Monday, September 09, 2013

What are You Afraid to Ask About Psychiatry?

On Thursday, ClinkShrink and I will be speaking at the Johns Hopkins University's  Fall Odyssey Program.  It's a lecture series, and we'll be speaking at the kick-off reception for a program called Mini-Med School.  We were asked and, flattered, we said "Yes!"  I didn't ask what they'd like us to speak about, and I started hearing details from people after the brochure came out.  Our talk is titled,   "Everything you always wanted to know about psychiatry but were afraid to ask."  One hour.  Two speakers.  Please leave lots of time for questions.  Okay, so I'm tasked with condensing my 12 years of higher education and 20 years of experience into 20 minutes (10 minutes for questions), then ClinkShrink gets her go at it.  

So I have a question for our Shrink Rap readers: What do you want to know about psychiatry that you're afraid to ask?

If you'd like to come, we'd love to have you.  I have no idea if there is still space, last I heard (back when I asked what I was talking about and where I should show up), I was told there was a good response, so I don't know if there are seats left.  

Here's the link to the brochure: 
If psychiatry isn't your thing, there are many other choices.  


Anonymous said...

Just stick with your experience and leave out your hire education unless it's a comedy act.

Dinah said...

Anon: thinking a little humor might be good.

pdf doc said...

Not meaning to insinuate that any of your patients are boring, but how do you stay awake through some of those sessions?!

Elbee said...

I think a catchy topic would be sex and the psychiatrist. Not trying to be suggestive, but so much in the media (movies, etc.) is about people who sleep with their shrink. It could be good to bring up these portrayals (ex. Side Effects, In Treatment) and tackle the myth/truth (and "rules") head on. Also, don't people always want to know if psychiatrists are going to psychoanalyze them when they meet them at cocktail parties or is that outdated?

Dinah said...

pdf doc: How I stay awake is a trade secret.

Elbee: funny, I already put in that psychiatrists can't read minds (I may have to modify that for you). I don't know what to say about sex: Psychiatrists don't have sex with their patients? But unfortunately (per Board Sanction newsletters) that does not appear to be an absolute.

Ms. Q said...

I have a question. Are there are any bits of information that you should simply not mention to your psychiatrist? Political beliefs, religion, etc. I notice they sometimes ask about religion and I try to dodge that one. I only go for med management. Also, they ask about ethnicity sometimes, and I decline to state.

But sometimes, they are sooo sneaky! They ask a seemingly innocent question or find a roundabout way to uncover that info, and without realizing it I just revealed my religious beliefs or ethnicity. And I think, Darn it!

I know people shouldn't typically talk about religion and other sensitive topics with people they don't really know. Is it ever a bad idea to talk about it to a shrink? Especially when it is only med management?

Anonymous said...

I'm always wondering how many shrinks entered medical school planning on becoming psychiatrists and how many get into it later. Just because psych work seems so different from other specialties.

Also, how do other medical specialists see their psych brethren, really? I get the impression it's a low-status speciality in the doctoring world, which is a little funny considering how high and mighty some people see shrinks coming off as.

Sarebear said...

What am I afraid to ask about psychiatry and always wanted to? a couple of things. I'll email you some time.

Anonymous said...

Are those stats that are in the media about mental illness true?
(e.g. that 1 in 5 people will have a mental illness)

Anonymous said...

What does a shrink talk about with his shrink?

jesse said...

Just got back fom the Shrink Rap talk at Odyssey. Good questions asked, but none as incisive, difficult or thought provoking as those above. Dinah and Clink did a great job; unfortunately Steve could not make it..

Amy said...

I'd like to know what YOU are thinking during a session with a very ill patient.
Are you possibly judging the illness or the patient? Why don't Psychiatrists tell patients in psychological terms what you think of them. I have depression, but every Doctor I've seen has never explained what I do in my daily life in professional language. I understand such language (especially medical terms) and am desperate to hear the description of my illness. I have a post-graduate degree and can understand professional terminology. Why am I treated like I am dumb?

ClinkShrink said...

Amy: I can only speak for myself, but personally I think a patient's description of their symptoms in their only language and terminology is much more helpful diagnostically than throwing around medical terms of art. It's easy to explain a diagnosis and diagnostic criteria (or a psychodynamic formulation for that matter) using professional terminology, but that doesn't really capture how this disorder or dynamic is expressed **for that person**. If and when I use professional terms with a patient, I try to link the term with an example or description given to me by the patient.

I can explain that "anhedonia" means lack of enjoyment or pleasure in one's usual hobbies or activities, but when I talked to a patient I don't say, "How is your anhedonia today?" I ask, "Have you been doing any of your (hobby X) lately? Did you enjoy it?"

I'm not sure this answered your question. I avoid medical terminology because I understand my patient better when I don't use it, not because I don't think they'll understand "my" language.

And what I'm thinking when I'm with a very ill patient:

"Ugh, he sounds like he's suffering. We need to do something about this."

Anonymous said...

how do you deal with increasing your fee, particularly with sliding scale patients?

Dinah said...

Oh GosH:

I am not the one to ask about fees, I once went 13 years without raising my fees and financial issues are the worst part of practice.

Amy: I don't even understand "no doctor has ever told me what I do in my daily life in professional language." Don't you just go to work, the store, make dinner, have coffee with friends, watch TV, do the laundry, surf psychiatry blogs, like the rest of us? What professional language? And Clink is right, when someone is suffering, we thing "Ugh, I feel badly for your suffering." Sometimes when people are in a lot of pain, it hurts on my side of the room! I think: what's going on that's caused this? should we change the medicines? are there real life things you could do that could help? Why don't you touch base with me in a day or two and come back sooner than usual? I think I think mostly in plain English.

Shrinks talk about the exact same things with their shrinks that everyone does. Their kids, the frustrations of their life, what they are anxious about, their upbringing, movies they saw and stuff they read on blogs.

I don't know about the 1 in 5. I don't even know who these 'mentally ill' are. Community studies say that 56% of people suffer from a psychiatric disorder at some time in their lives. 10% of people at any time take an antidepressant, and 25% of women in the 40-50 age group. My best guess is that the 1 in 5 is one in 5 with chronic mental illness, but how you differentiate someone with Bipolar disorder who is not having symptoms (because of meds or good luck) and is able to Work and to Love, from someone with Bipolar Disorder who is crippled by it, I don't know. Maybe 1 in 5 adults is on disability for psychiatric reasons, but that would seem high. I would be surprised if 1 in 5 people spend time in a psychiatric unit --- that would seem very high.

Depression said...

I would like to add another question: how many objective studies are known about the effectiveness of drugs for the treatment of depression?