Donald Trump: the psychological impact of toxic masculinity and how healthy, happy men diversify

I want to begin this piece by sharing how challenging it can be for me to understand the underpinnings of American masculinity as an American woman of color. Even after 10 years of experience as a clinical psychologist, coach and professor I still feel stumped sometimes in helping men navigate their career development and improve their interpersonal relationships, particularly as it relates to their masculine identity. I have a deep sense of curiosity and motivation to understand the perspectives of all my clientele. Public figures can also also stir my intellectual curiosity, especially when similar issues are cropping up among those I’m helping in my practice. I write as a way to synthesize the research and consultation I do with professional colleagues and members of various social groups to increase my understanding of particular clinical issues. By improving my understanding of how men operate within their gender framework, I can more effectively support their goals for happiness and achievement while respecting their values and world view. Donald Trump’s entire public life provides a rich opportunity to examine how male gender expression, at it’s extreme, can lead to a toxic psychological crisis in masculine identity. In this article I’d like to set aside drawing conclusions about his potential to effectively lead as President of The United States of America. Why? Just imagine for a moment, what it would be like to be Donald Trump’s therapist. You see, as difficult as it may be, therapists must aim to reserve judgment in order to understand and assess how to be helpful in creating healthy change and growth. If we can we understand Donald Trump’s psychological make-up as it relates to masculinity, surely we can learn something about the gender confines that men face in getting their psychological needs met as they strive for fulfillment and achievement. Why is this important? Trump reflects the toxic side of American masculinity, and if we don’t take a close look at how and why toxicity develops and festers within male culture, we can’t begin to stop it from infecting others in small or large ways in men everywhere. Imagine for a moment, a four way street intersection, where gas fueling stations are housed on each of the four corners. At each fueling station, you can ‘fill up your tank’ on: Physical Aggression/Strength/Athleticism Money/Influence of Financial Wealth Control/Influence Upon Others (at work or in personal relationships) Sexual Prowess and Virility/Sexual Satisfaction These four fueling stations can be seen as representing the most traditional, socially acceptable, even socially celebrated opportunities for men to fuel their sense of masculinity. Whether or not you personally agree with this, the vast majority of American men are measured by others against these four standards of traditional masculinity at various points in their life. While men also aim for other forms of achievement (e.g. intellectual development, family life development, practice of religious faith) those strivings aren’t typically seen as embodying strength of masculinity in and of themselves. Traditional masculine-affirming pursuits do not have to be at the expense of other’s rights, take on a quality of malicious manipulation and oppression, or require a man to rely on them as his sole means for fulfillment. Masculine identity serves men best when it allows space for them to thrive in these traditional areas should they choose, but also allows them ample space to enrich their lives through other areas of fulfillment and connectivity. Some men whom I’ve worked with appear to be ‘stuck‘ in the relentless pursuit of boosting one or more of these traditional areas of masculinity in the hopes of achieving lasting happiness. The theory of masculine overcompensation dates back to Sigmund Freud’s notions of ‘reaction formation‘ and ‘defense mechanisms‘. Some men respond to having their masculinity questioned by emphasizing their expression of traditional masculine traits. In 2013, a group of sociologists put this theory to the test. In Overdoing Gender,” a study for the American Journal of Sociology, men were given feedback suggesting they were ‘feminine’, which led to an increased support for war, homophobic attitudes, interest in purchasing an SUV, support for, and desire to advance in dominance hierarchies, and belief in male superiority. Research from The American Journal of Men’s Health and a host of other studies conclude that the expression of traditional masculine traits can be hazardous for men’s health functioning. William Ming Liu, editor of the journal Psychology of Men and Masculinity describes toxic masculinity as providing a very limited way for men to relate to each other- when boys are socialized to avoid feelings and weakness it increases their overall psychological stress. As a woman and mental health professional, it can be tempting to say “hmmm…have you considered seeking fulfillment from OTHER areas? You’ve already experienced objectively high levels of achievement through these traditional areas, and you’re telling me you’re still unhappy/unsatisfied. Why not pivot and diversify? See if some other areas of personal development could help you feel better/more fulfilled for the long term?” In my professional experience, toxicity can take root in a man’s masculine identity when he gets stuck searching for fulfillment from these 4 traditional areas of masculinity only. Without diversification, it can lead to toxic overdose! In Donald Trump’s case, he keeps going back for more and more like an addict- all of his accomplishments are no longer getting him that desired high, so he keeps upping the ante. Overdosed on orange self-tanner and sporting a shellacked comb over, surrounding himself with garish gold interiors, aggressively forcing himself sexually upon countless women, accruing more debt in the relentless pursuit of financial return, publicly decrying ideas of racial superiority that benefit himself at the expense of others, and finally, seeking political office as the world’s most powerfully influential men. He is feeding his own internal beast and he does not appear to be slowing down. I suspect there is a deep, empty abyss inside his sense of identity that is always starving for increasingly grandiose, self-serving displays of ‘success’. This particular phenomenon of toxic masculinity is not only psychologically unhealthy, but socially destructive when public figures like Donald Trump effectively normalize misogyny, sexism, racism and xenophobia. donald-trump While many American men aspire to experience some degree of his accomplishments in the areas of wealth, power, influence, access and opportunity with beautiful women, it’s important to underscore that these gains alone may very well NOT lead to the level of fulfillment and happiness one might imagine. Encouraging a more well-rounded sense of masculine identity, one that allows room for pursuits that go beyond the traditional male gender constructs will increase men’s opportunity for lasting and balanced happiness. Research by Levant and other psychologists reveal healthy aspects of masculinity might actually protect and improve men’s health. These healthy aspects of masculinity include: Self-Reliance Responsibility (personal, familial, societal) Emotional maturity/emotional intelligence Investing in making a positive impact on society/the environment that is personally meaningful Aiming to grow and diversify oneself in these key areas can help men achieve lasting personal fulfillment beyond traditional masculine pursuits for success. Each are common treatment goals I work on with the high-achieving men in my executive coaching practice. Many have shared with me how rewarding it feels to build upon what they’ve already mastered and thrive in these important life aspirations. Dr. Christina Villarreal is a mental health expert, executive coach, professor and writer practicing in the San Francisco Bay Area. Professional inquiries may reach her at www.drchristinavillarreal.com

Are you a tech junkie? When tech and media collecting becomes digital hoarding

Melinda Beck, a journalist with The Wall Street Journal welcomed me as a psychological expert and contributor to her article, Drowning in Email, Photos, Files? Hoarding Goes Digital. The extent to which technology is infiltrating our lives is taking a toll on our psychological well-being, and some of us are particularly at risk. This article skillfully discusses the development, associated symptoms and treatment of digital hoarding.

An excerpt from the article:

Christina Villarreal, a cognitive-behavioral therapist in Oakland, Calif., says she has clients in the tech industry—young men mostly—who spend so much time and money amassing collections of music or games or gadgets that they withdraw from the real world. “They can’t pay their rent or buy food because they have to have this latest piece of equipment to support their habit,” says Dr. Villarreal. She notes that hoarding often starts out as a way to feel good or fill an emptiness in life, but it leaves sufferers even more isolated. She helps clients relearn basic social skills and find other enjoyable activities instead.
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The field of psychology is still establishing healthy standards of functioning when it comes to the consumption of technology. The Diagnostic and Statistical Manual for Mental Disorders IV (DSM-IV) does not currently recognize digital hoarding as a mental disorder however it is being considered for inclusion in the DSM-V's main manual or as an appendix for further research, which will be published in May 2013. To better understand the basis of hoarding, review Do you have Chronic Disorganization, Clinical Hoarding, or are you just a 'packrat'?

How do mental health experts currently determine when digital collecting becomes 'digital hoarding' and dysfunctional in a person?

Psychologists like myself are likely to diagnose someone as dysfunctional when their digital collecting behavior begins to impact multiple areas of their functioning in the following ways:

occupational and/or academic demands are no longer consistently met due to the quanitity of time spent researching, collecting and organizing digital devices and/or media
social withdrawal and/or isolation patterns emerge with friends and/or family
social relationships begin to deteriorate and/or suffer negative consequences
physical functioning/self care habits show decline, such as neglecting regular exercise, poor dietary choices that result in significant weight gain or loss
sleep deprivation
poorly managed finances/debt as a result of digital/technology driven spending habits
difficulty stopping or reducing their collection of digital devices and/or media files that go largely unused
noticeable changes in mental functioning that result in symptoms of depression, obsessive/compulsive anxiety, or substance abuse
poor insight/inability to see the connection between their collecting habits and the negative consequences of their behavioral choices


What kind of treatment, if any, helps someone with digital hoarding problems?

Cognitive Behavioral Therapy (CBT) is an evidence-based form of psychotherapy that can help to alleviate negative symptoms and improve overall functioning. A well planned treatment regimen may include:

Systematic Desensitization also known as Graduated Exposure Therapy
assessing the need for psychotropic medication to reduce symptoms of obsessive thoughts and behaviors, anxiety and/or depression
identifying/increasing other enjoyable activities into daily life
increasing social opportunities for support
social skill building when necessary
developing and maintaining healthy self-care for diet, exercise and sleep patterns
support for debt management

Dr. Christina Villarreal is a licensed clinical psychologist in Oakland, CA. For further questions or referrals email her at christina.villarreal@gmail.com

Mental health of Californians- Find out what factors put you at risk. By Dr. Christina Villarreal

Researchers from UCLA have determined that 4.9 million people in California believe they need help for a mental or emotional health problem. So why are so many of us suffering without getting the treatment we need? Part of the problem may be stigma. It’s hard for many Californians to acknowledge they need help — to their family, friends or their doctor. The goal and challenge for policymakers and mental health care providers is to both target appropriate services to those in need, and to reduce people's fear of seeking help.

“There’s a lot of need, but also a lot of obstacles connecting those in need to the services that can help them,” stated David Grant, Ph.D., lead author and director of the California Health Interview Survey (CHIS).“The recession has created even more stress for people,” he acknowledged. As a result, this study “is probably an underestimate of the true level of mental health need in California right now.

Researchers from the UCLA Center for Health Policy Research also determined that approximately one in 25, or more than 1 million, reported symptoms associated with serious psychological distress (SPD), which includes the most serious kinds of diagnosable mental health disorders. Of those adults with either “perceived need” or SPD, only one in three reported visiting a mental health professional for treatment, a factor potentially attributable to fear of stigmatization, as well as lack of insurance coverage, the researchers said. The study draws on data from the 2005 California Health Interview Survey (CHIS), which is administered by the UCLA Center for Health Policy Research.

What factors put you, or others you know at risk?

Women at risk
Women were nearly twice as likely as men (22.7 percent vs. 14.3 percent) to say they needed help for a mental or emotional health problem (“perceived need”), such as feeling sad, anxious or nervous.

Working-age adults at risk
The prevalence of perceived need was twice as high for adults under 65 as for those 65 and older (20.2 percent vs. 9.2 percent).

Income a significant factor
The poorest adults — those living below 100 percent of the federal poverty level — were much more likely to report symptoms associated with SPD than those with incomes that were even just slightly higher. The poorest were more than five times as likely to report SPD as those living at or above 300 percent of the federal poverty level.

Distress pervasive regardless of race or ethnicity
Although racial and ethnic disparities in mental health were found in the study, those differences diminished when adjusted for income. These findings suggest that mental health status is more closely related to socioeconomic status than ethnicity or place of birth.

Insurance coverage improves access to services
Adults with health insurance coverage were almost twice as likely to have received mental health services during the previous 12 months as adults without health insurance.

Stigma, cultural factors may impede access to services
Men, adults aged 65 or older, and Latino and Asian immigrant groups were far less likely to seek help with a mental health professional than other groups. The authors note that these findings suggest that stigma and cultural factors may pose a significant barrier to care.

So how do Californians compare to the rest of the country with regards to our mental health? California ranks at # 15th on overall occurrence of depression compared to other American states, according to the study "Ranking the States: An Analysis of Depression Across the States", which was researched and written by Mental Health America and Thomson Healthcare. It looks at data from 2002-2006 and was conducted from July to November 2007. The report compares depression levels and suicide rates in all 50 states and the District of Columbia and uses the information to highlight solutions to improve states' mental health status.

Composed by Dr. Christina Villarreal, Clinical Psychologist in Oakland, CA

Sources: UCLA, NMHA

The Impact of Health Care Reform on Mental Health Treatment

Congratulations to President Obama and Congress for the historic passage of the health care reform legislation, the Patient Protection and Affordable Care Act (H.R. 3590), along with the Health Care and Education Affordability Reconciliation Act of 2010 (HR 4872) which makes improvements to the Senate bill. The reforms should provide quality, affordable health care to nearly all Americans for the first time in our nation's history.

So what does this mean for mental health care? As a Clinical Psychologist in private practice for the past 3 years, I have seen many patients struggle to afford the psychological treatment they needed for their mental health. When I first began my practice in 2007, essentially all of my patients were paying for therapy out of pocket, or without the help of their insurance benefits. In the Bay Area, the average cost is $150 per therapy hour, with some therapists allowing a sliding scale fee for therapy. My patients’ average length of treatment is approximately 4 months of weekly therapy, with some coming in for brief, specific types of treatment, and others choosing to engage in long term treatment for 2 years or more. While many of these patients have health insurance, their insurance benefits frequently do not cover their psychotherapy because their mental health diagnosis is not considered parity. (see What The California Mental Health Parity Law Means: AB 88.) Further, in the face of many job loses and the rapid decline of the American economy in recent times, many patients found themselves no longer able to afford to pay for psychotherapy out of pocket.

"These reforms will allow Americans to achieve full health and recovery through significant investments in expanded health care access, including mental health, substance use, rehabilitation and prevention services, as well as collaborative care and chronic care management," said Laurel Stine, director of federal relations at the - The Bazelon Center for Mental Health Law. "This is particularly notable given that four of the ten leading causes of disability in the United States are mental disorders and 87 percent of Americans cite lack of insurance coverage as the top reason for not seeking mental health services," Stine added.

"Furthermore, these reforms are truly significant triumphs in the integration of mental health in health care," said Stine. "Building upon the recent congressional victory of mental health parity in 2008, millions of Americans will have parity benefits and the guarantee of mental health coverage and will not live in fear of being denied coverage due to a pre-existing condition, such as a mental disorder."

Only time will tell to what extent the health care reform will significantly influence the management of mental health problems in the United States. However, this appears to be a step in the right direction in addressing the dilemma of untreated mental illness in this country.

This article was composed by Christina Villarreal, Ph.D., Clinical Psychologist in Oakland, CA

Mental Health of concern to Denver Convention attendees

Chatting with convention goers outside the Colorado Convention Center on Sunday August 25 I met Hope Turlington of Raleigh, North Carolina, who has abundant concerns over federal funding for mental health, both in terms of military veterans, and non-military citizens of the USA. She is distrubed by the prospects for returning Iraq vets dealing with mental stress and trauma as a result of service to this country.

Hope is deeply concerned about the effects of the scheduled "transition/closing" of the Dorothea Dix Mental Hospital. She pointed out that the great North Carolina Senator Jesse Helms has said that "our sick deserve a view from Dix Hill as much as anybody," yet developers are bidding to take that land away - to turn it into a money maker for a private entity at the expense of people suffering from various forms of acute and/or chronic mental illness. De-institutionalization is not a viable treatment protocol for many of the people who have been diagnosed and committed, yet the transition from John Umstead and Dorothea Dix Hospitals to Central Regional Hospital (CRH) began last month (July 2008.) The CRH-Dix Unit will be operational upon the closing of Dorothea Dix Hospital, but Hope fears a downscaling under the guise of the Olmstead decision that will force people out into society who are not able to cope without the support structures serving them today.

She was looking forward to the Health Care forum with Hillary Clinton later in the week, and hoping Elizabeth Edwards would be present as well. The looming upswing in U.S. citizens needing institutional care will place further pressures on the system - which is why any cutback in Raleigh is of overwhelming concern to Hope.

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