Dr. Stanley Goldstein - Author and Psychologist

Abuse victims fall apart psychologically (decompensate) in stages. The victim first denies the reality of imminent danger with a stubbornness bordering on psychotic. When this defense against the reality of the situation fails, the victim tends to lose control of themselves and give up.

As other people fail to help them, the victim feels given up on and enters a state of resignation. Finally, as all sense of a different future disappears, flashbacks of past trauma occur and the victim enters a state of complete surrender. This is not easily breached without outside help or getting a lucky break. Victims who are coerced into behavior that violate their moral code may be at greatest peril.

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.

Though scary dreams frighten and can greatly upset, "they are our friends" I tell my young patients. Stories that our mind creates to tell what is bothering us and, like the mystery movies we love, that we must try to figure out.

A scary dream could mean that we are nervous about school the next day or learning a new task like swimming. Or even of growing up and leaving home, which is a common worry as one grows older.
Explaining nightmares in this manner reassures a child and reduces their fear. And, if scary dreams don't frighten their parents, perhaps they are not to be feared at all. Once, having spoken this way to a five-year-old girl and repeating myself a month later, she dismissively said, "Oh I know that!"

There has been much publicity about what has been termed the Havana Syndrome: debilitating physical and cognitive symptoms allegedly caused by an unknown foreign government. So certain is this origin that doctors relating these symptoms to psychological causation are ridiculed though experts insist that no evidence of such weapon has been found nor are they conceptually possible.

I have no special knowledge of the Havana Syndrome nor do I wish to minimize the symptoms or pain of its sufferers though the power of the unconscious generally tends to be ignored or minimized. All would prefer to believe they have ultimate power over their behavior. Which is true except when stress or emotions overpower it. Then physical symptoms can occur. Forty-to-sixty percent of those rushing to an Emergency Room, fearful that they are suffering a heart attack, are really suffering the extreme anxiety of Panic Attack during which the normal symptoms of anxiety are misinterpreted as a deadly medical event.

Anxiety symptoms can mimic virtually every physical disorder, even causing visual symptoms when stress causes an optical migraine. Nature behaves economically, having adapted systems to multiple uses with a large gland like the liver performing hundreds of tasks from processing glucose to generating hemoglobin.

A hospital coworker suffered recurring nightmares from which she awoke screaming with marks on her wrists, these being identical to those occurring when she had been repeatedly held down and sexually abused as a child.

The unconscious is very powerful and one must respect its power.

Parents have varying levels of success in coping with their child's lingering medical illness. This derives from whether "poorer" or "better" interactions are used by their doctors and medical establishments. Some are vague regarded diagnosis and prognosis when communicating with parents while others describe the illness realistically but also focus on possible research breakthroughs and the parents' hopes during remissions when the child lives comfortably at home. Yet family mourning is inevitable since, until the child's diagnosis, they were considered normal and happy rather than chronically ill and suffering.

Dreaming occurs nightly but they are not always remembered. The more painful the dream, the more likely it will be remembered and dreams can be painful indeed.

A young child dreamed repeatedly of being eaten by wild animals, and for an adult woman the dreams mirrored her continued sexual abuse when a child. Yet eliminating this pain is not rocket science since dreaming has long been understood. And despite their occasional discomfort, all dreams are our friends I tell my young patients. They are movies that we create in our mind to tell what is troubling us, perhaps being afraid of a school test or the like.

Interpreting a recurring nightmare, whether of a child or adult, will usually eliminate it. Unless the interpretation was faulty, or incomplete with there being more to the emotional conflict that it symbolizes with the person being unable to resolve it at that point in their life. An adult's nightmare that persisted for decades took three years and two interpretations to disappear completely, there having been important personality changes needing to occur first. The initial interpretation reduced the nightmare's frequency but a timely, second interpretation was needed to eliminate it.

There is a logic to nightmares just as with physical symptoms. A fever disappears when the infection is gone, as does a nightmare when the emotional conflict that it symbolizes is resolved.

While parents rarely feel guilty when their child becomes physically ill, this is not true when they develop emotional problems. Autism is perhaps the most affected of these attitudes which, in its severest form, devastates family life.

Though recent infant research has confirmed what clinicians have long sensed, that the parent-child interaction plays an overwhelming role in its development, denial of this fact persists. Thus we read of continued, failed attempts to relate autism to vaccines or pollution or whatever, any cause but parenting. This is understandable since the sight of a severely autistic child horrifies and no parent would willingly accept blame for this.

All children have strengths and limitations, as do parents who had their own childhood struggles. A parent's personality must mesh with their unselected child and mismatches naturally occur. The unconscious is very powerful, and one must recognize its power. Thus, once a child's emotional problem is recognized and help for it is sought, any parental guilt is undeserved and counter-productive.

A positive thought is that autism is vastly and inaccurately over-diagnosed. In my long experience, in both medical and psychological settings, I have seen fewer than five severely disturbed, self-mutilating autistic children, and fewer than twenty diagnosable autistic children with lesser symptoms. Moreover, young children whose behavior exhibit some autistic features can have these symptoms disappear through ordinary play psychotherapy, sometimes in just a few months. And with lengthy, extensive services, major change can be made in even the most disturbed autistic child's life.

The aloofness noted in autistic children often becomes a self-fulfilling prophecy when their therapist considers it a given, something amenable only to simplistic reward/punishment behavior modification techniques. But the autistic child does have relationships though these are inadequate and require nurturing through play therapy.

No special techniques are required since the basic difficulty of autistic children is communication and play is the primary language in conducting psychotherapy with children. Thus, autistic children must be related to individually with their aloofness not being taken as a rejection of interpersonal contact but merely their inadequacy at it. A recent study found that most infants, who had communication difficulties associated with autism in their second year of life, were later no longer diagnosable as autistic when their mothers were given early intense instruction in communicating with them.

The Attention Deficit Hyperactivity Disorder (ADHD) diagnosis persists despite it possibly being the most unsophisticated notion in mental health for the past two-hundred years. In the late 1700s an English physician described the symptoms as "mental restlessness." In early 20th century America it was described as Minimal Brain Dysfunction (MBD) of which a Harvard psychiatrist remarked that any doctor who uses this diagnosis has a minimal brain dysfunction (a cute remark, I think). ADHD is merely its latest incarnation and makes no sense with more diagnoses on the East Coast than the West Coast and more boys than girls, apart from its symptoms being identical to anxiety and depression.

In both children and adults, when these symptoms are present and not related to real worry or unconscious conflict, they reflect Elements of a Borderline Psychotic Psychostructural Organization. Which does not mean Psychotic or Borderline Psychotic but rather a weakness of basic ego capacities because of faulty early developmental experience which occur during the first three years of life and affect the development of reality testing, mood regulation, sense of self, and control of behavior and thinking.

The ADHD diagnosis has persisted, I believe, for a number of reasons:
1. Large, profitable mental health and pharmaceutical industries have grown up around it.
2. Ego psychology has grown out of favor with a consequent dearth of education of clinicians on sophisticated early life ego and child development. My (long deceased but still mourned) doctoral advisor once said that to understand human behavior one must go to psychoanalytic concepts, that there is simply no where else to go, and I agree.
3. Sixty years ago most psychiatrists provided therapy but today few do, apart from those who have had psychoanalytic training and these are not many. Thus, apart from reasons 1 and 2, they prescribe drugs. Which, alas, some parents demand and doctors comply. As a mother once said to me, she would rather that her child had a brain tumor than an emotional problem since a tumor could be cut out. Most new patients don't know what therapy is and must be educated.

While not downplaying the power of unconscious motivation, Petito's murder, which is not unusual for abused women, might have been avoided had she followed one simple rule: to better know your partner before becoming intimate.

Nearly a hundred-years ago, an unmarried American psychiatrist underwent his training analysis with Freud in Vienna. This then lasted six months and, at their last meeting, Freud expressed the wish that the doctor be lucky enough to gain a happy marriage. "With all your psychological knowledge can luck be a factor?" the surprised doctor asked. "Of course, because one cannot know someone without living with them for a long time."

Thus Freud's good advice for all: It takes a long time to know someone. Take it.