Dr. Stanley Goldstein - Author and Psychologist

I once had a patient with a disabling symptom, a fetish which is an obsessive need to touch or photograph or otherwise involve themselves with an object or body part, which can be a woman's shoe or foot, just about anything. Being almost always a male symptom, women tending not to develop them, it reflects early life trauma during which the object involves what has been termed "castration anxiety," the boy's fear of losing his penis. The boy, having seen a naked female and fearing they may lose their penis as he incorrectly believes the female did hers, uses the fetish to symbolize this fear and underlying anxiety. Which tends to persist since early childhood has immaturely developed thinking capacities and is the bedrock of the adult personality.

 

After explaining the nature of fetish to this man, I advised him to talk to himself: to tell himself that while the fetish helped him when he was a child it was no longer needed. Still, both he and the fetish would remain friends throughout life but the fetish could relax. Using this technique, which contains elements of play therapy with children, his obsession with the fetish disappeared within several months.

 

Similarly, when one has experienced a traumatic experience, during wartime or after rape or assault, if one tells oneself that the later symptoms were created to help them and not the problem, they are better able to cope. Understanding that the associated symptom such as nightmares are friendly warnings to resolve an unconscious conflict and not an enemy.

 

So while talking to oneself has a bad reputation, it often being associated with psychosis, it can be healing. But it should be done when alone and need not be spoken aloud.

 

An article in The Wall Street Journal aroused these thoughts ("Green Beret in Tesla Explosion Suffered From PTSD, Authorities Say"/Jan. 3, 2025). PTSD (Post-Traumatic Stress Disorder) can occur in anyone, even children, when stress exceeds the mind's capacity to cope with it. Its possible feared, painful symptoms (nightmares, flashbacks, others) are not the real problem since they reflect the mind's normal healthy attempt to re-integrate after experiencing the unbearable stress. Thus the most effective treatment is education and psychotherapy with medication, which can produce serious side effects and interfere with thinking, being avoided or used only briefly. Which is not how it's usually treated.

As an aside, many American veterans who are receiving compensation for PTSD never experienced combat or even left the USA. Their symptoms reflect early life psychological issues exacerbated by recent extreme stress. That its diagnosis can involve financial compensation complicates its diagnosis and treatment. In Israel, which has had several wars and continuing danger, PTSD is treated differently. Their suffering soldiers are explained the nature of PTSD before being sent home for several weeks leave. They then return to their unit without the PTSD symptoms lingering. These statistics were remembered from a past article in Armed Forces and Society, an outstanding international journal on military and related matters. It's well worth subscribing.

 

 

Violence can cause personality change and military combat is among the most intense. One pesonality change, called the "heart of darkness" syndrome, transforms a previously normal person into an enjoyer of killing, exceeding the normal reactions to prolonged combat though having revealed no antisocial behavior earlier and having a close, caring relationship with their comrades. The personality change from "normal" to "happy killer" occurred after witnessing their comrades' deaths.

 

Yet this reaction to combat trauma is extreme since soldiers with brief combat experience need not make such a personality adjustment to how they relate to reality in order to psychologically survive, having adjusted to it with controllable fear during their potentially fatal experiences. But continuous combat tends to produce a sense of denial despite the close-by death of comrades, causing a persistant blunting of feelings that can affect relationships long after military service has ended.

Three possibilities exist within the combat continuum of personality change: (1) none, where the ex-soldier remembers and re-experiences past events without denial or the blunting of feelings or becoming a lover of killing; (2) the soldier develops a warrior mentality but functions under orders and kills only for military purposes, retaining a sense of ethics; (3) the soldier has come to love killing, feeling invulnerable and lacking empathy for those whom they kill.

But this continuum of human personality change cannot be so clearly separated since courage, heroism, self-control, and intense comradeship exist in all.

Reference: "Combat and Personality Change" by Samuel L.Bradshaw, M.D., Carroll D. Ohlde, Ph.D., and James B. Horne, M.D. - Bulletin of the Menninger Clinic, Fall, 1993, pp. 466-47

Post-traumatic Stress Disorder (PTSD) has gained much of its erroneous though popular knowledge from frightening movies depicting berserk ex-soldiers on killing sprees. Yet PTSD symptoms can develop in anyone including children. It exists because the mind has a limited capacity to cope with stress and, when exceeded, symptoms develop. A symptom is the sign that something is wrong and, with PTSD, can include nightmares, flashbacks of the causative event, psychogenic seizures, over-sensitivity to startling noises, or odd fears and obsessions. These reflect the urgent message from the unconscious that help is needed to avoid damaging the mind or body as great continuing anxiety can do. Thus PTSD symptoms are like the bodily fever that warns of infection, being temporarily uncomfortable but needed since it leads to gaining the required care and regaining health.

A common characteristic of Post-Traumatic Stress Disorder (PTSD) is emotional desensitization, becoming unable to feel those feelings which make us human such as warmth, closeness, and joy in relationships. What feeling is experienced is rage which may be expressed through unwise, self-defeating, or even violent behavior, the mind having created this blockage as a survival mechanism after the frightening, paralyzing trauma.

The extreme behavior that can follow reflects the anger of frustration and attempt to smash this blockage of feelings, to feel something.
This emotional blockage can derive from combat or civilian experience as an adult or a child, from a terrorist bombing or the continuing child abuse of grossly inadequate parenting. Insight into its nature increases the probability of healing.

The pandemic has brought Post-traumatic Stress Disorder to the attention of many for its upset is considerable: distressing thoughts and nightmares; recollections of the traumatic event(s) which may include reliving them through illusions and dissociative flashbacks; avoiding conversations about the event(s) or places where they occurred; marked symptoms of anxiety causing problems with sleep, concentration, and functioning on the job.

 

Yet though painful, these symptoms are intended by the mind to be helpful for they serve two critical functions: forcing into consciousness the fact that the person's tolerance for stress has been exceeded and change must be made, and reflecting its healthy, normal attempt to re-integrate--to repair itself--from the damage of intolerable stress. The unconscious is very powerful, and one must respect its power.

Thirty-years ago I was asked to treat an eight-year-old child who, stricken with leukemia, had been discharged from the hospital to die at home. Though fearing the emotional turmoil, I felt unable to refuse the request, feeling that he needed someone.

 

The boy looked terrible at our first meeting, holding a white enamel tray lest he vomit. I introduced him to "our friends," the stuffed animals in my office (Bertram Bear and Darrell Dog and Barry Bird and Gregory Gorilla) while we played a board game. He looked healthy at the following sessions, not bringing a tray, and playing and interacting with our friends comparably to my other young patients. He seemed so normal that I embraced the frequent delusion that his doctors were wrong and he wasn't dying. Then one day, when he became too ill to travel, I went to his home and spoke with his parents in the kitchen while he lay in bed.

 

Despite my heavy work schedule and preoccupation with him since we met, I felt nothing when he died but my body reacted differently. Though continually healthy, I immediately developed an unpredictable explosive diarrhea which made me unable to perform my duty as expert witness in court. Medical tests found nothing wrong and when the diarrhea ended two months later, I sensed it was gone forever and it never returned. Had my body tried to expel the poisoning stress through diarrhea? I wondered. A primitive reaction explained by psychosomatic medicine which holds that what cannot be spoken will be expressed through the body.

 

Twenty-six-years later I was referred for treatment an adult who, after extensive surgery, was being heavily medicated by his doctor for pain and self-medicating himself with forbidden alcohol and cigarettes. Having become a troublesome hanger-out in her office, she referred him to me "for therapy." A first glance told me he was dying. He had no interest in therapy, I didn't see him for long, and my increased blood pressure lasted as briefly. A week later, without conscious intent, I spontaneously spoke of the boy who departed life too soon, leaving his parents and me and our friends to grieve. Then I did cry.

I was a member of the American Society of Clinical Hypnosis for many years and, while a hospital administrator, got pains in my neck at the end of the day. A year later I interpreted this as reflecting some of my employees being a pain in the neck which they were. An ASCH entire journal issue was on cancer and hypnosis and I used one of the article's research protocols (the article related stress to the immune system and the tendency to develop cancer) to make a ten-minute tape which I then used twice and, low and behold, my neck pain disappeared.

 

Years later, when a nurse at my (stressful) job found that my blood pressure was high, an internist I had known since adolescence recommended that I take it as often as possible, there being no way that I would take medication. I did, used the self-hypnotic relaxation CD repeatedly daily and graphed my readings. My blood pressure readings gradually went down over several months to superb readings (low 120s over low 70s or better) and have remained so. I'm a great believer in the efficacy of hypnosis, considering it not a learned reaction but fostering the entrance into a different physiological state, this "drop" being experienced by many. Napping using self-hypnosis is far more restful too, a 1/2 hour nap, upon awakening, feeling like a several hour ordinary period of sleep.

 

I've since used the tape (now a CD and on my Android phone) daily and given it to all of my adult patients without charge for relaxation, though hypnosis is useful for far more. I regard hypnosis as mostly best for physical conditions such as alleviating the pain of childbirth, burns, and back ache; to lower high blood pressure along with the use of a digital blood pressure measuring device as a biofeedback mechanism; for sleep difficulty; to reduce the stress of asthmatic children so they're less likely to have an asthma attack, and with similar issues.

 

On the whole, apart from relieving stress and anxiety, I believe that hypnosis, and mostly the teaching of self-hypnotic technique which is quick, isn't particularly useful when coping with specific trauma. Here, psychological education about its nature and psychodynamic interpretation of the trauma residue would be most beneficial. It is also far safer than the use of medication.

 

While nightmares and flashbacks are frightening enough, another symptom is worse: agitated (anxiety-laden) depression which can seem never-ending. This feeling of being alone and helpless arouses from infancy, a period when the child is completely dependent on their parents for survival. Gradually, the child's mind creates an image of an all-nurturing parent who, when  Read More 

The experience of panic, which often occurs in PTSD sufferers, is the feeling of confronting overwhelming danger even if none exists. The prototype for this is the infant’s state of helplessness when intense anxiety is experienced over which they have no control.
During development, the child learns to use their anxiety in a  Read More