Anyone watch House tonight?

[surftheiop]

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I seem to remember that there where a couple House fans on the board at some point.

This week's entire episode revolves around House having an appointment with his psychiatrist. I'm sure their interraction is probably just as outrageous as any other "normal case" on House, but was entertaining none the less.

Also, the last couple minutes were kind of thought provoking to me (as someone who is still just in undergrad) about what the "goal of psychiatry" is.

 

[zenman]

I seem to remember that there where a couple House fans on the board at some point.

This week's entire episode revolves around House having an appointment with his psychiatrist. I'm sure their interraction is probably just as outrageous as any other "normal case" on House, but was entertaining none the less.

Also, the last couple minutes were kind of thought provoking to me (as someone who is still just in undergrad) about what the "goal of psychiatry" is.

 

[surftheiop]

Maybe I didn't express it clearly enough -

It seemed to be proposing the question whether it is more important for a psych patient to become a "well behaved/adjusted member of society" or for the patient to be "personally happy/satisfied with their own life"

 

[zenman]

Well, Manson and his followers were happy with their lives but wound up in jail after killing others. So you try to find happiness somewhere within societal norms or you get your palms smacked.

 

[surftheiop]

Well, Manson and his followers were happy with their lives but wound up in jail after killing others. So you try to find happiness somewhere within societal norms or you get your palms smacked.

I think the example in House is much more interesting than serial killers though because gaining happiness from being a jerk isn't illegal.

Essentially you had House sabotaging several of his friend's other relationships over the years and as a result he always had Wilson to hang out with.

Then House starts to conform to "societal norms" and suddenly Wilson is in a relationship and House is lonely/depressed and seems likely to relapse to drug abuse.

Obviously it seems like a "win" that the therapy got House to a point where he was respecting "societal norms", but on the other hand now he is miserable and will probably relapse.

It seems in this case the "best interests" of the psychiatrist's patient (House) are in conflict with the "best interests" of those people surrounding the patient.

 

[Jack Napier]

I think the example in House is much more interesting than serial killers though because gaining happiness from being a jerk isn't illegal.

Essentially you had House sabotaging several of his friend's other relationships over the years and as a result he always had Wilson to hang out with.

Then House starts to conform to "societal norms" and suddenly Wilson is in a relationship and House is lonely/depressed and seems likely to relapse to drug abuse.

Obviously it seems like a "win" that the therapy got House to a point where he was respecting "societal norms", but on the other hand now he is miserable and will probably relapse.

It seems in this case the "best interests" of the psychiatrist's patient (House) are in conflict with the "best interests" of those people surrounding the patient.

Or maybe its just a TV show.

 

[Regnvejr]

To short it down, the "job" of a psychiatrist is to give their patients more control over their own lives.

 

[surftheiop]

Or maybe its just a TV show.

I always figured that folks on physician boards would be insightful enough to realize that just because something takes places in a fictional setting, doesn't mean that it is not useful for considering real life circumstances. Media distills life into a concentrated and concise form that is often easy to use as a starting place for analyzing the actual world around us.

Obviously House in completely fictional, but I'm 100% certain that their are instances when psychiatrists (or any physician for that matter) have to consider the implications of their decisions on individuals other than the patient. Bringing House into the picture was merely a way of "putting some meat on" the question instead of asking it in a vacuum.

After taking adult psychopathology from a clinical psychologist who also happened to have an additional PhD in English literature from Yale, I have become much more aware of the insight that fiction can offer to reality.

 

[surftheiop]

To short it down, the "job" of a psychiatrist is to give their patients more control over their own lives.

This is the sort of response I was looking for, very concise and helpful.

How much concern is it of yours (the medical community) what patients will do with this new control?

 

[sideways]

This is the sort of response I was looking for, very concise and helpful.

How much concern is it of yours (the medical community) what patients will do with this new control?

Wouldn't behaving "inappropriately" with this newfound control just point to the need for further psychiatric work to be done? Or maybe that they aren't as "in control" as they may believe?

Just from my layman's perspective it seems as though "healthy behavior" wouldn't really end up manifesting itself in negative ways.

Sorry for all the "air quotes."

 

[surftheiop]

Wouldn't behaving "inappropriately" with this newfound control just point to the need for further psychiatric work to be done? Or maybe that they aren't as "in control" as they may believe?

Just from my layman's perspective it seems as though "healthy behavior" wouldn't really end up manifesting itself in negative ways.

Sorry for all the "air quotes."

In general I'm sure your right and your probably right it all cases.

Although wonder though if their might be cases where people have essentially manipulated others to become close to them and therefore by behaving "appropriately" they will end up with "nobody".

That sort of situation would seem to be a "net gain" for society, but would appear "detrimental" to the patient.

 

[ClinPsycMasters]

It seems in this case the "best interests" of the psychiatrist's patient (House) are in conflict with the "best interests" of those people surrounding the patient.

That is the norm not the exception. A well-functioning society is a compromise, a type of balance between self-compassion and other-compassion.

 

[Jack Napier]

I always figured that folks on physician boards would be insightful enough to realize that just because something takes places in a fictional setting, doesn't mean that it is not useful for considering real life circumstances. Media distills life into a concentrated and concise form that is often easy to use as a starting place for analyzing the actual world around us.

Obviously House in completely fictional, but I'm 100% certain that their are instances when psychiatrists (or any physician for that matter) have to consider the implications of their decisions on individuals other than the patient. Bringing House into the picture was merely a way of "putting some meat on" the question instead of asking it in a vacuum.

After taking adult psychopathology from a clinical psychologist who also happened to have an additional PhD in English literature from Yale, I have become much more aware of the insight that fiction can offer to reality.

I guess when I was earning my undergraduate degrees in philosophy and psychology I turned to reading philosophy/psych for insight as opposed to "Must Watch TV". But then again, I was overly idealistic and curious as well when I was 18-22 y/o and an undergrad.

I would also advise you to take caution in making assumptions/generalizations about what patient-provider relationships are/should be given your pre-med status.

 

[Regnvejr]

This is the sort of response I was looking for, very concise and helpful.

How much concern is it of yours (the medical community) what patients will do with this new control?

Part of control is to not be in trouble with society, family, etc.

 

[surftheiop]

I guess when I was earning my undergraduate degrees in philosophy and psychology I turned to reading philosophy/psych for insight as opposed to "Must Watch TV". But then again, I was overly idealistic and curious as well when I was 18-22 y/o and an undergrad.

I would also advise you to take caution in making assumptions/generalizations about what patient-provider relationships are/should be given your pre-med status.

I'm not making assumptions, that's why I was asking

And apparently unlike you, I don't like to partition my "academic" and "entertainment" lives, I enjoy considering the implications of situations both real and "fictional"

 

[surftheiop]

Part of control is to not be in trouble with society, family, etc.

That makes sense.

What about on the other side of the coin, when caregivers/parents are sort of "pushing you" towards a certain treatment or approach?

For example you have a child patient that you feel is "almost diagnosable" with ADHD, but its a "stretch".

Lets say he has behavior issues and it seems that his single parent has abusive tendencies that are exacerbated by the child's behavior. (But you don't have enough evidence to get social services involved). The parent is campaigning hard for you to put him on meds.

Is it unethical to turn faster to ADHD meds as a "child abuse prevention pill", while if the patient had high functioning parents, you would take a much different approach?

In a vacuum it would seem absolutely unethical to "appease the parent", but what if by doing so you prevented child abuse in the future?

(Obviously I have no training in this area, so this is a completely hypothetical attempt to try to capture the sort of "tension" that I could see existing.)

 

[Regnvejr]

That makes sense.

What about on the other side of the coin, when caregivers/parents are sort of "pushing you" towards a certain treatment or approach?

For example you have a child patient that you feel is "almost diagnosable" with ADHD, but its a "stretch".

Lets say he has behavior issues and it seems that his single parent has abusive tendencies that are exacerbated by the child's behavior. (But you don't have enough evidence to get social services involved). The parent is campaigning hard for you to put him on meds.....

Depends on how the kid handles stress. Maybe off to therapy, so the kid can develop coping skills to handle the parent. Or SSRI so the kid is less bothered and reactive about the parent. The focus is always on the patient, not on making the parent/spouse/whatever happy.

 

[zenman]

I always figured that folks on physician boards would be insightful enough to realize that just because something takes places in a fictional setting, doesn't mean that it is not useful for considering real life circumstances. Media distills life into a concentrated and concise form that is often easy to use as a starting place for analyzing the actual world around us.

Obviously House in completely fictional, but I'm 100% certain that their are instances when psychiatrists (or any physician for that matter) have to consider the implications of their decisions on individuals other than the patient. Bringing House into the picture was merely a way of "putting some meat on" the question instead of asking it in a vacuum.

After taking adult psychopathology from a clinical psychologist who also happened to have an additional PhD in English literature from Yale, I have become much more aware of the insight that fiction can offer to reality.

The patient comes first but you must always consider the ramifications of your decisions on individuals other than the patient, their family as well as others. For example, there seems to be quite a few people with cluster B traits in the military. While this might be good in some situations, when one requires hospitalization, you have to consider the needs of the military as well in your discharge planning.

Stories are powerful in the healing process. Just ask any indigenous tribe. The psychiatrist Lewis-Mehl-Madrona has also written some good books on the subject.

 

[Kosebamse]

To short it down, the "job" of a psychiatrist is to give their patients more control over their own lives.

What does being in control of your life mean, and what is the litmus test for it.

Fat parents more often have fat kids. Are the fat kids in control of their lives?

People are more likely to be depressed if they have grandparents who are, even though they never met them. Are people with depressed grandparents in control of their lives? Same argument for depressed parents.

If you start smoking because of peer pressure, you are highly normal and living within society's norms. Are you then in control of your own life?

It is funny, if psych goal was uniformly as broad as to eliminate all signs of behavior falling outside of a precisely defined number of standard deviations from mean, then I guess objecting to stoning women in Somalia would be seen as ill, too.

- Nobody is in control of their lives, as we are products of quantum mechanical chaos. (but we need to feel we are in charge)
- There are no philosophical or quantitative ways of proving a cut-off value as to how normal one must be, my guess is that psych docs have pragmatic minimum values here, as in what type of delusions one can have without being subjected to forced therapy, and this balances self-interest and society's interests up against the wish to be the patient advocate. And to further facilitate the second, rationalizing every therapeutic measure with patient interest could be helpful. I am only guessing.

About House: I have noticed that House MD is fictional BS on many occasions when it comes to diagnostics. But I don't know that much about psychology, so I can't overrule many of the main characters comments on human behavior and human nature, like "everybody lies," but I like it. I don't know if that fictional character states that out of a will to be offensive, or if he states that out of disgust of people's need for reality cosmetics in order to remain positive. If the latter, I would also understand why he despises positivity.

 

[Regnvejr]

What does being in control of your life mean, and what is the litmus test for it.

They feel more in control.

Fat parents more often have fat kids. Are the fat kids in control of their lives?

Who knows. But if they feel they have lost control in some form, you may be able to help them regain that control.

People are more likely to be depressed if they have grandparents who are, even though they never met them. Are people with depressed grandparents in control of their lives? Same argument for depressed parents.

Once they see you, can they handle things better? That's the goal.

If you start smoking because of peer pressure, you are highly normal and living within society's norms. Are you then in control of your own life?

If you're smoking and don't want to, but you can't stop, then if I help you quit, then you got more control over your own life.

You seem to misunderstand "control" with "perfect."

It is funny, if psych goal was uniformly as broad as to eliminate all signs of behavior falling outside of a precisely defined number of standard deviations from mean, then I guess objecting to stoning women in Somalia would be seen as ill, too.

But then, that also isn't the goal. You seem to not understand psychiatry at all.

- Nobody is in control of their lives, as we are products of quantum mechanical chaos. (but we need to feel we are in charge)

And, if it is not perfect, then we should just give up and never try to do ANYTHING for ourself and feeling in control? You are really not making sense here.

There are no philosophical or quantitative ways of proving a cut-off value as to how normal one must be, my guess is that psych docs have pragmatic minimum values here, as in what type of delusions one can have without being subjected to forced therapy,

As in, when you are not a danger to yourself or other? Something wrong with that standard?

and this balances self-interest and society's interests up against the wish to be the patient advocate.

How are we "balancing" society's interest? Once again, what you are espousing makes no sense at all. Are you just spewing some preconceived, ill-thought-out anger at the filed of behavioral health without understanding what the field actually stand for?

And to further facilitate the second, rationalizing every therapeutic measure with patient interest could be helpful. I am only guessing.

Yes, you clearly are only guessing. I recommend you figure out what the work in the field actually is about.

About House: I have noticed that House MD is fictional BS on many occasions when it comes to diagnostics. But I don't know that much about psychology, so I can't overrule many of the main characters comments on human behavior and human nature, like "everybody lies," but I like it. I don't know if that fictional character states that out of a will to be offensive, or if he states that out of disgust of people's need for reality cosmetics in order to remain positive. If the latter, I would also understand why he despises positivity.

He is a TV CHARACTER. Try real life next.

 

[worriedwell]

In my opinion, good therapy helps someone build a "narrative" of their life and their decisions that allows them to feel that their emotions and thoughts are predictably triggered by something, and that something stems from their own vulnerabilities as well as strengths.

Thus, one step in the process of therapy with someone with maladaptive personality traits (or overt personality disorder), such as House, is to make that which is ego syntonic into ego dystonic psychologically. In other words, something simply like "being a jerk" which House considers "the way I am", but which gets in his way of him satisfying ultimate goals (like stable relationships, certain career achievements, pursuit of personal passions, etc), has to first be seen as maladaptive by House himself, and then he can begin to understand where it comes from, and then can start to practice new behavior realizing he has a choice in how to act. But the process is a long one with character problems like his and it often feels worse before it feels better.

The fact that he is having that internal dialogue is a part of the process of therapy (although I didn't see this particular show, so I don't know the specifics). A therapist has to let the patient come to his own conclusions but to guide him to be able to see that these maladaptive things are happening and hopefully where they come from (ie earlier life experiences).

A lot of times I find that my patients who are going through a successful transition in therapy into a healthier pattern tend to struggle with at first overcompensating to the opposite extreme of their inherent personality traits as they are trying to avoid acting in ways that have been problematic in the past, but then they have to learn to find a balance somewhere in the middle where they recognize that those maladaptive traits are still part of their personality and can and should be embraced sometimes as they are there for a reason, they just shouldn't be "overused".

Essentially, therapy is about helping someone be able to have a choice of how to cope with something through various "defense mechanisms" rather than automatically coping in their usual ones.

 

[surftheiop]

Or maybe its just a TV show.

Ironically enough I just saw an article in the WSJ talking about psychiatry and psychology programs using popular fictional characters in their training

http://online.wsj.com/article/SB10001424052748704025304575284753379542376.html