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In Part 1 of this newsletter I addressed the demoralization of many physicians in this country. I discussed why doctors are leaving medicine and retiring early. This letter is devoted to a significant portion of my patients who have been experiencing their own kind of malaise.

A couple of months ago a patient whom I’ve known for years came to my office for a routine visit. Her husband is a recently retired dentist and she was his office manager. Together, they worked hard, raised a family, and served their community. A few minutes into her visit she began to tell me how sad she was about what was happening to her country. She said that the day before she just sat down and started to cry. She was not clinically depressed. She was mourning the loss of an America that she treasured.

She is not alone in her thoughts and feelings. Many of my patients, regardless of their political stripe, have expressed similar feelings. All of the major polls have shown a consistent disappointment with our leaders. The latest Bloomberg poll shows that 68% of Americans say the country is headed in the wrong direction. The president’s approval rating is now only 45%.

Congress has an approval rating of only 15% and people are frustrated with Republicans and Democrats alike.

If you’ve been listening to the rhetoric and observing the behavior of our leaders in Washington, the problem is clear: the problem is weakness. These people are weak. They are simply inadequate to the challenges of our time.


What is behind this weakness?

The reason that many Americans are frustrated is that they feel powerless to change Washington. And the problem with Washington lies with its people. Washington is made up of career politicians. With few exceptions, these career politicians are narcissists. I am speaking as a physician here; not as a layperson or a citizen. I am using the term “narcissist” not in a general sense, but as a specific, diagnostic term. What I am saying is that many politicians in Washington suffer from the narcissistic personality disorder. Managing the complex problems of this nation has become all about them – every decision they make, every vote that they cast, every speech that they make. It is all seen through a prism of what will increase their power, guarantee their reelection, or give them the spotlight.

Despite the soft scientific underpinnings of psychiatry that I discussed in a recent newsletter, the narcissistic personality disorder does indeed exist. It is a recognizable phenotype. We currently do not understand the genetics or the environmental causes of narcissism. Who knows if these people were toilet trained too early, raised by wire monkeys, or dropped on their heads at a critical stage of their brain development? But regardless of its cause, these narcissists are causing widespread dysfunction in our country.

Any honest psychiatrist or psychologist will tell you that the narcissistic personality disorder has a dismal prognosis. Narcissists make up only 1-2 % of the population, but narcissistic politicians create a wake in their path that can affect millions. There is no drug to treat narcissism nor do narcissists respond to psychotherapy. The mental health professionals I work with screen for narcissism before accepting a new patient. Good therapists will not accept a narcissist. It is a waste of their time and energy. Better to treat someone you can help. (For those who are interested in the characteristics of the narcissist, I have provided an addendum at the end of this letter.)

Once you find yourself entangled in a relationship with a pathological narcissist, the only way to survive is to extract yourself and get him out of your life. If you’ve ever had to deal with a narcissist in a business setting, as a neighbor, or even as a family member, you understand exactly what I am saying. You must cut all ties with the narcissist or she will suck the life out of you. So the practical question then becomes, given our weak and narcissistic leaders, how do we live our lives without becoming demoralized?

The Antidote to Malaise

As I was writing this newsletter, I came across a two page plan that I had written for myself three years ago. At that point in time I had reached the peak of my own frustration. During the public healthcare debate I was invited to do a lot of public speaking. I offered my professional opinion regarding the dangers of ObamaCare. I’m glad I made this effort, but I soon realized that it was not making a difference. My efforts were futile.

To treat my own malaise, I stopped wasting time on things I could not fix. I stopped being a medical Paul Revere. I declined all further public speaking engagements. I dropped out of the national concierge medicine organization and resigned from its board. In place of these efforts, I decided to put all of my energy back into my own work – my own practice. I decided to work on becoming a better doctor and a stronger person. These were the only things that I could control.

During these past three years I’ve done something else to feed my soul. I’ve had the privilege of doing some medical work with our Special Forces. As I tell them, they have done more for me than I could ever do for them. They have restored my faith in humanity. They are mentally tougher and physically stronger than I am. They have inspired me.

My Advice

So my advice to people who are feeling down about the state of our country is to first acknowledge the problem. Recognize that there is good reason to be worried, for yourself, for your children, and for your grandchildren. We currently have a group of weak, narcissistic leaders who are wreaking havoc in this country. Our country is not as strong as it once was. Sorry, but this is the truth. Some very smart people have argued that we have already reached a point from which we cannot recover. This may or may not be true. But even if it is, even if this country cannot reclaim its former greatness, this cannot be an excuse for us as individuals to stop striving to be the best that we can. We can reject the mediocrity.

To become stronger, there are 3 principles that I have continued to relearn throughout my life. I thought I understood these concepts the first time around, but I’ve often forgotten them during times of stress.

  1. Set tangible goals. When faced with despair, work hard on what you value most. Continuously set new goals. Get stronger. You will need that strength in the future. Because based on the daunting challenges that we face, things will almost certainly get worse before they get better.
  2. Surround yourself with excellent people. Seek out those who have something to teach you; people who have strengths that you do not possess. Allow yourself to be inspired by them.
  3. Cultivate an indomitable spirit. I don’t watch TV and I am not a fan of the ladies of The View. However, I remember a story told by Barbara Walters that may be applicable to the moment. When she started working for ABC News, Walters was panned by the critics. She was failing and she knew it. It was a time of great self-doubt. Then one day, she got a letter from someone whom she had never met. The letter read simply, “Don’t let the bastards get you down.” – John Wayne


General Features of Pathological Narcissism (Note: These are not the DSM V criteria for the narcissistic personality disorder, but are descriptors.)

Plug in the name of the politician of your choice and see if the description fits:

  • Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognised as superior without commensurate achievements);
  • Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist)bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;
  • Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);
  • Requires excessive admiration, adulation, attention and affirmation – or, failing that, wishes to be feared and to be notorious (Narcissistic Supply);
  • Feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favourable priority treatment;
  • Is “interpersonally exploitative”, i.e., uses others to achieve his or her own ends;
  • Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;
  • Constantly envious of others and seeks to hurt or destroy the objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel the same about him or her and are likely to act similarly;
  • Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, “above the law”, and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.