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Deeper Perception Made Practical

Arlene, the Groovy Psychiatrist, on Narcissists and More

 

Yes, Blog-Buddies, here is the rest of my interview about the differences and similarities between Energy Spirituality and traditional methods of therapy, including psychiatry.

Many thanks to Arlene, the Groovy Psychiatrist, and to Gladys, the Blog-Buddy who volunteered to transcribe our interview.

For other posts in this series see:

Are all narcissists the same?

Rose:  Greetings, Arlene! This is Rose Rosetree, and I want your perspective as a groovy psychiatrist about some very varied questions about the intersection of healing when the approach is psychiatry, when the approach is Energy Spirituality, or other mind-body-spirit approaches.

Long story short, I want to ask you, related to Comment 28, about narcissists. There’’s a lot of talk on the Internet and off about narcissists. As a psychiatrist, do you put them all in one category?

Arlene: I don’’t. I did see that question. It seems like narcissism is a very hot topic right now, but I don’’t think all narcissists are the same.

Rose: And so, you don’t have on standard advice for people, either, in dealing with them?

Arlene: I don’’t. The one thing I also was thinking about as I read that comment — and I’’ve actually had this conversation with one of my supervisors — is the corollary to answering the question.

At times it has becomes popular to label people, and to use psychiatric terms in popular lingo. In some ways it’’s nice that psychiatry has that larger cultural impact. But in other ways it kind of demeans those terms, and that’s why people now say “Oh, that’s all psychobabble.” I kind of cringe when I hear that.

Rose: Well I would, and I haven’’t even gone through all the years of medical school the way you have. You’’ve certainly earned to right to cringe.

You’’re not responsible, surely,when people take specialized terminology in your field and use it for a variety of reasons.

Arlene: I think “narcissist” is a helpful term. There’’s a category in psychology called personality disorders, but it’’s generally not a good idea to use the terms from the personality disorders and then adapt them for common usage and then to start labeling people. Oh you know, “That person is a narcissist.”

Because they might be, from a popular usage standpoint. But they might not actually have narcissistic personality disorder. So that would be issue #1.

And the second issue would be, sometimes people like to use terms to label people simply because they don’’t like them.

And so it would be like, “I’’ve taken a dislike to someone and so I just decide, well, he’’s a narcissist or she’s a narcissist.”

My concern about doing that is first of all the label may be inaccurate, but second, it may be a way to avoid dealing with a problem. Now the person has been labeled, but whatever problem this person is causing may go unaddressed, because it’’s easy to say, “Well, I can’’t do anything about that because that person is a narcissist.”

And that would be my personal concern. It’’s handy to have labels because, you know, we all need a common language for communication. If we don’’t have language or terms it’s hard to communicate; the clarity of the communication becomes muddled.

But the flipside is that half the population isn’’t narcissistic. It takes meaning away from the term. It takes away the specificity of the term. That would be the issue with that.

Rose: I find that fascinating, particularly the idea of not solving problems because instead the person is diagnosed so it’’s assumed nothing can be done.

But I’’d like to take it even a step further, because I have been charting the usage of terms like “narcissist” in popular discourse, on Google. Terms that particularly catch my attention are narcissist, psychic vampire, energy vampire, and toxic person.

You might know that I actually started to compile some statistics and put them in a blog post about grey slime and narcissists here at Deeper Perception Made Practical.

Between May 1st and July 1st, 2011, there was a jump in the hits on those terms combined that was approximately 20 million.

It’’s just extraordinary how these terms are very much used. In addition to the terms being used to just blame people and not address problems, a big concern that I have is that sometimes people consider that self-improvement means labeling the difficult people in your life: If you can put them in those categories of being various types of toxic personality, then you know to avoid them, and this will make you a skilled empath, or this will help you cope beautifully in your love relationships.

I just don’t get that! What is your comment here, Arlene?

Arlene: You mean, like avoiding people as a solution to problems?

Rose: Yes, first you categorize them, and maybe you categorize them very carefully, like you don’’t mix up the narcissists with the energy vampires, and then you feel you have done something very sophisticated. As if “You’’re really protected now.”

Arlene: Well, that usually doesn’’t work.

That has generally been my experience. First of all, we have to interact with people in our lives. So a blanket “Avoid a whole group of people” usually is not practical.

Even if you could do that, which most of us can’’t, what I have observed when I see someone labeling groups of people, or if this becomes a common habit, and especially if a certain label is used more than others, it usually tells me something about an issue that the person is struggling with.

So maybe if someone labels half the people she knows as narcissists, she is really struggling with issues of trying to be more assertive and have other people respect her.

In response I might make a comment to her like, “I’’ve noticed you have a lot of narcissists in your life or people you think are narcissistic. I wonder if one of the issues you’’re struggling with right now is trying to be more assertive and to feel heard.”

I try to think of what would lead someone to have a desire, or a need, to label so many people with a term like that.

Rose: Beautiful. Now here’s something on this topic that comes from one of our very prolific commenters, PRIMROSE sometimes called PRIMMIE. In Comment 29, she is talking on this topic of narcissism and her own process of recovery at a certain point. She wrote:

Personally, I’’m happy that thanks to the internet that there is more awareness of personality disorders. It might mean narcissism becomes a bit of a topic for a while, but the more discussion out there about that kind of thing, the better, as far as I’’m concerned. Better it’s a buzzword than it’s something people have no awareness of at all.

It makes me think of the first time I came out of denial about the alcoholism in my family. Suddenly I thought everyone in the world was from an alcoholic background.

That was a stage for me, and I see others have a similar stage of seeing alcoholism or anorexia, etc., everywhere. It settles down in time and you get a more realistic view of the world. I think that might be happening with narcissism at the moment.

Arlene: Yeah, I think that, like anything, like certain things come into vogue, like certain terms or certain fashion for example.

You know, things come into style and kind of wane.

I think that’’s part of the nature of being human. Certain things become really popular for a while and then they kind of die down. I think that right now, the term narcissism is having its moment in the sun.

Rose: How exciting, not only being a narcissist, but having your moment in the sun at the same time!

Arlene: So I’’m definitely someone who really believes in dialogue. I think it’s great that people are having conversations about narcissism or, you know, other personality disorders.

I truly think that’’s a wonderful thing. I mean the same way that I think it’’s wonderful that people are much more open with problems with alcohol and illicit drugs — like the conversations that are happening on your blog. Because I would like to believe that these conversations help, #1, to destigmatize issues and, #2. to help people who may need the help feel more open about seeking it, to know that there are other people who are struggling with similar issues.

I think psychiatry, for whatever reason, tends to generate quite a bit of discussion among the general public; that has been my general impression.

Rose: I think you’re right! Hm. So here’’s one last question for now.  This is Comment 23 from JANE.

The role of consciousness in the future of psychiatry

Where do you see the future of psychiatry going? What role will deeper perception and consciousness play? Do you have your own vision of what you’d like to see happen?

Arlene: That’’s a really interesting question because there a lot of articles about that now. Recently there was an article in the “New York Times” about psychiatry. So I see it going in a couple of different directions, and I don’’t know which direction will predominate.

One is that, because psychiatrists are medical doctors, psychiatry has become increasingly more what we would call “biological.”

So a lot of psychiatrists spend a good portion of their time prescribing medication.

That doesn’’t mean we think everyone needs medication, but we tend to be referred clients who need medication. Out of the community of licensed clinical social workers, psychologists, therapists of all stripes, we’re the only ones who have a medical degree. So we’re the only ones who can prescribe. That would be on direction.

Rose: Is that still true? I’’m wondering if that’’s still true, because the understanding that I had was that other MDs are able to prescribe, like general practitioners. Is it really true that only psychiatrists can still prescribe those? Forgive me for interrupting, but I was just so curious.

Arlene: General practitioners can prescribe psychiatric medications. Any doctor can prescribe any prescription medication, and actually probably the majority of psychiatric medications are prescribed by internal medicine doctors and family medicine doctors, what people refer to as “Your PCP,” or “Your primary care provider.”

But usually when the primary care provider has a difficult issue that he hasn’’t been able to solve, then the patient will be referred on the psychiatrist for further input. And patients may also be referred to a therapist as well, but the therapist can’t prescribe medication, only the psychiatrist can.

Rose: Thank you. Meanwhile, so that’’s one possible direction. What else?

Arlene: That’’s one possible direction. So that possible direction would be that psychiatrists can no longer really provide therapy because insurance companies won’t pay for it. So psychiatrists would do pretty much all the medication management and then a client sees a therapist for counseling. So patients would see two providers, essentially. That would be one direction.

Another direction would be, and this could depend a lot of how the national health care system works out, that if there is more mental health parity, then psychiatrists can go back to doing what they used to do, which was to provide medication management and therapy concurrently — which I know some people do, but not as many people do that.

So, patients would automatically get counseling along with medication management. That’’s a second direction that it could go in.

Rose: Very different direction…

Arlene: And a third direction would be, all psychiatrists work for a community mental health center. So rather than solo practitioners, you would have people in more of a system-based health care delivery system. A patient would go to a group of psychiatrists, like a group practice; that would be another direction.

Or go to a community mental health center. Or something that is more structured or government funded, so that to increase access to psychiatric care, there would be more clinics or clinic of psychiatrists attached to primary care clinics. A patient would have more care in one place, with more physicians. That’’s another possibility.

And then another direction [for the field of psychiatry], and this is actually the area that I’’m interested in: Overlap between psychology and psychiatry.

Right now, there’’s a lot of interesting research being done by social psychologists on, like subjective well-being, happiness studies, decision-making theory. I think there are a lot of interesting crossover applications between what the social psychologists are doing and what the psychiatrists are doing. But you know, historically the two fields have never met.

Rose: You think they like people, they’’d want to get acquainted!

Well, what do you believe that psychiatrist do better than people in any other profession, including social psychologists?

Arlene: I definitely think is like a sort of self-editing question, but I’ll explain it. We definitely provide the best psychiatric care. That seems like answering, “What does the cardiologist do best?” They provide good cardiac care…

Rose: Please continue.

What psychiatrists do best

Arlene: I think that psychiatrists, we definitely are the best at prescribing psychiatric medication, or what we would refer to as psychotropic medications.

So, like anti-depressants, anti-psychotics, anti-anxiety medications, often referred to as anxiolytics, even sleep medications, we are absolutely, bar none, the best. We know the most about those medications.

We are the best at dosing them, combining them; being a psychopharmacologist we’re absolutely the best at that.

Treatment failures, knowing how long to continue a medication, providing counseling…

Before the split between medication management and counseling, when a lot of the counseling was provided by psychiatrists, we were, as a group, considered the best therapists and counselors as well. So I think that we do that really well when other physicians can’’t handle that.

You know, like if a primary care provider has a patient who is has been refractory to antidepressant medication, we’re very good at sorting out:

  • What medications were tried?
  • How long were they used?
  • What doses were they used at?
  • Were they combined with anything else?

We’re really absolutely the best at that, because we’re the most confident with using those medications and we have the most experience with them.

I think we’re also really good, even during our medication management visits, at realizing what choices in lifestyle are contributing to what appears to be a psychiatric problem.

Rose: Now that’’s important.

Arlene: Usually we don’’t just ask people about how they’’re responding to medications. We also ask them what’s going on in their lives, and how are they sleeping, and what’s their energy like, and how is their appetite.

We get a lot of information doing that, because we can focus on those questions, whereas if you go to see a primary care provider, they have to focus on other questions and may not have time to get to those questions. So I think we’re very good at that.

I also think, in general, we’re really good at utilizing systems-based resources. Because we tend to that a lot more.

Rose: What does that mean, “Systems-based resources“?

Arlene: Historically it used to be that, as a physician, you were also aware of what is going on in the patient’s family, in the patient’s workplace, what is going on with her health insurance; does the patient need approval for this medication?

So we’re utilizing, for example, in child and adolescent psychiatry, school-based therapy is becoming more common to identify problems in schools because all children go to school, where screening for psychiatric disorders might be a systems-based intervention.

We tend to be more aware of those kinds of issues because we’re aware of parity of mental health and the lack of parity in mental health. So I think that psychiatrists tend to take more of the advocacy role as a group than other specialists.

Rose: And, when you talk about systems-based resources, are you also talking about family systems or the internal dynamics within the family that are affecting the patient?

Arlene: Yes. We don’’t do that as much in adult psychiatry, but certainly the child and adolescent psychiatrists do a lot more of that. But even seeing adults, we are aware; we do have an awareness of what’’s going on in the patient’s life outside of the time that they’’re sitting in front of us at the clinic.

Rose: What a scope, what a huge scope of psychiatry. This is a far cry from the first songs of Sigmund Freud. Big, big range of ways of helping and combining science and medications and what people sometimes call “Talk therapy.”

Arlene: Yes.

When a psychiatrist is a skilled empath

I think with experience, and also certainly if you’’re an empath, I think you can get a feel for who will respond to a particular medication better than another. I can certainly say that at the end of my year now, I’’m much better at prescribing.

I think I would say that I’’ve gotten much better at being able to predict which medication will probably work better for a person than I was at the beginning of the year. And part of that has been my own experience, but I think part of it is just that I’’ve gotten more skilled, with talking to you in sessions and things like that. So I think it has been a combination of both.

Rose: Exciting! Well thank you so much for your time and your responses. Thanks again to everyone at Deeper Perception Made Practical who contributed to this thread. And is there any last thing that you would like to say, Arlene, on any topic whatsoever?

Conclusion

Arlene: Well, I can say that psychiatry is never boring, it’’s always interesting.

It really thrills my soul. I really enjoy the work that I do; I think that it’’s very important work.

I really thank all the bloggers who responded to your invitation for questions, I really enjoyed reading them, and I hope that one day I’’ll have to opportunity to actually meet some of the people who asked the questions or some of the other bloggers who I haven’’t actually met yet.

So I thank you for the opportunity, Rose, and the readers who provided the questions, for giving me the opportunity to answer questions, and I hope that this has been helpful.

Rose: I found it fascinating, thank you so much, and bye for now.

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Join the Discussion

  1. 1
    Jody G. says:

    This series was great, so interesting. Thank you, ROSE and ARLENE.

    I am particularly interested in the prescribing aspect of mental health care, what is the best course of treatment, how the different treatments affect different people.

    Like in Ayurveda, how different physiologies respond differently to the same herbal remedy. So when treating the common cold, maybe one person would do better on a more purgative-based remedy, and another person would require a more nuturative-based remedy.

    I found psychiatrist Dr. Daniel Amen’s work very interesting. He uses brain imaging to help with a patient’s diagnosis and treatment. He finds that the SPECT brain scan image will show the areas of the patient’s brain that are underfunctioning, overfunctioning, and/or relatively well-functioning. Then with the understanding he has of the effects of different medications on different parts of the brain he can better prescribe from there.

    For example, Dr Amen has found there to be seven different types of anxiety and depression, and they respond to different treatment protocols. Some a more purely medication-based treatment, some better with cognititive behaviour therapy, some with essential amino acid supplement, etc.

    It is all fascinating!

  2. 2
    Jane says:

    Wow, this was a fascinating interview. I read all parts of it with interest. Thank you both for taking the time to do this!

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