Dr. Stanley Goldstein - Author and Psychologist

This item was inspired by a Wall Street Journal Article ("Bill Gates: I Coded While I Hiked as a teenager. Was I on the Spectrum? Probably"/Jan. 24, 2025). There are fashions in labeling mental health disorders. A clinician confided that in his West Coast psychiatric hospital it was now forbidden to describe patients as "crazy," that the term "insane" must be used instead, and another that in his Washington DC hospital "crazy" was the preferred nomenclature with "insane" being forbidden. Similarly, the term "mentally retarded" has become abolished though without a favored accepted replacement. Or perhaps today all must be regarded as possessing genius lest feelings be hurt though both cognitive and physical abilities have long been known to follow the a bell curve, which is nature's way of saying that most people are about average.

During the newspaper interview, Gates was reported to have said that were he born today his obsessive interest in coding would be described as "neurodivergent," which has become the present term for children who were once termed "strange" or "weird." Even autism is now depicted as merely "neurodivergent," implying normality, though it is perhaps the most disabling of all mental health conditions, and often misdiagnosed.

Knowledge of child psychological development and developmental psychopathology (a term coined by my doctoral advisor decades ago) is minimal among both doctors and the general public.

The shocking suicide in May, 2024 of 30-year-old top golfer, Grayson Murray, stunned the golfing community. Diagnosed with social anxiety as a teenager, he battled distress for the rest of his life, perhaps not realizing that "social anxiety" is merely a description and not explanation for his unhappiness.
Suicide reflects complex motives deriving from early childhood during which one is made to feel worthless, a feeling that can resurrect during times of great stress. While almost all consider suicide at some point in their life, few do, the act being determined by whether suicidal intent (as contrasted with its mere thought) is present, the degree of self-control possessed, and if lethal means (as a gun or medication) are present. Though all such thoughts should be professionally investigated, the incidence of suicide when compared with its thought is like the proverbial needle in a haystack, which explains why suicide prevention programs tend to fail.
Because of the instinctive biological intent to live, when suicide does occur the use of alcohol or drugs is frequently involved.

Sadly, knowledge of child psychological development, which can prevent it early on, is minimal among doctors and the general public. One pediatrician, upon being told by his teenage patient that he was thinking of killing himself, responded, "You shouldn't talk like that. It upsets you mother." Nuff said.

News reports identified the murdered woman who was burned alive on a New York City subway as fifty-seven-year-old Debrina Kawam of Toms River, New Jersey. She had briefly stayed in a New York City homeless shelter despite her conventional early life. Forty-years before she was a high-school cheerleader with the public hope to be an airline stewardess and secret desire to "party forever." She was one of three girls voted to have a "million-dollar smile." Though working in her thirties as customer service representative for Merck, the giant pharmaceutical company, her life had been less than auspicious containing dozens of minor arrests for trespassing, public drinking, and disorderly conduct. She filed for bankruptcy in 2008 and her relationship with her romantic partner from 2011 to 2014 was chaotic.

The emotional conflicts precipitating Ms. Kawam's descent can only be speculated. At her father's death she described him as having been "the best father a daughter could have had" with the "regret that it took me later in life to figure that out." These statements may indicate that she ignored his sound advice. That alcohol abuse played a role seems likely in view of her many arrests for public drinking and disorderly conduct. Still, as with all troubled souls, she did her best, having lacked the needed support structure.
Yet while her burned body molders in the grave, her killer will enjoy for the remainder of his life, free food and health care and, in New York State prisons, a laptop, free college study (if desired), drugs (methadone) if he claims to be a drug abuser, and even a medical change of sex if sought.

Not fair. Not just. There is a justice of lawyers and the courtroom, and a justice of the Prophets and of God. Nuff said.

An article in The Wall Street Journal aroused these thoughts ("Green Beret in Tesla Explosion Suffered From PTSD, Authorities Say"/Jan. 3, 2025). PTSD (Post-Traumatic Stress Disorder) can occur in anyone, even children, when stress exceeds the mind's capacity to cope with it. Its possible feared, painful symptoms (nightmares, flashbacks, others) are not the real problem since they reflect the mind's normal healthy attempt to re-integrate after experiencing the unbearable stress. Thus the most effective treatment is education and psychotherapy with medication, which can produce serious side effects and interfere with thinking, being avoided or used only briefly. Which is not how it's usually treated.

As an aside, many American veterans who are receiving compensation for PTSD never experienced combat or even left the USA. Their symptoms reflect early life psychological issues exacerbated by recent extreme stress. That its diagnosis can involve financial compensation complicates its diagnosis and treatment. In Israel, which has had several wars and continuing danger, PTSD is treated differently. Their suffering soldiers are explained the nature of PTSD before being sent home for several weeks leave. They then return to their unit without the PTSD symptoms lingering. These statistics were remembered from a past article in Armed Forces and Society, an outstanding international journal on military and related matters. It's well worth subscribing.

Though painful and feared, anxiety and depression (the "depressing" of feelings) are instinctive survival and developmental mechanisms of the human condition. Both can indicate the presence of danger, external or internal. With anxiety it might be hearing a close-by noise while traveling a crime-ridden neighborhood alone at night; with depression it could be the sensing of an impending long feared feeling for intimacy or self-assertion. A common problem is when the primary goal is to avoid the anxiety or depression rather than interpreting its reason. Which, admittedly, is not easy since emotional conflict is part of human personality development and distinguishing actual from unrealistic danger can be difficult since the unconscious is powerful.
Normal anxiety and depression associated with healthy grieving, as after the death of a loved one or the loss of a bodily function due to accident or illness, are exceptions to these statements.

Childhood experiences are the bedrock of adult personality and functioning and not easily changed. Early in life one develops beliefs about such basic human experiences as trust and the possibility of gaining comfort from another. Thus when a spouse declares that they don't understand their mate's concern, this may honestly reflect an inability to grasp the underlying emotion that the other is expressing rather than being oppositional or passive-aggressive. They having feared certain feelings since childhood when they were used by their parents to control them and thwart their desire for self-expression and autonomy.

These conflicts, when extreme, reflect what is present in Autism and Asperger's Disorder which are among the most debilitating of mental health conditions. The unconscious is powerful and one must respect it's power.

Movies have not often portrayed psychotherapy accurately, usually including fanciful mysteries, murder, or romance between doctor and patient which, though rare, is illegal outside film. I recently watched the classic (1962) "David and Lisa," and was struck by its accurate depiction of the psychotherapy of the severer adolescent disorders. The doctor was empathic, understanding, and accepting while the patients were driven by unconscious impulses deriving from long-term parenting mistakes done unknowingly.
What was clear in the film was that the unconscious is powerful and personality change is not easy or quickly done.

While the film's acting and script were superb, my unexpected deep emotional involvement with it likely derived from my work in a similar treatment setting many years ago and described in my first book, "Troubled Children/Troubled Parents: The Way Out," which contains its own dramatic stories including that of a clinician who secretly married his much younger patient. "David and Lisa" is likely available online or in your library. Watch it!

A recent Wall Street Journal aarticle ("One Surprising Psychosis Treatment That Works: Learning to Live With the Voices"/December 21, 2024) aroused these thoughts. Schizophrenia is vastly misdiagnosed particularly with substance abusers, and no medication can "cure" it since its symptoms reflect faulty early-childhood development of the basic critical ego capacities governing control of thinking, behavior, and more, apart from the debilitating side effects of psychotropic medication when used for more than briefly. The benefits of psychotropic medication tend to be exaggerated by drug companies and doctors with their side-effects downplayed.

Long ago a gifted psychiatrist/psychoanalyst in my training told of treating a hospitalized VA patient who frightened others by talking aloud to himself. The doctor advised him that if he continued this behavior he would be given electric shock treatment, which neither of them wanted. So when he felt compelled to behave like this he should go to the bathroom and talk into the toilet. Years later the patient's sister thanked the doctor for the remarkable improvement in her brother's behavior. Sadly, America's National Institute of Mental Health prioritizes drug treatment of emotional disorders though a study fifty-years ago showed the highest rate of recidivism (re-hospitalization) of severely disturbed psychiatric hospitalized patients was of those who were prescribed psychotropic medication in the hospital and following discharge, the lowest recidivism rate was with patients prescribed no medication in the hospital or after discharge, and the in-between recidivism rate was with patients who were prescribed medication in the hospital but not after discharge. Nuff said.

In the era before cellphones while driving outside St. Louis, my car got stuck on a road's divider while making a turn.

It was early morning with no help or cars to be seen. As I stood beside it, a car finally appeared and stopped opposite mine. It held four huge guys and I regretted leaving my pistol at home.

The driver came over and asked what happened. "My car's stuck," I said nervously. After briefly speaking to his companions they came to my car, picked it up, and moved it back onto the road.

I wanted to pay the driver but he refused. "There's a revival meeting at St. Louis Stadium tomorrow night. Come," he said.

Then, without another word, my four angels drove off and vanished into the night.

A December 10, 2024 Wall Street Journal article reflected on the inadequacies of America's students ("In a Test of Adult Know-How, America Comes Up Short The least-educated workers are falling behind on basic skills such as reading a thermometer and planning a trip.") To explain the problem with America's students' literacy, look to early-life parenting. When first read to and then with as toddlers, almost all children will learn to read on their own since the child's mind has the innate ability to induct the nature of reading just as it does the language grammar of the nation into which they are born. No formal teaching of reading is needed. But, sadly, some children do not experience a "good-enough" (not perfect!) parenting. Culture matters too, whether parents prize education and achievement, but these are not popular political talking points. Nor should teachers be expected to re-parent their students.