fischbachpsychiatryblog

The Arc of Psychotherapy: What is Personality? What Are Personality Disorders? Most people are not familiar with the process of psychotherapy. To non-professionals, psychotherapy may look like a lot of hocus pocus with little clarity or focus. Because of this I thought it would be useful to publish a series of case studies in several therapies that I've been privileged to perform. I will outline, in clear and concise detail, the specific problem which generated the therapy, the treatment course(the "arc"of therapy), and the therapeutic outcomes.  I  will comment on some of the theory and techniques employed in psychotherapy. I hope, thereby, to demystify an otherwise arcane process, and to demonstrate how it can lead to important changes in thoughts, feelings, and behaviors. But first, some basic understanding of the underlying biology of personality. We are all born with differing temperaments. When I was a medical student at NYU, our attending, not a psychiatr

Psychotherapy Part I: Is It for Real? Does it Work? What Do I Look For? Psychotherapies work, and work well. They are gaining ever more attention and prominence, even in the world of medicine. In Part I will discuss personality, personality disorders, and the variety of "talking therapies" to treat them. Medical and medication therapies are outlined in other posts. The question of how therapies achieve their goals, their mechanisms of action, are touched upon here, but will be elaborated more extensively in Psychotherapy: How Does it Work?  Part II Let's begin with some basics. Even before we consider psychotherapy, we need to ask: What is the "psych" in psychotherapy, This is Greek  for "mind," such that psychotherapy refers to treating the mind. What functions constitute mind? Simple. All thoughts, feelings(emotions) and behaviors fall into the realm of psychology. Moreover, though less intuitively, most thoughts are themselves connected in t

What Happened to  Medica l CARE? : Upside Down Medicine                                                   I was recommended to visit a well-regarded foot surgeon for repair of a dislocated toe, likely incurred while running. At the initial (and only) appointment with him, I was kept waiting 3 hours. When he arrived, he was followed by his surgical residents, and for much of the 15-minute appointment, the surgeon directed his comments to them rather than to me. I did not see him at the surgery center either before or after the surgery. Indeed, I never saw him again. Immediately upon arousing from anesthesia, I was instructed to get up and was placed on crutches after just  5 minutes of training. I was so dizzy I could barely hold myself upright, and struggled extensively with the crutches. I was  nonetheless ushered out the door within minutes. When I arrived home, my foot, still numb, brushed a stair up to the mudroom. The stitches opened, and my wife whisked me to the an ER for a r

Do I Have Mental or Behavioral Symptoms ? A primer for the ‘walking unwell’ Millions of Americans don’t recognize that they’re suffering needlessly from easily treatable mental illnesses July 10, 2016, Pittsburgh Post-Gazette •     By Marnin E. Fischbach A 26-year-old woman entered my psychiatrist’s office in Denver years ago, red in the face, trembling and sweating profusely. She could barely speak a whole sentence. Thinking that she might be suffering from extreme social anxiety, I asked if she was especially nervous talking in person. She nodded yes, so I sent her home after three minutes and completed her evaluation by telephone. During the phone interview, I learned that this young woman had not been able to leave her home for seven years, except to go to the 7/11 in her neighborhood at 2 in the morning when virtually no one would be there. Her story ended happily: I prescribed medication for her social phobia, her fears gradually eased, she got married, and she moved o