Dr. Stanley Goldstein - Author and Psychologist

1. Schizophrenia is greatly misdiagnosed particularly when substance abuse is present. 2. The benefits of psychotropic drugs tend to be exaggerated and their side-effects downplayed. A 1970s extensive study found the lowest rate of recidivism for severely disturbed hospitalized patients being when no medication was given, the next best result when medication was prescribed only during hospitalization, and the poorest outcome being when patients were told they need take medication after discharge (by believers of the "chemical imbalance" myth). 3. Explaining psychodynamics to patients can have a powerful healing effect as that paranoia is simply being overly watchful. Simple organization incompetence is often misinterpreted as conspiracy. As an aside, long ago the Silicon Valley guru, Andrew Grove, then head of Intel, wrote a famed book, Only The Paranoid Survive. 4. Information from mental health professionals varies in validity depending on their training, talent, and experience with some being worthless or even harmful. Still, people don't go to clinicians for advice, they almost always knowing what they want but being unable to achieve it and with which they need help. 5. Suicide reflects complex motive deriving from long term unhappiness exacerbated by recent stress, it often involving drug or alcohol use since there is a powerful biological imperative to live.

The recent suicide of forty-seven -year-old Heather Armstrong, who was also known as Mommy Blogger and Dooce, aroused much publicity. While almost everyone has a suicidal thought sometime, the critical factors for its acting-out are whether it is serious, if the person has a realistic plan and means of carrying it out (as a gun or pills), and their degree of self-control.

Because of the biological imperative to live, suicide usually requires that the person's thinking is addled by drugs or alcohol or both as with Armstrong. Conceptually, suicide reflects early life experience during which the person was made to feel worthless, this belief returning later when, as adult and burdened by exceptional stress, the person considers themselves to be unworthy of life.

Suicide is alway a tragedy and, as has long been said, a permanent solution to a temporary condition. I've long thought that, to increase its understanding, psychological autopsies of prominent figues should be publicized regardless of family embarrassment. After all, it no longer matters to the principal character.

An essay in The Wall Street Journal on April 1, 2023 ("We Need to Talk About Suicide"), by a person who attempted suicide three times, aroused comment. Though the biological imperative to live is powerful, all think of suicide at some point in their life, the critical factors predicting its lethality being the presence of suicide intent, the availability of lethal means (a gun or a drug), and the degree of self-control possessed. While the actual incidence of suicide compared to its thought is like the proverbial needle in a haystack, it should always be professionally evaluated. But sadly, Emergency Room evaluations can be unsophisticated, leading to unneeded hospitalization (the professionally "safest" decision) which has emotional risk, the person now viewing themselves as "a crazy person," unlike earlier when they considered themselves merely part of the human race. And as has long been said, suicide is a permanent solution to a temporary problem.

A February 18, 2023 article in The Wall Street Journal ("Teens' Mental-Health Distress Could Be Worse Than CDC Data Suggest") describes an alleged crisis. I tend to be leery of alarming statistics and particularly about suicide. As a psychologist who has treated children and teenagers for decades, my experience is that true suicidal ideation, having all the required diagnostic symptoms of suicidal plan, intent, means, and inadequate self-control, is rare. Searching for such individuals is, as has long been stated, like searching for a needle in a haystack. I remember only two youth that I've referred for hospitalization. While all such instances should be professionally evaluated, many youth are inappropriately hospitalized causing harmful development consequences.

With regard to the effect of the COVID emergency on youth academics: some survived it without difficulty, doing as well as they usually did; others missed their friends but also did as usual except for math which seems of particular difficulty when taught online; and others did poorly, particularly those for whom sports are important. Certainly not an enviable situation but... The COVID situation seemed regarded by youth with equanimity, being typical of the adults' craziness they must endure and, when grown-up, will remedy.

The important of "good-enough" parenting, from infancy and toddlerhood onward but particularly then, is critical to healthy psychological development. Sophisticated knowledge of child psychological development is widely lacking among doctors, the public, and school systems resulting in student misery and inadequate academic achievement.

A recent study of suicide in the American military found: (1) The more concurrent risk factors that are present, the greater the risk of suicide; (2) The greatest risk factor for suicide is the loss of an intimate relationship; (3) Other risk factors are job, administrative, or legal problems; Post-traumatic Stress Disorder, and combat experience coupled with substance abuse. It was recommended that the Defense Department's emphasis on mental health education and suport should be expanded to include spouses and intimate partners. From "Risk Factors Explaining Military Deaths From Suicide, 2008-2017: A Latent Class Analysis" by Scott D. Landes, Janet M. Wilmoth, Andrew S. London, and Ann T. Landes in Armed Forces & Society, January 2023, Vol 49, Number 1, pp 115-137.

While any youth's suicide is shocking, that of Stanford University's soccer star/college senior Katie Meyer was particularly upsetting. While every suicide reflects complex emotions, the action causing her great stress seems particularly illogical and unwarranted. According to a November 27, 2022 article in The Wall Street Journal, Ms. Meyer had been accused of spilling coffee on a fellow student who was accused of sexual assault by another student, an accusation that was not found worthy of action by either the school or the police. An administrative charge was filed against Ms. Meyer by the University's Office of Community Standards. Six months later Ms. Meyer was sent notice of a formal disciplinary charge which could result in "removal from the university" and that her diploma  was being placed on hold. She replied to this e-mail that she was "shocked and distraught" and immediately killed herself.
In hindsight, she should have informed her parents who likely would have hired a lawyer to quash this nonsense but great stress inhibits rational thinking. What is clear however is that the federal 1972 Title IX civil rights law prohibiting sex-based discrimination, which was intended to protect students from harm, is now being used to bully them.

Though suicide is never an acceptable alternative to living, it can seem so in an experienced world of continuous unbearable anxiety and hopelessness. One may also choose suicide to communicate how intolerable their life had become. During this struggle between life and death a relationship with a compassionate friend or psychotherapist, from whom to draw strength, can enable time for ego strength and self-esteem to recover with the powers focused on life and not ending it. Freed from the self-imposed punishment of death to use their abilities and resolve important life issues.

Because of the innate biological imperative to live, suicide can be difficult to understand. Yet its occurrence with even highly successful people, as the former Miss USA Cheslie Krystal, who was also a lawyer, and the widely applauded CEO of the Atlanta rail transportation system, Jeffrey Parker, can be puzzling without visualizing the psychology of despair.
Obsessed with a tunnel vision of their suffering, the suicidal person sees no other ending for it, and in a manner that appears fitting though illogical to others. Krystal leapt from a skyscraper and Parker jumped in front of a moving train.
While the symbolization of the self-destructive means is irrelevant, the prior turning inward of the personal world is significant though there are gradations of this experience since virtually all consider suicide at some point in their life.Perhaps after receiving a serious medical diagnosis or during a particularly stressful work situation. Yet relatively few do, the proverbial needle in the haystack being an accurate metaphor for this act. And as has been said, suicide is a permanent solution to a temporary problem, even that of long term distress.

The motive of all suicides is complex and can range from long term distress since childhood to the loss of a loved one and more, being particularly puzzling when the deceased is relatively young and successful. I was reminded of this upon reading of the recent suicide of fifty-five-year-old Jeffrey Parker who successfully led the Metropolitan Atlanta Rapid Transit Authority (MARTA) after providing noted public service in Connecticut and Massachusetts. While the virtue of privacy is often sadly ignored, I believe that conducting a psychological autopsy after a widely publicized suicide can serve the public good as do medical treatment case histories, by educating people about the complexity of behavior and power of the unconscious. Thus, hopefully, dissuading others from such tragedy while creating a fitting memorial to the deceased who, as has long been said of those who suicide, chose a permanent solution to a temporary problem.

Considering the widespread public and clinician ignorance about psychological development it is unsurprising that Canadian legislation is being considered to assist suicide of the "unbearably suffering mentally ill." While death is inevitable for all and none would wish to prolong pain, I suggest that this proposal reflects both the universal fear of insanity and the reluctance to accept that treatment competence affects healing.

The fear of insanity has a central organizing role in living since what is termed the Executive Function controls behavior, what is considered human. To sense its importance, try to consider how your life would change were you to believe yourself sliding toward psychosis. Many widespread fears, as that of flying or elevators, owe their power to this underlying fear which is usually repressed and thus unavailable for conscious awareness.

While a doctor's skill is considered crucial in the treatment of biological illnesses, this tends not to be the case with psychological disorders though education and talent should logically be considered critical factors in the healing of both. This disparity derives from the widespread ignorance of public and clinicians of the effect of stresses on normal psychological development, this enabling the attractive notion that significant life issues can be quickly resolved using drugs or gadgets. There are now being marketed do-it-yourself, brain-wave machines which purportedly eliminate depression and anxiety. Where little is understood, everything is deemed possible and particularly among those who treat feelings as facts.

To quote F. Scott Fitzgerald in his final line of The Great Gatsby, "So we beat on, boats against the current, borne back ceaselessly into the past." Our sorry past of lobotomies and shock treatments which have destroyed so many lives.

https://nationalpost.com/news/politics/government-agrees-mentally-ill-should-have-access-to-maid-in-two-years

More about Canada's assisted suicide law for the mentally ill