How the Emergency Room taught me to confront a bully


by Russ Peterson

The stench of charcoal and vomit told me more than the patient did, and the story was all too familiar: “My girlfriend left me and I wanted her back.”

His mouth still black from charcoal, administered post overdose, the 22-year-old rambled a while longer before finally confessing: “I just wanted her to be scared.”

I waited, staring at him until he was uncomfortable. “Are you religious?” I asked.

“Here it comes. Preach to me!” he taunted.

“Ok,” I said. “Hell is where you send your loved ones when you toy with suicide. It’s not just about you. Everyone else has to pick up the pieces.”

For the first time he fell completely silent.

As an ER psychiatric evaluator, I had learned that suicidal patients weren’t always intent on dying. While a small number sought death, most were temporarily overwhelmed by pain or loss. This patient practiced end-stage manipulation, and recognizing that in my work could make the difference between life and death.

How does manipulation like this begin? The answers are many, but I’ll focus on a particularly relevant one. Among the most common lessons learned on the childhood playground is reciprocity, or give and take. Life mandates a series of social transactions, and children learn that to get they must also give. Others have something to offer, and the price is subject to negotiation. Trade—whether for material possessions or social influence—is one of the foundations of human society.

But what if a child develops in an environment where—because of enormous power, wealth, or influence—he or she doesn’t have to negotiate with peers? When an imbalance of power persists, the child may fail to see others as peers and remain unable to identify with their needs. Instead of developing an empathy-based paradigm for relating, the child may develop an object-based paradigm, seeing others as resources to be exploited.

When a powerful person views others as objects, he may overpower them for personal gain. This bullying has a natural response: victims learn that to overcome the imbalance of power they must organize against him. The bully becomes acutely aware of this dynamic: “They’re all against me, so I’m going after them.” The bully’s object-based paradigm is strongly reinforced and conflict becomes his norm.

Conflict is not only normal for the bully; he leverages it to propel him to power. History is replete with tyrants agitating against scapegoats. For his part Trump agitated against Hillary; the war cry, “Lock her up!” was a staple at his campaign rallies.

As the bully’s worldview is reinforced, his pathology advances, encompassing each of the following:

narcissism: the world revolves around me
predation: willingness to crush others to achieve one’s goals, and
manipulation: ability to create an alternative reality and cause others to share it.

When the bully gains power, his grasp remains forever insecure, for he recognizes that those he crushed are likely to organize against him. Knowing this, how does a bully prepare to retain power?

By creating chaos.

Although chaos is inherently difficult for most to grasp, it’s the bully’s instrument of choice to thwart organization against him. If a bully can set enemies against each other, they are less likely to combine against him. Even if unsuccessful, the bully can use the time it takes for enemies to regroup to his advantage. From this perspective, Trump’s conflict creation stems not from garden variety incompetence; it is instead the work of a skilled bully plying his trade—creating chaos to strengthen his grip on power. It’s what he knows, and the art of his deal.

Two examples from the Trump presidency illustrate this point. First, consider his fight with the intelligence community. A rational person might wonder why Trump would “bite the hand that feeds him.” But in a bully’s mind it’s always “us against them.” Trump understands that the intelligence community already possesses unfavorable information about him. By going on the offensive he gains the strategic ability to preempt release of the same: “Of course the intelligence community would say ____ about me; I’ve been critical of them in the past, and this is merely retaliation.”

Similar dynamics are at play in Trump’s relationship with the press. Past presidents have courted the press, but doing so requires time and a capacity for reciprocal relationships. Trump has more to gain here by making enemies. By playing the victim he can further distort the truth, avoid accountability, and garner sympathy from the unwitting.

It is not uncommon for the bully to accomplish some of his intermediate goals, only to later find his gains threatened by shifting circumstances. When this happens he is apt to move toward end-stage manipulation, bargaining with things (life, safety, or relationships) that wouldn’t normally be negotiable. The bully ups the ante as he plays an increasingly dangerous game.

What can be done?

Beyond explaining—and thus unmasking—the designs of a master manipulator, I have four specific recommendations:

1. Predictable Pathology. Early in my career I worked at a state hospital on a unit for high-functioning personality-disordered patients. My jaded boss made a game of predicting how patients would react to various situations they encountered on the unit. To my surprise I found he was almost always right. Personality-disordered individuals often exhibit highly predictable patterns of behavior.

One recent example: When Meryl Streep publicly rebuked Donald Trump’s behavior, Trump publicly betrayed his insecurities about what she had said. Whatever else can be said about Trump’s negotiation skills, no astute negotiator, businessman, or politician publicly displays his personal reaction to criticism, for in so doing he shows his enemies how to exploit his vulnerabilities.

Trump might recognize this on some level, but his narcissism is such that he cannot restrain himself. Much of his behavior can similarly be understood and exploited, especially by those experienced in personality disorders. If this doesn’t happen domestically, it will certainly happen abroad as foreign agents employ sophisticated resources in managing and outmaneuvering the United States president.

2.  Intelligent Leaking. Although America was divided prior to Trump’s entrance into politics, Trump has accelerated and exploited this division because it has been to his advantage to do so. His “me vs. the world” ideology allows him to dismiss opposition as a personal or political attack.

It follows then, that intelligence gathered on the current commander in chief must be disseminated in a new way. When either side can dismiss intelligence or dirt gathered on the other, credibility requires that important material be shared with an organization such as WikiLeaks or another party whose enemy is the secrecy endemic to both major political parties.

3.  Nuanced Reporting. I cringe when I see article after article with nothing good to say about Donald Trump. I cringe not because Trump isn’t deserving of criticism. I cringe because such articles play into Trump’s us/them narrative and reinforce his worldview; as such they are easily dismissed by his supporters.

If there is a better way and a more conciliatory tone, it won’t be proffered first by Donald Trump. The media can refuse to perpetuate the strictly adversarial discourse on which Mr. Trump thrives. In so doing, it can dilute the strength of his rhetoric.

4.  Escape Clause. The framers of the Constitution recognized that a president could be found unfit to serve even after being elected. They articulated steps whereby a sitting president could be peacefully removed from office. Two former presidents have been impeached for comparatively minor offenses. If impeachment is inappropriate at present, when would it be proper?

Some had argued in favor of giving Trump a chance, suggesting that once he reached his goal, he would soften his approach. But Trump hasn’t reached his ultimate goal. As with every narcissist, Trump craves universal admiration to compensate for his lack of real connection. With his assumption to the presidency, Trump has reached an intermediate goal. When threatened, he will be perfectly poised to practice end-stage manipulation.

Understanding Constitutional checks and balances, American citizens have the liberty of dismissing Trump as an overinflated demagogue. Unfortunately this view cannot transcend our national border. As the elected leader of the United States, Trump’s actions are seen internationally as conveying—accurately or not—the will and intent of the American people. Thus a dysfunctional president can cause irreversible damage to the reputation and leadership of the United States and undermine stable international relations for decades.

Unmasking manipulation in the ER often meant the difference between life and death. Countering bullying and manipulation on the national stage could prove the difference between preservation of the rule of law and the death of our Constitutional republic. It’s not all about Donald Trump. After he’s gone, everyone else will have to pick up the pieces.


Originally posted on Medium. Reposted with permission.