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A Journey Through Bizarre Psychiatric Cases

Audio

Aired 10/19/10

Psychiatrist Dr. Gary Small's latest book is a journey through his most unusual and bizarre cases, from naked headstands to hysterical blindness to fainting schoolgirls. Small writes about his challenges helping these patients over the years.

Psychiatrist Dr. Gary Small's latest book is a journey through his most unusual and bizarre cases, from naked headstands to hysterical blindness to fainting schoolgirls. Small writes about his challenges helping these patients over the years.

Guest:

Dr. Gary Small is a professor of psychiatry at UCLA and author of the new book "The Naked Lady Who Stood on Her Head."

Dr. Gary Small will be signing copies of his book tonight at Book Works bookstore in Del Mar.

Read Transcript

This is a rush transcript created by a contractor for KPBS to improve accessibility for the deaf and hard-of-hearing. Please refer to the media file as the formal record of this interview. Opinions expressed by guests during interviews reflect the guest’s individual views and do not necessarily represent those of KPBS staff, members or its sponsors.

MAUREEN CAVANAUGH: Many people seek out psychiatric help, when the usual ups and downs of life, become too much to honestly, most often their problems fall into a typical range of symptoms that professionals are used to seeing, and they can be helped by standard diagnostic procedure, then there are the cases presented in a new book by psychiatrist and author Gary small. His book, called the naked laud, what stood on her head, documents a series of rare disorders of the mind. Stories of doctor Small's most bizarre cases are told in a warm and even humorous style, which brings us into the mind set of both the patient, and the doctor treated. I'd like to welcome doctor Gary Small, who is professor of psychiatry the UCLA, and as I I say, doctor small, and his wife, Gigi Morgan are authors of the new book.

GARY SMALL: Thank you Maureen.

MAUREEN CAVANAUGH: When you encounter a bizarre symptom like a naked lady standing on her head, what's your first reaction?

GARY SMALL: I think probably fear, awe, and in fact, when I saw this patient in the emergency room -- an insecure first year resident of course that was my reaction, not really knowing what to do, and in the standard centric text, trust me, there's no case study to figure out how to do this, and so what you see are my reactions, the book, it's like being I fly on the wall in the psychiatrist's office, you get inside my head. It's very personal, and you understand, how a psychiatrist reacts to these kinds of baffling situations and how we use our own emotional reactions to help the patient.

MAUREEN CAVANAUGH: You're absolutely right. But when you have that encounter in the book, I think for lay people, when we hear the word psychiatrist, we expect someone to be extremely knowledgeable at all times, that they come up against some sort of bizarre symptom hike like this, they know how to handle it, but you take us through the idea, you don't know how to get through to this woman. Basically you're saying hello or --

GARY SMALL: I go through a series of futile attempts to get her to talk, and I try a medical expectation, we check some laboratory tests, then I stumble on the diagnosis, so immediately, I think, well, it must have been some brilliant question, I asked, then it comes to me, she's hypoglycemic, and that's why she's delirious and in the talking. ! And she had no memory of behaving in this way, after she came to, and she got her OJ, and she started talking to you as a real person.

GARY SMALL: And that often helps when people are out of touch with reality, that they don't remember what occurred. And I'm an expert, I've spent my career trying to understand what happens to memory as we rage. But I've also come upon the realization that it's not all about memory. If we're anxious or depressed we probably don't want to remember anything. We're concerned about these feelings. So this book really attempts to help people to understand that there is help out there. And It's psychiatry, it's not magic it's not wizardry. But it is something that can bring them back to help.

MAUREEN CAVANAUGH: I want to invite our listeners into the conversation if they have a question or comment about Gary Small about psychiatry, or some incident that has happened to you or to you family. They can give us a call at 1-888-895-5727. Doctor Gary Small and his new book. Now you say doctor small that in any given year, one in four adults suffers from a mental order, what kinds of mental disorders are we talking about here.

GARY SMALL: Major depression, where it really interferes with the person's life where they actually get physical symptoms they lose weight or sometimes gain weight. Anxiety disorders that cripple them. And it can be even milder states that affect them. Some people don't have access to help, but a lot of them have this misperception of psychiatry, that we're going to control their minds. I remember the old joke, how you can tell a psychiatrist at a cocktail party, that's the person that either stares right at you or looks right through you. There still is tremendous stigma. And that's one of the purposes of this book, Gigi and I wanted people to know that psychiatrists are people. And they do have an impact. There are many studies that have been done showing that psychotherapy, medication, sometimes together, sometimes separately. Have a huge impact on people's lives.

MAUREEN CAVANAUGH: One in four of the adults suffering from a mental disorder. Whether ask the spectrum of mental disorders that you talk about in in book. Where does that fall on that curve? Is is that a very, very small amount of people who exhibit disorders like a naked lady standing on their heads and the other things that you describe in the book?

GARY SMALL: Each of the stories are the most unusual cases throughout my career, and each is a medical mystery. It's a bit like watching an episode of House but with a psychological element on it. And they're unusual, but within each of them, there is something that's very usual. So for example, the naked lady, she had a mental disorder, delirium, she had a he had spontaneous panic attacks and the fear of going outside his house or agoraphobia. Each of these conditions are more common. . And we tried to touch upon one case of a guy felt that he had to amputate his arm. Many of us have bad hair days or mystery surgery that we're considering or some people starve themselves. Get anorexic, so what about these issues of how we perceive our bodies in what do we feel where that?

MAUREEN CAVANAUGH: I think that's one of the most fascinating, cases, the naked lady who stood on her head, the idea that this develop came to you or talked to you, and eventually you got out of him, the idea this he just difficult that one of his hands or arms was supposed to be on his body. And you go into, in that chapter, a whole range of reasons people can feel as if they are -- there is something about their body that shouldn't be the way it is.

GARY SMALL: There's a range. This is the extreme, most of us don't want to do that. Am but there -- I mean, how much do we obsess about our looks? It definitely kicks in when we're in adolescence, it's very important for being accepted by our peers and it continues throughout our lives of we spend a lot of timing with what we eat or whether we exercise enough, it's all over the --

MAUREEN CAVANAUGH: And now you make, the point, that there are a lot of people who have plastic surgery, that comes to mind. A lot of people who go in over and over again for plastic surgery, yet they're not necessarily under observation at a facility, and where do we draw that line.

GARY SMALL: I think that's part of the debate, and in that particular story, I talked with a surgeon friend, and asked him, I mean, at what point would you stop doing serial plastic surgery, and I think it comes up in many yours of psychiatry, when is I condition just a person the trait or a disorder? At what point does it disrupt the person's life? And I think because of those arguments they rationalize, I have control, this isn't really an addiction, I can quit any time, whatever it may be.

MAUREEN CAVANAUGH: We're talking about the new book that he and his wife, Gigi Morgan have written, called the Naked Lady Who Stood on Her Head. And we are taking your calls if you'd like to join the conversation at 1-888-895-5727. Just one last question, if I may about that particular gentleman who had a problem with his hand, you documented in the book a very interesting conversation you had with him, when he comes in, and it becomes clearer and clearer to you, that this is something who is at risk. And you make the determination to send him for observation to a hospital. When criteria do you use when someone -- you people someone has to have that kind of attention?

GARY SMALL: In this statistic case, I was talking to a 28-year-old carpenter who began telling me about the electric saw in his basement, and about finally confusing to me how he felt, and his despondency and his ambivalence about cutting his happened off. So that was kind of an alarm that went off in my head. the basic criteria, a psychiatrist will use is to look at whether someone is an acute danger to himself or someone else. Ear whether they just can't take care of themselves. And when that occurs, we're required to hospitalize someone against their will of it's not always comfortable, and in the book, and in the scene, I see how I --

MAUREEN CAVANAUGH: He was not happy.

GARY SMALL: No, he was not happy. I've seen that many times where people are not happy. But many thank me later. When what we find with many of these mental conditions, whether it's a disorder, they don't have amount of insight. And when you bring them back, and when they get treated, they have some ability and perspective, and they realize that they're more themselves after the treatment. And they appreciate that.

MAUREEN CAVANAUGH: Another fascinating case, request actually a series of cases, that you talk about in the book come under the headliner of the fainting school girls.

GARY SMALL: These are out breaks of mass hysteria, where people look like they have physical illnesses, but it's really from a psychological cause. Will this began and there was a whole outbreak in a Boston suburb, and I drove out there in my 1974 Toyota Corolla, and started looking at these outbreaks. All the turmoil that -- push back and resistance from families in accepting the possibility that this might have a psychological cause, and these outbreaks, these occur all the time, and I've studied them over many years, it's not just about the psychiatric science behind it. But sometimes it has political ramifications, when they occur in delicate areas of the world. One side blames the other side.

MAUREEN CAVANAUGH: These are instances where people feel absolutely convinced that they had to faint or they become sick to their family, or something, a group of usually it's younger people, but not always. And they -- they're absolutely certain that some toxic substance must have caused this.

GARY SMALL: That's often a chinned reaction, and there's a heightened state of emotion, and very often an attribution of an organic cause. And what we see today with this concern of the environment, plus a psychological outbreak, so the job of the investigator is to tease out one from the other.

MAUREEN CAVANAUGH: I'm speaking with doctor Gary Small. Wee talking about his new book, the Naked Lady Who Stood on Her Head. Taking your calls at 1-888-895-5727. Let's hear from John, calling us from cardiff.

NEW SPEAKER: I just wanted to comment, that that was interesting talking about the fainting issue. It kind of reminds me of Victorian women, fainting when they saw blood in the nineteenth to 20th 7. What I wanted to addresses the issue -- had a lot of issues with depression and substance abuse, and initially sought treatment in the form of more traditional religious approach of AA, and a lot of psychiatrists backed that, and eventually found that the more alternative more scientific method of smart recovery, I wonder if the doctor had any comments on those kind of methods in this field.

MAUREEN CAVANAUGH: Well, thank you for the call, John, I don't know that that's your specialty, but would you like to comment.

GARY SMALL: Well, there are, whether it's substance abuse abuse, depression or anxiety disorders, there are often different schools of thought and different approaches, in the area of substance abuse, yes, there are different approaches of if you take alcoholics anonymous, that has been a tremendous on what works for them, I've seen in my own practice that this combination approach can be very helpful, and sometimes, We'll recommend a medical treatment, maybe a social support treatment like AA or some other kind of 12 step program and see what that fits for that individual. So you have to customize the treatment for the individual.

MAUREEN CAVANAUGH: Let's hear from mike in the north county.

NEW SPEAKER: Like I told your screener, I was hiking, I slipped on some wet rocks, I landed on my forehead and face, I was knocked unconscious for 45 minutes. Some other people discovered me laying there, they didn't know me, and if are the next three hours they were trying to coax out of me, who are you, where are you from, how can we contact your relatives or family or help, and from my perspective, I kept arriving in the presence about every 2 to 3 minutes so I -- for me it was like suddenly finding yourself sitting at work, at your desk, and how did I get here?

MAUREEN CAVANAUGH: Ah.

NEW SPEAKER: I don't remember anything that went on for three hours then finally I arrived next day. And unless you've ever experienced that, you cannot imagine the terror of not having a past.

MAUREEN CAVANAUGH: Wow, mike, thank you for telling us about that. So he lost his short term memory.

GARY SMALL: It sounds like a concussion, and that often happens with concussion, and it is very scary to people. Our memory defines who we are, it defines our past, without it, we can't plan the future, and we have now present. So far I think he describes that fear, that gripping fear, and it's not just memory loss that can be a problem, people for severely remember depressed, they're not the same. They can't get out of bed. Everything is distorted. They see the world through gray glasses. So when our relates are distorted like this, it's not great. And we don't have the insight that it can change but one thing we know, for example, take depression, I know that I can treat depression. I know there is a very good prognosis for that, much better than many other areas of medicine, and I think a lot of people don't realize that.

MAUREEN CAVANAUGH: I'm speaking with doctor Gary small. And he is the coauthor of Naked Lady Who Stood on Her Head. It's the stories of doctor small's most bizarre cases. You tack about doctor small a woman who wanted to be pregnant so badly, she had at least one false pregnancy, possibly multiple false pregnancies, and how is it, I think you know people can understand how your mind can make you glum and depressed and so forth. But how can your mind actually are make your stomach swell and make your monthly cycles stop, how can it do that.

GARY SMALL: Just hearing you ask that question blows my mind right now. And that's part of what drew me to psychiatry, the fascination of this, how the mind can make the body sick. You mentioned mass hysteria, how when it happens in a group, it's tremendously powerful, but here's a situation where a woman can not only fool herself, but sometimes fools a doctor. And a doctor doesn't even realize this this is a false pregnancy. And this have been a lot of explanations, physiological explanations of sometimes the stomach is just bloated from gas, so there could be a variety of factors that contribute to this, but it's relatively rare, but it does happen, and in this particular case, we got into some of the psychological issues, how for this particular woman, having a baby was really important, she had siblings, all the sisters had babies, got a lot of attention, so we got into that psychodynamic or interpersonal force that drove her body to make her think she was pregnant.

MAUREEN CAVANAUGH: And she didn't want to believe it. She didn't want to believe that she was actually causing this herself.

GARY SMALL: It was hard for her to accept it. And I think it's hard for us to accept how powerful our minds are.

MAUREEN CAVANAUGH: Good morning, don and welcome to These Days.

NEW SPEAKER: I want to say hi to doctor small from one of your old classmates in van Nuys high.

GARY SMALL: Fantastic, hi don. Of.

NEW SPEAKER: My question relates to memory retention with regard to being over stimulated when you have a lot of input, some of the work I do has, you know, high energy, a high degree of inputs and issues going on simultaneously. And I noticed the retention may be affect would by just the volume and are there techniques to deal with that type of thing to cam part mentalize the issues and retain them better.

MAUREEN CAVANAUGH: Thank you don. Thanks very much for the call. We were just talking about that, before we started talking, how too much information all of it just leaves, you just don't have it anymore.

GARY SMALL: I know Don graduated high school the same year I did, so I know he's a baby boomer, I know he's middle aimed. it's like the rest of the body, and it's hard for us to multitask. I think younger people are better at it. So we tend to be very focused on one task at a time. And I think this is just part of the brain aging and there are strategies we can compensate for. Gigi and I have written several books on this. The memory Bible and others. on ways to improve memory capacity and 206 good memory happen. So don't worry, don, there's good memory out there. You just have to remember where to get it. But speaking of memory, I wanted to mention that this evening I'm gonna be at book works in Del Mar, and I'll be signing books and I'll be reading sections of the book. And actually my wife and coauthor, Gigi Morgan will be reading with me. She is a former actress. So I'll be playing the part of the psychiatrist, she'll be playing the part of the unstable patient.

MAUREEN CAVANAUGH: Doctor small, at the beginning, I mentioned the fact that all these cases issue it's not a very clinical rendering of these cases, it's warm, it's sometimes humorous. And I think you make the comment in the book that there is a great deal of humor that exists among medical professionals and psychiatrists, not so much making fun of the patient, but rather because you're keeling with such serious issues, you want to maintain a level of the human.

GARY SMALL: I think that humor can be very delicate in these conversations about gallow's humor and medical settings and how it demeans patients. But Freud described it as a defense mechanism, and a way to cope with anxiety, with stress, it helps us in a pleasurable way, step back and get perspective. And in many times .

MAUREEN CAVANAUGH: In just the final minute that we have, perhaps you can tell us about the last case that is in your book, because it's very poignant, it's one of your mentors who's getting older who has been diagnosed with Alzheimer's disease, and all of a sudden, thinks his life's work, thinks he's a fraud.

GARY SMALL: And that actually is the theme of the book, where I start out and I feel uncomfortable, I feel like I'm playing the role of a doctor or a psychiatrist. At some point we have to go from the textbook to life. And here is somebody who I admired later in his life, having those findings of experiences and feelings and we talk about how we dealt with it. I think one of the difficult things with that case. in that I couldn't help him any more than what's available. And I can imagine what it's hike for the millions of family members going through this every day with their patients who suffer from this illness.

MAUREEN CAVANAUGH: That brought you closer to it.

GARY SMALL: It really did. he was so bright, he made the diagnosis before me. And it brings up issues of when you say, maybe, step over the professional and personal boundaries. How it's important -- there's an old saying, a doctor who treats him has a fool for a patient. And it's a tricky situation. We try to avoid it, but we can't always avoid it. What do you do if someone very close to you is having a psychiatric medical emergency and you say I can't deal with it.

MAUREEN CAVANAUGH: Well, I want to thank you for being here and talking to us today, and also congratulate you on the book. Thank you c small.

GARY SMALL: Thank you, it's good to be here.

MAUREEN CAVANAUGH: He and his wife Gigi Morgan have written a new book called Naked Lady Who Stood on Her Head. And at book works store in Del Mar. If you'd like to comment, please go on.

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