Dr. Paul Hokemeyer

Wealth Power & Celebrity: The New Frontier of Cultural Competency

The other night I came across a clip from “The Daily Show” with Jon Stewart, where he mocked of the phenomenon known as Sudden Wealth Syndrome. In the video, a “reporter” conducted an interview of the two clinicians whose research in treating people of wealth led the concept. During the interview, the reporter made the clinicians look like fools and lampooned them for being concerned with the emotional wellbeing of people of wealth. While I understand comedy can be biting, I was disturbed by the mean spirited nature of the piece and the insensitivity it showed to the full range of human experience. Essentially, the piece maintained that people of wealth are not deserving of compassionate clinical care; and that the two clinicians who devoted their time to understanding the very real phenomenon of Sudden Wealth Syndrome are in the crass conclusion of the reporter, “dick heads.” Like other minority groups, people of wealth and celebrity operate in a distinctly unique world where they face distinctly unique problems. Central to this experience are deeply entrenched power dynamics that keep them trapped in destructive mental health and addictive cycles. But most people, and many clinicians, fail to fully understand and effectively address these systemically based cycles. In their minds, wealth and celebrity are goals to strive for and imbue the holder with omnipotent and enviable control over their lives. They resent the power these people hold and label them as “whiney” and “self absorbed” if they reveal their vulnerability – vulnerability that comes from being fully human in a chaotic and uncertain world. Case Study: Jason*, was 42 when he came to see me for treatment. A super star in the world of finance, he grew up the youngest of three boys in an aspirational Jewish family. His father, the only son of Russian immigrant parents, suffered from untreated alcoholism and bounced from one failed business to another. In an attempt to bring financial stability to the family, Jason’s mother took a job in the handbag department of Neiman Marcus in Beverly Hills. She resented the fact that she had to serve the very people she longed to be and hated her job. Instead of receiving a legacy of unconditional love and support from his parents, Jason inherited his father’s alcoholism and his mother’s anxiety-fueled aspirations. “I learned from an early age that poor was bad. In my family, money and success was love.” Smart, charismatic and manipulative, Jason did exceptionally well in school and learned the ropes at a prestigious Wall Street firm. A short time later, he opened up his own hedge fund where he realized financial success beyond his wildest dreams. But like many people who aren’t emotionally and culturally equipped to deal with the financial windfall that came with his success, Jason found himself paralyzed by anxiety over his new identity in the world. “I was much more comfortable wanting to be rich,” he admitted after several intense and challenging sessions. “Now that I am really rich, I feel lost and alone.” To manage his emotional discomfort, Jason drank cases and cases of expensive red wine, utilized the services of “women of a certain commercial interest” (escorts), bought garages full of finicky sports cars that he never drove, a townhouse in Manhattan’s West Village, a beach house in East Hampton, a ski house in Aspen and villa for the “shoulder season” on the island of St. Barth’s. He came into treatment, not on his on volition, but rather through the demands of his wife who found in his phone a trail of infidelities and betrayals. Treatment In order to deliver effective mental health and addiction treatment services, clinicians must address their patients in the entirety of their being. This includes a host of features including their socio-economic status. Typically, clinicians are trained (as was I in both my M.A. and Ph.D. programs) to be highly sensitive to minority populations who exist in positions of powerlessness. But nowhere along this academic path is attention paid to minorities who occupy positions of power. But power, especially the power that comes from wealth be it suddenly acquired or acquired over time, fuels a host of mental health and addictive disorders. We see this most visibly in the lives of celebrities. But for every celebrity whose struggles are splashed about like pig’s blood in the tabloids, Internet and nightly news, there are legions of others who struggle under the radar with the intense power of their wealth. Sure it might be a problem that you wish you had, but there’s no denying that it’s a problem none the less – and a problem that deserves to be treated with clinically and culturally competent care. To be effectively delivered, mental health and addiction services that are provided to people of wealth and celebrity must address the powerful role money plays in their psyche and in their relationships. To be comprehensive, this analysis needs to occur on the following five areas of the patient’s life: The sociocultural framework in which they live: This includes the dominant cultural view of wealth and the zeitgeist surrounding money. In America, and other capitalistic countries, wealth is seen as an aspirational goal and a panacea that can solve all problems. At the same time, we are living in a time of great wealth disparity, hostility and mistrust towards people of wealth. This schizophrenic view of wealth, wherein it’s simultaneously idolized and demonized, causes people on all levels of the economic spectrum to view one another with mistrust and distain. Their family of origin: Just as we track mental health and addiction issues inter-generationally, we can also see how money is used in families as a reward or a vehicle to control. We can also look for compulsive spending, poor boundaries around money, bankruptcies and other financial events that impact a patient’s sense of place in the world. The inter-personal relationships in their lives: Money can be an energetic that is used to control and manipulate, to foster unnatural dependencies and serve as a substitute for intimate connections and emotional nurturance. The intra-personal relationship they have with their selves: Everyone has an internal dialogue and self-concept. For many, notions of external success are used to measure one’s sense of self and value in the world. This leads to a destructive “I am what I own” mentality. The psychotherapeutic relationship the patient has with his or her clinician: The typical clinician has not been trained in dealing relationally with a person of wealth. As a result, they either deny they’re impacted by money or use their wealthy patients to fuel their own narcissistic ego. In addition, many people of wealth are accustomed to being in charge of their relationships and either consciously or unconsciously intimidate their clinicians to avoid being challenged. In applying these five factors to the case study cited above, we can see how Jason’s drive to succeed was fueled from a position of pathology and weakness rather than from a place of strength and self-actualization. Rather than acquiring his wealth in a way that could contribute to his development as a fully functioning adult, he remained stuck as the little boy who desperately craved the love and approval of his mother. His mother in turn, didn’t have an outlet to constructively process her disappoint over her husband’s failure to achieve success in America, the land of opportunity and abundance. In her chronic state of anxiety, she passed on to Jason a legacy of uncertainty and fear. But perhaps the biggest tragedy in this family system is Jason’s father who came into a new and foreign land that valued material possessions over strong family bounds, biologically wired for addiction, with absolutely no understanding of his disease or tools to deal with it. So it was only natural that Jason from the tender age of 12 resolved to transcend his economic class, save his family and earn the love and respect of not just his parents, but the also the world around him. Instead of finding peace of mind and a secure sense of place in the world, however, Jason discovered the platinum trophy he sacrificed so much to acquire was cold, hard and insatiable; and that behind the curtain of his American Dream was the wizard of his addictions, pulling strings and forcing him to betray his self and those who loved him. To recover, Jason had to get a holistic perspective on his motives and drives, his emotional and biological makeup, and his relational patterns. He had to tease out those aspects of his self that were exceptional and harness them in constructive rather than destructive ways. Central to this process was Jason’s need to see how wealth, power and external success should be used to upholster the high performance jet he had become, instead of being the fuel that propelled it on dangerous and destructive missions. The good news was that in addition to inheriting challenges from his cultural, genetic and psychic environment, Jason also inherited incredible strengths. These included a strong middle class work ethic, a keen mind, a healthy and physically robust body, the drive to become a better person, solid family values and a willingness to change. With the proper clinical care and psychotherapeutic interventions, Jason’s prognosis was optimistic and promising. There’s no denying that material wealth and the comforts it brings are worthy goals to strive for. Used properly, money and the power inherent in it can provide a person with heightened sense of safety and security. It buys higher quality food, safer cars and homes, leisure and access to a full range of quality educational and healthcare options. But let’s not pretend that money and the effort expended to acquire and maintain it don’t also hold the power to enslave, because they do. Therefore, it’s critical when seeking help for mental health and addictive disorders that all patients, regardless of their place on the economic spectrum, look at the role money’s power plays in their lives and the full price of the external success they strive for.

Dr. Paul Hokemeyer

Dr. Paul Hokemeyer

Dr. Paul Hokemeyer on Arise TV's Entertainment 360 discussing stress

Seasonal Affective Disorder

This article originally appeared at FOXnews.com Eat your daily dose of happy by Paul Hokemeyer, PhD Seasonal affective disorder (SAD) is a form of depression that affects up to 10 percent of the U.S. population during the dark and cold months of late autumn and winter. In my Manhattan-based psychotherapy practice, I see a dramatic uptick in the number of patients who complain of SAD— a condition that features feelings of sluggishness and lack of motivation— starting around the middle of November. Rather than recommending medication, which they may become dependent on, I work within the realm of nutrition, exercise and traditional talk therapy to help these patients endure seasonal challenges. If you suffer from SAD, know that nutritional options are available to you. By incorporating a variety of food groups into your diet, you can maximize your brain’s inherent capacity to ward off sadness and cultivate a sense of well-being and contentment. Foods that are rich in the following have been shown to remedy seasonal depression: 1. Omega 3 fats Omega 3s enhance the brain’s capacity to produce serotonin. Serotonin is a neurotransmitter that researchers have linked mood regulation, and a deficit of serotonin leads to depression. During the wintertime, when serotonin production tends to slow down, foods rich in Omega 3s help rev its production. Omega 3 fats can also improve overall brain functioning and ward off intellectual sluggishness. Think of them as high-octane fuel for our brains. Great sources of Omega 3s include cold-water fish such as trout, salmon, mackerel and sardines, as well as flaxseeds, chia seed and walnuts. 2. Tryptophan Another way to increase serotonin levels is by eating foods that contain tryptophan, the chemical from which serotonin is made. In addition to producing serotonin, tryptophan works with two other hormones, noradrenalin and dopamine, to lift mood, promote relaxation and help deal with stress. Foods that contain high levels of tryptophan include lean chicken, turkey, brown rice, milk eggs, nuts bananas, peas, pumpkin and spinach. 3. Vitamin D In addition, several studies have found a correlation between depression and low levels of vitamin D. Also known as the sunshine vitamin, vitamin D is naturally produced when we are out in the sun. Because we tend to hibernate inside during the winter months, we need to supplement our vitamin D intake through our diet. Foods high in vitamin D include egg yolks, fortified dairy products, fortified cereals, beef liver and cod fish oil. 4. Whole, unprocessed foods In addition to adding key food groups into your diet, it’s important to subtract foods that cause a spike and corresponding crash in your blood sugar levels. Diets high in processed foods— those that contain high levels of simple sugar and white flour— will cause your mood to rise to unnatural heights and fall rapidly to uncomfortable depths. To avoid these unpleasant mood swings, eat foods made from whole grains, legumes and the freshest fruits and vegetables you can find. In addition, you can stabilize your blood sugar, and therefore your moods, by eating smaller, protein-rich meals several times throughout the day. Think lean chicken rather than white pasta, and omelets instead of sugary cereal. During snack time, avoid chips and other fat, salty or sugary foods and opt instead for yogurt, nuts and seeds. Remember, too, that comfort isn’t synonymous with happy and healthy. While fried chicken, macaroni and cheese, and pistachio ice cream may promise comfort in the moment, these foods will drop you like a brick shortly thereafter. Delay the instant but short-lived gratification you’ll get from eating comfort food for the more stable and longer-lasting pleasure you will get from making more solid food choices. Instead of languishing in your seasonal depression, use these winter months to make healthy diet and lifestyle choices. You will feel better emotionally, and welcome the spring in a happier and healthier frame of mind and body. Paul Hokemeyer, Ph.D., JD, is based in New York City, where he maintains a private clinical practice and serves as the senior clinical advisor for the treatment center Caron Ocean Drive in Boca Raton, Fla. A licensed marriage and family therapist, he is a clinical member of the American Association for Marriage and Family Therapists and a certified clinical trauma professional. Follow him on Twitter at @drpaulnyc.

Compassion Fatigue

One of the greatest gifts I receive in my work as an addictions therapist is to witness individuals and families surmount incredibly difficult challenges and embrace a life of recovery. Often the breakthrough occurs at the bitter end, when I’m scratching my head in disbelief that they can endure such intense levels of frustration and pain. Witnessing the thrashing that occurs at addiction’s hands is grueling. I’ve spent countless sleepless nights wondering if a patient will “make it” or “get” the breakthrough they need to begin the healing process. Fortunately, as a professional I’ve been trained to deal with the frustrations that come with this work. As a young clinician, I had wonderful mentors who taught me to never to give up on the human spirit. “You never know when the seed you planted will take hold,” was the steady advice of Dr. Stanly Evans, a man of enormous integrity and a pioneer in the field of addiction treatment. Another, Sid Goodman, creator of the highly effective Florida Model and Family Restructuring programs, constantly reminds me to be fearless and tenacious in challenging a family’s resistance to change. “You must think systemically,” he constantly instructs me when I’m baffled with what to do in a particular case. “The patient is the family and the family is the patient.” But even with this exceptional support, there are times when I get exhausted, crushed by the weight of a disease that diminishes the dignity and souls of my patients and their families. What is Compassion Fatigue? Compassion fatigue is a well-established concept in the realm of health care providers. First observed in nurses who worked in emergency rooms, it describes the sense of helplessness and hopelessness that can overtake a person providing care for someone whose suffering seems never-ending and insurmountable. It’s also a condition that I observe frequently in the families and loved ones of the patients I treat. Marsha* is an example of a wife and mother whose emotional spirit and physical health were beaten down by the seemingly hopeless addictions that plagued her husband and daughter. A once beautiful and vibrant woman, Marsha presented for treatment disheveled and profoundly depressed. Coffee stained her blouse, mud caked her shoes and silver roots defined the brittle locks of her auburn hair. Although she had a master’s degree in English and for years taught American literature at a local college, she could barely put together a coherent thought. “I’m just exhausted…tired…no energy.” It didn’t take long for me to realize why. Her 17-year-old, heroin-addicted daughter was expelled from school for selling OxyContin and had been in and out of five $30,000-per-month rehabs in the last three years. As if that wasn’t enough, Marsha’s husband of 27 years was on the verge of losing his middle management job at an insurance company for excessive absences due to his late stage alcoholism. “It seems he loves cheap vodka more than he loves me and our kids” Marsha sighed as she finished telling her story. Exhaustion, frustration and an overwhelming sense of hopelessness: these are just a few of the symptoms described by people who suffer from compassion fatigue. The following is a more thorough list compiled by the American Academy of Family Physicians. Common Symptoms of Compassion Fatigue Abusing drugs, alcohol or food Anger Blaming Chronic lateness Depression Diminished sense of personal accomplishment Exhaustion (physical or emotional) Frequent headaches Gastrointestinal complaints High self-expectations Hopelessness Hypertension Inability to maintain balance of empathy and objectivity Increased irritability Less ability to feel joy Low self-esteem Sleep disturbances Workaholism You can determine if you are suffering from compassion fatigue by taking a self-assessment test. If you respond with a 1 (very true) to more than 15 questions, it’s critical that self-care is your first priority. For Marsha, self-care meant finding something to anchor herself to when the gales of her daughter and husband’s addictions thrashed against her. Since she was a child, Marsha had internalized the belief that if she fixed those upon whose love she depended, then all would be well. It was a message she learned as an infant, completely reliant on the conditional love of a narcissistic and anorexic mother. But while her selflessness enabled her to survive her childhood, it trapped her in relationships that crushed her spirit and enabled those she loved to march uninterrupted down paths of self-destruction. Fortunately, for Marsha and millions of other people like her, there is a way out of these devastating relational patterns. The key of liberation is to acknowledge that your unhealthy response to other peoples’ behavior is a habit – and most importantly – that it’s a habit you can break. In his best selling book, The Power of Habit, Charles Duhigg, an investigative reporter for The New York Times, distilled habits into three key components. The first of these components consists of a cue. This is the cause of your reaction. The second is a routine. This is the effect. It’s the behavior you engage in or the reaction you have in response to the cause. The third is the reward. This is the benefit you derive or the instantaneous relief you feel once you’ve had your reaction. In Marsha’s case, the cue for her reaction to save and protect others was the unmanageability of her life, caused by the insanity and chaos of her family’s addictions. The routine she fell into was to become a caretaker extraordinaire. When a crisis struck (and there always was a crisis), Marsha became super mom and super wife. Like a caped crusader she swooped in and solved their problems. The reward she got from her behavior was having a moment, if only fleeting, of mastery and control – and perhaps most importantly – of being validated as a person who mattered. Unfortunately her habit, while enabling her to survive as child, had outgrown its usefulness. Now instead of adding value, it became deeply rooted in her family’s disease. How Can We Overcome Compassion Fatigue? Fortunately, Marsha possessed within her the tools to change. To recover, she needed to become hyper conscious of when her cue arose and implement different routines to address it. So instead of looking to control the externals of her life, she needed to enhance the mastery of her internal, emotional state. Central to accomplishing this skill was her coming into therapy and talking about what was going on in her life with a person who was completely present for her. Second, she needed to find and cultivate a life outside the stagnate confines of her family. In Marsha’s case, this expansion occurred slowly. Initially and reluctantly she started attending Sunday mass at her community church. A month later she was back at work, teaching English as a second language to families in need. Finally, she was able to get her daughter into a treatment program that had a robust family therapy component as a central part of its curriculum. The work that she and her family were able to do in this program broke the strangle hold of their addictions and liberated them in a spirit of mutual respect, love of self and each other. They were finally able to hear each other out and set boundaries that were clear, consistent and enforceable. Six months have passed, and is Marsha’s life perfect? No. But, it’s infinitely better than the life she found herself in upon entering treatment. Although her husband did lose his job, he was attending AA meetings and was cobbling together periods of sobriety. Her daughter was clean and living in a half way house in Florida and had just started a part time job in a coffee shop in Delray – a wonderfully robust recovery community. The greatest transformation, however, was that which occurred in Marsha. No longer were her eyes flat orbs surrounded by craters of darkness. In them shown a light of recovery and hope –evidence that her compassion fatigue had been replaced by compassionate strength for her self and others. *The name and identifying details have been changed for patient confidentiality. THIS ARTICLE FIRST APPEARED ON REHABS.COM- PROTALK