LOGIN JOIN

People sometimes wonder whether I “analyze” everyone I meet. This is usually asked with some fear that as a psychiatrist I can “see right through them” and instantly know things about their innermost thoughts they’d prefer to keep hidden.  Although this is true (just kidding), I try to reassure them with the following analogy.

Imagine an architect whose business and personal life includes walking into and out of buildings all day. Does the architect “analyze” every building —  home, coffee shop, office, gym — all day long? I doubt it. Perhaps if a particular construction is especially creative, or unusual, or singularly beautiful or ugly.  But most of the time an architect relates to buildings the same way everyone else does: for the personal reasons he or she visited there.  (If there are any architects out there, please confirm!)

In my experience the same is true of psychiatrists and other mental health practitioners. We deal with people all day, both professionally and personally.  When working, our attention is directed in a certain way, toward understanding the person in front of us.  After all, this person paid good money for us to focus our attention exactly this way.  Other than this, though, we deal with loved ones as loved ones, colleagues as colleagues, store clerks as store clerks, and so forth.  It is only when someone’s personality or behavior is noteworthy and unusual that we may find ourselves viewing them momentarily through our “psychiatrist glasses.”

I’ve heard it works similarly for doctors and medical diseases.  Occasionally a case of acromegaly, cerebral palsy, rheumatoid arthritis, or psoriasis can be diagnosed in a stranger on the street, or in a crowded elevator.  Most of the time, though, people are just people.

The question about analyzing everyone often seems to harbor some anxiety.  It feels threatening to have possessors of mystical and limitless insight lurking among us, wantonly tearing holes through the public persona and self-image of each innocent bystander.

Fortunately, this is a fantasy.  Being a psychiatrist doesn’t make me a mind-reader.  It usually takes an hour of formal intake interviewing before I begin to have a sense of a person’s personality.  Often it takes more than one session. While it’s true that people, not just psychiatrists, can pick up clues to personality early in a conversation, psychiatrists aim more for accuracy than speed.   Instant on-the-fly psychiatric diagnosis or case formulation is fraught with uncertainty and error because it is based on insufficient data.  As professionals, we are trained not to shoot from the hip, and for good reason: because our opinion should mean something.  If the considered views of psychiatrists are to matter more than the hunches of untrained persons, we must refrain from offering half-baked, “cocktail party” assessments.  I cringe when I hear a colleague spouting off about a politician or celebrity known only through the media.  A detailed study of someone not personally interviewed, e.g., a psychohistory, may be defensible; an off the cuff opinion cloaked in psychological jargon is not.

“Analyzing everyone we meet” is literally impossible, and as in the case of the architect, would be a huge distraction from everyday life.  Moreover, even attempting it is unprofessional.  We should reserve any such analysis for the clinical office, where the setting is conducive, and the data sufficient, to make a meaningful assessment.

For more reflections from Dr. Reidbord, check out his blog: http://blog.stevenreidbordmd.com/