Not Sure Anymore......

[BackToday]

So, I'm a 4th year med student getting ready to apply. I'm currently on my sub-i, and I don't know what's gotten into me. I did Child Psych months ago, loved it, and it got me interested in it. Then, I did my adult psych rotation and saw a general psych population, really liked it and thought it solidified my intention to go into Psych. Then, I did a few weeks on geriatric psych and really enjoyed it too. I loved the residents, the attendings were great, and I genuinely enjoyed talking to the patients and trying to get them through their struggles. Now, however, I'm doing my sub-i with mainly depression and bipolar and a big piece of me just doesn't believe in it. I find a lot of the patients' behavior to be lazy and I feel like my team just encourages it. Whatever they do, my attending just blames it on depression. They don't want to work? Depression. They don't want to take care of their kids? Depression? They have all these psychosomatic complaints? Depression. The thing is, though, is that she's dedicated to them, and and spends hours and hours on their care. I respect that, but I just can't believe it's all depression and bipolar.

It's also disheartening that so many of our treatments just don't seem to do anything. It has me wondering if any of this is even real. I also got the talking to from some of my relatives that I'm wasting my degree by doing psych. I didn't think that would affect me, but it was a bit disheartening. It didn't help that I saw another attending get attacked by a patient, and I'm sitting here thinking do I really want to spend a career getting attacked or stalked by patients for something that I may not really believe in? I saw depression in child psych and I believed it then. Maybe it was because those patients were kids who were really trying? I don't know.

I also have to admit that the appeal of the work/life balance that Psych has was really appealing to, but I know I genuinely enjoyed it. I don't know what happened all of a sudden over the past few weeks. I still think I want to do it, but I guess I'm just not as gun ho as I was just a short time ago. Sorry for the venting rant, but anyone have any words that could help me here? Similar experiences and feelings maybe? Thanks.

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[Achillees]

I'm a PGY-I that started on IM. I might as well be doing IM/Psych because it seems every other pt has a Psych issue. More recently, a pt was admitted to my team. She's got nonspecific abdominal pain. She's a seemingly healthy 40-ish year old woman. What does she do for work? Nothing. She's on disability. For depression. I also found that disheartening. Is this the kind of pt I'll be working with in a few months?
I suppose it doesn't help that I'm currently on IM which is concrete and Psych is not. I'm worried I'll be less empathic towards pts with actual, life-threatening MDD.
I don't really know what to say at this juncture, except that I understand your feeling. Hopefully I'll have a better feeling once I'm actually on Psych. Looking forward to the responses.

 

[J ROD]

Psychiatry has lots of folks that are playing the system and folks that need real help. You have to deal with the crap to help those that really need it. I have been able to help folks turn around and get help. Also, some that just wanted to avoid legal stuff or a bed for a few days. Just have to take it in stride. Just wait until you lose the new car smell........then you get used to it. Only you can answer if you want more medicine. I love not dealing with the medicine and just psychiatry. Well, I like a taste of medicine here and there.

 

[Jules A]

I think this is a natural response to some degree considering this will be your long term career. It is possible to eventually tailor your practice to a specialty that you find interesting and tolerable. It hasn't been my experience that patients with depression are particularly coddled so I wonder if this has more to do with your present attending? Spending hours on a patient especially one with garden variety depression isn't generally a good use of provider resources so that is a bit odd. My inpatient teams overall have been hard working, dedicated and salty which is perfect for me. Being assaulted doesn't particularly worry me, been there done that, and although one of the easier presentations to prescribe for observing a psychotic patient improve is still nothing short of magical. Best wishes with whatever you decide.

 

[Blitz2006]

So, I'm a 4th year med student getting ready to apply. I'm currently on my sub-i, and I don't know what's gotten into me. I did Child Psych months ago, loved it, and it got me interested in it. Then, I did my adult psych rotation and saw a general psych population, really liked it and thought it solidified my intention to go into Psych. Then, I did a few weeks on geriatric psych and really enjoyed it too. I loved the residents, the attendings were great, and I genuinely enjoyed talking to the patients and trying to get them through their struggles. Now, however, I'm doing my sub-i with mainly depression and bipolar and a big piece of me just doesn't believe in it. I find a lot of the patients' behavior to be lazy and I feel like my team just encourages it. Whatever they do, my attending just blames it on depression. They don't want to work? Depression. They don't want to take care of their kids? Depression? They have all these psychosomatic complaints? Depression. The thing is, though, is that she's dedicated to them, and and spends hours and hours on their care. I respect that, but I just can't believe it's all depression and bipolar.

It's also disheartening that so many of our treatments just don't seem to do anything. It has me wondering if any of this is even real. I also got the talking to from some of my relatives that I'm wasting my degree by doing psych. I didn't think that would affect me, but it was a bit disheartening. It didn't help that I saw another attending get attacked by a patient, and I'm sitting here thinking do I really want to spend a career getting attacked or stalked by patients for something that I may not really believe in? I saw depression in child psych and I believed it then. Maybe it was because those patients were kids who were really trying? I don't know.

I also have to admit that the appeal of the work/life balance that Psych has was really appealing to, but I know I genuinely enjoyed it. I don't know what happened all of a sudden over the past few weeks. I still think I want to do it, but I guess I'm just not as gun ho as I was just a short time ago. Sorry for the venting rant, but anyone have any words that could help me here? Similar experiences and feelings maybe? Thanks.

Well I'm PGY3, but if anything, psychaitry's future is very exciting. just have a gander at the neuropsychiatry thread. Some pretty cutting edge stuff, specifically with brain stimulation studies.

http://forums.studentdoctor.net/threads/neuropsychiatry.1214309/#post-17996516

Attacks do happen, but it is relatively very rare. In my 2 years of residency, I was never attacked. Of course, thats n=1, but still. The beauty of psych is that its so diverse. If you're not interested in depression, mania, schizophrenia, you can always branch off into Addiction/Forensics. Obviously there are mood disorders/psychosis present in those fields, but that won't be your focus as opposed to general psych where you are only treating that.

Also, you can branch out into more interdisciplinary fields, like Consult-Liasion/Sleep/Pain/Neuropsychiatry if you are missing "real medicine", as some of my medical students state. But it appears like you really enjoy Child, so worst case is you stomach 3 years of psych residency and then bolt to C&A world....

Although you didnt' specify, but it sounds like your sub-i is primarily an inpatient setting? Also, if you loved child psych/adult psych/geriatric psych, and not liking your sub-i, I don't think you should throw away your career because you don't enjoy 1/4 psych rotations. But just my 2 cents.

I personally found inpatient to be frustrating, because after stabilizing them, patients would be discharged and I wouldn't see much therapeutic improvement. However, now in outpatient world, I'm loving it, as i can see MDD resolve after 2 months of pharmacotherapy (a luxury not possible in short term inpatient, average length of stay being 14 days).

My opinion is obviously biased, but I truly believe psychiatry/mental health is the way forward and a great "investment" for a 2016 medical student. Trust me, you're not wasting your MD on Psychiatry when in 5-6 years you'll be swimming with job offers and providing people who truly need help a great service.

 

[BackToday]

Well I'm PGY3, but if anything, psychaitry's future is very exciting. just have a gander at the neuropsychiatry thread. Some pretty cutting edge stuff, specifically with brain stimulation studies.

http://forums.studentdoctor.net/threads/neuropsychiatry.1214309/#post-17996516

Attacks do happen, but it is relatively very rare. In my 2 years of residency, I was never attacked. Of course, thats n=1, but still. The beauty of psych is that its so diverse. If you're not interested in depression, mania, schizophrenia, you can always branch off into Addiction/Forensics. Obviously there are mood disorders/psychosis present in those fields, but that won't be your focus as opposed to general psych where you are only treating that.

Also, you can branch out into more interdisciplinary fields, like Consult-Liasion/Sleep/Pain/Neuropsychiatry if you are missing "real medicine", as some of my medical students state. But it appears like you really enjoy Child, so worst case is you stomach 3 years of psych residency and then bolt to C&A world....

Although you didnt' specify, but it sounds like your sub-i is primarily an inpatient setting? Also, if you loved child psych/adult psych/geriatric psych, and not liking your sub-i, I don't think you should throw away your career because you don't enjoy 1/4 psych rotations. But just my 2 cents.

I personally found inpatient to be frustrating, because after stabilizing them, patients would be discharged and I wouldn't see much therapeutic improvement. However, now in outpatient world, I'm loving it, as i can see MDD resolve after 2 months of pharmacotherapy (a luxury not possible in short term inpatient, average length of stay being 14 days).

My opinion is obviously biased, but I truly believe psychiatry/mental health is the way forward and a great "investment" for a 2016 medical student. Trust me, you're not wasting your MD on Psychiatry when in 5-6 years you'll be swimming with job offers and providing people who truly need help a great service.

Maybe that's it? We don't get much OP exposure here. The few weeks I did of OP on geri was great. I really liked the fast paced nature of OP vs IP, and I definitely plan on doing that vs IP in my future career.

 

[Blitz2006]

Maybe that's it? We don't get much OP exposure here. The few weeks I did of OP on geri was great. I really liked the fast paced nature of OP vs IP, and I definitely plan on doing that vs IP in my future career.

Oh its definitly the reason why psych is not as competitive as it should be. Most med schools have MS3 do 4 weeks of inpatient, and thats it. Some are lucky and get 2 weeks of CL. Yet 75% of Psychiatrists go into OP. There is under representation of psych in medical school.

No exposure to Addiction (Suboxone/Methadone clinics, rehab units). No exposure to Forensic Psych (I mean even most residency programs have limited exposure to Forensics!). No exposure to Neuropsychiatry/Neuroimaging/Brain Stimulation (I'm shocked by the number of medical students that say they have never seen ECT). In England, all medical students are expected to see ECT. And obviously, stuff like Sleep and Pain is not even on the radar. Even a large percentage of psych residents have no idea they can do Sleep/Pain. No exposure to child psych.

So MS3 walk out of the rotation thinking all psychiatrists do is take people's rights away, throw them inside a locked unit, 5/2 them until they are stabilized, and discharged into world they never see. Don't get me wrong, inpatient psychiatry is a very challenging, and stimulating field itself.I highly respect my inpatient psych mentors, they taught me a lot. But I think you need a certain personality/skill set to appreciate inpatient units, and to be able to manage patients in that setting. And i'm not sure medical students have the knowledge/foundations to grasp this.

Or the other stereotype which is that our patients lie on couches and we do psychotherapy all day. Even though outside of NYC/SF/Chicago/Boston psychotherapy is carried out by small percentage of psychiatrists. But there is also a whole world of CBT/DBT that may prove to be very interesting to you as well.

A lot of scope in Psych. This is why I chose psych, the variety and diversity within the field. I can't do the same thing over and over again, like scopes all day or Dialysis all day (no slam towards those specialties, just examples of repetition).

 

[splik]

It's also disheartening that so many of our treatments just don't seem to do anything. It has me wondering if any of this is even real. I also got the talking to from some of my relatives that I'm wasting my degree by doing psych. I didn't think that would affect me, but it was a bit disheartening. It didn't help that I saw another attending get attacked by a patient, and I'm sitting here thinking do I really want to spend a career getting attacked or stalked by patients for something that I may not really believe in? I saw depression in child psych and I believed it then. Maybe it was because those patients were kids who were really trying? I don't know.

This is a great example of what psychoanalysts call projective identification. You believed psychiatry was the specialty for you but your relatives destroyed that for you, invalidating your career (and by proxy - invalidating you), and you are enacting the projection by wondering whether mental illness is even real. I mean, how can it be, if your family tells you that you are just wasting your degree by doing psych? As such you are viewing your patients with skepticism and contempt. Take a step back and consider that you were really enjoying your psychiatry rotations beforehand! Now your family have ruined it for you and you are enacting their projections. My guess is that you also don't like the approach of whatever attending you are working with. You know, it is quite possibly true that someone may be so unmotivated or disinterested in life because they are depressed, that they dont want to work or they don't want to take care of their kids. The ennui of existence weighs to heavily, the effort of every thought so paralyzing that doing nothing becomes the only possible choice. On the other hand you may be tapping into a diagnostic clue in your countertransference (which is what this, negative countertransference). Countertransference often gives us clues into the mental states of our patients (and the diagnosis). Depressed patients usually make us feel despair and hopeless, whereas patients who are simply lazy make us feel angry. You don't appear to be experiencing anger, but helplessness, believing there is nothing that you can do for your patients. That is probably how many of them feel and why they have just given up. I think your countertransference here has come from you being really affected by losing the approval of your family. I would talk to your attending about this. In psychiatry, it is perfectly okay (and in fact encouraged) to own up to your hateful feelings towards patients! Though in your case, I don't get the sense that you hate these patients (which would be perfectly okay), simply that you are experiencing the helpless countertransference that these patients with chronic mental illness can elicit, and it is aligning with the projections that your family have hoist upon you and you are now enacting.

 

[wolfvgang22]

Is there another specialty you enjoy as much or more than psychiatry? Like has been said already, every specialty is going to have cases that aren't as interesting or other down sides.

 

[BackToday]

This is a great example of what psychoanalysts call projective identification. You believed psychiatry was the specialty for you but your relatives destroyed that for you, invalidating your career (and by proxy - invalidating you), and you are enacting the projection by wondering whether mental illness is even real. I mean, how can it be, if your family tells you that you are just wasting your degree by doing psych? As such you are viewing your patients with skepticism and contempt. Take a step back and consider that you were really enjoying your psychiatry rotations beforehand! Now your family have ruined it for you and you are enacting their projections. My guess is that you also don't like the approach of whatever attending you are working with. You know, it is quite possibly true that someone may be so unmotivated or disinterested in life because they are depressed, that they dont want to work or they don't want to take care of their kids. The ennui of existence weighs to heavily, the effort of every thought so paralyzing that doing nothing becomes the only possible choice. On the other hand you may be tapping into a diagnostic clue in your countertransference (which is what this, negative countertransference). Countertransference often gives us clues into the mental states of our patients (and the diagnosis). Depressed patients usually make us feel despair and hopeless, whereas patients who are simply lazy make us feel angry. You don't appear to be experiencing anger, but helplessness, believing there is nothing that you can do for your patients. That is probably how many of them feel and why they have just given up. I think your countertransference here has come from you being really affected by losing the approval of your family. I would talk to your attending about this. In psychiatry, it is perfectly okay (and in fact encouraged) to own up to your hateful feelings towards patients! Though in your case, I don't get the sense that you hate these patients (which would be perfectly okay), simply that you are experiencing the helpless countertransference that these patients with chronic mental illness can elicit, and it is aligning with the projections that your family have hoist upon you and you are now enacting.

This is probably really accurate, honestly.

 

[BackToday]

Is there another specialty you enjoy as much or more than psychiatry? Like has been said already, every specialty is going to have cases that aren't as interesting or other down sides.

Not really. I've been reading a bit about PM&R, and it sounds appealing, but I haven't done a rotation in it and it just might be my thinking the grass is greener on the other side.

 

[F0nzie]

Depressed mood is a normal reaction to the consequences of being lazy. Too lazy to pay the electric bill? Having your power cut off with resulting fines should make you feel depressed. Are you "lazy" because you are depressed? Mental illnesses can mimic bad habits and everybody has bad habits. This is why our field can be so complex and challenging.

Psychiatry if taught correctly should help you think more analytically so that you can respond appropriately. It is hard work and you need to always revise your hypothesis/plan over time-- unfortunately checklists are not enough.

With more experience it will be easier to resolve your internal conflict with thinking patients are all real vs all fake. Our brains trick us into taking these types of mental shortcuts to avoid the hard work involved in analytic thinking. If you do not want your patients to be lazy (in any field involving human interaction) you need to set the stage by not taking these shortcuts yourself.


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[clausewitz2]

Not really. I've been reading a bit about PM&R, and it sounds appealing, but I haven't done a rotation in it and it just might be my thinking the grass is greener on the other side.

PM&R gives you many opportunities to carve out very specific practices (being mainly a sports team's doc, doing all the medical stuff for orthotics, cutting edge research in spinal cord injury and post-stroke rehab) but the bulk of the field is internal medicine for disabled people. If you did not like IM very much, you are not going to be super thrilled.

 

[clausewitz2]

This is a great example of what psychoanalysts call projective identification. You believed psychiatry was the specialty for you but your relatives destroyed that for you, invalidating your career (and by proxy - invalidating you), and you are enacting the projection by wondering whether mental illness is even real. I mean, how can it be, if your family tells you that you are just wasting your degree by doing psych? As such you are viewing your patients with skepticism and contempt. Take a step back and consider that you were really enjoying your psychiatry rotations beforehand! Now your family have ruined it for you and you are enacting their projections. My guess is that you also don't like the approach of whatever attending you are working with. You know, it is quite possibly true that someone may be so unmotivated or disinterested in life because they are depressed, that they dont want to work or they don't want to take care of their kids. The ennui of existence weighs to heavily, the effort of every thought so paralyzing that doing nothing becomes the only possible choice. On the other hand you may be tapping into a diagnostic clue in your countertransference (which is what this, negative countertransference). Countertransference often gives us clues into the mental states of our patients (and the diagnosis). Depressed patients usually make us feel despair and hopeless, whereas patients who are simply lazy make us feel angry. You don't appear to be experiencing anger, but helplessness, believing there is nothing that you can do for your patients. That is probably how many of them feel and why they have just given up. I think your countertransference here has come from you being really affected by losing the approval of your family. I would talk to your attending about this. In psychiatry, it is perfectly okay (and in fact encouraged) to own up to your hateful feelings towards patients! Though in your case, I don't get the sense that you hate these patients (which would be perfectly okay), simply that you are experiencing the helpless countertransference that these patients with chronic mental illness can elicit, and it is aligning with the projections that your family have hoist upon you and you are now enacting.

Yeah, I've discovered that my first clue that someone has ASPD proper rather than just people enacting many antisocial behaviors in the context of serious addiction is that I only want to go outside and fight the former in the parking lot.

In virtually every other context I am an avowed pacifist, for what it is worth.

 

[Jules A]

Yeah, I've discovered that my first clue that someone has ASPD proper rather than just people enacting many antisocial behaviors in the context of serious addiction is that I only want to go outside and fight the former in the parking lot.

In virtually every other context I am an avowed pacifist, for what it is worth.

Loved this and I've also found cluster b traits can be ameliorated with long term sobriety and a therapist who pulls no punches.

 

[PikminOC]

Loved this and I've also found cluster b traits can be ameliorated with long term sobriety and a therapist who pulls no punches.

First the cluster b has to want to change....

 

[thoffen]

Glad to see people supporting the examination of our countertransferrence reactions for clinical benefit in routine psychiatric interactions. Hard to endorse splik's explanation fully, though, without knowing yourself better. Feeling like your patients are lazy & being angry at your attending and colleagues for playing into it -- seems like you have plenty of aggression in these encounters. Would be interesting to challenge yourself to consider that at least some of your anger might be displaced onto your attending because it seems unacceptable to you to be angry at a patient.

Anyway, you are definitely on to something. There are many who believe they are helping patients by facilitating placing ownership of their problems onto an external object (in this case, "depression"). It certainly gratifies the patient's wish to not be responsible for their deficiencies and the provider's wishes to be loved by their patients, avoid conflict, etc. A great deal of self-awareness is often necessary to recognize these traps, and a great deal of fortitude may be necessary to do what is right for the patient instead of what feels good to both of you.

 

[Attending1985]

Every specialty will have it's annoyances, pitfalls, ect. We have all felt your frustrations. What strikes me is your description of not believing in what you're doing. This is a strong statement and I would take this feeling seriously. Finding meaning in and and believing in what you're doing is essential to fulfillment. Take some time and listen to your gut.

 

[BackToday]

Glad to see people supporting the examination of our countertransferrence reactions for clinical benefit in routine psychiatric interactions. Hard to endorse splik's explanation fully, though, without knowing yourself better. Feeling like your patients are lazy & being angry at your attending and colleagues for playing into it -- seems like you have plenty of aggression in these encounters. Would be interesting to challenge yourself to consider that at least some of your anger might be displaced onto your attending because it seems unacceptable to you to be angry at a patient.

Anyway, you are definitely on to something. There are many who believe they are helping patients by facilitating placing ownership of their problems onto an external object (in this case, "depression"). It certainly gratifies the patient's wish to not be responsible for their deficiencies and the provider's wishes to be loved by their patients, avoid conflict, etc. A great deal of self-awareness is often necessary to recognize these traps, and a great deal of fortitude may be necessary to do what is right for the patient instead of what feels good to both of you.

Thanks for this. I just feel like, in this patient's case, it's a terrible approach, and frankly, I just don't believe depression is to blame for everything going on in her life, and I guess the past two weeks, I've had to feel like everything is due to depression or mania.

 

[randomdoc1]

I also agree with a lot of what has been said already. Yes, in the field of psychiatry you will come across many people who do not have a genuine mood or other disorder that has good evidence behind it. There will be people who will malinger, people with predominantly maladaptive personality traits that just want you do solve everything for them with meds and not engage in therapy at all, and people with psychosocial stressors who just want to believe if you just prescribed them "the right meds" it will all somehow go away. That is just to name few. But You will also have your rewarding cases. For example, I've had cases that looked psychiatric but had strong organic causes like a frontal lobe mass or medication induced neuropsychiatric side effects that went undetected for years! It was rewarding that I got to apply my general medical knowledge, take a good thorough history, and practice some good quality medicine to get to the bottom of some of these cases and really see these patients improve.

Also, as was said, every specialty will have it's annoyances. My colleagues in primary care get annoyed that no one seems to give a damn about their diet and exercise. They keep eating fast food, never lift a finger, and just want you to keep adding meds for their DM2 and HLD. Then as the weight gets piled on, off they go to bariatric surgery. Of course, there's the challenges of adhering to an even more strict diet after bariatric surgery and next thing you know, the patient's got Wernicke's encephalopathy now! I used to practice in another specialty but there was so much liability involved and so much defensive medicine and iatrogenic problems due to the nature of that specialty. Likewise, I have friends in neurology who are ready to pull their eyeballs out because they get consulted on every little vague complaint of "numbness," "weakness," "dizziness," etc.

In short, I think you've got the heart to do well in whatever you pursue. Look for something you find meaning in, no matter what specialty you go into to and hold onto that. Take it in stride. At the end of the day, we are fortunate to get to be physicians. But a job is still a job. Something I tell myself is, even though I get some cases I really dislike, I say "hey, this is my job and it is my duty to do the best I can regardless of my countertransferance." I put in my due diligence, and then enjoy my time at home with my family .

 

[deleted736562]

Well, I've spent a month so far as an intern on the inpatient unit and so far I'm pleasantly surprised on what we can do (started with low expectations I have to say).

One patient mid 20s, schizophrenia, awful case. Intelligent, quite insightful, came in full blow catatonia, terrible positive symptoms AND negative symptoms, on top of messed up family dynamics which were also contributing to his paranoia and delusional system. It took us 3/4 weeks to adjust his meds, but I left him being able to read through books, making consistent eye contact, recognizing his paranoia, reporting for the first time no AH for the past year. Another case, woman in her 50s with fixed delusional beliefs for the past 5/6 years. Came in shouting, screaming.. needed multiple IMs. Started on Haldol and left the hospital cheerful and wouldn't be able to stop giving thank yous to all of the staff.

Those meds really do work. I realize selective memory is at work here, but we ARE able to do a lot.. so much more work though needs to be done too.

 

[st2205]

I think what you're seeing are reasons why you should go in to psychiatry. Though the phrase "chemical imbalance" phased out long ago, the underlying philosophy is still pretty strong. Half of psychiatrists have a decent head on their shoulders. There's the other half that's a bit baffling. We certainly can use more people who haven't been staring at the magic eye so long that they think they see the sailboat.

There's plenty of real illness in psychiatry. Unfortunately, there's a lot of other stuff, too. But that's true with any other field. You'll likely perceive this much more as a psychiatrist, as well, as a significant amount of patients who seem well-adjusted superficially are presenting to other specialists and being reinforced in the sick role for their other "non-psychiatric" complaints. There's an enormous amount of secondary iatrogenic damage done to society by medicine as a whole (not to say there isn't an even larger amount of good). You'll be more aware of this as a psychiatrist. Well, you should be more aware of it as a psychiatrist, which probably won't make those negative impressions any easier to deal with.

Feeling like your patients are lazy & being angry at your attending and colleagues for playing into it -- seems like you have plenty of aggression in these encounters. Would be interesting to challenge yourself to consider that at least some of your anger might be displaced onto your attending because it seems unacceptable to you to be angry at a patient.

Maybe, but I'm a believer in Occam's razor, which I believe would suggest that the OP's description of the situation above is common enough to not warrant much evidence to support it, and a deep analysis may miss the mark.

 

[MacDonaldTriad]

If you put medical students on an inpatient locked psych unit and then ask them if they would like to do this for a living, 99% will say no. Inpatient is for some people and we definitely need it, but only a small portion of psychiatrists do it.

 

[thoffen]

Maybe, but I'm a believer in Occam's razor, which I believe would suggest that the OP's description of the situation above is common enough to not warrant much evidence to support it, and a deep analysis may miss the mark.

I was just pointing out a different possible interpretation. None of us have grounds to decide on which pieces of which are applicable.

I do believe in Occam's razor here as well, but I see it differently than you do. Occam's razor here is finding the thing stirred up in these encounters that is most unacceptable for a person to see in themselves.

 

[smalltownpsych]

As a psychologist, I would prefer the term unmotivated as opposed to lazy. Many of our patients are unmotivated and very few of them have a lack of motivation that is purely due to MDD that will respond well to medication. Heck, I'm unmotivated today because I was busy on-call all weekend and don't really feel like working today! The main point for not using the term lazy is the fundamental attribution error and I just gave an example of it. More specifically, I have an external and situational reason for being unproductive; whereas, the flaw is when I think other people are unproductive because of some stable internal personality flaw such as "lazy".

The key to any case always starts with figuring out what is causing the problem and intellectual shortcuts will get in the way of discovering what that is, especially when it is a complex interplay of causal factors. That is why the directions to examine your own reactions to the patients and your attending and taking it a step further is spot on. This meta-cognitive aspect is what separates the real psych docs from the pretenders. If you find that you enjoy thinking about this stuff then you might just be headed into the right specialty.

 

[Jules A]

There are many who believe they are helping patients by facilitating placing ownership of their problems onto an external object (in this case, "depression"). It certainly gratifies the patient's wish to not be responsible for their deficiencies and the provider's wishes to be loved by their patients, avoid conflict, etc. A great deal of self-awareness is often necessary to recognize these traps, and a great deal of fortitude may be necessary to do what is right for the patient instead of what feels good to both of you.

Well worth repeating!

 

[smalltownpsych]

Anyway, you are definitely on to something. There are many who believe they are helping patients by facilitating placing ownership of their problems onto an external object (in this case, "depression"). It certainly gratifies the patient's wish to not be responsible for their deficiencies and the provider's wishes to be loved by their patients, avoid conflict, etc. A great deal of self-awareness is often necessary to recognize these traps, and a great deal of fortitude may be necessary to do what is right for the patient instead of what feels good to both of you.

Well worth repeating!

Agreed and highlighted what I thought was the most important. Avoidance of conflict is akin to colluding with the defense or from 12-step people: co-signing someones b.s. or being a people-pleasing puke. I love the lines that come out of 12 step groups. I personally have had to really work hard to fight against my own need to be liked and avoid conflict so as to be of the most help to my patients. Side benefit is that I have improved my own relationships as well. In line with another thread on a related topic, I didn't need to participate in psychotherapy to learn some of these lessons.

 

[northernpsy]

Also, as was said, every specialty will have it's annoyances. My colleagues in primary care get annoyed that no one seems to give a damn about their diet and exercise. They keep eating fast food, never lift a finger, and just want you to keep adding meds for their DM2 and HLD. Then as the weight gets piled on, off they go to bariatric surgery. Of course, there's the challenges of adhering to an even more strict diet after bariatric surgery and next thing you know, the patient's got Wernicke's encephalopathy now! .

I definitely can relate to being jaded about patients since I recently posted on here about how I hate when people get admitted to psych for social reasons but I think in at least some cases if we could REALLY put ourselves in the patient's shoes it would be easier to have a little more empathy and be less frustrated.

For example, with the morbidly obese patients, it may seem to their PCP like they just don't care, but I think very few people who have never been morbidly obese REALLY get how incredibly damn hard it is to completely change your diet when you've never known any other way of life. In addition to possibly fighting against your own body's desire to maintain its "set point" weight, you have to spend time educating yourself about what you should be eating instead, have the money to buy good quality food and the time to make it, resist peer pressure from your fat friends and family, get used to no longer eating to celebrate or cope with negative feelings, etc.
Exercise on its own often isn't enough to lose significant weight, but even if you're just trying to work out for fitness rather than weight loss, it is often downright painful to try to workout if you're fat and out of shape. Then you also have the fact that some people out there will make fun of fat people out for a jog or at the gym (which makes as much sense as mocking an alcoholic for going to an AA meeting, but we all know that people don't always behave rationally).
I think it's easier to have some compassion when you really stop and think about how hard it is to find the willpower, motivation, and courage to totally change your life despite the fact it means enduring pain, humiliation, and also possibly losing one of your coping mechanisms. I feel many doctors don't really get it and that's why a lot of fat people dread seeing doctors.

Morbid obesity isn't a character flaw. It is a tragic illness. So are many of the illnesses that we in psych deal with. I think it is hard for those of us who have never actually dealt with a mental illness personally to understand the depth of suffering that things like MDD or schizophrenia cause. We see it every day so it's easy to just become numb to the tragedy we are watching unfold over and over again in people's lives.

While not all people who claim to be depressed truly have MDD, clearly there are people who are genuinely depressed enough to be genuinely suicidal. How horrific would it be to feel such misery in life that you truly feel like you're better off dead - even though you don't have anything going on in your life that *should* be making you that unhappy?
How terrifying it must be to experience things like hallucinations or paranoia. If you have no insight it's terrifying because you truly believe these horrible things are really happening, and if you do have any sort of insight into your illness it must be horrible to realize you can't trust your own mind. I honestly feel that a disease that affects your mind is more terrifying to live with than many physical disorders are.

 

[BackToday]

My issue, honestly, wasn't with the patients. That played a role, sure, but it was more with the attending's approach to them. Clearly, the attending has more experience than me, but to blame everything on depression just didn't seem accurate to me.

I've worked with other attendings that took a more balanced approach, and I thought it was more effective.

 

[oldanddone]

My issue, honestly, wasn't with the patients. That played a role, sure, but it was more with the attending's approach to them. Clearly, the attending has more experience than me, but to blame everything on depression just didn't seem accurate to me.

I've worked with other attendings that took a more balanced approach, and I thought it was more effective.

Denial ain't just a river in Egypt baby
The lady doth protest too much....
Some juice there. See if a psychodynamic attending willing to dig deep with you and get a taste of that kind of supervision.

 

[Crayola227]

While not all people who claim to be depressed truly have MDD, clearly there are people who are genuinely depressed enough to be genuinely suicidal. How horrific would it be to feel such misery in life that you truly feel like you're better off dead - even though you don't have anything going on in your life that *should* be making you that unhappy?

and when you do have something that should be making your life that unhappy?

 

[BackToday]

My issue, honestly, wasn't with the patients. That played a role, sure, but it was more with the attending's approach to them. Clearly, the attending has more experience than me, but to blame everything on depression just didn't seem accurate to me.

I've worked with other attendings that took a more balanced approach, and I thought it was more effective.

Well, if it means anything, we switched attendings late last week, and I'm enjoying my time a lot more now. I really like this attendings' approach much more.

 

[smalltownpsych]

My issue, honestly, wasn't with the patients. That played a role, sure, but it was more with the attending's approach to them. Clearly, the attending has more experience than me, but to blame everything on depression just didn't seem accurate to me.

I've worked with other attendings that took a more balanced approach, and I thought it was more effective.

Experience does not predict competence very well in this field. Sometimes it just means that the persons own unhealthy patterns of interacting with patients has become more entrenched or eventually even pathological. I wouldn't waste too much time analyzing the dynamic that is playing out between the attending and their patients. Although a few ideas do come to mind, it doesn't help much. I would look at your own reactions to the attendings approach and what that touched upon with you personally and how to respond or think about it differently. After all, patients will push that same button - again and again and again. If you go to the place of questioning the whole shebang and frustration with laziness very much that would be a problem. If you can't connect the dots of how this dynamic relates to your own life and how to shift it, then consult with someone to figure that out. Also, it has been my experience and observation that it typically doesn't need to be in-depth long-term analysis to learn how to understand and manage our own counter-transference effectively.

 

[Ψ-117]

It's also disheartening that so many of our treatments just don't seem to do anything. It has me wondering if any of this is even real. I also got the talking to from some of my relatives that I'm wasting my degree by doing psych. I didn't think that would affect me, but it was a bit disheartening. It didn't help that I saw another attending get attacked by a patient, and I'm sitting here thinking do I really want to spend a career getting attacked or stalked by patients for something that I may not really believe in? I saw depression in child psych and I believed it then. Maybe it was because those patients were kids who were really trying? I don't know.

Just wanted to add my two cents here for anyone who does not think mental illnesses are real. Simply put, they're wrong. When I was in my first two years of training and working several months on our inpatient unit, I often thought how it would be nice to have those people come visit our unit and see what full-blown mental illness looks like, and to see patients get better with treatment. Or to see what happens when a patient decides to stop taking their "mind-altering" medication against the advice of their physician. Not every patient responds well to treatment, however, and many times there are other variables going on besides just having the right medicine. Sometimes if a patient has tried "everything" but says nothing works, it may be that they have an undiagnosed personality disorder which has not been addressed. Plus, sometimes you may not see the results of treatment until it has been applied consistently for an adequate period of time. Medical students on a 4-week rotation only get to catch a glimpse of patient's psychiatric timeline. A student on the inpatient unit might see an acutely psychotic patient who never seemed to get better, but a few months later another student might see the same patient in clinic and wonder why anyone ever said this patient had a mental illness.

 

[Ceke2002]

My issue, honestly, wasn't with the patients. That played a role, sure, but it was more with the attending's approach to them. Clearly, the attending has more experience than me, but to blame everything on depression just didn't seem accurate to me.

I've worked with other attendings that took a more balanced approach, and I thought it was more effective.

Honestly, as a patient I probably would have found that attending's approach to be frustrating as well. To me there's a big difference between understanding when you might have to back things off a bit, and infantalising a patient to the point where they don't have to take responsibility for anything, not even their own well being. Unfortunately, in my experience, the latter is often seen in those with rescuer fantasies, and more often than not it ends in disaster when the patient doesn't follow the rescuers imagined script and doesn't play into the rescuers own ego needs by showing some sort of miraculous turn around in a prescribed amount of time.

 

[oldanddone]

Well, if it means anything, we switched attendings late last week, and I'm enjoying my time a lot more now. I really like this attendings' approach much more.

Means avoiding some personal growth with a psychodynamic supervisor brought up through irritation with a particular attending? Dive deep! The water's warm and welcoming!

 

[dissonance_]

.

 

[nancysinatra]

This is a great example of what psychoanalysts call projective identification. You believed psychiatry was the specialty for you but your relatives destroyed that for you, invalidating your career (and by proxy - invalidating you), and you are enacting the projection by wondering whether mental illness is even real. I mean, how can it be, if your family tells you that you are just wasting your degree by doing psych? As such you are viewing your patients with skepticism and contempt. Take a step back and consider that you were really enjoying your psychiatry rotations beforehand! Now your family have ruined it for you and you are enacting their projections. My guess is that you also don't like the approach of whatever attending you are working with. You know, it is quite possibly true that someone may be so unmotivated or disinterested in life because they are depressed, that they dont want to work or they don't want to take care of their kids. The ennui of existence weighs to heavily, the effort of every thought so paralyzing that doing nothing becomes the only possible choice. On the other hand you may be tapping into a diagnostic clue in your countertransference (which is what this, negative countertransference). Countertransference often gives us clues into the mental states of our patients (and the diagnosis). Depressed patients usually make us feel despair and hopeless, whereas patients who are simply lazy make us feel angry. You don't appear to be experiencing anger, but helplessness, believing there is nothing that you can do for your patients. That is probably how many of them feel and why they have just given up. I think your countertransference here has come from you being really affected by losing the approval of your family. I would talk to your attending about this. In psychiatry, it is perfectly okay (and in fact encouraged) to own up to your hateful feelings towards patients! Though in your case, I don't get the sense that you hate these patients (which would be perfectly okay), simply that you are experiencing the helpless countertransference that these patients with chronic mental illness can elicit, and it is aligning with the projections that your family have hoist upon you and you are now enacting.

Splik, normally I agree with your comments, but in this case, I think you're off the mark. You can't possibly be objective about the topic of "the validity of psychiatry as a career," because you are a psychiatrist. There's a good chance you projectively identify with the profession.

How would you feel if I came on here and tried to diagnose you with delusional disorder based on what I perceive to be your unjustifiable level of confidence in the field of psychiatry? You wouldn't like it right? Research on how people choose careers shows that it's very idiosyncratic, and can rarely be explained psychologically. I think it's unfair to try to psychoanalyze some poor med student who is only trying to figure out which specialty they want to do.

It's totally legitimate for people to care what their families think about their choice of a profession. No one wants their mother to be embarrassed by their job. And most people on earth don't end up pursuing their first choice ambition. In this case, the OP isn't sure if psychiatry is his or her first choice.

I'm sure it won't surprise anyone, but a lot of what the OP is saying, I agree with. I don't like dealing with depressed people. Or bipolar patients, or insomniacs. Insomnia is the most boring medical complaint ever invented, and almost every psych patient has it. With many depressed patients, I find their complaints trivial. I do care, and I work hard to empathize, but it's work. I would say I enjoy pretending to be interested in people's depression symptoms and SSRI regimens about as much as I would probably enjoy working at a 7-11 for the rest of my life.

This is not countertransference. It's simply an OPINION I hold based on experience. I spent 7 years in misery doing psychiatry and having many of the reactions the OP described, and now I have been doing something else for only one month and have not been happier in years. Psychiatry is not for everyone. I'm happy for those who enjoy it. But students should be encouraged to explore the upsides and downsides of all medical specialties.

 

[nancysinatra]

Now, however, I'm doing my sub-i with mainly depression and bipolar and a big piece of me just doesn't believe in it. I find a lot of the patients' behavior to be lazy and I feel like my team just encourages it.

What you're saying is how I felt every day of my job between when I matched in psychiatry and finally left, but I didn't feel like I could say that to many people. It isn't politically correct, and at every level of the system, from the top of the APA down to the NAMI reps in the community, and including on this forum, people will accuse you of disloyalty or "stigmatizing" the mentally ill if you admit that you question if what we are doing is "real." If you do go into psychiatry, be ready to endorse it, with or without convincing scientific evidence or clinical results.

And I liked my psych rotations as a med student too. I guess in my case, I liked them partly because all I had to compare them to was a series of malignant rotations in other specialties. My attendings were awesome and many of the cases were interesting. But med students tend to get the red carpet rolled out in psychiatry.

It's also disheartening that so many of our treatments just don't seem to do anything. It has me wondering if any of this is even real. I also got the talking to from some of my relatives that I'm wasting my degree by doing psych. I didn't think that would affect me, but it was a bit disheartening. It didn't help that I saw another attending get attacked by a patient, and I'm sitting here thinking do I really want to spend a career getting attacked or stalked by patients for something that I may not really believe in? I saw depression in child psych and I believed it then. Maybe it was because those patients were kids who were really trying? I don't know.

I find it both easier and harder to believe that kids are really sick. A lot of the times it's the family that's messed up. And there is a huge push to get every American kid on psych meds. But at least kids tend to be pretty honest, and they haven't been socialized to identify with an illness yet, so when they do complain, I tend to believe them more.

 

[splik]

How would you feel if I came on here and tried to diagnose you with delusional disorder based on what I perceive to be your unjustifiable level of confidence in the field of psychiatry?

well i'm not sure anyone would say that i have a high level of confidence in the field. as you know I have argued that psychiatric training is based on pseudoscience, do not believe in psychiatric diagnosis (as much as i like eponymous syndromes i only believe in 3 diagnoses), do not believe most people with serious mental illness need lifelong medication, and do not believe in forcibly drugging people except in rare circumstances.

my comments were of course highly speculative but based on him having previously enjoyed the field thinking it wasn't psychiatry that was the issue but this particular attending's approach and his family's lack of support skewing his view. That seems to me different from someone just always having a negative reaction to people who are depressed etc. Personally I believe it is extremely damaging to label people as mentally ill and attribute all their problems to it, apart from being invalidating, it undermines any personal responsibility and agency an individual has. At any rate, he seemed to agree that my speculation might be part of what is going on. It doesn't mean that being skeptical about what he is seeing is not justified, it's good to question everything.

 

[smalltownpsych]

Splik, normally I agree with your comments, but in this case, I think you're off the mark. You can't possibly be objective about the topic of "the validity of psychiatry as a career," because you are a psychiatrist. There's a good chance you projectively identify with the profession.

How would you feel if I came on here and tried to diagnose you with delusional disorder based on what I perceive to be your unjustifiable level of confidence in the field of psychiatry? You wouldn't like it right? Research on how people choose careers shows that it's very idiosyncratic, and can rarely be explained psychologically. I think it's unfair to try to psychoanalyze some poor med student who is only trying to figure out which specialty they want to do.

It's totally legitimate for people to care what their families think about their choice of a profession. No one wants their mother to be embarrassed by their job. And most people on earth don't end up pursuing their first choice ambition. In this case, the OP isn't sure if psychiatry is his or her first choice.

I'm sure it won't surprise anyone, but a lot of what the OP is saying, I agree with. I don't like dealing with depressed people. Or bipolar patients, or insomniacs. Insomnia is the most boring medical complaint ever invented, and almost every psych patient has it. With many depressed patients, I find their complaints trivial. I do care, and I work hard to empathize, but it's work. I would say I enjoy pretending to be interested in people's depression symptoms and SSRI regimens about as much as I would probably enjoy working at a 7-11 for the rest of my life.

This is not countertransference. It's simply an OPINION I hold based on experience. I spent 7 years in misery doing psychiatry and having many of the reactions the OP described, and now I have been doing something else for only one month and have not been happier in years. Psychiatry is not for everyone. I'm happy for those who enjoy it. But students should be encouraged to explore the upsides and downsides of all medical specialties.

Sometimes a cigar is just a cigar and we always need to be wary of our interpretations both as clinicians and as clinical supervisors. It can be harmful to interpret everything as resistance or countertransference or to foist interpretations especially when there is a power differential. Nevertheless, part of this field is the interpersonal and it is healthy to examine our reactions with a skeptical eye and any good supervisor should always encourage some exploration of those reactions and it doesn't always have to be or even should be from a Freudian analytic stance.

For example, one of my supervisors would tell a story about how early in training he would use a lot of humor to try to make depressed patients laugh and connected that to his experience growing up with a parent who was prone to depression. He realized that sometimes that wasn't what the patient needed and he had to shift the more automatic pattern of responding to be more empathic and connected with a patient in distress without always trying to cheer them up. It doesn't have to go much deeper than that typically.

 

[MacDonaldTriad]

What do parents know about the field of psychiatry other than they don't like it? Antagonism to psychiatry is mostly generated by ignorance because lay people have such a distorted view of what we do. Going into psychiatry takes the fortitude to disappoint your family, class mates, and teachers (except during psych rotations). I rather like this price it take to join our club.

I have a distant relative who claims he dedicated his PhD thesis to "My parents; without whom none of this would have been necessary" I'm not completely centered on "forget what your parents think", only selectively so. There is a story about the boy who went to college and came back surprised to discover how much his parents had learned. Still, most people's knowledge of psychiatry comes from movies and television. Medical students who finish a 6 week core rotation aren't much more informed either.

 

[BackToday]

To be clear, it's not my parents. They're supportive of whatever I do. They just wanted to make sure there were jobs in psychiatry (lol!). It was more extended family.

 

[northernpsy]

and when you do have something that should be making your life that unhappy?

We in psych actually do get consults sometimes for things like "Patient with new diagnosis of metastatic cancer crying. Evaluate for depression." In those kinds of cases my approach is generally to validate that their feelings are normal, that it's OK to be sad and angry at the unfairness of the situation, and offer to set them up with therapy or other support services. My view is that sometimes it can be helpful to the patient to hear from a psychiatrist that what they're feeling isn't "crazy".

 

[oldanddone]

The final interpretation of the counter transference or 'what got kicked up in you' will be yours. I'm from gestalt and not psyhoanalysis so I place the best interpretation with you. So good to have a guide like a therapeutic supervisor to help you get deep and feelingfull. You'll know you got there as you'll have a sense of clarity and less feeling conflicted.

 

[smalltownpsych]

Also, keep in mind that some reactions and feelings that we have are normative and to be expected. No one really wants to to hear the painful things that our patients tell us or experience the painful feelings.

During training, I had a case where the patient was about as depressed as you can get. After two weeks of treatment on the inpatient unit, we could finally get him out of bed and he moved like a sloth. Literally. Best example of psychomotor ******ation I have ever seen. After discharge, I was working with him in a day treatment program and progress was painfully slow. As I was clearly getting frustrated and feeling stuck, my supervisor asked me about my own reactions to the patient. As I examined them I realized I was repulsed by the black hole of despair that he was in and felt a fear that I would fall in myself. The supervisor asked about that fear and as I examined it I quickly realized that it was irrational. I had way too much positive going on in my own life to get stuck in the kind of pit the patient was in. Next session, I was much more comfortable empathically attuning to the patient because I had lost that irrational fear and feeling of repulsion. As my supervisor said, "It's our job to go in there with them when no one else will and cause we have the strength to show them the way out. Sort of like firefighters who run towards danger when everyone else runs away. Just not nearly as exciting, dramatic, or dangerous.

 

[Salpingo]

I find a lot of the patients' behavior to be lazy and I feel like my team just encourages it. Whatever they do, my attending just blames it on depression. They don't want to work? Depression. They don't want to take care of their kids? Depression? They have all these psychosomatic complaints? Depression. The thing is, though, is that she's dedicated to them, and and spends hours and hours on their care. I respect that, but I just can't believe it's all depression and bipolar.

This actually reminded me of an article in this month's AJP (link). The idea of hypersomnia and hyperphagia are actually relatively new additions to the diagnostic criteria -- basically, lazy and fat. I think we've all reached a point in our careers where we've felt demoralized, and that we've medicalized people who are simply locked in a miserable cycle of overeating, oversleeping and underworking. They're not going to get better on a psych floor.

But if you think you can avoid these people by going into another speciality, you're going nowhere. These are the people that are going to be re-hospitalized, re-vascularized, re-scoped, re-scanned, re-tain, until you throw your hands up and call a psych consult. You could enjoy figuring out aspects of complex problem solving and diagnosis, but when its all undone at the end of the week after they've binged on opiates/fast food/Netflix/SDN, that's going to lose its luster.

The nice thing about psychiatry is that you will gain some insight into this behavior and a small arsenal to deal with it (as well as dealing with burnout in general). I think you're right to be wary of someone who will reify and medicalize bad behavior, and realize you're not a social worker or life coach. Hopefully you could still learn a lot from this attending. There are niches in psychiatry where you don't have to deal with this frustration, but like I said, its pretty pervasive in all of medicine.

 

[Ceke2002]

Also, keep in mind that some reactions and feelings that we have are normative and to be expected. No one really wants to to hear the painful things that our patients tell us or experience the painful feelings.

During training, I had a case where the patient was about as depressed as you can get. After two weeks of treatment on the inpatient unit, we could finally get him out of bed and he moved like a sloth. Literally. Best example of psychomotor ******ation I have ever seen. After discharge, I was working with him in a day treatment program and progress was painfully slow. As I was clearly getting frustrated and feeling stuck, my supervisor asked me about my own reactions to the patient. As I examined them I realized I was repulsed by the black hole of despair that he was in and felt a fear that I would fall in myself. The supervisor asked about that fear and as I examined it I quickly realized that it was irrational. I had way too much positive going on in my own life to get stuck in the kind of pit the patient was in. Next session, I was much more comfortable empathically attuning to the patient because I had lost that irrational fear and feeling of repulsion. As my supervisor said, "It's our job to go in there with them when no one else will and cause we have the strength to show them the way out. Sort of like firefighters who run towards danger when everyone else runs away. Just not nearly as exciting, dramatic, or dangerous.

Therapist Pro Tip: You're not actually supposed to jump down in the hole with us.

And yes normative feelings are normative, and not everything needs to be run through the analysis mill. I have clinical depression, my husband has clinical depression, you'd think that would make us both the bastions of mutual understanding but no, not always. I could come up with some BS about how I'm subconsciously transferring past frustrations with my Mother's constant need to play the sick role onto my husband, or I could just accept that it's perfectly normal to feel frustrated/exasperated/exhausted/oh god please stop taking you're hurting my brain in this kind of situation - especially if you're own reserves are running low as well.

 

[oldanddone]

This actually reminded me of an article in this month's AJP (link). The idea of hypersomnia and hyperphagia are actually relatively new additions to the diagnostic criteria -- basically, lazy and fat. I think we've all reached a point in our careers where we've felt demoralized, and that we've medicalized people who are simply locked in a miserable cycle of overeating, oversleeping and underworking. They're not going to get better on a psych floor.

But if you think you can avoid these people by going into another speciality, you're going nowhere. These are the people that are going to be re-hospitalized, re-vascularized, re-scoped, re-scanned, re-tain, until you throw your hands up and call a psych consult. You could enjoy figuring out aspects of complex problem solving and diagnosis, but when its all undone at the end of the week after they've binged on opiates/fast food/Netflix/SDN, that's going to lose its luster.

The nice thing about psychiatry is that you will gain some insight into this behavior and a small arsenal to deal with it (as well as dealing with burnout in general). I think you're right to be wary of someone who will reify and medicalize bad behavior, and realize you're not a social worker or life coach. Hopefully you could still learn a lot from this attending. There are niches in psychiatry where you don't have to deal with this frustration, but like I said, its pretty pervasive in all of medicine.

I'm doing hospitalist this month. My experiential training in psychotherapy (ie support going deep) has me energized when with patients like this. And able to add dynamics that may help them just as much as what I do akin to more typical hospitalist stuff. Just takes a bunch longer. So fighting for the right to take time with patients is key especially when medicine becomes more and more corporate and less autonomous profession. Psych still can be more autonomous. Once thorough personal training has taken place I reiterate that encountering 'stuckness' can give and not take energy.

 

[oldanddone]

Therapist Pro Tip: You're not actually supposed to jump down in the hole with us.

And yes normative feelings are normative, and not everything needs to be run through the analysis mill. I have clinical depression, my husband has clinical depression, you'd think that would make us both the bastions of mutual understanding but no, not always. I could come up with some BS about how I'm subconsciously transferring past frustrations with my Mother's constant need to play the sick role onto my husband, or I could just accept that it's perfectly normal to feel frustrated/exasperated/exhausted/oh god please stop taking you're hurting my brain in this kind of situation - especially if you're own reserves are running low as well.

Once again...the lady doth protest too much you're pointing your own way. What did you learn then as a kid who couldn't challenge and just shut up and listened thst you still do now when you don't have to. Where do you get the safety to creatively try out a new way....A safe bet is in therapy. Primary relationships echo and echo. If relationship dynamis now don't work there are many ways in. Via primary relationships is often powerful. Or something like nvc and rosenbergor here and now relational therapy if mother isn't your shtick. Or just grin and bare it whatever is useful that moment.