He said he ate very reasonable “balanced” (which is not what obese people need) meals during the day, but every night he got “crazy hungry” and “snacked” on everything imaginable, mostly sweets, from the minute he finished after-work dinner until his late bedtime, while in front of the television. He said his doctor was irate and told him to stop eating at night because eating in the evening and before bed made people fat and sick. Read more on Meats or Sweets For Weight Loss…
Every honest and complete psychiatric evaluation includes screening for delusions. A delusion is a strongly held belief that is totally without basis in the factual reality that we all use to live our daily lives. I have taken care of several people, institutionalized and not, who have had such beliefs. Medications known as “antipsychotics” can be very effective on the hallucinations — the hearing voices and seeing things and such — that are the hallmark of a lack of mental “normalcy” as is generally expected and accepted in the community. The same medications may be less effective on these delusions, these beliefs. Sometimes, in a particular kind of delusion, a kind that hits folks somewhere between 18 and 90 (average age 40) where there are no hallucinations, just beliefs. They are less frequent. They are also hard to treat, with antipsychotic medicines working maybe about half the time — in those who can actually be convinced to take them. Read more on Screening For Delusions…
In my previous blog post, I talked about “Keeping Up With The Kardashians” — and asked some fans for advice for aspiring reality TV stars. If you got drawn in by that, I continued the topic in my private opt-in newsletter. If you haven’t followed that, you can register for free by filling in that little form up in the top right-hand corner. It’s a no-spam non-commercial commentary blog and you can opt-out at any time. But there is more to say — and this time, I’m reaching deep into the psychology of those who are in the spotlight and want to be in the spotlight.
The tie between the popularity of reality TV shows and celebrity worship was not immediately evident. But it is obvious that our American society is clearly increasing in — Narcissism. In Greek mythology, Narcissus was a handsome young man who was sitting on a stone precipice, admiring his own reflection in the water, when he fell in and drowned. The spot where this happened was allegedly marked by the first Narcissus flower. In modern times — like at dinner last night — the narcissus is a wonderful edible flower that is often served as garnish with sushi. Go figure. The queen of the current American psychology of narcissism in unquestionably Jean Twenge, PhD., a professor at the University of California San Diego, who has written a couple of books and lots of articles on the phenomenon of modern narcissism, and has been much interviewed in the public media. In a recent article, she is defending her own research and findings. Frankly, my non-systematic review of clinical data suggest she is right on. She has been criticized — a badge of boldness and popularity, think I — for attributing narcissism somehow to children having been brought up to believe they are special. Once again, I personalize. My parents filled my head with feelings of being special. Comparing me to Wonder Woman” and, when I was very young, telling me that I was “smarter than the average bear” like Yogi.
But they also told me this gave me a terribly heavy responsibility, They impressed this on me mainly through religion — most especially, making sure that I read parts of the (Jewish) prayer book before the service at all holidays and Sabbath. And we got to temple early, long before services started, because my father of blessed memory had to “warm up” the organ. (He also directed the choir) They never failed to remind me that I was named after Queen Esther, the woman who saved the Hebrew people. In the Book of Esther, she did this by winning a (Royal) beauty contest. I can’t have been older than 6 or so when I explained to her that if we were waiting for me to save the people by winning a beauty contest, then the people are in trouble. She told me I could maybe do this by working hard in school. I guess the rest is history. Many have told me I must have been “raised right.”
Narcissism is a concept that originated with Freudian psychiatry. It was believed to originate in a man when his relationship with his mother was overly close. Other theorists have suggested in may be related to excessive closeness or neglect from either parent. Here is a good summary of the evolution of the concept, as well as the currently accepted diagnostic criteria. There seem to be biological and/or genetic factors, as well as psychological reasons that people can end up diagnosed as the full blown “Narcissistic Personality Disorder.” A personality disorder is a way of dealing with the world that a human “develops” during adolescence that is dysfunctional, causing pain to the individual and/or to the people in the world who deal with this person. Estimates of prevalence (frequency) of this disorder in the general population is estimated at about 6%. If you know more than 20 people (you do), chances are you know at least one. They come across as egotistical, to put it mildly. They are not particularly empathic, blame other people for their problems. Their self-esteem is inflated. Their attitude toward themselves fluctuates between feeling “omnipotent” and feeling “devalued.” Curiously enough, I seem to be more likely to meet people with this disorder as colleagues or associates than I am to see them as patients. I believe that to be because when they have troubles in life, they invariably believe the difficulties that caused them are other people’s problems, and not theirs. So it is no surprise that folks with these problems don’t usually show up in a psychiatrist’s office seeking treatment. I can think immediately of a couple of technically excellent surgeons who would meet criteria, as well as a couple of psychologists and psychotherapists. Especially one who believes herself so gifted in application of a certain psychotherapeutic method that nobody else should perform psychotherapy in any other way. Of course, it just ain’t so. I shall avoid discussing narcissism in presidential candidates for now, although it is not hard to imagine another posting about that one. When people note there is an increase in narcissism, they do not usually mean the same full-blown personality disorder we are discussing above. Very often we diagnose narcissistic “traits” for people who have some aspects of narcissism in their personality. There is a fair amount out there. In case you are curious, there is an online test (with a bunch of disclaimers that it should not be used for a clinical diagnosis) to see if you are in any way a little narcissistic. Narcissism seemed historically to be just a little more frequent in men than in women. However, most of the followers of the Kardashians known to me are women. Some statistics suggest that the growth in narcissism that has taken place in our generation comes mainly from women. Remember, they want to be admired, but may also feel “devalued.” While all these changes in the world have been going on, I have been aging. I do look at objective research findings to confirm observations whenever I can. Still, I think the page indexed below is correct when it infers more people will look at a woman’s physical appearance than at her character development. Put this into the context of the age of the internet and most particularly, Facebook. It is possible for a woman who craves more admiration and self-esteem than she has got, to vicariously live the life of someone with the ascribed status that comes with wealth, fame, and physical attraction. This page adopts Twenge’s work and associated studies into a set of directions to help men avoid “hooking up” with narcissistic women. By this time, I have pretty much made up my mind that I am not terribly likely to get a Kardashian-type status in any social context known to me. But I am still wondering — what do I really know about the people, the women who make up a non-negligible amount of people I know either casually or as folks on a professional staff? What do I know about them if they like and follow the Kardashians? Yes, the obligatory formal academic type psychological studies do exist, and have been reviewed. Note that this article focuses on “celebrity worshipers,” who have taken a scale relevant to that entity, which seems to be far from having 100% consistency with the designation of “narcissist,” although I suspect there may be more than a little overlap. This paper specifically cites a fairly large study (343 folks) where 4 of 5 scales on the inventory for narcissism correlate with the Celebrity Attitudes scale for “celebrity worship.” Aspects of psychopathology (that is, mental illness) that are found in the population of celebrity worshipers more frequently than in the population at large include a “proneness” to fantasy and a “tendency” toward addiction, and criminality, depression and anxiety. This particular combination sounds like more than a few of my “dual-diagnosis” patients — that is, folks being treated simultaneously for addictions and mental illness. As for me, I have at least decided that I am not suited for Kardashian-type celebrity worship. Given the above psychopathology, I am very glad I do not encourage such psychopathology, for I was imprinted with the notion that with great power comes great responsibility (many years before the popular Spiderman movies picked up this slogan). Somehow, I still want to believe that every human has the capability of elevating the entire human race by elevating individuals to higher moral situations. I will cling to these beliefs of my childhood, as anachronistic as they may seem. I feel somehow noble that I have put this effort into explaining what is going on.
People often want to know something about their psychiatrist.
There is this thing called “transference” where their past relationship history can certainly color what they think and feel. I have no big secrets to hide from my patients, so I can usually be direct and take only an insignificant amount of time on these issues. Usually it just takes one of my stabs at humor.
For those to whom religion is an important facet of life, I am often asked about my beliefs. I often end up saying things like, “I am very sorry I am Jewish and not the Christian you would have preferred, but do you think Christ could work through a crazy old Jewish lady like me who would work really hard to help you feel better?” A “yes” and a laugh and we get straight into the meat of things with that one. Read more on Liberal or Conservative — Different Brains or Different Opinions?…
I love being a ”shrink-lady.” (okay, a “psychiatrist.”)
I did not pick it out of a hat. I tried a couple of other medical specialties. The “doctor” part — well, there was never any doubt about that part, really. I mean the idea of taking care of other folks came into my head pretty early on, as did the idea that I was smarter than most other kids, ahead of where I was “supposed” to be.
My family had some health problems as I persevered in schooling. It became evident that doctors had not only status but power over other people’s lives. Read more on Your life, Your Work – What’s The Difference?…
In 1932, my paternal Grandmother-Of-Blessed-Memory bought the house where my father and aunt – and eventually my brother and I — grew up. Until her passing while I was in medical school, she was the undisputed queen of the castle.
As a stereo-typical Jewish Mother, she was in constant competition with my mother in the kitchen. My mother always tried to act pleasantly, but between her father driving in from two hours to the west and arriving at 6 am on Sundays to tell her she was too fat, and my father’s mother besting her in the kitchen, she was generally miserable and had little ability to hide her misery from me.
My father did not show my mother any affection where I could see. Read more on The Power Of Silence…
I was traveling the United States looking for a graduate level training job in neurosurgery. Women were not as accepted in medicine as they are now. Personally, I think it is at least in part because medicine was still considered a serious profession. Most of the places I interviewed had never hired a woman as a neurosurgery resident before. They would ask me behind closed doors (with no witnesses) if I planned to have a family or practice part time and thus compromise the investment in time and money they planned to make in me.
I had met Mother Rocky, the great Jewish matriarch of a hunk of St. Louis, on a flight to that august city, where I had lucked out by getting a free upgrade to first class.
She seemed to think I would have some interest in an arranged marriage. Read more on The Part of Being Female I Still Wrestle With…
Even though I am both a woman and a psychiatrist, I am no expert on the mother-daughter relationship.
My Mother-Of-Blessed-Memory was a “good” woman by any measure — the faithful and virtuous homemaker. She spent a lot of time thanklessly trying to nurture my Father-Of-Blessed-Memory — a pretty grandiose if creatively powerful music writing and arranging manic with some Asperger traits — and my Brother-Of-Blessed-Memory — a full blown Asperger’s who was also bipolar.
They took so much of her psychic energy it is a wonder she had any left at all for me. But she did, and she told me how she had to fight to get me freedom, the days she would drop me off in the car when I went to the Secondary Science Training program, or even just to walk in downtown Boston. Read more on Mothers and Daughters and Such…
I was wearing my best pastel multicolor weave suit as I walked up the stairs of a drab gray Victorian mansion converted into a medical office on the outskirts of large mid-western city. It was a bit cool, early spring, and I had been through all of the other principal personalities in a fairly large and well respected neurosurgery department. The emeritus chief of the department — older, semi-retired, wrote hunks of textbooks about 20 years before; was the last one I had to see. Although nobody seemed wildly excited, I had “passed” the interviews to make it this far.
The Victorian mansion was the office building of the neurosurgical group that was the residency faculty. I was ushered into a richly furnished Victorian style office with antimacassars and gigantic velvet wing-backed chairs.
The father-to-us-all type neurosurgeon spent over five minutes asking me about France and my passion for the brain before asking me if my period gave me any problems. Read more on Women In Science Sore And Soar…