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A Psychologist's Thoughts on Clinical Practice, Behavior, and Life

Confronting Adolescent Evil

The recent attacks by bicycle riding teenagers on two cars in mid-town Manhattan, a taxi driver (causing him thousands of dollars in damage) and another containing a terrorized family, were shocking but unsurprising during these days when society's expectation of personal responsibility has diminished. Yet even more surprising was mere official call for "consequences," and a victim's hope that the perpetrators aren't jailed.

 

The psychological capacities enabling a person to distinguish reality from fantasy, modulate mood, develop a secure identity or "sense of self," and to control their behavior and thinking develop within the first three years of life. For their healthy growth a "good-enough" parenting is required which some lack, this reducing their likelihood of successfully achieving adolescent goals (to provisionally separate from parents; to construct realistic educational and vocational goals; to explore intimacy through dating). This failure produces frustration and anger and, in some youth, acting-out behavior though only rarely like these teenagers which, according to local shopkeepers, was not their first outrage.

 

As has long been known, exemplary adults can arise from the most impoverished families since it is parenting that counts. The famed, recently deceased, Black economist, Walter E, Williams, credited his achievements to having had a demanding mother and teachers "who didn't give a damn about my self-esteem." His mother must have taught him values too.


No matter how greatly distressed, destructive behavior should not be engaged in and cannot be tolerated. All, including parents who do their best, are the product of an imperfect childhood and will make mistakes though some are inexcusable.


A school's structure and rules enable psychologically damaged youth to function better, and society relies on the police and law to do this in the larger society. Yet regardless of personal inadequacies, evil cannot be tolerated and must be condemned and punished since no desirable society can exist which lacks this.

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Silicon Valley Discovers Hypnosis

An article in today's (December 29, 2020) issue of The Wall Street Journal told of Silicon Valley's recent financing of startups marketing hypnosis apps aroused by stress caused by the pandemic. Yet hypnosis is a long accepted psychological technique for alleviating the distress of many conditions including cancer, burns, high blood pressure, headaches, and childbirth. It is taught to asthmatic children since the less stress they experience the less likely they are to have an asthma attack.

 

Basically, hypnosis is "selective attention" with researchers having varied between considering it a learned reaction to those believing it a entirely different physiological state. I have long believed the latter based on personal experience, that of feeling a "drop" at some point and being reluctant to "wake-up."


About ninety-percent of the population can use hypnosis to reduce stress, with ten-percent of these being such good subjects that major surgery can be performed while in the hypnotic state. Ten-percent of the population can't be hypnotized. A quick test of hypnotic suggestibility is asking whether the subject lost themselves in reading as a child, they usually being good hypnotic subjects. Using hypnosis to lose weight or stop smoking depends on motivation and rapid change should not be expected. Those who accomplished this were extraordinarily well-motivated.


Several warnngs: (1) do not become a subject for a hypnosis event in a club or while on a cruise ship. While often skillful practitioners, there have been cases in which not all of their suggestions were eliminated with the subject winding up in an Emergency Room weeks later complaining of weird symptoms that no one can figure out; (2) do not use hypnosis while wearing contact lenses; (3) do not use listen to a hypnosis audio while driving (this may seem obvious, but...).

 

With these cautions, hypnosis is eminently safe though best learned with professional guidance (the American Society of Clinical Hypnosis can be contacted for a local practitioner).


On a personal note, decades ago a nurse who took the blood pressure of clinic workers advised that mine was high. A physician who I had known since my teenage years agreed, saying that if it stayed that way I could take medication, which I was adamant against. Taking my blood pressure frequently would more likely yield accurate readings, he added (having abnormally readings during a stressful doctor's visit is well known).


I followed his advice, also frequently using using a self-hypnotic relaxation audio that I made from the research protocol in a journal article relating the use of hypnosis to stress reduction and the development of cancer. After two months, my blood pressure readings became optimal and have remained so.

 

By graphing these readings I found that my systolic reading (higher number, the force of blood against the artery walls) correlated with my pulse rate while my diastolic reading (lower number, the heart's resting rate or blood pressure between heartbeats) was independent of both. With digital blood pressure monitors being cheap, it would be well for all to monitor their blood pressure at home.

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Autism and Creativity

 

An English researcher and author of The Pattern Seekers: How Autism Drives Human Invention, Dr. Baron-Cohen, has found an association between autism and the capacity for hyper-systematizing, the ability to see patterns where others cannot, which is important in creative invention. Yet it is important to keep in mind that these individuals are but a tiny minority of autistic sufferers, that autism is vastly mis-diagnosed and of a wide range and, when severe, is perhaps the most disabling of all the mental health conditions and the most resistant to healing since it originates very early in life.

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Advice to Writers From Somerset Maugham

"The writer should seek his reward in the pleasure of his work and in release from the burden of his thought; and, indifferent to aught else, care nothing for praise or censure, failure or success." - From The Moon and Sixpense

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The Promise and Peril of Silicon Valley Medicine

The COVID-19 crisis has fast-tracked change in the delivery of health services though diagnosis and treatment recommendations via audio-video have existed in a more primitive fashion for decades. It is thus unsurprising that start-ups are bolstering their product with the promise of near instant service. Have a headache/backache/sinus problem/fever? they ask. There's no need to worry! For a small sum per month you can consult a doctor as often and whenever you wish, change doctors at your whim, all being top notch! Yeah…

 

My objection is not that these services are delivered via audio-video since the accessing of health services without travel is a welcome development. But will these companies meet their vow with sufficient quality staff? How many doctors will sit before their computer on a 24/7 basis, and how low must their wages be to assure the company a healthy profit?

 

The rudiments of this service have long been provided by health insurers using nurses and telephones. Can the only thing that these startups are adding is killer advertising? Hmm…now that would be a cynical judgment.

 

Moreover, the major public health crises derive from habits. The choices of poor diet, alcohol and substance abuse, and unhealthy lifestyle are not easily changed without lengthy contact with one clinician. But we must be modern, mustn't we?

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The Unacknowledged Benefits of Delusional Thinking

A middle-aged woman told her physician, "I've never had a chronic illness and don't think I can develop one." "That's a good delusion. Keep it," the doctor replied. Yet delusions have a bad history, being associated in many minds with horrific scenes from countless horror movies. But delusional thinking can have benefits too.

A person whose life has been a succession of personal disasters from psychiatric hospitalizations to painful injury to poverty develops the delusion that the FBI is watching them. Similarly, a soldier on the battlefield, close by comrades who are being killed, tells themself they will survive. In the first example, the delusion may protect the person from suicide, since if the FBI is watching them, they must be of great importance and is thus worthy of respect. A soldier's delusion of certain longevity keeps them fighting and increases their and their comrades' probability of survival.

Yet delusional thinking is, of course, generally destructive since only through reality-based thinking can the problems of living be resolved. The anxious depression that accompanies delusional thinking is proper since this type of thinking reduces situational adaptability and thus increases personal peril.

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Healing Childhood Psychological Damage Through Creativity

The stress of creativity has long been known. Dedicated artists struggle all their lives, seeking financial success which is rarely achieved, motivated by what one might call their "creative addiction." But creativity, though not healing, can also grant meaning to an artist's life, rescuing them from life-long despair as they seek perfection in their work. These include such survivors of dreadful childhoods as Edvard Munch and Thomas Wolfe. Thereafter, Munch led a nomadic life and Wolfe's relationships were notoriously troubled as both unconsciously sought, through their creations, the good-enough parenting which they lacked as children.

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When the Mind Ignores What the Body Knows

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.

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The (Confused) Rooster That Crowed - A True Story

In a semi-rural Community Mental Health Center where I once worked, a social worker, without telling anyone, brought in a caged rooster to give to another worker at the end of the working day, parking it in a closet in the women's bathroom. When one entered the bathroom and turned on the light, the rooster crowed, mistakenly believing that it was dawn. Women leaving the bathroom and reporting having heard a rooster crow were considered crazy by the staff ("probably their time of the month").

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Murder, Mayhem, and Evil

During my first job as a psychologist at a psychiatric hospital, I told my psychoanalyst/supervisor my adolescent patient's statement. "That's psychotic," the doctor replied. Though able to define "psychotic," until that moment I hadn't grasped the power of this condition.

Similarly, when mass murder horrors become public, the perpetrators are often viewed with surprise for these men had seemed so normal. They lacked the twisted features of horror film characters and spoke coherently though of bogus beliefs. Columnists asked the usual question of "why," and provide their usual answer that "no one knows." But this is not true!

 

While predicting violence cannot be certain, it correlates highly with several factors: failure in life; substance abuse; the ego capacities governing thinking and behavior being inadequately developed; and having a fragmented "sense of self," sense of who they are. The killer's frequent decision, to suicide in "glory," is considered preferable to their continued painful existence.

 

Though their act was horrendous, these individuals are not often considered "insane." The legal definition of insanity is determined by state statute, most usually whether a person can distinguish "right" from "wrong," and rarely succeeds as a defense. But to describe them as sane does not imply that they possessed "normal" control over their behavior though, except for those with extreme limitations, this should not influence their punishment. There is evil in the world and some succumb to its temptation. Yet even for the rest of us, the unconscious is very powerful and one must respect its power.

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