Posted by: thealienist | November 20, 2014

What To Expect If You And I Disagree

My patients and I will not always agree.  This should not surprise us.  We may have different political beliefs — that’s fine.  We may have different religious beliefs — that, too, is fine.  We will likely have markedly different values and preferences — no problem.  Some people worry about what will happen if they disagree with their psychiatrist.  I suppose that that is not an unreasonable worry for some people.  We might as well get this out in the open for me and my patients.

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Posted by: thealienist | November 11, 2014

Games, Meta-Games, Meta-Meta-Games, ….

One problem in seeing life as a conglomeration of games is that sometimes we are not all playing the same game.  We might think we are playing the same game and only later realize that the other involved were using completely different rules and were aiming for different goals.  For example, we may be playing the governing game in which we think that the rules are that the person elected works for the benefit of the people he represents — for which job he receives an appropriate salary.  We are later frustrated to find out that our elected official was playing another game in which he courted the interest of large companies and wealthy power-brokers to obtain personal power and campaign money so that he could get reelected and later have a job as a lobbyist for his benefactors.  He might have represented us when it served his purpose, but his rules and his goals were not those of the governing game.  Not that this only happens in government, it can also happen at work.  A man is hired to play the working game.  As part of this game, the man is expected to make telephone calls and sell some items or some service.  In return, the man will have certain signals sent between the payroll department as his bank, resulting in further signals being sent between his bank and his mortgage company, utilities, magazine subscription office, cable provider, etc. Finally leading to him having a home, lights, water, gas, Scientific American, The Big Bang Theory, and a little money left over for groceries and (hopefully) savings.  Later, the boss finds out that the man was really playing the filling-up-my-timecard game, in which he spends the day surfing the internet, hiding from his boss, and counting this as work.  The list can go on forever.  The question is, “How can we live together, cooperate, pursue our individual goals, and function as a society when we are not sure that we are all playing similar games?”

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Posted by: thealienist | November 4, 2014

Psychotherapy as a Game of Discovery

Of all the games we play, I think that psychotherapy is the most fun, and for many, one of the most valuable.  Many of the games we play are games of discovery though they may be so only on a trivial level.  We might try golf to see if we are any good at it or to see if we can control our frustration tolerance.  We may use the Ouija board to learn some deep, dark, mystical secrets.  We may play Truth or Dare to find out things about our friends.  But the most intense games of discovery are certain types of psychotherapy.  The reason that I like the game of psychotherapy is that both the therapist and the patient can learn important things about themselves.

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Posted by: thealienist | October 23, 2014

In Defense of Coercion

I know that I addressed this issue in an earlier post on involuntary hospitalization, and this post may be redundant.  Still, I have been reading more posts complaining about the use of coercion in mental health treatment and especially by psychiatrists.  In these posts, and in the comments on my previous post on involuntary hospitalization, it seems that many of the comments by many (though not all) of the writers are addressing particular misuses of coercion rather than a general consideration of whether coercion has a legitimate place in the role of a mental health provider.

To begin with, I acknowledge that there is clear potential for misuse of coercive methods in all forms of health care but particularly in mental health care.  Therefore, an important question is whether it is so dangerous as to be eliminated from use.  Next, if one agrees that there is some role for coercion, we would need to decide what circumstances would permit it.  We would also need to consider what methods would be appropriate if coercion were allowed and if the situation permitted it.

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Posted by: thealienist | October 20, 2014

Who is the Monster in “Frankenstein”?

My wife and I were wanting to read a book for Halloween and decided to read Mary Shelly’s Frankenstein.  For those of you who have never read the book, it is NOTHING like you might expect from seeing most of the movies supposedly based on the book.  I highly recommend the book to those of you who have an interest in Gothic horror (though it is not that scary) and especially those who have an interest in the personal and social psychologies of evil.  Please continue below the fold for further discussion (spoilers ahead).

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It seems to me that some games are better than others.  Some are trivial.  Some are boring.  Others are fascinating, fun, and profound.  Given that it is possible that all of life is a game (a given that I am not convinced of yet), what makes a game “good”?  Is it merely a matter of taste?  Are there some criteria that we can apply to judge the quality of the games we play?  If indeed it is true that live is a game from top to bottom, then it seems essential to me that we be able to choose what games we play and what role we play within them.  I wonder if this is not a great part of what mental health care is all about.  We help people to find their game and to remain suitable for effective participation in it.  We are part coach and part team physician.  Let’s think some more about this.

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Posted by: thealienist | October 14, 2014

The Game(s) of Life

I have been interested in games and game theory for a long time.  I think that play is an important part of life.  I also think that I see our modern western culture trying (ironically) to squeeze play out of the average person’s life while trying to get more and more people to play their particular type of game.  I have read with interest the works of many authors who emphasize the role of play in human experience, but I have found no agreement among them as to what constitutes “play” or what the essential components of a “game” are.

I am going to use this category to explore (perhaps only for myself) what constitutes “play” and how much of our lives are taken up by games – either intentional or unintentional.  In addition to defining these abstract terms, I plan to comment on and analyze (to the extent of my ability and aided by any who would like to help) how the idea of “games” enriches or impoverishes our lives.  I expect that the posts in this category will be more rambling than usual and may take me (us?) down some blind alleys.  Overall, however, I hope that in our wanderings we will see interesting, beautiful, and revealing sights.

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Posted by: thealienist | October 13, 2014

The Depression Trap

Just as in anxiety and bipolar disorders (see previous posts), major depression has its own traps.  If seen far enough in advance, they are usually easily avoidable.  Unfortunately, many patients do not recognize these traps until they are neck-deep in them.  Let’s examine them in more detail.

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Posted by: thealienist | October 10, 2014

The Bipolar Traps

In the same spirit as I wrote previously in “The Anxiety Traps,”  I see some common traps faced by those who suffer from bipolar disorder.  Some of the traps occur most often in those who find themselves frequently stuck in depressive episodes.  Other traps are built for those in frequent (and especially mild) manic or hypomanic episodes.  Let’s see what it is best to avoid.

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Posted by: thealienist | October 7, 2014

The Anxiety Traps

When it comes to mental illness, I see several “traps” that my patients fall in. How they fall for these traps and how they are lured into these traps are easy to understand. Avoiding them is usually fairly straightforward, though it may be difficult. Let’s talk about the traps that the anxious need to avoid.

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