Nervous breakdowns come in twos. A first trauma causes the first one and leads you to feel utterly defenseless. When as sure as you thought you were is as wrong as you turn out to be, it can cause you to doubt all your past decisions and any upcoming ones, at which point you are frozen in limbo.

When you’re in such a state of feeling exposed and at risk, you live with the constant fear of being re-traumatized. You think that if the first trauma caused a severe crack in the porcelain of your well-being (that you turn away from your public face, lest others see), a second one will shatter you completely and you will never recover.

This is what PTSD victims, many concentration camp survivors, rape victims, financial collapse, and prolonged unemployment have in common. All of these traumas introduce you to an extreme vulnerability that on bad days you can barely live with. The world may think you got over those traumas, but the secret you keep inside is that you never did; you merely got past them.

All subsequent behaviors following such traumas — from social withdrawal to excessive alcohol/drug/prescription abuse to moodiness and irritability (when pushed to do something you don’t want to do) to rage (when cornered or provoked) to suicide — can be viewed as an effort to avoid re-traumatization at all costs.

Treatments from Cognitive Behavioral Therapy (re-evaluating your thinking and perceptions in light of reality) to interpersonal therapy (helping you stay involved in relationships and more effective in them) to biological (from anti-anxiety, to anti-depressant to anti-psychotic meds) and other modalities are an effort to intervene with people living in this psychological abyss and help them manage their emotion and land back on the track back to a functional life.

Sometimes one step in the right direction is to talk and walk a traumatized person back from the edge, as for example recently happened when I spoke with a financially ruined person teetering on the brink of psychologically falling apart (and something you might try with a traumatized person you know

Dr G: How big a trauma has losing all this money been?

Client: Big.

Dr. G: How big?

Client (now beginning to cry with upset and relief): I can’t even think about it.

Dr. G: What does it make you want to do?

Client: I don’t know. I guess, just hide. (He then continues to speak about this for several minutes).

Dr. G: How well do you think you could handle another trauma with your wife, children, parents, health?

Client (looking at me incredulously): Are you nuts? I couldn’t.

Dr. G: What do you think you’d do?

Client: I couldn’t even imagine. (He continues to speak about this for several minutes).

Dr. G: So, you’re as scared as you’ve ever been.

Client: More than I’ve ever been.

Dr. G: Tell me about another time in your life that you never thought you’d get through, but that you did.

Client: I remember when my dad abused everyone and he got so angry I thought he was going to kill someone… (He continues to speak about this for several minutes)

Dr. G: Yes that. Tell me about that incident, how you never thought you’d make it through and how you did.

Client (continuing to talk at length)

As the client began to talk and answer these questions and tell the story (of another trauma he made it through) he visibly calmed and realized he’d survived bad times in his life before. As he continued to relax, he became more open to talk about his options in his current crisis.

For more information check out my book, PTSD for Dummies.

As a psychiatrist and medical doctor it would be improper to diagnose Bernard Madoff without interviewing him directly and having him take various psychological tests.

 However what is not off limits and just as relevant is not what his behavior says about him, but what it says about us.  What is there about human nature that makes some of the smartest and supposedly shrewdest financial minds ignore red flags and abandon judgment?

How Madoff was able to do it is can be explained by social psychology and why he was able to do it can be explained by neuropsychology.

Social psychology is the study of how people and groups interact.  Robert B. Cialdini is a social psychologist, Professor of Psychology at Arizona State University and author ofInfluence: Science and Practice..   He is one of the leading researchers in the field of influence and persuasion.  His work is compelling, convincing and so powerful that he vigorously decries it use in any exchange that lacks integrity and ethics.  Unfortunately too often, people with impure motives have learned to apply this effective approach to their impure ends.  I don’t know if Madoff was a student of this approach, but his behavior indicates that he followed all of Cialdini’s principles.

Cialdini’s six “weapons of influence”:

* Reciprocation -People tend to return a favor. Thus, Madoff’s offer to clients to be part of an exclusive list of wealthy clients and institutions, caused clients to be grateful for this special invitation and return the favor by investing more money than common sense would dictate.

* Commitment and Consistency – Also referred to as “confirmation bias,” if people commit, orally or in writing, to an idea or goal, they are more likely to honor that commitment and be inclined to keep saying, “Yes” to reinforce their believing they have made the best judgment call to begin. With Madoff, the more that people originally invested, the more they continued to invest and the more they invited their friend to invest. This all served to reinforce their believing they had made the best decision to begin with. Finally, this also caused people to overlook or negate any facts to the contrary and made them all too willing to take a “don’t ask (Madoff), (Madoff) don’t tell” position.

* Social Proof - People will do things that they see other people are doing.  So when people discovered that others who they thought were smart and wise were investing, that increased their confidence that it was safe for them to do so.

* Authority - People will tend to obey authority figures, even if they are asked to perform suspicions or even objectionable acts. Madoff was a former Chairman of the NASDAQ and philanthropist.  So it was assumed that if anyone could understand the potential opportunities and risks of younger growth companies, it would be him.

* Liking - People are easily persuaded by and buy from other people that they like. It was easy to confuse Madoff’s sly smile as a shrewd one.  Also we tend to like people who demonstrate swagger and exude confidence.  They trigger swagger and confidence envy in others who would also like to possess those qualities.

* Scarcity - Perceived scarcity will generate demand.  Madoff’s reserving his offering for elite investors and by invitation only, made more people want to be part of his exclusive club.

Neuropsychology is the applied scientific discipline that studies the structure and function of the brain related to specific psychological processes and overt behaviors and may explain why Madoff was able to trick us.  One area of neuroscience that has generated a great deal of interest and study in the past two decades is the discovery of an area in the premotor and parietal cortices referred to as the mirror neuron system.

In the late 1980′s this region of neurons was discovered in Macaque monkeys. These neurons which were first referred to as “monkey see, monkey do” neurons were activated when a monkey watched another monkey perform a behavior and when the first monkey performed the behavior that it saw.  When the discovery was also applied to humans, the region also fired when a person imagined doing that activity in his mind’s eye.  So when a golfer imagines the flight of a ball before he hits it, this part of the brain actually thinks it’s hitting the ball.

Further research including fMRI scans (which show what is happening to the brain as it is thinking or doing an activity) have indicated this site might be the prime location for where imitation, learning and empathy develop and when dysfunctional, a possible site that might lead to autism.

The significance of this discovery is that people not only have a reaction when they respond/react to the people around them; they also have a very positive and satisfying reaction when people are mirroring them or “getting where they’re coming from.”  That is why many people cry and feel disarmed when someone is kind to and understands them without it being solicited.

This neurological region may be the underpinning for why Cialdini’s “weapons of influence” are so powerful, i.e. applying them causes the other person to feel empathized with and understood.  When people feel that way, they lower their guard and lean into the relationship and trust it more. In essence when people really feel that you get where they’re coming from, they’re much more likely to trust you to take them where you’d like them to go.

Just as guns do not kill people, people kill people empathically mediated persuasion techniques do not manipulate people for evil, people do that.  Hitler and Osama bin Laden were both extremely empathic in that they both knew all too well how terrorizing people can almost paralyze them with fear or at least completely disrupt their ability to function.

What it comes down to is a person’s values.  It’s their values that determine whether they will use persuasion and empathy in the best interest of their clients (as medical doctors who are sworn to “first do no harm” do with their patients) to do good or to greedily exploit their fears, insecurities and yes, their clients’ own greed to violate ethics and morality.

How can all of us use these findings from social psychology and neuropsychology to be more fortified against the charming manipulators and psychopaths in life?  First, go into any meeting with any person who is pitching you knowing explicitly what you want and need from them. When you don’t know these, the charm of these people can cause you to be vulnerable to their persuading you to need and want what they are offering.  Second, make certain that whatever they are offering makes sense, feels right and seems actually doable.  Third, realize that whatever they’re offering is a good deal for them, so push them to tell you why it’s a good deal for them.

Finally, be prepared to walk away, no matter what they say.  If they say, “Take it or leave it,” leave it. If it feels too good to be true, it is.