paranoid thinking – Inside The Mind of a Psychiatrist

I looked in the mirror and nodded. Yeah, I really liked my jacket and wool cap. It was chilly this morning, but with the new additions to my wardrobe, I’d be warm and look good.

Minutes later, I was browsing the window of Barnes & Noble when a homeless man, pushing his cart filled with all his possessions shoved into plastic bags, announced loudly, “Lookin’ cool, but a fool”.

Shocked, I stepped away from the window and watched as the man shuffled past. “Jesus”, he was talking about me! I glanced at my reflection in the store window and shuddered. How did he know? I was feeling so full of myself this morning, and the old guy picked right up on it. It was brilliant.

It’s uncanny how some untreated schizophrenics have the intuitive skill to read our minds. Like a psychiatrist uses his “third ear” to pick up hidden nuances in psychotherapy, the schizophrenic can be even more acutely in tune to another’s inner workings.

To me it is absolutely amazing and mysterious. Sadly or happily or whatever one’s perspective, when treatment is successful, the magic fades — as do the voices and paranoid ideas.

Before they’re treated, how do psychotic people do it?

Probably being paranoid, with all senses on alert, allows the primitive, reptilian part of the brain to pick up and decipher the hidden thoughts of all potential attackers. The biochemicals in the brain align just so and magic happens.

I loved my first year of psychiatric residency when I was surrounded by untreated schizophrenics. I loved the mystery and the magic. I loved all aspects of how the mind works.

I still do…

Like mysteries and magic? Check out Chasing Backwards, a psychological mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear.

Dr. Smukler has won the prestigious Golden Ear Award for excellence in teaching at Harbor-UCLA Medical center and excellence in writing fiction at The Santa Barbara Writers Conference.

All books are available as ebooks and paperbacks. You can find them at amazon.com/author/arthursmukler or https://artsmuklermd.com/

It was 2 AM when the phone jarred me awake. It was a busy evening in the ER and I had gotten back to the on-call room at 1:30 and had just fallen asleep.

“Doctor Smukler,” I said, yawning, and fumbling with the phone, hoping the ER nurse made a mistake.

“Sorry to wake you. We have a 50-year-old male physician who’s extremely agitated. Pacing, diaphoretic and saying he has to talk to a doctor.”

“Why?”

“He won’t say. He said it has to be a doctor.”

A loosely organized thought wormed its way into my overloaded brain. “What kind of doctor is he?”

“I don’t know.” The nurse sounded a little defensive.

“Please ask him.”

A minute later she came back on the line. “His name is Doctor Jeffrey. He’s an ophthalmologist.”

I seemed to recall a fellow resident mentioning something about a violent ophthalmologist. Was I remembering it right? Something about him having to be restrained…

“Does he seem violent?”

“No. Just agitated.”

How many violent ophthalmologists could be hanging around emergency rooms? “You know what. I think you should call the police.”

“The police? I really don’t think it’s necessary.”

“Maybe not, but please call them. When they get here, ring me back.”

“You’re the doctor.” Translation: what an idiot. She might be right. She probably is right. Christ, only six months into my first year of psychiatric residency and I’m going to come off like an absolute fool.

Twenty minutes later, I walked into the ER and the nurse said, “The officers are waiting outside the examining room.” The expression on her face implied that she was doing everything she could to not roll her eyes.

I started to explain why I was doing what I was doing, but then just shut my mouth. As I approached the officers, another bit of memory came back. The guy was a Karate expert.

“Hi officers,” I said, and shook each of their hands. “I may be overreacting, but this patient is a physician who has a history of violence and a blackbelt in Karate. The nurse thinks I’m being a bit, I don’t know–”

“–Don’t worry about it Doc. That’s why we’re here.”

I sighed. “Thank you. I’ll leave the door open. Could you both stay off to the side and give me a few minutes. If I holler, you know what to do.”

I walked in the room and before I could even introduce myself, Doctor Jeffrey screamed some unintelligible obscenity, leaped out of his chair, and charged towards me. Before I could even open my mouth, the officers had raced into the room, grabbed the doctor, and slammed him down on the floor. Seconds later, he was in handcuffs. Minutes later, he was strapped to a gurney and on his way to PGH, Philadelphia General Hospital, where there was a special unit for violent patients and criminals.

On the way out of the ER, the nurse came up to me and shook my hand.

“Doctor, I will never doubt you again.”

“Sometimes, you just get lucky.”

“Maybe. But if you ever decide to go to Vegas, take me with you.”

We both laughed and I dragged myself back to bed.

The next morning, I spoke to the resident who had mentioned Doctor Jeffrey in morning rounds. Doctor Jeffrey had a history of a severe Bipolar Disorder. When he stopped his medications, he went into a paranoid, manic state and often became violent.

I learned a very important lesson that night. It’s okay to be afraid.

Interestingly, it was fear that helped me to be lucky. Luckily, I remembered what my fellow resident said and erred on the side of caution. Luckily, I was too tired to care much what the nurse thought of me. And luckily, the police were really good at their job.

Please don’t forget to subscribe to Inside the Mind of a Psychiatrist.