratitude.
5. Taking the opportunity to re-evaluate your relationship with your faith or spirituality. 

Bereavement support groups often are sponsored by churches and synagogues in most communities. You may also find resources and lists of both local and online community support groups from the following websites: https://hospiceandcommunitycare.org, https://debra.org, and https://grief.com

Grief is a complicated process; it is also a natural part of life. Losing a loved one, whether it is a spouse, a friend, a parent or child, or a pet, carries with it the weight of the suffering we must inevitably bear to confront and eventually come to terms with its harsh reality. It may also serve as an opportunity for us to grow in ways that can bring a deeper understanding of the meaning and purpose that life has to offer.

Hatred is the emotion few people love. It simmers, its seethes, it corrodes. We might say it is a form of anger, taken to an extreme and tainted with a toxic brew of disgust, vengeful contempt, and revulsion. It is like rage inasmuch as its lives at the extremity of baleful human emotions, but unlike rage that suddenly pounces and erupts, hatred is a slow broth of emotional bile that lurks, stalks, and simmers. While rage acts, hatred waits. Nonetheless, hatred by virtue of its passive nature belies its toxic effects.  In the book of Leviticus of the Torah or Old Testament of the Bible, God commands mankind “not (to) hate thy brother in thy heart,” as a testament to its destructive effects on both the human psyche and human relationships. Hatred is a scourge.

Despite its unmistakable destructiveness, hatred contains a certain appeal. Like a guilty pleasure, hatred can be harbored secretly as a kind of revenge that satisfies in perpetuity. William Hazlitt, an 18th century artist and philosopher wrote an infamous treatise on “The Pleasures of Hating.” From the point of view of the protagonist from Edgar Allen Poe’s A Telltale Heart and Dostoyevsky’s Raskolnikoff from Crime and Punishment, hatred becomes an obsession that almost takes on the dimension of a reason to live. Iago from Shakespeare’s Othello is a sower of distrust and ultimately jealousy-driven murder whose counsel presumably satisfies some kind of sadistic motive by proxy that wreaks tragic destruction. And then, of course, there is the devil. The vengeful schemes of Lucifer, or Satan, sometimes make for more interesting intrigue and drama than the admonitions and even miraculous feats of God. 

WHERE DOES HATRED COME FROM?
The answer to this question should take us back to hatred’s nature, viz., it waits rather than acts. In the 1970’s, psychologist Martin Seligmann posited on the basis of studies with animals that when put into situations where they could not save themselves from demise or extricate themselves from danger, animals give up. He coined a term, learned helplessness, to refer to this unfortunate state of being and from it extrapolated that most human depression derives from this same state of helplessness. In other words, when we believe we are in a situation about which we can do nothing we learn to become resigned to the situation; if by virtue of temperament and/or repeated experiences this generalizes or becomes a pervasive expectation toward any problem or life situation, depression will ensue. These beliefs about helplessness may be realistic, such as a child living in a household that fails to respond to its needs or a citizen living under a totalitarian government that grants few liberties or opportunities for justice. They may also represent distortions resulting from low self-esteem and distrust toward others even though these distortions could originate from real experiences in the past. 

Hatred can serve as a defense or bulwark against depression inasmuch as it is imbued with power and direction toward a target, in this case the identified perpetrator. This defense thus serves to deflect focus away from a “self” constrained by an overwhelming feeling of helplessness and impotence. Its effectiveness as a defense, however, is limited to the extent that unless a conduit for action is formulated a sense of helplessness or self-blame will ensue once again.

Aside from its purposes of defense against a state of helplessness or self-loathing hatred can also be manifest from jealousy, envy, or humiliation, the toxic emotions. In the ancient Greek playwright, Euripides’s play, Medea, the protagonist murders her two sons, her husband (their father), and his new wife, out of revenge for his betrayal to their matrimony. For Medea, “the laughter of my enemies,” humiliation, is a personal insult that justifies her retributive action taken for the sake of restoring her dignity.

Resentment about a threat or violation to one’s physical, emotional, or financial well-being or the well-being of loved ones can also foment hatred.  Here, once again, we can rely on Euripides, in his play, Elektra, for a story about murderous revenge committed by a daughter against her mother for the murder of her father which her mother in turn attempted to justify as revenge for the sacrifice of her other daughter, Elektra’s sister. In all these instances, hatred arises from a feeling of violation or threat, real or imagined, to one’s safety, survival, or dignity. To resign oneself to the belief that taking action would be futile leads to a sense of helplessness and depression, but to harbor them and not to act is like drinking poison. Hatred, like anger, is a noxious emotion that harkens the self to take action toward a state of restoration.

WHAT CAN WE DO TO RID OURSELVES OF HATRED?
Retribution: This is Charles Bronson in Death Wish, Keanu Reeves in John Wick, and Francis Ford Coppola’s entire Godfather series, the complete set unabridged. This is the ethic of an eye for an eye, a tooth for a tooth, with interest. Revenge is one of life’s sweet pleasures. Unfortunately, it doesn’t come without a price. In the case of Poe’s character, guilt, and Dostoyevsky’s Raskolnikoff, punishment. At a broader, societal level, we all know the lessons of the proverbial Hatfields and McCoys, and in recent history the endless retributive wars of the Near East or British Isles, as well as, of course, Mario Puzo’s Corleone family. Primal justice doesn’t sit well with our karma.

Restitution: This is the attempt to make things whole, to repair the wrong, to restore the damage done. Reparations and heartfelt apologies often do help as long as they are deemed sufficiently compensatory by the victim and the alleged perpetrator is available and, if so, either willing or coerced to cooperate. Restitution is the basis in our criminal justice system for community service and civil litigation, not so juicy as retribution but in the long run much better for the sake of healing the injury for all parties involved.

Transformation: At a personal level this may be the most difficult to achieve inasmuch as it requires letting go of a wish for revenge or compensation, summoning instead our inner capacity to transcend the need for these kinds of reward in order to “move on.” To do this requires a combination of forgiveness, restoration of the self, and empowerment of the self. 

Forgiveness is the art of letting go. We forgive mainly for ourselves in order to relieve ourselves of the burden of resentment. Meditation and learning compassion, first toward ourselves, help to take the force and strength out of the power that hatred holds on our emotions.

“Restoration of the self” entails devoting time and energy to contemplating one’s strengths, virtues, and accomplishments that give one self-worth. We get these from ourselves and from friends and those who care about us; when these are too difficult to produce or procure, psychotherapy is designed to help us learn the tools to do so. 

“Empowerment of the self” entails taking action to recover and rise above the injuries and challenges that foment hatred. This might include making the effort to establish new relationships after the heartbreak of a betrayal, taking political action to fight an injustice, confronting the perpetrator in a nonviolent but assertive manner, or learning new skills and taking on new challenges to combat the impotent rage, feelings of helplessness, and injury to the “self” hatred can incite.

Hatred is a state of mind, a human emotion that produces intense energy which either when held inside has a corrosive effect on one’s well being or when acted on foments chaos and destruction. When restitution is either not possible or sufficient to quell its destructive force, we may seize it instead as an opportunity to grow within ourselves by learning how to have compassion for our limitations, pride in our virtues and accomplishments, and discovery of our power and creative potential to establish new ways to find meaning and purpose in life restorative to the self. 

  ​What is love and when we find it what makes a relationship work? This is a question many of us have pondered over, talked with our friends, and consulted the experts about. There are many kinds of relationships, of course, and all relationships require some degree of attention, forethought, and investment. We might also add to that list qualities such as commitment, reciprocity, empathy, social intelligence; navigating a relationship successfully takes a lot. However, of all the kinds of relationships there are none evokes more interest, fascination, and unfortunately, vexation than romantic love. 

PASSION
What is romantic love? Passion is the fuel that constitutes its first “pillar,” but first let’s examine what romantic love is. When we say “love” we can mean many different things. The ancient Greeks had names for eight kinds of love. Eros, or romantic love, was just one. In Western history, romantic love originated from the Middle Ages when troubadours serenaded maidens from ivory towers, but this is probably more myth than reality. When we are “in love” we are susceptible to a kind of confused state of mind that simulates madness. The ancient Greeks called this “mania.” In Act 1 Scene 1 of Romeo and Juliet, Shakespeare describes this state eloquently,

          Why then, O brawling love, O loving hate,
          O anything of nothing first created!
          O heavy lightness, serious vanity,
          Misshapen chaos of well-seeming forms!

          Feather of lead, bright smoke, cold fire, sick health,
          Still-waking sleep, that is not what it is!
          This love feel I, that feel no love in this.

 Love. It’s that other four-letter word. When we speak of it, we usually think of the romantic kind, though, generally understood, it can have several meanings; love is difficult to define and for good reason, it’s a complex emotion. More than that, like the proverbial Eskimos’ legion nomenclature for snow, there can be many kinds of love. The ancient Greeks identified eight different kinds of love. Let’s examine what those are.

 Agape: This is the slogan you sometimes see on bumper stickers; it refers to a love for others in the broadest sense. Another term for agape might be altruism. Often this kind of love is associated with God or religion because it is a selfless kind of love that generalizes toward humanity or the world. It is perhaps for this reason the most difficult kind of love to achieve inasmuch as it entails the ability to extend one’s feelings beyond what we are most familiar with to embrace something that might seem otherwise merely abstract in nature.

 Eros: This is the kind of love we are most familiar with when we use the term. Eros is romantic or passionate love. Cupid’s arrow blindly aimed at no one in particular suggests that it is a feeling we are prey to, struck by an emotion that jolts us out of our senses. Romantic love, actually, is a recent development in Western civilization, originating with the troubadours of the Middle Ages serenading maidens aloft in ivory towers, hence its association to a more idealized kind of love that, nonetheless, arises from sexual longing. While Eros is the stuff “that makes the world go round,” it is generally regarded as a more immature kind of love because it is usually transitory, self-serving, and at least in part biologically driven. 

 Ludus: Ludus means “playful” in Greek. Playfulness is often a part of flirting though it needn’t be limited to sexual relationships. When we play we open ourselves to our creative side. In order for us to become playful or creative we must be in a situation or relationship where we feel safe from harsh judgment. Otherwise we expose ourselves to feeling foolish, self-conscious, or embarrassed, so when we are playful with someone it suggests there is confidence and trust in that relationship. Intimate and close relationships depend on playfulness to demonstrate that special bond still exists.

 Mania: As the name suggests, mania is an intense emotional fixation on someone or something. When someone is manic it means they are obsessed. Sometimes love relationships or feelings a person has for someone else can take on manic qualities. Romantic love has an element of it. There are also instances when an individual becomes obsessed with another person that sometimes can lead to stalking behavior (we may remember the pathological relationships portrayed in the movies Play Misty for Me and Fatal Attraction).  Erotomania is a term for instances when someone develops the delusion that another person is obsessed with them. Understandably, manic kinds of attachments often are directed toward movie stars and celebrities and thus a common subject for the tabloids. 

 Philautia: Self-love; a modern term we commonly use today is narcissism. This word has a bad connotation and reputation but it isn’t all bad. Love of self is the foundation for the ability to love others. It is only when love for self fails to mature into generosity of spirit or when it ultimately prevails in relationships that it becomes problematic. In order for love of self to evolve into mature love one must cultivate the capacity to experience the joy of how giving of oneself is a sacrificial investment well worth spent.

 Philia: As the slogan on the license plate of the state associated with The Society of Friends reads, philia, the love of friendship, is the linguistic root for its largest city. Friendship, perhaps the most rewarding and enduring kind of relationship, entails sharing things held in common and that each party deems valuable; it also is founded on loyalty and reliability.  Friendship takes time and effort to develop. It may constitute the most important aspect of romantic love that enables it to become a lasting relationship.

 Pragma: What we might more familiarly call commitment, pragma is the emotion one feels toward those with whom one is engaged in a long-term project or mission. You might call it an allegiance by virtue of shared purpose. This might include a business partner or workforce, a legion of soldiers, even a married couple. A long-term relationship entails working together for the good of the relationship, children, or family; it is a vital element that anneals the bond of a long-term relationship.

 Storge: The closest word we might have to this kind of love in the modern dictionary is compassion. Storge is the emotion we feel toward those close to us that compels us to provide succor and caring attention when needed. As with philia and pragma, storge seals the bond in a relationship that promotes long-term commitment.

All of these words for love from ancient Greece, no wonder how difficult it is to understand and express our feelings when this emotion is the topic of discussion. Love is complex! And when we express our love toward someone it involves more than likely an admixture, not any one, of these definitions. All these definitions of love are part of what makes us human, none is more human than another though some might be identified as reflecting a more mature state of emotion than others.

In his classic book from the 1950’s, The Art of Loving, the German psychoanalyst, Erich Fromm, identified four types of emotions that express mature love: Care, responsibility, respect, and knowledge, the last pertaining to awareness of our strengths and weaknesses as opposed to idealization. The hallmark of maturity according to Fromm is the extent to which our love extends into the world as opposed to the self-absorbed and consuming relationship a strictly passionate love entails. Nonetheless the author grants that all must originate from love of self without which love for others is not possible. 

Love for oneself has not always been accepted by our society and it still carries negative connotations. In his treatise, The Heresy of Self-love that explores this topic the author, Paul Zweig, points out how in the fourth century St. Augustine's personal conversion from Manichaeism helped establish the notion of the sinfulness of self-love as a founding precept of Christianity. This ethic prevailed at least until the dawn of the modern era beginning with secular philosophers such as Spinoza and Rousseau in the 17th century .  Self-love forms the foundation from which all love derives because our emotional investment in others which is made possible through our capacity to feel for others begins with how well we are able to identify in others what we feel in ourselves. When either from self-centeredness, resentment, or fear the other remains “other” and empathy fails to be sufficient the development of feelings of love is inhibited. 

In my work with patients in private practice, we sometimes explore the dimensions of love in personal relationships and how both the experience and expression of love is influenced by our relationships with ourselves and our personal histories. It is our endeavor, then, to confront the fears associated with the trust necessary for love to develop, and all the unconscious defenses we unwittingly erect to keep ourselves safe from sharing the most cherished emotion of human life. Love, like intimacy, is not for the faint of heart.

It isn’t easy to be human. Beyond the lessons of learning and striving for what is necessary to survive and to meet our creaturely comforts, there is something that takes us beyond the animal kingdom, what we call civilization. Through the invention of language coupled with a capacity to contemplate the sublime humans are unique in that we can transcend what is momentary to visit in our minds civilizations from a distant past, possibilities in a distant future, abstract languages such as mathematics, to create sophisticated technologies, appreciate art and music, extract meaning from metaphor, and more. But it comes at a price, the ability to experience in a rudimentary way the world as we did when we were young children, without prejudice, without beliefs and judgments. It is extremely difficult to undo what we learned since early childhood through a process known as acculturation. Acculturation is the internalization of beliefs and values handed down to us through generations; it is part of what makes us human. It is also the source of racism.

So, racism is a set of beliefs rather than a reflection of the “natural” state of our species as it is. The word, “race,” implies that a distinction is made among members of our species that sets us in competition with one another; we are in a race set by the laws of natural selection in which only the fittest survive. However, the competitive connotation of this term, race, also suggests it can be used as a measure of judging who is superior. While it is likely that racism has some measure of origin in our ancestral past that reflects a xenophobic attitude toward strangers and those who are different than we for the purpose of survival, as a belief system this aboriginal tendency to distrust “the other” can be used for any purpose whose agenda is to divide and establish a hierarchy by which groups of people may be judged and ultimately privileged. As Kurt Barling, professor of journalism at the University of Middlesex, England, observes in his book, The R Word: Racism and Modern Society, “racism is about getting deep into people’s imagination and shaping the way they feel about the other.”

CONCEPTS AND FOUNDATIONS OF RACISM

Our conventional definition of racism establishes this concept as a belief that is seated in our conscious mind, in other words, an attitude or belief that is endorsed by any individual or group who hold ideas deemed racist in nature. However, a more modern definition broadens the meaning of the term as being also systemic in nature. This broader definition encompasses a less consciously held but subtly manifest and thus, in effect, insidious belief system embedded within a culture itself. 

The confusion between the more overt, conventional and the more covert, systemic definitions of racism is nowhere more clearly exemplified than by the common reaction, “No, All Lives Matter!” in reply to the slogan, “Black Lives Matter.” If we take this phrase literally it is simply an endorsement for Black lives, but it implies that none but Black lives matter, what defines racism in the conventional sense. However, if we understand it as an expression of a deeper implication that the purpose for proclaiming the phrase is to reclaim what is absent in society it makes sense according to the modern definition of the word. Identification of racism as systemic in nature through the phrase, “Black Lives Matter,” reclaims acknowledgement that it still exists.

The idea that a belief system can be subtly embedded in culture is not new. Nominalism, the concept that all classifications and qualities attributed to them are man-made constructions, goes back to the Middle Ages. The school of structuralism in 19th century philosophy held that the structure of language itself constitutes the primary source for how we interpret the world, not the way the world itself is constructed. Certain philosophers who followed went a step further by claiming that political and social forces influence how language shapes beliefs for the purpose of serving the interests of those groups of people associated with them.

Language, then, is an effective means to influence beliefs insofar as it constitutes the source for how we interpret the world and is at the same time assumed to be a reflection of the world as it truly is. Mystification, a term introduced by the French philosopher, Paul Ricoeur, refers to any system of beliefs that is purposeful in nature whose effectiveness is predicated on the degree to which it is able to keep its agenda hidden. Creating a “serviceable other,” a concept introduced by Toni Morrison, the Nobel Prize winning playwright and author in her essay, Playing in the Dark: Whiteness and the Literary Imagination, is an example of how the purpose of establishing superiority is thus achieved. A “serviceable other” is a process by which one’s identity as a group is affirmed by assigning complementary qualities to another group that serve one’s own identity through comparison. This concept explains how, in Sam Keen’s book, The Face of The Enemy, creating a serviceable other promotes a cause to go to war by painting the enemy as evil and how, in Black Panther author, Eldridge Cleaver’s landmark book, Soul On Ice, racism has been perpetuated in the United States for centuries by assigning qualities to African Americans that elicit contempt and distrust.

TAKING ACTION

The challenge to address the problem of racism at the social level is a matter of changing belief systems about identity, deeply-held ideas that are both personal and as they apply to “the other.” Racism is a concept that divides. To dismantle it requires unification, to undermine its corrosive effects entails finding commonality of experience and mutuality of interest, with a tone of openness and respect. These are the principles familiar to a psychotherapist in that they are necessary to establish a trusting relationship, to suspend judgments and prejudices, which is not the same as ignoring them, for the purpose of establishing a working relationship that forms the crucible for change to take place. In order for therapy to be effective, a patient must trust his therapist enough to become open to explore and examine deeply-held beliefs about oneself and others that otherwise prevent change from taking place.

To address racism effectively at the personal level we should follow the principle used by psychotherapists to heal ourselves in order to heal our relations with others. Healing begins within ourselves. When we take pride in our identity, we may choose how we wish to be defined. To put this into practice, identifying the subtle mechanisms embedded in our society that subvert the power to do so, the institutions that contribute to systemic racism, should lead to political action that produces real change. Identity politics recaptures one’s own voice to speak in a language that, by virtue of defining the self, empowers the self.

We must also learn how to actively listen to others with both respect and a spirit of inclusiveness. Mark Lilla, a professor of humanities at Columbia University, observed that identity politics devoid of inclusiveness, as in the case of contemporary American society, for example, the broad segment that feels forgotten, disenfranchised, and disillusioned, those most likely to resist efforts to promote change whose deference to “the other” that has been targeted and scapegoated as responsible for their condition, can only inflame longstanding grudges and feelings of resentment. To exclude is to divide; hasn’t history already taught us how ignoring its weight can influence the calamitous tide of fortune against what ultimately lies in the best interest for us all? 

The opportunity to talk about racism occurs in my practice when this topic is introduced by my patient or when I feel it has relevance to their work in psychotherapy. For those who have difficulty understanding racism, drawing a parallel between the struggle to identify and change subconscious beliefs about oneself that are destructive and the difficulties changing beliefs about racism that are systemic in nature promotes an appreciation for the challenges those fighting racism confront. Others sympathetic to its cause may benefit from discussion about how they may contribute through political activism and, for those victimized by racism, empathic listening as well as guidance to navigate personal relationships or at the workplace provides the validation and skills necessary to confront racist issues at both a personal and systemic level. 

Confronting racism is about investigating and challenging our beliefs about ourselves and “the other,” the historic foundations and rationality of their premises, as well as how they manifest our communities and society in general. These insights support efforts to heal the self through self-examination and establishing the self as agent for the purpose of learning how to put these insights into practice as it pertains to one’s personal life and through social and political action.

In 2003, the British author, Analis Rufus, published a book entitled, Party of One: The Loner’s Manifesto, which was a tribute to introversion and those who prefer solitude in a world dominated by extraverts. Henry David Thoreau, the famous 19th century naturalist once observed, “I never found the companion that was so companionable as solitude.” To be alone, then, is a privilege sought after by some yet, evidently, a cause of suffering for many. According to a recent survey conducted by Cigna Healthcare in January 2020 as many as 61% of adults report they are lonely, and this was before the coronavirus pandemic. A 12-month study in 2012 on the prevalence of loneliness that prompted the appointment of a “Minister of Loneliness” in the United Kingdom found that people above the age of 65 and below the age of 25 are most susceptible to loneliness. Over a third of elderly people reported feeling “overwhelmed” with loneliness. In Japan, “elder loneliness” is a recognized phenomenon. A survey here in the United States in May 2020 found that nearly 1 in 3 millenials suffers from loneliness and one of the reasons for this, paradoxically, is the advent of social media inasmuch as it can become a substitute for real in-person interaction, cyberbullying, and an impression from images posted on social media that suggest the popularity of those who are contributing to these social media sites.

One of the sources of confusion when discussing loneliness is that, strictly speaking, loneliness is a state of mind not to be confused with being alone. Susan Pinker, a psychologist and author of The Village Effect, explains that loneliness is an emotion associated with the belief that the state of being alone is not of one’s choosing. Examples might include imprisonment and house arrest, ostracism and social exclusion, agoraphobia which is an irrational fear of leaving one’s home, social withdrawal associated with depression, low self-esteem, or an anxiety disorder, a medical quarantine such as in response to a pandemic, or a catastrophic event such as Tom Hanks’s character in Cast Away, the survivor of a plane crash who was stranded on a distant island. Thoreau was not lonely in his blissful sanctuary of solitude called Walden Pond, therefore, because it was his choice to dwell there.

Loneliness may also be engendered by a subjective state of social disconnection. Perhaps one of the loneliest places to be is in a heavily populated city where you know no one. This phenomenon is supported by neuro-imaging studies which show that activity in the medial prefrontal cortex of lonely people differs from others with respect to the magnitude of disparity in the relative loci of excitation in these areas of the brain when conjuring images of oneself in relation to that of other people.

Loneliness not only contributes to mental distress and depression, it is also hazardous to one’s health. Studies have suggested that effects of social isolation on one’s health are worse than smoking the equivalent of 15 cigarettes a day as well as the debilitating effects of obesity, air pollution, and physical inactivity. It has been estimated that loneliness increases one’s chances of an “earlier death” by as much as 26%.

HOW DO WE ASSUAGE FEELINGS OF LONELINESS?
In order to learn how to feel less lonely, we should attend to the two fundamental aspects of lives, our relations with others and our relations with ourselves:

Our relationships with ourselves: Since loneliness is a subjective state, in order to address this problem one should learn how to cultivate a state of joy and learn therefore how to become a better companion to oneself. This may be accomplished in the following ways, for example:

1.  Develop a sense of purpose in life. Become goal-directed.
2. Take on tasks and challenges that give you a sense of mastery and accomplishment.
3. Practice meditation and calming exercises to discipline one’s mind from the longings and suffering of mental distress.
4.  Practice positive self-affirmations and learn to monitor and modify negative expectations of oneself and of life.
5.  Take good care of your body through regular exercise, physical recreation, and a healthy diet.
6.  Develop a self-reflective mode by journaling and reading that promotes insight, curiosity, and a breadth of knowledge.

Our relationships with others: Although loneliness is ultimately a subjective state, it is assuaged by the quality of life we establish with others:

1.  Plan social activities on a regular basis and expand your social network.
2.  Cultivate friendships and intimate relationships by sharing your time, your resources, and your listening presence.
3.  Cultivate a sense of communality by assuming a friendly demeanor and making “small talk” with strangers.
4.  Join a club, civic, or religious organization to become a part of something greater that is purposeful in nature.
5.  Doing volunteer work gives purpose, promotes self-esteem, and exposes you to other people in a similar, positive frame of mind.
6.  Pets make wonderful companions and offer unconditional acceptance and positive regard.

It wasn’t but long ago when anger was all the rage. Concerns about reports in the media that some disgruntled employee went “postal,” on a murderous rampage. Disaffected young, teenage boys, misfits and loners raising suspicion about what they might be capable of doing. Heightened public attention to the prevalence of domestic violence. Whether for the purpose of sensationalizing a tragic event or raising public attention to a social problem that has lurked for too long behind the private curtain of everyday family life, anger has become a topic of concern in the public eye. And with this concern questions have been raised whether anger is a destructive emotion rooted in the blood of our primeval ancestors, merely a vestige of an uncivilized part of our human heritage.

Are All Negative Emotions Really Bad?
The value we give to temperance, the apparent opposite of anger, is a matter of civility, what it means to behave in a civilized manner when in social situations. When anger is counter-posed in this way, i.e., as both primitive as well as dangerous, it isn’t a far stretch to understand how the social pressures of political correctness have railed against it. In my blog, “Can we be positive all negative emotions are bad?” I raised the question whether emotions generally regarded as noxious or unpleasant, such as anger, are necessarily toxic or harmful. While granting that the emotion, anger, can give rise to the enactment of terrible things, the question, then, whether anger is useful or simply a remnant of primeval instincts becomes confused when we conflate emotions with actions. In other words, it is important when answering this question to be clear that just because one feels anger doesn’t mean that one is necessarily acting in accord with it or even at all. Moreover, not all useful emotions are pleasant. By the same token, not all civil actions are necessarily pleasant, to wit our jurisprudence system, an institution that harnesses adversarial relationships within the confines of a civil society. 

Whether anger is useful or harmful, then, depends in part on how we define it. Acknowledging the difference enables one to recognize and accept anger without judging oneself as aggressive or destructive to others. Anger serves an important purpose as all emotions do. When we feel angry something within ourselves is telling us that something is not right that harkens us to take aggressive action, whether it be from a threat to ourselves or those we care about or from an insult to our sense of dignity. 

Rather than judging ourselves or others for experiencing anger, what matters is first, your awareness of the presence of the emotion, secondly, what are its likely causes, and finally how should one respond to it. If we disavow our feelings of anger, we are susceptible to projecting it onto others and when we disavow anger in actions we are inclined instead to play a semantics game with ourselves and others, for example, “Oh, I wasn’t angry, I was just upset!” Anger is a broad term for a wide range of emotions, from annoyance and irritation to rage and all the gradations in between. It can be cumulative, a thousand irritations can lead to a volcanic explosion, or sudden, like striking a nerve, depending on the level of threat that elicited the emotion. 

Knowing what causes us to become angry enables us to know where to direct our response to take action. When we don’t know the origins of our emotions we are susceptible to repressing them and directing them elsewhere, such as displacement, when we redirect anger toward an easier or more available target or intro-punitively toward ourselves. Suppressing anger over a long period of time as we know can lead to stress reactions that are toxic to one’s self-esteem and physical well being. As the cliché goes, resentment is like drinking poison and waiting for the other person to die. Anger is sometimes the result of stress, fatigue, hunger, frustration, etc., and in other cases it can be an effect of a mental disorder such as major depression or bipolar disorder. Rage reactions can arise from  situations that present imminent threat, certain kinds of drug reactions or withdrawal, a personality disorder, or flashbacks associated with post-traumatic stress disorder. 

Perhaps, most importantly, what determines whether anger is a useful or destructive emotion depends on what we do with the emotion. When we disavow anger we confuse those we care about or worse give others cause to blame themselves undeservedly; when we repress our anger we deprive ourselves the opportunity to understand ourselves much less resolve problems that beset us. People with “anger management” issues don’t express their emotions constructively. Sometimes these issues serve to intimidate or manipulate others. Effective anger management on the other hand uses empathy and clear and specific communication in order to maximize the likelihood that the party toward whom anger is directed will respond in a sympathetic and cooperative manner. 

When you are angry at someone or about something, use the following guidelines:

1. Before acting, take time to think about what it is that upset you. Write it out if that helps or consult with a friend or a counselor. 
2. Relax! Don’t approach the situation when agitated or physically upset. Take some time beforehand to relax through deep breathing or other meditative exercises.
3. Think about what purpose it serves to express your anger. What is your goal, what do you wish to accomplish by expressing your feelings.
4. Be empathic. Think about the person toward whom you have these feelings, what is their side of the issue, how do you think they will receive what you have to tell them and when you confront them acknowledge how you imagine they might feel or think. This might take some time and effort, even over several discussions, to achieve and in some instances no resolution or agreement can be achieved in which case a fundamental disagreement must be acknowledged. 
5. Be specific. Avoid ad hominem criticisms and judgments, “kitchen sinking,” that is throwing in a whole list of grievances unrelated to the topic. Stick to what it is that they did to anger you and then explain why you are angry.
6. Keep the discussion civil. If tempers flare call a time-out and plan a time when discussion can resume so the other party is reassured you aren’t trying to evade them.
7. When and if a mutual understanding of the situation that upset you is achieved, and only then, it is time to formulate a solution either of recompense for the injury or to resolve how to avoid such problems in the future. 
   
   

Anger as well as other emotions are among the many issues I work with in my private practice. If this is an issue that has been troubling you in your life or in the lives of others you care about, please contact my office at (860)236-2131 or by email at robjhamm@comcast.net. I also encourage you to read all about my practice at roberthammphd.com.

When I was a child, I remember thinking to myself, “boy, if I could only have that toy, I would never want another thing the rest of my life!” Happiness was something that one has, a thing to be possessed. Of course, when I did get what I wanted the joy it brought was short-lived. How puzzling it seemed to be disappointed, disabused from what seemed sure to guarantee eternal contentment. A lesson learned throughout a lifetime, happiness is not a material object or a thing to possess. It is not an attainable state of eternal bliss, nor is it the promise of a future obtainable through the satisfaction of a desire. If not these, what then is happiness and how is it obtainable, if at all? Much attention has been given in recent years by several authors and studies to try to answer these questions. Perhaps we best start by examining the wisdom of philosophers from antiquity to modern times.

Aristotle, the great philosopher of Greek antiquity, regarded the achievement of happiness an ethical issue. To live an ethical life is to live a good life, a balanced life engaged in purposeful endeavors. Happiness, he said, is an end in itself, a purpose toward which all other endeavors, such as friendship, financial prosperity, and good health, serve. Thus, to be happy one must be engaged in life, driven toward achieving goals, and capable of appreciating the joys engagement in purposeful activity brings. 

Epicurus of Samos was a philosopher who lived in the third century B.C. who believed happiness to be the goal of life itself. For Epicurus happiness is a long-term project achieved throughout a lifetime by living a simple life and avoiding extremes. A life of balance and temperance and tendering good friendships, he believed, offers one the greatest prospects of freedom from the hardships and perils that unbridled ambition and indulgence in pleasure risk.

Arthur Schopenhauer was a 19th century German philosopher who is known for helping found the movement in philosophy known as existentialism. Schopenhauer noted wryly that it is a tragedy of life that pleasures are fleeting whereas misery and suffering seem to endure forever. Life is a mortal coil in which we all are entangled and cannot escape; to invest in happiness that is derived from earthly pleasures, therefore, is doomed to bring bitter disappointment and emptiness. For Schopenhauer the solution to this tragedy is to invest in the more enduring rewards that transcend one’s biological and mundane needs, such as in the arts, humanities, and philosophical practices that promote empathy and compassion.

The Rewards of Altruism
Balance, moderation, friendship, investment in a future and in altruistic concerns, these are the themes that resonate with the great thinkers throughout civilization. Recent studies have supported these notions by and large. Living a life devoted to helping others and involvement with others builds networks of support that create purpose, a focus away from one’s personal troubles, and a lifeline that offers stability and enrichment of life. While financial security is a necessary condition to live a safe and stable life, recent studies have found that earning more than a moderate level of income does not increase one’s level of happiness over-all. Altruistic endeavors, such as contributing to charitable causes, elevate one’s self-esteem and sense of well-being.

Self Reflection To Gain Wisdom
I recently heard an ad on the radio quoting the famous pop/jazz musician, Herb Alpert, whose basic advice to artists and musicians seeking success and fulfillment in their professions is to “find your own voice.” An appreciation and knowledge of oneself and one’s own talents and limits, “know thyself,” the famous philosopher, Socrates, once advised. In order to know oneself one must first accept oneself and secondly develop the capacity for self-reflection. From the love of oneself both a generosity of spirit and capacity for self-examination grow and it is through self-reflection that one may develop a capacity for wisdom and to actualize all that one is capable of offering. 

Posted by Robert Hamm, Ph.D.

These are difficult times. Experts had been warning us for some time now, it would only be a matter of time before a pandemic like the Coronavirus would arrive. The world’s population keeps growing and its mobility makes what used to be far away so much more accessible. The world we live in today is a much smaller place and with so many more people in it the likelihood of the COVID-19 pandemic we are witnessing today was a matter of inevitability. The experts tell us not to panic but how hard it is not to think about it when considering the devastation it has wrought so far on the world’s economies, transportation, and commerce industries, not to mention the health and safety of billions of people. How hard it is not to think about it when the latest news floods the channels of broadcast media each and every moment of the day and night. How seriously should we take these news announcements and how do we cope with the reality of a truly serious world situation? Anxiety about a pandemic can be more contagious than the disease itself!

First of all, experts tell us not to panic. Easier said than done. Here are some tips on how to cope with the anxiety that has gripped much of the world population as we continue to learn more about this new virus every day:

1.   Limit the time you watch the news. It is tempting to watch for the latest developments and we should keep abreast of what is happening but continual reading about catastrophes, and so much of the news is about that and the many troubles of the world, creates a distorted view of its dangers that can reach the level of panic and mass hysteria.
2.  Limit your news sources only to those in the mainstream generally regarded as relatively reliable and be wary of claims made on unreliable sources such as found on various social media sites on the internet.
3.   Stay active and engage in activities you normally enjoy such as hobbies and pastimes. Distracting ourselves is not always the best way to cope with problems but in this case it is. If it is advised to stay away from crowds and large groups because of the potential of contagion, watch a favorite program or a movie on TV or read a good book instead.
4.  Stay in touch with friends and family. Being socially isolated can compound the worry and fear that would be expected in a crisis like this one.
5.   Practice meditation and relaxation exercises. There are many apps out there today, many of which are free, that have been designed to promote sleep, relaxation, and calm. I teach my patients a meditative exercise called autogenic training described in my blog and TV Show hosted interview on this topic.
6.   Be prepared: Make sure you have provisions such as medicines, paper and hygiene supplies, dried and canned food in case you must quarantine yourself for a length of time.
7.  Practice stringent hygiene habits, such as washing your hands thoroughly, cleaning off and disinfecting frequently touched surfaces, such as doorknobs, cellphones, furniture, etc., washing your hands thoroughly after sneezing, coughing, or using the bathroom, and keeping your hands away from your face.
8.   Use caution by avoiding situations that increase your risk of catching the virus, such as crowds and public events and refraining from handshakes.
9.    If you have children, use judgment about what you tell them and how. Assess what they know about the virus before responding. Generally, children under the age of 6 are not able to understand but if they ask about it the forthcoming book by Abi Gewirtz, Ph.D., “When the World Feels Like a Scary Place: Essential Conversations for Anxious Parents and Worried Kids,” may be helpful to guide you through these situations. Try not to dismiss the child’s fears while at the same time putting the problem into perspective and reassuring them about all the efforts that are being made to address the problem.
10.   If you don’t already have one, seeking professional consultation with a counselor or psychotherapist can provide the support, guidance, and sympathetic ear to help you through these fears. If you are quarantined, talk with your therapist about whether telehealth or telephone sessions would be an option they could offer.

Posted by Robert Hamm, Ph.D.

What do you see when you look in the mirror? When you strip away the physical features looking back at you that you readily recognize and have been long familiar with a layer is revealed that engages our emotions and judgments about what we see. In Greek mythology, narcissus was the son of the river god who fell in love with his image reflected in a pond. Some days and in some ways most of us are like narcissus. When we look at our accomplishments, our feats, or even our endowments, we swell with pride. Other days, in other ways, we might feel otherwise.

Shame and pride are opposite sides of the same coin. When we look at ourselves in the mirror we see ourselves not only through our own eyes but more importantly perhaps through the eyes of everyone else. Self-consciousness is a fundamental part of what it means to be human. It means we have a sense of self, a capacity to reflect, to introspect, and ultimately use this knowledge to better ourselves in this life. This sense for who we are largely originates and continually derives from our awareness of the impressions others have of us. It is through our ability to see ourselves through the eyes of others that when those impressions are unfavorable we feel a sense of shame.

Is shame a “bad” emotion? Is it an emotion we would best be without?
Shame is a reminder that we live in a world with fellow creatures toward whom we have responsibility and from whom we judge ourselves. It is founded within deep psychological mechanisms known as projection, identification, and empathy. So when we find ourselves falling short of what is expected of us whether it be acting in an irresponsible way or failing to give our best efforts toward those endeavors deemed important in life we feel shame. In our minds these matters reflect who we are in relation to others, our status, social identity. These concerns reflect the fact we are social creatures. Shame incentivizes us to become responsible to ourselves and others with whom we identify.

When is shame problematic? Richard Grannon, Life Coach, has identified “toxic shame” as an irrational feeling of worthlessness and susceptibility to humiliation that usually originates from childhood experiences often associated with complex post-traumatic stress disorder. As adults, as one might expect, those who suffer from toxic shame often avoid intimacy, withdraw from social life, or become guarded and distrustful, hidden behind a mask of pleasantness and eagerness to please others.

Freud - Secondary Narcissism
One might also suffer from an apparent lack of sufficient shame. Here we would find the classic antisocial personality, the person who lacks sufficient conscience to care enough about how others feel or think. The narcissistic personality, on the other hand, presents a more complex issue. What Sigmund Freud called “secondary narcissism,” a withdrawal of investment in others for the sake of investment in one’s self or ego presumably serves the function of protecting oneself from feeling shame. In narcissistic personality, therefore, what appears to be a fundamental conceit belies a deeper unconscious defense against self-loathing and feelings of unworthiness. As the psychoanalyst, Benjamin Kilborne, points out because he is fixated on himself narcissus cannot distinguish between himself and his image and thus lacks insight or the capacity for corrective self-reflection. For Freud this is a defensive reaction against feeling intense shame. Thus, when confronted a narcissist typically will deflect responsibility or become antagonistic.

Finally, shame becomes problematic when we feel ashamed by association such as when we belong to a group, family, or are in relationship with someone deemed shameful, reviled, or ostracized by others. These are the sources of prejudice and discrimination, the infamous scarlet letter, used to defile, scapegoat, or marginalize those deemed inferior or in some way inimical to the values of the majority or of those in power. It is incumbent on all of us to raise awareness to these prejudices, identify their sources, and at a personal level speak out and collective level volunteer our efforts to help remedy these problems as they arise and presently exist.

Shame is two-faced. It serves a useful function to bring to awareness our identity which is embedded in our social structure and relationships. Thus, it can help us know ourselves better and motivate us to be responsible and take of ourselves and others properly. It becomes problematic, however, when it becomes internalized and thereby poisons our capacity to love ourselves and trust others, or in order to avoid its toxicity evade responsibility, assume an attitude of entitlement, superiority, and vindictiveness. Shame can also be used as a weapon to marginalize or scapegoat individuals and groups unfairly.

Posted by Robert Hamm, Ph.D.

Social Support

We are social animals. We thus live in a world with other creatures, including members of our fellow species, our human race. As members of a greater collective, our families, our community, our nation, we enjoy the benefits of the supports that being a social animal provides. There is a price to pay to belong to this club, however, our obligations to others. When we become aware of how we have fallen short, fail to meet our obligations, or worse, brought harm whether by intention or not, the emotion we feel is guilt. However not everyone feels guilt when perhaps they should. And for the majority of us who do, not everyone experiences guilt the same way. Why is this so? Perhaps we should start with the question, “How does guilt develop in the first place?”

Sigmund Freud’s Psychoanalysis of Guilt

Freud believed that guilt arises in early childhood out of a fear of punishment for harboring forbidden feelings toward one’s parents, namely incest and patricide, and failure to negotiate this stage of psychological development may result in narcissistic personality traits. However, Melanie Klein, one of Freud’s most eminent early followers, believed that guilt is a natural outgrowth of the human psyche which is divided between love and hatred. The challenge of human development is to integrate these two opposing emotions within each relationship. Without integration, and its emotional by-product, ambivalence, our perceptions of others remain distorted and human relations thereby become chronically conflictual and problematic.

Guilt arises therefore from an awareness of the animosity we harbor toward those we love, the price we pay to have healthy relationships. Neither Freud or Klein described what kinds of conditions in a child’s life promote healthy psychological development but common sense tells us a healthy dose of guidance mixed with unconditional love and attention. Without guidance, children remain self-centered and fail to internalize the standards and morals necessary for healthy human relationships. Without love and attention self-esteem suffers, equally disastrous for building healthy relationships.

Psychological Effects of Guilt

Not everyone experiences guilt in the same way and these differences can be a product of our state of mental health. For example, some people who have witnessed a tragedy or human disaster suffer post-traumatic stress disorder complicated by survivor’s guilt which can prolong and render their symptoms more difficult to treat. Major depression and bereavement are other psychological conditions that can result in excessive guilt and self-blame.

How we experience guilt may also be a function of our emotional maturity.  A child or self-centered adult might regret their actions for fear of punishment or reprisal or failure to follow a rule but a more mature individual, when they commit a transgression, is more likely to feel remorse. Remorse is a human emotion that relies on an internalization of how others feel, in other words, empathy, in addition to an understanding for the reasons why. This emotion reinforces the sense of responsibility toward others that in turn deepens the emotional bond, trust, and commitment upon which human relations are built. Certain personality disorders, especially those classified as “Cluster B,” such as narcissistic and antisocial, usually lack sufficient empathy to foster the guilt and remorse necessary to assume sufficient responsibility to the feelings and concerns of others.

Guilt, the internalization of responsibility toward others, is a complex emotion that arises from the human condition in which one must live in a world founded on relationships. Inasmuch as man is a social creature, he is dependent on relationships for survival and a sense of well being. Therefore, guilt is an emotion that anneals the bond upon which trust and commitment are fostered in human relationships. When it is missing or deficient these qualities inherent to healthy human relationships are compromised and when it is excessive it can be the cause of unnecessary suffering and personal anguish.

In my private practice I have helped many patients who suffer from excessive guilt and self-blame as well as those who are deficient in their awareness of or concern for how their actions affect others. If you or a loved one are seeking help for concerns such as these please contact my office at (860) 236-2131 or visit my website at roberthammphd.com.

Posted by Robert Hamm, Ph.D.

I usually don’t afford myself the luxury to pamper myself but recently I had injured my neck fairly seriously so I relented by making an appointment with a massage therapist. Long before the therapist’s skillful, kneading hands had an opportunity to begin to do their work to heal the injured tissue, I couldn’t help but notice how reassuring it felt just to be touched at a time when I needed succor.

I have two pets at home who, as all pets do, require attention and tending to their welfare and well being well compensated by the joy and companionship they provide. Whenever I take one of them in my lap I cannot help but notice an immediate response on my part to breathe a deep sigh of relief and begin to relax.

Years ago my clinical psychotherapy practice included work with residents who lived in a skilled-nursing or residential-care facility. One of the first things I remember my supervisor in training encouraging me each time I visited with a resident to offer some kind of physical contact; it could be something as simple as a warm handshake or a reassuring stroke on the arm. The elderly are unfortunately the least likely to receive this kind of attention, especially in an institutional setting such as nursing homes where people are all too often shunned, neglected, or treated in perfunctory fashion.

The Healing Power Of Touch
Few things in life are at the same time both as important and sorely overlooked as the power and healing of touch. Our society shuns physical contact when it comes to daily interaction with other people. Yet touching is a powerful way to communicate. Matthew Hertenstein of DePauw University, Indiana, demonstrated in a series of studies that touch alone can communicate eight different kinds of emotion, such as anger, disgust, gratitude, and sadness, with up to 78% accuracy. The power of touch thus can influence our effects on other people and even success in life. For example, studies have shown how touch enhances tips for waitresses, cooperation from strangers, and camaraderie among teammates that led to greater success for their teams. Touch is also essential to the emotional bonds we establish throughout life, from the instinctual touch that anneals the vital connection between a mother and its infant to the lifelong bond that endures through a marriage or deep friendship. Moreover, touch communicates the strength of that relationship bond by how often that touch is reciprocated by one’s partner.

Not all touch is welcome or healing. Some cultures frown on touch more than others and mores can change over time. A touch initiated by a man is more likely to be received as unpleasant than that by a woman and we all know about the controversies raised by #metoo in which the relationships among touch, intention, and acceptability, have been reexamined.

The Power Of Touch In A Relationship
The power of touch to heal and establish bonds should bring to mind how important it is to tender our relationships with others, to become mindful about how important it is toward communicating our intention, and how necessary it is to live a life that maximizes our health and emotional well being. For those who are alone, single, or widowed, with fewer opportunities for intimate touch, it is even more important to become mindful about whether this need is being met in one’s life. Noticing whether and how we make physical contact with others, how much contact we have with others on a daily basis, and for those who are alone, realizing how pets can provide a vital connection, even getting a massage on a regular basis: Touch can make a vital difference in our lives.

Posted by Robert Hamm, Ph.D.

In my first blog on the challenges of being a man in today’s world I discussed the politics of identity and gender and how this may affect men of all ages. A rigid adherence to male gender stereotypes once sanctioned in our culture creates problems for everyone. For women, disparagement of character and abilities, abridgement of opportunities, and the abuse and exploitation, both subtle and not-so-subtle, publicized in the revelations of the #MeToo movement. For men, less obviously perhaps, gender stereotypes of masculinity, such as dominance, stoicism, aggression, honor, and risk taking, are also fraught with consequences. These might include avoidance of vulnerability necessary for intimacy, anger management issues, addictions, and difficulties identifying one’s feelings.

Masculinity And Stereotypes
As men age into their late 40’s and 50’s, these stereotypes associated with masculinity compound the problems that naturally occur with the aging process. Age affects men and women differently and these differences are a product both of biological and social sources. Research has shown that after age 50, men have greater difficulty adapting to change than women as evidenced by the different rates of depression, anxiety, and suicide. Why is this so?

In my work in private practice, I have found older men, i.e., generally in their 50’s and older, are more susceptible to social isolation, depression, and addictions. In their youths, men are conditioned to believe in their independence and their measure of esteem is largely contingent on what they achieve in terms of status, accomplishments, and financial growth. Less emphasis is given to tendering supportive relationships, more on competition and achievement, individualism as opposed to collective concerns. Hence men are more inclined to show signs of narcissism and sociopathy than women. But as men get into their later years, their paths set in life and time for more reflection and settling into what they have “sewn,” as their potentials and stamina begin to decline, as well as their health and their earning power, some men are not prepared to deal with what they need to cope with these changes that are a natural part of the aging process, the life cycle.

Instead of aging gracefully, the dark side of the masculine imperative, such as difficulties accepting one’s limitations and showing one’s vulnerabilities, deficits in identifying one’s feelings and showing empathy, and insufficient skills and practice establishing supportive relationships and networks of friends, eventually come home to roost thus leaving these men more susceptible to depression, loneliness, and addictions as a way to cope with these emotions. Even worse, these men often lack sufficient self-reflection, awareness of one’s feelings, and attention given to the practice of good health habits and knowledge about how to nurture oneself emotionally and otherwise.

Loneliness - A Health Risk For Older Men
As a result, men are at a greater risk of developing health problems as well as suffering from loneliness and isolation than if they are living with a spouse or significant other. In my practice when working with older men I help identify these problems to help them develop insights about how and why these problems arise in their lives and then help them to establish goals and coping strategies that will enable them to learn how to better take care of others and themselves in order to lead a healthier life mentally, spiritually, and physically, free of addictions, into what should be the golden years of their lives.

Posted by Robert Hamm, Ph.D. - Psychologist

When I was a graduate student my doctoral dissertation was written about people who have difficulty accepting limitations in themselves. I remember one fellow student asking me, “That isn’t a good thing is it? Shouldn’t we not be willing to accept limitations?” There was some truth in what he was asking. We are taught to try to be all that we can be and to follow our dreams in life. To accept anything less is tantamount to settling, isn’t it? And to extend that philosophy to everything else is compromising. Shouldn’t we fight for what we believe in, even against all odds? Isn’t that what we are told in the many stories written in our culture, the hero who rises above the improbable? A patient of mine recently asked me this very question: How do I know when to accept what seems too difficult to change?

The Nobel Prize Complex
A disorder that subverts the resolution of these concerns is known as The Nobel Prize Complex. People with this disorder expect to be the best and nothing else will do regardless of their limitations or how much or little effort is expended. The famous psychoanalyst, Karen Horney, once observed that those who live by such idealized images of themselves “want to be on top of the mountain, but don’t want to climb it.” For people such as these, ambition is a hindrance because it isn’t tempered by cognizance of realistic limits, such as how much effort it takes to achieve one’s goals in life and that no one can win or be the best every time nor, more importantly, should one have to in order to be successful in life.

There is another benefit to accepting one’s limitations which is that by so doing one is freed up to pursue what is possible either by changing one’s goals in life or by finding other, better ways to achieve them, what we psychologists call “second-order change,” as opposed to hammering away perseveratively to the point of futility.

So, it is a paradox but to accept limitations can serve rather than hinder one’s ambitions. This is where Eastern philosophy has offered benefits to our way of living here in the West. In the West we have been taught that effort and hard work are necessary to achieve one’s goals. This is consistent with our puritan heritage in which hard work is rewarded in the afterlife and emphasis is given to individualism and freedom. These are ideals and as such need to be grounded in reality that hard work alone doesn’t guarantee success, individualism can only succeed in the context of purpose greater than oneself, and freedom isn’t an entitlement but a privilege granted through an acceptance of responsibility. These then are the limits of what is possible by the rules of life itself.

Eastern philosophy teaches us that life must be balanced by an acceptance of all that remains beyond our control and deliberation. Not to be confused with resignation, acceptance entails a surrendering to all that lies beyond our control and in so doing granting us wisdom and a sense of peace. Clarity ensues from this process, opening a window to seeing all that is possible that lies within reason. In ancient Greece, the stoic philosophers assigned this grounding principle through which we may discern all that remains possible to fate.

The Serenity Prayer And Acceptance
The famous serenity prayer from the Middle Ages adopted from stoicism asks for the wisdom to know when to accept the limitations of oneself and of life itself and when not to. Acceptance of oneself and the limits of what is possible enlightens us toward that wisdom to know the difference. For everyone, wisdom as with ambition fulfilled is a process gained over a lengthy arc through hard work along with thoughtful reflection, not a gift or an entitlement. So, how do we know when to accept what is too difficult to change? When we realize through this wisdom that the fruits of our efforts bring more destruction and hardship than prosperity and happiness to the prospects for ourselves and those we care about. When working with my patients in clinical psychotherapy practice, I don’t try to answer these questions for them but instead encourage them to work through self-reflection whether they have given what in good conscience they feel has been sufficient effort and assessed the products of these efforts to answer this question for themselves.

Posted by Robert Hamm, Ph.D.

There is an old joke that goes, “Why do today what you can put off tomorrow?” The humor in this joke gives testament to the universality of the problem of procrastination. We all can relate to this phenomenon. While most of us view procrastination as a time management problem, Dr. Tim Psychyl, a professor of psychology at Carleton University in Ottawa, Canada, claims that it is more an emotional regulation problem. In other words when we procrastinate, we give priority to making ourselves feel better over the pursuit of long-term goals. This is the reason why mood disorders such as depression and emotional states such as anxiety can create or even exacerbate tendencies to procrastinate. Dysfunctional thought patterns often associated with depression and anxiety, such as perfectionism, black-and-white thinking, and fear of failure, are often found as underlying causes for procrastination habits.

HOW TO OVERCOME PROCRASTINATION – THE TOP 10 TIPS
Here is a list of measures you can take to overcome procrastination:

• Create checklists and schedule your time. Plan your day and check off things that need to be done. Getting things accomplished is a motivator in and of itself.
• Set modest goals. A little at a time does it. Setting goals too high only reinforces procrastination. By the same token, avoid all-or-nothing thinking.
• Just do it. If you find yourself endlessly planning or mulling the consequences over and over (paralysis by analysis), force yourself to take action.
• Be accountable. Find someone to be accountable to (a therapist or a friend) when you make a commitment to a plan of action.
• Make it a team. Find someone to help you accomplish a task you have been avoiding with whom you can reciprocate the favor or hire someone if need be.
• Practice the Premack Principle. Reward yourself with things you enjoy for doing the things you’ve been avoiding.
• Identify and eliminate saboteurs. Make a list of things you typically do (reading email, surfing the internet, eating, sleeping, etc.) to avoid doing what needs to be done, then make a conscious effort to remove them from your environment or refrain from engaging in them when you are engaged in a task.
• Make the task more fun or interesting to do if boredom is a reason for procrastination. Playing your favorite music while you work or setting goals to finish your task within a certain time and then trying to best your record the next time you are engaged in the task can make the time go by quicker.
• Avoid the rush. The rush of waiting until the last minute can be addictive in and of itself. Plan ahead and stick to a schedule as best you can.
• Subsume your goals to a grander plan. Sometimes goals, such as exercising for better health, for example, aren’t enough by themselves to motivate but if we make it a part something greater that gives it greater purpose such as doing it for charity, for our family, or for the purpose of enriching our lives, that task can become more meaningful and something more worth the investment.

While these suggestions are often successful, they alone might not be enough when mental health issues such as depression, an anxiety disorder, or attention deficit disorder, that can contribute to procrastination tendencies require professional help. If you or someone you know suffers from procrastination and need help overcoming these kinds of problems, please contact Dr. Robert Hamm, at his private practice, at (860) 236-2131 or by email at robjhamm@comcast.net.

Posted by Robert Hamm, Ph.D.

Identity Politics And The Male Gender

In this era of identity politics, it seems nearly everyone is in a minority, nearly every one belongs to a group that is maligned or oppressed. Nearly everyone strives to have a voice to carve out a space in the human race in order to be heard and to define an agenda about what matters. Everyone that is, except those deemed privileged not to be victimized by these social forces, or worse, benefiting or even responsible for promoting such conditions. One of these groups that belongs to the default population that does not benefit from identity politics is the male gender.

For this reason, the American Psychological Association only recently published guidelines for psychological practice with men and boys. When the concerns and grievances of the oppressed minority are addressed it eventually becomes apparent that the so-called benefactors of these inequities are victimized as well. A culture that rigidly defines how people should behave and the values they should hold, even if those behaviors and values are deemed privileged in some way, restricts the freedom people may have to express themselves authentically and compels them to live up to standards inconsistent with deeply held beliefs and inclinations.

Dominance, stoicism, aggression, honor, risk taking. These are values and qualities deemed valorous and associated with success and achievement and these are qualities traditionally assigned to the male gender across many cultures. Ours is no exception. Yet when rigidly adhered to these values can take on destructive proportions. A rigid adherence to dominance can take on abusive dimensions and contempt for those disassociated from these qualities, in this case women. Misogyny eventuates from assigning complementary qualities to women that might include susceptibility to moral corruption, underhandedness, manipulativeness, etc. But a closer look at the effects of these biases reveals that men themselves are likewise victimized in various ways.

Men are more likely to commit homicides and engage in reckless behavior resulting in shortened lifespans and higher rates of incarceration. And an ethic that values stoicism discourages self-reflection, showing weakness and vulnerability, seeking help when needed, self-neglect, greater health risks, and isolation. Men are three times more likely to commit suicide than women.

Traditional Gender Roles Need Balancing

Research has shown that those people that embody a balance of traditionally male and female qualities, called androgyny, as opposed to a rigid adherence to one type or the other, benefit from a greater sense of emotional well being and social adjustment. Men benefit when offered the socially sanctioned means to discuss their private concerns about these matters. This may take place in the form of men’s support groups or in a counseling or psychotherapy relationship. The majority of my private practice is devoted to talking with men of all ages about these and other personal concerns. Issues such as relationship problems, anger management, communication difficulties, sexual performance, aging and its effects on self-worth and one’s sense of purpose and place in this world. These are some of the issues addressed in my work with men and adolescent boys.

If you or someone you know would benefit from talking about these issues in the confidential setting of my professional psychotherapy practice in West Hartford, CT, please contact my office at (860) 236-2131 or visit my website at roberthammphd.com.

Posted by Robert Hamm, Ph.D.

Sex is a good thing, isn’t it? It feels good and it is necessary for life to continue. Medical researchers claim it is good for your health; after all God made us sexual creatures. Yet sex historically has been one of the most controversial topics known to mankind. It’s complicated!

Even though sex isn’t necessary for survival of the individual organism it certainly is for the species inasmuch as it is the foundation of reproduction and the evolution of life itself. Witness all the attention given to it in literature, conversation, musical lyrics, drama, comedy, humor, even politics, art, and fashion. This isn’t just a human thing; aside from disputes over territory and food, courtship rituals and battles for mating rights seem to consume the animal world.

Sex is then no small matter. Mating and reproduction are integrally tied up with property rights, emotional well being, our futures, identity and gender roles, status, and concerns about exposure to potentially serious communicable diseases. With all this emphasis on the importance given to sex, it is no wonder that distinctions are made with respect to when sex is a good thing and when it isn’t.

When is sex a good thing?
Sex is a good thing when it serves as an integral part of one’s life that enhances or enriches life itself. This means that whatever problems, risks, or complications sex brings into life those problems are outweighed by the degree to which it benefits the individual. For some this may mean that sex serves to anneal the emotional bond between individuals through which a relationship, and in many instances, a family can grow. For others, sex can serve a recreational purpose and have no other purpose, albeit contrary to the dictates of many organized forms of religion. Many people believe that as long as sex is between consenting adults it is acceptable. Others, including those in the field of psychiatry, make distinctions between healthy sex and perversions, also known as paraphilias. These kinds of distinctions, however, are debatable and may vary according to cultural standards and the times we live in. One of these distinctions has to do with the question, “Is there such a thing as too much of a good thing?”

When is sex not a good thing?
Can there be such a thing as too much of a good thing? Of course! If you eat too much fattening food, however delicious, you can develop obesity and health problems later in life. Alcohol in moderation according to some medical research can have salubrious effects, in excess it can be a disastrous addiction. Too much of almost anything isn’t good. Epicurus, the philosopher during the Roman Empire, hence espoused a philosophy that extolled the virtues of moderation.

When then does sex become too much of a good thing and is this an addiction? I define an addiction in a pragmatic sense, i.e., a behavior constitutes an addiction when its net effects are detrimental to an individual’s life. This definition can be taken broadly as including anything pertaining to the life of an individual whether it be health, finances, or relationships. Sex can become addictive when there is significant time, energy, and involvement invested in this behavior, efforts to desist from or reduce its frequency resist change, and it becomes detrimental to an individual’s life in the following ways:

Time consumption: So much time is invested in sexual behavior, whether this be having multiple relationships simultaneously, masturbation, watching pornography, or visiting prostitutes, that it interferes with time otherwise spent constructively at work, in relationships, or involvement with family, hobbies, etc.

Financial and legal costs: Money spent on dating for the purpose of having sex, or on prostitutes or massage parlors, detrimentally affects an individual’s financial well being or puts them at risk of committing a crime.

Health risks: When the pursuit of sex is at the expense of protecting oneself or others from exposure to sexually transmitted diseases.

Risk to Trust in a Relationship: When a partner in a relationship doesn’t know about the sexual behavior and it is a violation of trust and transparency in the relationship. When a partner in a relationship considers such sexual behaviors as tantamount to infidelity to the relationship. When sex substitutes for a healthier way to establish a private life or the portion of life otherwise spent in solitude. When sex objectifies human relationships and prevents one from establishing a healthier way to developing intimacy in relationships or puts others at risk of emotional or physical harm.

When sex serves as a substitute for dating and meeting people for the purpose of establishing intimate relationships. When sex impairs arousal or has a desensitizing effect on real or emotionally intimate sexual relationships. When sex serves as a gateway, either intentionally or unintentionally, that leads to efforts to engage in illicit relationships, solicit prostitutes, or engage in riskier sexual situations.

What are the causes of sexual addiction?
Addictions represent an imbalance in an individual’s life. They often serve to gratify needs in a person’s life not necessarily related to sex at all, such as gratifying self-esteem, assuaging loneliness, or dealing with loss, alleviating boredom, as maladaptive ways to cope with frustration or anger, avoidance of engagement in goal-directed activities or substantive direction in life, or avoidance of emotional intimacy. There can be deeper reasons why these kinds of problems develop which best be explored with a trained psychotherapist. Many individuals with sexual addictions are victims of sexual abuse or premature exposure to sex at an early age.

How can a sexual addiction be treated?
From a practical standpoint, sexual addictions can be treated much the same as other kinds of addictions are, by identifying events, situations, and emotional states that elicit the behavior and teaching the patient in psychotherapy alternative, more adaptive ways to cope with the needs and fears contributing to the problem behavior. Sometimes participation in a support group or “12-step program,” such as Sex and Love Addictions Anonymous or Sexaholics Anonymous, provides social support for a patient beyond what a therapist can provide in an individual session on a weekly basis. Practicing stimulus control, a behavior-therapy principle in which a patient is encouraged to avoid people or places in which such behavior occurs, relinquishing possession or control of electronic devices that permit or promote such behavior whenever possible or at least limiting the time and places where such usage is permitted, is often necessary.

While the aforementioned methods are often helpful, sexual addictions usually represent personal issues that require psychological intervention beyond behavioral techniques. Addressing one’s lifestyle by encouraging a patient to fill one’s time with more constructive activities, devoting more time to relationships or one’s career, addressing issues in a current sexual relationship that are either contributing to or are a function of the addiction, and addressing psychological issues such as low self-esteem, a personality disorder, loneliness, or social anxiety in therapy are often involved. Finally, exploration of deeper psychological issues caused by abuse or neglect in childhood or losses in life is often necessary and best conducted by a trained psychotherapist.

If you think you or a loved one is suffering from a sexual addiction, a consultation with a trained professional may help you determine whether these kinds of interventions might alleviate the problems of life that can ensue as a result.

Posted by Robert Hamm, Ph.D.

What is OCD?
Strictly speaking, OCD (Obessive Compulsive Disorder) is classified as an anxiety disorder. As the name implies, it has two parts to it, obsessive and compulsive. Some people who suffer from the disorder have one part, others may have the other part, and some have both. Let’s take a look at these parts.

Obsessions represent thoughts that one cannot get out of one’s mind, like an annoying song that gets stuck in our heads. The more annoying the song is the more it won’t go away. Some professionals refer to this as “intrusive “ thoughts. I like to call them “sticky” thoughts because like flypaper it is hard to get rid of them.

Compulsions are behaviors that one can’t resist, such as washing one’s hands repeatedly, checking over and again whether the door is locked, or symmetry compulsions where everything must be done in even numbers. Compulsions are often confused with impulsive behaviors, such as gambling, overeating, and smoking addictions, behaviors that are inherently pleasurable even though they can be destructive when they get excessive or out of control. Compulsive behaviors on the other hand are not inherently pleasurable. They may be inherently value-neutral such as hand washing that becomes unpleasant because repetition cannot be resisted or inherently painful or unpleasant, such as giving in to the irresistible urge to pull one’s hair out repeatedly.

Likewise, an intrusive thought, or “obsession,” is distinctive by its unpleasant content. Often these thoughts are distinguishable from “ordinary” obsessive thoughts in that they seem “out of character,” such as engaging in some immoral act one would never even remotely consider doing. An example of an intrusive thought would be imagining a loved one being harmed, hitting a pedestrian while driving, sexual thoughts that are unwelcome, etc. Intrusive thoughts are obsessive in the sense that they occur repeatedly even though they are unwelcome, like the unpleasant song that won’t go away.

Obsessive thoughts and compulsive behaviors can be annoying, embarrassing, and even frightening. The prevalence of this disorder is probably underestimated because many who suffer from it are too embarrassed to admit it. An intrusive thought can be frightening because it is sometimes mistakenly believed that these thoughts represent intentions or inclinations even though this is never the case.

OCD is often confused with OCPD, obsessive-compulsive personality disorder. Years ago there was a movie, “As good as it gets,” starring Jack Nicholson, Helen Hunt, and Greg Kinnear, that added to this confusion by conflating these two separate disorders which statistically are only mildly correlated. OCPD represents what we usually mean when we say facetiously or disparagingly that someone is “anal” because certain features of personality such as rigidity, punctuality, and stinginess, were believed by Freud and his followers to arise from a fixation that presumably were associated with a specific stage of psychological development in childhood. OCD and OCPD are not the same and only occasionally are they manifest together in the same person.

What causes OCD?
As with most mental disorders, no one knows for certain. Epidemiological studies evidence a hereditary contribution to most mental disorders and OCD is no exception. OCD is not curable but its symptoms are treatable to help people better manage the disorder and diminish its effects. My experience in clinical practice suggests that symptoms wax and wane and are most likely to resurface during stressful life situations.
How can someone who has OCD be treated in clinical practice for this disorder?

OCD Treatment
Obsessive-compulsive disorder (OCD) is treated with a combination of cognitive and behavior therapies and in some cases I might also refer a patient for a psychiatric evaluation when a combination of psychotherapy and psychiatric medication is indicated. For intrusive thoughts I reassure my patients that their thoughts do not reflect their intentions or tendencies. To the contrary, they represent ideas and images that are abhorrent so it is fear, not desire or intention, that produces these symptoms. In some instances an intrusive thought may represent an idea that may symbolically serve some useful purpose to that patient at that time in their life which may stimulate discussion about what that may be. Autogenic training, a meditative exercise I teach many of my patients, helps them to let go of these thoughts more readily.

For compulsions, exposure therapy in combination with response prevention helps a patient to gradually gain control over these behaviors. This is used in conjunction with coping skills training that includes meditative exercise. I help normalize by reinterpreting these symptoms as a remnant of magical thinking that once long ago served an adaptive purpose in human history before science helped us better understand how and why things happen in life.

Compulsions, as with superstitions, act under the principle of negative reinforcement which means that it is rewarding to avoid something that is feared. People who suffer from these symptoms act out of a fear of what might happen if they resist even though they know their behavior is irrational. They might not even know what it is exactly that they fear might happen if they resist. It is the emotion of fear, not reason, that produces this behavior because it is an anxiety disorder. These are difficult behaviors to change because avoidance prevents one from challenging the expectation, however irrational it might be, that its imagined outcomes won’t occur.

If you or someone you know is suffering from obsessive-compulsive disorder it is encouraging to know there are steps you can take and resources you may rely on to remedy the effects of this problem. The International Obsessive Compulsive Disorder Foundation publishes a newsletter at www.iocdf.org with information about the latest OCD research and support groups in your area.

Posted by Robert Hamm, Ph.D.

Relationships can be difficult at times but we seek them because we are social creatures and thrive when we find intimacy and closeness with other people. Intimate relationships provide us with the richness of life, companionship, and security we seek to make life more meaningful. But as with anything in life that is worthwhile it comes at a price and one of those is dealing with conflict.

It takes skill and experience to deal with conflict successfully. I know as I teach these skills to many of my patients and couples I work with in psychotherapy. However, just as important is using judgment about which issues should be discussed and when. Each of us is different. Thus, the problem of how and when to discuss matters is further complicated by the fact that some of us are conflict-averse, some are comfortable with it, and others seem to thrive on it.

Confronting Relationship Issues
W.R. Hess was a Swiss physiologist who introduced the concept of “ergotropic” to refer to the power of the sympathetic nervous system to exert energy and “trophotropic” to the parasympathetic nervous system’s function to rest. Relationships may be viewed in a similar way. At times we need to work on our relationships, confront issues when they arise, and work through problems together. Other times we need rest and relaxation while enjoying each other’s company and having fun together. Knowing which issues to work on and when can be a challenge sometimes. Added to this problem are the differences between couple’s personalities. Some are more eager to work on problems, process issues and concerns, others tend to avoid or procrastinate in dealing with these matters. Each of us has our own comfort zone so to speak and when they don’t mesh well problems in a relationship can ensue.

How do we decide which issues to discuss, whether we are engaged in ergotropic mode too often or not enough, and when should issues be brought into discussion? Here are some suggestions:

If not sure, think before you say something. Some people have difficulty controlling their reactions and then often regret it later, saying something in an unkind way, losing their temper, getting defensive. If this is you, learn how to relax, recuse yourself, take a walk, call time out and get back to it later.

If something is on your mind and you are not sure whether to bring it up, discuss it with a friend or bring it up in with your therapist. Write down your thoughts and reflect on them. Don’t sweat the small stuff. Life is full of problems. Our partner is likely to have many faults and so do we. Complaining or bickering much of the time wears down a relationship, so does too much intensity. If you have a tendency to be peevish or intense imagine what it would be like if the shoe were on the other foot. How pleasant would that be?

If you think something is important enough to bring up, find a time and place that seems right to raise it, when there aren’t a lot of distractions and your partner seems receptive. If it is difficult to find such a time ask your partner when it would be a good time. If you find yourself feeling like you are walking on eggshells or your partner seems to be doing the same, take some time to reflect on why that may be. Ask your partner whether there is anything bothering them they would like to discuss.

If you find yourself feeling resentful or becoming emotionally distant, consider this a warning that something that needs to be addressed isn’t. Talk with a friend or your therapist about your hesitancy to confront your partner if you are reluctant to do so so that you may find a way to bring it up for discussion.

Posted by Robert Hamm, Ph.D.

We have all heard of the term, “black sheep” of the family. It is only natural to want to be accepted and to belong and when we feel different or shunned because of our differences from others it can be very stressful. Witness the bullying that takes place on the internet, peer pressure to conform, the power that fashion and the media leverage on society to live up to certain standards we are beckoned to follow. It can be extremely difficult just to stand up to others for the sake of integrity, to be ourselves. But when one feels that somehow one is fundamentally different from others, certain fears are evoked that might include being ostracized, being teased and made fun of, and feeling inferior or inadequate.

Ugly Duckling Syndrome
The Ugly Duckling is a fairy tale written by Hans Christian Andersen, a Danish poet and author, in the 19th century, about a homely little bird who suffers abuse from others around him until he grows into a beautiful swan. The story won wide acclaim because it resonates with a fairly universal theme in families and society that says we are not necessarily the person or individual we seem to be as judged by others. More than this we carry within us the potential to become more than what any of us might have dreamed possible.

There is another message in the Ugly Duckling Syndrome story beyond the idea that being different carries within itself the potential for transformation. And that is that by virtue of being different we may possess a greater potential to be elevated beyond the ordinary. Just as in natural selection a mutation increases the likelihood that either a failure of adaptation will occur or that a new variant has emerged that is superior to what has come before. Or one might explain the transformative power of being different as deriving from the psychological pain and suffering being different causes from which one may draw inspiration and motivation to rise above the judgment and ostracism differentness evokes from others.

Normality In Psychotherapy
In psychology as in society there has existed a bias to extol the virtues of normality  inasmuch as it suggests that one is thereby free from psychological features that are abnormal or defective in some way. Thus we psychologists are also guilty of contributing to the pressure to conform and to suppress differentness to some degree. An early pioneer in the field of psychotherapy, Otto Rank, who was once a close associate of Freud’s in the early 20th century, recognized this bias in psychology as inspiration for creating a classification system of human development in which those who suffer from feeling inferior because they are different, what he called the “neurotic” person, possess greater potential to evolve as persons in a creative fashion than the average person. He devoted his practice in psychotherapy to help those people who suffer from self-doubt and paralysis of will to begin to accept themselves as they are instead of attempting to identify what is wrong with them in order to eliminate whatever it is that makes them different and therefore abnormal in some way. Rank’s ideas paved the way for modern psychotherapy to emerge out of a more medically-based model. Specifically, it emphasized the therapeutic value of being open to and accepting the patient or client in psychotherapy and by virtue of bringing these qualities into the therapeutic relationship instilling these very same qualities in the patient or client.

As a psychotherapist, I try to adhere to these basic principles with the understanding that only within a relationship that fosters trust and openness without judgment or condemnation can one begin the creative process of self-exploration. What brings many patients to my office to seek my services, the pain of loneliness, low self-esteem, harsh self-criticism, feelings of dejection in life and in relationships, resonates with the theme of the ugly duckling in which one feels somehow different, less than others, defective, and/or incurable in fundamental ways. It is my goal in working with patients to help them see how their perceptions are distortions with a negative bias, formed by their experiences in life consistent with this bias, and how they possess the power to create a new narrative of self-empowerment, that transforms ugly into beautiful, limitations into potentials, and self-condemnation into self-endorsement.

Posted by Robert Hamm, Ph.D.