Dr. Stanley Goldstein - Author and Psychologist

To successfully treat those with severer mental health disorders, the therapist must take little for granted, ignoring accepted beliefs about prognosis and motivation  since clinician prejudice can arouse unjustified feelings of defeatism and hopelessness.

Each person is unique with another being unable to know their experience fully and the depth of their suffering. The sicker patient knows much about themself but, from guilt or fear of acting-out impulsively, is afraid to allow themselves to feel what they know. Nor because of their low self-esteem do they value this knowledge. So they retreat from what is most useful: to feel what they know.

Thus when a patient refers to the presumed hopelessness of the diagnoses they had formerly been told, they should be reminded that they are a complex human being and not a simple diagnostic classification.

Communication isn't always straightforward. About the only thing that a parent can be sure of is if their child complains of feeling ill, this being evidenced by fever or another serious symptom. Otherwise, a child's complaint may be valid or indirect, which is similar to the behavior of adults.

Consider the man who is asked to purchase something by his wife and "forgets." This may be accurate if he has pressing issues on his mind or indicate his indirect expression of anger by behaving passive-aggressively. Similarly, a youth may behave in a puzzling way or make a puzzling statement to express a concern about the parent or another which they fear to express openly. Perhaps wanting greater independence than the parent allows or to react against what they interpret as the parent's deprecating comment.

As I never tire of repeating, the unconscious is very powerful and one must respect its power.

Testifying in court is a stressful experience and just being there can be nerve-racking. During my first visit to a judge's chambers I asked where to sit though this was obvious. With experience I came to enjoy testifying in court as the government's expert witness. Providing information which always helped the participants since the more accurate information which a judge has the better will be their decision.

Judges have great power and making a mistake when testifying can elicit their verbal wrath and more. The following tips may help avoid this.

1. Never lie when testifying no matter how attractive this possibility may seem since the consequence can be severe. A New York psychologist who falsely embellished his excellent credentials lost his license after an attorney's investigation and complaint.

2. Never express anger when testifying since this works against you. Remain calm no matter how upsetting or even ridiculous is the attorney's question. It's not personal, he only doing his job.

3. Prepare yourself before testifying, winging it in court can be problematic even for an experienced lawyer. After describing the nature of the Thematic Apperception Test, a psychological instrument in which a subject creates a story in response to a drawing, the lawyer asked, "Well, Dr. Goldstein, if I made a story that I had sexual difficulty with my wife, how would you interpret my problem?" I could hardly believe the opening he gave me. With a straight face I responded, "Sir, I can express no professional opinion about your sexual adequacy with your wife." The courtroom broke up in laughter and even the judge smiled though I probably should have avoided temptation since there is no laugh line in court transcriptions.

Yet even with the best preparation pitfalls can occur. I once earned the verbal wrath of a judge by mentioning that I had been originally referred the plaintiff by his insurance company though I had not been instructed to avoid stating this. Nor, testifying under subpoena, did I even know who he was suing or why.

Remember that every new experience creates some degree of anxiety. Thus, because most people experience a courtroom only once in their life if ever, this discomfort should be expected.

Children are usually cooperative unless they're hungry, tired, ill, or emotionally unable to do what a parent requests. Which they usually do since they want to grow up, to behave in an adult fashion.

When a child continually misbehaves it is always because they are unhappy, because their parents are not providing what they desperately need. Yet determining this may not be simple and require professional advice. My suggestion about this: if the clinician revels in jargon, is unable to explain in easily understandable language why your child is unhappy and what need be done to remedy it, find another specialist! You are the customer who need be satisfied and not the other way around.

There may be no more unsophisticated, longer-lasting diagnosis than ADHD which was described two-hundred-years ago as "mental restlessness, later as Minimal Brain Dysfunction (MBD), and most recently as Attention Deficit Hyperactivity Disorder (ADHD). This, despite its diagnostic symptoms of anxiety, depression, and concentration difficulty being present in nearly all serious medical and psychological disorders.

Unsurprisingly, adult ADHD has now  become a popular diagnosis, often resulting in treatment with a stimulant medication having potential side effects of seizure, stroke, abnormal heartbeat, mood changes, and more.

But concentration difficulty that has existed since childhood may also reflect a paralyzing fear of fear, a heightened sensitivity to anxiety against which normal ego defense mechanisms had never developed due to the early faulty interaction between parent and child. During thoughtful work, an individual is experiencing their sense of self, an ego capacity that can be deficient due to childhood deficits.

Relieving this deficit's crippling effect in an adult, in the absence of lengthy individual psychotherapy to replace their deficient ego capacities with more mature ones, may possibly be gained with the same technique which is used for battling many fears: by providing psychodynamic understanding, and engaging in the feared activity under a controlled circumstance.

Thus, one who has difficulty concentrating should practice concentrated work for a short time each day. As the fear of impending anxiety is reduced, their ability to concentrate may improve. Being cost-free and lacking dangerous side-effects, this technique is certainly worth a try.

Considering the widespread public and clinician ignorance about psychological development it is unsurprising that Canadian legislation is being considered to assist suicide of the "unbearably suffering mentally ill." While death is inevitable for all and none would wish to prolong pain, I suggest that this proposal reflects both the universal fear of insanity and the reluctance to accept that treatment competence affects healing.

The fear of insanity has a central organizing role in living since what is termed the Executive Function controls behavior, what is considered human. To sense its importance, try to consider how your life would change were you to believe yourself sliding toward psychosis. Many widespread fears, as that of flying or elevators, owe their power to this underlying fear which is usually repressed and thus unavailable for conscious awareness.

While a doctor's skill is considered crucial in the treatment of biological illnesses, this tends not to be the case with psychological disorders though education and talent should logically be considered critical factors in the healing of both. This disparity derives from the widespread ignorance of public and clinicians of the effect of stresses on normal psychological development, this enabling the attractive notion that significant life issues can be quickly resolved using drugs or gadgets. There are now being marketed do-it-yourself, brain-wave machines which purportedly eliminate depression and anxiety. Where little is understood, everything is deemed possible and particularly among those who treat feelings as facts.

To quote F. Scott Fitzgerald in his final line of The Great Gatsby, "So we beat on, boats against the current, borne back ceaselessly into the past." Our sorry past of lobotomies and shock treatments which have destroyed so many lives.

https://nationalpost.com/news/politics/government-agrees-mentally-ill-should-have-access-to-maid-in-two-years

More about Canada's assisted suicide law for the mentally ill

Becoming a parent involves not only bearing a child but adopting a new identity, an expected identity, and new behavior. If soon after birth one asked a mother or a father if they felt like a parent they would say "no," and likely give the same answer several months later since they had not yet fully incorporated parenting into their self-image and range of behavior. The young parent must battle to safeguard an area of "self" against the demands of their baby-intruder.

Then, years later, the opposite happens when the parent must re-discover and re-mold their sense of who they are when their child leaves the home, depriving them of the caretaking role.

Slowly, throughout life, multiple behaviors and new functions are added to the expanding sense of who one is: the being as sexual, the being as worker, and the being as parent, all intertwined, similar to how the biological body metabolizes food to make it usable before incorporating its nutrition within itself.

The pandemic has brought Post-traumatic Stress Disorder to the attention of many for its upset is considerable: distressing thoughts and nightmares; recollections of the traumatic event(s) which may include reliving them through illusions and dissociative flashbacks; avoiding conversations about the event(s) or places where they occurred; marked symptoms of anxiety causing problems with sleep, concentration, and functioning on the job.

Yet though painful, these symptoms are intended by the mind to be helpful for they serve two critical functions: forcing into consciousness the fact that the person's tolerance for stress has been exceeded and change must be made, and reflecting its healthy, normal attempt to re-integrate--to repair itself--from the damage of intolerable stress. The unconscious is very powerful, and one must respect its power.

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.

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.