Dr. Stanley Goldstein - Author and Psychologist

I once had a patient with a disabling symptom, a fetish which is an obsessive need to touch or photograph or otherwise involve themselves with an object or body part, which can be a woman's shoe or foot, just about anything. Being almost always a male symptom, women tending not to develop them, it reflects early life trauma during which the object involves what has been termed "castration anxiety," the boy's fear of losing his penis. The boy, having seen a naked female and fearing they may lose their penis as he incorrectly believes the female did hers, uses the fetish to symbolize this fear and underlying anxiety. Which tends to persist since early childhood has immaturely developed thinking capacities and is the bedrock of the adult personality.

After explaining the nature of fetish to this man, I advised him to talk to himself: to tell himself that while the fetish helped him when he was a child it was no longer needed. Still, both he and the fetish would remain friends throughout life but the fetish could relax. Using this technique, which contains elements of play therapy with children, his obsession with the fetish disappeared within several months.

Similarly, when one has experienced a traumatic experience, during wartime or after rape or assault, if one tells oneself that the later symptoms were created to help them and not the problem, they are better able to cope. Understanding that the associated symptom such as nightmares are friendly warnings to resolve an unconscious conflict and not an enemy.

So while talking to oneself has a bad reputation, it often being associated with psychosis, it can be healing. But it should be done when alone and need not be spoken aloud.

This posting was inspired by a March 24, 2025 article in The Times of London. That euthanizing unhappy youth would be permitted by a nation was unheard of until recently when it became Netherland's policy. This violating the inescapable accepted belief that suicide is a permanent solution to a temporary problem. Of the ten-thousand persons who died by euthanasia in the Netherlands last year, there was a sixty-percent increase in cases involving psychological suffering compared with 2023.

In one case, following approval by a committee consisting of a doctor, an ethicist, and a lawyer, "a boy aged between 16 and 18 who had autism, anxiety and depressive feelings was euthanized legally. The young man described his life as 'luckless.' He felt very lonely, was deeply unhappy and did not enjoy anything. He could not connect with peers and society, and felt misunderstood...The doctor was convinced that the young man's suffering was hopeless. He did not expect current and any future treatments would improve the quality of life."

How many teenagers (or adults) have said the same at some time in their life? One can't help wondering if approval would have been given by these officials were this child their son. It beggars the mind that while in the past we treated suicidal individuals, approval is now given to support and assist their delusional beliefs. The current minimal public knowledge of child psychological development and developmental psychopathology may explain this horror.

Despite media clamor both Autism and Asperger's disorder are often misdiagnosed and relatively rare, particularly in their severest form. Yet, when present, they have devastating social affects. The early years of life are critical during the development of psychological and social capacities which include the ability to trust, to share feelings, and to tolerate intimacy and gain comfort from relationships. Because these disorders develop during those years, severe weakness of these capacities are common, causing their often odd social interactions. Though, with luck and ability, they may be fortunate enough to succeed in becoming financially independent, the potential joy of human interaction may continually elude them.

An article in The Wall Street Journal ("We Are Turning Too Many People Into Medical Patients. The swift rise in in diagnoses for everything from autism to ADHD may be doing more harm than good./March 17, 2025) aroused these thoughts.
Long ignored ignorance about child psychological development and developmental psychopathology (a term coined long ago by my doctoral advisor) enables much faulty medical diagnosis, as is decried in the Wall Street Journal article. Several factors have contributed to this.
1. Anxiety can mimic just about every physical symptom: feelings of warmth or cold; feeling faint; headache; stomach pain, elevated blood pressure and check pain; even visual symptoms in an optic migraine. Distinguishing the true medical concern from symptoms of heightened anxiety requires training which the typical physician lacks.
2. Autism is vastly misdiagnosed with some children's autistic features vanishing after brief play psychotherapy.
3. ADHD, Attention-Deficit Hyperactivity Disorder, though enabling a lucrative treatment industry, is perhaps the most unsophisticated notion in medical history. First diagnosed by a seventeenth-century English physician as "mental restlessness," it took root in early nineteen-hundreds America as Minimal Brain Dysfunction, of which a Harvard psychiatrist remarked that any doctor affixing this diagnosis must have a minimal brain dysfunction. Its symptoms are identical with anxiety and depression, which are present in nearly all medical and psychological difficulties and school difficulties too..
4. Another diagnostic error is affixing the diagnosis of Bi-Polar Disorder to children. It is difficult to speak calmly of the degree of this error since the Bi-Polar Disorder diagnosis requires a fixed, adult personality which youth lack by definition.
5. The treatment for these misdiagnoses is usually one or more of the psychotropic medications, long articles of their misuse having been recently published both in The Wall Street Journal and The New York Times. A rarely acknowledged reason for this is that today's psychiatry residents receive only ten-percent of the training in psychotherapy they received seventy-years ago, fostering the belief that the treatment of choice for any of life's ille is a drug.
Truly, ignorance abounds. Nuff said.

A moving article in The Wall Street Journal ("Generation Xanax: The Dark Side of America's Wonder Drug"/March 13, 2025) aroused these thoughts. Myths such as such the unsophisticated etiologies of "chemical imbalance" and Attention Deficit Hyperactivity Disorder (ADHD) have long troubled the mental health field. The latter has diagnostic symptoms which are identical to the anxiety and depression associated with nearly all medical and behavioral disorders. While a hospital administrator, when I spoke to the Director of Psychiatry about the side-effects of psychotropic medications he angrily stormed, "There are no side-effects!" And he was not a stupid man, one of his degrees being from Cambridge University. Myths that reduce income tend to have long lives.

That psychotropic medications can have crippling physical and mental side-effects tends to be ignored and the Wall Street Journal asrticle does a worthy service, describing the disabling psychological and neurological symptoms and even suicide of users. What's eqally troubling was another article describing the current push of several drug companies to create and market drugs which allegedly "cure" schizophrenia and Bi-Polar Disorder though their psychological etiology has been understood for decades except, of course, by those who don't want to know. Abetted in these quests are many present-day psychiatrists, which is understandable since today's psychiatry residents receive only 10% of the training in psychotherapy that residents gained sixty-years ago.

A large study fifty-years ago found that, of previously severely disturbed hospitalized psychiatric patients, the most favorable outcome post-discharge was those who received no medication with the highest rate of recidivism being with patients who were prescribed medication while hospitalized and after discharge, with former patients who were prescribed medication while hospitalized but not after discharge having an in-between recidivism rate.

To paraphrase the sixteenth-century proverb of the English writer, John Heywood, there are none so blind as those who refuse to see.

A parent shouldn't feel badly when their child's behavior causes them to feel inadequate for it might just indicate that they're behaving in an exemplary manner as their child is comfortable expressing their true feelings!

Adults tend to believe that everyone they speak with are relating logically but this isn't true of children. Their mind is immature, they have an inadequate, often erroneous view of events and, when ornery, are simply behaving as adults sometimes do when they're ill or tired. If persistent in children this is termed Oppositional Defiant Disorder. If persistent in adults it is termed being passive-aggressive or simply being irritating.

When frequent in a child it should be investigated since it indicates their distress. Which, if not reduced, will harm their developing personality and later adult functioning. Occasional parent anxiety is normal and beneficial since it indicates their fear of making a parenting mistake and the common feeling of "mommy-guilt." But they shouldn't be overly fearful since children forgive parenting errors so long as they feel loved.

Long ago I knew a much older, well-regarded woman holding a high corporate position. She and her husband had worked for the American government in London during World War Two. There she left him for what she later regarded as a trivial matter, a decision that she later greatly regretted, once considering suicide.

As a teenager I loved a novel, The Song Of The Red Ruby, by the Norwegian writer, Agnar Mykle. After publication in 1956 it became a best-seller, selling seventy-five-thousand copies in its first year and a million copies in its English edition. Which should have guaranteed the author's success until the book was condemned as obscene. He was acquitted after a year-long legal battle which included reading the entire novel in court. Later information suggested the charge was politically motivated. Though Mykle had been the Labor Party's most talented author, his book poked fun at socialism and he became considered a traitor.

The rest of Mykle's life was a shambles. "I have survived my crucifixion," he said, but he hadn't. His reputation was destroyed, he divorced his wife during the trial and retreated into depression. He later declared bankruptcy, was frequently treated in a psychiatric hospital, and shut himself off, living like a hermit and rarely opening his door, dying in 1994.

Two talented people of different social and business worlds whose lives became devastated by choice and event. Evidencing what can't be repeated too often: that while the unconscious is powerful, understanding and forgiving one's mistakes is critical since it opens the door to freedom.

Two statements of long ago friends linger in my mind: "I've never been sure what love means" and "It's hard to believe what you once believed when the craziness is gone." In a sense, these thoughts describe why some people remain loveless or continually behave in self-defeating ways. Not from genetics or the mythical "chemical imbalance" which unjustly profits some doctors and corporations but because of early childhood experiences which can deform the human personality into adulthood. 

An important goal of childhood maturation is to gain control over feelings, to not behave impulsively as occurs with "road rage." After birth the infant is overwhelmed by feelings, having left the comfort of the womb to enter a booming buzzing world. They do so gradually by assigning positive and negative valences to experiences: positive to those that fulfill their needs and negative to those which ignore them or arouse anxiety.

Most powerful are the negative valences which become associated with angry aggressive behavior and persist, becoming visible during later experiences that produce overwhelming anxiety because of lingering childhood emotional conflict. Though these happenings may be desirable as when seeking intimacy or being assertive on the job. 

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