I am a psychiatrist and former director of a psychiatric hospital. Go insane, AMA!

I recently heard of a story where a professor challenged his students to check themselves into a mental hospital, then try to talk their way out of it. No one believed them or let them leave, and eventually the professor had to go and get them out.

Is there any way to actually convince the orderly that you're sane once you're committed?

I find hard to believe that such story could happen nowadays. The diagnostic tools of psychiatry had improved tremendously in the last two decades and it is simply difficult to fool a good psychiatrist. Nonetheless, as in any other profession, there are good, bad and terrible professionals.

I was a mental health patient for roughly seven years and voluntarily institutionalized myself for a short period of time. I'm actually pretty grateful for my treatment, although it has been a long and difficult journey. There are some things you have to figure out on your own...

Many people still think of psychiatritry as a pseudoscience; often used for ulterior motives. In my experience, it is pretty vague, but only because we don't quite understand what's going on with the brain. Some drugs do work though. They're not perfect, but they can do incredible things.

How do you combat negative statements about your profession? What do you think needs to improve in psychiatry in order to become more credible?

Great question!!

For centuries, the mental illness has been stigmatised. Patients, treatments, doctors or anything related to mental illness have been looked with eyes of horror.

People understand quite well that if you have a medical disorder, you should take your meds. But if it is a mental disorder, people have negative and wrong believes about psychotropic drugs and treatments ('addictions' among other myths).

The only way to fight against all these negative believes is through education. Media, forums and informal chats carrying the message of mental health professionals is a good start.

An intense campaign is required and lots of work remains to be done.

what do you think about the guy with two dicks?

Seems like a fortunate individual to me!

It's like having a spare tire in the trunk of your car.

I'm a psych nurse and since we don't get thanked for our work often (never), let me say....Thank you for your work!

Thank you too!!

This is unfortunately common in all the medical industry, not only in psychiatry.

I hope you read this!

I was diagnosed with paranoid schizophrenia 2 days after my 19th birthday, and turned 21 just over a week ago. I am just about one year without serious symptoms, and have been on Clozaril for a little over 14 months now. I have CBT/DBT twice per week, and abstain entirely from drugs and alcohol (I used heavily prior to my diagnosis).

Following a series of hospitalizations throughout 2012, I was released into outpatient care and put under the wing of a psychiatrist in Chicago (where I was hospitalized/released, I now live there and go to school). I am a Junior in university with decent grades, volunteer at a local writing center, work for an educational non-profit and am moving into a new apartment with my long term girlfriend.

And I am happier than I ever was before treatment.

That psychiatrist saved my life, as he treated me, not just the diagnosis. And he cared. He still does. I meet with him tomorrow morning.

This comment is honestly just a thank you drawn from the depths of my heart, from my antsy little kid in me who needed help for so many other reasons than just the diagnosis, for what an incredible impact a truly committed, intelligent, and compassionate doctor can make in a person's life.

You seem like one of those doctors, and even if you weren't, thank you for so openly acknowledging the person, not just the illness.

That said, I think a question is appropriate: how would you recommend approaching my best friend with bipolarism and an eating disorder who has had bad experiences with therapy/psychiatry to continue pursuing help? Sometimes it feels being patient and genuine isn't enough, but I have a tendency to think of insecurities in those relationships as being my own, not a fault in the relationship.

They struggle immensely with the hopelessness, and more so the label; what little or big thing can I work into my relationship with her to, at the very least, help her feel grounded?

Sometimes you are lucky and end in the hands of a good professional as in your case. Sometimes you are unlucky and end in the hands of a bad "professional".

Please don't let her lose faith. Maybe you could help her by getting her in contact with your doctor who seems to be a great one.

Congratulations on your successful treatment.

Go crazy. Okay you're on.

We see a lot of abbreviated nonsense linked here about 'How to spot six signs of a sociopath/schizophrenic/whatever."

Can you explain how difficult it is to diagnose a serious mental disorder? And the process and list of professionals it takes for a person to be diagnosed as schizophrenic/sociopath/delusional paranoid/etc?

1. Diagnose is indeed difficult. In some cases, several interviews are required to reach a diagnose.
2. All diagnose process is mainly done through clinical interviews. Unlike other medical specialties, psychiatry currently lacks tools like lab exams, x-rays and other fancy images. All diagnoses must be performed by medical doctors specialised on psychiatry. And frequently, there is support of other specialists and psychologists to achieve a more precise diagnosis.

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I've never encountered face to face with this disorder.

This disorder was probably more common during the 19th and 20th century but it is becoming more and more hard to find.

Some cultural aspect seems to be in play here: hysterical phenomena are less frequent everyday.

Si pudiera decirle algo a una mamá que tiene un hijo recién diagnosticado con esquizofrenia... ¿Que le diría?

Tenga paciencia con él y coopere con el tratamiento. No permita que lo abandone, la esquizofrenia es una enfermedad crónica y tratable.

for the english-speaking:

Q: What would you tell to a mother of a recently diagnosed son with schizophrenia?

A. Be patient with your son and comply with the medical treatment. Don't allow him to abandon it. Schizophrenia is a chronic but treatable disease.

How often are cases of depression not helped by medication?

I was on 2 different SSRIs, one did nothing, and the other ruined my life for the 6 months I was on it, and I still don't feel right after it. I'm a bit too scared to even try a different class of antidepressants. Advice on this?

In general, when a patient is unresponsive to a SSRI we try with a different kind of antidepressant known as 'dual'. In my opinion, I would have chosen that route. One possibility is that you are among the 35% of patients with depression that are unresponsive to antidepressants or that you didn't received the right dose. My advice is to keep looking for treatment with a different professional.

Please don't forget that in the first weeks, all antidepressants cause collateral effects that will disappear gradually.

Thanks.

It was much more than a few weeks - try 6 months of ever-increasing suffering.

Love the name reference, by the way!

Yeah, quite a fan of King Crimson here!

I was institutionalized under a 5150 about two years ago after an attempt on my life, and even though I had been nothing but cooperative and genuinely anxious to get better, my asshole doctor put me on a 14 day hold for essentially no reason and without any further consideration. Do you think that this is an institutional (pun intended) problem, or more of a singular occurrence?

It's hard to tell but, the possibility that you were not properly evaluated, exists. I hope everything is better now. Prozac hugs.

What do you do if you're one of the 35%?

I've been seeing a psychiatrist and a psychologist for several years now and can't seem to make any traction. I can't even remember all the different drugs we've tried. The best I got from any of them was a small raise in spirit for a month or two. Then, it's right back to always wishing I were dead.

I'm tired of giving a substantial portion of my paycheck for something that just doesn't seem to work.

Other alternative treatments exist, for example: trans-craneal magnetic stimulation and electro-convulsive therapy. The rates of success for them are as high as 90%.

There are lots of myths around this treatments and certainly they don't look nice, but they reserved for cases like yours (refractory depression to antidepressants) and they do work.

Do depression meds actually work on people or are they just enjoying a nice placebo? It always seemed so weird that they say it takes like 30 days to kick in. Is there a reason for that?

1. It has been scientifically proven that antidepressants are superior to placebo. There is no doubt about this.
2. They take so long to act because they need to trigger lots of changes in the nerve cells (neurons). Depression is a biochemical disorder in which lots of changes need to take place in order to fix it.

What are the best moments on the job? ie A big break through with a patient things of that nature.

When you have a patient whose life is shattered and you turn it upside-down for the best. :)

who's => whose. grammar points to /u/chesky

Did you ever have any high-profile patients? If so, how did you handle that?

Were you ever involved in any involuntary hospitalizations? Any interesting court cases you were involved in?

What is your opinion on treating personality disorders?

1. All patients are treated in a personalised way no matter where they come from or how famous they are.
2. 50% of hospitalisations are involuntary, most of the times patients are not conscious about their mental disorder. Every time a patient is hospitalised the relevant authorities are notified so kidnapping, missing person file or any other legal fuzz is avoided.
3. Interesting court cases: one involving a patient 'kidnapping' a young child during a psychotic episode. We all went to court, I explained the medical condition and the story had a happy ending.
4. They are hard cases but attitude changes (not personality changes) are possible through psychotherapy.

I work at a psych facility but don't get to sit down with a psychiatrist and ask these questions, so I figure I will ask now:

What do you say to severely mentally ill and involuntary patients who tell you that they do not have a mental illness and don't need medications? Who refuse to take medications or go to their appointments for injections? Who are convinced that homeopathic remedies and exercise are all they need to manage their recurrent suicidality or psychotic symptoms?

Do you believe in DID? When interacting with someone diagnosed with DID, do you call a patient by their alter's name if they ask you to? Or is this less common in Mexico?

1. Although we try to convince them, most patients refuse taking their medication. Sometimes it works and sometimes it doesn't. If the last occurs, we go with parenteral medication and occasionally some stronger persuasion will be in order to preserve the integrity of the patient and of the people around her/him.

2. In general, DID are short termed due to current meds. I see nothing wrong on calling them by the name they ask, the disorder will recede swiftly anyway.

What are some of the rarer forms of mental illness?

Koro is one of the strangest I can recall.

Imagine your penis and then... BAAAAM!! it's gone.

Sorry if this is tmi or nsfw but is there any anti anxiety/depressant med that won't take away my ability to orgasm?

Bupropion is the best antidepressant in that case. It doesn't interfere at all with the sexual response.

Ping your psychiatrist and let her/him know all your collateral effects.

I suspect I may be a sociopath, but without really ever harming anyone.

Have you heard of Jim Fallon? TED Talk link. He is a neurologist that discovered he is psychopathic.

I often feel like some of the more anti-societal urges I have are higher than a normal person, but still under the threshold of what would be required for me to want to go though the effort to carry though with them.

What is it like to be around a sociopath / psychopath? What sort of things to they say about the way they feel? I'm worried I might be a timebomb, but maybe this is how all people feel and I'm just being a drama queen.

Sociopaths act (they don't just think) and don't exhibit feelings of guilt or remorse from their actions.

As long as it remains as thoughts and not acts that harm anybody or anything, you are probably just a drama queen.

If your last name was a unit of measurement, what would you like it to measure?

Also, what was the most convincing/complex delusion you've ever heard from a patient?

1. You kids have lots of spare time! I would like it to describe your mood. 1z would be happy, 2z euphoria and 3z mania.

2. A delusion about aliens controlling the patient through a system of cables installed in his body. The patient was unable to act on his own will and was always controlled by these cables like a puppet. The description of the delusion was incredibly vivid and detailed. I was almost considering wearing a tinfoil hat myself!

Do patients ever receive sex as treatment?

If your question is: do you administer doses of sex to the patients. The answer is obviously 'no' since it is unethical.

If your question is: Have you suggested patients to increase the frequency of their sex life. The answer is yes, in some cases.

What are some of the most severe cases you've come across?

Paranoid schizophrenia, bipolar disorder and eating disorders are the hardest ones.

Paranoid schizophrenia and bipolar disorder respond poorly to pharmacotherapy and psychotherapy; eating disorders require a multidisciplinary team for a successful treatment.

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I'm just chiming in, my brother has bipolar 1 (or the worst kind, if you will) and he has had therapy and is now a completely different and overall great person. I am not sure about success rates but I was surprised by how successful it was.

Good for him! I wish he continues improving.

To be honest, it is one of the most difficult disorders to control.

I've only seen partial success stories.

Have you ever had a patient react extremely negatively (namely, attempting suicide) to sudden discontinuation of Venlafaxine?

Not so negative, but some symptoms have been reported to me: headaches, severe anxiety and sweating.

Keep in mind that all antidepressants can present suicidal thinking as a collateral effect (suicidality).

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Good one!

• Sadness, 'being bummed out' is a natural emotion.
• Depression is an illness characterized by symptoms and signs that make it different from just being sad. For example: insomnia, feelings of guilt, loss of appetite, tiredness and suicide thoughts.

Common sadness doesn't exhibit those symptoms.

1. Do you ever think there will be a cure for schizophrenia, bipolar, and other mental health problems?
2. What are some things or techniques, besides take medications, that an individual with a mental health problem can do to improve their quality of life and be a functioning adult?
3. Once you have a mental health problem is there a way to get back to your previous self?

1. Not to long ago, there was no known cure for cancer. Nowadays, there are some kind of cancer that is curable. 90s was known as 'the decade of the brain' and psychiatry had a big progress knowing more and more about the cause of mental illnesses. I believe that some disorders will be curable in the near future. Thanks to pharmacotherapy, today, lots of patients that would have been interned in psychiatric hospitals, can live outside institutions living a normal life.
2. Indeed. Medications are not the only component of psychiatry. A human aspect should always be considered. Psychotherapy is a powerful instrument to improve attitudes and behaviours to deal better with life.
3. Depends on the disorder and the magnitude of it. Some diseases are not curable. Others are transitive and allow the individual to return to their 'previous self' (as you mentioned).

Thanks for doing this! Have you ever refused to give someone drug treatment in favor of psychotherapy (CBT, PE, etc)?

Also, you say you are a psychoanalyst, but do you ever incorporate other schools of thought into your work?

1. Yes. Actually made that call today! Patient with depression and liver failure. I decided to go with cognitive-behavioural psychotherapy since prescribing an antidepressant would have been lethal (the patient's liver would be unable to metabolize them).

2. Yes, cognitive-behavioural psychotherapy.

What is your opinion treating anxiety disorders with Ketamine such as OCD? Do you think a ketamine/CBT combo would be effective in fear extinction?

Why and why not?

The clinical essays on this kind of treatment are almost anecdotical and have been performed on very small samples. Given these conditions, they are almost invalid.

At the current moment their use is not justified and, occasionally, ketamine can trigger severe anxiety.

Have you read "The Day the Voices Stopped" by Ken Steele? I'm reading it right now and it is pretty frightening and sad.

No idea of it. I might try to find it in Amazon if it's worth it.

Sadly, mental disorders are one of the most devastating illnesses for the human being.

What education did you have to get where you are? Which school and which (specific) degrees?

1. I first completed a degree as a Medical Doctor in the National University of Mexico.
2. Then, I finished my specialization as Psychiatrist (same university).
3. After that, I went for a sub-specialization in liaison psychiatry in the National Institute of Psychiatry (Mexico)
4. Finally, I studied Psychoanalysis based on the Erick Fromm school.

They were 16 years of very long nights and lots of coffee and cigarettes.

Have you ever had a patient that you truly thought was possessed?

Possession is a non-existent phenomena.

In some cases of psychosis, patients present delusions of possession. This doesn't mean they are actually possessed but it is just a symptom of their illness.

For the actually possessed (ha, ha) a dual treatment of anti-psychotics and holly water is advised.

I actually got into a debate with a preacher on this subject. He insisted possession is real, I asked him to prove it.

I had a case of a nun with panic disorder. The preacher told her she was possessed, but said possession was exorcised with antidepressants.