The Doctor gives us one hundred years.

By Dr David Laing Dawson

What an interesting time to be alive. I had grandparents who drove some of the first mass produced automobiles; parents who listened to the radio, took penicillin, and flew in planes; I grew up among a generation of boys who dismantled cars and rebuilt them to drive when we got our licenses at 16; we watched television going from black and white to colour, and analogue to digital, from large boxes to thin screens; we bought 64K computers; watched the first messages pass through the internet and modems; watched portable phones, libraries, laptop computers, arcades, cameras, pagers, slide rules, and calculators merge into this ubiquitous instrument we call a smart phone; we learned to say double helix, and then genome; we saw small amounts of data stored on microfiche evolve into terrabytes of data stored in something smaller than a thumbnail; my son and daughter work in the high tech industries; my grandson is studying artificial intelligence at University; and Stephen Hawking tells us we need to colonize another planet or two within 100 years or risk extinction.

If he is right, then the generations alive today are humans who have links to the early days of mass production in the industrial revolution, to the beginnings and early evolution of modern science, medicine, and agricultural practices, right though the digital age, space travel, and on to the destruction of the planet.

Our dramatic success over the past few generations (give or take some stupid wars, genocides and catastrophes) is leading directly to the demise of our species, all within a dozen generations. That is impressive if sad.

Hawking includes possible “acts of God” in his list of destructive forces (direct hit by a large meteor) but most scenarios include one form of suicide or another (pandemic spread around the globe, nuclear holocaust, the consequences of over population, and global warming).

Biologically our evolution has spanned millions of years. Until the industrial revolution our social evolution had been almost as slow and incremental. Capitalism, democracy, science, medicine, and technology have jet propelled (literally and figuratively) this social evolution the past 150 years.

Before then we were creatures surviving within a complex ecology, our population very slowly increasing, subject to the whims of weather, drought, wars, and pestilence. We had minimal effect on our planet. We could build a boat, a city, a canal, and a damn, but the oceans and forests continued, the rivers, deserts, and most of our earth’s life forms persisted. To survive through those centuries we needed to expand, explore, conquer, and exploit.

Not now.

Now quite suddenly we are the shepherds of our own destiny as a species, a life form. To survive we must all cooperate. We must give up notions of magic and Gods and competing feifdoms. We must stop population growth through all humane means of birth control. We must husband our planet’s resources rather than exploit them. We must have in place an international program ready to act instantly when the next pestilence arises. We must stop talking about economic growth and replace this with equitable economic distribution. We must stop destroying our oceans and forests. And of course we must either reduce our CO2 emissions or figure out how to capture them.

A tall order. Especially when some leaders of our fully industrialized nations want to pull us back to an age of competing xenophobic fiefdoms. A hundred years is but a blink of a galaxy’s eye.

Suicide Prevention. Let’s Talk. But Let Us Talk Truth. Part Four

By Dr David Laing Dawson

Part iv

Special populations

Teenagers

Juliette is shy of her 14th birthday and Romeo perhaps 16.  Shakespeare knew this tragedy would not play had these “star-crossed lovers” been much older.

The brain has not fully developed until age 22 to 25. Yet the years before that involve an intense social learning curve, a testing out and practicing, competing, comparing, shunning and sharing. The prizes are belonging, achieving, competence, prominence, intimacy, self-esteem and sex.

Our brains are also uniquely forward looking. We listen and scan for the minute and hour and day to come. We perceive and select from our environment information that informs us of what is coming. Even when we retrieve memory we shape it for tomorrow. We reform, reinvent the memory to serve our needs for today and tomorrow.

It is no surprise to me that when I ask a teenager what really happened at school yesterday or last week they respond with at least three versions that support their wishes for tomorrow, with total disregard for logical narrative. I have to fill in the blanks to get the true story, or at least a plausible facsimile.

And as teenagers they have limited perspective, limited sense of a world beyond themselves, limited sense of the many years and experiences to come. They live in the now, anticipating only tomorrow. Only a teenager could mouth the words, “If I’m not invited to the prom my life is over.”

And today teenagers live within this cauldron of social competition 12 to 20 hours per day every day of the week. Even when they reject it, as some do, they are defining themselves by rejecting their peers.

So, along with the risks for suicide listed in Part II teenagers also pose the risk of concluding – on the basis of what we adults know is a temporary setback but they see as life defining – that they should kill themselves: the posted naked picture, the rumour at school, the rejection, the betrayal, the public or gossiped accusation….

As I was writing this a Washington Post article popped up on my Blackberry Passport. A girl in the US is on trial for manslaughter. She had encouraged her boyfriend to kill himself through a flurry of texts. When he was parked in his pickup truck filling with carbon monoxide he stepped out and texted her. He wasn’t sure. He had second thoughts. She told him to get back in. This he did. She was 17 when she explained to him that a better life awaited him in heaven.

Apart from anti-bullying initiatives are there ways we can reduce this risk unique to teenagers and youth? Maybe.

  1. Ensure they have reprieve from the adolescent peer cauldron. Electronics off by 9 pm at the very least. Holidays totally away from this. Family time without electronics. More of their time with peers spent in supervised skill building activities.
  2. Know what is happening in your child’s bedroom.
  3. Know what is being posted on your child’s facebook and instagram account.
  4. Know what they are texting to one another. At least check on it occasionally.
  5. Never, ever let them have access to lethal weapons. And there are times a car or a truck can be considered a lethal weapon.
  6. Understand what I have written above about the adolescent brain.

And for teenage and youth counselors, therapists, psychiatrists and family doctors. Please, please, always see these kids with a parent. Make the time you see a kid without a parent an exception for a good reason. Not the kid’s reason, but a good adult reason. And the only good adult reason for not having a parent present is that you have seen the parent(s) and he or she is hopelessly drunk, violent, stupid, immature or in jail.

You see, it is seldom you (therapist, counselor) who can provide an alternative reality to a teenager drowning in his peer group, at least not for much more than an hour a week. But a parent might be able to with some encouragement, instruction, and advice. Just simply having a parent in that consulting room with his or her son or daughter may empower a parent to be a parent, may assign responsibility where it really belongs, and open the window for a teenager to see that there is an adult world with a broader and longer perspective.

Kim Jong-Un Goes to the White House

By Dr David Laing Dawson

In our histories there were times the mad arrogant king could demand that his subjects, especially the Lords and Ladies of his court, prostrate themselves in obedience and offer unlimited praise of his highness. They would do this because to refuse brought about death for themselves and a life of penury or slavery for their families.

To my knowledge Donald Trump does not have such powers (yet). But still his cabinet engaged in such a ritual display before the world. As if from a script they each in turn offered the same words of honour and subservience, rounding off with a fantastical account of the state of the nation, the world, and their particular spheres of influence, and indebtedness to his majesty.

I could only listen to a few of these and perhaps, maybe, someone in the circle diverged from the script later. The last to speak I listened to described such a delusional world view I could watch no more.

This is not something we should be watching in a democracy. Perhaps North Korea, or Saudi Arabia, not America. The penalty for not complying, of thinking for themselves, of being principled and honest is not death. At least not yet. Where is their pride? Where is their courage?

More importantly, if they do not find this courage soon, the day may come when the penalty for disobedience will be death and a life of penury for their children

Suicide Prevention. Let’s Talk. But Let Us Talk Truth Part 3 Suicide Ideation

By Dr David Laing Dawson

At least every second night on television I can watch an ad for a pharmaceutical during which a calm mesmerizing voice tells me of all the possible side effects of the drug being promoted. It is a voice playing over reassuring music and a pastoral video. Often, for a certain class of drugs, the warnings include “may cause suicidal ideation in teens and youth.”

The SSRI medications (from Paxil to Zoloft) come with the same warning and patients going on these medications are cautioned to watch for “suicidal thoughts”.

This is nonsense, of course.

If we had actually found a drug that, when taken, could instill a specific thought, the CIA would be all over it.

Pharmaceuticals can affect our arousal systems, heightening or dampening; they can affect our physiological sensations; they can affect our energy levels, our pain, our comfort, our ability to think clearly; but they do not instill specific thoughts. The very idea is ludicrous. Even the ingestion of mescaline or LSD requires specific anticipation, context and guidance in order to provoke either ecstasy or horror.

There is a history of how those warnings came to be, and political and legal reasons for drug companies to continue them.

When these warnings were first published and doctors in those small northern European countries (that keep complete and excellent national data) stopped prescribing these medications for depressed younger people, the actual suicide rate over the following ten years went up in that population. So most physicians went back to prescribing these along with the caution to “watch for suicidal thoughts”.

But there is something very instructive in all of this. We are social beings. How we think, how we express our thinking, how we react, how we negotiate with each other, the language we use to express our unhappiness or anger – these are all socially and culturally determined. We learn what works and we use it. We are highly impressionable. Especially when we are young.

So it is not surprising that with the dramatic increase in public awareness of, and the exhortations to watch for suicidal ideation, both the experience of and the reporting of a “suicidal thought” have dramatically increased.

People are routinely asked that question on surveys, on screens for depression used in family doctor’s offices, on psychological testing and in most encounters with a mental health care professional. The question is asked of most distressed people.

SSRI medication is prescribed for people who have been at least identified as being distressed and the question of suicide ideation has been asked of them. In some cases, often.

As a medical test used for an assessment of risk of suicide, the question, “Are you experiencing suicidal thoughts?” (in whatever form it is asked), now yields about 95% false positives. All clinicians know that it also yields about 1 or 2% false negatives.

The truth is many people who answer yes to a variant of that question are brought to emergency (see charts in part I). In the emergency department they are assessed in various ways. And they are allowed to leave when their answer to that question reverts to “No.”

At that point they are often asked to “contract for safety”. This is a particularly silly intervention and amounts to the patient being allowed to leave after he or she has promised to not hurt themselves.

This has caused several obvious and a few less obvious problems.

  1. With the emphasis on that question, the actual cause or nature of the person’s distress may be missed entirely: e.g. relationship distress, abuse, anger, anxiety, guilt, teen drama, need for parenting, fear, loss, grief……
  2. Misuse of relatively scarce medical resources.
  3. Support for and reinforcement of the “suicide threat” as being a legitimate way to negotiate with others.
  4. The emphasis shifts from patient care to safeguards against legal liability.
  5. Unnecessary admissions to hospital of people whose answers don’t revert to “No.” until they have been on the inpatient ward for a few days.
  6. Reliance on that question produces the 1 to 2% false negatives who should have been kept in hospital and treated, not because they said yes or no to that particular question, but because they were agitated, psychotic, or severely depressed, and truly at high risk.
  7. With mental health workers, nurses, doctors, so focused on people expressing “suicidal ideation” they can miss far more important indicators of high risk.
  8. Finally, some people experience suicidal thoughts not because they are suicidal, but as specific obsessive thinking, and sometimes, as an intrusive or unbidden thought, and sometimes as an inserted thought, experienced as being put in one’s head. This thought can take the linguistic form of either, “I should kill myself.” Or “You should kill yourself.” The thought itself is distressing to the patient. In the case of this being an obsessive thought torturing someone with OCD, it is not an indicator of high risk of suicide. But it is treatable with the same drugs and counseling that work with other OCD symptoms.

When the thought is experienced as being put in one’s head, and as a command, it does indicate risk, as well as psychosis. It is a symptom of a psychotic illness requiring treatment. However this person is unlikely to answer yes on a screen for “suicidal ideation”. It is a command hallucination that this patient will only admit to experiencing, reluctantly, within a longer, slower, quieter interview.

I know I can’t, but I would like to ask all clinicians and counselors to stop asking the suicide question, at least not as routine, not as a survey.  It is not preventing actual suicide.

Short Unofficial Profiles of the People Around Trump.

By Dr David Laing Dawson

Sessions: Obsequious little man who hides his hatred beneath an endearing smile and a soft southern drawl. Iago comes to mind. But Donald is not Othello. Think Richard III instead.

Kushner: Unreadable age, temperament and intentions. A Mona Lisa smile. No apparent anxiety, worry, puzzlement, or humour. That degree of control and confidence in what should be overwhelming complex human situations can only be explained by psychopathy. If this were a kingdom and he were next in line for the crown he would be plotting the death of the King already. Perhaps he is.

Bannon: I know this man, but not in a position of power. Intellectually brilliant, alone in his squalid rooming house, paying no attention to hygiene or diet as he pores over history and its many conspiracies, iterations and cycles to arrive at his own nihilistic philosophy in which mankind destroys itself and he can then look upon the rubble knowing that he is close to being a God.

Pence: A child-like belief in God and destiny, so much so that he can forgive the most egregious sins and comfort himself that it must all be part of God’s plan, even if it elevates him to a position for which he is not remotely qualified, and even if it casts him among sinners.

Ivanka: Though perhaps a little smarter than her father and perhaps slightly more empathetic, she has otherwise inherited or absorbed his tone-deaf sense of entitlement. I can hear her say, when told the peasants have no bread, “Let them eat cake.” Or at least, “Tell them to architect their own destiny as I have.”

Tillerman: A blunt and successful force in the business world, he became depressed when confronted by the daunting task of being Secretary of State for a naked emperor. He, alone among the group, realizes he has much to learn about government and nations. He will soon have a crisis of conscience. He knows he is on stage in “The Scottish Play”.

Spicer: Sean is a lost soul approaching the gates of hell. He knows it is too late. Ignominy awaits if he rejects Satan now. Ignominy awaits if he continues on this path. He will one day die the Death of Ivan Illych, tormented by his cowardice and his failure of conscience.

Conway: Kellyanne is Madam Bovary, trading on looks and charm, attaching to the man in the room who is most likely to bring her fame and fortune, luxury and TV time. She will happily say whatever pleases this man, easily convincing herself that truth is an overrated commodity. As her looks fade she will have to trade more on her willingness to flatter and lie. And she knows that when her Lord falls under the knives of impeachment she will be a welcome guest on all the talk shows.

Paul Ryan: A career politician since his days as student council president. The gift of a hollow smile and a brain always calculating the vectors of power. Honesty, ethics, morality, reality all fall beneath the sword of political expedience.  He is something of an Ayn Rand libertarian, which really means, “Let no agency have power, unless it is I.” and “I’m all right Jack; so bugger the rest of you.”

 

 

Suicide Prevention. Let’s Talk. But Let Us Talk Truth. Part Two

By Dr David Laing Dawson

Part 2

The problem with a public campaign to prevent suicides by identifying suicide ideation is that it is akin to a public campaign to prevent heart failure. Both actual heart failure and actual suicide are end stages of other processes, but in the case of heart failure we know enough to target cardiovascular disease, obesity, hypertension, diabetes, smoking, rather than “heart failure”. We do not say, “Call this number if your heart is failing.”

It is not a perfect analogy but one can imagine what would happen if we established dedicated phone lines across the country to respond specifically to people who felt “their hearts were failing”. And then what would happen if each of these callers were instructed to go to an emergency department.

Curiously the authors of the original article that surrounds the four graphs I included in Part 1 of this series, summarize by emphasizing the importance of identifying suicidal ideation and going to the emergency department for assessment. More of the same. Stay the course. Double down.

We do not easily give up our cherished beliefs. And as with many human endeavours, it is often politically and personally more important to appear to be doing something about a problem than to actually do something effective.

We know the demographics of completed suicide. We know the risk factors. We know the specific and sometimes treatable illnesses that all too frequently lead to suicide. So if we truly want to reduce the actual numbers of people who kill themselves (not threats, small overdoses, passing considerations), then we need to stop wasting resources on “suicide prevention programs” and put them into the detection and continuing treatment of those specific conditions so often responsible for suicide.

Let’s break that down.

There are some basic demographics that contribute to risk. These are older and male. This does not help us.

Then there are all the social factors that increase risk: poverty, unemployment, social isolation, divorce, living alone, alcoholism, drug addiction, chronic pain. Each of these can only be addressed by specific social programs (minimum wage increase, income equality, safety nets, affordable housing, retraining, community support systems) and focused treatment programs for alcoholism and addictions.

But there are specific high risk groups we can identify and for which we can increase accessible treatment and continuity of care. And these account for the majority of completed suicides. They include:

  • Recently discharged psychiatric patients.
  • Unrecognized developing serious mental illness.
  • Under treated serious mental illness.
  • Stopping treatment for serious mental illness.

So to put a dent in the actual suicide rate we should be putting our resources in:

  • Recognizing and making treatment available for Depression, Anxiety, Bipolar disorder, schizophrenia, severe OCD, PTSD (not for or identified by “suicide ideation”)
  • Providing good continuity of care, especially after discharge from a treatment center.
  • Using all the tools available including involuntary commitment and community treatment orders to ensure the seriously mentally ill are adequately treated.
  • Working hard with our patients to keep them in treatment and on medication.

We know, for example, that people with bipolar illness are very high risk for suicide when not receiving treatment. We know they continue to pose a risk for suicide when receiving treatment. But a very important study found this: Those with bipolar illness who were thought to be receiving treatment and who still killed themselves, were found, at autopsy, to not have psychiatric drugs in their systems. They had all stopped treatment.

Hence bullet point 4 above.

To be continued.

Suicide Prevention. Let’s Talk. But Let Us Talk Truth.

By Dr David Laing Dawson MD

A Five Part  Series

1. Background (Reality)

Over the last 20 to 30 years we have all witnessed an increasing emphasis on “suicide prevention”. This has included TV spots, public health announcements, and the development of crisis lines. Most major emergency departments now have some form of mental health team available to them. Many police departments now have mental health teams, psychiatric nurses, or social workers working with them. All doctors, mental health workers, school counselors, school nurses have been encouraged to ask the question. The phrase “suicide ideation” has become part of our popular jargon.

Fair enough. Though some suicides result from competent and rational choices to end one’s suffering from incurable disease, many others are tragic, tragic both to the victim and his or her survivors. And it always seems even more tragic when the victim is young and the suicide unexpected or unfathomable.

One of the obvious results of this heightened awareness of suicide, “suicide ideation”, and the behaviours that are called “suicide attempts”, has been a dramatic increase in the numbers of people seen in emergency departments for the identified problem of “suicide ideation.”

Below are four graphs showing just how dramatic this increase has been. An increase of 11 to 14 percent per year for six years is quite astonishing. These are American figures but I am sure the trend would be the same in Canada.

From: HCUP Overview. Healthcare Cost and Utilization Project (HCUP). April 2017. Agency for Healthcare Research and Qualityfigure1sb220

Now, at first glance this would imply that the new “awareness” and alertness with regard to suicide, and especially suicide ideation, is working. It means, doesn’t it, that far more people are being identified as “at risk” and coming to, or being brought for, an emergency assessment. Which in turn would mean that the actual suicide rate should be declining.

But it isn’t.

The suicide rate in Canada for the years 1950 to 1960 averaged about 7.5 deaths per 100,000 people.

The suicide rate in Canada for the years 2000 to 2009 averaged about 12 deaths per 100,000 people.

In the United States the suicide rate increased 24% between 1999 and 2014 to 13 deaths per 100,000.

I cannot scientifically claim there is a cause-effect relationship here, only an association, but I can certainly claim that the awareness of and the alertness to “suicidal ideation” has NOT decreased the rate of actual suicide in any age group.

But I do think that by focusing on, advertising, talking relentlessly about, “suicidal ideation” we have dramatically increased the use of “suicidal thinking” and suicidal threats as interpersonal negotiating tools, while making no difference to, and certainly not preventing, actual suicides.

What we have been doing is not working. It may even be exacerbating the problem. Yet every month or two I hear more of the same being promoted. We have not reduced, we may even have increased, the incidence of the very personal and often tragic act of suicide. And we may have simply caused or grown another public health problem unnecessarily straining our resources.

(continued in parts II through V)

 

Thoughts on the Making of a Suicide Bomber

By Dr David Laing Dawson

After the Manchester bombing I read some articles in which the authors despaired of ever understanding any suicide bomber, any killer of “innocent children”. (I don’t know why we need the modifier ‘innocent’ in front of the word ‘children’, other than to imply there might be some not-so-innocent children it would be all right to kill.)

I often write to understand, a way of thinking things through carefully and with a degree of logic, using what we all know about these events and what we know about human behaviour. The following is what I arrived at. I do not know if this helps in any way, but here it is:

What are the layers of the pyramid that lead to an act of terror, especially an act of suicide terror, whether the weapon be a truck, a gun, or a bomb?

A mind experiment reveals the foundation of the pyramid: Imagine a group of 18 year-old boys (make that 16 to 23 years old if you will) being taken by their teacher to a small museum filled with artifacts. Once there the teacher tells the boys they have two choices. They can choose an artifact and the culture surrounding that artifact, spend the entire day studying it, and write a five page essay about it in the evening to be handed in the next day – or – they can each take up one of these baseball bats and spend an hour smashing the artifacts and then go for a beer in the nearest pub.

If need be we can refine this experiment by removing one or two of the most successful young men (academic, social, sexual, vocational) and by having the teacher demonstrate use of the bat on one of the artifacts.

I am not betting on the survival of the artifacts.

There is a developmental phase in the lives of young men when most experience some anger. Most put at least one fist hole in the dry wall before this passes. They are now quite suddenly responsible for their own futures; they are faced with years of unrewarding industry; it is now up to them to plan and organize and work if they are to eat, sleep under a roof, own a car, win the mating contest. And they must do this while watching it, seemingly, come so easily to others.

And this is new to homo sapiens – this span of adolescence reaching into the mid twenties. Until these last few generations most 16 to 23 year old boys were quickly embedded into a life of work, survival, training, routine. Just this morning there was recognition of this in the local paper with a proposal that boys in care be supported until age 25.

In his immature and random use of language Donald Trump may have actually been partially accurate when he recently called the Manchester bombers “losers”. I think he meant it as a school yard epithet with the modifier “evil” added, but within that pyramid of angry young men mentioned above, some are successful, some are struggling, and some perceive themselves as unjustly losing in the academic, social, vocational, sexual competitions.

So on this second level of the pyramid we find angry young men who perceive themselves as losing, unjustly losing.

We have to assume family has an influence here, though it seems suicide bombers are the progeny of both extremist angry fathers, and of fathers who are moderate in their religious beliefs. But we also know that the two psychological states by which boys react to their fathers is by either (sometimes both) imitation or opposition. Family then provides a third level of influence, though not necessarily as direct promulgation of extremist views.

But these are boys looking for direction, seeking answers for their disappointments and rage. They are also seeking simple answers to reduce their existential anxiety. So they easily fall prey to mesmerizing leaders, gurus, exhortations to violence. This can be an Imam at the local mosque, or a Youtube video or an extremist or racist website. The general source of their distress and their failures is made clear to them. This is the fourth level, a powerful influence in the form of an older man, a guru, a man with explanations and answers. A man, or group, who can point this angry and failing young man to a cause for his dissatisfaction and disaffection.

But this must be combined with some social isolation, a retreat from social influences that would otherwise undermine or counter the influences of the newly acquired “teacher”. And most friends or acquaintances interviewed after a suicide attack report something like, “He was always a little quiet, but I haven’t seen him for the last five or six months. He stopped coming to our….” And some do report a change of behavior such as an angry confrontation at the Mosque before they stop coming or are banished.

So now we have a fifth level: withdrawal from alternative social forces.

There would be a division at this point in the development: Those who end up being called a “lone wolf” because they act alone, and those who become part of a network.

The former, the lone wolf, is truly suicidal, and probably suffers from, by now, a psychotic depression (depressed and delusional). This person would have been in trouble before, perhaps summarily discharged, fired, or known to mental health services and local police. His attack will be one of rage with suicidal intent. The creed of groups like ISIS or the white supremacists simply give this person a final excuse and a sheen of righteousness. His weapon will be whatever is available to him. His target may be personally symbolic to him: People enjoying and celebrating when he cannot. Women who have spurned him. Gays who enticed him. A corporation that fired him. An army that excluded him. The group that gives him that “sheen of righteousness” could be white supremacists, fascists, extreme Islam, anti-Semites, or even, today, talk radio and Donald Trump.

The latter, the suicide bomber who uses a more sophisticated weapon crafted by others in a network, is the dupe. He is the youngest, weakest, of the group. He has been gradually pressured and convinced to carry this out. Though he may be a believer in the creed, and though he may also believe in the rewards of martyrdom promised, he is really doing this to please, to not disappoint his cult leaders and be cast out. These leaders may include an older brother, an uncle, a father. Or they are strangers who have become his family. To retain his position with them, at least in his imagination, he must carry out the act. They are the ones with the political agenda and the level of sociopathy required to inure them to the consequences.

Standing By Trump – Or Not

By Dr David Laing Dawson

As social scientists point out, it is a prime directive for homo sapiens to maintain standing in their community (power, pecking order, value); it is not a prime directive to listen to reason and apply educated perceptual and deductive processes to arrive at a truth. Hence the amazing displays of twisting, selecting, avoiding, diverting, and denial coming from Republican law makers when asked to comment on a particularly stupid, childish or even incriminating comment by Donald Trump.

In the Hans Christian Andersen story it is only a child who is free to blurt out, “But the emperor has no clothes.” The lords, the noblemen, the ladies, the merchants – they all have much to lose. As does the emperor himself.

This emperor, The Donald, likewise has much to lose should he ever admit either ignorance or failure. His whole narcissistic edifice would crumble. He would find himself staring at a reality he has never allowed himself to see before.

And perhaps some of those Republicans do not have law degrees or other marketable skills, and rely on their Government salaries to support five children, an invalid wife, two aging parents, and a large mortgage. These I forgive. They should keep their heads down and avoid microphones. But there are others I am sure who have many options. They would lose but the ephemeral status of a title and invitations to the old boys club.

Yet none speak up.

It is disappointing to learn that in an old democracy an incompetent man can be elected President on the basis of misdirected anger, show business glitz, and ridiculous promises, all flavored with misogyny and racism.

But it is more disappointing to see that not one nobleman, not one lawmaker, is able to overcome the prime directive from our days in the jungle – not one has the courage to put his standing in his community at risk and announce, as the child would, “The emperor has no clothes. The emperor is lying. The emperor is incompetent. I can no longer support the emperor. I resign.”

What To Do When King Donald Goes Mad

By Dr David Laing Dawson

In November of 2016 I wrote the piece that follows. Predictions for the Trump Presidency. As Donald himself might say, “Who knew impeachment was so complicated?” So, I got that wrong. It will be a long and messy process. If only they had a parliamentary system and could simply call for a vote of non-confidence.

And I did not guess the extent to which Trump would  incriminate himself with both his careless tweets and his loose boastful talk in both the Russia affair and the obstruction of investigation into the Russia affair.

Other than that though, my predictions are depressingly accurate. And I still think the danger for the U. S. of A. and the rest of the world is that Donald Trump, unlike Nixon, will not go gentle into that good night. The sane and rational leaders of America need a plan. As the bad news mounts; when Trump’s counter attacks and deflections begin to fail; when he is cornered, he will lash out. They must make sure he cannot bring the temple down.

Predictions for the Trump Presidency

By Dr David Laing Dawson (Nov. 24, 2016)

The good news:

Donald Trump has neither the knowledge nor patience to figure out how to repeal parts of Obamacare, renegotiate NAFTA, build a great wall, prosecute Hillary, create the mechanisms to actually find and deport 3 million immigrants, or even change the tax system.

He won’t interfere much with climate change accords, because he doesn’t really care one way or the other and this is also a very complicated endeavor. He will continue to contradict himself from day to day, responding to his immediate impulses and his (I must admit) well honed intuitions about his public.

He can interfere with the TPP because all he has to say is, “Not gonna do it.” China can take the lead and a trade deal will be struck with all countries on the Pacific excluding the USA. I have no idea what that means for the USA or Canada.

Anything that requires a great deal of work, attention to detail, building a consensus, formulating a complex plan, he will not do.

The bad news:

Within a few weeks of his presidency Donald Trump will manage to mix his business dealings, his self-aggrandizement, and his petty peeves with his presidency, with his representation of the people of the United States, to such a degree that the democrats and a few republicans will start an impeachment process. In the ensuing hearings his business dealings around the world and at home will be exposed. He will respond with anger and outrageous accusations. This will convince others to support the impeachment.

As it becomes clear that Donald J. Trump will be successfully impeached he will become a raging bull. He will not simply announce, “I am not a crook.” and board the helicopter in disgrace. He will rage. He will suffer an extreme blow to his narcissism. He will rage and lash out.

This will fuel the racist fires at home and cause great anxiety abroad. He could well bring the temple down.

Sane American leaders need to be thinking about a contingency plan.

Perhaps the fully sane leaders of the rest of the world could form a club and plan a contingency of their own. What to do when King Donald goes mad.