doctor sir. imagine someone being put through the right stress becomes suicidal and when that stress is alleviated the suicidality lessens or of manageable due to the lack of that stresser.
A disability insurance company is harassing me “legally” because of the size of my claim (millions of dollars). They are using a tactic that resembles malingering entrapment through a forensic psychiatric independant medical exam. I’ve been dealing with psychiatric problems since my teens, and now have physical problems because I’m getting older(I stopped working after a back surgery). I’ve been honest since the start of the claim, but they are using highly trained psychiatrists to ask very specific questions, over and over. They are not letting me answer “it depends”, “I don’t know”, “I don’t remember” or let me explain. The questions are something like: Between the ages of 14-17, how many times per week did you have (enter symptom here). I could honestly respond 3 times/week in one interview, and 4 times at another time. How is that malingering!? This is not fair. I have suicidal ideations (conditional, I guess). I’ve had some all my life. I’ve always hated life. My mind automatically goes there in times of misery. But I have a family to take care of and I can’t quit. But if the disability insurance company cuts me off because THEY are playing a shady game with my life, I’m afraid this will be the end of me. I’m done. I can’t be a burden to my wife and kids anymore. Disability insurance companies are EVIL. They ruined my life.
If you have suicidal thoughts, please go to an emergency room. I hope things improve for you soon. Thank you for sharing your experiences. Peter Goertz
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
I had a friend who was suicidal because he didn't have a place to stay. He has been dead for a few years now... Due to suicide over not having a place to stay. I don't think he was malingering...
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
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?
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.
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.
Thank you for this video into your insights, Dr. Goertz. I unfortunately take some pause at your conclusion, however. Even if there is a level of possible lethality, I believe that we also have to look at the later consequences by admitting a patient to a psychiatric unit without true medical necessity. I work in an ED in an urban setting, so we unfortunately face extremely high rates of psychosocial issues that cause patients to attempt to seek hospitalization as an escape to these issues. I'm sure you share the experience of having patients present straight to an emergency room, sometimes even the same day that they are discharged from a psychiatric unit with the same current complaint as prior to their hospitalization. When I can occasionally review the notes from the attendings at the psychiatric unit, often the patient is truly reporting no acute symptoms even hours before they present to my ED. By reinforcing the malingering behavior, I worry that we may inadvertently cause dependence on the system for shelter/safety. Our department has a binder of patients that have county-wide care plans to avoid exactly this issue. While I agree that these individuals are at some risk of suicide, their presentations to the emergency department do constitute self-preservation, and as you expressed in your video, will sometimes report their suicidal ideations in an instrumental manner to gain access to shelter. I can't count the number of times I have heard that a patient would no longer be suicidal if, "I didn't have to go back to my room and board where everyone is high all the time." I admit, I have had patients do as you have said, and had suicide attempts on hospital grounds. I struggle with this grey area, as in those cases, I do feel that we have to move towards hospitalization. But then we create a system where patients learn that if they attempt to die by suicide, that is their instrument to gain access to hospitalization. I don't have any clear conclusion I necessarily want to make, nor do I think we should have a strict formula of when and when not to admit patients. Clinical judgment is always going to be paramount. But I wanted to add those concerns to the discussion and hopefully foster further consideration from this community. (And ultimately, I feel that the correct answer must lie with increased community programs and outpatient resources to better support these individuals.)
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.
@@goertzpsychiatry9340 i do want to add that I did take her once towards the end of the “episodes” to a youth facility state funded that housed teens short term and gave them therapy. After one weekend there she wanted to come home and realized these places are not like the are glamorized on TikTok and you tube. It’s too trendy to have issues nowadays and teens especially girls want to do anything to feel like they belong…even if it’s toxic.
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
Thank you for taking the time to share these stories with us.
Thank you Allie!
doctor sir. imagine someone being put through the right stress becomes suicidal and when that stress is alleviated the suicidality lessens or of manageable due to the lack of that stresser.
A disability insurance company is harassing me “legally” because of the size of my claim (millions of dollars). They are using a tactic that resembles malingering entrapment through a forensic psychiatric independant medical exam.
I’ve been dealing with psychiatric problems since my teens, and now have physical problems because I’m getting older(I stopped working after a back surgery).
I’ve been honest since the start of the claim, but they are using highly trained psychiatrists to ask very specific questions, over and over. They are not letting me answer “it depends”, “I don’t know”, “I don’t remember” or let me explain.
The questions are something like: Between the ages of 14-17, how many times per week did you have (enter symptom here).
I could honestly respond 3 times/week in one interview, and 4 times at another time. How is that malingering!? This is not fair.
I have suicidal ideations (conditional, I guess). I’ve had some all my life. I’ve always hated life. My mind automatically goes there in times of misery. But I have a family to take care of and I can’t quit.
But if the disability insurance company cuts me off because THEY are playing a shady game with my life, I’m afraid this will be the end of me. I’m done. I can’t be a burden to my wife and kids anymore. Disability insurance companies are EVIL. They ruined my life.
If you have suicidal thoughts, please go to an emergency room. I hope things improve for you soon. Thank you for sharing your experiences. Peter Goertz
Thank you, doctor Goertz. These thoughts are very important for me as a future psychiatrist.
Thank you Anna! Peter Goertz
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
I had a friend who was suicidal because he didn't have a place to stay. He has been dead for a few years now... Due to suicide over not having a place to stay. I don't think he was malingering...
I am sorry to hear this. Thank you for sharing it. Peter Goertz
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
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?
Thank you Sena! There are many good psychiatrists in the US whose mother tongue is not English. 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.
Thank you for your input on this.
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.
Thank you for sharing this. Peter Goertz
😂 you’re an awful parent
Well I am homeless. The psychiatric hospital is very nice, but I don’t know if they can help me
Thank you for this video into your insights, Dr. Goertz. I unfortunately take some pause at your conclusion, however. Even if there is a level of possible lethality, I believe that we also have to look at the later consequences by admitting a patient to a psychiatric unit without true medical necessity. I work in an ED in an urban setting, so we unfortunately face extremely high rates of psychosocial issues that cause patients to attempt to seek hospitalization as an escape to these issues. I'm sure you share the experience of having patients present straight to an emergency room, sometimes even the same day that they are discharged from a psychiatric unit with the same current complaint as prior to their hospitalization. When I can occasionally review the notes from the attendings at the psychiatric unit, often the patient is truly reporting no acute symptoms even hours before they present to my ED. By reinforcing the malingering behavior, I worry that we may inadvertently cause dependence on the system for shelter/safety. Our department has a binder of patients that have county-wide care plans to avoid exactly this issue.
While I agree that these individuals are at some risk of suicide, their presentations to the emergency department do constitute self-preservation, and as you expressed in your video, will sometimes report their suicidal ideations in an instrumental manner to gain access to shelter. I can't count the number of times I have heard that a patient would no longer be suicidal if, "I didn't have to go back to my room and board where everyone is high all the time." I admit, I have had patients do as you have said, and had suicide attempts on hospital grounds. I struggle with this grey area, as in those cases, I do feel that we have to move towards hospitalization. But then we create a system where patients learn that if they attempt to die by suicide, that is their instrument to gain access to hospitalization.
I don't have any clear conclusion I necessarily want to make, nor do I think we should have a strict formula of when and when not to admit patients. Clinical judgment is always going to be paramount. But I wanted to add those concerns to the discussion and hopefully foster further consideration from this community. (And ultimately, I feel that the correct answer must lie with increased community programs and outpatient resources to better support these individuals.)
Thank you so much for your thoughtful comment! Yes, sadly the social aspect is often a key stressor for patients. Peter Goertz
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.
Yes, lack of resources is problematic.
The thoughts that a medical ‘professional’ laughs at a patient who got urinated on makes me lose what little faith one could have in the medical field
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
Mentally healthy just means psychopath.
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.
@@goertzpsychiatry9340 i do want to add that I did take her once towards the end of the “episodes” to a youth facility state funded that housed teens short term and gave them therapy. After one weekend there she wanted to come home and realized these places are not like the are glamorized on TikTok and you tube. It’s too trendy to have issues nowadays and teens especially girls want to do anything to feel like they belong…even if it’s toxic.
do you think it’s malingering if I hit my head 🤔
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 oh, no. sorry I meant I fainted and hit my head. now I feel different
@@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
@@goertzpsychiatry9340 the hospital does think it’s some sort of malingering, I’ll get a second opinion and call it quits ig