Dr. Stanley Goldstein - Author and Psychologist

Childhood experiences are the bedrock of adult personality and functioning and not easily changed. Early in life one develops beliefs about such basic human experiences as trust and the possibility of gaining comfort from another. Thus when a spouse declares that they don't understand their mate's concern, this may honestly reflect an inability to grasp the underlying emotion that the other is expressing rather than being oppositional or passive-aggressive. They having feared certain feelings since childhood when they were used by their parents to control them and thwart their desire for self-expression and autonomy.

These conflicts, when extreme, reflect what is present in Autism and Asperger's Disorder which are among the most debilitating of mental health conditions. The unconscious is powerful and one must respect it's power.

Movies have not often portrayed psychotherapy accurately, usually including fanciful mysteries, murder, or romance between doctor and patient which, though rare, is illegal outside film. I recently watched the classic (1962) "David and Lisa," and was struck by its accurate depiction of the psychotherapy of the severer adolescent disorders. The doctor was empathic, understanding, and accepting while the patients were driven by unconscious impulses deriving from long-term parenting mistakes done unknowingly.
What was clear in the film was that the unconscious is powerful and personality change is not easy or quickly done.

While the film's acting and script were superb, my unexpected deep emotional involvement with it likely derived from my work in a similar treatment setting many years ago and described in my first book, "Troubled Children/Troubled Parents: The Way Out," which contains its own dramatic stories including that of a clinician who secretly married his much younger patient. "David and Lisa" is likely available online or in your library. Watch it!

A recent Wall Street Journal aarticle ("One Surprising Psychosis Treatment That Works: Learning to Live With the Voices"/December 21, 2024) aroused these thoughts. Schizophrenia is vastly misdiagnosed particularly with substance abusers, and no medication can "cure" it since its symptoms reflect faulty early-childhood development of the basic critical ego capacities governing control of thinking, behavior, and more, apart from the debilitating side effects of psychotropic medication when used for more than briefly. The benefits of psychotropic medication tend to be exaggerated by drug companies and doctors with their side-effects downplayed.

Long ago a gifted psychiatrist/psychoanalyst in my training told of treating a hospitalized VA patient who frightened others by talking aloud to himself. The doctor advised him that if he continued this behavior he would be given electric shock treatment, which neither of them wanted. So when he felt compelled to behave like this he should go to the bathroom and talk into the toilet. Years later the patient's sister thanked the doctor for the remarkable improvement in her brother's behavior. Sadly, America's National Institute of Mental Health prioritizes drug treatment of emotional disorders though a study fifty-years ago showed the highest rate of recidivism (re-hospitalization) of severely disturbed psychiatric hospitalized patients was of those who were prescribed psychotropic medication in the hospital and following discharge, the lowest recidivism rate was with patients prescribed no medication in the hospital or after discharge, and the in-between recidivism rate was with patients who were prescribed medication in the hospital but not after discharge. Nuff said.

In the era before cellphones while driving outside St. Louis, my car got stuck on a road's divider while making a turn.

It was early morning with no help or cars to be seen. As I stood beside it, a car finally appeared and stopped opposite mine. It held four huge guys and I regretted leaving my pistol at home.

The driver came over and asked what happened. "My car's stuck," I said nervously. After briefly speaking to his companions they came to my car, picked it up, and moved it back onto the road.

I wanted to pay the driver but he refused. "There's a revival meeting at St. Louis Stadium tomorrow night. Come," he said.

Then, without another word, my four angels drove off and vanished into the night.

A December 10, 2024 Wall Street Journal article reflected on the inadequacies of America's students ("In a Test of Adult Know-How, America Comes Up Short The least-educated workers are falling behind on basic skills such as reading a thermometer and planning a trip.") To explain the problem with America's students' literacy, look to early-life parenting. When first read to and then with as toddlers, almost all children will learn to read on their own since the child's mind has the innate ability to induct the nature of reading just as it does the language grammar of the nation into which they are born. No formal teaching of reading is needed. But, sadly, some children do not experience a "good-enough" (not perfect!) parenting. Culture matters too, whether parents prize education and achievement, but these are not popular political talking points. Nor should teachers be expected to re-parent their students.

A recent robust online clinical discussion concerned whether a teenager's proper diagnosis was autism or a subtype of schizophrenia despite the treatment of both conditions being the same: for the therapist to provide such a comfortable experience that the patient will eventually renounce the symptoms which keep them socially isolated and gain social skills. Both conditions reflect what has been termed Elements of a Borderline Psychotic Psychostructural Organization: the weakness of basic ego capacities which develop during the earliest years of life and control thinking, behavior, the sense of who one is, and more.

Autism is vastly diagnosed. With true autism the very young child senses the grave inadequacy of their parenting and tries to function independently. After inevitably failing because of their age and despairing they enter a personal universe to psychologically protect themselves, which is the autism. An Australian study found that when the parents of very young children with autistic features were provided extensive parenting education almost all the children were no longer diagnosable as autistic by the age of four.

A recent Wall Street Journal article inspired this blog ("Three Killings, One Suspect, and a sister Who Warned Her Brother Needed Help" - Nov. 30, 2024). Forty-one-year-old Chris Ferguson struggled with mental illness since his twenties, working as an unskilled cashier despite being a college honors graduate.
Though experiencing a dozen psychiatric hospitalizations and prescribed psychotropic medications his improvements were brief and tenuous. Longer than his provided three-day hospitalizations was barred without his consent or a court order, causing recurring experiences of deterioration. Despite his sister's plea that he was losing control, the hospital refused to admit him without his consent, which he refused to give. He was finally hospitalized after murdering three elderly neighbors, having been arrested while staggering through the neighborhood shirtless and barefoot with bloody footprints, recorded by security cameras. His latest trip to the hospital was his fourth in five months.
While the prediction of violent behavior will always be imprecise, several factors seem relevant here and with similar events: the reliance on psychotropic medication to allegedly "cure" mental illness; the limited knowledge of child psychological development and developmental psychopathology by doctors who have had minimal training in psychotherapy, today's psychiatric residents receiving only ten-percent of the training in psychotherapy they did seventy-years ago.
While state psychiatric hospitals were imperfect they did provide a place of safety for patients and the public. Their closing with the promised savings promised for supportive housing and outpatient services never occurring, the myth that medication can cure complex problems of living having been accepted..
An exhaustive study of severely disturbed, hospitalized psychiatric patients conducted more than fifty-years ago found that the lowest rate of recidivism (re-hospitalization) occurred with patients who were given no medication in the hospital, the next lowest rate was those provided medication in the hospital but not upon discharge, and the poorest prognosis was of patients taking medication both in the hospital and following discharge.
While legal and treatment changes cannot guarantee against crimes like Ferguson's, continuing present policies will guarantee their occurrence.