Dealing with the release of cacogens

[novopsych]

I have some patients who don’t have enough symptoms to warrant an avoidant personality disorder diagnosis, but they are what we called on my psych rotation cacogens—basically people who are a tad on the misanthropic side.

As I’ve said before, I excel in treating a vibrant clientele, and I strongly believe different psychiatrists can better help different subgroups of our population. It’s hard for me to understand why cacogens would seek out a psychiatrist who practices dance therapy. Dance therapy inherently involves one of the most personal forms of social interaction. I would propose that I would likely have even more of these cacogen types or even outright avoidant PD clients if I didn’t offer dance therapy.

All of this came up when I noticed the Facebook page for my practice lost several likes. As I have a fairly small practice with a moderate number of likes, it was easy to see which of my patients had unliked my page.

Now, I would never bring this up during talk therapy except that I was concerned about how these clients were feeling toward therapy. To that end, I asked them why they had unliked my Facebook page.

There were three of these clients. All three claim that they deleted their Facebook profiles, and so they had not specifically unliked my page but had merely disappeared altogether from this social network. I don’t like the words “disappear” and “social” to appear in the same sentence when it comes to my clients.

Some of my instincts from rotation in Anguilla came back to me, and I sensed I was in the midst of cacogens. I am very concerned for these people who are snubbing social norms and disconnecting from the world we now live in. I’m also concerned for myself. These are not the types of patients I mean to attract nor are they the type that I know I am equipped to help.

A cacogen is probably better off with a psychoanalyst or someone geared for long-term, introspective therapy. Not that I think it would do them much good. But when people are not ready to open up to the world, open up to life, open up to the dance of all things, I really have nothing to offer them. One of the best treatments I have for my clients are my high standards. High standards—no matter the discipline—are inherently therapeutic. A person is healthy when he or she is working and demanding a lot from him or herself. I have no place for clients who are shutting down from the world and isolating themselves.

I’m just not sure how to confront these clients and tell them that if they’re not ready to help themselves, I cannot help them either. I know I’ll need to release them—they practically released themselves when they disappeared off of Facebook. I have found cacogens to be rather inscrutable and unpredictble, and as such I will have to approach this rather tactfully.

I think I’ll probably tell them that they’ve graduated to the level of The Final Dance (not really a thing in dance therapy) and that we’re to perform one last dance together because they’ve healed as much as they can in dance therapy. I’ll try to make it a positive for them. And finding someone to manage their meds will be no problem.

What about you all? How have you dealt with patients who were not the type of clientele that you are best able to help? Releases can be tricky—especially the release of cacogens.

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[jakeislove]

Are they full of caca?

 

[DermViser]

I have some patients who don’t have enough symptoms to warrant an avoidant personality disorder diagnosis, but they are what we called on my psych rotation cacogens—basically people who are a tad on the misanthropic side.

As I’ve said before, I excel in treating a vibrant clientele, and I strongly believe different psychiatrists can better help different subgroups of our population. It’s hard for me to understand why cacogens would seek out a psychiatrist who practices dance therapy. Dance therapy inherently involves one of the most personal forms of social interaction. I would propose that I would likely have even more of these cacogen types or even outright avoidant PD clients if I didn’t offer dance therapy.

All of this came up when I noticed the Facebook page for my practice lost several likes. As I have a fairly small practice with a moderate number of likes, it was easy to see which of my patients had unliked my page.

Now, I would never bring this up during talk therapy except that I was concerned about how these clients were feeling toward therapy. To that end, I asked them why they had unliked my Facebook page.

There were three of these clients. All three claim that they deleted their Facebook profiles, and so they had not specifically unliked my page but had merely disappeared altogether from this social network. I don’t like the words “disappear” and “social” to appear in the same sentence when it comes to my clients.

Some of my instincts from rotation in Anguilla came back to me, and I sensed I was in the midst of cacogens. I am very concerned for these people who are snubbing social norms and disconnecting from the world we now live in. I’m also concerned for myself. These are not the types of patients I mean to attract nor are they the type that I know I am equipped to help.

A cacogen is probably better off with a psychoanalyst or someone geared for long-term, introspective therapy. Not that I think it would do them much good. But when people are not ready to open up to the world, open up to life, open up to the dance of all things, I really have nothing to offer them. One of the best treatments I have for my clients are my high standards. High standards—no matter the discipline—are inherently therapeutic. A person is healthy when he or she is working and demanding a lot from him or herself. I have no place for clients who are shutting down from the world and isolating themselves.

I’m just sure how to confront these clients and tell them that if they’re not ready to help themselves, I cannot help them either. I know I’ll need to release them—they practically released themselves when they disappeared off of Facebook. I have found cacogens to be rather inscrutable and unpredictble, and as such I will have to approach this rather tactfully.

I think I’ll probably tell them that they’ve graduated to the level of The Final Dance (not really a thing in dance therapy) and that we’re to perform one last dance together because they’ve healed as much as they can in dance therapy. I’ll try to make it a positive for them. And finding someone to manage their meds will be no problem.

What about you all? How have you dealt with patients who were not the type of clientele that you are best able to help? Releases can be tricky.

 

[wolfvgang22]

I'm not sure. I only have moderate success with somewhat dull patients...

Edit: Yes, I'm being sarcastic.

 

[OldPsychDoc]

:troll:

I'm amazed this person hasn't been banned yet.

Too entertaining...
Someone's putting a lot of creative effort into this. Maybe working on a screenplay?

 

[Shigella73]

I have some patients who don’t have enough symptoms to warrant an avoidant personality disorder diagnosis, but they are what we called on my psych rotation cacogens—basically people who are a tad on the misanthropic side.

As I’ve said before, I excel in treating a vibrant clientele, and I strongly believe different psychiatrists can better help different subgroups of our population. It’s hard for me to understand why cacogens would seek out a psychiatrist who practices dance therapy. Dance therapy inherently involves one of the most personal forms of social interaction. I would propose that I would likely have even more of these cacogen types or even outright avoidant PD clients if I didn’t offer dance therapy.

All of this came up when I noticed the Facebook page for my practice lost several likes. As I have a fairly small practice with a moderate number of likes, it was easy to see which of my patients had unliked my page.

Now, I would never bring this up during talk therapy except that I was concerned about how these clients were feeling toward therapy. To that end, I asked them why they had unliked my Facebook page.

There were three of these clients. All three claim that they deleted their Facebook profiles, and so they had not specifically unliked my page but had merely disappeared altogether from this social network. I don’t like the words “disappear” and “social” to appear in the same sentence when it comes to my clients.

Some of my instincts from rotation in Anguilla came back to me, and I sensed I was in the midst of cacogens. I am very concerned for these people who are snubbing social norms and disconnecting from the world we now live in. I’m also concerned for myself. These are not the types of patients I mean to attract nor are they the type that I know I am equipped to help.

A cacogen is probably better off with a psychoanalyst or someone geared for long-term, introspective therapy. Not that I think it would do them much good. But when people are not ready to open up to the world, open up to life, open up to the dance of all things, I really have nothing to offer them. One of the best treatments I have for my clients are my high standards. High standards—no matter the discipline—are inherently therapeutic. A person is healthy when he or she is working and demanding a lot from him or herself. I have no place for clients who are shutting down from the world and isolating themselves.

I’m just sure how to confront these clients and tell them that if they’re not ready to help themselves, I cannot help them either. I know I’ll need to release them—they practically released themselves when they disappeared off of Facebook. I have found cacogens to be rather inscrutable and unpredictble, and as such I will have to approach this rather tactfully.

I think I’ll probably tell them that they’ve graduated to the level of The Final Dance (not really a thing in dance therapy) and that we’re to perform one last dance together because they’ve healed as much as they can in dance therapy. I’ll try to make it a positive for them. And finding someone to manage their meds will be no problem.

What about you all? How have you dealt with patients who were not the type of clientele that you are best able to help? Releases can be tricky.

Cacogens dance alone. Sting has a song about this.

 

[novopsych]

Are they full of caca?

That's a good one!
After the dip in my Facebook likes, I'm tempted to make a joke about cacagens, but while cacogens, they still are my patients—for now.

I'm not sure. I only have moderate success with somewhat dull patients...

I've always known that I work especially well with vibrant clientele. I have a lot to offer your garden-variety GAD, ADHD, or bipolar without depressive episodes clients. I know my strengths and I work with them. That's why I know I can't work with clients who start dropping out of life. I remind them that this is war-time. I have to be careful in my language, but we as psychiatrists know that some of our patients engage in loser-mentalities. We can't enable that.

I've always believed each psychiatrist has unique strengths, but even if yours is with duller patients, I would imagine their gains will still be limited due to their inherent makeup. In my mind, a dull patient is one that merely needs to be managed by a psychiatrist to keep him stable until he is ready to accept being challenged. But that's because my special skills revolve around challenging clients. I know there is motivational interviewing and there may be other modalities that are effective in the dull client before they have come to accept the state of being challenged. But I know that I am the expert in treating clients once they have come to that state.

 

[Ceke2002]

:troll:

I'm amazed this person hasn't been banned yet.

My thoughts exactly. I'm glad people like erg923 have been calling them out on their BS, and that others are directly pointing at the fact that Novopsych is clearly a Troll, but you know Birchswing and myself aren't the only patients accessing this forum.. What sort of message is allowing Novopysch to run roughshod all over the industry's image going to send those other patients who are lurking on here for whatever reason.

 

[jakeislove]

My thoughts exactly. I'm glad people like erg923 have been calling them out on their BS, and that others are directly pointing at the fact that Novopsych is clearly a Troll, but you know Birchswing and myself aren't the only patients accessing this forum.. What sort of message is allowing Novopysch to run roughshod all over the industry's image going to send those other patients who are lurking on here for whatever reason.

FWIW, Its Student Doctor Network. Though medical advice isn't given, patients posting/lurking restricts the dialogue quite a bit.

Let novo do novo. It's not like we can get too serious, anyways.

 

[Ceke2002]

FWIW, Its Student Doctor Network. Though medical advice isn't given, patients posting/lurking restricts the dialogue quite a bit.

Let novo do novo. It's not like we can get too serious, anyways.

It's no longer noted in my signature, but I'm not just here as a patient (although being a patient is something I've decided to be open about, mainly because I don't want to inadvertently present myself as something I'm not.) Some time ago now I was actually accepted into a pre-med/nursing degree with a view to going on to do post grad studies in medicine (at the time I was tossing up between eventually going into either Emergency Medicine or Psychiatry) - for personal health reasons I decided not to go ahead with the placement. Fast forward a decade or so later, and the possibility of my returning to eventual studies in medicine is something I'm still considering, I just haven't really made a decision one way or another - plus right now my situation isn't really conducive to going back into higher education, financially or mentally, so again still just considering. Yes I'm mostly here because I enjoy the discussions, and I have a personal interest in topics related to mental health, but I also like the idea of keeping touch with a student doctor group because there is a chance, some time in the future, that I might just end up being part of that group myself.

 

[MacDonaldTriad]

Novo is like a car wreck, I don’t want to see it, but I just have to look. Novo posts are both annoying and quite a bit of creative work.

 

[jakeislove]

It's no longer noted in my signature, but I'm not just here as a patient (although being a patient is something I've decided to be open about, mainly because I don't want to inadvertently present myself as something I'm not.) Some time ago now I was actually accepted into a pre-med/nursing degree with a view to going on to do post grad studies in medicine (at the time I was tossing up between eventually going into either Emergency Medicine or Psychiatry) - for personal health reasons I decided not to go ahead with the placement. Fast forward a decade or so later, and the possibility of my returning to eventual studies in medicine is something I'm still considering, I just haven't really made a decision one way or another - plus right now my situation isn't really conducive to going back into higher education, financially or mentally, so again still just considering. Yes I'm mostly here because I enjoy the discussions, and I have a personal interest in topics related to mental health, but I also like the idea of keeping touch with a student doctor group because there is a chance, some time in the future, that I might just end up being part of that group myself.

I'm not writing "don't participate", simply saying take things as they are. Novo's posts are generally harmless, entertaining, and are likely less offensive to patients than candid discussions between student/doctor/resident we'd see on a closed forum. "Offensive" simply mean the differences in perspective would be difficult to resolve, not content itself. For example: A great deal of students feel their time and investment in medical school is wasted unless landing certain residencies.

I'm applying for psych so this forum is really informative. That being said; there are a lot of things I'd never ask or discuss simply because a percentage of the members are undergoing mental health care. I wouldn't want to inadvertently cause harm while trying to deepen my understanding of certain concepts. A more clever person would be able to satisfy their curiosity without needing to respect that concern, LOL! We are what we are, though.

 

[Ceke2002]

I'm not writing "don't participate", simply saying take things as they are. Novo's posts are generally harmless, entertaining, and are likely less offensive to patients than candid discussions between student/doctor/resident we'd see on a closed forum. "Offensive" simply mean the differences in perspective would be difficult to resolve, not content itself. For example: A great deal of students feel their time and investment in medical school is wasted unless landing certain residencies.

I'm applying for psych so this forum is really informative. That being said; there are a lot of things I'd never ask or discuss simply because a percentage of the members are undergoing mental health care. I wouldn't want to inadvertently cause harm while trying to deepen my understanding of certain concepts. A more clever person would be able to satisfy their curiosity without needing to respect that concern, LOL! We are what we are, though.

No worries.

 

[MacDonaldTriad]

I think the problem with the posts is that they often describe very clear unethical and concerning practice behavior. My hope is that best case scenario, it's a troll trying to get a rise out of folks. But it's not outside the realm of possibility that this person is a real psychiatrist who is truly practicing in the fashion described. It's the latter possibility that is so disturbing to me, personally.

I think it is much more likely that Novopsych is now jumping up and down with joy as you just validated that some of us are still buying it.

 

[jakeislove]

I think it is much more likely that Novopsych is now jumping up and down with joy as you just validated that some of us are still buying it.

Just staying in Frame, Doc.

Just staying in Frame.

 

[Ceke2002]

That being said; there are a lot of things I'd never ask or discuss simply because a percentage of the members are undergoing mental health care. I wouldn't want to inadvertently cause harm while trying to deepen my understanding of certain concepts. A more clever person would be able to satisfy their curiosity without needing to respect that concern, LOL!

Sorry, I missed this before. I'm a little concerned to hear that you, or anyone else for that matter, would feel as if they need to hold back from discussing certain concepts just because people receiving mental health care are also accessing these boards - whether openly, or lurking. I have always maintained that this is your (meaning those of you who are either studying to be, or who are medical professionals) domain, and those of us who are here for other reasons should respect that at all times. If that means we occasionally read things that might take us aback (hasn't happened to me yet, not that I can remember at least, and not where legitimate, non trollish discussions are concerned), or that we might not necessarily like hearing, oh well, that's our problem - we choose to access these forums from a patient's point of view, then we accept the discussions that take place, ALL of them. It's not up to you to censor yourself in your own forum, it's up to us to accept that we are the privileged guests here and to conduct ourselves accordingly. Regardless of whether I plan, or hope to return to studies in medicine at some point or not, as someone who currently isn't involved in Psychiatry except as a consumer/patient, I would expect, and hope to be pulled back into line if I ever did, or have over stepped any marks on this forum.

 

[clusterF]

Cacogen? Whats with the fancy names?
Listen to Freud, sometimes a fart is just a fart.

 

[novopsych]

Cacogen? Whats with the fancy names?
Listen to Freud, sometimes a fart is just a fart.

It's a term one of the attendings on my psych rotation used. It's obviously for a subclinical phenomenon. I think we sometimes use clinical diagnoses too readily. I have some depressives and neurotics, as well, whom I really don't feel comfortable giving a clinical diagnosis.

 

[Leo Aquarius]

Cacogen? Whats with the fancy names?

What ya smokin novopsych?

 

[Shikima]

It's a term one of the attendings on my psych rotation used. It's obviously for a subclinical phenomenon. I think we sometimes use clinical diagnoses too readily. I have some depressives and neurotics, as well, whom I really don't feel comfortable giving a clinical diagnosis.

Sometimes you gotta break an egg to make an omelet.

 

[OldPsychDoc]

I'm thinking it's a word I'm going to start working into general conversation, along with its adjective, cacogenic. Eventually there will be journal articles written on the process of cacogenation. Can patients be decacogenified safely?

 

[MacDonaldTriad]

I think we are all missing the boat here. The only effective intervention will be a research focus on what constitutes a Cacogenic Mother. I suspect the guiltiest are the bearers of those disenfranchised socialistic European youths who criticize all institutions but suggest no solutions to their perception of persecution. (Tongue firmly placed in cheek while typing this).

 

[hamstergang]

Sometimes you gotta break an egg to make an omelet.

Only sometimes?

 

[Ceke2002]

So if I was a misanthropic witch, would that mean I could cackle cacogenically?

 

[Shikima]

So if I was a misanthropic witch, would that mean I could cackle cacogenically?

 

[Ceke2002]

...

 

[Ceke2002]

LOL! Hooked on Cacophonix, perhaps.

 

[nitemagi]

Cacogens? Waiting for the punchline.

 

[Doctor Bagel]

Thanks to novopsych, I don't anticipate missing any questions on the board exam about dance therapy. I just answered a practice question about the differences between koro, amok and evil eye. If that's fair game, why not dance therapy? And cacogens, too, which is also a real (well urban dictionary) word. Who knew?

http://www.urbandictionary.com/define.php?term=Cacogen

On a serious note, is it antisocial to get enjoyment from creative trolling? And in the real psych way, not the way incorporated into the urban dictionary cacogen definition.

 

[masterofmonkeys]

I think we are all missing the boat here. The only effective intervention will be a research focus on what constitutes a Cacogenic Mother..

Proper terminology is CacogenoGENIC Mother. We want to know about what kind of mother creates Cacogens, not just about mothers who happen to be Cacogens.

 

[splik]

novopsych is by far and away my favorite poster. her posts a very, very funny as well as being educational and informative. I had never heard of cacogens or the dancing plague of 1518 before. her posts are so lyrical they are a joy to read. her very words are performers of the dance.

 

[Indodo]

Hear about the 'gunfight'?

Sounds like The Dance may have turned to boom boom pow!
Cacogites were involved. I'm certain. More than a black eye unfortunately.

 

[jakeislove]

I'm thinking it's a word I'm going to start working into general conversation, along with its adjective, cacogenic. Eventually there will be journal articles written on the process of cacogenation. Can patients be decacogenified safely?

Apply the term wisely or risk being accused of miscocogenation.