Dr. Stanley Goldstein - Author and Psychologist

A recent news report stated that prior to allegedly murdering his parents, Nick Reiner's medication for his diagnosis of schizophrenia was changed, causing his behavior to become increasingly erratic. I know nothing of this apart from the news report but feel there are facts to keep in mind.

1. Schizophrenia is often misdiagnosed with those suffering from addictive disorders.

2. While both schizophrenia and addiction have the same etiology, a weakness of basic ego capacities governing control of thinking and behavior because of faulty early developmental experiences, they are very different disorders since the weaknesses are far greater in schizophrenia though they may, briefly, look the same

3. Psychotropic drugs have wide ranging debilitating effects. Long ago a psychiatrist co-worker told me that during his psychiatric residency he took a small dosage of a psychotropic drug as an experiment and its profound effect caused him to be exceedingly cautious about prescribing them thereafter.

4. A long ago study found that most school shooters had been prescribed one or more psychotropic drugs.

5. The treatment of mental health and addiction disorders is sometimes governed more by financial gain than treatment value.

A story: There had been much stress in a teenager's divorced family and she was upset by an upcoming math test. After expressing suicidal ideation to a classmate, their guidance counselor was informed and it was advised that the girl be seen by her doctor. The doctor recommended evaluation at a psychiatric hospital which was done. Months later, whenever the mother wanted to bring her daughter home, the girl's diagnosis would be changed to indicate her need for further treatment. Understandably so since the hospital was being paid a substantial daily sum and, just as a car dealership needs customers, a hospital needs patients.

Feeling desperate, the mother described her dilemma to me. I advised her phone the hospital and say she was coming to bring her daughter home that day or would come with her lawyer. You can guess what happened. Her daughter's diagnosis was immediately changed to "improved" and she rode home with her mother. I spoke with the girl thereafter with her biggest worry being how her friends would relate to her after she'd "been in a crazy hospital." But they said only that they were glad to see her back.

This girl never should have been hospitalized. While suicidal ideation should be professionally evaluated, actual suicide is relatively rare, like the proverbial needle in a haystack. Almost everyone expresses suicidal ideation at some time in their life, its seriousness being determined by whether the statement is serious or metaphorical, the degree of self-control present, and whether the means for suicide (gun, drug, etc.) is present. It, like schizophrenia, autism, and other mental health concerns is often misdiagnosed. Sadly, ignorance of child psychological development and developmental psychopathology is widespread. Nuff said.

The recent murders of Rob Reiner and his wife allegedly by their son, while shocking, raise critical issues on addiction and parenting. Contrary to popular belief, addiction is not genetic but caused by the lack of a "good enough" though not "perfect" parenting which none have. The early life parent-child interaction enables the child to develop basic ego capacities including the ability to control thinking and behavior, modulate mood, and develop a sense of self (sense of who they are).
Substance abuse begins during adolescence though, rarely, it can begin earlier or later. Its motivation is the stress encountered when the troubled adolescent tries to cope with its normal challenges: becoming provisionally independent of their parents; deciding their educational and vocational future; and dealing with the powerful feelings aroused by dating. A teenager who isn't ready to fulfill these tasks will experience painful stress that some try to relieve with drugs or alcohol. Thus using drugs or alcohol simply reflects the attempt to feel better despite its associated legal and psychological harm.
The treatment needed to replace deficient ego capacities with more mature ones is not simple or quick unlike the addictive substance that grants relief. I have known teenagers who experienced many rehab experiences before turning their life around, particularly since many are poorly staffed and theoretically suspect. Media have documented some with practices resembling a concentration camp. It's a Wild West for parents seeking quality treatment for their troubled or addicted teenager.

After viewing the engrossing series, Love and Death on Netflix, what most struck me was its dramatized insight into the power of the unconscious, how a casual event of childhood can effect a horrendous adult act. In this film, when an element of a toddler's situation was duplicated during a life-threatening adult interaction, dissociation and murder occurred. Past celebrated movies like the Hitchcock masterpiece, Psycho, also emphasized this, making stars of its performers.
Adult ignoring of this fact may result from both limited knowledge of child psychological development and fear. A child's father felt shattered because his toddler said he wished him dead though the statement reflected only anger and the common misuse of words by children. Yet parental fear, were they to recognize the strength of a young child's rage, is another element too. More than one mother has expressed fear for her safety were their physically aggressive child's behavior not to improve as their size increased.
The unconscious is very powerful and one must respect its power.

Jean Piaget, the great developmental psychologist, once said that the most common question an
American asks after he described child psychological development is "How can we speed up the process?" To which he replied, "You can't."
What seems like a child's behavioral difficulty often derives from they inhabiting a different mental universe than their parents. Children possess many beliefs which, being incorrect, differ from that of their parents. Not realizing this, many parents criticize or punish their child for, simply, being human.
But being "difficult" does not mean being continually difficult since most children slowly learn the error of their ways. If not, their behavior reflects not normal developmental issues but unhappiness, the source of which need be investigated and possibly treated.

The title of a recent Wall Street Journal article tells it all ("Millions of Kids Are on ADHD Pills. For Many, It's the Start of a Drug Cascade"). "I was living in a body hijacked by the medication," a youth said, and they aren't alone. Many parents, when confronting their child's difficult behavior, consult their pediatrician or psychiatrist or neurologist whose advice is almost always a medication. And if one psychotropic doesn't work, the dosage will be increased or more drugs follow.
The most popular diagnosis for difficult children is ADHD (Attention-Deficit Hyperactivity Disorder) which is almost certainly the most absurd concept in mental health in the past two-hundred years when a British doctor termed it "mental restlessness." The precursor of ADHD in early nineteen-hundreds American was MBD (Minimal Brain Dysfunction), which a Harvard psychiatrist said only a doctor with a minimal brain dysfunction would use. The diagnostic symptoms of ADHD are identical with anxiety and depression which are present in virtually every medical and psychological disorder.
For many youth their first drug is the start. Concerta may be prescribed for inattention or Lorazepam for moodiness or Abilify for defiance. I've long wondered if the latter's name was chosen to identify it with "ability" for better marketing.
Incidentally, a past study found that virtually all of the youth involved in a school shooting were on a psychotropic drug.
Several factors led to this "poisoning of America" with economics leading the way. Drug companies earn huge sums from their medicines and most doctors have little knowledge of child psychological development and developmental psychopathology. One pediatrician, when told by a twelve-year-old boy that he was thinking of killing himself, said "You shouldn't talk like that. It upsets your mother."

Because ignorance abounds, the best way to remedy this situation is through education. Educating that such popular mental health concepts as "chemical imbalance" and ADHD are nonsense, and that a child is "difficult" when they're unhappy, tired, ill, or unable to do what is asked for a psychological reason that makes sense only to them. Children want to behave as their parent or teacher request, striving to behave in an adult fashion and grow up. Educating them on proper behavior is the best way to interact with "difficult" children though sometimes psychotherapy is needed. So, Secretary Kennedy... 

Having long been a compulsive worker, my periods of unemployment were a major stress, despite they being deliberate since I quit each job. As I've often remarked, I may not have been too smart in several of the jobs I took but knew exactly when to leave. Which is when your boss wants you to stay. Every manager has a life expectancy, changing in image from the organization's savior to, after needed, painful changes were made, its current problem. But to return to the topic of this essay.

Unemployment creates major stresses. Usually financial, unless the person (family) has good resources. Also the partial loss of identity since, in America, one's identity is often gained from their job. The commonest question upon meeting a stranger at a party is, "What do you do?" But there is an unconscious element too since a job provides sustenance which is similar to what a child requires as they slowly achieve the capacity for independent living. Thus unemployment unconsciously thrusts one back into that early perilous period of existence, and how it would be had one lacked parents for aid. To quote a well-functioning young adult with a six-figure job who had several everyday chores to attend, "I wish I still had parents to do them for me."

But your mind also contains the mechanism for coping with stress by using its natural obsessive-compulsive ego defense, an obsession being a recurring thought and a compulsion being a recurring act. In other words, by involving oneself in an activity, such as looking for a job, cleaning a room or whatever, anxiety naturally lessens though, of course, worry still persists. So, get busy!

A troubling article in today's The Wall Street Journal related criticism of psychotropic medications to ignorance ("What Influencers and Critics Aren't Telling You About Antidepressants"). Or, in other words, Doctor Knows Best. But do they? Psychotropic drug research is minimal to describe it most charitably, and ignorance of child psychological development and developmental psychopathology is widespread among doctors. These circumstances motivate such unsophisticated but financially lucrative notions as Attention Deficit Hyperactivity Disorder (ADHD) despite it having symptoms identical to the anxiety and depression which are present in virtually all medical and psychological disorders; and diagnosing youth with Bi-Polar Disorder though its diagnosis requires an adult mental structure which youth lack by definition.

These ideas follow such a historic "gold standard" belief as the efficacy of lobotomy which destroyed countless lives including that of Rosemary Kennedy, the oldest sister of President John F. Kennedy, who underwent a lobotomy at 23 which permanently incapacitated her, making her unable to speak intelligibly. This procedure was permitted by her father, Joseph P. Kennedy, to manage her behavioral issues. Electro-Convulsive Treatment, is still being used though being best described in the title of a book by Peter Breggin, M.D., who has been called The Conscience of Psychiatry, "Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock, and the Psychopharmaceutical Complex."

Motivating this unholy alliance between psychiatry and the pharmaceutical industry is money: the drug companies rake in billions and most psychiatrists have little training in psychotherapy with today's psychiatry residents receiving only ten-percent of the training in psychotherapy compared with seventy-years ago but compete with psychotherapists of other professions. This also explains the huge sums wasted by the government on genetic research though most mental health conditions have been long understood as reflecting traumatic early life experiences, the lack of a good enough (not perfect) parenting experience. I end with two quotes. In early twentieth-century America the diagnostic precursor of Attention-Deficit Hyperactivity Disorder was Minimal Brain Dysfunction, which a Harvard psychiatrist said was so dumb that only a doctor with minimal brain dysfunction would use it. When working in a long-term residential treatment setting for teenagers which emphasized psychotherapy and rarely used medication, the physician father of a patient described psychotropic drugs as "chemical lobotomies." Enough said.

Every person is a psychologist of sort, making conclusions about human behavior throughout their life based on folklore and their own experiences. Long ago a noted psychologist, Fritz Heider, coined the term "naive psychology" for the conclusions about human behavior which a person naturally acquires in the course of their life. But some of these "facts" are wrong. One of these is that the most important distinction between child and adult is that a child possesses less factual information; another is that because the primary source of information is visual it makes sense to hide when unwanted chores are handed out.

Why it is difficult for an adult to distinguish behavioral fact from fantasy derives from two factors: a lack of knowledge about psychological development; and the power of the unconscious which prizes comfort over distress even at the price of behaving unwisely or irrationally.

A simple solution to this problem is that when feeling impelled to act quickly one should stop and ask oneself why? Is this behavior in my best interest or for my immediate comfort? As I never tire of repeating: the unconscious is powerful and one must respect its power.

Perhaps no human activity is so regularly engaged in and failed at as is the search for love and why is complicated. Early childhood experience is the bedrock of adult functioning. While none experiences a perfect parenting, one that is "good-enough" is needed to develop the capacities for trust and intimacy. If the parenting was deficient the adult's romantic relationships will suffer but this too it is not an absolute since varied capacities will exist.

Recognizing this, and responding to a lover's troubling behaviors with understanding not condemnation, can help maintain and develop the relationship. But with those who are greatly damaged, either from a critical lack of trust or having never learned that intimacy is comforting and not threatening, therapy is needed to heal the early life wounds. Which for some won't be easy since therapy involves dependency which also may have been believed dangerous as the child moved toward independence. Human development is not a simple task.

Depression, which differs from the normal grief caused by the loss of a bodily function or death of a loved one, is best understood by viewing it as a reaction to self-esteem, the feeling that one has about oneself. Depression is the emotional correlate of a partial or complete collapse of self-esteem since it feels unable to live up to its aspirations: to be loved not inferior, to be strong not weak, and to be good and loving not aggressive. Depression stems primarily from mental tension while elation is the expression of an actual or imaginary fulfillment of a person's aspirations.

Basic depression represents a mental state characterized by a lowered self-esteem, a feeling of helplessness, a more or less inhibition of functions, and a more or less intensely felt particular emotion. Basically, depression represents an affect state in terms of helplessness and inhibition of functions.

There are similarities and differences between depression and boredom. With depression the unconscious goals are maintained as in boredom but in boredom the ability to reach them is interfered with by the repression of the true goals and rejection of substitutes because they are either inadequate or prohibited. This results in a lack of direction, the inability to bring about goal directed behavior, and subsequently a feeling of emptiness and boredom.

In depression the mind is shocked into passivity not because there is a conflict regarding goals but because of its incapacity to live up to its aspirations. Depression is the human way of reacting to frustration and misery whenever the person finds themself in real or imaginary helplessness against overwhelming odds with the most frequent factor predisposing to depression being the adult's early life experience during which they really are dependent and helpless.