Clarity Through Chaos

One of the most difficult parts of being a psychologist is thinking clearly through chaos. Those moments are part of the job, and they matter. Decades ago, when I began training to become a therapist, my supervisors gave me several guidelines for evaluating a client, to help me think with balance, care and precision through emotional storms. They told me to begin with the basics, the setting.

Setting: 

Presidential Debate. 

Date: 

Just over a month before the 2020 presidential election. 

Place: 

National television, and immediately available internationally (in other words — everywhere).

The experienced therapists taught me to listen not only to the content (what was said) but also to the form (how it was said).

Content: Dangerous

Form: Chaotic

If I saw any sign of dangerous or chaotic thinking, then I needed to evaluate who might be at risk (self or others), along with the level of chaos.

Danger To Others: 

Consumed by self-interest. Appears unaware when his approach compromises the safety of others. 

Level of Chaos: 

High (unable to follow basic rules, violates boundaries, disregards structure).

If others were endangered, I learned to identify the targets and take steps to warn them.

Targets:

1. We The People

2. Our Democracy 

To Those Targeted: Consider yourselves warned.

In evaluating patients, I gauged their capacity for insight (self-awareness, understanding) and judgment (the ability to consider behavior and its effect on self and others). Insight and judgment are helpful markers for assessing overall mental status.

Insight: 

Little-to-no evidence of self-awareness or understanding.

Judgment: 

Impaired (unable to control his speech and contain his impulses, even though he knew he was on national television).

If insight and judgment showed signs of impairment, then I needed to evaluate reality testing (ability to assess accurately the surrounding environment, and one’s role in it).

Reality Testing: 

Evidence of inability to distinguish between truth and untruth. 

Words, behavior and thought process evident in my office provided a microcosm of words, behavior and thought process in the client’s life outside of my office. Using my interaction with the patient, I created a medium-to-long-term treatment plan.

Medium-To-Long-Term Treatment Plan:

Words, behavior and thought process evident in the debate provide a microcosm of words, behavior and thought process outside of the debate as well. As I imagine his debate-behavior at home with his wife and young son, or at an international summit, I am deeply concerned about this person’s capacity to function personally and lead politically. I strongly suggest forming a team to assess the damage and begin the (long, uphill, multi-faceted and jagged) process of healing on all levels — personal, family, community, national, international.   

To begin treatment, I was expected to document an immediate-to-short-term plan.

Immediate-To-Short-Term Treatment Plan: 

For The Subject — 

Subject is unqualified for his current job, and (urgently) needs to map out (assisted by others with intact mental status) an (effective and calm) exit strategy.

Treatment Plan For Everyone Else In the USA — 

VOTE.

Clarity through chaos. 

This moment matters.