Whenever I go into a new situation with a medical staff, the other psychiatrists seem to enjoy having me assess and treat people who have stumped them.  It doesn’t matter if it is a community mental health center, a VA facility, private HMO clinic, University hospital – whatever.  The favorite game is “Stump The Renegade Doctor.”

One challenge was a woman was 28 years old who was a little on the hypomanic side (meaning only a mild mood-swing toward the manic) and a little on the depressed side and a little paranoid — and a lot uncomfortable. She was informally and a tad sloppily dressed in clothes which nobody would have called “new” or “chic,” and her hair was a little messy.

She explained to me: “I can’t sleep.  I never get more than two or three hours in a night, with a lot of ups and downs and stuff.  I don’t know what is going on, but they already gave me all the medicines for sleep, and on me nothing works.”

Yeah, sure.  I suspected already that her problem had nothing to do with picking the “right” medicine, but people really do think that pills can fix anything psychiatric.  She had obviously had drilled into her head the idea that the right medicine would fix her. “They said you were good with pills, and you could figure me out,” she said.

I was flattered.  My colleagues generally won’t say such things to my face – they just dump their problem patients on me and go back to whatever they were doing.

I told her that first, we were going to talk about something called “sleep hygiene.”  She had never heard the words before and acted like I was talking a foreign language.  There are lots of things that can stop someone from sleeping, and lots of things that can help someone sleep. Read more on Sleep Problems Often Solved By Common Sense — Not Drugs…