Can psychiatrists read your mind?

Elderly lady in training posted a comment on 2009/04/09 at 3:41am.

A question for you as a psychiatrist.    To my complete surprise my brother suffered an acute episode of paranoia recently and is currently an inpatient in a psychiatric hospital. His wife has left him with the children – which was possibly what brought on the attack. So with his wife out of the picture it falls to me to help him continue his recovery when he leaves hospital. Yesterday my brother and I had a meeting with his treating psychiatrist.

As well as talking about my brother’s future, I couldn’t help thinking – good heavens – this man is a psychiatrist – what is he going to make of *me* – will he some me up in a flash and spot all my oddities and see me as a patient about to happen? Even – how do I portray myself as “normal”?

I guess I am not alone in wondering this sort of thing about psychiatrists. Are you as a group all-seeing, all-knowing? What quirks do we “normal” people give away without realizing it? What do you see as we fumble over our words, wriggle in the chairs, hesitate, avoid eye contact or whatever? Is this the kind of thing that trainee psychiatrists take about at dinner parties? i.e. what people give away about themselves? I’d love to hear your views as a person – a friend even – who happens to be a psychiatrist.

Part of doing a psychiatric evaluation is the same as what any observant individual would do. A professional detective can detect most of the listed items below as well as many observant individuals. Many people pick up on these clues and aren’t even aware that they are doing it. Probably the main difference is that a psychiatrist is more keenly aware of what some of these cues mean.

We do not read minds, feelings and others’ thoughts. This takes training and work and are elicited during a psychiatric interview and may take many sessions with an individual to clearly obtain from the individual.

I’ve always been amused whenever I’ve attended a social function or a party. When speaking with someone, it is common to discuss what we all do for a living. I’ve tried to just say that I’m a physician in order to not ‘scare’ someone away. Many people settle for this, but there are others who enquire about “what specialty do you practice?” OK, you’ve asked for it. When told, the typical and usual response is, “Oh. I better watch what I say. Are you analyzing me? Are you reading my mind? Am I crazy, etc?” My usual response is, “Oh, just relax. Analyzing takes work and I’m not at work now. I’m just relaxing and enjoying myself, etc.” They usually don’t linger with me very long.

However, since we, like all other observant people, do read and pick up on the following very easily just because we do it all day long. So it becomes 2nd nature to do it. After a period of time, I’ve just done it so routinely that I’m not even aware that I’m doing it. I make no attempts to read anything into it though.

Here are some of the clues and cues we all show to others:

Does the person seem to know where he/she is?

What the general time of day it is as well as knowing who they are. Those with dementia often fall short on these as well as anyone ‘stoned or high’ on drugs/alcohol.

What kind of movements do they show?

gestures Restless, agitated, slow, pacing, immobile, hyperactive, gestures, mannerisms, posture, tics, gait, paralysis, tremors, gait, limp, shuffle, twitches, compulsive movements and rigidity

What is their attitude and behaviors?

sad face Cooperative, resistive, sociable, reserved, seclusive, belligerent, negativistic, suspicious, apathetic, fearful, confident, over-confident, sarcastic, act superior, depression, elation, euphoria, anger, anxiety, fear, composed, complacent, irritable, happy, elated, exalted, boastful, self-satisfied, distant, aloof,  indifferent, apathetic, dissociated, perplexed, anxious or tense, calm, panicked, seductive, playful, ingratiating, friendly, interested, attentive, frank, indifferent, evasive, defensive, hostile, Alert, dull, stuporous, smiling, crying, blank, mask-like facial expression

How do they dress? Their personal hygiene? Overall appearance?

face Obese, over-weight, under-weight, emaciated, hair — bizarre style, unnatural, color, unshaven, wounds, scars, tattoos, jewelry, glasses, dental braces, disheveled, soiled, body odor, halitosis, dress, overdressed, bizarre dress, neatness and the appropriateness of his appearance; his apparent and real age. Clothes —  tidy, slovenly, neat, careless, dirty, decorative, mourning. Do they appear sex appropriate — androgynous, masculine, feminine

What is their speech like?

Rapid, slow, hesitant, whispering, shy, humorous, screaming, mumbling, loud, soft, whisper, overly talkative, intelligibility, slurred, stutters, accented, hesitant, emotional, monotonous, unspontaneous



Remember, we all show some of these general behaviors, attitudes, movements and speech patterns to the world. So, not to worry. However, it might explain why we tend to gravitate to some people and others we want to avoid. Psychiatrists are trained, however, not to allow his/her feelings interfere with helping someone seeking professional help.

I hope this helps!       Bottom line. Just be yourself.



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5 Responses

  1. As always, your comments are Soooo interesting, David. I like to play “psychiatrist” when I first meet someone, looking for many of the signs you describe. Sometimes I have had to swallow hard in order to eat my own, private judgements of people; but generally, I have a good eye.
    I couldn’t help but smile on your description of social events, when some people avoid you knowing what your profession is. It reminded me of my husband, who worked for the FBI -as a translator- and the reaction of people who had asked him what was his line of work was always: “Oh, I better be careful!”
    I have a question: Do you read my comments on your blogs? I’ve never tried to go back to one to make sure they are actually here.
    Hugs for you and Pam. I hope you have a sunny spring day. I’m looking through the window at a spring snowy day!

    • Raquel………I read each and every comment that people write. I reply to many of them but not as consistently as I should.

      Keep ’em coming!


  2. Hi David,

    My husband has a Psychiatrist that was so wonderful I had no trouble asking him to evaluate me. He gave me the mini mental test, and came back into the room, and said I was perfect! What a relief!

    Thank you for this today, It reminds me of the years I have spent reading body language, because I was deaf as a small child, and have little hearing now. It helped to be able to understand some movements, in order to make out was people were talking about.

    So, I see why a doctor reads these things. An M.D. (Well, you are am M.D. too. I mean one that is in family pratice.) He reads many signs to understand the person’s illness.

    One time a doctor said I had enemia, I asked, “How can you tell, I have on so much make up. He said, “I have ways.”

    Thanks for this list of things you have learned, and do automatically.

    Have a wonderful and peaceful evening,

  3. Hello David. I have twice tried to make a comment to say thank you for such a helpful response to my original comment. On both occasions I’ve hit a particular combination of buttons – not sure which exactly – and my typing has disappeared. As you said in the past when you lost a post – maybe it wasn’t to be. So this time I will simply say thank you.

  4. That’s a question everybody wants to ask a psychiatrist but they’re too afraid to ask! You listed signs that should be most obvious but aren’t to us lay people!

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