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

Helping a Child Cope With Their Severe Illness

Being seriously ill as an adult arouses terrors. These are infinitely worse for a child since their understanding lacks mature insight. They perceive their all-powerful parents as deliberately bringing them to doctors who cause them discomfort and pain. Which are unavoidable for those suffering from cancer or convulsive disorders even when the prognosis is favorable. The child feels friendless, having none who can understand except for their stuffed animal friend who mutely observes.
Young children consider stuffed animals as friends who are no different from living friends with whom adults share their secrets. Children talk to them, play with them, and sometimes hurt them which, like good parents, they lovingly forgive.
Speaking to these children of their medical situation, by using their stuffed animal friend as intermediary, can be supportive by relieving their trauma and isolation and giving hope.

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Living With A Tyrannical Boss

What one can tolerate in a boss is individual. Someone I that once knew, who worked unbothered by her crazy boss in the entertainment industry, had survived a difficult childhood, living in her car until being helped by a concerned teacher who let her live with her until she graduated from college. Upon quitting her job the young woman was asked to train her replacement to tolerate the screaming boss. But when psychosomatic symptoms (as neck pain, etc.) begin it's time to leave. I've often said that I may not have been too smart about some of the jobs that I took but I always knew exactly when to leave, which is when they want you to stay. I've learned that a manager has a certain "shelf life," initially being viewed as the organization's savior but, after it functions well, as part of any lingering problem. Still, as my (now deceased) graduate school advisor said after receiving my tale of woe/complaining letter, "Think of the job as a chapter in your memoir." Sound advice from one that I still miss.

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Parental Reluctance to Confront Their Child's Emotional Problems

Years ago a mother brought her child to my office. While speaking with her alone, I referred to her son's "emotional problems." "My child does not have emotional problems," the mother insisted, and stormed from my office. Had I been given the chance I might have asked, "Then why are you here?" but already knew the answer: to gain reassurance that, despite having observed his bizarre behavior, her child was perfectly fine.
This illogic, when a parent's emotion-based reality clashes with actual reality, is understandable. Though unwise, it reflects the parent's feeling of shame from the belief that they failed as a parent. Which is undeserved since children are not born with instructions nor have all parents experienced a "good enough" parenting during their own childhood. Once a parent gains help for their troubled child they have no reason to feel guilt and it is counter-productive to the success of their child's treatment. But not seeking treatment for their child, especially when it leads to harm, is inexcusable.

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Shooting Atrocities and Politician Response

While guns should certainly be kept from children and the mentally disturbed, behaving simplistically, as politicians tend to do following public distress, accomplishes little. The cause of the recent shooting atrocities is mental illness, virtually all deriving from lack of a "good enough" parenting during earliest childhood when the basic ego capacities governing control of thinking and behavior, modulation of mood, development of a sense of self, and the ability to separate fact from fantasy are formed. Yet no politician spoke this, doubtlessly because few know it since knowledge of child development is minimal even by doctors. What some seem to fear, even more greatly than guns, is awareness of the fearsome power of the unconscious. Can that a gun symbolizes this explain why it goes unspoken following shootings? Hmm...

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Explaining Fetishes

There may be few behaviors as puzzling to the non-clinician as a fetish, which is an overwhelming interest by a man in an ordinary object like shoes, feet, an odor, or an article of clothing for it rarely afflicts women. Though apparently "crazy" there is a logic to the interest since it derives from the ealiest years of childhood when the mind is most immature and the child is easily frightened. The creation of the fetish was motivated by a sight which so terrified them that a "screen memory" had to be created to hide it in a symbol, the fetish. This protected them from remembering the overly exciting event, perhaps the sight of a naked female or of adults having sex. While virtually all adults have some irrational fear or interest only those interfering with normal functioning require treatment.

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The Exhibitionist Surgeon and the Popular Concept of Normality

A talented psychoanalyst once wrote of his treatment of a San Francisco surgeon who persistently exhibited his genitals in public. During his treatment the doctor realized that his powerfully motivated behavior reflected the persistence of an early childhood desire to show his mother how powerful he was. An act which is not unusual for very young children and properly discouraged by their mother,
This doctor's behavior evidenced a generally ignored truth: that the unconscious is powerful and cannot be ignored. Though most people prefer to believe that consciousness governs our behavior--until they are forced to believe otherwise.
All humans are a product of their upbringing from which infantile misconceptions and fears may erupt at any time, which must be understood and controlled. Being "normal" means functioning in line with developmental expectations whether as youth or adult. Not that one is totally free of the apparently inexplicable thoughts and feelings that can lead to unwise behavior.

When one responds to a situation with greater emotion than warranted the behavior is motivated by an unconscious element, often deriving from an early-life event. Consider the unfortunately common "road rage" if you will.

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Three Important Thoughts About the Frightening Symptoms of Panic/Anxiety Attack

1. Your scary feelings are not dangerous. Anxiety can mimic the symptoms of virtually every medical disorder and what you're experiencing is just an exaggeration of the normal response to extraordinary stress.
2. Don't think what "might" happen.
3. Facing your fear will make it less intense and ultimately vanish.

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The Attempted Murder of Justice Kavanaugh and the Often Ignored Power of the Unconscious

An unfortunate current development is the ignoring of unconscious factors in human behavior. Thus in our "I'm OK, You're OK" era on steroids, virtually any belief or action has now become acceptable no matter how weird it was once considered. But the murder attempt on Justice Kavanaugh evidences the power of unconscious motivation.
That the accused, twenty-six-year-old Nicholas Roske, is mentally disturbed cannot be questioned since he admitted this. "I wouldn't say I'm thinking clearly," he said in court. Yet his preparations--acquiring pistol, pepper spray, the Justice's home address, and more--indicates coherence. Fortunately before acting, Mr. Roske phoned the local emergency services, stating his murderous plan and asking for help. Thus did the sound logical conscious element of what psychologists call the Executive Function overcome the unconscious conflict driving him to kill. As I never tire of stating, the unconscious is very powerful and one must respect its power.

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My Old Black Suit

An article in the June 4, 2022 issue of The Wall Street Journal ("Not Wearing Suits Anymore? Here's What to Do With Them") aroused a memory. During my training at Washington University Medical School's Child Psychiatry Department I had a class given by a gifted child analyst who became idolized by his students. One of his anecdotes impressed several publishers and is in my first book, "Troubled Children/Troubled Parents." He always wore a black suit and I bought an identical one. I no longer remember if I ever wore it (maybe for a job interview) but still have it, occasionally looking at it fondly in the closet and dusting it as one would a holy relic. I will NEVER recycle it as suggested in The Wall Street Journal article.

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Defining Psychotherapy and Other "Therapies"

Therapy has become a popular term with people speaking of music therapy, art therapy, horse-back-riding therapy, and even shopping therapy. Yet though relaxing, these activities are not psychotherapy as it has long been conceived. Ideally, a psychotherapist understands the nature of a person's problems and its aberration, this deriving from their training in human development and unconscious processes which these other "therapies" do not. So if seeking permanent emotional change you know which office to call.

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