Always and forever avoid the following rabbit-hole topics when working with a psychiatrist. Includes Doctor of Medicine (MD), Nurse Practitioner (NP) and med providers exclusively (not therapists). Not only will they roll their eyes in frustration, but often they will refuse to acknowledge these items entirely. Pushing industry issues without proper platforming simply results in valuable psych time (and patient resources) lost. Of which you don’t get much of.

It’s important to delineate the difference between psychiatric and therapeutic care. While therapy depends on establishing completely unhindered trust, psychiatric medicine is much more procedural. Honestly, there is little time for unfiltered honesty in psych… save that for your therapist. The goal with psychiatry is getting in and getting out with as little headache as possible. The very limited time leaves no room for nonsense. Follow these 10 steps to avoid that nonsense.

1. Big Pharma

Thousands of lives lost to medications and drug addictions worldwide among a greedy industry of flailing integrity. But try bringing this up to any psychiatrist and watch their eyes roll back in fatigued dismissal. Their entire backbone has arguably spineless (and questionable) integrity well documented. And yet good luck finding a professional willing to admit this, let alone discuss it.

If McDonalds milkshakes caused even half the deaths some medications have, would we trust their french fries? Likely not. Nor should we be expected to. Or at the very least, it certainly warrants a patient discussion of high priority. Yet the ugly elephant in the psych room never gets talked about at all. And you may be considered difficult, paranoid, and uncooperative for trying to discuss it.

It’s not the existence of failure in psychiatric medicine that is so concerning, it’s the blind ignorant attempts to sweep this failure under the social rug. A psychiatric reckoning is long past overdue. No need to start a revolution all by yourself though… it’s a battle no one has ever won.

2. Conspiracy Theories

No one cares anyway. But the key here isn’t to avoid social injustices… keep fighting that good fight! The goal is not coming off inherently paranoid to any of your providers, ever. They play the game, so feel free to play it back.

Of course, we mean high functioning paranoia here… If you think tree-gnomes are following you seeking troll-harm, for God’s sake speak up and get some help. But if you just have a subtle social proclivity to not trust big business (like Big Pharma), it’s better you keep these perceived character-fading insights to yourself. Even if there is good reason, implied paranoia only works against patient credibility, becoming a short and long term dismissal threat.

Always remember, your psych provider not only trusts Big Pharma, but their whole profession revolves around it; They are practically trained by them, and dedicate their daily lives to being their direct mouthpiece and salespeople (respectfully). In other words, they drank the coolaid long ago. So pick your small talk topics accordingly. These med-providers have thousands of paitients and a measly 30 minutes a month to decide if you are just a drug addict seeking asshole. Don’t give them leverage they don’t need.

3. Your Substance Abuse or Drug/Alcohol Addictions

If you party part time, or meander through addictions cumbersomely… know that most psych providers will frown upon this. They may even limit the medications prescribed; controlled substances are often the most effective clinically, but they require perceived responsibility to get prescribed, else you risk getting pegged a drug seeker.

Despite no addict ever being able to support an actual drug addiction on 30 day supplies, your med provider will think differently, proudly insinuating they are on some frontline fight against addiction. While laughable, it’s best you let them keep this facade for ideal treatment, else it risks getting in the way.

That said, this doesn’t excuse your reckless drinking. Still handle your addictions directly and professionally, just do it separately, outside of generic psychiatric care. Instead, work with a psych/therapy provider specialized (and experienced) in addiction. And make sure sympathy is included, versus psychiatric policing.

4. Any Disagreement, Controversy or Hypocrisy

Psychiatrists are used to dictating advice. They work alone and are accustom to being final word. Their ego is intimately intertwined with their profession, as many like to believe they are on the front lines fighting for good. They help people. And gosh-darnit, they’ve been doing it a long time and know better than you or anyone else. It’s one of the negative side effects of operating an entire career inside an industry vacuum (#).

It is because of this position of inherent (unchallenged) superiority, that makes trying to argue opposition completely futile. Remember that time your best friend found bible thumping and tried to argue against reason? It’s the same mechanism at play in psychiatry: push come to verbal shove, it’s patient opinion against prescriber “profession”, which ironically is usually still just opinion… but “professional” opinion nonetheless.

Under normal social passings, standing your ground and reiterating your passionate point would make perfect sense. In a psych room without any checks and balances present, patient just sets themself up for dismissal. After all, you are almost fucking crazy. What do you know?

Letting your prescriber continue to believe they are right will often serve patient best long term. It just makes the relationship easier when you keep prescriber on pedestal like they want. Disagree with them? Pick your battles carefully, or risk degrading social bonds; frayed and strained relationships do not go in patient favor.

5. Your Guns or Violence

There are few instances where you can lose your rights (and freedom) as a patient being honest. Threats, harm, or violence of any kind are some of them. Think of it like saying “Bomb” at the airport: Just don’t do it, Ted. Nothing good can come of it.

That said, if you are hearing voices or having delusional thoughts asking you to harm things, ignore these requests and seek immediate professional and pharmacological intervention. This article is not for you. This article is for high functioning madness of which is never a physical threat.

Small-talking about violence or weapons can land you in legal trouble, even in passing. Shoot guns on weekends? Sleep with a firearm under your pillow? Street fighting for kicks? Yeah, just don’t mention it.

6. Self Medicating (Kratom, THC, CBD, Exercise, Etc.)

Earthly medications like Kratom and THC are in direct threat to big Pharma. As is not taking medication at all. While not actually an existential threat, this does jeopardize fundamental bottom lines. While this article is not written to support Kratom’s use, it is supportive of being creative when it comes to self managing almost being crazy. Particularly when medications fail you or are not effective.

But the small narrow-minded world of psychiatric pharmaceutical interventions is certainly not discussing fringe science, nor anything outside clinical considerations (some exceptions). So don’t expect your med provider to support or even care about your all natural living. In fact, they may even challenge you or prevent prescribing certain controlled meds.

Is your diligent fitness strategy keeping the madness at bay? THC helping you sleep? CBD helping with depression? Telling this to your psych provider may result in challenging responses. The risk here is twofold: losing patient respect and provider undermining patient beliefs. Keep in mind, the placebo is up to 50% effective under clinical trials. This is real science: but believing is critical to its success; it takes Peter to pan out.

Yet in less than 8 words, or with a brief scoff, your psychiatrist can (and will) belittle your self medicating as potentially irresponsible rogue science. And poof, your placebo effect pops like your childhood dreams. Right or not, the solutions within psychiatric care mercilessly return back to pharmaceuticals almost every time, beating a dead horse eternally. It’s the only tools they have: pills.

7. Their Ego

Psychiatry holds a high Karenian risk; It behooves the patient to make it seem like it was all their prescribers professional idea. The nature of independent operations lacking any oversight, mental health “professionals” operate in a vacuum. This leads to bias drift, contempt, and resentment. Opinions can solidify into skewed fact, unchallenged for decades. It can also just cause really bad advice and poor psychiatric leadership.

Take notice, psychiatric treatment is almost always just one person in a room talking with you in private. Statements made, advice given, and medications prescribed are almost never peer-reviewed short or long term. By anyone. This means when inevitable mistakes get made, there is almost no room for effective accountability. So you become your only advocate, and have to quietly police your treatment.

That said, this perceived authority is indeed important to psychiatrists and MDs alike; it’s a type of social currency they depend on. So always ask them for permission humbly for everything decided, even if just a formality shielding your own decision making.

For example, “Adderall helps me and I would like it prescribed asap” should instead be more humbly stated: “I’ve always had great luck taking adderall for ADHD, but I trust your professional opinion and appreciate your direction here. What do you think?” The only issue here is, sometimes they make the wrong decisions. So patient knowing when to stand up vs back down is critical to long term psychiatric success.

8. Their Wealth (Exploitation)

Psychiatrists make a lot of money prescribing meds, an apple not falling far from the Big Pharma tree. Greed aside, some might feel this is even exploitative. I once asked a Miami drug rehab owner why he thought helping people should cost so much money (mine cost nearly $60,000 for ~45 days… 10+ years ago). If they really wanted to help people, why would they require such exorbitant fees from humans struggling so hard? It didn’t go over well. There was a lot of back peddling and justifying high costs. Blah blah blah.

Meanwhile, a black man hand-cleaned the owner’s every single vehicle on a daily basis outside his shiny rehab. We would watch in awe like addicts sucking down rehab smokes. The owner had more cars than Jay Leno, and not a shred of guilt for doing it, shamelessly flaunting his own addiction-defeating success materialistically.

Do they deserver it? Who cares. The point is: don’t expect a kind response when you bring up your psychiatrists 2nd Rolls Royce, or their 3rd vacation home in Aspen. It’s much better to insinuate your provider is struggling humbly helping humanity one script at a time, like a troubadour of human health bravely traversing human emotion selflessly.

Remind them how hard they work, and how much they help those lost soles out there struggling med-less (even if they don’t). Thank them for helping you, even if they haven’t. Trust the process: The ass-kissing will always go miles further for everyone, patient and provider included.

9. Their Personal Lives (ex: Children, Family or Sex)

The last thing any psych provider wants is some half-crazy patient ogling their children. So just don’t. In fact, its best you never ask about their lives at all. A provider offering too much information about their lives is a huge red flag in itself. You have 20-30 minutes per month tops to decide your medication fate for years. Don’t waste precious time on their dopey children. It will only raise red flags for everyone. This is patient time and patient time alone.

So averse to sharing personal information, psych providers will commonly operate significant distances away from their home town residence. This way they don’t have to stumble across you chewing your cotton-tongue in the produce isle of the grocery store.

So if you see your med provider in public, back off Bob: ignore them or give an acknowledging quiet nod tops. Excessively trying to befriend your psychiatrists will blur the professional lines, and problematically raise concern. Remember, psychs are expecting their patients to be a little crazy, which means they can sometimes project this crazy onto your non-crazy life. Making sure you never give them that potential will go a long way for everyone.

10. Their Mistakes (Critique)

In the same spirit of operating in professional vacuums discussed above, psychiatrists almost always think very highly of themselves. And there is never anyone there to humble them otherwise. They have spent lifetimes dedicated to “helping” patients in need. And while you may disagree with the term “helping”, they feel proud of their professional dedication and believe in their work wholeheartedly. The problem is: the industry completely pads itself away from outside feedback. To their own detriment.

Psychiatrists like to be right; they’ve spent entire careers dictating advice. And even when they are wrong, they never actually have to be held accountable or face the repercussions of these mistakes. I’ve even seen critique get met with patient dismissal. I mean after all, many of these patients are almost fucking crazy.

I once told a haphazard MD she was “sloppy” for not writing down the many meds we have already tried after recommending some 2-3 times. Realizing my med provider lacked the adequate time and due diligence required to pay attention to her patient, I got upset and tried holding her accountable verbally. She got very offended, and I was met with a strong “provider is always right, patient is always wrong” mentality. In this case, my feedback was met so poorly, it ended up destroying our entire treatment plan together prematurely. This caused a rippling effect of negativity throughout my treatment plan for 3 months after.

Avoiding these topics will streamline your psychiatric experience. While honesty is critical in therapy, it can backfire psychiatrically. The mental health providers notoriously overbook their patient-quota, leaving each patient interaction to 20-30 minutes per month, tops. Sessions are almost always late to start and quick to finish… just like your sex life. And watch out for dangerous “hipshot” advice (#), its notoriously present in psych.

Catching Karens (CK) does not provide professional or medical advice, only opinions and experiential patient insight. In a mental health crisis? Dial 988 (free 24/7) and visit Suicide and Crisis Lifeline. Medical emergencies Dial 911 (US & Canada)

If you are mentally ill or worried about the safety of you or anyone you know, please talk to a mental health professional about the available options. Delusions, suicidal thinking, unwanted thoughts, harmful thinking, or anything else threatening yourself or others is reason for serious concern and requires action, including potential pharmaceutical interventions.

CK is a strong supporter of modern western medicine, including effective pharmaceuticals. Raised by an MD to believe in Western medicine, I have witnessed its success and failures first hand. While in some cases, not taking medication is dangerous and irresponsible, it’s certainly not a positive solution for everyone, especially high functioning madness.

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