Sunday, October 04, 2009

Demystify Me!



We have a blog, we have a podcast, ShrinkRapRoy does some tech/med/psych twittering, and now we're writing a book. We've given one talk together, and once we're finished writing the book, we'll plan to do more as part of marketing the book (and the blog, and the to-be-resumed podcast) There's nothing to say we won't find more projects that compel us as time and technology move on. It's got me thinking that we need some umbrella organization to encompass all the different aspects of our work. I had a quickly-thought-of name; Clink says she can do better. Roy asked what our purpose would be and I assured him we'd have a mission statement, something to do with promoting dialogue, demytifying psychiatry, and decreasing stigma for mental illness. Roy added that we'd want to promote the destigmatization of both psychiatrists and the treatment of mental illness.

It got me thinking about what we do, and the issue of demystifying psychiatry. Do people want their psychiatrists/therapists demystified? Is there something about having that element...that distance, that assumption that the therapist is a little bit mysterious, unreachable, or somehow special in a way that regular people aren't, that is helpful (even if it's just not true)? Sometimes my patients ask questions about my life, or express surprise that I'd like, or do, something that isn't in keeping with the image they hold of me. What might be uncovered? Maybe that doc eagerly taking notes is actually writing a letter to his mistress (I hope not!) or behind the wise therapist fascade is an ordinary person stressing about bills, or a sick parent, or an ornery child, or their own irritable bowel. So demystify or leave it all alone?

On a totally different note: Roy got a New Puppy today. Oh my, is it precious. I went over to bond and the little guy (and he is little) curled up and slept on me.

25 comments:

Anonymous said...

I prefer when a psychiatrist or therapist seems human. The most helpful person I ever saw was a graduate intern at the college where I was majoring in psychology, so my opinion may be more based on my positive experience with that particular person. There's less mystery between a psych graduate student and a psych undergrad than in other counseling situations.

I've generally thought that that level of "mystery" was more a choice of individual professionals than anything universal. Recently I attempted to explain to a therapist why it was particularly hurtful to me that I wasn't in advanced math in elementary school, because my mother is a math professor. She replied that it's not genetic. When I attempted to illustrate my point by asking if she had kids and if they spoke fluent psychobabble, she told me I was "putting her on the spot." I thought it was a perfectly valid point-- you teach your children your own worldview. I guess my attempt at putting it into a frame of reference she might understand bothered her, but it's awfully difficult to explain oneself to someone else when you have no idea where their own views come from.

Dinah said...

I think a psychiatrist can seem human and still have a little mystery. And I don't think that equates at all to knowing personal information about them. It seems to me that people like their therapists to be not-too-warty and to believe they possess at least a little bit of wisdom.

My kids, by the way, don't speak psychobabble at all. They are teenagers, and I'm not sure if they share my world view. I believe the oldest may have been raised by aliens.

Midwife with a Knife said...

Puppies are awesome! Roy: puppies + tennis balls + hard wood floors equals fun for all! Puppy soccer! :)

The Girl said...

So cute! Love the picture of the new puppy. :)

I agree that a certain level of distance is better when you are going to somebody for therapy, but it is okay to share a little bit as long as you keep the session about the patient.

Pleochroia said...

At the level at which you're likely to demystify things, I think demystifying is a good thing. Perhaps it is related to stigma reduction? People with mental illnesses aren't possessed, and psychiatrists don't have magic powers.

But wisdom is still a plus in someone who is a) messing around with the mind and b) in a position to decide how healthy other minds are.

The other thing is that for those who need the mystery, or should I say total mystery, well, they don't have to read your book or listen to your podcast or read your blog. Presumably those in your audience are eager for a little demystification.

Anonymous said...

i say demystify.
i think many people harbor the secret belief that their therapist/psychiatrist knows more about the patient than they let on.
or maybe that's just me.

~emily

mindful said...

At a general level, I also say demystify. It brings a more human element to the process and in itself destigmatises psychiatry as something that is perceived as distant and “not of this world”. Obviously discretion needs to be exercised on how much is disclosed/demystified on a case by case basis.

Anything that provides more information about psychiatry and helps with destigmatisiating the treatment of mental illness should be wholeheartedly supported and I endorse your aims. This week is Mental Health week in Australia and I have written an op-ed about the importance of mental wellness that was published in our equivalent of NYT to tie in with mental health week. You can check it out online here

Novalis said...

A Counterfeit -- a Plated Person --
I would not be --
Whatever strata of Iniquity
My Nature underlie --
Truth is good Health -- and Safety, and the Sky.
How meagre, what an Exile -- is a Lie,
And Vocal -- when we die --

Dickinson

mysadalterego said...

Knowledge = Power.

Demystify.

Of course, I say that about all of medicine.

Jen said...

I think that the more demystifying that occurs the better, of psychiatrists and therapists as well as the science as a whole. I volunteer in suicide prevention, and I can't count the number of people that I talk to regularly who believe that psychiatrists will just throw them in the hospital and pump them full of evil drugs, and that psychologists will report your depression immediately and you'll be locked up forever (granted, some of these people are not firing on all barrels, but it seems to be widespread even in "healthy" people). There is a real perception that all doctors work for the pharma and insurance companies, and all that they want to do is make money off of their patients.

I do think that there can be oversharing- I've had a few psychiatrists and therapists over the years who have been extremely forthcoming about their own lives and problems to an uncomfortable degree, but generally, I'd prefer to know that my doctors are human, because I can't imagine that some all seeing, unreachable person would have any clue at all about any of the things that I deal with.

jessa said...

I'm for demystification. A lot of people seem to think that mental health care professionals have somewhat magical powers, that they can know what is going on in the patient's head better than the patient, that mental health care is more than just trying a bunch of different things to see what works. If people knew that, they might realize better that mental health care is not a cure-all, it will not necessarily make your husband decide not to divorce you, it will not necessarily make your grades improve, it will not necessarily even make you any less depressed.

I'm for professionals being as forthcoming as possible with their patients. By this, I don't mean that you have to tell your patients about your marital problems when they tell you about their marital problems. I mean that patients should not have to feel like information is being withheld from them. When I have been in mental health care, I have constantly had that sensation. Some of the time, there is no good reason to withhold the information because it is so insignificant, but it is still withheld. Sometimes there is a good reason to withhold information. However, professionals tend to be so cagey when patients ask questions, that it is easy to assume that they are withholding information for nefarious reasons. (I'm having difficulty expressing this briefly, but I wrote a whole blog post about it at http://madewithawesome.blogspot.com/2009/09/if-you-dont-tell-us-we-dont-know.html)

Anonymous said...

My shrink is a complete mystery to me and I think that is, in part, due to me. She has never divulged any personal information but I haven’t asked because I don’t really feel comfortable doing so. I’ve been seeing her for about a year and a half and most of what we’ve talked about; I’ve been able to do because I don’t “know” her. However, now we’re getting to things that I’m having a little bit of difficulty opening up about because I know nothing about her. I would like to “demystify” her but only to point. I don’t want to know too much. I definitely think some mystery is good and I realized that a few months back because of another blog (that you have a sidebar link to) that is written by a pdoc who I started to think might be my shrink. I think we’re in the same city, her office situation/description sounds like my doc’s, vacations were taken at about the same time, etc. I was a little panicked when I started seeing all these similarities. Then I read a couple of things that confirmed that she definitely wasn’t my shrink, one of which was that she wasn’t in the office on a day that I had an appointment. I had really mixed feelings when I got confirmation that it wasn’t her. On one hand I was a little disappointed because I really like what she had to say both professionally and personally but on the other hand, I was relieved because I felt that I knew too much about her life even though it wasn’t anything bad. She was too demystified. At least I can keep reading the blog because it’s not her. I would have stopped if I found it was her because that would feel wrong reading about her life on the internet.

Anonymous said...

OMG!!! That dog is so freakin' cute!! But why is there a cat toy tied to his neck? LOL

My shrink is a complete mystery to me and I don't feel comfortable asking her personal questions. I feel a little bit like the previous anon that I want to know about her but am afraid to ask and don't want to know too much. So, I've used your blog and a few others to help "demystify" the way shrinks think in general. I'm fairly new to therapy (a year or so) and didn't know how the whole thing worked, so you guys have really helped me a lot! Thanks! I stumbled onto your blog when I first started seeing her and had many questions.

Anonymous said...

I don't think my psychiatrist-who-provides-therapy-as-well is "somehow special in a way that regular people aren't." I don't know much about her personally, and at times, I'm curious, but I recognize the value of boundaries -- they apply in my own field as well. I've been curious at times about what theories might be informing her thought process and so for a while I sent myself off on a course of advanced psychological reading.
As far as a person? My shrink isn't supposed to be my friend. My friends and family aren't supposed to be my shrinks. They both provide invaluable "services" (to be crass) including different forms of support and insight, which occasionally coincide but typically do not.
But no, I don't think that my (or any) therapist is "somehow special in a way that regular people aren't." And frankly, I'm sort of alarmed that you assume your patients do. Do you think you are "somehow special in a way that regular people aren't?" No? Then why do you assume your patients think so?

Anonymous said...

Jen,

Actually, in my state, even people who are not antipsychiatry are afraid of the mental health commitment laws that have been toughened. As a result, people who are suicidal are afraid to get help out of fear of being locked up.

I also knew someone who complained to a psychiatrist about a med side effect. This person had always been med compliant but the complaint was blown off. When this person became admittedly beligerent, he/she was forcibly committed. I am not making this up.

I understand this happens more than you think it does.

I really think you unintentionally do a disservice to people when you minimize these concerns about being locked up.
Trust me, the fears are based on reality.

No, I don't think most psychiatrists are drug whores. But I think that once you are labeled, you seem to lose all credibility as everything is attributed to your label. It is a very cruel thing to do to someone and definitely does not help to reduce stigma.

AA

Roy said...

He's holding the cat toy in his mouth. It's a still from the Youtube video (where he keeps picking it up and dropping it... think he likes the sound of the bell).

So is knowing your doc got a cute new puppy who likes cat toys TOO demystified?

And, to AA's point, civil commitment to prevent a suicide is indeed a proper concern, though I'd argue that ignoring a suicide risk is also of concern. Most states require us to hospitalize if there is a risk, but how that risk is defined varies from state to state.

The area of consternation is likely that different docs interpret "risk" in different ways, so one could go to an ER on 2 different occasions after overdoses taken while drunk, and end up committed one time and released another.

Commitment demystification: factors that increase the chance of hospitalization after a suicide attempt:
-lethality of the amount/drug type taken
-planning it out over several days
-a suicide note
-taking it in a manner that reduces the chance one is found in time
-buying the pills for that specific purpose (versus finding them in the medicine cabinet)
-living alone/limited social supports
-attempted hanging
-stabbing/shooting
-not having anyone to corroborate story with
-lying (thus how would one know you were being truthful about being safe)
-not having access to aftercare over the next several days to week

FYI: coming in to ER via police petition does not appear to increase risk of hospitalization.

EN said...

I'm with some of the others. Is it medicine or magic?


However, if the science bears out it's better to stay mum, then do that.

An interesting question that comes to mind is, is the responsibility of a patient's welfare the overriding concern, or is the societal reduction of stigma (which could conceivably help the patient in the long run) more important? Suppose it also ties back into that discussion of reality tv/psychotherapy mashups.

Anonymous said...

Roy,

Knowing that you have a cute little puppy definitely isn't too demystifying! I would love to know if my doc has any pets.

Fordo said...

Love the puppy!

Ok. I've never seen a psychiatrist or therapist, so I may not be in a position to opine.

In seeing regular doctors- family doctor, allergist, OB/GYN- I've never asked them any personal questions about themselves. I don't think its appropriate to do so until I know them better. Its their personal life and its not relevant to our discussion.

However. However, I love it when one of them mentions a personal fact about themself. "Oh, I've had that problem- its nothing to worry about." or "I've been there- isn't it wonderful?" Little snippets like that demonstrate they are human and friendly. It takes them from "above me" to "beside me", if you know what I mean. It can also make me feel better about whatever little factoid I'm disclosing.

Sunny CA said...

My psychiatrist encourages me to ask personal questions and he shares a lot. I know his views on politics and religion and what movies, books and music he's enjoying. He has mentioned favorite restaurants and what he eats plus his favorite wines. I know about some of his friends, where he goes on vacation, what car he drives, hikes he has done. I know about the death of his wife, the death of his mother, what his 2 adult daughters are like, and what his mother, father and sister were like when he was growing up and what is sister is like now as an adult. I know his brand of mattress, brand of high fidelity equipment, what kinds of dogs he has had and his taste in art. When he finds a book he really likes he encourages me to read it, and that goes for movies too. I have read and watched almost everything he's suggested, and ended up becoming an opera season ticket holder as a result of his enthusiasm. While that may all seem like too much, most of what he has told me has had a point. He has suggested books, music, movies, restaurants to try at times because they illuminate my situation and other times to get me out of brooding within my 4 walls. Many stories he tells offer insight into my life.

Rach said...

Sunny CA,
what purpose does it serve you to know all this information about your shrink?

It seems to me that it would only reinforce the impossibility of a natural relationship with that individual - that is, by knowing about his dead wife and his brand of mattress, there are invisible and inevitable steps towards that ever grey line of boundary crossing...

Just my two cents.

Sunny CA said...

I know about the mattress brand because he recommended the brand when I told him I was having bad back pain. He also told me where the mattress store is located. I checked didn't buy one due to the cost. I did not know mattresses that expensive were made. I know a lot about his deceased wife including about her cancer and last days. He's in another relationship now. He has used his relationship with his wife to illustrate what a good relationship should look like. Her death was brought up when I was going through the death of my father and the death of my mother. I have been seeing him for 2 and a half years so there's lots of opportunities for a story here and a story there to add up in 50 minutes a week, plus for the first 2 years I saw him twice a week. That's a lot of hours. Sometimes he does talk too much but mostly he brings up very targeted illustrations which shed light on my situation. If you listened in, I don't think you'd think he's crossing the boundary.

me,me, and me said...

to sunny in ca...
ewww....i would so run from this "helper"and fast...
Delane

Anonymous said...

you "have a podcast?" present tense?

Anonymous said...

Demystify. I've asked my psychiatrist on numerous occasions what he is doing when I'm there that would warrant my having to go see him every 3 weeks. He always evades the question. I distrust him, in part, because of that. I suspect that coming in every 3 weeks is all about the money he gets for his services. If it's not, and it's not about something else nefarious, why on earth shouldn't I be allowed to know about it?

I haven't figured out why I should waste 3 hours of my day to travel to see him, sit in his waiting room for 20 minutes, see him for 15 minutes and then travel back home.

I feel that psychiatry still embraces paternalism even as all the other specialties have, or are becoming, enlightened about the collaborative partnership that is necessary for healing. Psychiatry has dropped its psychosocial roots and tends to rely solely on biomedical treatment while taking enormous amounts of money from pharmaceutical companies, all while increasing the number of meds patients are on, in some cases, often. If it's not the number of drugs, it's increasing the dosages. Perhaps if the psychosocial aspects of depression were at least acknowledged, people wouldn't need such excessively high doses of sometimes dangerous medications. Can you say "conflict of interest?" It's ridiculous.

Demystify if you want credibility with me. Psychiatrists aren't special. They are human beings doing a job and performing a service. They just also happen to be in a position to take a lot of money from drug companies while doling out drugs like candy, even as they diagnose things for which there are no objective diagnostic blood or imaging tests (used in clinical practice)... and remember, psychiatric diagnoses are created by majority vote at the APA. Perhaps that's the reason for the sole reliance on medication. Perhaps it helps practitioners feel like legitimate physicians. Perhaps they feel insecure because of the tenuous nature of the foundation of their specialty. Who knows...

I've cut WAY back on my medication and I am fine. Imagine that.