Friday, February 12, 2010


I guess there are a lot of theories about psychosis. Does it stem from psychodynamic conflict? Is it purely biologic? Is it a combination of factors? I am in a more biologic training program, but a case I saw this week shows you where there is at least a gray area.
Mid-20s male comes into clinic after recent discharge from psych unit (first hospitalization). The guy has had 3 big psychotic breaks in the past few years, all of them related to his current girlfriend. With his first girlfriend, he began to think she was cheating on him. He got really paranoid and eventually attacked her. Admittedly, this alone is not enough to say he's psychotic-maybe she really was unfaithful.
Second girlfriend he dated, everything was going okay until he started to believe she was someone different. Not only that, he believed that she had undergone a sex change. She left before much more happened.
Now he comes to clinic with 3rd girlfriend (also with his sister in tow, which was awkward). The guy had begun to believe that when his GF was washing dishes or touching any long, cylindrical object, she was making a subliminal comment to him about his masculinity. He described how his girlfriend denigrates him by reaching for the cookie jar. He demonstrated this in my office by grabbing my canister of disinfectant antibacterial wipes and stroking it off. Even if his girlfriend touches an oven pan, that somehow sets him off.
He told me, "I even went and had sex with a few strippers. I asked them if I was big enough, and they said it was. I don't know why, but I have too much anxiety about my small penis." He later admitted that he is paranoid around pretty much everyone, and stays at home and to himself. It seems that when he gets into an intimate relationship, he can't escape his self-doubt and it escalates to a psychosis. The guy does no drugs, confirmed by drug screen and all family members present.
At some point, I think every guy not named John Holmes went through some period where he questioned whether or not he was properly equipped. But this is too much.
Freud woulda loved this guy. Next time I'm gonna ask him about his momma.
-Psych Doc


You're Blinking! said...

A guy I work with believes that all psychosis is caused by sexual abuse. If there isn't any history, then it's because the clinician screwed up, and there is undiscovered history. For every single case of psychosis.

This guy also supervises ClinPsych students and sees clients.

Mrs. L said...

Psychoanalyst parental units here [lucky me]. Yep, sexual abuse. If the patient didn't set it off with early drinking and drugs, somebody got to them.

Doctor D said...

How desperate are these ladies to have hooked up with such a charming guy?

Psych Doc, next visit you have to ask about the new girlfriend what inadequacies she feels to get her seeking affirmation from petite penis panic man.


Mark p.s.2 said...

"The guy does no drugs, confirmed by drug screen."
What about your psychiatric "medicines", that are not a drugs?

If no he is not on any psychiatric drugs, then he never learned to mind the store , so to speak.

Pharma drugs (antipsychotics, antianxiety) might surpress the symptoms for a bit, but the drugs, like all drugs will stop working in long term use when the human body adapts to the chemistry they induce.

Trust us....we're doctors said...

Dear Mark,

My point is that the guy was not on any drugs before this 3rd psychotic episode. In other words, it's not a substance-induced psychosis, which is probably one of the more common things we see.

This guy is the real deal. That makes him a lot cooler than your average meth tweaker.

Not sure what point you're trying to make. Sounds like you wanna go off topic or maybe you've been reading too much scientology.

-psych doc

pinky said...

I imagine he is on psych drugs now! And today's psych drugs are much kinder, are they not?

StorytellERdoc said...

Too funny...the John Holmes complex...I can see the reimbursements for it already! Good post.

Mark p.s.2 said...

Dear Psych doc

My idea is that legal drug-meds can make psychiatric symptoms worse. You attribute his mental illness to his brain chemistry (no such test exists), and forget Doctors have already introduced a drug to alter his brain. A med that only "helps".

You can not conceive that the psychiatric drugs might be making people worse. The psychiatric drugs magically only perform "good" brain chemistry.
Good thoughts-ideas and bad thoughts-ideas are mostly a conscious choice. A chemical med-drug you prescribe and say is the answer can not tell the difference between the two different thoughts.
Sanity comes from within , not outside forces.
Long term med-drug use will make people worse, as it shifts the responsibility of being sane in oneself, to finding and taking the correct magical medicine. Same as a crack addict looking for more crack as a solution.

DreamingTree said...

Interesting, Mark. How many schizophrenics have you counseled or treated? Before you answer, make sure you choose some good thoughts.

Anonymous said... have never treated a psychotic person. doesnt sound like you have ever been in contact with an acutely psychotic person. you sound like you contemplate things over a triple latte at starbucks. get a life...and a career. leave medicine to the professionals.

Mark p.s.2 said...

re:"How many schizophrenics have you counseled or treated?" + "you have never treated a psychotic person"
I live psychotic.

Straight from the horse's mouth.