Monday, May 07, 2007

My Three Shrinks Podcast 19: Xanax Blues

[18] . . . [19] . . . [20] . . . [All]

Last week's Grand Rounds podcast was very successful. We've had over 300 downloads in the past week and over 3000 hits from iTunes. For the Grand Rounds post itself, we've had over 6000 page views in the past week from over 3000 unique visitors. Thank you.

May 7, 2007: #19 Xanax Blues

Topics include:
  • Q&A: Emailing patients
  • Q&A: What is Psychiatry doing about asexuality?
  • Q&A: Talk about Munchausen's disease and Dissociative Identity Disorder (DID).
  • Is denying care malpractice?
  • California forensic psychiatry staffing problems
  • More troubles with Xanax

Find show notes with links at:
This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from

Thank you for listening.


Anonymous said...

Excellent job to the whole team. Such a big number of hits moreover from itunes have passed the 1000 mark. Congrats.

DrivingMissMolly said...

I enjoyed your podcast, as usual.

I have e-mailed my doc a couple of times when I just had to get something off my chest. I even posted his replies on my blog with identifying info removed, of course. I feel that I communicate better in a letter, especially when I feel that I am over-emotional and fear that a call would turn out with me in tears or angry.

Like, Dinah, I don't see the big deal. I don't care if people know what I wrote my shrink. Who cares? Now, if I were a political figure or a public servant, yes, I agree that it would be a big deal.

I'm glad that my doc replied to my e-mails seemingly without much concern. I don't think it is a big deal when he is replying. It might be a big deal if he initiates e-mail contact with an e-mail full of a lot of personal info, though.

I've never been dumped by a psychiatrist, but I have been dumped by SEVERAL therapists. I can't begin to tell you how much that hurts, especially after a suicide attempt.

Roy, you are so super nice, I wish we had you in Texas. You are right about attitudes towards addicts. I have the same attitude toward a family member with addiction issues. I especially resent the fact that insurance seems to give addicts better benefits such as longer hospital stays and more therapy visits. I feel like I am more "innocent" because I'm not an addict. I know it is an ignorant attitude of false superiority, but that's how I feel.

After a couple of visits, I asked my doc, via e-mail, if he would ever dump me. His reply;

"Never fired a patient in my career unless I thought I wasn't doing them any good and couldn't in the future, so I have rarely referred patients to people I thought would be more effective with them."

This was so reassuring to me because I know that even if he decided to ditch me, he would refer me to someone else and not leave me high and dry without anyone.

I see myself trying very hard to be likable in appointments. I've grown attached to this guy. I wish I hadn't, but I have.

I wonder if patients that are dumped by their psychiatrists are just patients that are not likeable to that doc for some reason, I guess that would be countertransference. Maybe some patients aren't likeable to anyone. So much of life and dealing with others is social skill, facial expression and body language.

When I was a teacher I was told by the experienced ones to find something to love about each one of my kids and that if I couldn't find something, to look harder. Maybe some psychiatrists don't have the ability to find something redeeming in a particular patient and they don't take the time/energy to take a closer look.


Sarebear said...

I liked it. Hey Mikey.

Anonymous said...

I love your podcasts, and I am so glad that I have discovered them! I have a suggestion for the future, if you are interested, although probably you will feel that it counts as giving professional advice. Anyway: how to handle mentally ill people who call you (in a customer service context). I work for a government agency that does not, in the normal way of things, handle anything not referred to us by law enforcement. We do have a phone line that people who are just misguided can be transferred to, and then I, in addition to my normal duties, will tell them to call the police/google the answer to their question/ make a phone call on their behalf in the hopes I can intimidate someone into helping them. No biggie- it's kind of fun helping people navigate the system, which as we all know isn't very user-friendly.

I also get sent the calls from people who are just "crazy", and I can never figure out how to get off the phone. I can't help them- I'm not at all qualified to counsel people, and it's not my job, and anyway, just letting people cry for a while until they feel better is fine with me, though frustrating.

The problem is not with the people who cry, who mostly just need someone on the other end of the phone and are mostly amenable to my suggesting they call a crisis line. It isn't even with people who call and scream at me: they don't know me, and they probably wouldn't do it if we were face to face, and they usually run out of steam in ten minutes or so.

The problem is with people who are clearly... crazy. I know that's not the clinical term, but you surely know what I mean. It isn't that I'm unsympathetic: they're clearly suffering, and they clearly can't stop themselves from suffering, but I can't help them, and I am getting very frustrated. My office mandates specifically that we take people, even the obvious crazy ones, seriously and listen to their problems and refer them appropriately (ie. to legal aid or the police or the child support division), but when it's the same people over and over again, and their problems are not fixable, how do I get off the phone?

They call repeatedly, wanting us to investigate the fact that the FBI is harrassing them, or Prince is harrassing them, or their family is out to get them, and all I can do is say over and over, when they pause for half a second, that we can't help, that we don't investigate anything at all... is it okay to just interrupt people? how do I make it clear that these problems are not in our purview, without making it sound like we don't care, which I am not allowed to do, or just hanging up, which I am also not allowed to do. Sometimes I just tell them that if a crime has been committed, they can report it to the police, but these are people the police know and tell not to call them anymore, and they know that. I feel like I should be calling their caseworkers about this... but that's really not my job either, and there's no way to know who their caseworkers are anyway.

It's frustrating, and it takes up a lot of my time, and it must be a fairly common problem- I am pretty sure the segment of the population I am writing about spends a significant percentage of their time calling their congressmen, the attorney general, the FBI, the police, and... me. But there's only one me, not a whole phone bank, and I have other tasks to complete! There must be a way to represent my agency in a positive light and not spend all day in futile "conversation". Any thoughts?

Rach said...

Thank you for answering my question on email. Grand Rounds included this blog post on the subject -