The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
Jump in the discussion.
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I need better professional boundaries. I gave well-intentioned general advice to a Redditor back in India, after their brother had ended up committed to a psychiatric hospital in the UK. They'd commented in /r/India seeking advice on how to bring them back. I was surprised when I received a DM request from a new account, wanting to talk to me. I had assumed it was related, and was happy to guide them through things step by step or put them in touch with medicolegal aid.
No, as I found out, only after I assented to their request to get on a phone call with me. I have probably scandalized or traumatized half the compartment in my train back to Scotland, solely on the basis of what they could overhear of my end of the conversation. I am definitely conked. I did not expect to hear Soprano-tier drama, involving petty Indian royalty, murder, rape, arson, fraud, kidnapping and levels of familial dysfunction and violence beyond belief. Almost everyone in this story is an awful person who almost deserves the things that have happened to them. I have a new benchmark for generational trauma.
The only thing preventing me from calling the cops is that I'm not entirely sure that the lady I was speaking to was sane. Nothing I have said is an exaggeration, I have a splitting headache and need some sleep.
This deserves a long response for you but I have a busy day today.
The good news: you are in good company, all of us need to figure this out.
The bad news: your family will ask for medical advice. Your friend's partner will complain about her vaginal discharge. Your barber will start telling you about their suicide attempt in the 8th grade.
Since you are a psychiatrist you will probably work on polishing your presentation and bedside manner and unless you run into demographic issues or somewhat you will have insane interactions with the general public. The same response to you will be useful professionally.
Figuring this out is hard. In psychiatry it will be a core topic at least, which will help.
Also with respect to psychiatry - don't sleep with your patients. It sounds stupid advice but it isn't.
Borderline girl. Realizes her psychiatrist is the only person in the world who "gets" her. Turns on the love bombing. Gets visibly horny in the office. She's hot, too. Psychiatrist, just a mortal man, fights for his life to resist.
There's like, a nasal spray you can all take that turns off your sex drive in case you have patients like this, right?
Some interesting things related to this:
Obviously it doesn't happen very often, thank god.
It's also more of a problem for therapists/psychologists/psychiatrists who do therapy (rarer) - consider that for many people talking to someone for an hour a week is more than they talk with most people in their life and family. Med management doesn't create that level of intimacy.
Also most men are not experienced with being hit on at length, especially by someone seductive (and with borderline the pleasing aspect is quite possibly why the pathology exists given its association with trauma).
For this reason old school docs would suggest to their trainees that they hire prostitutes if they weren't getting enough gratification in personal life.
Amusingly back in the day it was actually considered treatment for borderline women. It actually worked???* Obviously terrible from an ethical perspective however.
Malpractice has gone back and forth if it should be covered. Obviously it's a completely avoidable mistake that should end in the psychiatrists professional evisceration, but if malpractice covers it the victim can get more money.
Professional boundary rules are incredible strict for psychiatry. In other specialties you can eventually date patients if common sense steps are taking in most jurisdictions. In psychiatry never ever ever. This makes sense but is taken to an extreme - one guy lost his license because of a woman that he had a patient encounter with decades prior to them meeting again that neither remembered.
*Basically having someone who you can't push away successfully helps with developing appropriate personal relationships and coping skills. These days a boyfriend who don't peace out substitutes.
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