IamA psychiatrist AMA!

I had sex with my mother when I was younger(no I'm not that guy and I can't prove it) and I orally satisfied my stepdad. Sometimes I'd watch him fuck her, sometimes he'd watch me fuck her. When I was about 11 years old, it suddenly stopped happening.

However, no one has mentioned it since, and I'm too ashamed to bring it up. I think about it all the time. I also think that I hate her, but can't specify a reason. I enjoyed it at the time and was never forced to do anything. What's your take on this? I still can't see a psychiatrist since I'm 16 and still living with them. My sex life is normal, but I'm not sure about my sexual orientation.

EDIT: If someone's interested, I'd answer any questions about that time. If anyone was in a similar situation, please PM me. I need someone to talk to.

What you described is sexual abuse. Since it is bothering you so much I would recommend talking to someone about it. How about starting with a school counselor? People talk to me all the time about sexual abuse and rape. It's very hard for them to open up but once they've done it usually they feel better. Us mental health professionals are trained to help people with this issue.

I'm not from the states, and our 'counselor' is also my psychology teacher.

It's a small town, and I don't trust her. Also, I feel uncomfortable doing that. I really have no one to talk to. I want to tell my girlfriend, but I fear she'd never look at me the same ever again. I just don't know what to do.

Find a professional to talk with there has to be someone in your area- doctor, religious minister. These are common issues in any culture or society.

Why don't you tell us exactly where you are at? Maybe one of us resourceful Redditors can help you find someone.

How do you feel about the mental disorders being subjective diagnoses? How far are we from having objectively diagnoses mental disorders?

I think the diagnoses are pretty good. They provide common terminology which healthcare professional understand. If I diagnose someone with depression with psychotic features anyone else can have a picture in their head what I'm working with so they can continue care. There are some diagnosis that are a little more complicated but everything continues to evolve.

Do you get annoyed at the wat psychiatrists are portrayed in the media?

Yes

My wife followed a similar education path. However, she is terrible at applying her knowledge to her own life, and I see this often with people in the same field.

What can I do to get her to open her eyes to the fact that she is often affected by the very things she studied?

What do you mean? Can you provide an example?

She studied in Psych and Criminal Psych, as well as other related fields. I suspect she's depressed, along with other minor mental "problems". Nothing major, she's not about to snap and go nuts. She just has a hard time seeing the things in her own life that she daily helps other people with.

Sorry, I'm not very intelligent in this field and can't seem to get my words out properly. Thanks for the reply.

Doctors and healthcare professionals are terrible patients. You can't see yourself objectively. If I worked in tech and needed to fix my own PC that would be a piece of cake. However it doesn't work like that in healthcare. You can't diagnose yourself.

Do you believe that most everyone who is taking psychiatric medication should additionally be seeing a mental health counselor? Do you think there is a gulf between psychiatrists and counselors, does it harm the field, and what are your suggestions on how to close the gap?

Some people have a more biological depression, have completed therapy and need maintenance monotherapy with meds. But short answer to your question yes I believe most people should receive therapy+meds at least early on.

Me and my friend (both diagnosed) often talk/joke about "trends" in psychiatric care, where a diagnosis becomes very popular for a few years and almost everyone seem to have it, aspergers, borderline and bipolar seem to go big, and some people we know pile up very similar diagnoses.

Is there any truth in our blabbering, in your opinion?

Not really. I think some times money drives the system. Insurance companies decide they are only going to pay for a certain thing and then everyone gets that diagnosis. The problem is people really need the help but insurers don't want to pay so they get that diagnosis. I don't play that game, I call it like I see it and stay out of trouble that way.

Do you know the average cost of seeking psycho-therapeutic help in America? I'm personally interested in seeking therapy, but my insurance doesn't cover it, and I don't have much disposable income.

Probably $50-100 per hour. That's a pretty standard rate for most professional services. There are resources for free and reduced cost care in most communities.

I was in the same boat - it was much much higher than this....

$350-400 for the initial appt. $275 for those after. Or a 3 month wait for an appt at a clinic.

Damn how can I get in on that? I don't think that is ethical to cost so much.

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Lots of people come to see me and I tell them they don't need meds. I tell them strategies for coping which could include exercise and therapy. I've dealt with drug reps in the past. They come to your workspace and give you lots of expensive free food. Obviously it works in some way. I haven't seen a drug rep in over 5 years and have no desire to see one. I've never felt pressured to prescribe anything. I would say they influence prescribers if that makes sense.

My son is 23 lives at home, he contributes some money towards his keep from a job he had. He is reasonably polite to other family members when he interacts with them, which isn't very often. The problem is this, he regularly has 36/40 hour stints playing Runescape nonstop on his computer in his room, no sleep at all, occasional weed breaks and eats some food when it's there. Otherwise Runescape nonstop, after these enormous binges he'll sleep for 10 hours or so, then do another 30+hour stint. He argues that this does not affect him, that really it is none of our business, after all he is 23. He has some friends he see briefly during the week, the shared interest here is probably weed, they're nice guys, and we are glad of the interaction. He hasn't had a girlfriend for a few years. His life is progressively more isolated. In conversation he is increasingly intolerant of others opinions of anything, and seems to be more and more animated in his understanding of reality, he has little or no interest in anything else. I feel he is slipping into an extremity I have no experience of, I'm not sure what to do. He insists he doesn't need 'help'. But I think he is lost and probably depressed. Anybody got any input here I'd apprec

Sounds like issues with addiction both with weed and online games. His life revolves around the substances and the games. They have resulted in a severe negative impact on his life. They have severely impacted his relationships, job and other major life milestones. His substance and gaming use is out of control. He becomes irritated when anyone suggests he cuts back.

Have worked with patients like that who suffer from alcoholism. Their whole life revolves around alcohol. Treatment involves getting them into a 12-step program like AA and a substance abuse treatment program like a 30 day residential program. They sleep at the facility work non-stop on the addiction and can't access the stuff they are addicted to. Hope that helps:)

I'm 25 and love weed and video games but I live on my own and pay all my own bills. My suggestion for you is to set some "house rules" starting with "no weed allowed". Tell him if he wants to smoke he's got to get a job and move out and pay for it all himself. By allowing him to live in your house you are enabling him to get away with his current lifestyle. If he maintains that lifestyle while being able to pay for it all himself, in his own home (apartment, rented room somewhere else, etc) than that's all on him. I have a lot of former friends of mine share interest in weed and video games, but mooch off their parents because their parents don't put their foot down and enable their kids to live unsustainable lifestyles. Hope that helps.

"Enabling" key word there:) Good job!

There are some community support groups that might help you. NAMI is one. Maybe Nar-anon. Nar-anon and al-anon are for family members and friends with people suffering from addiction. Probably would be a liberating and very eye opening experiencing if you have never been to one.

Can a person's personality completely change/improve? Have you actually seen someone who was on the brink of suicide do a 180 and become productive and happy?

Yes

How do you help people work through and/or past depression/suicidal thoughts?

Try to help them examine their life, understand what factors are contributing and underlying their depression. Help them understand about themselves to empower them. Also a lot of times prescribe people medications. Lots of people have depressive tendencies because of genetics and other medical factors.

What happens when they cant or wont leave their underlying problem behind?

Can you provide more info?

How do you think social media is affecting people in the long run?

Hard to say. It creates a lot of peer pressure. Have a daughter in the 7th grade who is on social media. All the kids are on it. My sense is we can't change our culture and will have to teach my daughter to use it responsibly.

There was a study that came out in Germany last year that Facebook can actually make you depressed.

It's screwed up. I find myself on Facebook wondering how my friends think of me sometimes:)

What can patients do to get the most out of therapy?

Edit: spelling, dur

You've got to get comfortable with being vulnerable and opening up. People fear appearing weak but the reality is getting help is a sign of strength. You have to be able to tell your therapist when you feel it isn't going right. Tell your therapist, I'm not sure I like you or I don't feel this is going in the right direction and that opens doors to go somewhere you have never been:)

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No you would only be committed if you were actively suicidal and refusing medical treatment. No one wants to "commit" anyone. The vast majority of people get help behind closed doors. People get committed when the police get involved in a suicide attempt and they are refusing help.

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I went to medical school. I thought I wanted to do Internal Medicine but ended up changing my mind. Also come from a long line of doctors in my family:)

Do you think all of this research on psychedelic or MDMA assisted psychotherapy will ever materialize and become a thing in the future?

Also what do you think the next big thing in psychiatry will be? NMDA receptor antidepressants?

The next big thing in psychiatry is going to be genetics. You are going to go to the doctor and they will analyze your DNA to see how many genes you have related to each disorder. They will also use genetics to predict medication and probably psychotherapy effectiveness too. You go in get a cheek swab and say you need CBT and medication X:)

But I don't want any drugs or Cock-and-Ball-Torture :(

Can't I just tell you about how I feel instead?

Genetics probably will also predict psychotherapy effectiveness. actually would rather talk to people than rx drugs.

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There is always a way to get help. There are people who are willing to help and donate their time. Most city and state governments have programs and free and reduced cost medical care. Most areas have free and reduced cost medical clinics. Pick up the phone and call someone in the area. Ask what is available. Most medical schools have free and reduced cost clinics too.

I am seriously considering seeking a career in your field, as I've had an interest in psychology for a very long time (for reasons I won't discuss). I'm 25, but do not have any way to finance such an endeavour; it's been suggested to me to seek a scholarship, but having been "homeschooled" (read: unschooled) for most of my life, I'm not sure if I'd even qualify for lack of "grades" etc. Not only that, but the isolated lifestyle has left me unsure of how to function in such an environment even if I were to somehow manage that.. Or even where to start.

My questions to you are: 1) How did you finance your studies; 2) If you're aware of any way I may pursue my interest; 3) Whether a socially-inexperienced/awkward individual with no familiarity with organised education could handle the educational process.

There are some exceptions but to get to medical school, you have to get a four year undergraduate degree first. Probably you would work out a lot of kinks in undergrad. The process of education is like a step ladder. If you are at the bottom and look to the very top it seems overwhelming but over the years you climb one rung at a time. When it is all over you are at the top looking down:)

My parents helped pay part of my undergrad I paid the rest in loans. Also I worked hard in high school and got a 30% scholarship. If you get accepted into the program they will give you loans to cover it all. Many of my fellow doctors graduated with $200,000 of debt or more. It's an investment like buying a house. You end up paying it off $1500/month for the rest of your life:)

Did you get a Navy scholarship?

Yes Health Professionals Scholarship Program (HPSP)

Oh, okeedokee. Thanks for the response :)

AIM HIGH!

What's the next step one you figure out what's at the root of your issues? I had a revelation, but now what?

Tell us more.

Have you seen /r/depression or /r/socialanxiety?

Yes a little but I mostly hang out in /suicidewatch or /relationships.

What is the psychological basis for gambling?

Gambling is like a fantasy. It's a dream you are going to score big and live large. It's fun to buy a lottery ticket and live that. But then reality hits after you lose. What makes it more complicated is some time persistent gamblers win which makes them think the fantasy is obtainable and they keep going. It becomes a problem when people can't control it and lose everything. I think its also like an escape. People who are in a terrible situation are more susceptible.

I've had this thing since my ex and I split up where I'm in constant need of communication with others. I start to lose it a bit when I'm alone and it's too quiet. I was just curious if there's a certain name I can put to this need for constantly needing someone to be around or talk to, and an intolerance for silence. I can elaborate if you want me to.

I know the feeling. Maybe its "longing" or loneliness. You want to be back with that person. Kind of depressing:(

Hi there. It seems we have a lot in common. I did a year of internal medicine and realized I was very unhappy with it. Now, I in the match for a psychiatry residency. In what ways do you feel psychiatry was a better fit for you than internal medicine? How does the day to day of residency differ between the 2 specialties?

Diabetes, hypertension and renal diseases are cool on paper but I found the management of them grueling and boring. Love talking to people. Also my own past experiences with my dad and his schizoaffective disorder make it more rewarding for me.

What is your opinion on Intermittent Explosive and Oppositional Defiant Disorders as it pertains to blanket diagnoses? Specifically IED. Do you believe this is the new ADHD, over-applied to justify psychotropic medication?

I have personally worked with a some patients with IED though its very rate. It's pretty amazing when its a real diagnosis. They really do completely fly off the handle at slight annoyances. Like one guy broke a circuit board at work and smashed his playstation 3. Just had no control. With these cases meds helps them cool off and increase their reaction time.

What are your opinions on the dsm v? How is that going to impact your ability to diagnose and bill?

To me its just a manual with common terminology so healthcare providers can communicate. Very similar to DSM IV in my opinion.

Do you feel like there may be too many psychiatrists?

Actually there is a national shortage and its getting worse :(

What effects are you seeing as a result of the shortage?

Hard for people to access quality mental health treatment

In your opinion is it OK/safe to take Lamictal during pregnancy?

There are some meds that are known to be harmful during pregnancy but I think Lamictal is unknown. In that situation falls upon the patient and doctor to determine the risk and benefits ratio. Worked with some women who had such severe mental illness they became life threateningly incapacitated without meds. In that situation the recommendation would be to continue the medication.

I will have periods where it is very hard to go to sleep because my brain is going and going. My friends get a kick out of my non sequiturs because while having a conversation I will think of something associated with what you are saying then associate that with something so sometimes I say things that are a little random. I interact normally and multi-task very well so I don't think autism. I will sometimes fixate on something be it a tv show or even topic then as quickly lose interest. It seems like my thoughts are always racing and I find it hard to decompress. Any thoughts would be helpful, thanks.

Could be a tad bit bipolar like Bipolar I, Bipolar II, Cyclothymia or maybe a touch of ADHD:) Can't diagnose over Reddit:p

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Hard to say it falls on the judgment of the provider. Everything is always a mix. In psychiatry we have bio-psycho-social and spirituality. Genetics and medical issues play a role. A person's learned behavior and thinking patterns play a role. Also the environment they are in such as job and school impact their mental health. Finally there is there religious beliefs. Usually those things are all meshed together and you have to treat all of them simultaneously.

My girlfriend is really into becoming a psychiatrist (typo?). What steps should she take now to get prepared for achieving that goal?

Need to get a bachelor's degree in chem or bio in college and complete the prerequisites for med school. Need to focus on getting in and through med school and then you can worry about the next step:)

Hi Doc I've been told I have a delusion by a psychiatrist but it is very real to me. Is there any way I can judge whether it is a delusion or a real thing. I'm normally perfectly rational. And while unlikely my delusion is still plausible.

Rely on other people to make the decision for you.

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Go to medical school.

Go to medical school!

What's wrong with me?

You spend too much time on Reddit

I guess this is more of a question seeking the advice/opinion of someone else in this field.

About a year ago, I was having a rough time dealing with a terminated pregnancy. I was feeling a lot of things that I guess were normal for someone in my situation (depression, anger, emptiness, etc). I come from a family that is very open minded about therapy so I felt no shame in seeking help.

I went to see the first psychiatrist I found listed in the same hospital where I've seen a few other doctors (it's a pretty well known hospital). At my visit, I basically spilled my guts out to this guy, told him everything about the terminated pregnancy and what I was feeling, everything. After I was finished, he asked me "How is your spiritual life?" I told him that I'm not very religious, despite growing up in a Catholic family. He continued with "Are you aware of the great benefits that a relationship with God can have to your state of mind and overall health?" I shit you not, this asshole preceded to start babbling for almost half an hour (time I was effing paying for) about his church and how awesome it is according to him and how it has helped tons of people. Throughout the whole thing, I kept reiterating that I was exposed to religion growing up but I simply decided it was not for me and I WAS NOT a religious person. It all culminated with him showing me pictures of some trip he took to Israel where he saw where Jesus was taken after he died or some shit like that. After he was done, I stated one last time that I was not religious, that I was feeling depressed and anxious and I wanted help. He told me we could continue to discuss "those issues" at my next appointment and he gave me a prescription for Xanax.

After my appointment I was so upset and frustrated I actually went to where my boyfriend was working at the time and basically had a meltdown with him. I feel lucky that I had someone to talk to afterwards. Despite that, even though from time to time I still have bouts of sadness and anxiety over the terminated pregnancy, I feel no desire to talk about it with anyone, not even my boyfriend. I'm so scared of being completely ignored/disregarded, I can't bring myself to talk about it with anyone.

So I guess my question is, I don't know if I should do something or talk to someone about my experience with this doctor. I don't even know if it's worth it now. I just kind of worry from time to time about someone else who's feeling down going to see him and feeling like I did when they leave. And not having someone to talk to after. Your thoughts on the matter would be greatly appreciated.

The way you described it could be possible unethical conduct. On the one hand it is a good idea to discuss spirituality to someone coping with grief. On the other hand a doctor shouldn't preach to you and invite you into their church. I'm sorry for what happened. You could file a complaint with the state licensing board or American Psychiatric Association. Do you think he deserves that level of complaint??

What happens when a psychiatrist goes to see a psychiatrist?

It used to be in order to become a psychiatrist you had to undergo you own psychoanalysis. Meaning you had to lay on a couch and tell the senior psychiatrist your thoughts. Its probably pretty similar everyone is vulnerable and needs help from time to time. Also helps you know your own limitations.

Do you have to do clinical supervision?

What do you mean?

Maybe it's is not something that is done in the states, it is essentially a professional therapy. We have a pretty good emphasis on it here in New Zealand with a lot of employers paying for most of the sessions. Here is what wikipedia says:

It consists of the practitioner meeting regularly with another professional, not necessarily more senior, but normally with training in the skills of supervision, to discuss casework and other professional issues in a structured way. This is often known as clinical or counselling supervision or consultation. The purpose is to assist the practitioner to learn from his or her experience and progress in expertise, as well as to ensure good service to the client or patient.

That is something that occurs when you are in training for the most part. For example, to become a licensed clinical social worker you have to have 2,000 hours of supervision. Once you complete that you no longer need supervision. You always have the option of discussing complicated cases with peers.

Okay, here I go. First things first, yes I know this is the internet and a proper diagnosis would be better at a psychiatrist face-to-face(I'll be seeing one later).

Alright, when I was young child I would chat endlessly about the most mundane things. Even if I see you were bored I would talk away anyway. I never spent any of my own time on school work unless it was to avoid getting beaten for not doing it. Studying however, was simply never something I did. Couldn't find myself doing it for a too long. Simply put before I could even complete a page my mind would be on something else. Though you may remember those few moment where you'd have read something and realise you don't remember thing you read and had to immediately go back over the last page. This exact thing happened all the time with me. Even if I read for leisure. Some of the other things I remember about this time that persisted throughout the years were:

1. Zoning out frequently in conversations. I would go off an a thought as you were talking and pop back, mid conversation, trying to play catch up by reading signals. This wasn't a rare thing at all, it was very common.

2. I was very forgetful. I frequently lost track of things. Phones, glasses, keys, things I borrowed, etc. I wouldn't remember to do things requested of me.

3. I never organized anything. If I went to school it would be with the same books in my bag I had from the start of the week. I was always untidy and the depression simply made me not care about it in the slightest.

4. I have a thing against turn-based games of any form. Especially with friends. Uno, monopoly, card games, etc, I simply hated the thought of waiting for someone else to take turns. Even worse when someone decided to interrupt and ask to join. I had little patience and it easily infuriated me. Living in a country known for people showing up late to everything has taken a toll on my mind and I simply avoid asking others to drop me somewhere or any other thing that makes me dependent on someone else for my time management(what little I have).

My constant chatter somewhat isolated me and made me a prime target for teasing. My dad beating me for every little thing didn't help at all and by around 8 years old my outlook on my future was very bleak and I constantly thought about suicide.

I now talk a significantly less and pretty much avoid people. I was a lot friendlier as a young child but now I find reasons to avoid social events and typically avoid meeting new people.

All that said, with the things I mentioned my pscyhiatrist told me she thought it was ADHD but because I have a significantly high IQ (The number of which she never cared to tell me) and I showed no signs of being hyper she thinks it must be something else.

I soon left because it was honestly wasn't doing a thing for me but draining my pockets.

Looking up ADHD recently I noticed several things.

1. I don't have to be hyper and my IQ can be whatever it damn well pleases.

2. The things I mentioned directly pointed towards ADHD and depression. After reviewing her opinion I believe she must have thought the depression was the only concern.

What are your thoughts?

Sounds like ADHD. Did you try any medication for it?

When you first meet a patient what are you looking for?

I want to know whats bothering them. I ask them to talk to me about how they are feeling and what issues are going on in their life.

I used to be depressed and stressed, this was for the past 3 years or so, my life is going great now I'm completely relaxed and happy but as of 3 weeks ago I started getting anxiety and panic attacks, is it normal to have affects of stress and depression after the fact?

Hard to say. People evolve and change. Feelings come and go. Everyone gets depressed and anxious from time to time even me:) The question is it is severely impacting your life to the point you need to get into treatment.

Given that a lot of the patients you see will have problems rooted in their childhood, what would you say is the most important factor in bringing up children to be healthy psychologically? Nobody's perfect as parents but what might we be doing that we don't recognise might impact on them negatively as adults

Having unconditional love and providing a warm, caring environment. Spending time with them and showing interest.

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I dunno I've interact with some people on /suicidewatch but I don't think its as effective as in person. I think if you used Skype or something it would be much better. Don't have any experience with teletherapy.

When I look at my own life, I find that I know I need to change certain aspects in my life, can you tell me why I find no motivation, or willingness to do so? It is not at all that I am enjoying the things I desperately need to change, I just feel... for a better lack of words, motivation to do so. I am not depressed or such, it just seems that when it comes time to actually change those things its like I think .. I'll start tomorrow, but then never do. I often do things like let my kids take advantage of me, but then feel guilt if I don't. I need to be motivated to going to back to a job that I love and pays more, but have settled into job that doesn't pay anything but is completely stress free and redundant (this is not me at all).

It's hard to say without sitting down with you for an hour and discussing it. Have you considered getting into mental health treatment?

Most people hear are asking about a personal issue with mental illness, writing long paragraphs asking for advice. Is this more or less what you expected to happen?

Honestly had no idea what to expect. What do you think?

At what point during someone's CBT would you recommend they consider anti-depressants or anti-anxiety medication? I have been seeing my psychologist for a few years and successfully managing my problems but I am currently feeling like I am losing control of my anxiety. What are some things I should consider before looking into medication? And if I go on it, how easy will it be to come off it?

Also, if someone close to me is resisting therapy but clearly is not coping with their issues, what is the best thing I can do to help them/convince them to get help? Thanks for everything you do; I would be lost without my psych! :)

An adequate trial of CBT is several months. If you are still suffering despite several months of therapy maybe meds would be something to explore.

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To become a psychiatrist you have to go to medical school. That means you need all the medical school prerequisites like organic chem, physics, cell bio and calculus. When I went through the pipeline if you did all that you were only a few credits short of getting a bachelor's degree in bio or chem. Most people get those degrees although I know of others who got degrees in history, dancing or something and just did the science classes in addition.