Wednesday, August 08, 2012

Does it Help to be an Optimist in Psychiatry?


I am basically an optimist (I think).  I feel hopeful about most things, and I have this funny faith that people are basically good.  When people come to see me and they are severely depressed, I think they are going to get better.  Mostly, they are kind enough to humor me and they do get better.  The statistics seem to suggest that SSRI's work 40% of the time, and while that does seem to be true for the first go-around, I've found that if I fiddle with the medicines, augment, switch, augment, tweak, that many more than 40% of people get better.  If someone is doing well, and suddenly feels down, I encourage them to return soon, talk about it a bit, and don't rush to changing the medicines at the first sign of "the meds aren't working and I'm a little down."  Often (but not always), people get better without increasing or changing medications.  Clearly, though, my practice is not the stuff of double-blind-placebo controlled studies.  I tell people they will get better, I look for the good in them, and I encourage people to look for their strengths and try to get the good parts of who they are to work for them.  

Some people would say this is wrong: I shouldn't tell people they are going to get better.  How could I know that (? experience), and I may be offering false hope.  I may be.  And I've had at least one patient tell me that I try to normalize problematic behaviors.  Most patients, however, seem to feel encouraged by my optimism, and boosted by the good things I see in them.  Ah, remember my post from long ago: What I Like About You.

Another psychiatrist I know says he thinks you have to be an optimist in order to be a good psychiatrist.  Really?  I don't know about that.  I'm kind of optimistic that pessimists can also be good psychiatrists.  What do you think?

Ah, comment moderation is on for the time being because some of our commenters have been shaking my generally positive faith in humanity and I find myself feeling a bit pessimistic about blogging.  As always, it's not the message, it's the delivery.     

Please do listen to Podcast 68!