Random Psychiatry Jokes

Today's post comes courtesy of my Facebook Page - some random jokes about psychiatrists, therapists, patients, drug companies, alternative medicine, academics, and parents that I've been collecting and or making up.

WARNING!  

If you are a member of the habitually offended community, please do not read this.  I don't want you to have a stroke! 

To paraphrase fellow blogger The Last Psychiatrist, "If you have the urge to e-mail me complaining that my good-natured ribbing of human foibles indicates a total lack of empathy or cruel, unrelenting hostility towards patients and others, please don't, your brain is broken."  

And so it begins:

A recent journal article reviewing drug treatments for symptoms of borderline personality disorder was obviously pushing for the use of antipsychotics and anti-epileptic drugs over antidepressants. It concluded "“Antidepressants failed to show efficacy in treating BPD symptoms dimensions OTHER THAN AFFECTIVE DYSREGULATION.” That's like saying that an antibiotic "failed to show efficacy for pneumonia dimensions other than killing bacteria."

"If homeopathy is real, then dumping Osama bin Laden’s corpse in the ocean has just cured the world of terrorism." ~ Shiloh Madsen, on Google+"...what makes them defense [mechanisms] is not that they protect you from pain-- they don't, clearly. They suck at doing this, look around.

The purpose of defense mechanisms is to stop you from changing." ~ The Last Psychiatrist

"Zoloft and Paxil and Buspar and Xanax...

Depakote, Klonopin, Ambien, Prozac...

Ativan calms me when I see the bills

These are a few of my favorite pills." 

         ~ song from the Broadway musical, Next to Normal

"Become a psychotherapist. That way you get paid to chat with people who are more interesting than you are."  ~ Moviedoc

Jerry Scott and Jim Borgman of "Zits" fame have proposed a new psychiatric disorder of adolescence for the upcoming DSM-5, PDRD: Parental Direction Retention Disorder. That's for teens that can't seem to remember stuff their parents tell them to do.

Then there was the psychiatry resident who was not convinced by the faculty that there is no point in trying to talk a psychotic patient out of a delusion using reason and evidence. So he sees this patient who thinks he's Jesus Christ, and goes up to him.

 "Does Jesus Christ bleed?" he asks the patient.

 "No, of course not," the patient replies.

 "Aha, now I've got him!" the resident thinks. 

He pulls out a pin and pricks the patient on the finger. The patient then looks intently at his hand.

 "Well, I'll be darned," he finally says. "Jesus Christ does bleed."

Behaviorists are psychologists who believe that all human behavior is shaped by environmental rewards and punishments, and that the only valid psychological data comes from observing behavior, and never through introspection or speculation about internal mental processes. So two of these behaviorists just made love. One says to the other: “That was great for you. How was it for me?”

Bill Scheft, a longtime Letterman writer, offers this summary of his mother’s parenting philosophy: “You’ll get unconditional love when you do something to deserve it.”

"What's the point of duration criteria for manic episodes? Nobody takes a history anyway." ~ Moviedoc

I think I'll start a new dating service for people with personality disorders. It will run ads like: "Narcissists! Are you looking for that perfect borderline woman who'll be willing to at first feed your grandiosity but later completely destroy it with her help-rejecting complaining? Well look no further! Take our new, free online SCID-II personality test to help us find your perfect match!"

Overheard from a parent desperate to have an exceptional kid: "All the other kids are making sand pies, but only my kid is eating them!"

"Before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, just surrounded by assholes.” -William Gibson

"I only watch TV News for the commercials to keep up with all the new pharmaceuticals I'll need for all the new diseases." ~ John Fugelsang

If we have "Adult ADHD," I guess we should also have "Adult Oppositional Defiant Disorder." There could be two at least two main subtypes, the "Asshole" subtype and the "Angry Young Man" subtype.

Dennis the Menace diagnosed with bipolar disorder! News at 11.

"[psychiatric] Drugs are all about keeping bratty children in check. Or what we used to call 'parenting.'" ~ Bill Maher

The United States may be the only country in the world where parents obey their children.

 "A new study published in The Journal of Pediatric Medicine found that a shocking 98 percent of all infants suffer from bipolar disorder. "The majority of our subjects, regardless of size, sex, or race, exhibited extreme mood swings, often crying one minute and then giggling playfully the next," the study's author Dr. Steven Gregory told reporters." ~ The Onion

The pharmaceutical companies have come up with a new drug that "biological" psychiatrists will be very excited about. It will no longer matter how screwed up patients' lives are or how dysfunctional their families are. If they take this pill, they just won't care any more. The brand name of the drug is going to be Phuquitol.

Classic answers to questions from doctors taking a psychiatric history:

Therapist: "Are you narcissistic?" Patient: "Heck no, I'm too good for that."

Th:  Are you ambivalent?   Pt: "Well, yes and no."

Th: "Are you sexually active?"  Pt: " Nah, I just lie there."

Th: "Are you homophobic?"  Pt:  "No. Some of my best friends are lesbians, but wouldn't want my sister to marry one."

Carl Rogers, one of the founders of modern psychotherapy, believed that empathy, listening, unconditional acceptance, and minimal intervention would allow clients to become increasingly comfortable with aspects of themselves that may be threatening, shameful, scary, anxiety-causing, etc., which would then facilitate growth and eventual change.  Some people think this can be a bit naïve, as evidenced by the following transcript from a therapy session:

Client:  “I am so depressed, I just don’t feel like is worth living.”

Dr. Rogers: “I hear you saying that you are in pain and that you are not sure how you will ever feel better.”

Client: “I really feel I would be better off dead.”

Dr. Rogers: “You really are at your wits ends about what to do.”

[The client stands and moves to the window of the office and opens it up]

Dr. Rogers: “You are showing me how much pain you are in, how desperate you are.”

[The client then jumps out the window to his death]

Dr. Rogers: “Splat.”

Tangled Emotions

In a very funny sequence in the delightful new Disney animated fairy tale, Tangled, Rapunzel steps down from the tower that the woman whom she thinks is her mother has insisted she stay cooped up in all her life. She goes outside and touches the ground for the very first time - without that woman's knowledge.

She immediately experiences severe mood swings as she goes back and forth from the heights of ecstasy to the depths of despair over and over again in a very short time. One minute she is marveling at the feel of grass as she runs through. The next minute she is crying and wailing, "Oh, I'm a terrible daughter!" Soon thereafter she beams as she thrills in splashing through her first pool of water. Shortly after that she anxiously frets that she is hurting the woman who raised her and whom she loves.

The Harvard Guru of Drugging Children, Joseph Biederman, would probably diagnose her as bipolar.  The male character who entices Rapunzel to come down out of the tower, however, is a much better diagnostician.  He observes that she seems to be at war with herself.

Ah yes, neurosis.  That old Freudian psychoanalytic term that signifies a conflict going on within a person (intrapsychic conflict) that allegedly creates the severe anxiety and self-defeating behavior seen in patients who come for psychotherapy .  Different psychoanalytic, existential, and humanistic psychotherapy theoreticians (that is, those from certain schools of thought within the field) disagree over precisely what it is that "neurotic" people are most often conflicted, but they all stand by the concept.  

Freud thought the conflict was between our internalized values and our biological urges - most frequently aggression and libido (psychic and emotional energy associated with drives). 

Psychoanalyst Heinz Kohut thought it was over our needs to be validated, depend on others, and have a place to fit in within a family that may provide us with none of those things. 

Experiential therapists such as Carl Rogers and Fritz Perls thought it was over what our social system wants us to do and our need to self-actualize (achieve one's full potential through creativity, independence, spontaneity, and a grasp of the real world). 

Erik Erikson saw it as a struggle to negotiate different developmental stages over our lifetime, such as the struggle between the forces of identity and role confusion during adolescence or the struggle between the forces of integrity and despair in the elderly. 

Existential therapists think it concerns our need to find meaning and connection in an absurd universe in which our own death looms. 

Family Systems pioneer Murray Bowen thought it was between the forces of togetherness and the forces of individuality.

Almost all of the above concerns, one might note, center around a battle between doing what others expect of us and our own internal needs and desires.  Social conformity versus going our own way.  Such conflicts are hardly a novel or esoteric concept, and certainly they are well known to all of us.  Yet the term neurosis has almost disappeared from the psychiatric lexicon.  A huge mistake, in my opinion.

The term neurosis was all over the place in the first two editions of the diagnostic bible of the American Psychiatric Association (APA), the DSM, until the DSM III came out in 1980.  Then it was unceremoniously dropped.  To be sure, it had been invoked as a causative factor in disorders and behaviors which we now know it had no business being associated with, such as severe obsessive-compulsive disorder and homosexuality.

Just because it was not one of the major causative factors for some psychiatric or behavioral conditions does not mean, of course, that it is not a major causative factor in any of them.  Surely all of us think twice about doing what we want to do when we might be disowned by our parents or thrown in jail if we indulged ourselves.  Yet we still have our own powerful personal needs and desires.  That such conflict creates anxiety in us which can lead us to some strange compromises is almost indisputable.

But starting with the DSM-III, the powers that be wanted the list of psychiatric disorders to be merely descriptive and not get into the highly controversial area of what actually causes them (etiology).  Saying intrapsychic conflict is a major cause of a disorder is just psychoanalytic theory, so the reasoning goes.  And analysts have without a doubt been wrong about a great many things.

So psychiatrists are now stuck with the only official list of diagnoses in medicine that avoids the whole question of the causation of disorders.  It's like a compendium of the symptoms of infectious diseases that never mentions viruses, bacteria, or parasites!