Dr. Stanley Goldstein - Author and Psychologist

A troubling article in today's The Wall Street Journal related criticism of psychotropic medications to ignorance ("What Influencers and Critics Aren't Telling You About Antidepressants"). Or, in other words, Doctor Knows Best. But do they? Psychotropic drug research is minimal to describe it most charitably, and ignorance of child psychological development and developmental psychopathology is widespread among doctors. These circumstances motivate such unsophisticated but financially lucrative notions as Attention Deficit Hyperactivity Disorder (ADHD) despite it having symptoms identical to the anxiety and depression which are present in virtually all medical and psychological disorders; and diagnosing youth with Bi-Polar Disorder though its diagnosis requires an adult mental structure which youth lack by definition.

These ideas follow such a historic "gold standard" belief as the efficacy of lobotomy which destroyed countless lives including that of Rosemary Kennedy, the oldest sister of President John F. Kennedy, who underwent a lobotomy at 23 which permanently incapacitated her, making her unable to speak intelligibly. This procedure was permitted by her father, Joseph P. Kennedy, to manage her behavioral issues. Electro-Convulsive Treatment, is still being used though being best described in the title of a book by Peter Breggin, M.D., who has been called The Conscience of Psychiatry, "Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock, and the Psychopharmaceutical Complex."

Motivating this unholy alliance between psychiatry and the pharmaceutical industry is money: the drug companies rake in billions and most psychiatrists have little training in psychotherapy with today's psychiatry residents receiving only ten-percent of the training in psychotherapy compared with seventy-years ago but compete with psychotherapists of other professions. This also explains the huge sums wasted by the government on genetic research though most mental health conditions have been long understood as reflecting traumatic early life experiences, the lack of a good enough (not perfect) parenting experience. I end with two quotes. In early twentieth-century America the diagnostic precursor of Attention-Deficit Hyperactivity Disorder was Minimal Brain Dysfunction, which a Harvard psychiatrist said was so dumb that only a doctor with minimal brain dysfunction would use it. When working in a long-term residential treatment setting for teenagers which emphasized psychotherapy and rarely used medication, the physician father of a patient described psychotropic drugs as "chemical lobotomies." Enough said.

Every person is a psychologist of sort, making conclusions about human behavior throughout their life based on folklore and their own experiences. Long ago a noted psychologist, Fritz Heider, coined the term "naive psychology" for the conclusions about human behavior which a person naturally acquires in the course of their life. But some of these "facts" are wrong. One of these is that the most important distinction between child and adult is that a child possesses less factual information; another is that because the primary source of information is visual it makes sense to hide when unwanted chores are handed out.

Why it is difficult for an adult to distinguish behavioral fact from fantasy derives from two factors: a lack of knowledge about psychological development; and the power of the unconscious which prizes comfort over distress even at the price of behaving unwisely or irrationally.

A simple solution to this problem is that when feeling impelled to act quickly one should stop and ask oneself why? Is this behavior in my best interest or for my immediate comfort? As I never tire of repeating: the unconscious is powerful and one must respect its power.

Perhaps no human activity is so regularly engaged in and failed at as is the search for love and why is complicated. Early childhood experience is the bedrock of adult functioning. While none experiences a perfect parenting, one that is "good-enough" is needed to develop the capacities for trust and intimacy. If the parenting was deficient the adult's romantic relationships will suffer but this too it is not an absolute since varied capacities will exist.

Recognizing this, and responding to a lover's troubling behaviors with understanding not condemnation, can help maintain and develop the relationship. But with those who are greatly damaged, either from a critical lack of trust or having never learned that intimacy is comforting and not threatening, therapy is needed to heal the early life wounds. Which for some won't be easy since therapy involves dependency which also may have been believed dangerous as the child moved toward independence. Human development is not a simple task.

Depression, which differs from the normal grief caused by the loss of a bodily function or death of a loved one, is best understood by viewing it as a reaction to self-esteem, the feeling that one has about oneself. Depression is the emotional correlate of a partial or complete collapse of self-esteem since it feels unable to live up to its aspirations: to be loved not inferior, to be strong not weak, and to be good and loving not aggressive. Depression stems primarily from mental tension while elation is the expression of an actual or imaginary fulfillment of a person's aspirations.

Basic depression represents a mental state characterized by a lowered self-esteem, a feeling of helplessness, a more or less inhibition of functions, and a more or less intensely felt particular emotion. Basically, depression represents an affect state in terms of helplessness and inhibition of functions.

There are similarities and differences between depression and boredom. With depression the unconscious goals are maintained as in boredom but in boredom the ability to reach them is interfered with by the repression of the true goals and rejection of substitutes because they are either inadequate or prohibited. This results in a lack of direction, the inability to bring about goal directed behavior, and subsequently a feeling of emptiness and boredom.

In depression the mind is shocked into passivity not because there is a conflict regarding goals but because of its incapacity to live up to its aspirations. Depression is the human way of reacting to frustration and misery whenever the person finds themself in real or imaginary helplessness against overwhelming odds with the most frequent factor predisposing to depression being the adult's early life experience during which they really are dependent and helpless.

"'Girls, Take Your Crazy Pills!' Antidepressants Recast as a Hot Lifestyle Accessory' - Today's welcome article in The Wall Street Journal details the significant financial efforts by drug companies to market their psychotropic drugs, magnify their potential benefit, and conceal their devastating side-effects. But we shouldn't blame drug companies alone since understanding of such normal human experiences as anxiety and depression and grief are sorely lacking, as is accurate knowledge of child psychological development by doctors and the general public.

All medications have side effects. A good rule is that if the potential side-effects greatly exceed the potential benefits you don't want to take it. If the potential side-effects are equal to the potential benefits you want to think twice, and if the potential benefits greatly exceed the potential side-effects, and in a true emergency situation, you want to take it.

Two stories: long ago a psychiatrist co-worker at an adolescent in-patient setting which rarely used medication told me a story. As an experiment, during his psychiatry training, he took a small dosage of a psychotropic drug. The effect was so profound that he was exceedingly cautious about prescribing them thereafter. At that same setting the physician father of a patient refused to have a psychotropic be prescribed his teenager saying adamantly, "They're chemical lobotomies." Which is what they are.

The concept of self-esteem is often misunderstood with the false belief that compliments can raise it ("You're really smart!" "You're really pretty!") being widely believed. Actually, self-esteem reflects the ego's sense of whether a person has big problems or not with higher self-esteem being associated with having fewer problems. But false concepts linger because of the powerful unconscious, causing one who has behaved badly long before to retain a bad self-image ("I'm no good!") even after years of doing good works. Telling yourself that you are good in contrast to your past behavior will help but only if your words to yourself are as insistent as are those of your powerful unconscious.

The mind of a child differs greatly from that of an adult though nightmares can terrify both. Yet they, as does feeling anxious or depressed, are intended to be helpful since their purpose is to inform us about problems. As dreams do by telling us, symbolically, what troubles. Thus if an adult is angry with their boss they may dream of kicking their dog, the thought of hitting their boss being too frightening for their conscious mind to tolerate, and a child may imagine similarly about their parent or teacher. A common misconception about dreaming is that a dream of someone dying means they will. But dreams don't predict the future and dreaming of someone dying usually reflects either concern about their health or anger toward them.

To help a child cope with their scary dreams the parent should speak to them as follows: "Dreams are our friends. They tell us what we're worried about using pictures, like with a mystery movie that we try to figure out. If you dream about hitting a friend it just means that you're angry with them, not that you're going to hit them. If you do have a scary dream we can talk about it in the morning and try to figure it out." Many years ago I gave this explanation to a five-year-old girl and her nightmares stopped for a time. Later, after she again had a nightmare, I repeated my explanation and she erupted, "Oh I know that!"

Only weeks seem to pass before yet another child's murder by their parent is reported, often after activity by the Family Court which goal is to safeguard children. A New York State case immediately came to mind when a judge returned custody of a child to their parent who had just been released from prison for child abuse. This, despite professional plea not to do so. A lawyer later remarked that the judge had excellent legal credentials but lacked common sense. Sadly, the decisions of judges, lawyers, doctors, and the general public tend to lack knowledge of child psychological development, they instead relying on what a psychologist long ago described as "naive psychology," the knowledge about behavior which one gained through personal experiences, some being accurate but not all.
Other common troubling decisions derive from judicial beliefs that (1) children are best served by living with their biological parents, and (2) that a child should live with their biological parent despite the parent's lengthy non-involvement and failure to pay child support. Thus biology is considered to supplant psychology regardless of its harmful impact on the individual. Consider: would a grown woman accept being forced to live with a man to whom she was once married, years after he deserted her? Yet children are regularly forced into this equivalent situation despite state mandate that judicial decisions be made in the best interests of the child.

Contrary to popular belief, autism is relatively rare and often mis-diagnosed. One such four-year-old, when introduced to our stuffed baby dinosaur friend during the child's play psychotherapy session, stated, "He can't be alive. My brother told me dinosaurs are extinct." The reasons for these mis-diagnoses reflect several factors:  the widespread ignorance of child psychological development; the growth of a lucrative "autism industry;" a downplaying of the critical role of experiencing a "good enough" parenting in mature functioning; and a lessened belief in the power of the unconscious.
That a child exhibits some autistic symptoms does not make them autistic since these may be outgrown or disappear after brief play psychotherapy. True autism, since it develops during the earliest period of development, is perhaps the most devastating and difficult to treat of all mental health conditions. My successful treatment of a severely autistic teenager involved daily psychotherapy sessions in an inpatient treatment center over four years and is described in my first book, "Troubled Children/Troubled Parents: The Way Out." Having said this, autism is of a wide range and the sight of children possessing its severe symptoms is deeply troubling. But, as I said, these children are relatively rare.
Some years ago I read of an epidemic of symptoms among teenagers in upper New York State including stomach distress, feeling faint, and more. This caused great distress for parents and the community behaved responsibly, testing the water supply and school facilities. Then, several months later, the "epidemic" vanished, it being recognized as reflecting hysteria fostered by online media. Living as we do in troubled times, should the same be said of autism?

Parental responsibility has become a charged topic despite the old-time proverb that "the apple doesn't fall far from the tree." Why is a mystery though it may relate to diminished belief in the power of the unconscious and the lack of public knowledge of the importance of early life experiences on adult functioning, the time when basic ego capacities governing control of thinking and behavior are formed.

It might also be that people believe a perfect parenting experience, which no one experiences, is required rather than that which is "good enough."

Apart from the influence of rare genetic anomalies, which seem to hold public belief, criminal and self-defeating behaviors have nothing to do with genes and all to do with childhood experiences. As New York City's mayor asked several years ago: Where were the parents when their armed teenager was nightly wandering the streets?