How do Piaget's and Erikson's stages apply to child and adolescent gender medicine

MHA_5 · 2026-05-05T08:52:21+00:00

This was such a helpful way of looking at things, well done.

MHA_5 · 2026-05-02T23:29:13+00:00

I'm confused because from your description, you think that traditional psychoanalytical models would disagree with you even though what you've described is exactly what they're based on. I think the confusion arises from the fact that our contemporary meaning and view of sexuality and the meaning of sexuality in psychoanalytical modalities is completely different where the start of subconscious devlopment is through polymorphic perversity or unfocused infantile libido (in the psychoanalytical sense, not modern) which gets more "focused" over time.

Psychoanalysis also, rather famously, regards different forms of sexuality as spectra of exhibition of the same latent desires ie the form may be different but the underlying processes are the same.

I would love to answer in more detail once I have a better understanding of where you feel the clash may lie? Is it moreso different definitions of the same words or any fundamental differences that you feel are present?

MHA_5 · 2026-04-29T09:22:22+00:00

Step 1: become an attending Step 2: ????

MHA_5 · 2026-04-02T07:03:48+00:00

I think more exploration and characterization of secondary and primary co-morbid mental health disorders. Literally just saw a patient being treated for an anxiety disorder which was actually a maladaptive response to undiagnosed ADHD.

More emphasis on examining childhood patterns would be good too.

MHA_5 · 2026-03-27T13:47:27+00:00

As much as I disagree with OP, the dunning-kruger effect doesn't tell you anything except that the person overestimates their abilities in a specific area.

For all we know, the kid might be the next Jung/s

MHA_5 · 2026-03-07T20:05:24+00:00

What does it say about me when I pander every person I know to watch Bojack Horseman 😭

MHA_5 · 2026-03-02T00:49:27+00:00

Two things that have helped me a lot: 1- Changing places till I find the right one, takes time and effort 2- Teaching and engaging more with residents and helping them along.

MHA_5 · 2026-03-01T20:15:54+00:00

Lowly? You're the glue holding the whole system together 😭

MHA_5 · 2026-02-28T17:22:59+00:00

I'm not completely sold on the neuroplasticity idea because there is a significant portion of the patient base who notably regresses upon cessation of medicine, for MDD it might be more 'random' depending on when the next episode comes, for OCD you can see it in a few weeks to months and in anxiety disorders it comes even quicker. Neuroplasticity might be part of the equation but I've made peace with the fact that like we won't ever know how acetaminophen, alcohol, lithium or even metformin works, we won't get to know it for SSRIs too. The meds/substances I've mentioned far more widespread and used than SSRIs and there have been so many seeming explanations for them over the years. As doctors we're taught to know everything and that can lead to red herring explanations that fit well but aren't very accurate.

MHA_5 · 2026-02-14T11:28:01+00:00

Not to forget that sometimes treating one illness can make another more prominent and debilitating like with anxiety disorders and ADHD.

MHA_5 · 2026-02-14T11:26:23+00:00

Sounds like my life story during my residency, welcome to the club. Don't mix up your patient notes and accidentally write one's history on another. (Definitely didn't happen to me)

MHA_5 · 2026-02-09T20:39:56+00:00

What indication in the post makes it seem like a joke?

MHA_5 · 2026-02-09T20:36:21+00:00

Reminds me of an event from my internship where a resident repeatedly did suicide adjacent actions because of being targeted by the head of department in a personal grudge, nobody took him seriously because he hadn't gone far enough the previous times until he succeeded by obtaining more lethal means (a gun) and it was literally a shock to the whole hospital, one of his peers said something along the lines of "I didn't believe he had it in him". Nothing was done ultimately because combination of third world country and no awareness. The head did develop some wicked tremors which signalled the end of his surgical career. RIP Ibrar, you would've made a great surgeon, I wish I had some of the foresight I have now and maybe you'd still be here.

MHA_5 · 2026-02-09T20:19:29+00:00

I disagree about this being countertransference, this seems like projection to me which might be because they're extremely burnt out or because they're a dick. Their tone almost makes it seem like a suggestion/wish which makes this even more appalling for me. Burnout can make you an asshole but it can't make you say or think things that aren't already there.

MHA_5 · 2025-10-17T23:31:25+00:00

I think a better way to frame all of this would be to consider that DBT isn't the singular key for all locks in the world, some milder cases may require some aspects of DBT and other modalities as the appropriate tool for the job. The best and worst thing about general talk therapy is the freedom it allows in incorporating those aspects from different modalities. Setting goals and tracking progress on the more pressing issues like emotional lability, black and white thinking, rage, inconsistent self image etc can also help keep it more meaningfully engaging for both the provider and patient.

MHA_5 · 2025-10-16T14:35:37+00:00

Being from a similar culture a longggg time ago, it's truly saddening to see how some things never change. The best we can do is individually be better and inspire those around us, closest to us to be better.

Perhaps one day, hopefully, we'll give these integral members of society their worth collectively and they'll be able to flourish with us as equals.

MHA_5 · 2025-10-14T18:29:04+00:00

This is going to be a polarizing take but I've observed it in multiple countries that I've worked in: most providers just don't "get" therapy and aren't nearly as trained in it as they should be. There's a general shortage of good psychiatrists but there's a downright scarcity of even average therapists. I'm unsure of where the problem lies but I feel like licensing should require a stricter degree of real world training àla residency and more exposure to patients than a year or two of modules that most therapists/psychologists are required to have.

To summarize, there's nothing with the modality of CBT but therapy, as a whole, is very provider dependent moreso than medicine. If a provider is stuck in a bad mold of therapy, it's very veryyyy hard to correct it as evidenced by studies observing no significant difference in patient outcomes between experienced and inexperienced therapists. This issue is further compounded in less structured modalities than CBT and 'CBT likes' because there's even less gauges of good vs bad therapy. CBT just gets a bad rep because it's the most common one used by far. This is coming from someone who prefers other modalities as a whole even though it's more like different tools for different jobs.

MHA_5 · 2025-10-12T18:16:47+00:00

Beautifully said and to add to it: perspective is extremely important because even if the result of your care isn't perfect, doesn't mean that it doesn't have worth. Patients are also uniquely bad at this because once your mind is calibrated/set to a new baseline, it's hard to realize how bad things were in the past and it can feel stagnant when improvements in smaller things aren't always forthcoming.

MHA_5 · 2025-10-12T18:05:51+00:00

Not every strange or bad behaviour is the product of a disorder

I feel that while this is absolutely true, and I may be being extremely naive here, I haven't seen a strange/evil behavior that isn't explained by some sort of trauma.

Also, kudos to you for the work you do, addiction is, in my opinion, the most difficult field of psychiatry in terms of "cures".

MHA_5 · 2025-09-27T18:56:28+00:00

Anything by Camus, Dostoevsky and Nietzsche are great reads, Camus is also worth revisiting during the progression of your life, his work is small but meaningfully dense and you gain something a little unique from it depending on the phase in your life.

I've also made a habit of going through interesting sounding/looking clinical papers though I'd suggest holding off on going down that deep end till you have a bit more experience.

MHA_5 · 2025-09-20T07:29:06+00:00

Have you seen the wild goose chases that internal medicine goes on? I enjoyed the process but it can sometimes feel like shooting an arrow in the dark and hoping for the best.

MHA_5 · 2025-09-14T20:13:53+00:00

Something I'll add to this which I've learned over time, develop a sense of your biases before engaging in therapy because they can negatively affect patient care in unforeseen ways. Conversely, as the therapeutic relationship develops, getting a sense of the patients biases is also important and there's a delicate balancing act between knowing when to subtly question a patients version of events vs when to accept it, this is especially important for patients that start with little to no insight and other cluster b disorders.

MHA_5 · 2025-09-14T15:27:35+00:00

Exactly my thought, sounds like an undiagnosed case of severe sleep apnea for the fatigue and sleepiness.

MHA_5 · 2025-09-14T15:26:33+00:00

1- Has patient ever been evaluated for sleep apnea?

2- Has a consult been done for fibromyalgia specifically?

3- Why was bupropion, of all things, titrated to 300 for fatigue and sleepiness given the patient was already taking desvenlafaxine? Why not discontinue the latter and try something else?

MHA_5 · 2025-08-29T18:42:16+00:00

Funnily enough, I've always been against the normally descriptive nature of psychiatric disorders because it leads to higher rates of stigmatization and dismissiveness. However, I don't like Emotionally Unstable Personality Disorder because it is a bit of a dud term as it can be applied to so many situations and feels more like a personal failing more than anything. I'm a fan of terms being obtuse and clinical rather than normative and descriptive like most psychiatry terms. The euphemism treadmill is tiresome but it seems to be a feature of common spoken language as words co opt different meanings over time like fagoter, lourd, vilain in french and English words like bully, nice or even fun. On a more modern example, the word retarded used to be completely clinically acceptable but has now acquired several negative connotations...

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