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?
What is their attitude and behaviors?
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?
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.