Episode Transcript
[00:00:00] Speaker A: If I don't feel that I can help a patient, then let's find somebody who can. And I'm not for everybody, and not everybody's for me. There's a huge degree of personality that comes into play here. This is why I say that my work is an art based on science, that it needs to be grounded in solid clinical constructs, but it's delivered as an art form.
[00:00:21] Speaker B: I'm Diana Earley, and I've spent most of my life learning firsthand what privilege actually costs.
The legacy control, the family expectations, the guilt of feeling trapped in a life everyone thinks you should be grateful for. If you've ever wondered why having everything still feels like something's missing, you're in the right place.
Welcome to pressures of privilege, sitting with someone who completely changed how I think about wealth and well being.
Dr. Paul Hochmeier, lawyer turned therapist, Harvard Medical School graduate, and the guy who's directed millions to mental health services while also treating billionaires in crisis.
Paul, you live in Telluride, you practice headstands, and apparently you sing along with the Indigo Girls loudly.
[00:01:13] Speaker A: I do envy all those.
[00:01:15] Speaker B: You're not exactly the stuffy therapist that people might imagine. Well, five years ago, you taught me about hyper agency.
[00:01:21] Speaker A: Through my work, I take established theoretical constructs and extend them to address an identity of wealth.
And so I draw from a lot of literature and apply it to individuals of wealth. I'm currently working with the construct of intersectionality.
Kimberly Crenshaw came out of gender studies and race studies, and so applying that to populations of wealth. So I look at the construct of hyperagency in the context of a clinical relationship and how that interferes with the clinician's ability to establish therapeutic or reparative therapeutic relationship with the patient.
[00:02:04] Speaker B: That will be good for the professionals listening to this, but for people who might not understand how important this is for them in their daily life.
[00:02:16] Speaker A: Yeah, sure. So my work has been circuitous in terms of. Like you said, I started my career traditionally in economics, banking, lawyer. I was able to leave the practice of law and went into social justice, philanthropy, and observed in that. In that field that organizations that were working on behalf of humanity and doing amazing work needed to raise money, and they needed to raise money from people of wealth. But there was a dissonance between the work that they were doing on behalf of humanity and the way that they were talking about people of wealth who were.
Who were their funders. And there was this objectification of them and conversations like, he's worth. I don't know. A hundred million dollars. So he should give us $10 million or something like that. There were, and I. There was a dehumanization in that process, which I found disturbing. September 11th happened. I was living in Amsterdam, moved back to America and started working as a concierge lawyer with a wealthy family. And in that process came into contact, really was hit head on with an addiction in that family. And it cut against the dominant cultural message that I had learned as a white male in America that if you have enough money, you can solve all your problems. Money solves all one's problems. And I soon found in the field of mental health that that was not the case at all. And so really then pursued that work, did a master's in family systems and then a PhD in ultra high net worth identity. Looking at how an identity of wealth manifests itself internally in relationships and in the society and culture that we live in.
And then really, then hone, continued to hone the work. And, and I look at how an identity of wealth impacts a patient's client's ability to get culturally competent, clinically excellent care that. That very identity. While we think that the money would get by them the best care, that's not the case at all. That the care that they needed was care that was able to see the patient, the client, in the fullness of their humanity and connect to the human that resides underneath those labels, the label of being a person of wealth.
[00:04:35] Speaker B: So how does hyper agency tie into that?
[00:04:39] Speaker A: So there are three distinct cultural markers that I have identified through my work. The first one is isolation.
That people of wealth live in highly elevated states of isolation. The second one is hyper agency, which is the capacity to orient your world to avoid friction, challenges.
And the third is suspicion of outsiders. So because human beings are tribal, we orient around a common interest and against common throes. In our society and our culture, an identity of wealth is still one that it's perfectly okay to demonize.
I live until you're a Colorado, which is a very wealthy community. And on the post box outside the grocery store is a sticker that somebody said, eat the rich.
And that sticker has been there for months. Now, if that was against any other minority group or any other identity, there would be a lot of outcry. So if we look at those three cultural markers, isolation, hyper agency, and suspicion of outsiders, and we look at how clinical care, specifically psychotherapy, is delivered, what are we asking the patient, the client, to do? We're asking them to come out of their isolation, to share their vulnerabilities. And their pain with somebody who's going to be outside of their social class for the most part. Right. Relatively speaking.
So how can we expect a client to come forward and trust that the clinician can fully understand who they are without demonizing them and stereotyping them? Because the rest of society does.
And they're confronted with this all the time and have the capacity to hold their pain, pain of which they have used their wealth to avoid perhaps, perhaps their entire life. One of the, one of the challenges in terms of, I mean, we met actually you and I met through addiction treatment. And the notion of hitting bottom, right, is critical to a person's ability to get care. And for patients with wealth, the bottom can be avoided for a lot longer than it not. And it's typically not like I've lost my job or I'm going to get evicted from my home.
The bottom comes from not being able to tolerate the emotional pain that comes with the addiction. And so the way that traditional psychotherapy has been set up cuts against every single one of the cultural markers of that particular population.
[00:07:26] Speaker B: Wow, in what way?
[00:07:28] Speaker A: Because you're asking the patient to come outside of their isolation to share their pain, to acknowledge their pain, and to share it with another human being who comes from outside of their tribe. So they're asked to come out of their isolation, to hold their pain that they experience and then to share it with somebody who may not be worthy of their trust.
[00:07:51] Speaker B: Yeah, that sounds impossible.
[00:07:53] Speaker A: It's not impossible. Which is kind of where my work has come in and kind of my mission in life is to please place an identity of wealth amongst other identities that deserve cultural competency and cultural humility in the provision of mental health care and medicine.
[00:08:12] Speaker B: Imagine you have a client, high, high net worth client who, you know, can get on a jet, some, something that's close to me. You go through a breakup. My example was I, I, I move whenever there's a breakup because I don't want to feel the pain. Right. And not everybody can do that. Whereas somebody with wealth would move. And when I was going through a breakup in the Swiss Alps, my, my therapist said to me, Mrs. Early, if you could stick around for a little while and not move. Cause I, I want, I wanted to get out of there. This is a small village. I know everybody in the village. My boyfriend was driving back and forth in front of my house every day.
I really wanted to get away. And she's like, no, I want you. If you could stick around, it would be so good for you.
[00:08:50] Speaker A: Very good advice.
Yeah.
[00:08:52] Speaker B: And it was really painful. But I have to tell you, by the time I left Gstaad, I could see him drive by, and it was fine.
[00:08:59] Speaker A: That's the perfect example where people can just kind of move around. And one of the features of this particular population is the itinerant nature of one's life, that you winter here and you summer here, and you're at the shoulder season there, and you're constantly banging around, and that prevents you from establishing some deep roots in communities and having a sense of place. And one of the main things I work on with my patients is having a sense of place and peace of mind.
And it sounds as though that's what your therapist was helping you get.
[00:09:38] Speaker B: And then I did, because I actually reached out to a small community of women. They gave me that community I needed and that I didn't want to leave.
[00:09:45] Speaker A: No, that's exactly right. And you felt better and you grew. Right. And by. By. By dealing with that discomfort and not using your wealth to avoid it, you're able to grow.
The. The point of this was that you trusted your therapist to give you that advice. Right. If. If you didn't trust her, if you didn't have what's called a reparative therapeutic alliance with her, what was it about her that enabled you to trust her with that advice?
[00:10:15] Speaker B: Ah, it's interesting. She said a few things. One thing was I was, you know, groveling, trying to get him back, and he wouldn't take me back.
And she said, he's really doing you a huge favor. This is so good for you that he's not taking you back. And I was like, really? Like, to me, it seemed like she almost put him on a pedestal, which kind of was equal to how I had put him in a way. Like, I put him on a pedestal, maybe for another reason, but in this case, it was almost like he was on her side or she was on his side. Like, it's really good he's not taking you back. Like, you need this.
And the way she said it was so loving.
Maybe another reason I trusted her. I didn't feel any judgment from her. She worked with other families. Yeah, she worked with other families and this very wealthy village of Kstad, and she's a psychiatrist, so she had a lot of training. And I think once you work in that population for a while and you learn not to judge them, maybe she just was like you. She figured it out.
[00:11:18] Speaker A: It's a process. I mean, it's a process. And that's one of the things that I try to do in my work is train clinicians to be able to understand and hold the frame for these, for the, for this patient population to come forward with the fullness of their identity. And, and, you know, we all have internalized conscious and unconscious views towards what money is. I mean, you, you've been around this space for a long time and you have a real depth of experience. If I were to ask you, money equals blank. Fill in the blank. From your, from your experience.
[00:11:57] Speaker B: I think it just, it's a magnifier, huh?
It'll magnify the good or the bad, right? And it gives energy. I mean, it's maybe also energy, right?
[00:12:09] Speaker A: You're able to see the duality, though, because you have the lived experience of it. Where most people, the 90% of the population, when I ask that question, they say, money equals power, money equals freedom, and money equals happiness.
[00:12:23] Speaker B: No, I, I like the pursuit of happiness, which is getting to do what you want to do in my book. You know, you're not, you're not sort of put in a cast like in Europe. You know, if you're, if you're born a plumber, you're kind of going to be a plumber for the rest of your life. There's really no hope to maybe become a lawyer because in your family line, everybody was a plumber in America. It was like, oh, you can climb up the ladder and be a lawyer if you want.
[00:12:48] Speaker A: Right? That's the highly sophisticated, educated view of wealth. That it's not, it's not this binary of good and bad that there are nuances in it. And as you said so articulately, money is. Wealth isn't energetic and it can be channeled to really wonderful things, and it can be channeled to destruction. And that's why approaching the work consciously, thoughtfully, and avoiding the binary of good and bad, money's evil. And this is all hardwired into us, right? I mean, the dominant cultural message is, well, dirty money, right? He's filthy rich.
And then if you look, it's biblical that even in the Bible it's easier for a rich man to get to heaven than it is for a camel to get through an eye of a needle.
[00:13:40] Speaker B: Dr. Paul, I have a theory about that, though.
I think the eye of the needle is actually a gate in Jerusalem. And the only way a camel can get through that gate is you take all the luggage off and it can. And you have to get it on its knees and it can, you can go through the gate.
[00:13:55] Speaker A: Right?
[00:13:56] Speaker B: That's very symbolic.
[00:13:57] Speaker A: Don't you think, oh, it's very symbolic. Yeah. And I've heard that before and I think it's highly relevant. And it speaks to sort of the nature of Icarus. Right. And hubris versus humility and so approaching humility. And I think that that's actually. I'm glad you brought that up. It's a very good lesson in terms of avoiding hubris and being in a place of humility and particularly around understanding the incredible power inherent in wealth, because it's like fire. It's not something to be played with that. It's something to be used mindfully and thoughtfully.
[00:14:31] Speaker B: Going back to that image, though, and I want to put a pin in that inherited thing, I also interpret the luggage not as giving away everything you own, but it's attachment.
And there's a difference between having wealth and being attached to it.
[00:14:46] Speaker A: I think it's brilliant. It's another one of the constructs that I've just started working with and talking about is, you know, John Bowlby's work out of Britain in terms of attachment theory.
[00:14:57] Speaker B: So I actually am not familiar with that one.
[00:15:00] Speaker A: So attachment theory was developed after the war. I think it was the First World. It was the First World War where John Bowlby studied children who had been displaced from their parents because of the war and looked at the attach. How that informed their attachment. And there, as it relates to wealth. And I. And I look at how people are attached to wealth and there are different kinds of attachment. There is secure attachment.
So in a secure attachment to a primary caregiver, the child feels empowered to go out and explore the world and take chances, knowing that they can come back to a home where they will be nurtured and supportive.
And then there's insecure attachment, where the child feels very unsafe and insecure in the world and suffers from an enormous amount of anxiety when they are on their own or asked to become.
To grow and to change.
So. So we can talk about those two.
Because I think that in my work now, I'm looking at how people have attachments to their wealth.
Do they have a secure attachment to the wealth? Do they feel like the money is there as a place of safety and security that enables them to. To go out and explore the world and take chances and risks and try to try to become healthy, productive people in the world? Or do they view the money as something that's dangerous or that could go away, or the money that's used in a manipulative, destructive way? And certainly we want money, we want people to have a secure attachment.
To their wealth. And, and this, these constructs are tied to.
This is something that you put a pin in and we can go back to it now, but inherited versus earned and locus of control. And so the data show that people who have earned their wealth have a much stronger internal locus of control or secure attachment to their money so that they feel in charge of their destiny. They're captains of the ship. They would be cross if they lost their money, but they're confident that they could make. They made it once, so they figure they could make it again.
The other side is people who have inherited their wealth or a population that I work a lot with are spouses who have married into families of wealth that come from a different socioeconomic class. That's a calculus that's really difficult to negotiate.
Those people are skewed more on the side of an external locus of control where they don't know if they could survive in the world absent their wealth or maybe their family name or their family legacy.
And so they don't feel secure in the world. They have an insecure attachment to the money and do people like them for who they are or because of their surname or their wealth. And so two very, very different personality constructs.
[00:18:14] Speaker B: You just released Fragile Power 2.0, the new book.
[00:18:18] Speaker A: I did, and I need to be very clear about that too, that it's basically just kind of a re up of Fragile Power. There's some new stuff in there for sure.
[00:18:25] Speaker B: There's a bit more of like what people can do, like they can make the community aspect.
[00:18:31] Speaker A: Right. It's more prescriptive. Yeah.
[00:18:33] Speaker B: And one of the things you say is to pick a small group of friends who just have your back.
[00:18:39] Speaker A: Exactly.
I am really. One of the other things now that I'm really focused on is the creation of micro communities.
How lately you read this book that came out, station 11. It's a fiction book. Reading it in freshman English class. And it's basically a story of life in a post apocalyptic world.
It's fascinating because the author wrote it in 2015, it was published in 19. The pandemic hit on 20. So it's remarkable that she was able to write it and get it out before the pandemic. In any event, humanity has been decimated. Probably there's 1% of humanity living and the world has become a very hostile place. And there's a group, a micro community of people who survive and create meaning in the world by traveling around in a caravan and performing Shakespeare in these little villages. And it speaks to the destructive power of narcissism.
One of the main protagonists is a celebrity who suffered from narcissism. And putting that up against how these. This small group, this micro community, was able to survive these profound changes that were happening in the world through community and by supporting each other. And I think the parallels to what we're experiencing now in contemporary world are profound. The disruptions that we're facing on probably all three years of our existence, I think can be best managed through the creation of micro communities by us coming together as human beings and connecting and supporting yourself. I don't think we're going to find it in social media. I don't think we're going to find it on our Instagram account.
[00:20:29] Speaker B: So how would you go about finding your micro community?
[00:20:33] Speaker A: I think by doing this, I think by people who respect. I have a deep respect for you. I've known you for a long time, and I really respect your voice in the space. You have a lot of courage to say the things that you say, and you're putting light on topics that are difficult for people.
[00:20:52] Speaker B: I have an advantage because I have a foot in each world.
[00:20:54] Speaker A: You do, and you, and you. And you have a credible voice, and you have a good voice, and you write really well.
So that's all of those things that helps as well.
And I think you approach the work through. I mean, I know you approach the work through a place of integrity, but, you know, you're not motivated by creating an audience. You're motivated by putting a message out into the world that other people can relate to and heal and grow from. I think there's a real authenticity and real integrity to the work. So thank you.
[00:21:30] Speaker B: Well, thank you. I've been quoting you a lot to my clients, and also, I'm motivated by the idea that if people with wealth would feel better, they would maybe be more philanthropic, and they would. Instead of running off to, you know, as tax exiles, you know, to other, you know, countries to avoid taxes, they would stay put and invest in their communities.
But because they are being vilified and demonized and taken advantage of, they're running away.
[00:22:01] Speaker A: Absolutely. I did my master's degree at Antioch, which is a very progressive, liberal school, and it was beaten. It was driven home to us that part of our work as clinicians is being a social justice advocate. And so I started my career working with HIV positive transgender patients in a free clinic in Hollywood.
And so, you know, so I worked on both sides of the spectrum. What I saw, I saw a real need for somebody to approach this particular patient population through empirically based science, that it needs to be grounded in the literature, and that I believe that compassionate, clinically excellent, culturally competent care does. Should not have an economic threshold.
I think that you deserve to be seen and treated as a human being, both in medicine and in behavioral health care, as a human being, independent of those particular labels. And I also think that the clinicians who are treating you need to approach every population that they treat with cultural humility as opposed to cultural arrogance.
[00:23:13] Speaker B: I was sharing one of my coaching cases with a therapist, you know, obviously anonymously, like, what do you think?
She said, diana, you've got more patients than I would. That is such a first world problem. And I was like, oh, thank God my client's not working.
[00:23:28] Speaker A: And so what is that, in effect?
That's shaming, right?
[00:23:32] Speaker B: It is shaming, yeah.
[00:23:33] Speaker A: Exactly what she's doing. She's shaming the patient for having their wealth.
Yeah. That just feeds into the patient's view of themselves as broken and deficient. Because society and culture tells us that if we have money and wealth and we have the keys to the kingdom and we have no problems, I can solve that. I've been told that by academics in very prestigious institutions. I have been canceled in Ivy League settings because of my work. And how dare I say that people of wealth need to be viewed with compassion.
And the hypocrisy inherent in that was just effloric. Maybe it was one of those experiences where now, meanwhile, I had just sat in a week of trainings in a Medium in Medicine program where I was taught that I needed to have cultural compassion and cultural humility for transgender patients and for people of color and for women. And when it was time for me to present my work, a facilitator just shut it down. And.
And. And the thing of it is the blindness, like just the incapacity to sort of see, recognize that, you know, and tried to have a. Tried to have a conversation. But it's. So the point that I'm making, trying to make is that this stuff is so emotionally rooted that people have such intense emotional feelings towards money and wealth.
[00:25:05] Speaker B: I think in that instance, my friend, the therapist, I think it was the empathy fatigue, perhaps.
What's that called? The compassion fatigue.
[00:25:14] Speaker A: Listen, it's completely understandable. We all have it. And so it's just acknowledging that it's there and being a process to talk about it. I suspect that your clinician, I don't know, that maybe you addressed it and said. Brought it up and that she was willing to take a look at it and say, oh my goodness, yeah, you're right.
[00:25:36] Speaker B: Well the funny thing is she, she's a person that, that therapist was a person of wealth.
So I saw that as self, self shaming.
[00:25:47] Speaker A: There's a construct I did, wrote about it in my dissertation. I did my dissertation in ultra high net worth identity constructs. And one of the constructs that I used was I extended the notion of internalized homophobia to internalize wealthism.
So internalized homophobia is where queer people internalize society and culture's negative perceptions of having homosexual queer identity.
And internalized wealthism is where people of wealth internalize the dominant negative stereotypes about being a person of wealth.
And I see it all the time. I see it all the time.
[00:26:28] Speaker B: In my practice, during my trauma work, I was asked to visualize myself as a 6 year old. I had the hardest time. You know, I was put in a hypnotic state and, and, and I had to shut my eyes and picture myself. It took me about an hour to see myself.
And the therapist who was running the session said, wow, that's a long time. That meant that I felt eraped with a child like. And I erased myself.
And she said, if you don't, if you're not able to see yourself, Diane, you're not going to be able to see your own children. And I sort of see a link to where you do that. Said that example. Because if I can't have empathy for my six year old child within me, how am I going to have empathy for my, my actual six year old.
[00:27:10] Speaker A: Child or other children?
[00:27:11] Speaker B: Other brilliant.
[00:27:12] Speaker A: You've a good therapist.
[00:27:13] Speaker B: I needed a lot of therapy.
[00:27:15] Speaker A: So I.
You got it though, which is great. Which is, you know, part of the tenacity and sort of knowing that intuitively knowing that there's something there that needs to be addressed. And that's been the fuel that has really fueled my work. And the experience that I had after this incident with the professor just confirmed it was, you know, I say it as if it was a negative experience. It was an incredibly positive experience.
It just really showed me how important the work is and how even at the highest levels, echelons of academic rigor and the most, you know, super. The woman was super very accomplished, super intelligent, yet there was this reaction that she had. And so it showed me that the work has, there's something to it and that it needs, you know, that I need to continue to carry on. And I have. And I'm super grateful, I'm very grateful for that experience that I had.
[00:28:12] Speaker B: I'm getting Certified by the Mayo Clinic right now in their wellness coaching.
And one of the things we learned about was bias. And, and there are some tests out there that clinicians can take to see their underlying bias for different cultural groups.
[00:28:27] Speaker A: Yeah, Harvard has them online. You can go online. Harvard has them.
[00:28:31] Speaker B: I don't think wealth was in there.
[00:28:33] Speaker A: It wasn't. Listen, there's no shortage of a need for this particular work. And that's why I'm in terms of my micro community, I'm always looking for people who, you know, are kindred in spirit and who understand the work and bring and are motivated because they want to improve humanity. And getting back to my work as a social justice advocate that I learned at Antioch and that I took very seriously.
You know, there is this. We do have a profound division between the haves and the have nots in our society. And I think I've been reading literature about the French Revolution and Rousseau and Sartre and a lot of these existential. And we're seeing a lot of parallels here. And so I think that the bottom up approach, where the bottom part of humanity or the lower socioeconomic classes are demanding that people of wealth do X, Y and Z, it's not working. I mean it's done through a hostile tone. And what it's doing is it's causing people who have the resources to help ameliorate the legion of social problems climate. I mean like the list goes on, doesn't it? Are actually just kind of climbing in their jets and flying off to the private islands and saying, I'm not going out there. You guys are going to stick me with, you know, you're going to shoot arrows through me. So I think that compassion needs to work both ways. That if I expect you to understand me, then I need to work really hard to understand you.
[00:30:12] Speaker B: I like that. Well, understand that was, that was the definition of empathy is, is not pitying, it's understanding, seeking to understand.
[00:30:21] Speaker A: Right. People like to reduce my work to me saying be nice to rich people.
Well, yeah, I mean that's hard. Yeah.
But I'm also saying that in this larger context, I'm saying first of all, we need to be nice to everybody.
And so like this is an extension of the be nice to everybody narrative.
And specifically I work in a, you know, like I work in the field of behavioral health, like in terms of clinical care.
And so I'm a knitter. I'm. My task at hand is to place an identity of wealth in other cultural identities that deserve competency in the provision of behavioral Healthcare medicine. That's it.
That's my life work right there. So that we can deliver effective healthcare interventions that the patient can receive. This is getting back to the therapeutic alliance. It's no different from, like, let's. The analog is kind of like the pandemic in terms of vaccines.
So we have effective vaccines.
If we have faulty needles, the vaccine's not going to be delivered. So if we have clinicians who are unable to deliver the therapeutic interventions that the patient needs to heal and grow, then it's all going to be for naught, isn't it? And so my work helps the clinician establish the alliance to create the needle, the most effective needle that they can, to deliver the most effective medicine to the particular patient.
[00:32:02] Speaker B: You know what this reminds me of? I was just at a summit in Florida, the eudenomia summit, and Halle Berry gave a talk, and she said that she has, you know, she's on the mono. Menopause cause.
And she said that her.
Her physician was too afraid to call to say, Mrs. Barry, you actually have menopause. He was too afraid to say that because of who she was.
[00:32:29] Speaker A: That's it. Right. And she intuitively knew that. And by. And, and, and because her radar. Because this particular population is so used to being objectified and manipulated, people are trying to sell them stuff constantly and asking them for the things. It's. It's never ending. So they develop a very sophisticated antennae for feeling when they are being manipulated and viewed as an object.
And so the fact that she could recognize that and articulate that is fantastic. It's fantastic. And it's a fantastic example.
[00:33:03] Speaker B: Yeah. She was like, who's going to tell Halle Berry that she's going through menopause? That's not. You don't want to be a doctor to deliver that message.
Wealthy lady who's an alcoholic who's gonna tell her, ma', am, you can have a problem with alcohol. I mean, they're afraid that they're gonna lose all their millions of donations to their hospital.
[00:33:18] Speaker A: Exactly right. And their kids are afraid they're gonna get cut out of the will. We can bring it a lot closer to home for that.
[00:33:25] Speaker B: We only have, like, 15 minutes left. Would you. Would you be willing to talk about narcissism and your definition of it and how it's, you know, it's being. It's used a lot, and I hear it a lot like, my boyfriend's a narcissist. What's your view on that?
[00:33:38] Speaker A: In terms of this particular population? Data show that there is Higher incidence of narcissism among this particular population. The reasons for it relate to the construct of hyper agency. So that by virtue of the wealth that people can spend more time on themselves. Right. Invest their time getting their nails done, getting their head job. You know, I have patients who live in New York City and they drive to Greenwich to get their hair colored because that's where their color is, is. And so spending a lot of time on self and cultivation of self.
And so.
But in getting back to narcissism, narcissism just doesn't exist amongst people of wealth. It's, it's, it. It exists from people of all socioeconomic classes. And so the reasons for it for that in the person who's suffering from a narcissistic person personality disorder, somewhere along their developmental path, someone whose care and protection they needed betrayed them.
Big B, small B. This is where it's a nature versus nurture kind of comes in. Because my central nervous system is different from your central nervous system. And so what's a betrayal to me may not be a betrayal for you.
And so this is where what considers a betrayal is subjective depending upon the person's central nervous system. And some people are wired, people are wired differently. Like some people are highly sensitive. So the world is a super intense place for them. Lights are super bright, noises are really loud. They just feel the world, they just soak in the world really intensely. So as a result of that betrayal, because human beings are adaptive, they said, I will never trust another human being with my intimacy again.
That human beings are unsafe and relationships with other human beings are unsafe.
So I will build this external, this fortress around me based a lot of times on power, property and prestige.
Most, if you talk to most entrepreneurs who have made their fortunes, it's because they sustained a pretty severe betrayal early in life.
And they're like, that's never. I'm going to be on the top of the heap because anywhere other than the top of the unheap is unsafe. And I've learned that once and I'm never going to do it again.
So less saying that all entrepreneurs are narcissists. But what I'm saying is that there's a lesson here. And so narcissism starts out as being very adaptive.
It enabled that person to survive. Oh God.
[00:36:26] Speaker B: When I was a teenager, Dr. Paul, you know who I wanted to be?
[00:36:29] Speaker A: Who?
[00:36:29] Speaker B: Margaret Thatcher.
[00:36:31] Speaker A: Wow.
Because you were from China.
[00:36:34] Speaker B: I just, I loved it that she would sit with heads at stake. This image of her feet on up on the coffee table. Which I'm sure she didn't do, but somebody described that and a glass of scotch in her hand.
While the other women were in the other room discussing makeup and fashion, she was with heads of state.
[00:36:51] Speaker A: It's developing a sense of agency. But underlying this external bravado is this real fragility of self. Now, there are two different kinds of narcissism. There's grandiose, which is what we typically associate with narcissists, because they're the ones who are, you know, kind of out there. Look at me, I'm great. I do nothing wrong. And then there's covert narcissists, which operate on the other side of the spectrum. Passive aggressive, always the victim, but control relationship. All of this is about controlling relationships for safety and protection. And so narcissism started. And narcissism occurs on a spectrum from adaptive to pathological. And on the most pathological side, we see it in something called malignant narcissists or the dark triad, which is narcissistic personality disorder, sociopathology, and Machiavellian tendencies. So the scorched earth policy that everyone, let's just burn it down. Let's destroy everything.
[00:37:56] Speaker B: What's the difference between them and psychopath?
[00:37:58] Speaker A: Well, there really isn't, because psychopath is sort of sociopathology. And so they have no moral compass. They will do anything, whatever it takes, and they have no.
They have no moral compass to guide their actions.
It fits in with the Machiavellian scorched earth policy that if I'm go down, I'm bringing everything with me.
[00:38:19] Speaker B: Are any of these versions healable?
[00:38:22] Speaker A: You know, the edges can be softened, but the outcomes are dismal. First of all, the intervention is required to shift. If you're talking in terms of talk therapy, the value of talk therapy is in the interpersonal connection that the patient has with the therapist, which is based upon the therapeutic alliance that we talked about earlier and this construct of trust. And in the narrative that's created, being able to create a logical, linear narrative around these lived experiences.
Because at the core of narcissism personality disorder is this inability to establish a connection with another human being.
Talk therapy really is not. Is not really going to work because the patient can't tolerate the intimacy and the trust required in the therapeutic alliance.
And we look at other interventions, psychopharmacology, there aren't any psychopharmacological interventions to treat narcissistic personalities per se. You could maybe treat the depression and the mood disorder and anxiety around it, but you can't you can't treat narcissistic personality disorder. And then there's sort of, you know, that, that, that successful outcomes in clinical care is a function of a calculus between internal motivation and external motivation. And more internally the motivated patient is to change, the better the outcomes aren't going to be. And people who suffer from narcissistic personality disorders just are internally motivated.
[00:39:55] Speaker B: Even when they lose everything, like all their friends and everything, that's when they.
[00:39:59] Speaker A: Could hit a bottom and see. But typically, if depending upon the severity of the narcissistic personality disorder, often not that they, you know, age in a host of defense mechanisms, deny our rationalizations and projection, they externalize. It's not them, it's you.
They blame everything. And, and if we look at a lot of the patterns, right, there are three major patterns in terms of narcissism. It's the narcissistic cycle of abuse where the narcissist gets their ego, sustains an ego injury, they lash out in anger and in doing so they become the victim and then suddenly the other person is the perpetrator. And by doing that they switch the power dynamics. It's blame shifting essentially.
And then gaslighting where they come back and they try to shower the other person. No, that's love bombing where they shower the other person with love and gaslighting, which. Oh no, you're not really angry. You're just mad at your mother. You're not mad at me, you're mad at your mother and you're displacing your mother's anger on me. I'm the one here who's trying to help you.
[00:41:07] Speaker B: Aren't there some people who are still in the active in substance abuse who show signs of narcissism, but once they get into recovery, start working steps and all that, they start to, to lose some of those narcissistic traits?
[00:41:21] Speaker A: Yep, absolutely.
And a lot of that is done sort of in the reparative community. And part of the recovery. Part of the value of 12 step programs is these, like we talked about earlier, these micro communities, people where you are engaged in communities of others and you recognize and central to a lot of the work that's done in, in these 12 step works is substituting or mitigating hubris and developing humility.
[00:41:50] Speaker B: It just reminded me of my first sponsor in a 12 step program. Who was this? This was in this very wealthy village and which to answer your earlier question about why I like my. I trusted my therapist. My first sponsor was echoing my therapist.
[00:42:05] Speaker A: Ah, there you are.
[00:42:06] Speaker B: My so, yeah, she was saying to me, diana, just, you're in a dark tunnel. There's light at the end of the tunnel. Just stick with it. Don't lean into the pain.
You know, don't look as pain as something to avoid. And I was hearing that from the therapist as well as my sponsor.
[00:42:21] Speaker A: This is something that I write about in Fragile Power in terms of. I have a whole chapter in there devoted to therapeutic services and particularly residential addiction program. And the value comes from in what's called the social structure. And this is where there is some value in these economically segregated programs.
So that your clinician can tell you one thing, and you're like, oh, what do you know? You. You know what I mean? You just.
You know, your. Your fingernail power just chipped, like, whatever you find to diminish or devalue that particular clinician. And then you go and you have dinner. You're out in the patio with another client who's in your socioeconomic class, and they say to you, diana, you know, blah, blah, blah. The same thing that your clinician may have told you. Suddenly, because they're in your tribe, you're willing to listen to it. So, again, this is the value of the micro community. And, you know, getting back to the value of residential treatment, the real value of residential treatment comes from a frame. Who. We. If we look at what residential treatment is, it's a frame. You have a patient outside in the world who's causing an enormous amount of destruction to self and others. We need to get them into a safe, contained, structured environment where it's regimented and disciplined and they have a schedule and they're part of a community of other people. The community.
That's why when I, like, replace. When I'm placing a patient, I always say, what's your census like? How many patients do you have there? And why are these patients here? Because the value in that is there's extraordinary value in that micro community. And residential treatment is just the beginning. You know, it's basically to get the patient stabilized and figure out where they were and figure out the kind of treatment they need once they get out of treatment.
[00:44:16] Speaker B: I mean, there's some treatment facilities that only deal with one person at a time.
[00:44:20] Speaker A: Right.
[00:44:21] Speaker B: But don't they plug them into communities? Sort of. They take them off campus.
[00:44:25] Speaker A: I have mixed feelings towards that.
I feel like some of those programs perpetuate the isolation.
And there are so many variables that come into play in those programs. First of all, it's the patient.
The first level of analysis is who's the patient, what do they need?
And that's a clinical decision.
If they're living in a profound state of isolation, I'm not going to put them in a program where they're going to be isolated and surrounded by a team of clinicians who they're paying €100,000 a week. You know, that to me does not seem like an effective clinical intervention.
And so who is the patient and how is that kind of program clinically indicated? There are some cases where it is at those cases when it is, those programs are only as good as the people who are working in them.
And they tend to be a revolving door.
And so I always advise clients to do a due diligence and see who's there and who the treatment professionals are. And just like you would, you know, when you make an investment and you're going to invest in a fund and you want to know who the managers are and what the underlying asset classes are, make sure you do diligence in these programs. And the most expensive is not the best. And the fanciest website does not mean you're going to get the best care.
[00:45:53] Speaker B: So people need to do their research like they would a fund. Are there some sources that they can go to that give them unbiased opinions?
[00:46:02] Speaker A: I still think this is a handshake business and I still think that it's personal referrals and people experience that other people have had. That's why I work, I think a lot of family governance and private banks. And I think that it's important for professionals who work with this particular population who hold themselves out as full service firms to really have mental health professionals in their ecosystem on whom they can rely on to help guide in this process.
Or don't say you're full service or don't claim to be in this particular space.
[00:46:40] Speaker B: Oh, that's cool. So financial advisors have referrals to mental health professionals that they, you know, a.
[00:46:47] Speaker A: Good list wants to claim to be and are interested in doing the work. Right. I mean, it's not for everybody. And if you're basically just interested in the quantitative return of your clients, then you don't need to worry about it.
But if you really are interested in holistic health of your clients and really want to invest in the interpersonal relationship that you have with your clients, then I think you should have the resources to back that up, to be able to do it. And it's growing. I talk about it in terms of Family Governance 2.0. You know, I know we know that we have the Field is very fortunate to have super professionals who have really created the field of family governance and created a lot of great literature around them. And I think what we're looking at now is the second generation of that where issues of mental health are coming into play.
And by the way, these are tough, messy issues.
It's a nonlinear process.
And so if you say you're going to do it, make sure you can do it. And you're invested in doing it and recognizing that it's going to be a roller coaster ride. I mean, my friend blows up three times a day with things that just tend to blow up. And, you know, I have to manage situations.
[00:48:11] Speaker B: Who's this? Your.
[00:48:12] Speaker A: I do. My phone. My phone blows up with.
[00:48:14] Speaker B: Your phone blows up? Yeah.
[00:48:16] Speaker A: With clients that are just kind of this happened or that happened, or my son just got arrested or, you know, this. These sorts of things.
[00:48:24] Speaker B: How do wealthy parents accidentally mess up their kids while trying not to mess them up?
[00:48:29] Speaker A: The first is by sending conflicted messages. So if you want your kids to work and be invested in the environment and develop a good work ethic, you need to live that as well.
So I think just sort of recognizing that it's not what you tell your kids, it's how you live your life. Yeah.
[00:48:49] Speaker B: It's not what you say, it's what you do. They see it.
[00:48:51] Speaker A: They see it and they're really paying close attention.
And I think not being afraid to talk about wealth because you're going to spoil the kids. You know, kids know they're rich if they're flying private and they're chartering. You know, they're spending Easter on a yacht and classmates are lucky to go to Disneyland.
They know that that's going on. They know that that's what's happening. And so talk about it honestly and say, this is what we have and these are the decisions that we make. And it's a danger, you know, and it's dangerous.
[00:49:25] Speaker B: Are you foretelling them your net worth?
[00:49:27] Speaker A: It depends. I'm a knitter, and I don't really necessarily think my work scales like to say this is an absolute.
If you have a kid who is autistic or you have a kid who has a substance use disorder, or if you have a kid who's bipolar. I think every case is unique. And this is why I think that if parents are conflicted, just talk to somebody about it, you know, like, and talk about the positive and the negative, and there isn't one right, complete right or one wrong answer.
[00:49:58] Speaker B: So how should somebody pick a Therapist.
[00:50:01] Speaker A: I think you should trust your instincts. I think that it helps to ask people who you know and respect, who they know and respect and be like Goldilocks, you know, like going into the cabin and, you know, taste this, and some of it may feel right, some of it may feel wrong, and then taste something else and see what that feels like. And I have one person who just came to me who had spent like a year and a half kind of like researching me, like in my research, and read the book and did the podcasts, and that was a really thoughtful way to go about it, actually.
[00:50:38] Speaker B: How are they as a client? Can you say fantastic?
[00:50:41] Speaker A: Motivated, super insightful. People have all these such negative stereotypes about people of wealth. Like they have people of poor people, right? They're entitled, they're lazy, they're narcissistic, they're clean.
And yeah, some are.
I mean, like some poor people are, some middle class people are, some rich people are. But there's a generalization that occurs when we say that all rich people are like, I think I deal with probably a biased sample size that the people who come to me, like, you don't come to me if you want to be an arrogant jerk. Like, you know what I mean? You come to me because you want to be a better human being and you want to use your money in a way that's healthy and you want to recover from a mental health or personality disorder or behavioral health addiction. So there's a level of motivation. And the people who come to me are so motivated to. They really want to be good people, they're hungry to be better, want to use their money in a way that improves their lives, the lives of the people they love and the planet that they're privileged to live on.
So for me, like, just being it, just having the privilege of showing up and being able to do the work. I mean, not look, not every day is like rainbows and unicorns. I mean, there's, you know, there's always challenges. And the thing with this patient population is they test, right? They test me. Am I smart enough? Am I, am I kind enough? Am I, am I seeing them because of the money? You know, I'm like all these questions, of course they're going to have.
And so my work is being able to tolerate the challenges to my intentions and my credibility and my competency and bring it on, you know, Bring it on.
[00:52:25] Speaker B: Yeah, I would, I wouldn't imagine having boundaries is really important in the work that you do.
[00:52:30] Speaker A: Having boundaries is important. And teaching my patients boundaries and having you know, like a real self care practice.
I don't have an infrastructure and I don't have a big practice.
I had a client the other day saying, can you have your billing department contact me? And I'm like, well this, I, I, I, I have a billing department.
So I really don't want institutional responsibilities to interfere with the quality of care that I can give to my patients.
If I don't feel that I can help a patient, then let's find somebody who can.
And I'm not for everybody, and not everybody's for me. There's a huge degree of personality that comes into play here. And this is why I say that my work is an art based on science, that it needs to be grounded in solid clinical constructs. But it's delivered as an art form.
[00:53:22] Speaker B: Beautifully said. An art form.
[00:53:24] Speaker A: It's an art. Psychotherapy is an art form. It's a practice like yoga. It's striving for increments of better.
[00:53:34] Speaker B: Would you call it like mastery?
[00:53:36] Speaker A: I would call it mastery, yeah, yeah, it's a very good, very good descriptor.
[00:53:41] Speaker B: Because I know that when I'm with my karate senseis and with my piano teachers, even my assistant, I was telling her that I was like, you're like the ninja of personal assistants.
I feel that same feeling of flow or trust when I'm with people who exude that kind of mastery because they just love what they do.
[00:54:02] Speaker A: Yeah, I'm very self critical about my work.
I make mistakes on a regular basis. Clients, I say things that like, I probably should not have said that. But the repair, the work, the growth comes in our ability to tolerate my imperfections in that context.
[00:54:20] Speaker B: Okay, well, it's human, right? And you're showing accountability.
[00:54:23] Speaker A: It's human and I apologize and think of it as just to strive to be as best we can in that relationship. And then that sets the parameters for striving to be the best people we can be out in the world.
[00:54:38] Speaker B: Do you pick up the phone between 8:00pm and 8:00am?
[00:54:43] Speaker A: No.
[00:54:44] Speaker B: Okay.
I like your morning routine.
[00:54:47] Speaker A: Like I get up early, I have a cup of coffee and I journal for probably about an hour a day morning and I don't listen to any music. And I have gotten now where I don't check email. I sometimes I will Check texts or WhatsApp to see whether patients have canceled or what's up for the day. But I really, really try to stay off of my phone until like 9 o'. Clock. You know, it's not like I'm a heart surgeon Where I have to go, patient has a heart attack, I have to go to the emergency room and perform a.
[00:55:20] Speaker B: When somebody's suicidal, you kind of do.
[00:55:22] Speaker A: Well, it was suicidal. But if there's a suicidal situation, that's an example. I would be responsive. At the same time, sort of being grounded in myself and in my care is critically important. And towards that end, I have a yoga practice where I find that incredibly beneficial to me being able to tolerate the discomfort and breathe through, you know, the challenges. And I hate, hate it while I'm doing it, but afterwards I feel amazing and I'm glad I done it, picked up tennis again and that's very therapeutic for me.
[00:55:58] Speaker B: So what do you do in the evening?
[00:56:01] Speaker A: I read.
[00:56:02] Speaker B: I typically read real books. You said, right?
[00:56:05] Speaker A: Sianga, Real. But hard copy. If it's. I prefer hard copy books. There's no, like social media like Instagram. There's really. I mean, that's not a community, that's an audience. People are looking for an audience in. In Instagram, on Instagram. But I think the social media platform that I like the most is LinkedIn because I think there's. There's an element of decorum and professionalism and professional respect. I try not to scroll the news because there's not much news, just most basically sensationalistic opinions. I try to do that. And I'm kind of an early to bed, early to rise guy.
[00:56:42] Speaker B: Yeah, well, it looks like you're really taking care of yourself.
[00:56:45] Speaker A: Try. There could always be room for improvement, right? Progress, not perfection.
[00:56:49] Speaker B: I love that.
[00:56:50] Speaker A: And that's great.
[00:56:51] Speaker B: If someone listening recognizes themselves in everything we've discussed, the isolation, the performance, the never quite enough feeling, what's their first move?
[00:57:00] Speaker A: I think to acknowledge it. And I'm a big fan of, like I said, journaling. I love getting things on paper. And so like, and I'm like a Luddite, I'm old school.
So, like paper pens, like, remember these ink pens? I write? So write out, get those thoughts onto paper and then once you have those thoughts on paper, then figure out a strategy for how you're going to approach them, how you're going to address them, and then figure out the therapist that you want to find and look at it as like an adventure. Some of my patients, I always say, like, pretend like you're a journalist writing a story in all of your life. And so being like a participant observer in your experience and being able to look at it from the outside, from an objective standpoint. And if you were advising your son or your daughter or your best friend.
How would you advise them? What would you advise them to do? And then come up with a plan. Like, okay, I'm going to do like, 1, 2, 3, and then start yoga. I'm going to see a therapist. I'm going to journal every day. And that's enough.
[00:58:02] Speaker B: That's awesome. Thank you so much, Dr. Paul. I feel so motivated by the way my morning routine is like yours. So I love that you drink coffee.
[00:58:10] Speaker A: Oh, yeah, Yeah. I mean, I rue the day when the doctor's going to say, all right, Hokemari, we got to cut the coffee out. I'm going to be like, ah.
But that day is not here yet. So.
[00:58:21] Speaker B: All right, Dr. Hochmaier, thank you so much for your time and for coming on this show.
[00:58:26] Speaker A: Thank you. Thank you for the work and our connection and keep on writing and keep on speaking and keep on putting your voice out into the world.
[00:58:37] Speaker B: If this episode landed for you, share it with someone who might need to hear it. And if you haven't already, subscribe so you don't miss what's coming.
But here's the real thing. I want you to know if you're carrying something you can't talk about, if you have every resource except someone who actually understands what wealth costs. I work one on one with people like you navigating exactly that. You can reach me@diana oehrli.com. thanks for listening.
