# Ask the Psychiatrist **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [February 8, 2012, 4:10am UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161 "2012-02-08T04:10:04Z")\ **Posts on this page:** 11\ **Page:** 5
**Author:** ![Derleth](https://avatars.discourse-cdn.com/v4/letter/d/b9e5f3/32.png) [@Derleth](https://boards.straightdope.com/u/Derleth)\ **Post date:** [February 12, 2012, 9:36pm UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/81 "2012-02-12T21:36:20Z")
Did [my question](http://boards.straightdope.com/sdmb/showpost.php?p=14755280&postcount=44) just get lost in the shuffle? ---
**Author:** ![Purple\_Scottie](https://avatars.discourse-cdn.com/v4/letter/p/a698b9/32.png) [@Purple\_Scottie](https://boards.straightdope.com/u/Purple_Scottie)\ **Post date:** [February 12, 2012, 11:10pm UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/82 "2012-02-12T23:10:37Z")
No, I am just very behind on my responses due to being on call and having spent most of this weekend working. I will get to the questions but likely it will be Monday or Tuesday before I have more than five minutes to sit down at the computer. Also, I want to just say (in case I forgot to write it in my OP) that I am not going to give any medical advice – other than to direct questions about one’s specific treatment to one’s own doctor. To steal a line from one of my favorite blogs, for all y’all know I may not be a doctor but a yak herder… ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [February 12, 2012, 11:22pm UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/83 "2012-02-12T23:22:52Z")
> [@Purple\_Scottie](#): > > To steal a line from one of my favorite blogs, for all y’all know I may not be a doctor but a yak herder… I suspect that some of my psychiatrists were both… ---
**Author:** ![sisu](https://avatars.discourse-cdn.com/v4/letter/s/df705f/32.png) [@sisu](https://boards.straightdope.com/u/sisu)\ **Post date:** [February 12, 2012, 11:50pm UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/84 "2012-02-12T23:50:21Z")
> [@Purple\_Scottie](#): > > Currently, to my understanding it is not legal in the US. If there is appropriate research done demonstrating it is safe and effective and it becomes legal, then i would want to become more educated about the use and when it may be helpful. Since many of my patients may be acutely medically ill or have severe chronic medical problems, even if proven to be safe and effective in a healthy (physically) patient population, it may not be for mine. hmmm i think there is plenty of research that shows that they are safe but as you have said it is illegal. :smack: ---
**Author:** ![Sudden\_Kestrel](https://avatars.discourse-cdn.com/v4/letter/s/ecd19e/32.png) [@Sudden\_Kestrel](https://boards.straightdope.com/u/Sudden_Kestrel)\ **Post date:** [February 13, 2012, 1:57am UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/85 "2012-02-13T01:57:47Z")
> [@Purple\_Scottie](#): > > To steal a line from one of my favorite blogs, for all y’all know I may not be a doctor but a yak herder… I think a yak herder would come in mighty handy around here. I’m greatly enjoying this thread, by the way. Thanks so much for your very thoughtful responses, **Purple Scottie**. It’s nice to get some input from the other side of the couch, so to speak. ---
**Author:** ![Shirley\_Ujest](https://avatars.discourse-cdn.com/v4/letter/s/45deac/32.png) [@Shirley\_Ujest](https://boards.straightdope.com/u/Shirley_Ujest)\ **Post date:** [February 13, 2012, 2:22am UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/86 "2012-02-13T02:22:50Z")
Are mental issues a result of genetics, enviromental or both. ---
**Author:** ![Springtime\_for\_Spacers](https://avatars.discourse-cdn.com/v4/letter/s/a3d4f5/32.png) [@Springtime\_for\_Spacers](https://boards.straightdope.com/u/Springtime_for_Spacers)\ **Post date:** [February 13, 2012, 2:29am UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/87 "2012-02-13T02:29:57Z")
I have a question about Borderline Personality Disorder. I have a friend who has been given this diagnosis. However it doesn’t seem to me that he meets the popular definition of the disorder nor, as far as I am able to understand it, the standard psychiactric definition. What is confusing me is that he hasn’t fitted the pattern of chaotic, ever changing relationships. His (few) romantic relationships have lasted years at a time and it’s been more usual for the other party to bail. He has many friends, and generally avoids getting sucked into drama and has maintained a couple of very close friendships. The same with jobs, he changed jobs a few times when young and since then has held a few long term posts. So, as far as jobs, relationships and friendships go he is like a lot of people I know who don’t have psychiactric problems. What I have noticed however is that apart from the very few close relationships he is actually rather remote with people and plays his cards close to his chest. Without going into details, he has suffered from depression for a long time and has had a number of episodes of chaotic destructive behaviour, often coming in the wake of a relationship or a job ending. However rather than direct the chaos externally he tends to direct it at himself and withdraw from people. Also at these times his behaviour appears to veer from manic to depressive but that diagnosis (manic depression) has not been made. Purple Scottie, I’m not looking for you to remotely (re)diagnose this guy but I would be interested in any commentary you have, especially as to how BPD could relate to someone with this kind of pattern. ---
**Author:** ![Purple\_Scottie](https://avatars.discourse-cdn.com/v4/letter/p/a698b9/32.png) [@Purple\_Scottie](https://boards.straightdope.com/u/Purple_Scottie)\ **Post date:** [February 13, 2012, 6:25am UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/88 "2012-02-13T06:25:26Z")
I am sure I probably missed a few questions (perhaps my subconscious is working here)… > [@PandaBear77](#): > > Two other things I’ve always wondered … > > What is the difference between having a spiritual experience with some kind of deity vs. being crazy? > > (And I would thank anyone so inclined to not jump in and threadshit and imply that anyone religious IS crazy, kthx.) > > Do schizophrenics in, say, Saudi Arabia (or some other predominantly non-Christian country) hear from Jesus, or do they think it’s Allah telling them to jump in front of that train? Mainly I’m wondering if crazy people who think a deity is telling them to do wacky stuff tend to hear from whatever deity they’ve had the most exposure to, or does it pretty much seem to always be Jesus doing the talking? > > Offshoot of the previous question – who do atheist schizophrenics hear from? If someone’s schizophrenic and an atheist and thinks God is talking to them, are they somehow able to go “ok, this is definitely just in my head, I don’t believe in any kind of god so I am not going to obey that voice?” > > (And yes I’m aware that not all schizophrenics have auditory hallucinations, and not all of those who do are hearing from any kind of god; I’m just referring to those who do have them and do think some kind of higher power is communicating with them.) The intersection between religion or spirituality and psychiatry is actually one of my research interests. Part of what drew me to psychiatry is that more than other specialties there really is a push to look at the whole person: the physiological mechanisms (neurochemistry, endocrinology, etc) behind symptoms to the interpersonal relationships (current and past) that the patient experiences. For many (not all of course), religion or spirituality may be an important part of their life – either in a positive or negative manner – and to ignore that would be to possibly miss a part of the picture of what a patient’s experience is like. I do not think it is ethical of course for the psychiatrist to be an “evangelist” or to convince their patient to adopt or not adopt a specific religion. While I have my own personal beliefs I never disclose them to patients nor are there any “hints” in my office (i.e., specific religious texts or symbols) as to my faith. Hyper-religious behaviors can occur not only in psychotic states but also mania and psychotic depression and at times in dementia. Determining where to draw the line between highly observant and hyper-religious behavior is a challenge; there are some cases where there will be clear consensus among various psychiatrists and other times there will be a lot of disagreement. One general way to look at the issue (particularly for disorders where there tends to be episodic nature of symptoms) is to get collateral from family regarding the patient’s baseline beliefs/participation in religion and also to get input if possible from chaplain services (I use chaplain services generically – the hospitals I have practiced in usually have a fairly large network of religious leaders from various faiths and sects) regarding if the patient’s beliefs may be “normal” for their particular religious culture. For example, I was once one of the treating psychiatrist for a young adult male who had been raised by his family as a devout Muslim and active participant in religious activities at his mosque. With onset of his psychiatric illness, he became extremely preoccupied with religious symbols associated with Christianity such as hanging crucifixes around the city. Following initiation of treatment for his illness, his preoccupation with Christian symbols resolved and he returned to his baseline religious beliefs. He had very strong support from his family and religious community and was able to accomplish his goal of returning to his previous level of involvement in religious activities at his mosque. If a person becomes psychotic and has religious themes though I think generally the brain will draw on the language/fund of knowledge it already has access to – so likely it may be more common to incorporate elements from either their own personal faith or from language/terms that may have been common in the environment the person lives in even if they are not their own person beliefs. In other words, generally the patients who identified (either prior to their illness, following resolution of symptoms, or collateral historians suggested) as atheists or agnostics but were raised in an environment like the US (where most people ,at least with the Christmas music attack every year) may have heard terms like Virgin Mary, Jesus, etc and tend to use that terminology in expressing their delusions or describing their hallucinations. > [@Argent\_Towers](#): > > Well, Michael Swango certainly got long-term legal punishment, if three consecutive life sentences in 23-hour-a-day solitary confinement in the highest-security prison in America with no possibility of parole is long enough for you. But I think there’s a pretty gigantic difference between Swango and someone like Nidal Hasan, the Fort Hood shooter. > > Hasan committed a one-off burst of mass violence, motivated by a combination of religious extremism and some form of mental breakdown. Up until then he was, by all accounts, a normal and well-adjusted man. > > Michael Swango, from the time he was a small child, was absolutely _enthralled_ by death and by the idea of disaster and violence. All throughout his medical career, his co-workers observed that he was fixated on death and violence, that he was obsessed with incidents of mass murder and would make scrapbooks full of news clippings on same, and he was charismatic enough that he was able to continue working even with this bizarre persona. His obsession with death and his need to _cause_ death was _deeply_ ingrained into his mind and into his entire identity. It was like he was hard-wired to be a natural predator. > > I’m actually kind of surprised to hear you use the term “evil,” as that is just a word that we invented as a way of explaining certain kinds of behavior that are consistently detrimental to the greater good. But what _causes_ these behaviors? And is there any possible way that they can be harnessed towards something productive, or are people with these impulses irretrievably “broken” forever and destined to be killed or permanently imprisoned once they have been found out? Is it a chemical imbalance in the brain, or something else? I agree both Hasan and Swango are very different. Hasan frequently stands out in my mind because of the patient population with which I work – veterans. The question of whether certain people are “born bad” or if environmental factors cause them to become that way is one I don’t have the answer to and probably it is too simplistic when I resort to using the word “evil.” However, sort of like the boundaries I mentioned earlier – I try to avoid resorting to merely attributing the behavior of my patients to “evil.” I learned from doing a forensics rotation fairly early in training (actually in medical school) that I would likely not be the best psychiatrist to work in a correctional setting – that it would take too much of an emotional toll on me. Likewise, while it was not the only reason I chose not to do child psychiatry, working with extremely disturbed children who set fires and tortured animals was something I knew that I personally preferred not to do; those children deserved psychiatrists who could work with that patient population without as much counter-transference as I had. (Out of fairness, many of my colleagues think I am crazy for liking the type of psychiatry that I do!). > [@Esox\_Lucius](#): > > You beat me to it. I was going to say, The difference is in perception. To me, I have personality disorder. To others, I’m an asshole. > > You might not have been working long enough to answer this question, but in the current economic times, have you noticed an increase in people who need help mentally? I probably cannot answer it as well as those psychiatrists who have been practicing longer but a significant percentage of the patients for whom we are doing initial intakes for outpatient care had previously received care in the private sector but due to the economy have lost their insurance. There are also patients with adjustment disorders due to economic stressors and we have had a large increase in individuals seeking resources through our homeless service (which is not just for “homeless” but also for those at high risk of losing stable housing). Another way that the poor economy has impacted the patients is that for many of them who live in rural areas and drive to our center is that the cost of transportation may become a barrier to accessing some of the resources that we may offer (i.e., weekly group or individual therapy). > [@Fear\_Itself](#): > > Of your patients that start medication, what percent experience significant reduction in depression? I am not really able to answer that for my current practice setting since I am not one of the psychiatrists doing long (weeks to months) care of the patients. I know there are several more questions but I’m running on about two hours sleep since Friday morning (those yaks are really demanding). One quick final answer – I have no problems with being called a shrink. Other psychiatrists may but it just doesn’t bother me. ---
**Author:** ![PandaBear77](https://avatars.discourse-cdn.com/v4/letter/p/edb3f5/32.png) [@PandaBear77](https://boards.straightdope.com/u/PandaBear77)\ **Post date:** [February 13, 2012, 11:01am UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/89 "2012-02-13T11:01:56Z")
> [@Purple\_Scottie](#): > > I am sure I probably missed a few questions (perhaps my subconscious is working here)… > One general way to look at the issue (particularly for disorders where there tends to be episodic nature of symptoms) is to get collateral from family regarding the patient’s baseline beliefs/participation in religion and also to get input if possible from chaplain services (I use chaplain services generically – the hospitals I have practiced in usually have a fairly large network of religious leaders from various faiths and sects) regarding if the patient’s beliefs may be “normal” for their particular religious culture. Excellent answer. Thanks!!! 🙂 ---
**Author:** ![Brighter](https://avatars.discourse-cdn.com/v4/letter/b/ce73a5/32.png) [@Brighter](https://boards.straightdope.com/u/Brighter)\ **Post date:** [February 13, 2012, 2:35pm UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/90 "2012-02-13T14:35:24Z")
> [@Purple\_Scottie](#): > > To start with, I try to look at what a patient is saying verbally and nonverbally. A patient who states that they are very happy while sobbing uncontrollably may be an extreme example of a mismatch between what a patient is telling me in words and telling me in body language. Interesting thing. How would you describe the insight of patients regarding matters they are dealing with? How many of them, according to you, have very good, good, bad, very bad, ‘nonexistent’ insight? I’m asking about outpatients. ---
**Author:** ![Brighter](https://avatars.discourse-cdn.com/v4/letter/b/ce73a5/32.png) [@Brighter](https://boards.straightdope.com/u/Brighter)\ **Post date:** [February 14, 2012, 8:56pm UTC](https://boards.straightdope.com/t/ask-the-psychiatrist/612161/91 "2012-02-14T20:56:01Z")
> [@ralph124c](#): > > was Freud right when he declared all pleasure to be sexual? It’s more how he saw things. Psychoanalysis is something that attempts to explain human behaviour, one of many theories trying to explain human behaviour. Nothing is definite here. Some people find themselves within psychoanalysis, some don’t. Some people find poetry the ultimate thing for themselves, some fiction only. Freud says that pleasure principle applies to our actions. We don’t always have to be motivated sexually, that 100% our gratification will be of sexual nature, although for some people it might just be the case. Sex drive though is one of our most important primitive instincts, without it human race couldn’t survive. Thing is, we no longer live in primitive cultures that’s why our instinct is being regulated on conscious and nonconscious level. According to Freud, Eros is what drives us, Eros = life instinct, Eros = libido - something which makes us create anything you wish to create, a poem, a child, a car, a film, anything. Perhaps this will explain it easier: Freud himself stopped having sex (no sexual intercourses) at some point of his life to put his libidinal energy (libido, the thing which lets us create theories, poems, cars, plastic forks, pointless posts on forums or artworks other people laugh at making us miserable) into work. He was no longer motivated by sexual pleasure per se (orgasm for example or sexual closeness with his partner or sexual play with his partner), he was motivated by pleasure stemming from his work. [Previous page](https://boards.straightdope.com/t/ask-the-psychiatrist/612161.md?page=4)