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

Confession Time/Thank you, Madonna! (Note: I've changed the student's name)

As high school reunions arrive and one gets older, one wonders how other lives turned out. Yet, decades later, I remembered the name of only one fellow student, Gene, and not favorably.

An old saying is that one forgets those who have done us favors but never forgets those who humiliated us and I found this to be true. Throughout my life, Gene's name burned within my psyche.

During my lonely high school days he had seemed a Gatsby-like figure. Handsome and popular, always nattily dressed and with his intended goal of Yale, he would have been a shoe-in for Homecoming King had my school such a celebration. I envied his friendships from within my social circle of one.

Gene spoke to me only once. As he approached, I felt proud, anticipating that he would value me as a friend and share his approval with others and I would gain friends and especially a girlfriend. But he only wanted to borrow money, which I lent him and he never repaid. Nor did he approach me again.

Several years later I read in the high school newsletter that Gene had died young of cancer. From his obituary in The New York times, I learned that our professional lives were similar. We both earned doctoral degrees and wrote books but these were common achievements for graduates of my selective high school from which eight graduates won the Nobel Prize and seven won the Pulitzer Prize, more than any other secondary education institution in the United States. Yet I gained an achievement which, almost certainly, no other graduate had.

Years after graduating, while driven to a Manhattan TV interview and stopped at a red light, the limousine driver turned to me and said, "Madonna was the last person to sit where you're sitting." With this, I instantly told myself, "Gene, you bastard, I beat you!"

So, thanks to luck and Madonna, I did vanquish Gene in the long Game of Life.

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 Guns in America

An August 1, 2023 article in The Wall Street Journal ("Why America's Gun Laws Are in Chaos - Judges clash over history a year after Supreme Court upended how courts decide Second Amendment cases") aroused my thoughts.

During a class that I once attended, the firearms instructor gave memorable advice: you don't point a gun at someone unless you're willing to shoot them; a good reason for not shooting someone is to avoid being involved in many years of unpleasant litigation; during an ongoing crime you don't want to reveal you are armed since these are the first people being shot; what is considered a self-defense shooting is a complex legal issue.

Thus, perhaps courts would approve of mandating minimal training for gun carrying and restrictions on minors.

I never felt uneasy when patients carried a (licensed) concealed gun in my office, assuming with the police officers that they did and with a few others that they might. One judge quickly signed the concealed carry permit of a nurse working the night shift at a hospital treating addicts, stating she needed a gun.

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 Psychotherapists Who Advocate Politically To Their Patients

A July 16, 2023 article in The Wall Street Journal ("The Doctor Won't See You Now - Therapists who judge, recoil, or quietly rage at their patients can't provide effective therapy") quoted psychologists who advocate political positions to their patients, blaming the patient's unhappiness on these rather than unwise personal decisions. But here the patient is smarter than the doctor.

People know why they come to therapy. No patient raised a political issue during my long work as a psychologist in hospital, clinic, and private practice settings. They spoke of anxiety or depression or marital/parenting/job problems but never that, not even people holding political office.
What it comes down to the clinician's  lack of understanding what psychotherapy is and not acknowledging the historically accepted belief in the power of the unconscious. As a psychiatrist colleague, a long-time government consultant, once remarked to me, "The unconscious is very powerful and one must respect its power."

Lacking sophistication of developmental psychopathology (a term devised by my doctoral advisor) and child psychological development has created other issues including the current gender misconceptions. Long ago, during a months long graduate school course at Columbia University ("Human Reproduction and Sexual Development") taught by an OB/GYN, the word "gender" was never uttered.
A reader's comment to The Wall Street Journal article spoke of clinicians having their own emotional problems and suggested that sufferers avoid mental health treatment. While a 1970s paper in the Bulletin of the Menninger Clinic acknowledged this ("The Sad Soul of the Psychiatrist"), having experienced and resolved life issues can create a more effective, intuitive clinician. They having unresolved emotional problems are, of course, another matter. Nuff said.

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Addiction Treatment For The Rich

A July 11, 2023 article in The Wall Street Journal ("Sex, Drugs and Spreadsheets") described the surge of addiction among Wall Street executives. The function of all drug use is simply to feel better though healthy life changes are made by struggling with life issues, not drugs or medication (which can have wide-ranging side-effects).

The tendency to use drugs derives from early family issues during development. Thus addiction is basically a psychological not biological issue though stopping many drugs can arouse pain and effect health. Terming it "biological" makes psychological difficulties more socially acceptable and is widely used, it being a marketing term favored by psychiatrists who compete for business with psychologists and others.

The seven-hundred-dollar/session fee reported in the article is far higher than I've known even noted psychoanalysts to charge. But therapy is a business and not a saintly endeavor. One charges what the market will bear though cost and fancy office decor are irrelevant to healing ability.

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Shades of Dracula: The ADHD Myth Won't Die!

A July 6, 2023 article in The Wall Street Journal ("You May Have Adult ADHD, but Not Because TikTok Says So") fosters the ADHD myth and evidences how a profitable industry can develop from, essentially, nothing. The notion of Attention Deficit Hyperactivity Disorder has a long history, it being termed "mental restlessness" by a physician in seventeen-hundreds England and Minimal Brain Dysfunction (MBD) in early nineteen-hundreds America. A Harvard psychiatrist then remarked that a doctor using this diagnosis had a minimal brain dysfunction. ADHD is its most recent incarnation.

The ADHD symptoms are identical to those of anxiety and depression which exist in nearly every medical and mental health disturbance. When not related to a real worry (as about an imminent medical diagnosis) it reflects weakness of basic ego capacities governing thinking and behavior. These require, for their optimal functioning, havng experienced a "good-enough" parenting during early development, which has been long known.

To repeat the quote falsely attributed to P.T. Barnum, "There is a sucker born every minute." Nuff said.

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The Alleged Harm of Tablet and Video Game Involvement

A recent article in The Wall Street Journal "Why Kids From No-Screen Homes Sometimes Go Screen Crazy" referred to the alleged harm of tablet watching and video game play. Yet these are both not "bad" but are heavily obsessive-compulsive (an obsession is a repeated thought, a compulsion a repeated activity), which is the mind's innate healthy means of reducing anxiety. So when a child or adult engages in them excessively, it is either because they are troubled or that social contact makes them anxious. Remedying these requires psychotherapy to eliminate their pain. And research has found that video games, no matter now awful their content, do not increase a child's aggression since children do distinguish reality from fantasy.


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Teaching Reading in the Failing Public Schools

An article in the June 23, 2023 issue of The Wall Street Journal ("Phonics finally Gets Its Due in New York. It took the city's education bureaucracy 20 years to recognize that the Success Academy approach works") described the shocking failure of the public school's ability to teach reading. Yet the blame is not theirs alone since if parents read first to and then with their toddlers, almost all children would be reading simple books by the time they entered kindergarten. And if all parents explained their directives (apart from emergency situations) rather than saying, "Do it because I say so," their cognitive development would be further enhanced since not providing explanation depresses the development of both the capacity for abstract thinking and of intrinsic motivation ("motivation which is inherent in information processing and action," as the noted psychologist, Joseph McVicker Hunt, stated in his 1960s paper). Hunt's work was a major influence in beginning the Head Start program. Learning and its love begin at home. Sadly, these no-cost education remedies are far from universal.

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Sex and Gender Education

Much present social dispute concerns the need for "evidence-based" education about sex and gender though the term "evidence-based" has become simply a feel-good marketing term. The significant question in all education is what is truly based on objective research and what is simply disguised propaganda. My only, small, sex education class had (as I remember) only male students and is described in the first chapter of my novel, "Park West: A Novel of Love and Murder and Redemption," which is posted on my website. It was a graduate course at Columbia University, "Human Reproduction and Sexual Development," and taught by a well-known male OB/GYN. It must have impressed me since it is the only class whose name I still remember, along with several student questions which seemed to momentarily puzzle and surprise the teacher: "What is the function of pubic hair?" and "Does seeing your naked patients affect you?" He described the likely genetic function of pubic hair as being to provide protective cushioning; and said that his patients were only concerned with their health though, he added with a small smile, "Some vulva are prettier than others." Gender was never mentioned. Nuff said.


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A Prescient Sci-Fi Story About Modern Life

I recently read a science fiction story by Robert Silverberg, "Alaree," which was originally published in 1958. A crippled spaceship from Earth has landed for repairs on a small, previously unexplored planet. There they encounter a small humanoid creature with whom they speak using a speech converter. The creature has great difficulty understanding the concept of "I" since on his planet all the creatures are "we."

He becomes close to the space travelers, watching as they work. Soon other aliens appear, all identical to him. He implores the captain to take him with him back to Earth and, after initially refusing, the captain agrees, Alaree having said that if he remains he'll die. On the return journey, Alaree behaves in a puzzling manner, staring into the face of each of the crew members as if trying to merge with them. Then he suddenly dies and the captain understands why: because on his world he had been part of "we" and, when losing this identify and becoming an "I," he could not survive.
This reminded me of the fear of some people to reject popularly held concepts, perhaps from the subconscious fear that, like Alaree, they couldn't survive.

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Student Violence Against Teachers Is Increasing

An article in the June 3, 2023 issue of The Wall Street Journal ("'There Were Fists Everywhere.' Violence Against Teachers Is on the Rise") detailed the increased student violence against teachers. In one Nevada school district there were three dozen criminal battery assaults against teachers thus far this year. Yet the needed remedy is known and should be applauded by teachers, parents, and students. While youthful acting-out behavior varies in significance by age with a very young child's hitting often reflecting simple immaturity while a teenager's indicates serious developmental issue, the remedy is the same: having a comprehensive psychological assessment to determine the degree of psychopathology present and providing effective intervention.

But these cannot substitute for having school principals who won't tolerate such behavior and make this clear; and mandating legal consequences for assault. Having sufficient security staff is critical too. Several years ago there was public outrage after an assaulting teenager was pepper sprayed by police as they restrained him in school. Yet, as I then wrote, the benefit of this police action was that no one was hurt.
Learning and teaching cannot succeed where the safety of all is not assured. Nor should teachers be expected to be hostage to student rage.

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