Friday, August 21, 2009


It seems that some people out there have misconceptions of what psychiatrists can do. One of my attendings warned me about this last year, but now that I'm in clinics, I believe him. For some reason (probably Hollywood), a lot of the public believe that psychiatrists can read minds. Several recent events, including the gun post by my colleague, bring this to light.

I was at the mechanic the other day. I knew I needed some work done on my brakes, and I was getting a quote. Meanwhile, I made small talk with the brake guy while he was telling me all that I needed. Of course, I felt like he was trying to sell me more than I needed. I went with the minimum service. He said something like, "I bet that your psychiatry training helps you out with negotiations like this," implying that somehow I knew that he was trying to scam me. I did, but it had nothing to do with my psych training.

Another example is when someone recently mentioned that a way to keep guns out of the hands of suicidal/homocidal people is to make them undergo a psychiatric evaluation. Of course there would be a lot of logistic concerns (which psychiatrists would do it, who would pay, etc.) But what I want to make clear is that Psychiatrists can NOT read minds. I can only help you if you want help. If you are lying to me, maybe I can figure it out, but I probably can't. Sure, I may be able to tell if you're depressed or hearing voices. I can obviously tell if you're manic. But I can't tell if you're going to kill unless:
1. You tell me you're going to or
2. Your family/friends/police heard you make those statements or
3. Other aspects of your personal history (which you can lie about anyway) send up a red flag.

The third aspect of all this is what really hits home. I recently found out that the father of one of my daughter's classmates died. It made me confront my own mortality; I had seen him a few days before. He was fairly young and appeared happy and healthy. He did NOT look depressed. I figured he had a heart attack or car accident. Then I checked the medical examiner's website. He committed suicide. This was a person who on the surface had a loving family, a successful career, wealth, you name it. These are all protective factors for suicide that almost none of the patients that I treat at a county hospital possess. Who knows what his own personal demons were. But the point is: I'm sure nobody saw this coming.

I can't stop thinking about the hole that he left for his wife, kids, and friends. My initial sympathy turned to anger due to the selfishness of this action. That night, I told my family I loved all of them and promised to never do such a thing. It has been haunting me for a week now. Even though I didn't really know him, it touched me deeply. I am a mental health professional. I am supposed to help people like him.

Please, if you are having thoughts of suicide, or know someone who may be, please get them the help they need.

Sometimes they don't seek help on their own.

And don't expect a random psychiatrist walking down the street to read their mind.

Anyone can fake it.

Anyone can lie.

And I wouldn't know.

-Psych Doc


TechnoBabe said...

Last year I found out how hard it is to get help for someone else. For two months my husband was manic, it was living with a crazed angry stranger. I called all over. We had moved here in May and by July I was the one getting depressed. He was sure he was an alien. He did not sleep. Maybe it is different in other states but until he threatened me no one could help.

Reality Rounds said...

What a sad story. A have personally known 4 people who have committed suicide. It leaves such a path of devastation for those left behind. I am also involved in a program that helps women with postpartum depression. The program was started because two very beautiful women killed themselves after they had delivered their newborns. It is very hard not to be angry at the suicide victims, and call their acts "selfish." And, like your first commenter stated, it can be very hard to get psychiatric help for someone. Complicated.

Anonymous said...

My niece committed suicide a coupe of months ago. Her brother, a practicing psychologist was as shocked as the rest of us...

Anonymous said...

Primary care providers need to step up to the plate on this issue. I had a friend who was suffering from depression, who reluctantly saw a doctor at an urgent care clinic. He was sent on his way with 20mg lisinopril after being informed that white heterosexual men of his age don't suffer from depression. Never assume that a suicide victim has not sought help. And don't forget there are bad doctors out there just as there are bad mechanics.

Lisa said...

I always wondered why doctors/whomever bother asking someone if they are truly suicidal. Anyone who is truly suicidal they would lie out of fear of being locked up.

tracy said...

That is so very sad. And....sooooo true...believe me.

Anonymous said...


Actually many suicidal patients will tell you if you ask them. I ask all the time and a handful have admitted to active thoughts with plans and access to method. Many more have admitted to less detailed thoughts. Most want help and only need to be asked once they have made the first step of being in my office in the first place.

And as far as the patient presenting to Urgent Care I realie that may have been the only place he could/would go but that is about the worst possible choice of locations to go. A FP/IM office would be great, or an ER even is better than Urgent Care. It is just not set up to handle that type of complaint. There is not regular follow-up, often part-time docs, or not even docs but midlevels, and then not the resources to monitor someone for hours awaiting transfer, etc.

Pjane said...

Please don't call suicides "selfish." There are many reasons for committing suicide, and many are NOT selfish. Unless someone leaves behind a very detailed suicide note, how do you know why they did it?

My schizophrenic sister killed herself. She believed that she was responsible for all the bad things that happened to our family and friends. Her suicide was an act of love, not selfishness.

Karen Brook Westhaver said...

Your last three statements so well summarize our dilemma: anyone can fake it (to look good or bad), anyone can lie, and we wouldn't necessarily know, despite the need to ask when it seems this might be a possibility. Many WILL disclose ideations and/or plans, various levels of lethality, and sometimes my question has been out of a CYA move because a pt cannot agree that they can or intend to keep themselves safe or notify someone if they cannot, even if I feel certain they will deny any suicidality to the police. As a mental health practitioner, how do I make peace with all this? Although people are often very broken, this does not mean we can fix them...we are far more mystically made than the car your mechanic can tinker with and diagnose with various automotive computers. Our thoughts about the "selfishness" of suicde are most often due to our anger at not having been able to help that pt get another day in which they'd potentially see this is not the decision they'd ultimately make, and a whole host of other things including the pieces which will never really be picked up for surviving spouses/significant others, family and friends. This is another huge reason we cannot practice in isolation. We need colleagues to remind one another that no one is responsible for another person's life's ultimate decisions. We can only do our best and then let go with compassion and love. Our ongoing angst cannot help those who are lost, those they've left behind, or those we've yet to treat...and will diminish our own quality of life. Be well, friend(s).