Personality Disorders, Narcissism

The Personality Disorder called Narcissism is in the news quite a bit these days. This week’s post deals with two questions: “What exactly is a Personality Disorder”; and, “What are the general dynamics of the individual who exhibits narcissism to such an extreme degree that it can be labeled a disorder?”

Narcissism is one of several “Personality Disorders” listed in the Diagnostic and Statistical Manual of the American Psychiatric Association. Personality disorders can be tricky because they include personality traits that are pretty common for most people.

For instance, have you ever thought friends whispering over in the corner were whispering about you? (Paranoid Disorder) Have you ever shared an idea with someone and they said, “That’s kind of weird, you know!” (Schizotypal Disorder) Do your relationships get so “rocky” at times that you fear being rejected, abandoned, and alone? (Borderline Disorder) Do you ever feel kind of indifferent toward some of your friends, sort of a “whatever” attitude? (Schizoid Disorder) Do you sometimes fear rejection and criticism that makes you hesitant to enter into a relationship? (Avoidant Disorder)

Most people would answer these questions, “Sure, doesn’t everyone?” Does this mean that everyone has a personality disorder? (In the previous paragraph, the type of disorder would be the word in parentheses following each question). Of course not. So how do personality disorders differ from “normal” everyday tendencies in all of us?

Personality disorders involve traits, emotions, and actions that are chronic, enduring, intense, and exaggerated. We’re not talking about everyday tendencies that come and go; we’re talking about habitual, reliable, and consistent ways of acting that extend across time and different situations. Because these tendencies can become thoroughly ingrained in the brain, personality disorders are notoriously resistant to treatment.

Take narcissism, for instance. The narcissist is chronically consumed by egotism: “I am the best at everything. It’s all about me. I am the primary ingredient for solving any problem.” Narcissists see themselves as special, entitled, perfect, and always right. To help them assert their dominance, they love to “stir the pot,” keep things out of kilter for others. They create chaos so others can’t react sensibly, and the narcissist can step in and take charge.

Narcissists need constant praise, support, and validation from others, like a leaking balloon that regularly needs air. Ironically, however, what narcissists want from others – empathy – they can’t give to others. Narcissists habitually lack empathy and insensitivity to others’ emotions. Who has time for others when wrapped up in oneself? Others must be constantly devalued, which makes stability in relationships impossible. Treating members of the opposite sex as equals is impossible; to do so would elevate them in status, and make them a threat to the narcissist’s extremely fragile ego.

Here’s the key to the narcissist: Deep down, probably at an unconscious level, they’re filled with self-doubt, low self-esteem, and feelings of worthlessness. They constantly fight against letting these “I-am-inferior” impulses out. Such a threat – I am inferior – to their gargantuan ego must be suppressed, kept hidden, or their personality will disintegrate. Anyone who disagrees with them or challenges them must be defeated, bullied, and subjugated so they can reassure themselves that, “I am superior and in total charge.” They can never admit they were wrong, or apologize to someone, because that would release too much air from the “ego  balloon,” and they would be plunged into psychological chaos.

The narcissist is vulnerable to these core insecurities that generally have their origins in childhood. Therefore, any circumstance that triggers childhood fears – often the fear is of authoritarian parents criticizing and ridiculing them as unworthy – has the potential to plunge them into anxiety. Thus, they must constantly be on the attack against others to convince themselves that they are in control. One thing for sure: Give an extreme narcissist power and the results will likely be catastrophic.

Most of us have narcissistic tendencies. That is, we like to look out for good old number one! Few of us, however, habitually – and with great exaggeration – display the traits and actions described above in our interactions with others. Most of us do not let our egos constantly get in the way of being sensitive to the feelings of others, and developing empathy for their discomfort. Thank goodness for that!

Choosing Well

When you cope with the stresses of everyday living, you have chosen to live. Coping with life is the opposite of avoiding life. Too often, people choose not to face their problems to stay in their comfort zone and let life pass them by. Their choice, of course, gives them an easy road to travel in the short run; but, over the long haul they constantly fight the gnawing reality festering inside them that, “I could have done better.”

Facing up to stress accepting it, confronting it, attacking it – puts you on a rocky road that forces you to carry a stress load that cries out, “I can’t handle this!” But you can, and that’s why you must persist. Only by confronting stress can you discover that the obstacles in your life road are not obstacles – they are the road.  

Choosing to travel this road brings you long-term benefits: empowerment, self-esteem, and a healthy connection to yourself and others. You come closer to a humble realization of your potential, as who you are emerges from empathetic actions in service of others. You discover your Honor and the humanity that comprises it: integrity, decency, morality, and values.

The Authoritarian Personality

After World War II ended and the Nazi atrocities were exposed for all the world to see, people could not help but wonder, “Why would anyone follow Hitler and help him carry out murderous policies that extended far beyond conventional warfare?” In 1950, social scientists Adorno, Frenkel-Brunswik, Levinson, and Sanford, provided an answer to this question when they published The Authoritarian Personality, based on their research at the University of California, Berkeley both during and after the war.

The authors hypothesized a specific personality type – Authoritarian – and proposed criteria by which to measure components of the type. Their measuring instrument was called the California F-Scale, the F standing for Fascist. The scale identifies a personality type that makes one susceptible to fascist, anti-democratic messages. The components of this type include: Belief in conventional values, and admiration of authority figures who preach those values; a worldview that sees danger from those who express individuality, independence, and imaginative thinking; acceptance of a simplistic view of reality as black or white, right or wrong, us or them; a belief that those who are wrong – them, the outsiders – must be suppressed and dominated by a forceful leader.

Someone with this authoritarian personality would obviously be attracted to a strong, charismatic leader like Hitler, and believe that he knows how to solve problems. He is confident and self-assured, he divides the world into good guys (Aryan non-Jews) and bad guys (Jews and various political and social groups), and presents issues in unambiguous fashion. Following him makes sense.

In 2016, before election day, Matthew MacWilliams, a PhD candidate in Political Science at the University of Massachusetts, did an informal survey of 1,800 South Carolina voters. In addition to the usual demographic questions (gender, race, age, etc.), and for which candidate they intended to vote, he also asked them how they thought children should be raised. Specifically, he asked them to pick only one from each of the following pairs of words to describe the traits they valued most in children and would want their children to show:

(1) respectful/independent; (2) obedient/self-reliant; (3) well-behaved/considerate; and (4) well-mannered/curious.

The first word of each pair reflects the preference of an authoritarian parent; the second word reflects the preference of an egalitarian parent. Interestingly, the voters’ candidate preference was strongly correlated with whether they chose the first or the second word of each pair: Trump voters tended to choose the first word; Clinton voters tended to choose the second word.

Politics aside, the authoritarian personality provides us with a valuable reminder about coping with stress: Sometimes your personality dynamics can make you overly susceptible to particular individuals and their messages that may not be in your best interest. Recognizing that fact and being alert to your personality tendencies can help you maintain critical thinking about messaging that sounds a little too good to be true. When confronted with any messaging, exercising careful and critical thinking is a good coping rule to follow.

The authoritarian research also illustrates how you might inadvertently validate questionable messaging by literally indoctrinating your children into obediently accepting your beliefs as best. For instance, if children are rigidly taught that it is best to obey the dictates of the person in charge – such as, Dad – they may grow up being vulnerable to messages from individuals they consider to be authority figures – like their Dad! In essence, they become vulnerable to cult messages issued from dictatorial and autocratic cult leaders.

Your parental childrearing values may be genuine and honorable, but surely – unless you are an authoritarian personality – you want to raise your children to think for themselves, and be able to decide on their own to identify with your values – not from a sense of obligation but from free and autonomous choosing. It’s great to teach kids your values, but you must be vigilant to do so in a democratic-authoritative – not authoritarian – manner.

History Shows We’re Not Unique

It’s a wonder any of us are sane. I mean, look at all the stressors we have in society: We have the evils of social media; we have regular reports on TV news about horrible things going on everywhere; we have larger and larger cities that are noisy, polluted, and overcrowded. People run from the cities and what happens? The suburbs become noisy, polluted, and overcrowded.

Feeling stressed from all these pressures? Of course you are! How can anyone be expected to cope well? Sure, you have a lot of excuses, a host of things in society that you can blame for your inability to cope. Still, the bottom line is you’ve really got it bad these days, worse than any other generation, right? Wrong!

In the late 18th and early 19th centuries, in both Europe and America, so-called “nervous disorders” were increasing drastically, especially among women. Today, these problems would be called anxiety disorders, and would also come under the general rubric of what we talk about in this blog: coping with stress.

Practitioners 100+ years ago blamed the increase in these nervous disorders on the stressors of modern civilization. First, there were the railroads, which made a lot of noise and transported people around very quickly, maybe too quickly for their brains to process calmly. Second, there was the telegraph, which gave almost instantaneous communication. Talk about immediate news! Who can process that? No wonder people were all stressed out. Third, American society had the sensory overload of overcrowding and noise in larger and larger cities, and their dirt and filth that took people away from the serenity of nature. Finally, there were an increased number of newspapers, magazines, and popular media sources that spread disturbing news among the populace. Bad news traveled fast and was plentiful.

Sound familiar? From a stress perspective, just how different, really, is 2020 from 1900? Just like now, people in 1900 had excuses and scapegoats to blame when they were having trouble coping. And, amazingly enough, the agents of blame were the same ones we use in 2020!

“But wait,” you protest, “we also have a pandemic.” Oh, sorry, the Spanish flu hit in 1918. Also, Americans had that little disturbance called WWI to worry about around the same time.

The point here is simple: your stressors are not unique, not worse than anyone on the planet has ever experienced. That pity parade doesn’t square with reality. So, you might as well accept your problems as a part of life, make yourself accountable in facing them, and develop a rational plan – that includes reading this blog – to cope with them. Sounds pretty empowering, doesn’t it?

Coping in a Pandemic

Nothing like a good pandemic to bring on the stress, right? The coronavirus of 2020 provides all the elements for you: You feel a lack of control of events going around you; there’s little predictability for you to hang onto; you worry not only about yourself, but also about loved ones who may become infected; you worry about your kids’ education and future; you get frustrated and lonely from social isolation, physical distancing, and wearing a face covering.

And then there are media reports that describe increased cases of people suffering emotional problems from it all. The reports say that more and more people are seeking professional psychological help; research documents all sorts of mental health problems – depression, anxiety disorders, PTSD, outbursts of anger, guilt, jealousy, envy, insomnia – as a result of restrictions imposed by the pandemic.

Are you doomed? Certainly not! Yes, the pandemic poses coping challenges for you, but that’s what life is all about. You can meet the challenge!

Before we talk about how, please keep in mind that when you’re surrounded by all the messages and reports that we mentioned above, you are at risk of “buying into them.” That is, reading about emotional problems that can arise from the pandemic, you begin to assume that it’s inevitable you will be victimized by those problems. You become caught in a self-fulfilling prophesy: (1) the pandemic is increasing mental health problems; (2) you decide, “I’m under a lot of stress, so I’m going to develop an emotional problem”; (3) you develop an emotional problem.

We made the same point in the PTSD blog entry on April 20, 2019. We said

When trauma strikes, PTSD is not inevitable. You can cope effectively with the excessive stress and anxiety and go on with your life. In the context of PTSD, it is important for you not to accept any message that says exposure to a traumatic event will automatically make you fall apart. If you’re prepared, and have the confidence that comes with feeling empowered, you less likely to disintegrate in the face of adversity. Consider the following exchange:

Interviewer: “Why are you so stressed?”

You: “I’m worried that since suffering that stressful event, I’m going to develop PTSD.”

What could be worse than developing a stress disorder because you’re worried about developing a stress disorder? You have set the stage for a self-fulfilling prophesy.

OK, back to coping during a pandemic. First of all, let’s review the coping model we often talk about in this blog. The components are simple: Accept the reality of your situation; no denials – hoaxes, conspiracy theories – or other distractions. Resolve to face reality by being Accountable for how you deal with reality; no blaming someone else for what’s going on. If you live today blaming others for yesterday’s mistakes, you will never cope with the challenges of tomorrow. Find some Humility to admit that you’re hurting and may need some help. Reach out to others in a spirit of Empathy; share your concerns with others, be a source of support for others, and discover that you’re not alone.

Finally, develop a Plan to deal with your stress. Make sure your plan encourages you to take actions that provide you with social connections. One of the hardest things about the pandemic is the requirement to socially isolate: No parties, no dining out with friends, no group activities. Maintaining physical distance from others creates feelings of social isolation, and few things are more threatening or disturbing to humans. After all, we are social animals.

With that thought in mind, consider a plan that includes regular “contact” with friends and family through platforms like Zoom. These are far superior to the static contact of something like Facebook. There’s nothing like real-time contact with another that allows you to see others’ facial expressions while you hear their voices.

If your plan includes professional help – and it should if you’re feeling out of control, profoundly depressed, or concerned about harming yourself – look into virtual psychotherapy. One such program can be found at LiveWell-Coaching.com – a counseling platform developed by psychologist Mike Ronsisvalle – that allows you to interact with a real person to help you deal with your stress.

A good coping plan will also include strategies for getting involved in service projects that allow you to help others. Such involvement will show you that others suffer like you, that you are not alone, and that you have empowerment strengths you did not realize. Let those strengths emerge from your supportive actions in service to others.

Here’s the bottom line about the pandemic: As is true in any other challenging situation, the pandemic does not automatically make you helpless to meet the challenges it presents. Don’t put yourself down with self-criticism – “I’m too weak to deal with all this.” – or excessive dependency. You are not weak; you are not evil; you are not helpless and dependent; and you are certainly not alone. Let the challenges of the pandemic spur you into productive action to take care of yourself and serve others.

Comparing Stress Loads

A few days ago, I saw a tweet about Joe Biden written by someone who had lost a child. The writer commented how he couldn’t imagine Biden’s pain from losing two children and a spouse. Then I ran across a reply to the tweet that said, “I’ve had it a lot worse than Biden, and so have most Americans.”

Let’s strip this exchange of all things political, and talk about coping with stress. Specifically, let’s ask, “Does comparing the intensity of your stress with someone else’s – “I have suffered more than you have” – help you cope better?”

Suppose you are in a support group to help you deal with some stressful event. You have just shared your story with the group and someone says, “Big deal. I’ve had it a lot tougher than you! You got off easy.” Would you feel better after hearing their story? I would imagine not. No matter how intense their experience was, your trauma and pain do not simply go away.

Here’s the thing: Being stressed out and needing help is not a competition. When you hear that someone else has problems that make yours look minor, you might be tempted to say to yourself, “Why am I getting so overwhelmed by my situation? Others have bigger problems than mine.”

Maybe so, but if your life is being disrupted by a specific stressful event, you need to tend to the problem, or the stress will intensify and likely lead to worse difficulties. The degree to which stressful events affect you is not determined by how your stress stacks up against someone else’s. And, when you start comparing stress loads, you may even feel shame and guilt if you decide someone else’s issues are worse than yours. Any way you look at it, comparing stress intensities is a losing proposition.

Consider this question: When someone says, “I’ve had it a lot tougher than you,” what is missing from their comment? Two things really: First is Humility. As soon as someone says their road has been rockier than yours, they are descending into the depths of self-glorification; they are telling you, “I, not you, am the primary ingredient in the recipe we’re dealing with here. It’s all about me!”

When you remove humility from your coping actions, you won’t be able to deal with your problems effectively. Imagine this exchange:

Jim: “I lost my job, I can’t sleep, I can’t eat, I’m depressed, I don’t know                                    what to do!”

Bill: “Oh, for heaven’s sake, give me a break. Try having your wife walk out                          on you with another guy, and leave you with two kids to raise.”

Jim: “Well, if you still have your job, at least you can afford to feed them!”

Bill: “Young kids need their mother! I can’t do that kind of parenting. I                                    need help and don’t know where to turn.”

This is pretty absurd, isn’t it? Jim and Bill are each working very hard to convince the other that his burden is heavier. The fact is, the burden is heavy for both of them, and they each need to address their respective problem.

In addition to humility, the second thing missing when stress loads are compared, is the sprout of humility’s seed: Empathy. In the exchange above, for instance, neither speaker empathizes with the suffering of the other; each feels only his own discomfort. The result is that neither is able to resolve their stress.

The irony for Jim and Bill is that if they bothered to appreciate the other’s story, they just might gain some insight into their own difficulty. When you’re stressed and upset, you struggle to find ways to deal with emotions like fear, anxiety, guilt, grief, jealousy, and others that rob you of stability in your life. At this point in the coping process, you think it’s all about you, and this self-centered emphasis makes coping difficult.

When you get outside of yourself, however, and bring others into the picture, the coping picture brightens. Whether you reach out to others with problems similar to yours, or work at trying to understand the effect you are having on others, substituting an “other-oriented” – rather than “self-oriented” – focus will provide insight into your problem. This focus is what we mean by empathy.

One final point to make about comparing stresses: Such a comparison is less likely when a victim is in a support group designed for his or her difficulty. Thus, “Compassionate Friends” and “Healing Hearts” bring bereaved parents together. If the issue is divorce or separation, there are support groups for women, men, those over 40, and even those with a specific religious affiliation. When you’re with similar people who have experienced problems like yours, the issue of comparison is less likely to rear its ugly head.

When Children Report Molestation

A child’s safety. It’s a prime fear of every mother, a fear that can add greatly to her stress. Naomi is a mom with a 5-year old daughter, Susie. She knows her child well and is always on the alert for signs that something may not be right. Susie has begun weekly piano lessons with Mr. Butler, and after just a couple of weeks, Naomi notes that she tends to get moody as the lesson approaches.

Naomi gets suspicious and starts to question Susie about her lessons. The questions are pretty straightforward at first, things like, “Don’t you like the lessons? Your dad and I think you’re really going to get good.”  “Are the lessons getting too hard?”

Susie is generally vague and non-committal with her answers. At one point, Naomi asks, “Does Mr. Butler do anything that makes you uncomfortable? Does he ever touch you?” Susie nods with her head down, and when mom asks, “Where?” she points to the inside of her thigh.

We’ll get back to Naomi and Susie, but first let’s ask what psychologists know about asking very young children if they’re being molested. In one study, a pediatrician gave children (5 – 6 years old) a routine physical exam that was videotaped. Shortly after the exam, the children were given an anatomically-correct doll and asked to show a nurse how the physician examined them. (These dolls are often used in suspected cases of child sex molestation, the assumption being that the doll’s anatomical detail will increase accuracy of the child’s story.)

A few – not all – of the children re-enacted events that did not happen, showing how the physician had inserted a stethoscope or tongue depressor into body orifices, or had hit them using an instrument. Were these children compulsive liars, determined to destroy the career of this physician? Of course not! Why the distorted story then?

A likely explanation is that the anatomical detail of the doll was a novelty that encouraged them to get creative with their play. In other words, they were playing games with a new toy. Ironically, the doll used to increase accuracy of children’s stories actually decreased accuracy in some cases.

Results like these raise concern because in cases of child abuse, children are often the only witnesses. Attorneys representing the accused are especially skeptical of testimony or accounts offered by young children, noting that they have active imaginations, and can be influenced by props like the dolls, and by how questions are structured.

Psychologist Michael Lamb says children are good witnesses – if they are interviewed correctly. Lamb noted 4 types of questions that can be posed to a child: Invitations – “Would you tell me what happened?” Directive – “What time of day was it?” Options – “Did he touch you?” Suggestive – “He touched you, didn’t he?”

Lamb reported that the first type of question is generally best because it allows free recall on the part of the child. The options and suggestive questions would increase the likelihood of error because the child is obviously influenced to answer in a particular way. Note above how Susie said she was molested only after Naomi opened the door with her suggestive question, “Does he ever touch you?” It turned out that Susie hated the piano and was looking for a way out of the lessons without disappointing her parents. There was no molestation.

The lesson here is simple. When looking for accuracy in children’s stories, give them freedom to move in directions that take their perspective – not yours – into account. Also, be clear about your unconditional emotional support, which will reassure them that their honesty will not bring negative reactions from you.

When you think about it, these suggestions would be helpful in any conversation. For instance, suppose a friend of yours asks for advice about how best to resolve a stressful issue confronting them. Most people take a “Here’s what I would do” approach when asked for advice. This self-centered strategy, of course, completely overlooks the fact that a plan of action must be developed from the other person’s perspective, not from yours. Also, assuring your friend of your unconditional emotional support – within limits, of course! – can bring them a lot of confidence as they consider their options and decide what to do to resolve their problem.

Do You Have an Internal “Ethics Compass”?

There’s no secret to increasing your chances of being emotionally healthy and feeling good. These states emerge from your perceptions and interpretations about events and people around you, and the actions you engage in because of those perceptions and interpretations. Emotional health evolves from a way of seeing the world, and a lifestyle that gives you a sense of coherence, purpose, and the confidence to meet the challenges of life.

In a very real sense, if effective coping is a work of art, you are the painter, the creator of your personal masterpiece. For some people, their “work of art” emerges from religious faith; for others from a general spirituality about existence – something greater than themselves; for still others, it evolves from service to others, from experiencing the richness of the human enterprise. And this is just a small sampling of perceptions and actions that bring people “good coping artwork.”

Whatever the source of effective coping, all of them provide an internal ethical and moral compass, a guidance system that directs actions that bring the actors – “painters,” if you will – great intrinsic satisfaction. This fulfillment is not dependent on material rewards or recognition from others; it exists in the good works carried out.

“Wow,” you say, “I like that! Tell me how to create my masterpiece of living.”

Sorry, no one can tell you how to go about finding your guidance system because – like happiness – it is not out there to be found. Intrinsic guidance develops from the expression of social values, ethics, civility, and respect for others. It develops from exercising a social conscience. It’s not something you can search for like circling a date on a calendar with the notation, “Beginning on this date I am going to be happy, productive, and fulfilled!” Don’t waste your time.

But if you stop looking for some expert to run your life, stop looking for the artificial chemical crutches, and stop being passive and dependent, you will most definitely cope more effectively with your challenges. You will make fulfilling discoveries along your life’s path.

The key is that moral compass; it is the secret to coping well. Many people who are suffering the adverse effects of stress – whether from a severe trauma or from an everyday irritant – do not realize that to cope with the stress, they must focus on their character: their ethics, their values, their integrity, their conscience, their honor. These traits are the seeds of humility and empathy, and without them, effective coping will always be incomplete.

Dr. Carlea Dries, a former student, told me a story I share often. Decades after his active-duty service during the Vietnam War, I asked a veteran how he continued to cope with the personal losses he suffered during the war and in the time since. He replied: ‘I celebrate their memories by fulfilling their bucket lists. I do what I can to continue their lives. I give hope for those who are lacking it. I don’t attend pity parties. I read to those who lost sight because even though I lost things, I still can see. I get groceries for those who lost limbs. I do what good I can because there was a reason I was spared.’”

Prescription Privileges for Psychologists?

Should psychologists be given prescription privileges? What this means is simple: If a licensed psychologist is treating a client who has been formally diagnosed with a severe disorder, such as Major Depression, should the psychologist be legally able to write a prescription for an anti-depressant? Other drugs of interest would probably include antipsychotics, tranquilizers, hypnotics, lithium carbonate, and mood stabilizers. A handful of states already allow prescription privileges for psychologists, and other state legislatures are considering it. Is this a good trend?

Many psychiatrists – they obtain their MD and then specialize in psychiatry – argue that only those who have graduated from medical school should be allowed to write prescriptions as part of treatment of mental illness. Dr. Ryan Hall, MD, president of the Florida Psychiatric Society, says psychologists “should not be allowed to write prescriptions for things like opioids, benzodiazepines, mood stabilizers, antidepressants, or anti-psychotic medications.” Why not? Because psychologists do not have the extensive training in pharmaceuticals and the human body that medical doctors do. It’s a defensible argument.

I think there are additional arguments that can be made against privileges for psychologists. These arguments do not refer to limited medical training, but focus on the idea that drug intervention is not always the answer when treating psychological disorders.

For instance, doctoral-level clinical psychologists – who receive four + years of rigorous training beyond college – are exceptionally good at diagnosing mental illness and treating it. Some professionals argue that granting them prescription privileges runs the risk of diluting their focus on diagnosis and therapy, areas that are their true strength.

Granting prescription privileges might also tempt psychologists to think more like psychiatrists and rely too much on medications. Unfortunately, there are no medications that will help a client achieve the kinds of personal change psychologists stress: personal empowerment; learning that you control only your emotions and your thoughts; developing an action plan to navigate more effectively the challenges of life. Also, disruptions in emotions like anxiety and anger brought about by life circumstances can be confused with mental illness, and lead to unnecessary drug treatment. Do we want psychologists going down that road?

As another example, consider that psychiatric medications work well with severe levels of some illnesses – such as, Major Depression and Bipolar Disorder – but are generally no better than a placebo for low and moderate levels – such as, Persistent Depressive Disorder. It is the moderate illnesses that psychologists deal with most often, and medications might be inappropriate.

It’s also important to note that prescribing psychiatric medications, even by a trained psychiatrist, remains largely a trial-and-error process. Matching a particular compound with a particular body physiology is not as easy as some people think. Medications for psychological issues work only about a third of the time. When they do it can take weeks to “kick-in,” a delay that can produce considerable frustration and despair when a client discovers nothing is changing.

Given all these potential problems, why add psychologists – who are trained in assessment and diagnosis – to the prescription mix?

There is a coping lesson that emerges from this discussion. If you feel you have a persistent, chronic, severe problem that significantly interrupts your daily activities, consult both a psychiatrist and a psychologist. Research shows that for many conditions the combination of psychological “talking therapy,” and psychiatric prescription medication, is more powerful than either treatment alone. Many of these professionals work together and allow their respective areas of expertise to complement each other. This partnership will provide you with a thorough psychological evaluation and diagnosis, decrease the risk of diagnostic errors, and help you work actively as a participant in developing a treatment plan that may include medications.

On the other hand, if your “problem” is more along the lines of dealing with moderate everyday stressors of life – such as, you’re worried about a project at work; anxious about making a presentation; distraught because your son was caught shoplifting; wondering how best to tighten the family budget – you might be better off seeing a psychologist and receiving assistance that does not involve the use of medications.

Resolving a Conflict at Work

Sharon enjoys her job except for one thing: She finds one of her colleagues, Eric, a royal pain. He thinks he’s hot stuff, and when around Sharon he acts arrogant and likes to make flirtatious comments directed at her.

Showing some empathy, Sharon says, “He doesn’t mean any harm but he’s one of those guys in his early thirties who acts like he’s still a college frat boy. He never really grew up. So, he often makes these not-so-subtle sexist comments directed at me, or says how attractive something I’m wearing is. No touching, no hostility, just being a pain in my butt. I tell him to grow up but he usually just laughs. He acts like a teenage kid teasing his sister. Like I said, harmless, but I’m getting tired of it and need to deal with him without poisoning the work atmosphere.”

We’ll get back to Sharon in a minute. For now, let’s get a general view of coping with stressful situations, even relatively small ones like Eric. If you want to cope effectively with bumps in your life road, you need to focus on six areas, six intertwined processes that help bring some order and stability to your life.

First is acceptance. You must resist the temptation to engage in denial about situations that bring you uncomfortable emotions. Denial encourages avoidance of yourself, which is incompatible with resolving your emotional conflicts. You must accept reality and your emotional reactions to it.

Second is accountability. Yes, this means taking responsibility for your mistakes and apologizing for them if need be. But effective coping also requires holding others accountable for the discomfort they impose on you. When things go haywire, it’s not always your fault.

Third is humility. Like virtually everyone, you have a natural tendency to make it “all about me.” Bad move. The needs of others have to be a part of your life path or you will descend into narcissism.

Fourth is empathy. Understanding yourself emerges from understanding others. That doesn’t mean you must feel sorry for them; it means that you can resolve conflicts better, and feel more independent and empowered because you act with the needs of others in mind, not just your needs.

Fifth is values. You must base your life on moral guidelines; you need an internal compass to guide you, a set of standards that give you a sense of personal direction.

Sixth is a plan of action. Any effort to cope with stress requires action. Your actions, however, must be thought-out, organized, realistic, and logical. Plus, they must be implemented forcefully and confidently, but calmly and patiently. The thing to remember about coping plans is that they will be most effective when they are based on acceptance, accountability, humility, empathy, and values.

With all this in mind, let’s see how Sharon tackled her Eric problem. Without going into a lot of detail, Sharon thought through her plan of action. She had a private one-on-one meeting with Eric and told him his flirtatious, immature behavior had to stop. She showed him specific parts of the company Employee Handbook, and pointed out that she had a basis for filing a complaint, but didn’t want to do so for the sake of office morale. She showed humility, but with a dash of assertiveness appropriate for this situation.

Notice how Sharon decided not to let things ride and avoid confronting Eric. She accepted the reality of his behavior, the emotions it generated in her, and the likelihood that it would persist. She also accepted that she had no control about what he might choose to do on a given day.

We already saw how Sharon was empathetic about Eric’s immaturity, and that helped her stay calm; that is, she knew she had to confront him, but she was able to do so from a task-based, not an emotion-based, context. She used the Employee Handbook – not an emotional outburst involving threats – to make her point.

Sharon clearly put the ball in Eric’s court. His actions were up to him, but if he refused to see things from her point of view – notice how she required Eric to show empathy for her – there would be consequences. She placed accountability squarely in Eric’s lap.

Sharon enjoys her job, and believes in integrity, reliability, teamwork, respect for her colleagues, and loyalty to her employer. Her plan of action was guided by these values, and allowed her to be open – and not overreact – to her frustration and irritation caused by Eric’s behavior, and allowed her to confront – not avoid – the troublesome situation.

Fortunately, Eric got the message and began to treat Sharon with more courtesy and respect. Had he not done so, she would have gone to plan B – the Employee Handbook and filing a formal complaint.