Art Imitating Life: Therapy, Dystopia and How to Get Through a Trump Presidency

Alternative Universe

I love writing dystopian science fiction. I love creating a world-building, character-developing, plot-twisting story that is so real, the reader can feel, taste, smell, hear and sense it, see it and believe it. More importantly, dystopian fiction is at its finest when the reader puts the book down and is greatly relieved it is only a story. He or she can go back to real life. “I mean, the real world is bad but not like that! Sick!” the reader might say.

However, in the past several weeks, life has imitated art, and an alternative version of our universe—something I would have written—has embraced me as if I were stuck in one of my stories in some cruel twist of fate. Dystopian or not, I have to get through the day and here’s how I and others can do just that.

By day, in the real world, I am a clinical social worker, a therapist, and I love my work.

On November 8, 2016 I had five openings in my schedule to see clients for November 9, 2016. However, slots for therapy don’t always fill and I was looking forward to not being swamped with clients suffering from an array of mental health issues. The months prior had been very difficult: I had to increase my hours as a psychotherapist to accommodate an increase in clients. Between September and December, 2016, there had been a 47% increase in clients seen for an array of issues during that period and symptoms mostly fell in the areas of depression, anxiety, symptoms associated with post trauma, interpersonal conflict and an increase in paranoia.

During this same period, there was an escalation of political attacks, negative campaigning and hostility between the Republicans and Democrats at a fevered pitch. After a spring and summer of Black Lives Matter protesting law enforcement’s violence to people of color, and the countermovement of All Lives Matter, I was genuinely looking forward to the early months of 2017 when I had hoped the winter would cool the heated debates, the battle for “the soul of America,” and some healing of a divided nation. In January 2017, the month the new President, Donald J. Trump, was sworn in, there was a 40% increase in the number of clients seen when compared to same time last year.

I had thought there would be some resolution, maybe peace in our time. That did not occur. I was surprised by the outcome of the election. And while later I would discover, like so many Americans, that my candidate won the popular vote, it was the electoral vote that would rule the day. It was very reminiscent of Bush v. Gore.

Regardless of the national news, geopolitical world, and the seismic shift in political influence, I still had the job of seeing clients and assisting them to be happier and function better in interpersonal relationships, productivity and growth. The day after the presidential elections I was scheduled to start at 9:00 AM with five client sessions over the next seven hours. However, within twenty minutes of arriving at work, my five scheduled clients grew beyond the seven scheduled hours to eight back-to-back client sessions. In addition, all projected hours for the next week were filled, and I took three urgent calls from people looking for both a reality check and immediate support. Other therapists, being as human as our clients, struggled with coming into work. Some were still in shock, others were angry, and many feared that some clients might present as joyous over the election, requiring the therapists to be stoic, non-judgmental and focused on the client’s wellbeing. Therapists are human, too.

What became crystal clear was that in order to be helpful, it was imperative to get a framework together that would help me help others. This is what I came up with.


Theory of Mind & Loss

Depending on your level of interest, issues involving politics, religion, race, culture, gender, and other hot topics may or may not capture your attention. These symbolic constructs, however, define a person’s schema. These schemas–psychological constructs about our world–are created, supported and/or challenged by peers, family of origin and day-to-day interaction in a person’s psychological outlook, sociological and emotional anchors, and personal expectations of their world.

In other words, our schemas are our cognitive understanding of how and why things in the external world exist or work. These schemas interact and affect perceptions which interpret the world. Perception becomes reality. Perceptions lead to feelings and behaviors. Depending on which camp you were in, your expectations were either a hit or a miss on November 8, 2016. Perception of what happened – the reality – either supported or challenged your cognitive schemas of your world. Expectations were either met or not. For those who expected one political party to win and it did, their reality is realized and life goes on; for those whose expectations were dashed, reality dissolved into an alien place.

This is why November 8, 2016 was not a typical day. It changed many people’s schemas, their perceptions, and therefore, their realities. To lessen my own discomfort and failed expectations, I invoked theory of mind, a human being’s ability to predict what another person might be experiencing and what they might be thinking and feeling, just through observations. More than empathy, theory of mind provides us an opportunity to predict action and understand other peoples’ thoughts, feelings, and behaviors merely by watching them. Theory of mind is the process by which we as a species can co-exist and cohabitate in social groups of various sizes. We see the absence of theory of mind in people along the autism spectrum disorder.

So what was I feeling? Sadness, confusion, anger, and fear; my reality was gone. With expectations not met, old schemas dissolved, and with an uncertain future ahead, I was experiencing what many of my clients and others were dealing with–loss. Dystopian.

Dr. Elisabeth Kübler-Ross, founder of the field of post trauma treatment, generated a stepped system describing how people deal with loss, involving five stages of grief, in her landmark book On Death and Dying. The stages go something like this:

  • Denial – Inability to accept the loss; shock and disbelief that such a loss could happen
  • Anger – Hostility and anger about the loss; negative feelings about the “inequity” or “unfairness” of the loss
  • Bargaining – Appealing to a higher power to “undo” the event; to be more active to keep the loss from happening; if a recount were to change the loss, future behavior would occur to make sure it never happened again
  • Depression – When denial, anger and bargaining have lost much of their steam, depression–a state of helplessness and hopelessness–sets in; feelings of guilt, tearfulness, emptiness, and loneliness are often experienced but can be soothed by time and with being with others
  • Acceptance – This is a state when the “loss” is reluctantly embraced and accepted; a bitter pill of reality and the need to restructure a new set of schemas, a new lens to perceive the facts and a new existence.

Once I was able to remember all of this, it was a lot easier for me to work with my clients. Their feelings of loss, the new world and strange reality were all about the familiar leaving, expectations not met, and feeling unsafe. It was easy to see why clients with pre-existing depression, anxiety and post-trauma were profoundly agitated. That made sense to me. There is a treatment protocol for dealing with grief and loss.

But there was an additional emotion that was palpable. While still part of the Kübler-Ross stages of grief, anger hung in the frenetic winds of change.


Combating Anger

Both sides were angry: the winners were angry that the losers would not let reality sink in while the losers did not accept that the other candidate won. There were clients and staff who were tired of the fighting and wanted to let the past be done, and other clients and staff that were interested in battling on. Similar to the preceding months, the rhetoric and hostility were no less charged and escalation right from the beginning of the new administration polarized the encampments still more.

To be an effective clinician and person, I once again turned to theory of mind to glimpse both sides. It required some extreme rethinking and restructuring to put myself into the other camp’s mind. To understand their thoughts and feelings that led to their actions, it was important to take the side of something antithetical to my way of thinking so that my cognitive schema could understand the other’s point of view.

To do this, I engaged in some mental role-playing to put myself in the shoes of the “other.” As a professional male social worker of mixed racial and cultural heritage, I chose the perspective of being a property owner in the south just before the outbreak of the Civil War. As the landlord, I imagined that, similar to my horses, shears and plows, slaves were simply a commodity, property, and a crucial key to my way of life. These slaves were the very element that not only kept my farm and family above water, but also maintained the economy and food security of the entire southern United States. What if I was not a racist but rather a businessman who needed every economic tool and resource available to keep life as I know it going? Where the North had a healthy variety of industries and economies built on different foundations, the South relied heavily on one thing: agriculture. And now my economic safety net was being threatened and my way of life was being criticized and put on the brink of extinction. At that time it was the Republican President Abraham Lincoln that was harbinger of the South’s end of days. The Federal government has essentially told me that my source of income and lifestyle are to come to an end and what is more, they have called me awful person, too. I would be angry about that.

Flash-forward to November 5, 2008, when Senator Barack Obama becomes the 44th President of the United States. He is man of mixed-racial and cultural heritage and my schema is now challenged but my expectations are greatly exceeded: I never thought I would live to see a man of color be president. But what was it like for the people who supported Senator John McCain in 2008 and former governor Mitt Romney in 2016? Surely they imagined that there would be sweeping changes that would alter their way of life. Would the country be safe from foreign government and domestic violence? Would Obama bankrupt the country with welfare reforms? Would he crush the middle class with taxes that supported people who were not motivated? Would he allow illegal immigrants take jobs away? Would he support the same American ideals, work ethic, and the invisible hand of capitalism that made this country great? At the time, this country was on the precipice of the abyss that was the Great Recession which affected us all. Their perception is reality.

I bet there were a lot of people who felt the same uncertainty I feel now.


The Process of Change

Similar to Kübler-Ross’s work, the model for change comes is stages. Often used for mapping out steps in treating addiction and clinical work, the Stages of Change look like this:

  • Precontemplation Stage – This stage involves the earliest thoughts about the need to change; it is a time when hints and worries about the future are haunting the person and he or she starts thinking about the need for change. This is a time where the end result is hidden, the expense of changing is seen as “too high,” and the end result nearly impossible to achieve. One relevant example would be the time after the election is over and the President is sworn in, at which it will be too late to achieve any change, so why bother?
  • Contemplation Stage – This is the stage in which thinking about changes and taking steps to make those changes come into play. While no action has started and no plans have been implemented, this is a critical stage in that cost/benefit ratios are reviewed and return on investment of energy and resources is assessed. This is where hope is born and steps are initially thought of as to how to start and where those steps might lead.
  • Preparation Stage – Preparation is all about taking stock of what you have, looking at what you need, and putting it all in order to get you to the place you want to go. Whether it is to lose weight, run a marathon, or become politically active, preparation is about developing the plan to take action. While it is always good to start out with small, achievable goals, it is important to remember that, whatever changes you want to make, doing the same things as you did before will yield the same results. If you want different results, you have to do things differently. To expect that taking the same steps that previously led to failure would now lead to success is the very definition of insanity.
  • Action Stage – After all the thinking, processing and planning, the step to change course, initiate the plan, and move towards a change is finally launched. After the initial anxiety and possible false starts, the action stage involves movement towards your goal. People usually are ambivalent in this phase–excited about the possibility of taking control and influencing something, and yet fearful that all the thinking, planning, and action will be for nothing. It is at this phase that I remember what my old clinical supervisor would say: “It’s a marathon, not a sprint.” However, this is hard to remember.
  • Maintenance Stage – At this final stage, the very difficult part of the change process steps in to reinforce the positive steps gained, drop the things that were not successful, and systematize the resources, time, factors, and variables that made progress in action work. This phase is hard for three reasons–you have to remain vigilant, vigilance leads to fatigue, and fatigue leads to boredom. This is where a “relapse plan” needs to be in place to get a person back on track to continue the change he or she wants. Whether it’s creating a support group, daily reminders, or a new strategy, a relapse plan is critical to keep and push forward the gains from change process.

While not necessarily part of the Stages of Change process, I remember the best advice I got from a client twenty years ago: “You can start your day any time, Joe.” Just because things are difficult and you’re having a bad day, a change in attitude and action can give you a new start. And you have the power to do it any time you want. This was helpful on November 9, 2016.

Next Steps

So what do dystopia, theory of mind, cognitive schemas, stages of death, dying and change, and starting your day any time have to do with President Donald J. Trump? What comes next are things we’ve all heard but the reason they are repeated over and over is because they work. For many of us, these things might be something new that lead to different outcomes. The following plan will help me help my clients, colleagues, friends, families, and a couple of neighbors:

  • Embrace homeostasis – This is a physiological term that describes a system’s tendency to seek out equilibrium and balance things to an optimal point. After eight years of one form of leadership and politics, it was bound to swing back. Accept this.
  • Be flexible – As a species, those creatures that adapted quickly to a rapidly changing environment survived. Those who are flexible adapt the fastest. Evolution and survival of the fittest were never about intelligence as much as about adapting fastest to sudden changes.
  • Reframe reality – The “new reality” is an impetus for action. The way I look at it, it’s 1967 all over again: the space race is on, the Kennedy brothers are gone but we still have Martin Luther King, Jr., protesters swarm the streets over inequality, poverty, racism, and the Vietnam War, Jim Morrison and the Rolling Stones (band and magazine) are in play, and the Cold War is at an all-time high. For me, it’s just like old times (I was five years old); for those younger, here’s your chance to make history.
  • Find your friends – Support during these times is critical. As a species, we are social for a reason; together were stronger, ideas can be exchanged and resources shared.
  • Find your adversaries – It is our personal silos that keep us from understanding others. Theory of mind best occurs when time is spent with new people, different ideas, and novel situations. If we do this, we not only can step into other people’s shoes, we will be more tolerant, more open, and less rigid.
  • Go to your medical doctor – All things begin and end with your physical health. To keep stress at bay and to live a better quality life, taking care of medical issues, staying ahead of them, and treating them while they’re small will help during these critical years.
  • Get moving – Exercise will not only keep you healthy and reduce stress; it will also help with decreasing anxiety and depression, improve your attitude, keep you from getting sick, and energize you. If there ever was a time to be energized, it is now.
  • Watch what you eat – Exercise is only half of the answer when it comes to being energized. Like everything in life, what you do and what you eat and drink need to be balanced. Sorry, there is no magic menu or secret arrangement of nutrients or diet system I can recommend. It comes down to getting nutrients from food and liquids that are less processed and more natural and in combinations that are balanced for humans.
  • Get therapy – If, after doing everything above, you still think a) “I could be happier,” and/or b) “I could be functioning better,” then it’s time to see someone like me.
  • Be productive – Humans do best when they are engaged in productive, meaningful work. Sometimes we work because we need money. That’s alright if money is a means to more fulfilling work, not as an end in and of itself.
  • Be creative – Just as work is good, being creative–visual art, sculpting, dance, writing, poetry, reading, acting, music–all of these and more enhance the meaning of life. Being creative energizes us, keeps us from being bored, and makes life a whole lot more interesting.
  • Learn some new things – Similar to meeting people outside your comfort zone or trying to understand points of view that are diametrically opposed to you, learning something new enhances growth and allows for critical thinking and flexibility.
  • Get involved – If your candidate did not win, do something. Organize, protest, bang on doors, learn civics, and see your congressman or woman, but do something. If your candidate won but he or she is not what you expect, do something; if there’s a cause you believe in beyond politics, engage in it. And remember, mid-term elections are not far away.
  • It’s a marathon, not a sprint – Remember that it’s all about the long view. Whatever your long-term goals or desires, being patient is imperative. Keeping a steady pace and maintaining time, money and resources to get to the long view require patience.
  • You can start your day any time – The power to change perspective, shift attitude, and alter your own reality is in your hands. What you decide to do or not do is your responsibility.

And in regards to writing science fiction, maybe it’s time to write about a utopia–depending on your perspective–about an alternative universe where there is a Hillary R. Clinton presidency. I sure won’t give up my day jobs.