Dr. Stanley Goldstein - Author and Psychologist

A recent robust online clinical discussion concerned whether a teenager's proper diagnosis was autism or a subtype of schizophrenia despite the treatment of both conditions being the same: for the therapist to provide such a comfortable experience that the patient will eventually renounce the symptoms which keep them socially isolated and gain social skills. Both conditions reflect what has been termed Elements of a Borderline Psychotic Psychostructural Organization: the weakness of basic ego capacities which develop during the earliest years of life and control thinking, behavior, the sense of who one is, and more.

Autism is vastly diagnosed. With true autism the very young child senses the grave inadequacy of their parenting and tries to function independently. After inevitably failing because of their age and despairing they enter a personal universe to psychologically protect themselves, which is the autism. An Australian study found that when the parents of very young children with autistic features were provided extensive parenting education almost all the children were no longer diagnosable as autistic by the age of four.

A recent Wall Street Journal article inspired this blog ("Three Killings, One Suspect, and a sister Who Warned Her Brother Needed Help" - Nov. 30, 2024). Forty-one-year-old Chris Ferguson struggled with mental illness since his twenties, working as an unskilled cashier despite being a college honors graduate.
Though experiencing a dozen psychiatric hospitalizations and prescribed psychotropic medications his improvements were brief and tenuous. Longer than his provided three-day hospitalizations was barred without his consent or a court order, causing recurring experiences of deterioration. Despite his sister's plea that he was losing control, the hospital refused to admit him without his consent, which he refused to give. He was finally hospitalized after murdering three elderly neighbors, having been arrested while staggering through the neighborhood shirtless and barefoot with bloody footprints, recorded by security cameras. His latest trip to the hospital was his fourth in five months.
While the prediction of violent behavior will always be imprecise, several factors seem relevant here and with similar events: the reliance on psychotropic medication to allegedly "cure" mental illness; the limited knowledge of child psychological development and developmental psychopathology by doctors who have had minimal training in psychotherapy, today's psychiatric residents receiving only ten-percent of the training in psychotherapy they did seventy-years ago.
While state psychiatric hospitals were imperfect they did provide a place of safety for patients and the public. Their closing with the promised savings promised for supportive housing and outpatient services never occurring, the myth that medication can cure complex problems of living having been accepted..
An exhaustive study of severely disturbed, hospitalized psychiatric patients conducted more than fifty-years ago found that the lowest rate of recidivism (re-hospitalization) occurred with patients who were given no medication in the hospital, the next lowest rate was those provided medication in the hospital but not upon discharge, and the poorest prognosis was of patients taking medication both in the hospital and following discharge.
While legal and treatment changes cannot guarantee against crimes like Ferguson's, continuing present policies will guarantee their occurrence.

A Wall Street Journal article ('A Scientist's Final Quest Is to Find New Schizophrenia Drugs. Will He Live to See Them?' Nov. 26, 2024) aroused several thoughts - Schizophrenia is vastly misdiagnosed particularly amongst those with substance abuse problems. Knowledge of child psychological development and developmental psychopathology is gravely lacking among professionals. Psychotropic drugs produce severe side effects, which are termed "improvement," and can be hard to stop. Closing of the state psychiatric hospitals, which despite their inadequacies were safe, had its promised savings go into state general coffers and not the out-patient services promised. Another disastrous element is the FDA's belief and wasted billions in drug treatments, worthless genetic research, and electrical gadgets for basically psychological disturbances. The genesis of schizophrenia in terms of faulty early life ego development has been understood for decades--by those who want to know!

Yesterday's article on Ozempic in The Wall Street Journal ("A 12-Year-Old's Journey Into the World of Ozempic. A mother found success with a weight-loss drug after a lifelong battle. Noticing her daughter start down the same path...") aroused several thoughts.

The baby's first source of food is their mother and they later learn eating habits from their family. Children with eating disturbances tend to develop in families where food serves other purposes beside nourishment.

Anorexia (which has the highest death rate of all mental health disorders) and Bulimia develop in children where eating becomes entwined with their healthy desire for autonomy, which is resisted by their mother. Thus, control over eating for the child serves their emotional need of exhibiting their independence and, once created, is difficult to treat as it entwines with fanciful notions about beauty, nutrition, and exercise. Obsessive-compulsive exercising has its own motivation since, as reflecting an ego defense against anxiety, it serves to reduce the continuing anxiety of the anorexic/bulimic child.

Sadly, many doctors ignore the family underpinnings of these behavioral disturbances.

Some marital conflicts may arise from one partner seeking to heal their early developmental deficits through interaction with the other partner. Those who lacked a loving supportive parenting experience may seek this from their spouse, not recognizing its unconscious elements. Because of this, the partner may respond inappropriately, describing the behavior as silly or babyish, unworthy of a mature adult.

While the healing of these emotional deficits are best done through psychotherapy during which unconscious motives are recognized and their affect on behavior reduced, this is not to say that a supportive, loving relationship cannot provide its own healing element

Some parents believe their child's emotional difficulties derive from excessive video gameplay but this is not true. Video games are heavily obsessive-compulsive. An obsession is a repetitive thought and a compulsion is a repetitive behavior. An example is repeatedly worrying that one did not lock a door and then continually checking that it was done. Thus both youth and adults who play video games excessively do so because they're anxious, and the gameplay reduces their anxiety using the mind's instinctive obsessive- compulsive ego defense.
So it is anxiety which creates excessive gameplay and not the gameplay which creates anxiety or emotional difficulties. To reduce their child's play, a parent should try to discover what is distressing their child and alleviate it, alone or with the aid of a mental health professional. Only then will the gameplay become less important to them. Odering their child not to play the game won't work and will create the feeling they are misunderstood and arouse distrust.

An October 4, 2024 Wall Street Journal essay ("Why Do Older People Waste Their Time Playing Dumb Phone Games?") aroused these thoughts - Getting old isn't easy. It causes anxiety which the mind naturally tries to reduce using its innate obsessive-compulsive ego defense and video game playing is heavily obsessive-compulsive. This explains why such games are popular with other age groups too,  especially anxious troubled teenagers since it reduces their anxiety while playing them.

While both participants made good suggestions (the need to "harden" schools against intrusion; hire more security staff; provide more student mental health services) what is equally important is public education. Children aren't born with parenting instructions and the general level of knowledge of child psychological development and developmental psychopathology (a term coined by my doctoral advisor) among the public, teachers, doctors, and the legal system is low.

The basic ego capacities, those governing control of behavior and thinking, modulation of mood, distinguishing reality from fantasy, and developing a sense of who one is (the "sense of self") depend on experiencing a "good-enough" though not perfect parenting. The great power of the unconscious over behavior during childhood and adult life is another critical factor.. Pamphlets and instructional video explaining this, in a supportive non-judgmental fashion, might produce significant benefit at relatively low cost.

Newspaper reports of Ryan Routh, the man who was arrested for allegedly attempting former President Trump's assassination, describe Routh's long attempt to find a mission in life by making arms deals and recruiting soldiers for Ukraine and Taiwan with none succeeding. When younger he was rejected for military service and there was no news mention of current romantic interest though stating he was divorced and had children. Yet love or its equivalent is instinctive to all animals of which humans are a part. For humans, love, ideally, is when the other's welfare is made equal to one's own and honesty and communication is total. When absent, aloneness produces unbearable anxiety and a prison to escape. The total failure to achieve this can result in psychosis, a withdrawal from the outside world with behavior based on delusions during which the pain of separation disappears.
To be separate means to be helpless, arousing shame which can also be avoided by involvement in religion or artistic creation or obsessive work though the fulfilling solution for most is through love. Was Routh's obsessive involvement in his missions motivated by underlying problem with intimacy?

His behavior may also have reflected depression, the sense of having deep problems and cry for help, or the desire for what is termed "suicide-by-cop." The unconscious is very powerful and one must respect its power.

Note: This item was updated as further information became publicly available.

A Wall Street Journal Article ("Parents and School Shooters/Georgia has charged the father of 14-year-old Colt Gray. Is that fair?"/September 6, 2024) aroused several thoughts: 1. Babies are not born with parenting instructions and knowledge of child psychological development is greatly lacking among parents, doctors, lawyers, and politicians. 2. There is evil in the world which must be punished. 3. The unconscious is very powerful and one must respect its power. 4. Mental illness creates tunnel vision making crazy thoughts seem very real though when out of it one wonders how they could have once believed them. 5. Mildly poor parenting behavior shouldn't be criminalized but where to draw the line can be difficult to determine.