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

Youth Killings: The Unspoken Causative Elephant in the Room

Recently, after yet another shooting by a teenager, New York City's Mayor Adams asked where their parents were when the youth wandered the streets at night. Or, to put it more bluntly, why were his parents so lacking in parental responsibility. For expressing this truth the mayor was widely criticized, which is why this sound position is so greatly ignored.
That early developmental experiences are the bedrock of adult behavior is unquestioned for that is when the basic ego capacities governing thinking and behavior are formed. For this a "good-enough" parenting is needed, but this is a wide range with only greatly deficient parenting causing problems. Yet even here the presence of a helpful relative or teacher can make a difference as the child's mind latches onto the healthier notion of life from them. Nor, except in extreme circumstances, should parents be blamed for their child's misbehavior since children are not born with instructions and parents are a product of their own childhood and have their own issues. After gaining treatment for their child they should not feel guilty since they have done all that can reasonably be expected.
Thus does the Elephant in the Room of parental responsibility remain as politicians, who prefer to spout voter-popular phrases, fear to confront it.

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Why Psychiatric Diagnoses Are Often Worthless

Frequently after a horrifying multiple murder surfaces, news of the criminal's prior psychiatric diagnoses follows: that he had been diagnosed as "psychotic" or suffering from OCD (Obsessive-Compulsive Disorder") or ADHD (Attention Deficit Hyperactivity Disorder) or another. Yet the treatment that followed each diagnosis was unsuccessful and the critical question remains: why?
Despite the complexity of human behavior this answer is simple: because naming a condition according to current diagnostic nomenclature (ICD-10), which is required for insurance payment, has taken the place of understanding the person for which study of their childhood is essential but usually absent.
To explain a person's behavior one must know the state of their ego capacities, which develop before the age of four- years, since these govern the ability to control thinking and behavior, to modulate mood, to distinguish reality from fantasy, and others, all comprising the Executive Function. But for decades, the false reductionist pseudo-neurological/chemical notion of what governs human psychology, as the existence of a "chemical imbalance" best treated with medication haa been followed, with only recent increased criticism of this spurious notion. As the crimes and suffering continue.

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Assessing Dangerousness in Buffalo

After every multiple murder there is the usual criticism of why it wasn't prevented, particularly when the danger seemed so clear as with the recent murder spree in Buffalo. But, as has been said, everyone has twenty-twenty vision in hindsight.
Predicting suicide or homicide is not easy for, despite headlines induced popular belief, it is rare. While virtually all consider homicide or suicide at some point in their life, exceedingly few do, the risk factors being seriousness of intent, degree of control over behavior, the realism of the plan, and the availability of lethal means.

 

During my career, in a range of clinical settings, I have advised hospitalization for a literal handful of patients though witnessing many being hospitalized inappropriately, which can have a devastating personal effect. How is risk determined? By asking questions of the patient and family member(s), the doctor's conclusion deriving from their knowledge of human development and behavior. But the accuracy of this conclusion depends on the doctor's talent and knowledge, which varies greatly.

 

Once, while working in a general hospital, I spoke with a worried psychiatrist. His patient spoke seriously of killing the American President and the doctor didn't know what to do since the hospital was equipped for only short-term psychiatric stays so the patient must soon be discharged. I advised the doctor to phone the Secret Service. He did and they whisked the patient to another hospital. But these mental health decisions are not always so clear-cut nor are the appropriate facilities always available.

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The Benefit and Danger of Tunnel Vision

While focused concentration is prized, too great focus can be dangerous. Like when, obsessed by a personal concern, one incautiously crosses a busy street or, depressed by a recent job loss or romantic breakup, the person suicides. In these cases perspective is lost as tunnel vision predominates.
Yet tunnel vision, exaggerated narrow focus, can save lives too as when traversing a crime-laden neighborhood or on the battlefield. Unhelpful tunnel vision happens when the presenting situation is misperceived: as a permanent rather than temporary setback, and being perilous not innocuous.

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Explaining Apparently Incomprehensible Murders

This week's "murder most foul" was done by a Los Angeles mother who killed three of her children. Being apparently psychotic, she was unlike romantically fanciful Vicky White, the Alabama prison official who ran off with her imprisoned murderer-lover. Psychotic behavior, no matter how horrible, is easier to understand than the self-defeating act of a clearly sane person. While inmates are manipulative, what could have motivated a woman with a stable, established life to run away with a six-foot nine-inch prisoner for whom disguise is impossible. Instead of the suicide-by-cop which a lawman predicted, Vicky shot herself to avoid arrest.
The same week, in my area, Sean Armstead, a ten-year veteran of New York City's Police Department, tracked his wife to a meeting with her lover, then killed him and himself. Why, for if a marriage goes bust isn't divorce the smarter option?
Yet Vicky's and Sean's behavior have (possible) ready explanations: a hunger for love, and the hurt and wounding of self-esteem when it is denied.
Through evolution, humans have become increasingly conscious and deliberative. But the unconscious is powerful and one should not risk ignoring its power.

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Childhood Developmental Failures and Its Consequences

By the end of toddlerhood, important human lessons must be learned: that people can be trusted; that warmth from others is possible; that verbalizing feelings leads to greater comfort than behaving impulsively; and that continuity of relationships is the rule and not the exception.

These convictions and such basic ego capacities as the ability to distinguish reality from fantasy, to modulate mood, to control thinking and behavior, and to create an accurate sense of who one is ("sense of self") are critical if a child is to feel confidence and realize joy in living.
This is why the severer psychological disorders which derive from the earliest years are devastating, making many of these sufferers incapable of living an independent adult existence and achieving satisfying relationships. Leading to continuing frustration and despair, and even suicide.

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The Prevailing Cultural Ignorance

I've read The Godfather, seen its classic movies (Part One and Part Two) several times, and just listened to its audio version for the second time. Being now even more convinced that it is a masterpiece, filled with vivid characters and an unbeatable plot. Sadly, many teenagers have never heard of this historic classic, an example of what seems the prevailing cultural ignorance. I have known teenagers who never heard of the Vietnam War or Winston Churchill and when referring to the renowned play, My Fair Lady, in one of my books, I felt compelled to describe what it was. Yet memory is fleeting so, no longer remembering what I knew as a teenager, perhaps my judgment is too harsh.

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Four Advantages of Audio-Video Psychotherapy

Four Advantages of Audio-Video Psychotherapy:
1. Independence of Weather: Appointments need not be missed because of poor driving weather.
2. Ease of Movement: Parents need not bring their young child, one with their own activity in mind, outside their home.
3. East of Scheduling: Clinicians bunch their appointments to leave their office as early as possible. When practice is conducted via audio-video from a home office, they're freer to schedule an appointment at a time when they would be loathe to do if it required traveling to their office. A patient once phoned me as I was leaving my home. "Give me five minutes," I said.
4. Variable Treatment Venue: Sessions can be scheduled during a patient's lunch hour while they're seated in their parked car; a couple's session can be conducted while they're at different locations miles apart.

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The Benefit and Danger of Holding An Inaccurate Self-Image

While it is often believed that holding an incorrect concept of who one is (what psychologists term a "sense of self") is harmful, this is not always true. Being common with emotional disorders, these sufferers do benefit for it grants them hope and protection from deep suicidal despair. Moreover, the fantasy may indicate an embryonic talent which could lead to significant achievement after their healing through treatment. Yet while comforting, holding an unrealistic fantasy with no hope of success can lead to greater despair.

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The ADHD Epidemic

ADHD is an unsophisticated, nonsensical notion though with a long history, it being termed "mental restlessness" in 1700s England, Minimal Brain Dysfunction (MBD) in early 1900s USA (of which a Harvard psychiatrist said that any doctor using this diagnosis had a minimal brain dysfunction), with Attention Deficit Hyperactivity Disorder (ADHD) being its newest incarnation. It has symptoms identical to anxiety and depression which can be associated with every psychological and physical disturbance. Though a large profitable industry has grown up around it. Its belief largely reflects public ignorance of early life psychological development, and the attempt to "neurologize" psychological symptoms and life issues. And check online for the prescribed drugs' potential side effects, which are far from small.

To explain what is termed ADHD further: some children with school learning issues and adults with concentration difficulty do have psychological problems, reflecting what has since the 1960s been understood as Elements of A Borderline Psychotic Psychostructural Organization. Which does not mean "psychotic" or "borderline psychotic" but rather weakness of those basic ego capacities which develop in early childhood and include control of thinking and behavior, mood modulation, development of a sense of self, and others. This requires psychotherapy to heal, to replace the deficient ego capacities with more mature one. These weaknesses are not a present or absent diagnosis but a continuam of strengths and weaknesses which must be assessed through interview.

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