Three "Shrinks" Rap About Mental Health

Nicholas Genes, MD, PhD

Disclosures

May 01, 2007

Dinah's a psychiatrist in private practice. Roy's a psychiatrist who consults for generalist physicians in a hospital. And ClinkShrink is, well, a prison and forensic psychiatrist. They bring their specialized perspectives together at Shrink Rap, a group session that you never want to end. I recently had the chance to turn the tables and ask these keen interviewers a few questions about their online activities and long relationship together.

Dr. Genes: How do you all know each other? And how did you decide to start blogging together?

ClinkShrink: It's all Dinah's fault. That's the explanation that's worked for me in most situations over the years.

Dinah: Face it: Everything is my fault; just ask my kids (or Clink). One day, I decided I wanted a blog. I didn't know what a blog was, [but] I still wanted one. I love to write, and I thought this would be a forum for me to write and to express some of the issues and emotions that come up day to day working with patients...

Clink and I trained together in residency. Roy and I worked together in a clinic. Both of them are wonderful people. I asked them to help in the Shrink Rap endeavor because they are the smartest geek-shrinks I know. Now we get together frequently to do our "My Three Shrinks" podcast.

Roy: It's really worked out well having 3 of us. We each come from a different psychiatric viewpoint. There are times when one of us gets tired of blogging, has nothing to say, or "real life" gets in the way. The others can pick up the slack. It just seems to work. Most new blogs last, what, 3-4 months? We just celebrated our 1-year anniversary. I think the glue that holds it all together is the humor.

Shrink Rap hosts Grand Rounds
May 1, 2007

Dr. Genes: You still have the tagline "by psychiatrists for psychiatrists," but your audience is much broader than that. Has an awareness of your audience changed your style of writing? Until recently, psychiatry blogs were underrepresented in the blogosphere; why do you think that might be?

Roy: Ideally, we started out wanting a community of psychiatrists to talk with. However, we recognized that anyone interested in psychiatry may access our blog, so we do tend to explain some things that may be self-evident to our "intended" audience. I think that we have developed a "voice" that is of interest to all healthcare professionals, as well as laypeople.

ClinkShrink: I think the biggest reason psychiatry blogs were underrepresented was because of the concern about anonymity and confidentiality. Because we hear such personal information about people, I think we're keenly aware of the importance of privacy. Blogging about case scenarios is a tricky thing to do in a situation like this.

Dinah: Okay, yes, we started out wanting to talk to other psychiatrists, and found ourselves mostly getting comments from an assortment of patients and other mental health professionals, as well as some non-shrink MDs. Regardless of who reads it, I continue to be thrilled with it. I think having Clink and Roy support this with so much enthusiasm has kept my enthusiasm going.

But back to your question -- yes, our awareness that the audience includes non-psychiatrists changes how we write. How could it not? As Clink has mentioned, the issue of confidentiality is huge in psychiatry, and we are trained to be very careful about not talking about our patients. I think this does put the breaks on psychiatrist bloggers. Though with the anonymity of blogs (at least theoretically), and the fact that psychiatrists are often a group of people who lean toward creative expression, I have been surprised at how few shrink blogs there are.

Roy: By the way, I hate the term "shrink," which is well known to refer to psychiatrists and other psychotherapists. It is a pejorative term, in my humble opinion. However, "Shrink Rap" seemed catchy...and "My Three Psychiatrists" just doesn't seem sexy enough.

Dr. Genes: Most group blogs I've encountered, in the medical realm and otherwise, have some sort of "mission statement" or overarching theme or something. Yours, as far as I can tell, does not -- except for your common profession. Some of your posts are didactic, some are rants, and some are a discourse on human sacrifice. Is this by design or just how it's working out?

Roy: Oh, yes, we have designed a carefully constructed blueprint for posting exactly the right type of post at exactly the right time. Unfortunately, we can't share this trade secret with you. It is our "secret sauce."

Dinah: Yeah, duck sauce. We have no plans for themes -- actually, that would wreck the spontaneity of it all. Oh, unless you count the duck theme.

Roy: I'm not sure how the duck thing started...something about support animals, I think. My son loves ducks; he's also partial to chickens and geese. One of our listeners has even donated ducks to poor families in our honor.

Dinah: I think we may need to explain the duck references. Last May, The New York Times ran a piece about "support animals" -- you know: seeing-eye dogs -- only this piece was on how the concept had extended to emotional-support animals for those with mental illnesses, like people who claimed they needed their dog to be able to eat in restaurants. It said the airlines would let certified support animals accompany troubled fliers -- mostly dogs and cats -- but the article also mentioned that 2 people had flown with support ducks, one dressed in clothes (the duck, not the owner), and a support goat. Somehow, we embraced the whole emotional support duck concept.

Dr. Genes: On your blog, I'm particularly fascinated by ClinkShrink's glimpses of life "inside the walls," and I think they make for an interesting contrast with the other posts about private practice and consulting.

ClinkShrink: Bless you for that. My goal is for more people to become interested and involved in correctional issues. Too often the involvement happens in an adversarial way -- through class action lawsuits or scandalous news stories -- when it should be more like an ongoing collaborative discussion. The prisoners shouldn't disappear from society's memory once the prison gates close. (End of ClinkShrink rant; I'll save it for the blog.)

Dr. Genes: What are some of your favorite blog posts?

Roy: For me, I'd have to say Psych Notes for Smilies, which was inspired by a comment from one of our readers, who wondered why her doc never put her on an antidepressant: "God knows most days I wonder why not. LOL." (LOL = laugh out loud.) I responded, "It's because of the 'LOL.' If you couldn't LOL, then maybe he would."

ClinkShrink: The single post I like the most is Knowledge Is Obligation. I think of that as being the ClinkShrink manifesto. Unfortunately, I can't claim credit for it since it's mainly a quote from someone else, but I can lay claim to sharing the spirit of it.

Dr. Genes: Fellow psychiatrists and other healthcare professionals will want to keep an eye on the Shrink Rap trio, not just because their writing is thought-provoking and fun, but also because they're hosting Grand Rounds on May 1, 2007. Dinah, Roy, and ClinkShrink will collect and arrange the best new posts from other medical blogs on their Web site, putting their own unique stamp on this weekly tradition.

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