My choice of residency changes when I take my ADD medication

[l0st1]

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Here is a bit of a strange thread, apologies in advance.

I'm a third year medical student and I have been spending hours every day researching various fields for residency so that I can make a decision and narrow my focus.

I have a passion for psychiatry, I possess innate skills that I believe would make a great psychiatrist and have been told previously by friends, family and attendings. I do however have the regular doubts and worries about the future of the field and most importantly my future in the field. After much reflection, I've come to the conclusion that psychiatry is a selfish choice for me due to its great lifestyle- as it would allow me a lifetime of freedom of thought and intellectual enrichment which would be challenging to achieve in other fields. I have quite a few philosophical questions about life and the mind that I believe I would be able to find answers to (or at least try) as a psychiatrist.

On the other hand, I view fields such as IM, peds or FM as fields where my work satisfaction would be primarily derived from providing a lifetime of service to others. I don't believe I would be as intellectually fulfilled in these fields, but I would feel good about myself for giving my time and energy to help others. During rotations, I find the majority of the workup of these patients to be very mundane, memorizing best practices to be regurgitated during rounds and correcting electrolyte abnormalities of a diabetic patient seems extremely uninteresting to me.

Not to say that I don't believe psychiatrists provide a service to those in need, because they certainly do. However, during psych inpatient rotations, I did not always feel that my time and energy resulted in proportional results in my patients in the psychiatric ward. I would imagine this would require many months and perhaps years before results, if any, are seen.

Having said this, I was prescribed Adderall last year- I was not diagnosed with ADHD but tried it as it was deemed worth a try based on my presenting complaints to my psychiatrist. When I am on Adderral, I find that I have a passion for medicine (IM, peds, etc). Everything that seemed mundane and tedious becomes interesting and actually intellectually satisfying to pursue, and I feel like I can finally compare myself to some of my classmates or even residents who are pursuing these medical fields for the "intellectual satisfaction", etc. The structured thinking that I so despite otherwise, turns into a supportive playground where I can think about diagnosis, treatments and investigations. All of a sudden, life long learning of medical facts and best practices doesn't seem like hell anymore.

When in my sober, although caffeinated state, I am bored during medicine rounds, and my sights become completly set on psychiatry as it would keep me interested and would not limit my thought processes- as internists are trained to think in such a rigorous and linear ways to reach a diagnosis and management plans.

I am sharing this to probe whether my experience may be shared by others who are currently contemplating a choice between medicine and psychiatry, or those who have selected psychiatry and are looking back on that choice. Additionally, as practicing psychiatrists who prescribe Adderall and have a better understanding of its effects than I do, is this a typical experience?

 

[F0nzie]

Not sure psych would answer your philosophical questions about life.

Continue to treat your ADHD and go into internal medicine.

 

[Mass Effect]

Adderall doesn't necessarily make you like medicine. It makes you like everything. That's why people like it. Someone without ADHD who takes Adderall would likely find laying bricks fascinating. You can't count on Adderall to get you through a 30-year career if you don't like a field, especially when you don't have a diagnosis of ADHD (which makes me wonder why you were prescribed Adderall in the first place if you don't carry such a diagnosis?). Choose the field you like without the influence of medications that are questionable (in your case) at best.

 

[wolfvgang22]

Having said this, I was prescribed Adderall last year- I was not diagnosed with ADHD but tried it as it was deemed worth a try based on my presenting complaints to my psychiatrist.

You don't have ADHD but it was "deemed worth a try"? Worth a try of using an academically performance enhancing drug to get you through med school? 😎

 

[birchswing]

The first psychiatrist I saw (back in 1998 or so) thought the only way you could diagnose ADHD was to see what effect a stimulant had on a person. He took me off of Ativan (which in retrospect would have skewed the results) and put me on Aderall for a one-week trial. My results were mixed. I felt less anxious in many ways--I could sit still and listen and I actually had two AP tests that week and didn't have to leave, which I had previously had to do during testing, and scored well on both. But on the other hand, I felt a nervousness and shakiness that was different than what had previously been described as panic—it wasn't as bad. I would call it extreme jitteriness. I felt better in one way and worse in another. Now so many years later I realize that there was no way to isolate the effect of stopping the Ativan. Looking back at my history (my panic started with me being panicked in class and having to run out frequently), I feel like ADHD should have been more strongly considered. I was already taking college classes in 9th grade and I think the assumption was that you couldn't start manifesting ADHD if you had been this superstar student up until then. That my symptoms were described as panic makes less sense in retrospect given that they occurred on a schedule--it was every day as soon as class started. My current psychiatrist thinks that it's impossible to re-assess and diagnose until I'm completely off the benzos. Anyhow, going back to the story, the reason the psychiatrist didn't want me to continue on the Adderall was that there was one day I walked into the garden behind our house. And it was sunny and beautiful out. And I just sat there on the ground, which I had never done before. And it wasn't like I was completely at peace--it was like I saw a sliver of peace, like I felt better but still jittery. Anyway, I related this story back to him and I used the word euphoric, but I described how it was euphoric but not really. He didn't like that and said people with ADHD don't feel euphoria on Adderall.

It seems from this board that there are more sophisticated ways of testing whether someone has ADHD than trying an ADHD med. Back then the thinking was that a person with ADHD would paradoxically "slow down" on a stimulant whereas it would make a person without ADHD feel agitated. Or I guess in my case euphoric (though I never actually was--he just pounced on that word and made his decision based on that).

 

[HarryMTieboutMD]

Here is a bit of a strange thread, apologies in advance.

I'm a third year medical student and I have been spending hours every day researching various fields for residency so that I can make a decision and narrow my focus.

I have a passion for psychiatry, I possess innate skills that I believe would make a great psychiatrist and have been told previously by friends, family and attendings. I do however have the regular doubts and worries about the future of the field and most importantly my future in the field. After much reflection, I've come to the conclusion that psychiatry is a selfish choice for me due to its great lifestyle- as it would allow me a lifetime of freedom of thought and intellectual enrichment which would be challenging to achieve in other fields. I have quite a few philosophical questions about life and the mind that I believe I would be able to find answers to (or at least try) as a psychiatrist.

On the other hand, I view fields such as IM, peds or FM as fields where my work satisfaction would be primarily derived from providing a lifetime of service to others. I don't believe I would be as intellectually fulfilled in these fields, but I would feel good about myself for giving my time and energy to help others. During rotations, I find the majority of the workup of these patients to be very mundane, memorizing best practices to be regurgitated during rounds and correcting electrolyte abnormalities of a diabetic patient seems extremely uninteresting to me.

Not to say that I don't believe psychiatrists provide a service to those in need, because they certainly do. However, during psych inpatient rotations, I did not always feel that my time and energy resulted in proportional results in my patients in the psychiatric ward. I would imagine this would require many months and perhaps years before results, if any, are seen.

Having said this, I was prescribed Adderall last year- I was not diagnosed with ADHD but tried it as it was deemed worth a try based on my presenting complaints to my psychiatrist. When I am on Adderral, I find that I have a passion for medicine (IM, peds, etc). Everything that seemed mundane and tedious becomes interesting and actually intellectually satisfying to pursue, and I feel like I can finally compare myself to some of my classmates or even residents who are pursuing these medical fields for the "intellectual satisfaction", etc. The structured thinking that I so despite otherwise, turns into a supportive playground where I can think about diagnosis, treatments and investigations. All of a sudden, life long learning of medical facts and best practices doesn't seem like hell anymore.

When in my sober, although caffeinated state, I am bored during medicine rounds, and my sights become completly set on psychiatry as it would keep me interested and would not limit my thought processes- as internists are trained to think in such a rigorous and linear ways to reach a diagnosis and management plans.

I am sharing this to probe whether my experience may be shared by others who are currently contemplating a choice between medicine and psychiatry, or those who have selected psychiatry and are looking back on that choice. Additionally, as practicing psychiatrists who prescribe Adderall and have a better understanding of its effects than I do, is this a typical experience?

Is this actually a serious post?

 

[675015]

As others have alluded to above if:

1. You think psychiatry will answer your questions about life, you may be disappointed.
2. You have untreated ADHD, then the answer is clearly internal medicine.
3. You have a propensity to abuse prescription drugs to do better academically, then psychiatry might not be the best field for you.

 

[skunky386]

According to several attendings I've worked with, there is this pervasive notion among generally older generation psychiatrists that stimulants for "true add" should not cause anxiety and/or happiness/contentness. This is a false notion and there is no data to support it.

It's up to the OP to determine if he wants to be pharmacologically treated for ADD or not, and if he is happy with the way stimulants affect his personality and interests. If the OP can only function in a career in IM by being on stimulants, then that is something to consider in your career choice. Stimulants boost executive function in general, not just for people with ADD: increased goal-oriented behavior, decrease impulsivity, etc...so keep that in mind if you choose a life on stimulants...there are drawbacks to stimulants. In general, people who place a higher value on a personality that is spontaneous and whimsical don't choose stimulants as an option due to its diminishment of these aspects of cognitive functioning.

What you are describing does not sound like frank euphoria by the way. Also, have you ever seen a psychotherapist trained in treating adult add? Might be worth a shot.

When someone says "true ADD", what are they basing that off of? DSM criteria? As a whole we are moving away from strict DSM criteria in diagnosing and treating psychiatric disorders in general, and moving more towards core behavioral areas with symptomatic treatment targeting those areas. Likely it won't become a question of are you add or not, but rather, how add are you and how is that positively or negatively influencing your life, along with how much do you want to put up with medication side effects and therapy. As a society we'll likely have to draw a line in the sand somewhere and say that those falling on one side are symptomatic enough to warrant treatment and those on the other aren't, though there will be significant overlap and where to draw that line will be highly debated.
http://www.nimh.nih.gov/research-pr...rch-domain-criteria-rdoc.shtml#toc_background

Stimulants are great for alot of things, not just "true add"...decreasing the impulsivity for drinking in recovering alcoholics, the discontent and restlessness in the child with oppositional defiant disorder, the sleepiness in the patient with obstructive sleep apnea refractory to airway optimization, narcolepsy with and without cataplexy, countering the cognitive impairment secondary to anti-epileptics and antipsychotics, and there is even data to support its use as an adjunct to SSRI's in the treatment of patients with OCD (though I'm a little skeptical about this last one).

Psychiatry can likely help you come closer to answering questions about life than any other field of medicine. A key component to providing good psychotherapy to a patient is understanding counter-transference, and in order to understand that, one needs to explore themselves first. This has unfortunately been going by the wayside as psychoanalysis & psychodynamics has fallen in popularity in comparison with the more cost effective and easier to teach, standardize, research, and implement CBT/DBT paradigm. However, there are still several psychiatry residency programs generally in the larger cities and big-name academic centers that have strong associations with psychoanalytic groups and strongly encourage their psychiatry residents to take part in evening training courses which also involves one's own personal psychoanalysis.

 

[wolfvgang22]

Also, I hear steroids are great for muscle mass. /s

 

[Jorje286]

You will benefit your patients most in the field you're more passionate about. A care for the patients certainly matters, but I think most people who excel in their field (medical or otherwise) also derive very selfish intellectual satisfaction from the actual substance. Nothing bad about that, cause passion ultimately is the biggest driver and it is better of course, if you can make it work in a synergistic manner with patient care. You seem to be a lot more passionate (and talented) in psychiatry, whereas your liking for internal medicine seems very context and mood-dependent. The answer is obvious (for me).

 

[skunky386]

You will benefit your patients most in the field you're more passionate about. A care for the patients certainly matters, but I think most people who excel in their field (medical or otherwise) also derive very selfish intellectual satisfaction from the actual substance. Nothing bad about that, cause passion ultimately is the biggest driver and it is better of course, if you can make it work in a synergistic manner with patient care. You seem to be a lot more passionate (and talented) in psychiatry, whereas your liking for internal medicine seems very context and mood-dependent. The answer is obvious (for me).

I very much agree with this, if I was in your shoes I would definitely go for psychiatry. It's great to not rush into decisions and use some cognitive forethought, planning, analysis...but when your heart and head are telling you the same thing, you're golden. If it takes an artificial reward like amphetamines to make you find any interest internal medicine, then the clear choice is to go into psychiatry. The positive-reinforcement nature of stimulants won't last you an entire career in a field you don't have a passion or desire for at baseline.

 

[l0st1]

Thank you everyone for your replies and I apologize for the delay in posting mine. Some asked if my post was serious, absolutely! I've been pondering and researching this question for months now and it's incredibly valuable to get your opinions here.

Some have questioned my decision to try ADD medication, I would really rather not divert the focus of the thread toward the ethics of using stimulants but I thought skunky386 did a great job of summarizing my own view on the matter.

About my belief that psychiatry would allow me to find answers to philosophical questions, I suppose that I didn't mean that I would actively find these answers in my day to day practice. I think I meant that I would at the very least have more free time to read non-medical literature that may hold my answers. Additionally, I believe studying and analyzing human behavior and the mind may provide me with philosophical insight that I would not otherwise have (if I was a cardiologist for example). I of course could be wrong about this as you are the practicing psychiatrists and I'm the medstudent. Almost everything that I "assume" about a future life as a psychiatrist is derived from my 6 week rotation, these message boards and documentaries/films.

As for others who've said that the choice is clear: go with the field where you don't need stimulants to be happy, I will say that that view has not always been clearcut for me. I have long felt that I should go toward the more challenging field rather than taking the easier route. I believe our pre-med and medical student training play a large role in this sort of thinking, wherein I almost feel some guilt over choosing a field such as psychiatry where I feel like the workload is less, and there is less of a "cognitive burden" on me. I did not use stimulants in order to gain an upper hand or a permanent crutch, I have rarely used it and only to gain an understanding of my abilities and thus try to elevate my executive functions to that same level without medication. I've found that good sleep and exercise habits can actually simulate the effect of Adderral to some extent and certainly without the side effects and other downsides. So it is possible to enjoy a field like IM without medication but it requires great discipline and time management skills that I do not possess and have not been successful at learning (despite many attempts).

 

[l0st1]

I will ask another question that's been on my mind lately..

Is it possible to have a simple "uncomplicated" life as a psychiatrist? I worry that if I go into psychiatry, I will overcomplicate everything in life. I will have free pass and in fact be trained to analyze everyone and everything and frustrate my wife and family. Is there an off switch? Is it possible to practice psychiatry in a clean manner, akin to say- any other field in medicine, and do psychiatry as just a job. Or is it likely to change me into a complicated overanalytic hyperintellectual?

Views from both sides would be appreciated.

 

[birchswing]

I will ask another question that's been on my mind lately..

Is it possible to have a simple "uncomplicated" life as a psychiatrist? I worry that if I go into psychiatry, I will overcomplicate everything in life. I will have free pass and in fact be trained to analyze everyone and everything and frustrate my wife and family. Is there an off switch? Is it possible to practice psychiatry in a clean manner, akin to say- any other field in medicine, and do psychiatry as just a job. Or is it likely to change me into a complicated overanalytic hyperintellectual?

Views from both sides would be appreciated.

I try not to be bad, but as a patient this comment made me laugh. Psychiatrists IRL are not like Frasier. Psychiatrists don't overanalyze (in my experience, I'm lucky if they express a bit of curiosity). Ideally, they take a lot of information and make it simpler, not more complex. If they're good at doing that, they can be helpful. I know there are psychiatrists who still do various non-medication therapies and psychoanalysis, but for the most part it's about picking a drug. The things you're thinking are important are what the patient thinks are important. The psychiatrist looks at the process not the content. That may be an oversimplification, but remember they are coming at this from a medical model and applying it to human behavior. I would guess if you went into psychiatry you would probably become the opposite of what you're worried about. I have seen callous and indifferent psychiatrists; I have been ones who are brazen and arrogant. I've never seen one who is neurotic, though (except on TV, a la Frasier).

EDIT: I wanted to edit to say that I felt bad after posting this about making fun. I actually think someone like you would make a good psychiatrist, provided you had a good amount of time to spend with each patient. In my opinion, psychiatry needs more real human-like people. As odd as that sounds, I've come across a lot of very uncurious "turned off" psychiatrists. I think it's partially the amount of patients they see in a day. You always hear that people go into psychiatry because they have their own issues. I personally haven't seen that. In fact, I would say it's the opposite, with people who seem a little too detached from the human side of things. So that is to say that I don't personally see your hand-wringing as a negative. You do perceive that the over-intellectualizing you're worried about in the future is already a present thing? I love it, though. I'm a neurotic type myself and get along well with other people who are hand-wringers. I like to sweat the small stuff. I get annoyed when people brush over details. So, that's why I wanted to go back and edit my post to say that the very characteristics you're worried about having in the future seem to be ones you already have and that IMO they make you more human and probably a better psychiatrist. Having said that, it seems like people are changed by training, so who knows how you'll see things after that.

 

[sunlioness]

I will ask another question that's been on my mind lately..

Is it possible to have a simple "uncomplicated" life as a psychiatrist? I worry that if I go into psychiatry, I will overcomplicate everything in life. I will have free pass and in fact be trained to analyze everyone and everything and frustrate my wife and family. Is there an off switch? Is it possible to practice psychiatry in a clean manner, akin to say- any other field in medicine, and do psychiatry as just a job. Or is it likely to change me into a complicated overanalytic hyperintellectual?

Views from both sides would be appreciated.

If I may say so, it sounds like you're over complicating things now. And your impression of psychiatry seems to be based largely on stereotype. You also seem to not have a ton of respect for the field, which is off putting.

Psychiatry is not inherently easier than internal medicine. (And I started out in internal medicine.) Not if you want to be any good at it anyway. That doesn't mean it can't seem so if you truly enjoy it and derive pleasure from your work. That's a good thing. Would you want to see a doctor who genuinely looks forward to going to work every day of one who finds it tedious but is doing so to satisfy some personal idea of what constitutes real medicine?

Psychiatrists aren't analysts going around stroking their beards and asking people about their mothers. But to answer your question, yes, sometimes it's hard not to take work home and to view life through the lens of one's training. But you can achieve work life balance and this is not something unique to psychiatry. I had friends who did peds who would sometimes forget that there are healthy children. It happens.

 

[hamstergang]

I want to second everything sunlioness said, and I'll say it again to emphasize it.

I have long felt that I should go toward the more challenging field rather than taking the easier route. I believe our pre-med and medical student training play a large role in this sort of thinking, wherein I almost feel some guilt over choosing a field such as psychiatry where I feel like the workload is less, and there is less of a "cognitive burden" on me

It's certainly possible to practice psychiatry in a way that is less challenging and less of a cognitive burden, but that would be practicing bad psychiatry. Something I try to emphasize to all the students I get is that psychiatry IS a medical specialty, and when you are mindful that it should be practiced in a medical model, you realize it's not so different from other specialties.

I will have free pass and in fact be trained to analyze everyone and everything and frustrate my wife and family. Is there an off switch? Is it possible to practice psychiatry in a clean manner, akin to say- any other field in medicine, and do psychiatry as just a job. Or is it likely to change me into a complicated overanalytic hyperintellectual?

It's a little weird that above, you said psychiatry had less of a cognitive burden than IM, but now you think that psychiatrist are hyperintellectuals. Anyway, yeah, this isn't what we do. People ask all the time if I'm analyzing them, and I want to ask them what that even means. Like, learning psychiatry is not some magical power that allows us to see into your soul at a dinner party. If you were my patient and I got to ask you questions to obtain a thorough history and understanding of current issues, I could come up with a formulation for your current discomfort, but these aren't questions I'm asking friends/family/strangers outside of work. Would an IM doc hear you cough and then know your diagnosis? It's not different than that.

 

[sunlioness]

So true. I've been on dates with guys who ask, "So are you analyzing me right now?" when they find out what I do. I have no clue what that means either. I like the cough analogy.

Or sometimes even in the hospital people expect you to be psychic. I've gotten the occasional consult wanting me to tell them if the patient is lying. I mean, sure. There are instruments that can be used to ferret out malingering, but I think sometimes I'm expected to just look at a patient and know.

 

[dl2dp2]

wherein I almost feel some guilt over choosing a field such as psychiatry where I feel like the workload is less, and there is less of a "cognitive burden" on me

I would say general psychiatry is not easier (but perhaps not significantly harder) than primary care. If you want more complex cases, subspecialty psychiatry (i.e. addiction, child, forensic) is generally much more interesting (IMHO than primary care) and presents significant "cognitive burden."

 

[birchswing]

So true. I've been on dates with guys who ask, "So are you analyzing me right now?" when they find out what I do. I have no clue what that means either. I like the cough analogy.

Or sometimes even in the hospital people expect you to be psychic. I've gotten the occasional consult wanting me to tell them if the patient is lying. I mean, sure. There are instruments that can be used to ferret out malingering, but I think sometimes I'm expected to just look at a patient and know.

Isn't this because traditionally psychoanalysts were psychiatrists? I know that today most psychiatrists are not psychoanalysts, but of the people who do practice psychoanalysis it seems that all (that I have come across) are psychiatrists. And you still see depictions of analysis on TV. So I would imagine people who haven't experienced the very busy world of psychiatry aren't wrong in their impression of connecting analysis and psychiatry, it's just that the impressions are based on the wrong decade or geography (for example, New York City).

 

[hamstergang]

So I would imagine people who haven't experienced the very busy world of psychiatry aren't wrong in their impression of connecting analysis and psychiatry, it's just that the impressions are based on the wrong decade or geography (for example, New York City).

Connecting psychoanalysis and psychiatry is one thing, but that's not the same as saying that a psychiatrist is 'analyzing' someone in everyday conversation. Like, the mistake isn't in thinking that psychiatrists do psychoanalysis, it's in thinking that psychoanalysis is something that happens in regular conversation.

 

[HarryMTieboutMD]

To the original poster, you should really combine all three of your posts in this thread, unedited, and make that your personal statement for whichever specialty you choose.

 

[birchswing]

Connecting psychoanalysis and psychiatry is one thing, but that's not the same as saying that a psychiatrist is 'analyzing' someone in everyday conversation. Like, the mistake isn't in thinking that psychiatrists do psychoanalysis, it's in thinking that psychoanalysis is something that happens in regular conversation.

That's true. If I were to have made the connection more explicit I guess it's that the impression you get of psychoanalysis is that the practitioner makes the patient aware of something about themselves that they couldn't be aware of on their own. As far as bringing it up in conversation, since my grandmother was a psychiatrist, I would hear jokes about things like this, as well, but I never thought the people were serious. More like, "Oh you're a lawyer, better watch my wallet" type thing.

 

[splik]

maybe it depends where you train but psychiatrists are more likely to analyze people and situations more. But this is more of a self-selection thing because people who go into psychiatry are more likely to be like that. also the field you go into does change how you see things. When i was doing my addiction psychiatry rotation and became much more aware of all the addicts and dealers on my street and that kind of activity. when i was learning CBT i wasn't even able to watch TV without thinking of everything in cognitive-behavioral terms. people who do analytic training often talk about how it takes over their life and how they see things.

personally i do a mini psychiatric assessment on my dates (not in a way that is usually perceptible to them such is the deftness of my interview technique) also especially identify their attachment style and core conflicts. I am glad I do this as it helps me weed out the borderlines and other seriously personality disordered people quickly. also people are more likely to tell you about their own therapy etc if you are a psychiatrist (whether you want to hear about it or not).

 

[hamstergang]

If I were to have made the connection more explicit I guess it's that the impression you get of psychoanalysis is that the practitioner makes the patient aware of something about themselves that they couldn't be aware of on their own.

This is entirely accurate, but it only happens after the patient says things/the analyst asks questions that wouldn't occur in regular conversation. That's the part that I'm saying people get wrong.

Sure, psychiatrist might try to apply their training as splik mentions, but without a more thorough and guided history, they wouldn't really put much stock into it. Except maybe on a date, because then you can sort of lead the conversation into a real examination.

 

[peiyueng]

Be the best you can be. What is best? Are you under powered? A little boost gets you to be the best you can be?

Can you sustain it long term?

It comes down to this: If you choose IM, you are choosing a life time of med. That much is clear.

If you ever decide that you won't need it any more, you would be wrong and you may go for a while keeping up the appearances that you are handling and continue to push your self through the dreg that is IM.

Think long term. If in the long term, you feel that you can stay on this med and you can do it without escalating doses, then do it.

Onthe other hand, if all that doesn't work out, you can always kill yourself. On average, one physician kills themselves out of burn out each day. In a year, there are 300 to 400 suicides in the US from physicians.

Cheers.

 

[smalltownpsych]

You got that wrong about who does the overanalyzing. It's the psychologists, not the psychiatrists. 😉
We get the same questions and stereotypes, especially since most people don't know the difference between the two fields. I actually do see a lot more than most people as I am a trained observer of human behavior and I also was born with that ability. It used to get me in trouble when I was a younger and would helpfully point out what appeared to be underneath peoples defenses. No one likes that I learned. Now I use that ability more skillfully most of the time and some of my patients actually appreciate that I "get" them on a deeper level than their family and friends.

 

[F0nzie]

personally i do a mini psychiatric assessment on my dates (not in a way that is usually perceptible to them such is the deftness of my interview technique) also especially identify their attachment style and core conflicts. I am glad I do this as it helps me weed out the borderlines and other seriously personality disordered people quickly.

Badass

 

[Salpingo]

personally i do a mini psychiatric assessment on my dates (not in a way that is usually perceptible to them such is the deftness of my interview technique) also especially identify their attachment style and core conflicts. I am glad I do this as it helps me weed out the borderlines and other seriously personality disordered people quickly. also people are more likely to tell you about their own therapy etc if you are a psychiatrist (whether you want to hear about it or not).

This sounds like a great idea/algorithm for a dating website. All the PD and borderlines are put in their own pool based on severity. Then there's the moment of self-discovery when you show up for the date, they start binging and purging in front of you, threatening to cut themselves if you don't pay the bill.

But on a more serious note, every human being analyzes the people around them. We're listening for other people to talk about their fathers and mothers in weird ways, register an inability to stay in a stable relationship/jobs, or cope poorly with stress. We avoid or are attracted to those people based on that analysis and our own baggage. Psychiatrists are [ideally] more conscious of that analysis, and more interested in exploring it.

 

[Psychobabbling]

Dating website idea, let's do it.

Administer MMPI: Pair Histrionics with OCPD. Narcissist/Borderline with Dependent. Antisocial with Antisocial? Avoidants can just message people online.