Dr. Psych(o) – the weird psychiatrist

I don´t want this title to sound derogative – actually, I like Dr. Psych, precisely because she is so “weird”. As a reminder, Dr. Psych is the lady who gives the psychiatry lecture I currently attend. It deals with psychopathology (not psychopathy!), that is, with defining and recognizing all sorts of pathological mental symptoms such as “hearing voices”, “derealization”, “anxiety”. I believe this lecture will be very useful in understanding how mental health professionals form their opinions on their patients and how they reach their conclusion, that is, a diagnosis. Maybe it will also help me in deciding if I really have a symptom or if it is pure hypochondria.

The first session was three weeks ago. The lecture is held in a mental institution where they do not just treat patients, but also conduct research. It was the first time I went into that building and I felt very strange. First of all, I wasn´t sure if it was legitimate for a person who studied neither medical science nor psychology to attend that lecture (turns out it is). Then, I didn´t know where the classroom was. I didn´t know if I was supposed to be there at all, so I didn´t want to ask anybody (and besides, I feared that I could be mistaken for a patient…oh dear), but as I randomly entered one hallway because other people were going down there as well, I worried that I might accidentally end up in a room full of patients who would show some completely crazy reaction, like starting to yell at me. At the same time, it annoyed me that I was so bigoted and prejudiced – it´s not like I have any reason to see mental health patients as the “absolute other” or as people or, horribile dictu, beings completely different from me. Luckily, though, the other people in that hallway were students as well, and they finally worked up the nerve to ask someone for the way, so eventually we made it to the classroom.

So what is Dr. Psych´s lecture like? Thankfully, it greatly differs from what Dr. Bla delivers. The students are fairly quiet (and Dr. Psych has the necessary authority to make them shut up if necessary). Dr Psych herself is easy to listen to because 1) she has a loud enough voice and 2) she talks about interesting things, not just statistics, and 3) she actually bothers to structure her lectures and she sticks to her schedule.

First of all she handed us all a piece of paper which read like a checklist. It actually was. Listed on there were all possible psychopathological symptoms a psychiatrist needs to look for when first talking to a new patient, particularly when the patient is being admitted to an institution. Items on this list were, for example, suicidal tendencies, formal thought disorder and others. Dr Psych explicitly told us that this checklist does not yet lead up to a diagnosis. It is just used as a preliminary evaluation of the patient´s mental state. She said that the mission of her lecture was to acquaint us so intimately with these symptoms that we immediately see them in a patient while talking to him.

She started out by showing us a video of a manic patient. That patient was an old lady who was upset and angry at one moment, and next she would be cheerful and offer her interviewer a cigarette. She was talking all the time, and in a fairly loud voice.  Afterwards, we were supposed to tell Dr. Psych what we observed in that lady. I had the impression that most people talked about her “inappropriate” affect, or her body language, but few people mentioned what that old lady had been talking about. She had, essentially, been ranting about her domestic situation. Seeing the discrepancy between what was important to that lady and what was important to the interviewer and the psychiatry students made me feel quite low. The lady probably felt like her “manic” rage was perfectly appropriate, and she was happy that finally somebody listened to her. When you blindly trust your interviewer and let yourself go and pour your heart out only to realize that they don´t empathize with you, but take notes on how inappropriate your behavior is and in what way – don´t you feel incredibly fucked over? I cannot think about a concrete example right now, but something about that scenario felt depressingly familiar to me. I often perceived a lack of empathy, a lack of concern, a lack of interest in the things that I said from my former psychotherapists. And given that this approach is actually taught at college, I cannot assume that my experiences are exceptions. I would go on philosophizing about this approach and whether it is acceptable or useful or not, but I wanted to talk about Dr Psych´s lectures.

There are some really redeeming things about Dr. Psych, even though the above-described part of her lecture was depressing. First of all, she is honest and unpretentious. She explicitly told us that judging what is and isn´t normal is a risky and unprecise endeavour, something I wholeheartedly agree with. She also made clear how normal and abnormal are defined: Normal is the kind of behavior shown by the majority of people within a certain culture/society. It has nothing to do with good and evil. She even said that being abnormal is not necessarily bad (think about gifted people, for example). The question how you seperate sane and healthy from insane and ill is something that has been bugging me for a long time. When I confronted one of my former therapists, let´s call him Dr. Stoneface, with my opinion that normal and abnormal were no real scientific categories, but just judgements made by society, he replied: “Well, of course!”, as if that was a good thing. My opinion, naturally, was: If they are just man-made judgments, then they are only there to oppress people who are different! I´m not entirely sure of that opinion anymore, because some people simply suffer, and by saying that their suffering is not normal they can or at least might successfully make the case that they need help – and actually get it. I guess for now I can live with Dr. Psych´s take on this: “Normal and abnormal are not ideal categories and they must be handled with a lot of care and self-awareness, but right now they are the best thing we have.”

Another thing I like about her is that she shows us a lot of videos with patients who suffer from the symptoms on the checklist. That way we understand what those symptoms look like in real life. Dr Bla, if you remember, preferred to bother us with statistics. And Dr. Psych definitely goes to some lengths to make us understand what it is like to have a mental illness. Last session she told us she was going to show us a video about panic and anxiety. Everybody expected yet another patient talking about his symptoms. Instead, we got this:

It is hard to recognize anything because the hand holding the camcorder must be shaking madly. Eventually, you recognize a beach. There is a loud, undefinable noise in the background, and people are screaming in terror. Suddenly there is something dark moving into the upper part of the picture. As the camera angle changes, you see what it is: It is an airplane that is about to crash. It takes a turn, seems to head straight for a multistorey building behind the beach, then takes another turn and eventually crashes into the sea – directly in front of the beach.

“Well,” Dr. Psych said after a short pause, “what did you experience upon watching this?” People reluctantly started to describe an increase of heartrate, or holding their breath…and I was simply amazed. I applauded Dr. Psych for this nearly perfect mindfuck. As someone who suffers from “fear diseases”, I couldn´t help but feel a little mischievous as well. See what it´s like? I guess the most ironic thing is that in me, this video didn´t even trigger a fear response. Since 9/11 I have a morbid  fascination for plane crashes. It´s not like I don´t pity the persons involved. But watching that amateur video was exciting rather than scary.

Anyway, to sum up a few things: Independently of their personal differences, Dr. Psych and Dr. Bla are also teaching us very different things. Dr. Psych is teaching us which psychopathological symptoms there are and what they look like. She doesn´t talk about diagnoses like, for example, Histrionic Personality Disorder. This is what Dr. Bla is talking about. He acquaints us with more or less well-defined mental disorders (and unfortunately fails to acquaint us with their symptoms). He is also supposed to tell us how to treat these disorders.

It can be fairly confusing that someone can have a symptom  (like depersonalization),  without having the disorder named after that symptom (Depersonalization Disorder). One symptom can be part of a great variety of disorders (you might suffer from depersonalization when you have DD, but also if you have depression). This is good to know when you are a cyberchondriac like me and diagnose yourself with another mental illness every week.



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