Doctor, full respect to you for explaining this situation... Something which I feel (and witnessed time and again) is that those people who are very intelligent (as in IQ in the 150+ range), who may have had years of therapy or trained as a therapist.... They may have a degree of awareness of their situation, or full awareness. They are not displaying psychosis or anything like that, but their life events are such that they feel they don't deserve to live. ...... In times of coherence, they can ask for help. But they know there are times where they are too locked into the belief that the world would be better with them gone. So they ask for help when capable. Sadly, as they present as self aware and in control at that time, psychiatrists think they are fine. I have lost so many people, high flyers, judges, Cambridge grads, academics, PhDs....... All because psychiatrists were refusing to listen that they did desperately need help. My best friends, my work colleagues..... I'm just wondering if the guy stressed about his living conditions was actually returning to a place which caused him to feel he wanted to unalive: that is, it contained the memory of where he'd been raped; or the living conditions were so awful that it was unbearable; or that people in his block tormented him as he was different (or they all had drug issues & he didn't)..... At what point do the social situations surrounding us as humans, break us, break down our minds, to the point where death would be preferable to living..... This may not be schizophrenia, but if the social circumstances don't change somehow, or the person isn't given the therapy they're begging for..... It leaves them stuck in this space of repeated suicide attempts. Again: there is a schism between those who are intelligent any understand they need help, and acceptance that these are people who genuinely need help..... And too many people die, as it's assumed intelligent people, with awareness of their condition some of the time, will be completely fine all of the time.
Thank you very much Anna for your thoughtful, comprehensive comment. I am sorry to hear about the suicides of the people whom you have known. This issue may be a wake up call for mental health professionals to listen to our patients and to be open minded. Peter Goertz
My daughter would try to manipulate us with unaliving. It always came when she was told no with something. Or if attention had to go to another child for a medical reasons. Literally coming to us saying “I took a bunch of Tylenol, I feel weird”…never gave into the manipulative behavior that was consistent. Once she turned 18 I said well, you are now legally responsible for yourself so if you need help you can get it. Never once had she come to us with any kind of talk like that ever in four years. She claims she is depressed etc but won’t put any effort into getting herself help. She had no problem running us around all over the place multiple times a week for years though.
Hey Dr. Goertz - fascinated with your channel. Recently, I have been debating changing career paths to go to medical school and become a psychiatrist. What are your thoughts of going to medical school at 30/31 for this purpose? Any advice you would give someone planning on making a change in their career to pursue medicine? Thanks so much. Alex
Hi Alex, Thank you! What you are considering is not unheard of. It may be wise for you to get as much information as necessary, and then make a decision based on what feels right to you on a gut level. Peter Goertz
Thank you for this video doctor Goertz. I’m a medical student and I really want to be a psychiatrist one day. English is my second language and I’m going to be a physician in U.S. What do you think about being a psychiatrist when English is not psychiatrist’s mother tongue?
Nice video! How do you deal with the death of a patient that dies by suicide, or a patient who committed homicide. I understand that it is completely out of your control. I just wonder how you navigate that on a personal/ human level.
Thank you for bringing this up. It may be a topic for another video. I have found suicides of patients emotionally difficult to deal with. Peter Goertz
In my opinion, even basic care can be provided on an acute psych ward. Maybe the physician cant do much with medication, but the rest of the team can offer therapy, hope, coping skills, safety plans, and social services. I love how medicine is evolving to include all of those things, its just a matter of resources in my opinion. YES, we can treat the patient, even if perhaps the physician is not doing the heavy lifting for malingering cases.
Whatever the underlying intention is, hitting your head is not a good idea. If you would like treatment please to go to a mental health clinic, or if the situation is urgent to an emergency room. Peter Goertz
@@goertzpsychiatry9340 I know a mild traumatic brain injury can be associated with psychiatric disorders. I’ll probably go to the ER to get checked out
These situations are impossible, when we know what the patient NEEDS but cant give it to them. If we had unlimited resources, anyonee who walks in with ideation should have somewhere safe to recover and a team to help. We just dont have the resources, and are forced to throw the dice.
Thank you for your input regarding this. At times people can be blindsided by bizarre situations and laugh. In my opinion this does not necessarily come from a disrespectful perspective. Peter Goertz
I could tell an example. I am not proud of it. When I worked as an active member of a voluntary organization who helps prisoners, we were supposed to take a course and when the teacher told about the prison system in China I started laughing (I was not a Christian by then), it was so absurd. When they execute a prisoner in China they send an invoice to the family where the family has to pay for the bullets. It is a situation where you don't know whether to laugh or cry. Probably this health care worker was used to a higher standard of care. We should not judge people by their reactions, because we do not know their motives or intentions. Reactions are also a cultural thing. In a certain country in Africa, I don't remember which, it is considered polite to laugh when you hear a bad news. And believe me it comes natural sometimes. Not lately perhaps. But anyway.
