Paul Valent

Paul Valent

MBBS, DPM, FRANZCP
Consultant liaison psychiatrist, psychotherapist, traumatologist,
Co-founder and past president Australasian Society for Traumatic Stress Studies,
Writer.

Mental health in the pandemic

November 30, 2020

The widespread mental health effects of the corona virus pandemic have highlighted the inadequacies of our mental health system. The system needs ‘sweeping changes’, an ‘overhaul’ (The Age, Nov 17th), according to Prime Minister Scott Morrison.

The overhaul will require a huge budget, nearing ten figures. It may require changes in sites and systems of delivery, according to Stephen Duckett (The Age, Nov 17th).

Yet there is a degree of uncertainty at the core of the mental health problem. It is not in the quantity of such problems; they have certainly increased and will continue to increase, we know that from past disasters. But what is the nature, the quality of these problems? We can have all the infrastructure and money, but above all we need knowledge of what is required for what.

We hear that the mental health effects of the pandemic are suicide, anxiety, depression, and family violence.

But here are some voices of those who had asked for help. ‘My mind is racing.. my mind is blank.’ ‘I can’t concentrate. My memory is failing.’ ’I roller-coaster from anger, fear, and crying to total numbness.’ I am totally demoralised with this second wave. It will never end.’ ‘I’ve hit a brick wall and I’m like Humpty-Dumpty.’ ‘I anguish at letting my employees go. They were like family.’ ‘I am guilty because others are so much worse off.’ ‘I crave my boyfriend’s touch.’ ‘I can’t stand my husband nagging me all day.’ ‘I care and care and care but I crave being cared for.’ ‘I’ve put on weight.’ ‘My chest is lead.’ ‘My chest is exploding.’ ‘My mummy is angry.’ ‘I miss my friends.. I miss my teacher.. I miss learning.’ ‘He is bedwetting again.’

We see much wider symptoms than the above four often quoted. The problem is that unlike for psychiatry, we do not have a Diagnostic and Statistical Manual for stress reactions. Yet it is important to treat the stress reactions before they become chronic illnesses.

Following the 1983 Ash Wednesday bushfires I was lead author of a Red Cross pamphlet Coping With A Major Personal Crisis. It helped survivors in many Australian and overseas disasters recognize that their symptoms were normal in the circumstances and that they were not crazy.

Since then we have learned a lot about the sources and meanings of the variety of mental health consequences of stressful situations. We have long known that fight and flight are drives that can result in biological, psychological, and social symptoms. Now we recognize further drives: drives to save others, attaching to others to be saved, striving for essential goals, grieving having to give up what was essential, competition, and cooperation. Each drive manifests in its brand of symptoms, as well as moral judgements and existential outlooks.

Disasters throw set pieces up in the air. Compensation for the consequent suffering may involve setting the pieces together to greater advantage as they return to earth.

Overhaul of the mental health system may include treatment of upset mental equilibria early in age, early in time, closer to home, and with more sophisticated tools.

I believe we now have the knowledge for sophisticated early intervention and holistic help. So indeed let us take the opportunity to overhaul the mental health system and move toward a healthier and happier community.

Prepare for this. The Age, 29th Nov 2020 (Post-disaster euphoria).

November 29, 2020

Euphoria set in on Friday 27th of November 2020 as we were officially declared to be COVID-19 free. Perhaps we have even eliminated the virus. Self-congratulations ranged across the community. We achieved together, through sacrifice, a rare victory in the world.

We deserve to party, have a holiday, enjoy friends and relatives, to see each other full-face without masks. But soon we should put in context what is known as post-disaster euphoria, a result of shared survival, common across bushfires, earthquakes, and ends of wars.

We should prepare for the next long phase of reconstruction. This includes recognition of what has been destroyed and lost: people, health, and family and economic infrastructures. Grieving them and replacement with new equilibria, even if sometimes better than pre-disaster ones, is difficult and frustrating. This is the phase when pent-up suffering and exposed fault lines manifest in increased mental health issues, psychosomatic illnesses, and social tensions.

Understanding and being prepared for this phase can ameliorate its noxious effects.

 

Mental Health In The Times Of The Pandemic

October 24, 2020

2020 is the year of the COVID-19 pandemic. As with every other disaster, the numbers of dead and afflicted have been anxiously monitored. But as always, beyond these stark numbers are the larger soft numbers that nevertheless indicate the hard facts of mental illness. Mental illness is more extensive,  more ‘viral’ even than the virus.

But what is this ubiquitous ‘mental illness’? It is more than suicides, domestic violence, anxiety and depression, which are commonly quoted. The fact is that we don’t have a science of stress and trauma effects that explain the very wide variety of disaster and current pandemic distress.

This is where Mental Health In The Times Of The Pandemic is helpful. A pamphlet of 68 small pages, its easy to read style and plentiful clinical examples provide words and a framework that make sense and impart understanding of the widespread pandemic biological, psychological and social symptoms, which radiate in concentric circles from individuals to nations and from instincts to spiritual reaches. Readers will find reflections of themselves and their environments in the booklet, which in turn will promote fresh understanding and  healing.

Chapter 1 gives an overview of the history of the pandemic. Chapter 2 applies the international Red Cross pamphlet Coping With a Major Personal Crisis to the pandemic. Chapter 3  applies the wholist framework to naming and understanding the wide variety of pandemic symptoms, their sources, and the paths to potential healing.

The booklet is recommended for both professionals and the wider public.

Trump and Hitler; Comparing Their Mindsets

July 12, 2020

 

Comparisons to Hitler are a kind of taboo. It is like comparing mere mortals to the devil, or human lapses of conscience to ultimate evil.

For me, a Holocaust survivor, Hitler is like a standard measure of irrational thinking and destructiveness.

In the past I dismissed my tendencies to compare irrational leaders and dictators to Hitler as sensitivities from my past. However, lately I have found that others have been drawing similar comparisons.

For instance, in his book Donald Trump and Adolf Hitler: Making a Serious Comparison (2016), Horace Bloom compares the oratory styles of Hitler and Trump. Both were outrageous and disregarded truth, but ‘..getting the facts wrong matter[ed] much less than getting the emotion right.’ Both cultivated anger at their nations having been betrayed and made to suffer unnecessarily. Both promised to rectify this injustice.

Similarly, Rosenfeld (Cambridge University Press Online, Dec 2019) noted that a stream of scholars see ‘..that Trump’s ascent bears a worrisome resemblance to interwar European fascism, especially the National Socialist movement of Adolf Hitler.’ And Haaretz(26thFeb 2020) opined, ‘Donald Trump is not Hitler, but his words and actions encourage and embolden those who yearn for an Adolf of their own.’

For me, Hitler and Trump share other characteristics. Both branded themselves with unique physical characteristics, such as Trump’s orange face and straw-coloured special hairstyle. Both used characteristic postures and symbols. Both could draw loving and adoring crowds. Both harangued their followers with the injustices inflicted on them, which they, the leaders would reverse. Yes, they would lead them to dominance, dignity, and prosperity.

Both used simple language, repetitiveness, and slogans: ‘Deutschland über alles.’ ‘We’ll make America great again.’ All problems would be solved. Those who caused the problems, the malign political, racial, ethnic, and national ‘others’ would be walled off or be rid of.

To outsiders, both Hitler and Trump appeared comic, immature, base, lying, and nasty. Both had been considered to be mentally dysfunctional. Hitler had been labelled as delusional, psychopathic, narcissistic, sadistic, and paranoid. Trump has been labelled a malignant narcissist, and 350 psychiatrists endorsed judgments that Trump was brittle, cruel, vindictive, delusional and irrational; and that his mental state ‘could lead to catastrophic outcomes’ (The Independent, 4thDec 2019).

The problem is that none of these diagnoses capture the essence of the men. And if millions adore these men and adhere to their perspectives, by definition they cannot all be abnormal.

In 1938 the American journalist H.R. Knickerbocker asked the famous psychoanalyst Carl Jung, what constituted Hitler’s unusual power. Jung answered, ‘Hitler is the mirror of every German’s unconscious…He is the loudspeaker which magnifies the inaudible whispers of the German soul..Hitler’s power is not political. It is magic.’

Hitler and Trump believed in their different magics. Hitler believed that Providence, an inner voice guided him. When Trump countered those who thought that he was unstable with ‘I am a very stable genius,’ he meant that his instincts contained superior, innate knowledge.

What power of mind fascinates and inveigles millions of citizens? What magic dog whistles to people’s baser instincts?

Demagogues require circumstances in order to flourish. Germany in the 1930s had experienced a lost war, humiliation, the Great Depression, unstable government, and widespread starvation. The country was ripe for a Messiah or a Napoleon.

Circumstances in America have not been quite as dire, but the US had lost the Vietnam War, and could not win the Afghan and Iraqi Wars.

Increasing inequality added to demoralization. According to Forbes rankings, there are currently 630 billionaires in the US. At the same time, many underprivileged, often black or coloured Americans cannot afford health care, and 50% of children live under the poverty level.

Government and society became polarised, fragmented, and dysfunctional, to the extent thatThe Atlantic (Nov 2019) warned of lessons from the American Civil War- the ‘ties that bind us are fraying at alarming speed’.

Underprivileged America, with its strong evangelical movement, has also become ready for a Messiah or a dictator.

As a Holocaust survivor and psychiatrist, I needed to understand what was going on in the human mind. How could leaders rant and lie, and followers, as if hypnotised respond to the power and the promises? What divided the mind in which its currency was desire and belief from the mind in which the currency was thinking and logic?

I have learned that it is as basic as anatomy. We now know that normally there is a harmonious balance between the thinking, conscious, observing, logical left half of the brain and the instinctive, unconscious, emotional, non-verbal right hemisphere of the brain.

In major stress and trauma situations the two halves of the brain disconnect, with one or other half dominating perspectives of the world. The proponents and opponents of Hitler and Trump reflect these disconnected worlds.

We don’t know the future. History instructs but does not always fully repeat itself. It is possible that Trump’s supporters will realise that their leader prefers adoration by the crowds rather than shielding them from the corona virus. They may realise that he is part of the 1% who milk the nation and give little back. Perhaps Trump will fizzle out at the next election and become a bizarre historical aberration.

On the other hand, losing has never been an option for Trump. If he sees that he will lose, he may, like Hitler, take advantage of or create a state of emergency and suspend elections.

Beside Trump, the world that enabled Trump is in desperate need of renewal. The lessons of the World Wars may help here. Defeat, poverty and humiliation after World War One led to Hitler, fascism and war. Help and restoration of dignity to the defeated after World War Two led to seventy years of prosperity and peace.

This time, the defeated, poor, and humiliated reside within America. Blaming them or outsiders is unhelpful. The people need a new social contract, a type of generosity that helped to rebuild Germany and Japan after World War Two.

This is not just an emotional argument; it is also logical. Replacing gross inequalities that threaten people’s survival with dignity and a sense of justice releases energy, reciprocity, well-being, and peace.

Yes, Hitler’s Germany maybe does have lessons for Trump’s America.

 

Paul Valent is a retired psychiatrist and writer. His latest book is ‘Heart of Violence; Why People Harm Each Other’.

 

 

 

Hi All,

June 14, 2020

We are in the 4th month (or is it  forever, or is it limbo time of some kind) of the pandemic.

One way to keep sane for me was to write. And there was plenty to write about. The bushfires, the pandemic disaster, the deaths in America, and the ever-hovering Trump.

But hey, we had a resumption of family dinners, tentative visits to friends, and we went to a restaurant.

I hope you like my latest pages.

The Heart of Violence; Why People Harm Each Other

May 8, 2020

Dear Readers,

How are you all? I hope that the corona virus has not touched you. They are certainly strange times.

During my home detention I have reflected on this strangeness in three pieces you can find on the posts below.

But my biggest piece of news is my new book ‘The Heart of Violence; Why People Harm Each Other.’

Those of you familiar with my work, know that I have been a traumatologist, that is, working with victims and survivors. But since my childhood I wanted to know why people wanted to kill me and my family in the Holocaust. So this book is about understanding perpetrators.

As I delved into this quagmire, I realised that the Holocaust showed in sharp relief ‘lesser’ types of violence. So this book is about understanding all types of violence. I think, like traumatology, there is an emerging discipline of violentology.

Violence is not an encapsulated part of the mind. To understand violence, we must understand the mind, including love and lovelessness.

I conclude my journey thus:

“I loved the human mind, the most wondrous miracle in the universe. I felt sorry for its injuries, but admired its capacities and strivings.  I hope that this book will contribute to the mind’s self-knowledge, which in turn may, in these again precarious times, tilt the world, even if only a little, from ignorance and violence to understanding and love.”

What have we learned so far? (Corona pandemic)

April 30, 2020

  • What have we learned so far?

The corona pandemic has thrown our normal lives up in the air. How the pieces will settle is to a large extent up to us. Taking a look at how we got to where we are may help us choose a better future

Initially we heard reports from China and Europe of ever-increasing numbers of deaths. The pandemic was likened to the Spanish flu, the Second World War, even the plague and the Apocalypse

As infections and deaths reached Australia, we were faced with existential questions, such as do we let the virus rip through the community toward supposed herd immunity? But if in the process suppose ‘only’ 1% died, that would mean 250,000 deaths, which would almost equal three times the number of Australians who died in the two World Wars. Such attrition, accompanied by overwhelmed health workers who would have to decide who would live and who died, was unacceptable. Read more…

Letter to Child Survivors of the Holocaust in the Times of the Corona Virus

April 17, 2020

The current corona virus crisis has been likened to World War Two. For many child survivors of the Holocaust the crisis has indeed triggered memories and feelings from those times. The letter to child survivors mentions the similarities but also emphasises the differences between current and past times.

View the PDF letter

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Corona Pandemic; Taking Care of Our Minds

April 5, 2020

During this corona virus outbreak we must take care of our minds as well as our bodies.

I had a signal of the previous weekend. Normally the three generations of our family celebrate birthdays, tightly squeezed around our dining room table, with merry conversation and plenty of laughter. On Saturday we celebrated my granddaughter’s birthday in a park. No hugs or kisses. My arms ached to hug across the requisite two meters distance. Furtive glances. I felt like crying. What will become of us in the coming months? Read more…

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Seared by the Fires

March 31, 2020

Among current concerns about corona virus, economic and political downturns, and climate change, let us not forget survivors of our recent major bushfires. Understanding their survival and its costs, now becoming apparent (The Age) will not only help them, but can help us all as we lurch currently from one stress to another. Read more…

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