Since “Ask a Shrink” was fun I thought I would try it again.
This is your next opportunity to ask questions about mental health, its treatment, medication, counseling, theory, etc.
If I can answer I will do so – posting the response no later than this evening.
What’s on your mind???
Speak.
Demand.
We’ll answer.
26 comments
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July 2, 2009 at 6:23 AM
Ultra Dave
During an examination, when the doctor uses that thingamajig to look in your ears, what are they looking for?
July 2, 2009 at 8:42 AM
Urspo
When a Doc looks into the ears, she/he is looking for signs of infection, ear drum perforation, swellings, signs of scarring etc.
When a psychiatrist looks into your ears, he is looking for inner demons
July 2, 2009 at 8:41 PM
Ultra Dave
Thanks! another mystery solved!
July 2, 2009 at 6:58 AM
Jim
How about a 3 part question;
Why are some patients attracted to their therapist?
How do you handle it when someone develops a crush on you?
Any interesting stories you can share? (with the names changed to protect the innocent of course)
July 2, 2009 at 8:47 AM
Urspo
this is called transference, which was the sine que non of therapy – a patient recreates emotions towards the therapist that the patient has had before with previous people.
The transference is analyzed to learn about the patient.
Sometimes a positive transference is not analysed per se.
Sometimes a positive transference is not so much neurosis repeated but a ‘healthy sign’. You are finally around someone who is caring for you; this makes patients feel good. Sometimes it turns into a fancy, as people often combine fondness with physical attraction.
So ‘crush on the analyst’ is typical, useful and worth looking at , not for acting on it but for growth.
No overt stories now – they are legion and worth an entry themselves.
July 2, 2009 at 7:29 AM
James Figueiredo
Hi, Michael!
I have a question – When do you know it’s time to look for another doctor? Is it normal, or expected, to see the same psychiatrist for years without any visible improvement? Or is it something the people from outside the doctor-patient relationship can’t evaluate?
July 2, 2009 at 8:52 AM
Urspo
Most people have a gut intuition that tells them they are with someone not good for them. Listen for this before the mind does its BS.
In this day and age a good psychiatrist and patient will look at the process every 6 months and ask basic questions – is this working? is this doing well? are well stagnant – if so, why?
Sometimes when two people are working so close with each other, they loose vision. A consultation or a ‘fresh 2nd opinion’ is good, even when both think things are going OK enough.
I am suspiciuos whenever I hear someone is with the same therapist for many years – what are they doing? hae they set up some sort of symbiotic relationship?
Ultimately, therapy is a stepping stone; you can’t go out on your own. I have shooed patients away at times telling them they need to go out and learn from Life now.
July 2, 2009 at 9:55 AM
James Figueiredo
Makes a lot of sense.
Thanks, Doc!
July 2, 2009 at 9:41 AM
ElfBear
Dear Doctor,
I’ve been talking with myselves and though he doesn’t want to admit it, I think HE may have a weakness for salt and pepper therapists with a penchant for Haida art (DO NOT! you do so, you practically drool over the keyboard reading his posts! SHUT UP, YOU ARE EMBARASSING ME!) Now, say HE would like to pursure the matter further (STOP IT, HE’S GONNA FIGURE OUT WHO I AM!), would it be unacceptable for HIM to consult with the therapist in question even though it may be under false pretenses as what HE really wants is to get into the therapists’ pants (OMG, ARE YOU INSANE? I’LL NEVER BE ABLE TO FACE HIM AGAIN! Oh calm down, you know, Mom was right, you are the most maladjusted of my personalities!) So Doctor, waddaya think?
July 2, 2009 at 10:08 AM
Urspo
You and everybody you encounter needs medication as soon as possible.
And discipline
July 2, 2009 at 10:33 AM
Lou
Do you believe in “rock bottom” for alcoholics/addicts?
July 2, 2009 at 11:45 AM
Urspo
I do.
I have heard it enough from many patients – and friends – with a history of alcoholism and drugs. They call it ‘rock bottom’ and I defer to their expertise and experience.
It means they finally ‘had enough’ or had something occur that makes them truly motivated for sobriety.
Some people’s rock bottoms are very rock bottom indeed; others are not.
July 2, 2009 at 12:42 PM
William
Tell me what I can do for a friend who seems to be riding the roller coaster of emotions. She is up so high at times that she feels she can do anything. She makes lots of plans and expects everyone to work with her and follow her lead, take direction from her, and be fully as energetic as she is. Then, she sinks into the lowest depression, says she is so bored she can’t move, cannot follow through on any of the plans she has made. Often she will cancel appointments, vacations, and other activities with the people she was so enthusiastic to engage two or three days before.
An extended aspect of the question is what can I do for myself as I deal with this type of behavior.
Finally, am I correct in guessing that this is a form of bi-polar behavior formerly called manic-depression?
July 2, 2009 at 8:20 PM
Urspo
That is a good description of a bipolar condition – the high times which ‘crash’ into a depression.
One of the hardest thing I hear is “A” ill or going to hell in a hand basket while A’s loved ones feel helpless to intervene.
Most folks with bipolar disorder won’t listen when feeling high/good – they feel too good to listen. When they are in the depression they are more in pain and more apt to hear ‘get help’.
Good luck – hopefully you constant friendship and encouragement is eventually heard and she will go seek help.
July 2, 2009 at 6:00 PM
Robert
Dear Spo,
I have been on Effexor for the past 3 years. It has made me feel “good” (i.e. not depressed) and less irritable. I don’t want to be on this for the rest of my life, however. Should I just take that copper capsule forever, or should I wean myself off of it and see what happens? My life now, compared to 3 years ago, is SO much better. What do you advise your patients in similar situations as me?
Robert
July 2, 2009 at 8:24 PM
Urspo
Every six months I review with my patients their meds – are they worth continuing or not?
In favor of a successful cessation of meds – at least 1 year of ‘doing good’, no immediate problems and (hopefully) they have done some therapy work to deal with issue and work on symptom management.
It is an indvidiual choice – if a person has a long h/o depression sometimes it is best to stay on them.
Effexor can be a nasty coming off it; it sometimes causes a withdrawal.
it usually requires a slow taper down/off. Please do this with supervision !
July 2, 2009 at 9:36 PM
wcs
I can’t think up a question, but I enjoyed reading the others’. And your responses, of course.
July 3, 2009 at 4:08 AM
rick
What’s been your experience with natural remedies for depression such as St. John’s Wort? Also, Kava Kava for anxiety?
July 3, 2009 at 6:48 AM
Urspo
SJW is helpful for depression but the German literature says it is good only for ‘mild depression’, What that means exactly is a bit vague. I don’t see much ‘mild depression’ I see ‘major ‘, which SJW doesn’t touch.
SJW has so many drug interactions one has to take it by itself for safety’s sake.
no other Rx are allowed with it.
Kava works but thanks to greed it is now spoiled. The root contains the helpful bits – and it needs to be consumed with a heavy fat meal.
However, greedy people took the entire plant and marketed as kava. no one in polynesia would use the plant part as it is both useless for anxiety and toxic. People developed liver toxicitiy from the tainted Kava. Kava was pulled off the market.
Even if you can get Kava now, I don’t trust it NOT to have plant parts
If you can get guaranteed root only Kava, and take with grease, then it would be helpful for anxiety.
July 3, 2009 at 4:52 PM
Mark
Dr. Urspo,
Do you think I’m crazy?
Me.
July 3, 2009 at 7:30 PM
Urspo
No
You are absolutely fabulous.
July 4, 2009 at 3:34 AM
homer
Why do modern American parents often insist on circumcizing their male children?
July 4, 2009 at 7:03 AM
Urspo
This one is easy -
they want their boys not to look different from other boys
and
they don’t want him to be different than daddy, who is probably cut himself.
July 5, 2009 at 10:23 PM
Peter
No questions, just reading the others and your answers.
July 8, 2009 at 2:17 AM
sarah
Hi Spo,
I have had some years of existential crisis (called depression) and have been shunted around a lot from psychs to shrinks to counsellors to groups.I won’t take drugs. I never seem to get directed down any particular PATH. When I read about people in therapy, they are busily writing stuff and painting things and being guided through stuff; I thought that would happen for me too. But it hasn’t yet.
What should I expect from therapy?
Sarah
July 8, 2009 at 8:06 PM
Urspo
I’ll send you an email with a response. hold on.