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

Gabrielle Petito's Murder and Freud's Benediction on an Unmarried Psychiatrist

While not downplaying the power of unconscious motivation, Petito's murder, which is not unusual for abused women, might have been avoided had she followed one simple rule: to better know your partner before becoming intimate.


Nearly a hundred-years ago, an unmarried American psychiatrist underwent his training analysis with Freud in Vienna. This then lasted six months and, at their last meeting, Freud expressed the wish that the doctor be lucky enough to gain a happy marriage. "With all your psychological knowledge can luck be a factor?" the surprised doctor asked. "Of course, because one cannot know someone without living with them for a long time."


Thus Freud's good advice for all: It takes a long time to know someone. Take it.

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The Inexaustable Strength of Mothers

My experience with treating mothers has long impressed me with their strength. Despite their continuing daily tasks of tending to wandering-about youngsters, seemingly incomprehensible teenagers, difficult husbands, and an occasional sickly rabbit or other pet, they cook, clean, negotiatate with school officials, provide transportation to appointments, and cope with such intermittent crises as helping with children's homework and arranging for home repairs. All while trying, and often failing, to care for themselves.


Part of this is inevitable since, in most families, the mother is the emotional center of the family, which also makes her the major recipient of children's complaints. If a child is unhappy, it's HER fault. Is this fair? Of course not but that's how it is.


Which is not to say that the father's role is unimportant since, though the mother (or mothering figure who can be a male) is the most important figure during the first two years of a child's life, the father becomes equally important during their third year, serving to pull the child from the symbiotic relationship with their mother into the larger world and, ultimately, independent adult functioning.

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Why Some Youth Can Benefit From Psychotherapy and Others Can't

Critical psychological development is gained early in life. Later, this may not happen even if the patient is provided the most talented of psychotherapist.

Change is difficult and some cannot tolerate the inherent dependency of this type of treatment. A teenager or young adult may need a firmer path in life before they can accept this childhood-like experience that they struggled to escape though there are great differences between the two. Unlike during childhood, a therapist does not make demands, even that of being liked. Their goal is merely that their patient's goals be achieved, so long as they are healthy and some  of which they may be unaware.
Yet for some youth the completion of education through college or graduate school or technical training comes first. They must try to ignore their anxiety and depression until the better day when they feel confident that they can--independently--survive financially in the adult world.

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What the Deadly Disorder, Anorexia, Really Reflects

One crucial task of early childhood is for a child to develop a secure sense of who they are or, as psychologists call it, a sense of self. This ordinarily occurs naturally through a child's continuing interactions with their parents but if these were inadequate, the child's poorly developed ego capacities are unable to cope with severe stress, particularly when the powerful feelings of adolescence arise.

 

Then, symptoms occur with low self-esteem being the least severe. More troubling symptoms can include confusion about their identity or even personality disintegration (psychosis).

 

Anorexic symptoms typically arise in adolescence when there is a need to integrate powerful feelings within the personality. Feeling vulnerable and the loss of control over their body, which the ego's Executive Function provides, the teenager attempts to bolster their self-esteem and gain a sense of control over their body through concrete actions: obsessive focus on their body and diet, and constant exercise.

 

Because the anorectic person lacks awareness of the connection between these behaviors and their underlying fragmented personality, they tend to resistant psychotherapy. This, despite anorexia having the highest death rate of all the mental health conditions.

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Normal Lingering Grief

Watching the current Netflix documentary on the 9/11 terror attack aroused my teary memories: walking through Manhattan's Grand Central Terminal soon after with its posted photos of missing loved ones who were almost certainly dead, and at a later 9/11 memorial. This, though knowing none who died in the attack.


Contrary to popular belief, there is no normal way to grieve. Some initially cry, others cry years later, and some never do. Having dreams in which the deceased lives and speaks is common. The anniversary of a loved one's death can have a powerful impact with some tearfully describing it long after. A relative's death is occasionally even positive, liberating healthy autonomy strivings after an overpowering, destructively possessive relationship has ended.

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Reducing the Terror of Psychological Symptoms and Length of Treatment

The treatment of a psychological disorder is often long. Yet to paraphrase Freud's comment of a hundred years ago, it would be nice to have a rapid cure for severe medical problems too. But the problems of living do differ. A traumatic event troubling a previously healthy person may require only one to two months of therapy but not those reflecting a lifetime of distress.


For these sufferers it is important to intermittently relate their current (adult) symptoms to the early developmental experiences which produced them, as can result when one lacked a "good enough" parenting. This enables the patient to understand their life, why they repeat their mistakes. It also reduces their fear from believing that anxiety and depression are magical and may invade their consciousness at any time. All symptoms have a logical reason for existing. Learning their unconscious cause reduces the terror they inspire and gives hope.

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Why Your Child is Sometimes Impossible

While all children are sometimes irritating, occasionally they're completely impossible. I've joked with parents that the business office next to mine has a Saturday swap meet where children are exchanged.


But troublesome behavior has meaning since when a child is unhappy they don't spontaneously speak of their distress but instead act difficult. This is why Oppositional Defiant Behavior is the most common mental health diagnosis of children.


When asked to do something by their parent a child will usually comply since they want to grow up, to be an adult. Resistance thus indicates their inability to do what is asked because of illness, exhaustion, emotional upset, or an unspoken reason making sense to them but isn't logical. Then, speaking with the child is more productive than yelling, which should only be done when confronting a potentially dangerous or harmful situation. Otherwise, frequent yelling by a parent will cause warnings that a child should respect to be ignored.

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The Unavoidable Stress of a New Parent

While a child's birth is joyously anticipated, their parents' initial reaction is stress. This, even with a child who is generally considered easy to parent since this pain is both universal and unavoidable.


Beginning at birth, a newborn makes unceasing demands of their parents to become a more effective caretaker. Demands that are critical since a child is dependent on their parents for survival. But the adult mind is conservative and resists the rapid personality change that is needed. This clashing of demands and wills creates parental stress but, slowly, a melding of the needs of both.


An added stress is that a newborn is inserted into an ongoing (family) social system that has developed over time, and must now transform itself to incorporate this unselected newcomer.

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Pentagon Police Officer Killed or, Dangerous With Any Bail

The recent murder of a Pentagon police officer was made more shocking upon learning the prior behavior of his killer. In April, twenty-seven-year old Austin W, Lanz was arrested for trespassing and burglary after breaking into a neighbor's home where security cameras recorded him leaving inappropriate pictures and messages in their mailbox. He took nothing but spoke of police aircraft flying over the neighborhood and his phone being tracked.

 

While being booked into jail and without provocation, he attacked and seriously injured two sheriff's deputies, then asked that his restraints be removed so he could fight the deputies one-by-one. After being charged with aggravated battery on police, making a terrorist threat, and rioting in a penal institution, he was released on $30,000 bail, ordered to submit to a mental health evaluation, and barred from using alcohol or drugs and possessing firearms. For all the good this did!


While hindsight has 20/20 vision as the adage insists, one can't help wondering why Mr. Lanz wasn't hospitalized or jailed since the failure of court restraint against impulsive, disturbed people is countless as evidenced by the killing of the divorced by their former partners and road rage and street assaults on strangers though these can't be wholly stopped. A psychiatrist once told me of a colleague eating in the cafeteria who had been attacked by a patient with whom he had no prior contact.


The only possible explanation for these frequent crimes is that many still don't believe that some people are, perhaps temporarily, inherently dangerous. Failing to respect the power of the unconscious over behavior despite its continuing reminders.

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The Inescapable Pain and Benefits of Anxiety and Depression

While the pain of anxiety and depression cannot be denied, neither can it be avoided since they are part of the human condition, enabling us to become more fully human, more of who we can be.


Anxiety signals impending danger, actual or not, thus attempting to protect one from harm. An unrealistic danger indicates that an unconscious conflict, which may involve anything, is causing distress. Perhaps the desire for intimacy conflicting with its fear because of early life experiences, these being the bedrock of the adult personality.

 

Depression indicates a "depressing" of feelings for one of three reasons: being "stuck" because of an inability to decide what to do; sensing that one has deep problems and giving up; or having unsuccessfully attempted to emotionally reach a parent during early childhood, this creating feelings of inadequacy that can persist into adulthood and affect functioning.


Making significant life changes require confronting the unconscious conflicts which can afflict us all for these too are part of being human.

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