Dr. Stanley Goldstein - Author and Psychologist

A November 8, 2023 article in The Wall Street Journal ("Children in Mental-Health Crisis Surge Into Hospital E.R.s") aroused several thoughts on why the crisis in child mental health treatment exists: the lack of public and doctor knowledge of child psychological development; psychiatry's false biological/genetic bias rather than the critical role played by parent-child interaction during early life when the basic ego capacities governing control of thinking and behavior, modulation of mood, and others develop; and the emphasis on psychotropic drugs with exaggerated benefits and downplayed side-effects. All leading to inaccurate and potentially harmful Emergency Room decisions and excess hospitalizations.

An October 26, 2023 article in The Wall Street Journal ("The Cannabis That People Are Using for Anxiety Is Probably Making It Worse") described the dangers of cannabis use despite its current widespread marketing as a benign treatment for anxiety and other ills. Living in a culture where rapid change is expected, it should not be surprising that many turn to the alleged benefits of drugs, legal and otherwise. This, despite historical awareness that the benefits of drugs tend to be vastly exaggerated and their side-effects downplayed.

Anxiety is a greatly treatable condition with drug-free psychotherapy since it is an identical normal healthy reaction to actual external and unconscious internal threats. Thus an adult whose parents discouraged feelings will feel threatened when experiencing love, and with the same pain as when a thug with murderous intent approaches. Similarly, Panic Disorder is the misinterpretation of normal anxiety symptoms with the same physiological reaction as the deadly medical danger it is believed to be.

The unconscious is very powerful and one must respect its power. Sadly, many psychiatrists and other medical practitioners have become mere pill-pushers rather than thoughtful assessors.

Central to psychotherapy is the concept that behaviors can have symbolic, often unconscious motives. For example, a potentially dangerous road rage action can indicate both annoyance at another's driving but also anger from another situation: a workplace happening, an interaction in a relationship, or a lingering emotion from childhood.
Thus, missing several psychotherapy sessions without reasonable cause (illness, hazardous driving weather, death in the family), especially if the therapist isn't notified but left waiting, can reflect diminished interest in treatment, be an indirect expression of anger, or indicate excessive narcissism, the feeling that the world revolves about them.
 The therapist then has two choices: to accept that, in their patient's current level of emotional development, they cannot behave differently; or, if excessive, to end treatment. It is not unreasonable to expect simple courtesy from all.

Even with the best medical treatment the survivor of a serious medical condition is rarely as healthy as before their affliction overcame them. Similarly, while psychotherapy can effect profound improvement of behavior and capacities, a patient will never be as well developed emotionally as if they had experienced a "good-enough" parenting during their formative years.
Their healing can never be total since early life experience is the bedrock of the adult personality and the unconscious is powerful. Yet there are healing events outside therapy too: nurturance from a loving spouse; and helping others and identifying with them, as can happen with parents and health workers, creating interactions which foster the emotional growth of both
Having regrets, feeling guilt for past mistakes is part of the human experience and cannot be avoided when living a thoughtful life.

An August 31, 2023 article in The Wall Street Journal ("My Son Sam Doesn't Need Special Ed - His autism demanded it, experts said.") aroused several thoughts. My first book, Troubled Children/Troubled Parents, the first chapter can be read on my website, included my lengthy treatment of an accurately diagnosed autistic child. The current frequent misdiagnoses are caused by widespread inadequate understanding of child psychological problems by school personnel and doctors. To treat an autistic child the therapist must enter their personal world, which is their protective shell but can be relinquished with proper treatment. The belief they are uncommunicative is false and as erroneous as relating to them with behavioral modification (reward-punishment) methods. These children do communicate but in their way. With rare exception, schools do a poor to disastrous job of interacting with or advising parents about their troubled children.

An article in The Wall Street Journal (August 25, 2023), "Are You Sure You Have Cancer? ...Misdiagnoses are all too common..." aroused several thoughts. An excellent older book, Should I Be Tested For Cancer? Maybe Not and Here's Why, by H. Gilbert Welch, M.D., M.P.H. is well worth reading. And regarding misdiagnoses: years ago I was diagnosed with glaucoma by a local ophthalmologist/glaucoma specialist ("You have a little glaucoma in both eyes. Do you want laser or drug treatment?"). Distrusting him because of his personality and office staff's unprofessionalism (the receptionist being on the phone with her boyfriend), I went for a second opinion to a world famous glaucoma expert in NYC. After examination he said that not only did I not have glaucoma but that in his entire career he had never seen glaucoma in eyes like mine (I have unusually thick cornea in both eyes). Had I stayed with the first doctor I might have wound up blind and you can imagine the unneeded stress he caused me. For something serious in a non-emergency situation, ALWAYS get a second opinion from a noted authority in another town. It's well worth traveling for.

My gifted, now deceased dentist, loved to make jokes and was one of the two authentic geniuses I met in my life. The other was a multi-lingual Columbia University professor whose advice oddly sticks in my mind: that to learn Mandarin well one needs a Mandarin speaking grandmother. But to return to my story. My dentist discovered a new antibiotic while a teenager, was rejected by medical schools because he was Jewish (it was that time in America) and became a dentist. After graduation he was offered admission to medical schools but refused, having opened a Manhattan practice that prospered. Decades after his marriage to an enormously wealthy foreign heiress, their photo was on the cover of a national magazine, its accompanying article lauding "Manhattan's power couple" blissfully approaching retirement. A year later, after their divorce, the dentist told me his ex-wife said the most hurtful thing she could: "I never thought your jokes were funny!"

As high school reunions arrive and one gets older, one wonders how other lives turned out. Yet, decades later, I remembered the name of only one fellow student, Gene, and not favorably.

An old saying is that one forgets those who have done us favors but never forgets those who humiliated us and I found this to be true. Throughout my life, Gene's name burned within my psyche.

During my lonely high school days he had seemed a Gatsby-like figure. Handsome and popular, always nattily dressed and with his intended goal of Yale, he would have been a shoe-in for Homecoming King had my school such a celebration. I envied his friendships from within my social circle of one.

Gene spoke to me only once. As he approached, I felt proud, anticipating that he would value me as a friend and share his approval with others and I would gain friends and especially a girlfriend. But he only wanted to borrow money, which I lent him and he never repaid. Nor did he approach me again.

Several years later I read in the high school newsletter that Gene had died young of cancer. From his obituary in The New York times, I learned that our professional lives were similar. We both earned doctoral degrees and wrote books but these were common achievements for graduates of my selective high school from which eight graduates won the Nobel Prize and seven won the Pulitzer Prize, more than any other secondary education institution in the United States. Yet I gained an achievement which, almost certainly, no other graduate had.

Years after graduating, while driven to a Manhattan TV interview and stopped at a red light, the limousine driver turned to me and said, "Madonna was the last person to sit where you're sitting." With this, I instantly told myself, "Gene, you bastard, I beat you!"

So, thanks to luck and Madonna, I did vanquish Gene in the long Game of Life.

An August 1, 2023 article in The Wall Street Journal ("Why America's Gun Laws Are in Chaos - Judges clash over history a year after Supreme Court upended how courts decide Second Amendment cases") aroused my thoughts.

During a class that I once attended, the firearms instructor gave memorable advice: you don't point a gun at someone unless you're willing to shoot them; a good reason for not shooting someone is to avoid being involved in many years of unpleasant litigation; during an ongoing crime you don't want to reveal you are armed since these are the first people being shot; what is considered a self-defense shooting is a complex legal issue.

Thus, perhaps courts would approve of mandating minimal training for gun carrying and restrictions on minors.

I never felt uneasy when patients carried a (licensed) concealed gun in my office, assuming with the police officers that they did and with a few others that they might. One judge quickly signed the concealed carry permit of a nurse working the night shift at a hospital treating addicts, stating she needed a gun.

A July 16, 2023 article in The Wall Street Journal ("The Doctor Won't See You Now - Therapists who judge, recoil, or quietly rage at their patients can't provide effective therapy") quoted psychologists who advocate political positions to their patients, blaming the patient's unhappiness on these rather than unwise personal decisions. But here the patient is smarter than the doctor.

People know why they come to therapy. No patient raised a political issue during my long work as a psychologist in hospital, clinic, and private practice settings. They spoke of anxiety or depression or marital/parenting/job problems but never that, not even people holding political office.
What it comes down to the clinician's  lack of understanding what psychotherapy is and not acknowledging the historically accepted belief in the power of the unconscious. As a psychiatrist colleague, a long-time government consultant, once remarked to me, "The unconscious is very powerful and one must respect its power."

Lacking sophistication of developmental psychopathology (a term devised by my doctoral advisor) and child psychological development has created other issues including the current gender misconceptions. Long ago, during a months long graduate school course at Columbia University ("Human Reproduction and Sexual Development") taught by an OB/GYN, the word "gender" was never uttered.
A reader's comment to The Wall Street Journal article spoke of clinicians having their own emotional problems and suggested that sufferers avoid mental health treatment. While a 1970s paper in the Bulletin of the Menninger Clinic acknowledged this ("The Sad Soul of the Psychiatrist"), having experienced and resolved life issues can create a more effective, intuitive clinician. They having unresolved emotional problems are, of course, another matter. Nuff said.