Treating Trump

Eight Months into his tenure as president, we members of the psychiatric profession (and so many others)  know this man all too well. There is no mistaking his narcissism and the traits that go with it. We do not need diagnostic manuals to know him. Unfortunately we know how persistent and unremitting his problem, how treatment refractory to our pharmacological and relational ministrations. Donald is a plus perfect teaching case for young residents learning about narcissistic personality disorders. When Senator Diane Feinstein expects him to change and learn we, along with other students of human behavior, shake our heads in dismay.

I’ve seen too many people like Trump in my office to hold out much hope. They believe in themselves too much and underneath that unrealistic bravado lies painful despairing low self esteem. It is a deadly combination for a talking cure: challenge the inflation and you have a whining brat on your hands; ignore it and your bored for hour on end and wasting time.

Of course it is rare for individuals like Trump to seek help. It violates their first commandment, a variant of “I am the Lord God and there is None Beside Me.” If they come to a psychiatrist it is because they are temporarily indisposed around a divorce, a major family trauma, a business failure. Or because they see some temporary legal or interpersonal advantage in a few documented hours. But they rarely stay. Not with me, anyway. A few minutes in my office and they are  in full flight, attempting to devalue me and insist on their superiority–or both. And I know that will continue as long as I don’t challenge this first premise . And I know that if I don’t, nothing will happen.

I know I’m  really bad with individuals like Trump. They rarely pay their bills, they are no fun and they don’t change. So what’s the point.  There not   interested in themselves, certainly not finding out who they are, and without that commitment there is no way they can change. It   sounds harsh and at times I worry about missing the exceptions. So I devised the following test for guys like Trump.

My two Harvard diplomas and a couple more from UCSF are in my waiting room  not in my office.  When the first degrading comment comes, something like “Look, man. I don’t belong here. I can do what you do with both hands tied behind my back. And check out my net worth. When you come close to that big one I’ll listen.” There are variants of course but yes, they actually say things like that within a half hour of a first appointment. (Check out previous Dr. Scapegoat/CEO posts on this website) . At such time  I try to  look kindly and wise and  gently point them back to the waiting room.  “Check out the Latin diplomas, dude.” It’s a way of my saying, odds are strong that I’m way smarter than you here. Way. You might learn something   .And by the way  I don’t honor your definition of “net worth” If you can live with that you can stay.”

Honestly this ploy doesn’t work very often. I don’t expect it to. Being rejected by a shrink may be hard for them and they may even stay a session or two longer to cope with my refusal to see them. Rarely  they reflect on what I’ve said, check it out for themselves and maybe we get somewhere together.

Do I scapegoat potential patients like these? Do I negatively stereotype their ability to learn and grow from my  impressions of their self presentation? Could I spend months, perhaps years, soothing their low self esteem enough so that they would become interested in Plato’s transcendent maxim  “Know Thyself?” Do my comments actually reflect  jealousy of their”net worth.”?  All possible but rarely true. The Donald Trumps of the world may be good business men, or entertainers but they rarely change. Count on that, Dianne.




Help for the Scapegoat

Judging from the  number of  letters I’ve received recently  asking how to cope with their scapegoat role, many people feel like scapegoats. It makes sense given our collective world. There are so many warring factions and polarities in the United States and elsewhere and. thanks to our omnipresent social media, we find it more and more comfortable to hide out in congruent identities.

As I’ve emphasized before, scapegoating is a natural process nurtured in  group anxiety and dysfunction; it is also a first step in group transformation. At the end of a scapegoating process some fundamental realities have changed–for better or worse depending ones point of view. The moment we don’t only  see scapegoating as group pathology but also as a natural part of group transformation, we have a better chance of not becoming its victim. Its a little like sibling rivalry, at times vicious and destructive, but also an energy source, potentially useful in  escaping  the straight jacket of birth order and family demands. Understanding this larger perspective  can help! It provides a handle on  predicting  who will become the scapegoat of a group or family, how to take individual steps to  defuse and reject the role, how to reduce the intensity of  group scapegoating behavior and even decrease the group problem at its heart. These are some of the ways that the individuals can  decrease the chance of becoming a group victim, or if that isn’t possible, to use the scapegoat’s energy to change one own personal fate.  Check out my TED Talk on Scapegoating on this website (, particularly the diagram on the mechanism of scapegoating in a group.

For the group or individual to emerge from the scapegoating process relatively untraumatized takes a great deal of courage, fortitude and luck.  Abused children, victims of war, and other uncontrollable circumstances  can do little on their own against the group force and are destined to work out the effects of the trauma well into their adulthood, perhaps all their life. Healing systems which help always provide emotional support but also provide a reenactment of scapegoating  in a more manageable context and with a more benign outcome.

Learning about scapegoating as a process also offers the hope of preventing potential trauma before it occurs.  Understanding the various faces of scapegoating, e.g. bullying behavior, embarrassment in social media, hazing,  and then doing something about it is what works best. But most individuals are not equipped to make the verbal and behavioral interpretations and group adjustment needed to change an acutely damaging ongoing process. As an analyst and therapist I tend to see the victims after the group has labelled them, not just the identified victims but also the damage done to individuals who are the scapegoaters. Too often I hear of a sibling, parent, workmate, or friend who stands aside and watch, becoming complicit in the trauma. They understandably fear the personal damage they might incur in trying to change a difficult situation. Not many of us are heroes and taking on a scapegoating situation as its happening is definitely a heroic undertaking.

Our current politics are writhe with examples of lack of heroism, fear and  self serving cowardice. Most recently  FBI chief. Comey was afraid to stop Trump from exerting what he felt was  improper influence on him and others; Republicans act  afraid to vote against   changes in  health laws that they disagree with for fear of losing party affiliations and privileges ; democrats afraid to make the hard and risky changes in their own leadership structures for fear of losing their place in their parties pecking order. Fear and courage are the emotions at play no matter in complicit behavior !  My own rule of thumb  for knowing what to do when I find myself  in these difficult and self defining situations is recognizing an inner feeling that always accompanies a courage stance.  When I feel that a victim is being created (including me) and  also find myself  afraid to speak or act out to stop it, I try my best to swallow my fear and step forward and taking a risk. I It’s all about not giving  in to fear that allows risking a courageous stance.



Tayyip and Donald: Bullying Bedfellow

Dr. Scapegoat is overwhelmed these days.  Scapegoating, never just an academic matter or the stuff of family disputes, has become routine in the White House and international politics . I wake up remembering my Dr. Scapegoat blog and vow to write a post after breakfast  but  then pick up the newspapers (an ancient habit still  unreplaced by the various screens spouting real and fake news) and don’t know where to begin. Erdogan’s remarkably stupid comment telling Turkish families in Europe to have 5 babies rather than 3 to exact “revenge” on the Europeans and win the continent forced me to sit down and write.

Now I don’t want to scapegoat the current Turkish president. Part of scapegoating process is that victims seek revenge. So he is using a one-down political squabble with Germany and other European countries to unleash Turkish babies as a political weapon! (Palestinian Leaders and many others have asked for much the same thing from their population.) National pride is a way of mobilizing populations to do all kinds of acts. But more pregnancies? How about asking the parents before sending them to their conjugal bed?

But Erdogan’s invective is part of many world leaders’ bizarre hunt for new was to gain power by  bypassing  conventional war.   Nuclear power makes war problematic for national political leaders  (but not for terrorists).  In our current interconnected  world order, almost anything else is safer. So  they use lies, false news, blackmail,  scapegoating and now even full wombs, to feel potent and virile.

Tayyip and Donald are such such a natural bully, an archetypal scapegoaters, aren’t they?  Our Donald is the simpler man: uncontrollable as a child and limited in education despite the financial means, traumatized by sibling death, he actively hates anyone who threatens him and makes him reflect on his own inadequacies. So he attacks and scapegoats the weakest and most vulnerable people and communities. The more power he collects the bolder his bullying gets:poor seniors, CNN, the Endowment for the Arts, non whites,  Jews, Muslims, and other non-Christians are relatively easy marks. But Obama, Australia, Mexico England and Merkel? It’s becoming obvious that anyone who is not him is vulnerable!

As I looked over my political posts in Dr.Scapegoat,  I was struck with how well a knowledge of scapegoating helps in the difficult art of prediction. (See previous posts. Dr. Scapegoat Wonders  About CEO’S As Presidents, Bully Trump is a Great Scapegoat.) Projections of power onto CEO billionaires and Entertainers (Trump’s  claims  to fame), are our populations ways of ignoring and putting down other,  more substantial  talents and careers that are far more difficult, important and meaningful to our world. Trump was pushed to the foreground by our ignorance and false assumptions . His friends, more powerful people with greater and destructive visions, than used him, scapegoating him  the way many charismatic targets have been scapegoated  before him. (See the French revolution for example.) Now we have him as super-ordinate world leader. We have sown the wind and now shall reap the whirlwind.

On a positive predictive note. Scapegoating groups and leaders are not built on strength. They are the aggressiveproducts of their own weakness. When they face competence, energy, and most all non-complicit resistance they are threatened. Then they tend to enlarge their field of action beyond their limited competence and show themselves for who they. Well The gauntlet has been thrown down.  Hopefully we will all participate in  what happens beyond our TV and phone screens.


Legacy: 1 : a gift by will especially of money or other personal property : bequest. 2 : something transmitted by or received from an ancestor or predecessor or from the past <the legacy of the ancient philosophers>

Sure I’m interested in people besides family and friends  remembering me. But  shouldn’t one’s legacy be earned through actions and not by hiring PR experts and self promotion.

Case in point: President Obama, who is usually a savvy guy, is leading the way in the promotion of  his own legacy. Why? Of course he will be remembered for some of his contributions as president. Many presidents are; its part of the role. But the adage about actions speaking louder than words also applies. Talking about ones legacy, protecting ones legacy, advancing ones legacy, getting out without spoiling ones legacy,  all speaks more to defensiveness rather than accomplishment. The man protests too much. Our president has a psychological problem, an obsession with legacy, and much of the world are its victims.

Was a black man’s getting elected president Obama’s  legacy? Is what he represents as a black Harvard law School  intellectual with an elegant style his legacy?  Or the a priori Nobel Peace Prize he won? Yes, he will be remembered for these events but they are  a subtext to his legacy.

Legacy is action realized and transmitted to the future.  Mr. Trump is Obama’s legacy as is the loss of the House and Senate and even the Supreme Court to a party and individuals that do not share his values . Such are the fruits of what Americans and the world received from his regime and that legacy is just beginning to ripen.His legacy is  also his passive response to the horror of Syria, ignoring his own re line, , the loss of life and home, the chaos of the forced migrations, the dangerous political realignments that are its consequence.. Obama’s good work on health and the environment, almost certainly short lived,  do not begin to balance so much of what has happened and not happened under his sway. Perhaps reflecting on the take away under his own leadership, the ominous take away,  is why he is so stuck on defining and redefining and protecting his  ‘legacy. ‘ Its all there in front of him every day; Medusa in the shaving mirror.

He can craft  a campaign for his legacy but I”m afraid many of his countrymen and much of the world are now scapegoats to his  obsession . Fundamentally we have had a president who  is risk averse, afraid to take on difficult political challenges that he might loose, afraid to make mistakes which from the beginning  might be costly and reflect on his legacy. What has happened is understandably given the forces Obama has had to contend with but isn’t contending what leadership is about?

Dr Scapegoat Wonders About CEO’s as Presidents

Several years ago I reviewed the demography of the people I was working with and discovered that almost half were CEO’s of private corporations. The companies they ‘ran’ were mostly large and very successful; among them were  Fortune 100 corporations. Most  had human relations divisions  which made coaching and other therapeutics available to them. However these men (and all were men) did not believe their privacy could be kept in house.

None of these individuals were seriously disturbed. On the contrary they were well adjusted and relatively comfortable with themselves; they came with a situational problem such as divorce, family loss, or questions about future moves in their career. Only their particularly high profile jobs distinguished them from many of the other people I help.

Both the last two republican candidates, Donald Trump and Mitt Romney, highlighted their CEO experience as a major strength in bidding for the presidency. Superficially that makes sense but only if one takes leadership ability as a nonspecific monolithic skill. Actually leadership, like love, is all about context, in this case the goals and intents of the groups being led. The quality of leaders and the skills required to successfully lead are very different for different collectives and although they may have some functions in common they are rarely interchangeable. Business leadership is quite specific and limited compared to leadership in other contexts.  For example, as a physician I ran several large medical and psychiatric wards which required all kinds of people and organizational skills which might be equated with a small business. But the primary “bottom line” was not money as in business but successful treatment and the intent of healing. That defined whether I was successful in my role in my own heart and the heart of patients and staff.

The personalities of the men I worked with were compatible with business enterprises.They emphasized dominance, competitiveness, competence and acquisitiveness.   They prized financial success and power as compared to humanitarian concerns, ethics, and close relationships. They had worked hard and taken personal risks to get to where they were and wanted, often craved, recognition from peers and employees. They rarely mentioned the struggles of others.
Obviously this profile is subjective and limited by numbers and the context of advising and therapy. Still it never crossed my mind that any of these successful men would make worthy presidents!

Bully Trump is a Great Scapegoat

How remarkable that scapegoat and scapegoating have become such a familiar word in the coming election.  And how the concept has become so confused and self-serving.

Trump is a classic bully and while bullying, scapegoating and a scapegoat have much in common they are not the same. A bully is an individual who has many motivations: power, sadism, narcissism failing self-esteem and so on.  But as Dr. Scapegoat has tried to emphasize in this blog, scapegoating and the creation of a scapegoat is a group rather than an individual phenomena. Bullies like Trump are people “picked” for their special attributes to perform the scapegoating function for their cohort. The group process is fickle and so, as so many scapegoating leaders have discovered, they are always in danger of transforming into the scapegoat. (See Nixon, for example.)  The synergy between a bully and the scapegoating/scapegoated Janus is a favorable intersection between the individual’s special psychology and the group’s ongoing process.  As we have learned in the debate and the 3 AM twitter rants, Trumps psychology is well adapted to either identity.

But he is never alone in his pursuit of the presidency. His targets as a scapegoater are also ours. He is the mouthpiece and point person for   our  aims, chosen because he communicates racism, sexism, stupidity, and hysteria; all the attributes that we disavow or parade, depending on what side of us we show to the world,   Trump is our ‘star’, our best available scapegoater and a great potential victim as well. We are behind him wherever he goes until he falls. As Cassius said, “The faultdear Brutus, is not in our ‘stars’ / But in ourselves, that we are underlings.”

In a group, the difference between being a scapegoater or a scapegoat is micron thin.  At the moment Trump is servant-monster to both republicans and democrats. We both egg him on and he responds with more florid and over the top rants against our victims. If he breaks, and that could happen if he wins or loses, it is because we have found a weak vessel who we have pushed past his breaking point. It’s quite a show so far and both groups have enormous stakes in the outcome.

Scapegoats:Innocent and Guilty

DRSCAPEGOAT  was a created effigy ,  a serving simulacrum  inspired by what doctors should do best, that is provide help for people who suffer. Dr. S opened   theory and practice of scapegoating to the internet wilderness and promised to answer questions and provide advice for   wanderers in that dry and scratchy desert as well as providing space to struggle with others in similar situations.

Many people have contacted Dr. Scapegoat for help; few shared with fellow sufferers.  The people who experienced scapegoating, among the most traumatic experiences humans encounter, are generally loathe to share with peers in venues where there was little protection. The tales require trust. The doctor role, even if virtual, gave that. Dr. S received emails, phone calls and asked for and received personal interviews.  Hopefully the help and advice given was useful.   

The problems and suffering presented to Dr. Scapegoat were intensely personal and private.  The groups that was presumed to be scapegoaters, in almost all cases identified as the family, was usually mentioned.  Scapegoating groups   did not come forward when that was suggested. All was left to   individuals caught and victimized in the group and collective dynamic. The scapegoat stayed in role as the guilt eater..

As the creator of Dr. S, I have mentioned from time to time that Scapegoating is a professional concern.  As a psychiatrist and advisor I have worked hard with individuals, groups, organizations, even countries to ameliorate its negative effects and supports its salutatory ones. Lately I have personally felt its negative power in my own life   which has led to an even deeper consideration of its mechanisms, its ultimate dependence on the human need for revenge and sacrifice.

Revenge is not an easy subjects for any of us to be direct about but it has everything to do with scapegoating.  This month I spent a week in New York indulging my passion for opera (my nonfiction writing extends to Britten and Shostakovich as scapegoats—see The best of the four operas I saw was Richard Strauss’s Electra, based on one of the great revenge stories of all time. Electra obsessively plans to kill her mother (Queen Clytemnestra) and step father (Aegisthus) who together murdered her father, the famed Agamemnon. The need for revenge is so straight forward and yet so difficult to carry out. The conflict between love and hate, passivity and action, eventually drives Electra quite mad. Her brother Orestes is able to do the deed but not her. Both siblings suffer for their actions.

Despite conflicting desires, the characters’ are   understandable in some mythic fated way. Even Clytemnestra, one of the ostensible villains, has good reason for killing her husband   Agamemnon, for he was father of their daughter Iphigenia   killed her, a sacrifice to the gods to allow his war fleet to make war on the Trojans.

During the opera I thought of the many emails I received wondering about why they were being scapegoated. Unlike the Electra of Sophocles and Hofmannsthal, Strauss’s librettist, most felt innocent; they could not understand or even rationalize why their lives were being so traumatized by   family members and others. I believed most, questioned others. But the opera made me wonder about a basic division in the ubiquitous world of scapegoating: there are those of us like Clytemnestra who knowingly propagate physical and psychic violence e.g. brutalizing fathers, molesting mothers, violent siblings, and evil dictators.  Who then, taking responsibility or not for their actions, are ostracized and hunted and maligned. And there are others who just don’t understand. Like Job. Like a certain kind of patriarch. Like professional victims. Like the truly innocent.

I’ll go on with this theme in my next essay. But in the meantime I wonder if any of you out there, scapegoaters and scapegoats, innocents or guilt ridden, have some thoughts on this? Scapegoats are archetypal and mythic, bigger than the personal. In that context, does it really matter if we are conscious of our sins? Does it matter if we are scapegoated for reasons we know? And iss innocence the same as not knowing?

Never Again

This introductory note appeared in NY Times on March 12, 2016:
“LA SELLE-SUR-LE-BIED, France — “Jacqueline Sauvage and Norbert Marot married as teenagers and built their dream house of wood and stone with a big garden and terrace in this village 70 miles south of Paris. On the terrace of that home 47 years later, Ms. Sauvage shot her husband in the back three times with a hunting rifle, killing him, and putting an end to what she said was decades of physical abuse by him. She was found guilty of murder late last year and sentenced to 10 years in prison.
 The case has raised an uncomfortable question for France: If your husband abuses you for years and one day you shoot and kill him, is it self-defense?””

We are not told all the details of the quality of family life that led to this killing. But let’s assume severe physical and emotional abuse was present. The French (and our) dilemma could be guided by answers to the following question:  How long does the feelings of being a victim last? How often do these feelings morph into the need for revenge? What can be done for the scapegoat by the individual and society?  What constitutes self-defense, legal and otherwise?

After years of struggling with the ubiquitous nature of scapegoating and its seemingly inevitable link to revenge–in communities, nations, and particularly families, taken or not–I wrote two novels to clarify the issues for myself and others entitled   Cloud of Terns and Revenge of the Scapegoat. ( See for more details.)   The format I used for my novels was this:  Two young heroes on a houseboat in Sausalito,  California, where they advise their clients about revenge as a realistic possibility and help them reflect on how and how to proceed. Although Revenge is a popular subject among almost all readers of fiction  it is also  an embarrassment  and pariah among people who are struggling to find a healthier and more politically correct world which favors   forgiveness and letting as solutions to abuse. I learned this first hand from friends, colleagues and even  clients who were confused and even upset by my interest in revenge and especially my conclusion.

Scapegoats be they   individuals, groups, or nations rarely forget. Their aggrieved feelings last a very long time—years, decades, even centuries-and the ‘forgiveness’ premise when applied to all parties is only rarely the end of the story or the pain. In the writing I rediscovered that  revenge is behind much of behavior which we label with less offensive motives (for example see the excellent TV History series, Vikings ). Also that action of some sort is often crucial to healing. I concluded that only when the choice to enact revenge is in the hands of the scapegoated themselves  can they truthfully discover what is best for them.
Once thing that is certain: Revenge, even, when it begins as a personal need, always runs on collective time. As any student of history knows all too well, the span of revenge often transcends an individual’s lifetime.  Letters to Dr. Scapegoat or Dear Abby  document the duration and vitality of the  need for vengence. Mrs. Sauvage waited 47 years to act. That may present a legal problem but like it or not we humans resonate to the Mafia saying “Revenge is a dish best served cold” or Israel’s unofficial motto, “Never Again.”

Book burning, Afghan Style

Farkhunda Malikzada was 27 and an aspiring student of Islam when she was destroyed by a mob in Kabul. She was beaten, stoned, run over by a car, doused with gasoline, burned ( her blood saturated clothes barely caught fire); all this documented on video and posted on social media by the attackers themselves!  The huge crowd of bystanders did almost nothing to stop this abomination. On the contrary they participated verbally shouting “beat her” over and over again, and pitched in themselves with their own violence wherever they could.

The police mostly stood by until the mob had their fill.

Farkhunda’s alleged  crime was burning the Koran. there was no truth in that claim but should that even matter. I think not.

I have read the Koran from cover to cover in English. I speak as a layman but also someone who has read widely in the spiritual traditions.  Like the New Testament, the Koran is often  a stirring  biography of a  mystic and revolutionary. Like  similar stories of Jesus, Buddha, or even Moses, the depictions of Mohammed are complex: sexist, bigoted and warlike, his moral lapses cost lives. He is particularly gifted at finding  scapegoats to bind his followers together.  But he also has some remarkable stirring visions and offers a powerful political agenda.

Burning  any book, deemed sacred or secular, is a reprehensible act. Burning a person who may have burned a book is depraved idolatry.  No book is worth a human life.

As expected the modern Afghan legal system turned out to be  a weak vehicle for bringing justice to Farkhunda or her family and friends. One of the problems, besides corruption and favoritism, was finding a person to blame. Whose fist or stone killed her,  who was the inciting agent in her murder, the judges asked, and a lack of clear answer led to limited sentences for the murderers and complictors involved.

Who or what is responsible? A book which sometimes incites violence? A clergy who creates a god out of a man and  his all too human pronouncements and insights? And what about the teachers and true believers who support such a shallow understanding of human  complexity and spiritual brilliance.

Isn’t it time to think more intolerantly about religions (most of them actually) who create a culture so conducive to dangerous scapegoating routines chronicled in this blog?

When  a child of 6, standing next to an unfinished grave was asked who was buried there  , she answered as a naive but programmed ambassador of her community saying: “Her name is Farkhunda. She burned the Quran, so she was punished and she was lynched.”

Abusers and Complicitors

For the past few months I have had a number of letters asking for help in understanding the psychology of scapegoaters.  The writers, often self-identified scapegoats, wonders how their tormentors survive the difficult emotions that they  should   feel as they unjustly punish and abuse others.

My own experiences is that most abusers see themselves as abused. That helps because they feel that their acts are justified revenge, or its first cousin, retribution.  For this type of scapegoater, the real-time victims are displacements from the abusers  own painful memories, repetition  behavior based on what was done to them by parents, bosses, and gangs.  It gives them another chance  not to feel like a helpless coward.  And to get even even if it is years later.  Unfortunately bullying others, as with other kinds of revenge behavior, may serve the emotional needs of the abuser. As the Sicilian’s proverb says, it is still tasty when served cold.

There are many other reasons for the scapegoater’s lack of sentient feelings toward the people and sub-groups they abuse. Many scapegoaters, in vivo versions of characters that show up in the media as sadists and serial killers, have severe pathology: e.g. a psychopathic failure to feel and/or  adequately judge their own behavior. Paranoid character disorders and other mentally ill persons can manifest in this form. There is little point in quietly appealing to their “good” nature which has, for whatever cause, become distorted.  Setting a limit is far wiser and more effective behavior.

Some of these letter writers ask why appealing to the best in people doesn’t work. Actually they would be better off appealing to what I have called complicitors, those of us who inadvertently support the scapegoating abuse of others. Family members are frequently guilty of being complicitors:  parents, siblings and close friends who cannot bear to call someone they love on the carpet. Such behavior is understandable but ultimately hurts both the scapegoat and the scapegoated. It’s an easy way out, a way to stay uninvolved, but it has a cost. Appeasers end up feeling like cowards. Like co-dependents they end up supporting more and more harm to others. And they do feel guilt and that guilt lives beyond them in the very people they love.