Dr. Stanley Goldstein - Author and Psychologist

An article in The Wall Street Journal ("We Are Turning Too Many People Into Medical Patients. The swift rise in in diagnoses for everything from autism to ADHD may be doing more harm than good./March 17, 2025) aroused these thoughts.
Long ignored ignorance about child psychological development and developmental psychopathology (a term coined long ago by my doctoral advisor) enables much faulty medical diagnosis, as is decried in the Wall Street Journal article. Several factors have contributed to this.
1. Anxiety can mimic just about every physical symptom: feelings of warmth or cold; feeling faint; headache; stomach pain, elevated blood pressure and check pain; even visual symptoms in an optic migraine. Distinguishing the true medical concern from symptoms of heightened anxiety requires training which the typical physician lacks.
2. Autism is vastly misdiagnosed with some children's autistic features vanishing after brief play psychotherapy.
3. ADHD, Attention-Deficit Hyperactivity Disorder, though enabling a lucrative treatment industry, is perhaps the most unsophisticated notion in medical history. First diagnosed by a seventeenth-century English physician as "mental restlessness," it took root in early nineteen-hundreds America as Minimal Brain Dysfunction, of which a Harvard psychiatrist remarked that any doctor affixing this diagnosis must have a minimal brain dysfunction. Its symptoms are identical with anxiety and depression, which are present in nearly all medical and psychological difficulties and school difficulties too..
4. Another diagnostic error is affixing the diagnosis of Bi-Polar Disorder to children. It is difficult to speak calmly of the degree of this error since the Bi-Polar Disorder diagnosis requires a fixed, adult personality which youth lack by definition.
5. The treatment for these misdiagnoses is usually one or more of the psychotropic medications, long articles of their misuse having been recently published both in The Wall Street Journal and The New York Times. A rarely acknowledged reason for this is that today's psychiatry residents receive only ten-percent of the training in psychotherapy they received seventy-years ago, fostering the belief that the treatment of choice for any of life's ille is a drug.
Truly, ignorance abounds. Nuff said.

A moving article in The Wall Street Journal ("Generation Xanax: The Dark Side of America's Wonder Drug"/March 13, 2025) aroused these thoughts. Myths such as such the unsophisticated etiologies of "chemical imbalance" and Attention Deficit Hyperactivity Disorder (ADHD) have long troubled the mental health field. The latter has diagnostic symptoms which are identical to the anxiety and depression associated with nearly all medical and behavioral disorders. While a hospital administrator, when I spoke to the Director of Psychiatry about the side-effects of psychotropic medications he angrily stormed, "There are no side-effects!" And he was not a stupid man, one of his degrees being from Cambridge University. Myths that reduce income tend to have long lives.

That psychotropic medications can have crippling physical and mental side-effects tends to be ignored and the Wall Street Journal asrticle does a worthy service, describing the disabling psychological and neurological symptoms and even suicide of users. What's eqally troubling was another article describing the current push of several drug companies to create and market drugs which allegedly "cure" schizophrenia and Bi-Polar Disorder though their psychological etiology has been understood for decades except, of course, by those who don't want to know. Abetted in these quests are many present-day psychiatrists, which is understandable since today's psychiatry residents receive only 10% of the training in psychotherapy that residents gained sixty-years ago.

A large study fifty-years ago found that, of previously severely disturbed hospitalized psychiatric patients, the most favorable outcome post-discharge was those who received no medication with the highest rate of recidivism being with patients who were prescribed medication while hospitalized and after discharge, with former patients who were prescribed medication while hospitalized but not after discharge having an in-between recidivism rate.

To paraphrase the sixteenth-century proverb of the English writer, John Heywood, there are none so blind as those who refuse to see.

A parent shouldn't feel badly when their child's behavior causes them to feel inadequate for it might just indicate that they're behaving in an exemplary manner as their child is comfortable expressing their true feelings!

Adults tend to believe that everyone they speak with are relating logically but this isn't true of children. Their mind is immature, they have an inadequate, often erroneous view of events and, when ornery, are simply behaving as adults sometimes do when they're ill or tired. If persistent in children this is termed Oppositional Defiant Disorder. If persistent in adults it is termed being passive-aggressive or simply being irritating.

When frequent in a child it should be investigated since it indicates their distress. Which, if not reduced, will harm their developing personality and later adult functioning. Occasional parent anxiety is normal and beneficial since it indicates their fear of making a parenting mistake and the common feeling of "mommy-guilt." But they shouldn't be overly fearful since children forgive parenting errors so long as they feel loved.

Long ago I knew a much older, well-regarded woman holding a high corporate position. She and her husband had worked for the American government in London during World War Two. There she left him for what she later regarded as a trivial matter, a decision that she later greatly regretted, once considering suicide.

As a teenager I loved a novel, The Song Of The Red Ruby, by the Norwegian writer, Agnar Mykle. After publication in 1956 it became a best-seller, selling seventy-five-thousand copies in its first year and a million copies in its English edition. Which should have guaranteed the author's success until the book was condemned as obscene. He was acquitted after a year-long legal battle which included reading the entire novel in court. Later information suggested the charge was politically motivated. Though Mykle had been the Labor Party's most talented author, his book poked fun at socialism and he became considered a traitor.

The rest of Mykle's life was a shambles. "I have survived my crucifixion," he said, but he hadn't. His reputation was destroyed, he divorced his wife during the trial and retreated into depression. He later declared bankruptcy, was frequently treated in a psychiatric hospital, and shut himself off, living like a hermit and rarely opening his door, dying in 1994.

Two talented people of different social and business worlds whose lives became devastated by choice and event. Evidencing what can't be repeated too often: that while the unconscious is powerful, understanding and forgiving one's mistakes is critical since it opens the door to freedom.

Two statements of long ago friends linger in my mind: "I've never been sure what love means" and "It's hard to believe what you once believed when the craziness is gone." In a sense, these thoughts describe why some people remain loveless or continually behave in self-defeating ways. Not from genetics or the mythical "chemical imbalance" which unjustly profits some doctors and corporations but because of early childhood experiences which can deform the human personality into adulthood. 

An important goal of childhood maturation is to gain control over feelings, to not behave impulsively as occurs with "road rage." After birth the infant is overwhelmed by feelings, having left the comfort of the womb to enter a booming buzzing world. They do so gradually by assigning positive and negative valences to experiences: positive to those that fulfill their needs and negative to those which ignore them or arouse anxiety.

Most powerful are the negative valences which become associated with angry aggressive behavior and persist, becoming visible during later experiences that produce overwhelming anxiety because of lingering childhood emotional conflict. Though these happenings may be desirable as when seeking intimacy or being assertive on the job. 

The unconscious is very powerful and one must respect its power.

To save money on counselors, schools have been subscribing to chatbots, online AI companions who can be contacted anytime. As a mode familiar to students and a companion that will never be unavailable or reject them, what's not to like? Well, maybe a few things.
1. People have always had imaginary companions in their head and, when lonely, fantasize them. Youth, being immature, cannot fully utilize this though they have used it since infancy: imagining the image of their nurturing mother when they are in need, this being essential to the development of self-control.
2. A chatbot gives an unrealistic view of friendship, which is not always available and agreeable.
3. The intensive emotional support that youth need should be provided by their parents. When not available it is often from lack of knowledge of child psychological development which is widespread.
4. Use of a chatbot is inherently self-isolating.
5. A chatbot cannot sense psychodynamics, that a real need may be other than what is revealed online. And while therapists vary in their ability to do this it being dependent on education, talent, and experience, the best therapists can do so more regularly.

A recent news item described a lawsuit against such company when its AI companion reportedly spoke of youth who got so angry at parental behavior they killed their parents, this being the AI's attempt to foster camaraderie with the youth. Not smart!.

This blog was inspired by an article in The Wall Street Journal ("Schools Turn to a New Chatbot To Help Support Students/Feb 25, 2025).

A recent psychology listserv posting, referring to the layoff of federal workers, called it an "existential crisis." With which I must disagree! An existential crisis is a medical emergency or war situation and not unemployment though losing one's job is a major stress and one that all must learn to cope with. That unemployment can feel existential is another matter and that it can arouse depression and even physical symptoms is certain. But maturation means being able to consider matters in perspective. A job may feel like a supportive family that will provide sustenance for life but it is not.

I've had periods of unemployment and was once laid off from a government job with the union delegate stating that he'd never seen a government layoff before. But the county had financial problem, I was considered highly paid and so re-hired part-time.

All my periods of unemployment led to better results, as hopefully will happen with these laid-off workers. I've had patients who came to this country unable to speak English, learned it and more to earn more than many. I believe in the resilience of people, both youth and adults, which is a notion that seems to have become unpopular today. Nuff said.

The developmental origin of drug abuse has long been known. Early in life a child develops the basic ego capacities governing human functioning: the ability to control their thinking and behavior; the ability to modulate their mood; the ability to distinguish reality from fantasy; and their development of the sense of who they are or, as it is termed, their "sense of self."

No one experiences perfect parenting but if it was greatly inadequate a weakness of one or more of these capacities develop. This can cause difficulty with paying attention in school, socializing, and enabling later success with the critical development tasks of adolescence: dating, gaining appropriate separation from parents, and constructing realistic educational and vocational goals. These failings cause distress and, with some youth, the attempt to alleviate it using alcohol or drugs.

Substance abuse occasionally begins earlier or later but mostly during adolescence. Treatment is difficult because undergoing psychotherapy to heal the underlying personality issues that cause the substance abuse takes time while using a drug lessens pain quickly. The need for many episodes of in-patient treatment to become "clean" begins their life-long struggle to remain so. Longevity is not associated with substance abuse.

This article was inspired by my reading in The Wall Street Journal ("The Dark Side of Addiction Recovery for the Rich"/Feb. 16, 2025).

Few mental health subjects other than suicide contain more public misunderstanding. This article was incited by my county's mailed handout containing its risk indicators which include substance abuse, depression, and a family history of suicide. All being true though the major risk factors of suicide are the degree of self-control possessed, the presence of lethal means as a gun or drug, and if suicidal intent is present. Important facts were omitted, including reassuring ones such as depression (the "depressing" of feelings) being part of the human condition and commonly experienced when one struggles with an important personal decision.

While every expression of suicide should be professionally evaluated, its act is relatively rare when compared with its utterance. Virtually everyone hints of suicide sometime during their life ("I could kill myself") but relatively few do. Its incidence is like the proverbial needle in the haystack and why suicide prevention programs have questionable benefit though more public education about child psychological development and developmental psychopathology (a term coined long ago by my doctoral advisor) is certainly needed.

Suicide is motivated not by an immediate disappointment in love or work but from long-term despair: deep feelings of worthlessness derived from unsupportive parenting early in life. Then, at some future time, a major stress occurs, the early feelings of worthlessness resurrect and suicide is attempted. Because there is a biological imperative to live, alcohol or drug use is often present during this act.

A suicidal gesture is usually a cry for help, intended to gain the person their long resisted but needed treatment. And, contrary to another widespread belief, teenage cutting reflects self-hatred and the attempt to relieve stress rather than seeking death though accident can occur. Though certainly unwise, its real danger is the possibility of life-long scarring. Nuff said.

I once had a talented, highly accomplished friend who, a few minutes after asserting something, would say, "I never said that." Similarly, some children often deny responsibility for a misdeed despite evidence being apparent. In adults, this behavior has become understood in recent years as a selective impulsivity in an otherwise well-controlled person, they exhibiting such behavior only in selective areas of their life.

This usually reflects not an impulsive personality but contradictory impulses in particular areas of ife, perhaps those related to self-assertion or intimacy. As example, the person who is repeatedly sexually seductive only to quickly reject their partner to seek another "conquest." Another example is the person who lies impulsively but states lying is not a problem for them and accuses others of lying. These behaviors are emotionally disconnected from each other, being the essence of what is termed "compartmentalization."

The unconscious is very powerful and one must respect its power.