Developing a psych disorder as a psych resident?

Discussion in 'Psychiatry' started by IceMan007, May 11, 2008.

  1. IceMan007

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    Just curious if any of you psych residents felt that you have or are developing a psych disorder yourself while in residency, or if you're worried that could happen during your practicing career?

    The reason I ask is because I'm interested in psych, though I feel that I have some depressive tendencies (usually due to family issues that get me down) for which I have never received any professional help. I'm a bit worried that the more I learn about psych, or I'm around psych patients, that my own mental health will suffer. Am I justified in thinking this, and is this anything you guys can relate to? If so, did it curtail your interests in psych?

    Of course I could be just stressed out studying for my MCAT and overwhelmed with considering career options too.
     
  2. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    I have always wanted to do a study on clinical psych Ph.D students and OCD personality traits. Many times it is actually adaptable to have these in med school or a Ph.D program.

    On a serious note, this is something that you should think seriously about. Psych can be rewarding and emotionally draining at the same time (just as any medical specialty is I suppose). While you dont have to be a paragon of mental health, the treating clinician does need to be mentally healthy and maintain appropriate judgment in times of great stress in order to be effective in his/her work. Many Ph.D programs in clinical psych require students to complete a certain number of hours in psychotherpay themselves, in part so they can see what it is like for a patient when you are are on the other side of the therapeutic relationship, but also in part to help you work through preexisting problems that may affect your ability to be an effective clinician. If you feel you may benefit from therapy, most find it to be extremely beneficial, both personally and professionally. If not, I would jsut exercise appopriate judgment. Im sure you know yourself well, and what you are capable of handling. Although schizophrenia is obviously not contagious, a long day being involved in someones else's depressing emotional experiences can be, temporarily anyway. I can't promise that somedays you wont come home feeling kinda bummed out. However, these days will be much less than the days you come home feeling that you helped that one person see the light at the end of the tunnel.
     
  3. sunlioness

    sunlioness Fierce. Proud. Strong
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    In my opinion, it's hard to guide someone else to a place one has never been. But on the other hand, if you start working through your own stuff now, having been through that process would be a huge asset to you as a psychiatrist. So why not get some help with your depressive tendencies now?
     
  4. Ritz

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    We were having a discussion during the recruitment process for new residents and this was one of the major disqualifier - Candidate having any Psychiatric Problems. The Chair felt it is a big no no. Not the best plan.


     
  5. sunlioness

    sunlioness Fierce. Proud. Strong
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    The problem with that attitude though is you still get people with psychiatric problems anyway. You just get the ones who are in denial about it. ;) Kinda like my friend who is a flight surgeon in the Navy where there's a rule that you can't be on antidepressants and fly airplanes. Consequently, she sees any number of pilots in denial about their depression who continue to fly jets.

    Like I said, I don't think having a psych dx precludes someone from being a psychiatrist. But I would hope that the person knew they had it and had gotten (or was in the process of getting) it treated. The ones who have untreated psych stuff and are in denial about it are the ones who scare me.
     
  6. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    Yes, this can be a issue as well. I certainly would not write this in a personal statement or disclose your mental health hx to any of your faculty or attendings. However, having a mild dysthymic temperament is unlikely to affect your abilities as a physician. Psychosis on the other hand.......:rolleyes:
     
  7. IceMan007

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    I have considered getting some help at times, but I've always been hesitant thinking it might come up during medical board licensing and affect me negatively. What exactly is the policy on that? Does having received professional help for something like depression affect you adversely down the road for licensing/malpractice issues?
     
  8. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    Well I have seen my share of med students, and/or residents and doctors in psychotherapy so I would think not. My supervisors have had everything from residents to brain surgeons in therapy in our university walk in clinic just this past year. Although I cant think of reason you would want to tell any of your faculty or attendings during residency about your psych hx either. Do you really have disclose confidential medical records to become licensed as a physician....I have never heard of that? Some residency programs in psychiatry still heavily encourage (but not require like many doctoral programs) that residents seek their own therapy for the reasons I mentioned in my fist post.
     
  9. sunlioness

    sunlioness Fierce. Proud. Strong
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    I think there have been discussions about that here and in the general residency forum. I don't have the definitive answer, but my sense is that it varies by state. I know in PA, they don't ask. And I think in some other states the wording implies that you need only disclose if you feel the condition would affect your ability to practice medicine. And I think in some states, they can be real jerks about it (kinda like the Navy and pilots on antidepressants). But at some point I think a person has to decide as well whether NOT getting treatment would affect their ability to practice medicine too.
     
  10. silas2642

    silas2642 silas2642
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    What residency program are you at?
     
  11. Ritz

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    If someone has been diagnosed with Axis I already, probably it is not the best idea. May be choosing a non-psychiatric residency with Therapy/ Medication during residency would be safer course.


    The problem with that attitude though is you still get people with psychiatric problems anyway.

    So we agree it is a problem.:)

    You just get the ones who are in denial about it. ;) Kinda like my friend who is a flight surgeon in the Navy where there's a rule that you can't be on antidepressants and fly airplanes. Consequently, she sees any number of pilots in denial about their depression who continue to fly jets.

    I feel there is no need to open the Pandora's Box, lot of controversial stuff including high rate of Divorce, suicide amongst residents have been discussed here (search old posts). Not sure that data/ study was skewed due to the inclusion of people with diagnosed Axis I entering Residency.

    Like I said, I don't think having a psych dx precludes someone from being a psychiatrist.

    Doing surgery if you had appendectomy or your friend died of perforation is altogether different from doing Psychiatry if you have attempted suicide or have been abused in the past or have anxiety disorder. Counter transference is a known occurrence with Psychiatry.

    Well if someone still wants to do it, then surely there is no stopping. But it is a good idea to be aware of the possible risks.

    But I would hope that the person knew they had it and had gotten (or was in the process of getting) it treated. The ones who have untreated psych stuff and are in denial about it are the ones who scare me.

    You are reconfirming your fear !

    To later on develop or being diagnosed with some disorder is a different story altogether. ‘Untreated Psych stuff' sounds like some Axis II possibility, though there are some very high functioning Mania patients.

    IceMan007 All the best, hope you make an informed decision. BTW I will recommend Psychiatry over surgery any day. :)
     
  12. hippiedoc13

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    I disagree with drawing the line at Axis I. There are some Axis I disorders that would concern me less, and some non-Axis-I disorders that would concern me more.

    Depression and anxiety disorders are Axis I, and I don't think a history of one of those disorders necessarily precludes practicing psychiatry (or any other specialty)--depending of course on the severity and how successfully they have been treated. A history of bipolar disorder or a psychotic d/o would seriously concern me, and that's where I'd draw my line.

    I'd also have serious concerns about someone with certain Axis II disorders practicing psychiatry. I think it's important to remember that Axis II disorders are not "lesser" disorders than axis I.

    As has been argued on these boards many times, an individual who has experienced and successfully dealt with psychiatric illness could bring tremendous insight and empathy to the practice of psychiatry--but it depends on the individual and the specifics of the situation.
     
  13. whopper

    whopper Former jolly good fellow
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    IMHO if someone has a past history of mental illness, that should be no reason to hold it against the person, SO LONG AS THEY CAN DO THEIR JOB & HANDLE THEIR RESPONSIBILITIES.

    That being said, most programs I've seen have a horror story or 2 of a resident who suffered from a psychiatric disorder & wreaked havoc.

    I have come to a personal theory that several with bipolar or a psychotic illness have had their first break during medschool & were able to manage to graduate despite their illness.

    Then during residency, got into psyche--which these types chose because they had a psychiatric illness & wanted to better understand their own illness, and because with such an illness, they were hoping to be side by side with people who may have increased awareness & empathy over such an illness.

    However from my own experience I don't think many psyche programs are open to such candidates.

    Why?

    During my interviews for residency--several programs asked if I had an Axis I in an interogational style. I told them "no" (I don't have any axis I unless I happen to be a schizophrenic who falsely believes I am the Chief Resident, sees hallucinations of my Ohio Medical & DEA Liscence, has a hallucination of a Prius that I drive to work in & is in a folie-a-deux situation where my wife also believes I'm a psyche resident.)

    I asked what would spark such a question.

    The typical answer: "you took a year off from medschool, we got lots of residents who turned out to be mentally ill who had their first break in medschool & took a year off".

    Several programs never said it but they gave the impression they didn't want mentally ill people. One particular program did mention they didn't want mentally ill residents. I found this somewhat hypocritical given that there are several psychiatrists (and other doctors) who have had a mental illness & still able to practice effectively. I actually believe it is a form a job discrimination.

    However, so be it-it is what is is and I cannot change the world.

    (Anyways-the real reason why I took a year off was to make money & date women. Call that an Axis I if you'd like, I call it being a guy in my 20s who wanted to experience life a little.)
     
  14. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Judging from your avatar, you must have succeeded! :laugh:
     
  15. Faebinder

    Faebinder Slow Wave Smurf
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    Personally, I dont think someone with Axis I or II disorders should become a psychiatrist. Many other fields are way more tolerant including Family Medicine and Internal Medicine. I feel that psychiatry requires more insight than the other fields to complement the clinical experience. You might not see an abnormal thought or mood if you yourself have it.

    Just my two cents.
     
  16. whopper

    whopper Former jolly good fellow
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    You'll get no criticism from me Faebinder. I have seen residents with an Axis I wreak havoc on their patients & colleagues.

    I do though totally agree that a doctor with an Axis II Cluster B disorder should not be in the field, and if so, should be seeking therapy for their disorder. Last thing anyone needs is a doctor showing up to work with a belly shirt and making sexual advances on patients.

    Actually happened in my program--a resident with Histrionic DO did that. She was later removed from the program--after a trail of destruction.

    As many already know, 2 Axis II Cluster B people do not mix well. They either are at each other's throats or they're loving each other so much its also destructive. A Cluster B doc with a Cluster B patient spells disaster. IMHO, not letting someone with an Axis II Cluster B disorder is not job discrimination because its preventing someone with characteristics that you don't want for the job anyways that is within their legal responsibility.

    As for my avatar, common. What's wrong with the Hoff wearing some black speedos & a leather jacket? Don't mess with the Hoff.

    http://www.ebaumsworld.com/pictures/view/67110/
     
  17. sunlioness

    sunlioness Fierce. Proud. Strong
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    I would add that there are probably several excellent psychiatrists with Axis I or II disorders (even cluster B), which they have worked on or are working on, but because they are doing so it isn't immediately obvious that they exist. Yes, it is absolutely inappropriate to wear a belly shirt to work and hit on patients. But that doesn't mean that just anyone with a possible cluster B diagnosis shouldn't be in the field if they have gotten themselves treated and aren't wearing belly shirts to work. Also having mental health issues does not equal having no insight. In some ways, a person who has dealt appropriately with their illness could reasonable expect to have more insight because they have walked that path themselves. No, a person in the middle of a manic episode should not be seeing patients. BUT a person with well-managed bipolar disorder would have a lot of insight into what it's like to be manic.
     
  18. PeeWee137

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    this thread is so interesting. on a slight tangent, i heard many addiction specialists discuss this subject. some say the recovered addict makes a great dr because of their insight, others say they lose empathy because they've been through it and were able to overcome it. i guess it really is person-dependent.

    whopper and faebinder - just curious on your thoughts of kay redfield's jamison's story. we all know that now her illness is very well controlled, but what would have you done way back when if you were her colleague and she was manic?
     
  19. Faebinder

    Faebinder Slow Wave Smurf
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    A colleague who gets mania and still wants to be a psychiatrist? The scenario is so hard. I will admit that the scenario is highly influenced by whether the program likes the resident or not.

    Medicine is not all roses sadly. I'd go out of my way to support a colleague though, including taking over some shifts but there might come a time where they would need to sit down and assess if they can continue. This attitude might not be shared by other residents/attendings as well, so it's highly program dependant.
     
  20. whopper

    whopper Former jolly good fellow
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    As I mentioned before, I got no problem with a resident or attending with an Axis I where it doesn't interfere with their responsbilities.

    But if it does?

    They should seek help, tell their bosses that due to their medical issues they need to address how that would address their responsibilities so the department can do what it can to accommodate them. The person need not spell out every single detail of their illness.

    In short, I agree with the Americans with Disabilities Act.
    http://www.eeoc.gov/types/ada.html
    However IMHO this should not extend to those Axis II disorders.

    E.g. guy with antisocial personality disorder is caught stealing $500 from the job? That employer has every right to fire that guy & call the cops on him. The guy's ASPD bears no defense or excuse.
     
  21. IceMan007

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    I'm extremely ignorant about psych disorders, but if the definitions are strictly applied wouldn't just about everybody be diagnosed with a psych disorder or a mild form of one? I mean if you lost a parent and were down for a while, does that mean you have an Axis I? I guess I'm worried that I'm talking myself out of considering psychiatry due to have some "depressive" tendencies that may be common to just about every human being, thus being perfectly normal.

    Another question for you psych residents. Do you actually find yourself out of a clinical setting, perhaps at a social gathering, examining people's behavior and analyzing them? My girlfriend is a dental student and she says she can't help but look at people's teeth all the time when speaking to them. So do you psych residents experience something similar?
     
  22. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    The DSM-IV is a medical model and uses a polythetic diagnostic system. That is, there is a list of symptoms, and you have to have a certain amount of them for a specified period of time to reach the "clinically diagnosable threshold." (i.e., 5 out of the 9 diagnostic symptoms over X period of time). These criteria are not blindly applied. There is some amount of clinical judgment in psychodiagnosis (although interater reliability using structured interviews is decent for most major disorders). Additionally, in order to be diagnosed as a disorder, the symptoms must cause significant impairment in social or occupational functioning (for most disorders anyway). Obviously the nosology of mental illness is more complicated than this, but this is how diagnosis is currently done. DSM-V, due out in 2012 will likely modify this to some degree, but no one is expecting it to be totally dimensional diagnostic system, versus the categorical system currently in use.

    And those suffering from bereavement or the expected psychological reaction due to the loss of a loved one or a tragic event would not necessarily qualify for depression. A clinical depression would only be diagnosed if symptoms persist longer and/or to a greater degree than what is expected. This can be a gray area at times (and require subjective clinical judgment), but most of this comes down to the time specifiers and severity of symptoms (ie., adversely effecting social or occupational functioning). So the short answer is that while many of us might have certain symptoms or characteristics of disorder, that certainly doesn't automatically qualify us as having a disorder. I find that people in psych are more psychologically insightful than the average lay person, but I do not find myself analyzing or attempting to diagnosis people in social situations for the most part. Unless you happen to be heavily psychodynamic in your orientation, I doubt you would consider yourself to be "analyzing" anyone. Sometimes, you just can't help it though...lol
     
  23. Shalom77

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    The lifetime prevalence of DSM diagnoses in the US population is close to 50%. So psychiatric disorders are very common in the population.


    In terms of licensing, it varies by states. Some states don't ask. Others only ask about history of disorders that would impair one's ability to practice medicine. A few do ask about any history within a certain period of time (?maybe a few have no time limit?) You really have to look up the applications for the states you think you might end up in.

    There length of time between premed and when one applies for a license is a long time and I think the personal (and professional) benefits outweigh the risks of dealing with one's issues. Some people recommend paying out of pocket for any therapy. If you are paying cash - and doing it for personal wellness not to treat any specific illness - and you pick the right therapist you can avoid any potentially detrimental diagnostic labeling.

    I think it's a little premature to worry about this. It's very common to change specialty interests while in med school. During med school rotations you do get a sense of how you are affected emotionally by certain patients/problems. I found the rampant depression in primary care (at least 25% of all the people I saw) affected me much more emotionally than anything on my psych rotation. I find it pretty humourous that anyone would think that primary care would be less stressful psychologically. There are a tremendous amount of psych issues in primary care with less time and reimbursement to deal with them. But in any case everybody reacts differently to different fields. I loved surgical oncology which some of my classmates/colleagues found too "depressing."

    I'd approach med school and rotations with an open mind and don't worry too much or rule anything out. And I really would recommend doing what's best for you and not let the fear of stigma and discrimination keep you from dealing with any stuff. Countertransference isn't just an issue for psychiatrists and I think having worked through things can make one a better physician.

    Obviously from comments on this thread discrimination and stigma are alive and well. I'm still dismayed about the extent and depth of stigma within the medical profession. But there's really no way for residencies to find out about mental health issues unless you tell them about it or perhaps if you've taken some kind of medical leave for them. A little counseling on the side as a college or medical student will not hold you back. Unresolved issues might though and if you think they are significant enough to affect your specialty choice I think it's worth dealing with them.
     
  24. Chrismander

    Chrismander Junior Member
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    what's the equivalent sartorial presentation in a male doctor? a leisure suit & shirt open to about the nipple line with a big gold chain or two? Or (god forbid) have you seen male Cluster B docs show up to work bareing their midriffs like they're Hannah Montana??
     
  25. whopper

    whopper Former jolly good fellow
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    Only close to equivalent acts I've seen in male residents--

    One resident (Ob-Gyn) had intermittent explosive disorder. The guy blew up regularly at medstudents working under him. The guy even blew up at attendings, though much less. He was kicked out of a previous program. IMHO he should've been kicked out of the one he was in but wasn't. They did though make him stay a year longer & then on top of that the program was being phased out so he was the last resident & was working as if he was a 1st year even though he was in his last year.

    Another-in fact another guy in my own program who was "let go", the guy kept complaining about how he hated psyche & thought everything was BS-everything, psyche or not. The guy had a big chip on his shoulder which I thought might've been cannabis induced because as a medstudent he was a very good guy, then right after he graduates--he made a very sudden change of personality. He started to complain excessively about everything & from time to time make an inappropriate comment. (e.g. meets someone for the first time & calls the person a "*****"). He was specifically removed because he refused to come to work for several days (not because he was sick, he just didn't feel like going), which at the most extreme can be considered negligence since there were patients that he was expected to care for.

    Exactly why I mentioned that Axis II disorders should not be excused should that disorder's sx's interfere with a doctor's ability to perform his/her duties. There are various legal standards on judging whether someone with a psyche disorder should be held responsible for their actions. In general, and making this somewhat simplistic to avoid making this post too long, so long as a person has the ability to know right from wrong, that person is held responsible. E.g. someone with an Axis II Cluster B, if that person acted inappropriately in a manner that was consistent with their dx, well that person really does not have a legal defense because those with those disorders are still in full cognitive control & capacity to understand what they're doing.

    You can't let a murderer go free because that murderer has Antisocial Personality Disorder (another Axis II Cluster B). You can however find someone with schizophrenia who murdered because that person thought he was defending himself against a demon not guilty by reason of insanity because the person couldn't tell at that time.

    Axis II cluster B people IMHO do of course deserve support & should seek treatment but part of that treatment is that they have to be held responsible for what they do. Treating patients as a medical doctor is supposed to be a sacred, honored profession that imposes high standards of responsibility on physicians. This isn't basket weaving or flipping burgers. You can't excuse someone in the profession if they can't fulfill their obligations & perform standard of treatment care who is in full control & capacity to know their responsibilities.
     
  26. Faebinder

    Faebinder Slow Wave Smurf
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    Hey!!! That's my Halloween Pimp Custome!

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  27. Chrismander

    Chrismander Junior Member
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    ack, just to clarify before the flamewar erupts, i was (jokingly) asking about the *sartorial* (i.e. clothing, from the Latin sartor meaning "tailor") equivalent for males of a mid-riff baring Cluster B female. like if there's some male version of inapproriate mid-riff baring (my best guess is exposed chest hair).

    not implying in any way that male residents are less crazy than our female counterparts.
     
  28. nancysinatra

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    Well, there most certainly must be a role for the polyester pantsuit, preferably the white one! However--and since I am but a lowly med student here, don't hate me if I'm wrong about this--but doesn't it seem like psychiatrists tend more in the Cluster A direction, sartorially speaking? I'm thinking of your out-of-date, light blue suit, your beige footwear, your seersucker anything--general weirdness along those lines. And for women of course, what comes to mind is brown flowey garments and large, useless medallion jewelry that bespeaks a connection to a life beyond, intentionally or not. (Ok, I've only seen these things in movies about psychiatrists. But I did have an attending once show up to a patient-interviewing class decked out entirely in golf attire. He even mentioned his golf get-up at one point, in a weird, self-referential way that had a slight schizotypal air to it. I remember thinking, "is this magical thinking? Does this guy think he's a golfer, even though really he's an attending?" But I guess he was going golfing afterwards.)

    Now here's a question: if someone just dresses a little strangely--say a bit on the wild side, but other than that they're a super low key person--would that still be considered a Cluster B "trait" by psych people, even if their choice of clothing does not really spring from an underlying wildness, but just some fashion waywardness? Personally, I don't think I dress strangely, but after reading so much about "stigma" and about how Axis I and II people and their "moods" and "traits" are perceived by psychiatrists, it's really gotten me worried that every little thing I do could be interpreted as having some meaning that I myself am completely oblivious to! Lord only knows how I will be judged when I have to start residency and reveal to the world that I do not own a SINGLE nondescript, brown flowey outfit! I guess what I'm saying is, how can anyone be neutral enough that they please people around here?! ;-)

    Seriously, I can't believe all this concern is not just a bit overblown. In real life, I never hear people talk so much about "stigma" and mental illness as I do here on SDN! I know it's out there, but in real life conversations, I notice there is more reluctance to generalize, and more talk about empathy. And these stories about psych residents showing up in hot pink crop tops or the like--I mean, how often are psychiatry jobs REALLY lost (or gained?) over things like that? I have to believe it's the exception.

    Now I can understand having concerns about working with certain individuals or exposing patients to them. To make a generalized statement about an entire Axis--that seems a bit extreme!

    Also, if we ban Axis II from medicine, who will go into Ob/Gyn? (Sorry, I don't mean to offend, I just can't help it.)
     
  29. Chrismander

    Chrismander Junior Member
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    i hear seersucker is making a comeback (seriously).

    but yeah, i totally agree with your point about empathy/stigmatizing. psychiatry has a reputation for being less tolerant of mental illness. but at the same time lots of shrinks are quirky and "different" and are tolerated as long as they do their jobs well, so it's complicated. we've seen the range of responses in this thread, which probably gives a good sense of the wider world--some folks are very supportive of a resident with depressive tendencies, some think any hx of any behavioral disorder should be a disqualifier to be a psychiatrist, and a lot of folks feel conflicted about the issue.

    i got the thread off-topic, but the original point was very valid--people with strong cluster B traits often dress inappropriately. "inappropriate" here being a euphemism for "seductive/overly revealing", and having nothing to do with overall fashion sense or the quality of someone's clothes. it's relevant here because psychiatry has more boundary issues to be aware of than other fields of medicine.
     
  30. eforest

    5+ Year Member

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    This thread is really interesting. As someone with mental illness, I'm shying away from psychiatry even though I find it interesting. I tend to over identify with patients.
     

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