21 Paths

Minnie was forty years old, and came to see me in my office to discuss being depressed. She had felt depressed off and on for many years, but had rarely told anyone about it. It was like dragging a weight around. She could still get things done in her, just not quite as well as she’d like. At one point she had told her family physician about this, and she was offered an antidepressant, lexapro. She took it for a few days, didn’t like how it made her feel, and stopped it. Her physician told her they could try something

How to Not Burn Out

“I just can’t do it anymore.” People burnout everywhere, in every field. They burn out professionally. They burn out in taking care of others. I live in Los Angeles and I can understand how just driving a car can burn someone out in this level of traffic. No one plans to burn out. Maybe they do have a little awareness that they’re going down that road, though. We have a level of control over where we place our attention, as well as our effort. If you’re worried you’re burning out, consider preventing it. There’s two parts, I believe, to preventing

In Brief for Those New to Therapy

If you ask ten different therapists what it is they do, you’ll get twenty answers. A therapist talks. A therapist listens. Using the term “therapy” implies only one thing, so for those who don’t know what therapy is, it’s hard to get a grasp on it. It’s even harder to understand that there’s many types of therapy. So let me begin with a comparison to religion. Religion is similar to therapy, in that they both have belief systems. Therapy is usually based more on research and evidence, though, rather than faith. Trying to pretend that there is one “religion” doesn’t

Psychotic vs. Psychopathic

They aren’t the same. Going back to at least Hitchcock (one of my faves), who brought the muddy term “psycho” into the public psyche, conflated the definitions as if all are violent, and all “crazy” is crazy. I’m sure there are briefer answers out there for those wondering what’s the difference between psychotic and psychopathic. And even though SRSLY made it into the OED because of its widespread use, lay inaccurate uses of the term psychotic will likely not. Briefly in discussing how we got here, the words are interchanged because they sound alike, and are used commonly to describe

Portraying Mental Illness in Story

Mental illness as a term gets thrown around a lot. It’s used by politicians as a scapegoat for problems or a target for funding. It’s sought by individuals to find meaning to their experience, or sometimes a justification for their difficulties. It’s a thing, talked about like any other disease. And yet the term is a lumping of many conditions under a single term, as if all mental illnesses are the same. They are not, but we talk about them that way and “let the experts sort it out.” I get that. At the same time it maintains the mystique

Hitting Rock Bottom

Over the edge of the green precipice lays the blue ocean

I’ve been thinking on this a lot lately, as the issue has arisen in various clinical situations. We do many things as caregivers (clinicians, providers, physicians, friends and family members) in an effort to help another person. Sometime it seems that if only this person could get a little help, they’d do so much better. And that is absolutely true, some of the time. On the other hand I’m meeting many people who actively sabotage their own improvement. Maybe they do this by burning bridges with family or friends. Maybe they do this via drugs or alcohol. As this happens

10 Life Lessons from a Psychiatrist

I run into the same issues everywhere, from patients, co-workers, and friends. People are stuck, and not sure how to “un-stuck” themselves. I’ve noticed some basic rules on how to live a more fulfilled life, to make life easier, and make you more effective. Consider them like guideposts if you feel off track. Some may be obvious. Others, maybe not so much. It’s not about knowing them. It’s about where you put your attention and effort. 1. Be Polite I’m not suggesting to be fake or disingenuous. Instead find the way to being kind to others. And if kindness can’t be

Is Walter White a Psychopath?

Walt’s pathological and Machiavellian level of manipulation of others, even those who might describe him as a friend, makes us question who the real Walter White is. Is he a psychopath? Is he a guy who suppressed his basic needs so much during his life that that now he’s just having a narcissistic tirade to prove he’s all-powerful as he approaches death? As a psychiatrist, I view the evidence that points in one direction vs. another. As a writer, I see the brilliance in how we’re led into watching his dark side unfold, while still empathizing with him. Modern psychiatry

Why I hate Xanax

Macro shot of white pills with one blue pill

A lot of people like Xanax. It’s given out like candy. People get it from their friends, from their primary care doctors, even from their psychiatrist. I hate it. I might go so far as to say it’s evil, though really it’s just bringing out the worst aspects of our nature. In my professional opinion, it’s bad for you. But no one wants to hear that. Yes, it feels good when you take it. People take it for anxiety. They feel less anxious (usually) after taking it. Must be working, logic would dictate. Unfortunately this is short-sighted, in the same

Anti-Heroes Embodied: The Act of Killing

We love the bad guys. Scarface. Tony Soprano. Vic Mackey. Walter White. The Anti-hero is king in the world of TV and Film, especially of late. It’s probably a fantasy fulfillment, at least to some extent. We love to watch that unacceptable part of us get unleashed, just temporarily. We can barely imagine what would happen if the bad guy was unleashed permanently. What if his killing was legalized, even state-sponsored? Without stating it, that is the subject of the documentary The Act of Killing by filmmaker Joshua Oppenheimer, produced by Werner Herzog and Errol Morris. A long time ago

Paul R. Puri, MD