25min chapter

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Dr. K (Part 3): Therapeutic Non-Therapy

Decoding the Gurus

CHAPTER

Navigating Emotional Dynamics in Mental Health

This chapter explores the complexities of interpersonal relationships in the context of mental health, focusing on the interplay between assessment and informal therapeutic practices. It highlights the importance of understanding personal experiences with conditions like bipolar disorder and the impact of family history on treatment choices. The discussion critically examines the lines between friendship and therapy, emphasizing the need for professional boundaries and the ethical considerations involved in providing emotional support.

00:00
Speaker 1
I
Speaker 3
would ask them questions. So I think like there's like, the fundamentals are different here. So like, you think he needs help, right? And you've diagnosed some problem because you know him really well, right? So you preface this with, I've known you so long. So you started out by stacking the deck of like, here's all the evidence for why my opinion is correct, right? And then you said, this is what I've observed. It's clear to me that you love the guy and that you want to help him and your heart is in the right place. But if you kind of pay attention, how did he respond to what you said? He combated it. Absolutely, right? Some of it I agreed with. The stress I agree with. Sure. So you're self-aware and stuff like that, but affectively, like emotionally, like he did not like that, bro. Like y'all can go back and watch the tape, but just like watch it. There's a lot of good news. How did you feel about it?
Speaker 5
I'm indifferent about it. I think there's a healthy amount of like back and forth that Jack and I caught me. You're a critique to me. Oh yeah. Like I was given Jack crap for his haircut. So it's like this back
Speaker 3
and forth. I totally agree that there's a lot of health here. I'm not trying to create a mountain out of a molehill, but I saw something called micro expressions. Please don't dive into it. I love this. I love this. Okay,
Speaker 1
so there you go, Matt. That's that. Okay.
Speaker 2
All right. There we go.
Speaker 1
All right. So now after that, Dr. Mike's kind of needling about this. Specifically,
Speaker 3
I was pointing out certain dynamics that they have, and I was talking about Ayurveda, and a couple of these other like things, and I was educating about that using them as examples. But if you look at that, you know, I'm not assessing them, if you kind of think about that, let me put it this way. Let's say that that is the interaction that I have with someone who is presumably a patient. Would you consider that medical care? Like did I would you say that that is so if someone comes to you and that's the kind of interaction that you have, right? Does that qualify is diagnosis or treatment in your book?
Speaker 6
I think it partially is. Yeah, I also when
Speaker 3
you're getting
Speaker 6
a history of present illness from a mental health condition and as a trained individual in that area. Asking questions about mental health and then giving your read on it is so actually a history assessment. What would be the condition that you would say I was assessing for in that situation? Personality disorder, potentially mood, asking those questions and then giving your read of it. Again, I think when you're interpreting what someone is saying from your state and they're looking for you to have the answers, I feel like is that potentially making a diagnosis? And maybe I'm wrong. And this is a fantastic
Speaker 3
conversation. It's something I've thought about a lot and I really appreciate your perspective. So let's just think through that. So here's the way that I think through it.
Speaker 2
once again, once again, this is preempting stuff I think we're going to look at later on. But Dr. K is quite amazing in his instinct is always to lean into criticism. So as soon as somebody starts to cut a little bit close to the bone, he's like, no, no, no, this is fantastic. This is so good that we're digging into this. I'm jived to be talking about it. He only says that when things are getting a little bit close. But I'm with Mike here, like this is like, basically, if it looks like therapy, if it sounds like therapy, if it feels like you're giving a diagnosis, if the person perceives you as being someone with authority and special knowledge that is able to advise them, and it looks like you're giving them advice about what they should be doing, then it is for all intents and purposes, the conditions. So I don't really have much sympathy for Dr. K's sort of legalistic denying that there's any issues there.
Speaker 1
Well, here's his argument that he was about to, you know, respond that he was so grateful to have the chance to outline Dr. Mike is wrong.
Speaker 3
Like if I was precepting a medical student or resident and they did what I did and they said I've assessed this person for a personality disorder, I would fail them. Well, of course, that's why it's not complete. Right. So but I think there's a difference because if that is if you're saying that this is not sufficient for a personality assessment, then it is also not sufficient for a personality assessment. So if someone did that and they said, I assess this person for a mood disorder, I was like, no, you didn't, you didn't assess their sleep. You didn't assess their anhedonia. You didn't assess their guilt. You didn't assess their energy levels. You didn't assess their concentration, psychomotor, suicidality. I didn't assess any of those things. So if we really look at the, this is my read on it, the technicality of what it means to do a diagnostic interview, right? We literally have textbooks that say these are the questions that you should ask. So the DSM-5 has sample algorithms for assessing diagnostic interviews. And I think the big difference is if we sort of say, okay, what constitutes the practice of medicine? Assessing someone for a mood disorder, if you do what I did, and I bill an insurance company and I say, I assessed you for a mood disorder, I could be sued for malpractice because I didn't actually assess for a mood disorder. And so that's kind of the way that I think about it, is if we say assessing for a mood disorder or a personality disorder and I'll get to your point because I think there's validity there. If we say that this is what it is, did I do that? And the answer is
Speaker 6
in my opinion, no. Therefore, I didn't do that. Is that kind of makes sense? Yeah, that you're saying it's not complete. So that therefore it's not actually happening.
Speaker 3
I would even say that not only is it not complete, it's not like I did assess eight out of the nine criteria. Usually speaking, I'll assess zero to one out of the nine criteria because I still won't do a clinical assessment. Chris,
Speaker 2
let me check my understanding here because we've heard Dr. K do what can only be described as an extremely half diagnosis of someone, saying, oh, you know, within 30 seconds of them telling him about their problems, then this is all because of your, you know, you haven't got enough meaning in life or something. That is an incredibly poor kind of assessment that wouldn't be recognized as a good assessment in any rigorous clinical setting. So his argument there is because as long as he does very bad clinical work of a very low standard online and it doesn't meet clinical criteria rigor, then it's fine. Is that the argument? Yeah,
Speaker 1
well, we know because he'll cover this in another episode that we'll look at various clips from that he focuses on the kind of technical definitions. So you heard him there about the technicality of a diagnostic interview, the DSM-V5 textbooks, and the diagnostic criteria. So if you're not taking, if you're not following the diagnostic manual, you're not really doing appropriate diagnosis, like in a medical setting, that could be presented as mild practice if you don't follow the proper clinical procedure. So obviously, Dan, what he's doing is not clinical therapy because it doesn't fit with those criteria. But Dr. Mike is right in saying, right, but like, you can still be using the tools and techniques from like clinical therapy and therapeutic settings, but not doing all of them or not adhering to the whole thing. And he's saying, so if you're not doing it all, you're not doing it. And Dr. K kind of responds that said, well, but no, no, look, I'm not even doing like a bit of it. Maybe now is a good time after this to play some clips to show you know, what happens in the interviews because he's saying, you know, basically, I'm hardly doing any of that, right? It's just a conversation. We're having.
Speaker 2
Yeah, okay. All right. I'll reserve my comment to laugh to with play those clips. So
Speaker 1
here's a clip of him talking with the streamer, Reckful. This is, uh, I think the first interview together and very early into the interview, he brings up the issue about Reckful struggling with depression. This is an issue that was well, he was well known as somebody that went through bouts of depression that had suffered with suicidal thoughts and had a family history of it, right? But um, in any case, so here's the conversation with reckful.
Speaker 3
So tell me, um, What do you mean by depression? Let's start there.
Speaker 4
Well, I've been diagnosed with bipolar type two. Ah.
Speaker 3
And
Speaker 4
when I was six, my brother killed himself. He also had it. How old was he? He was 21. Very big age gap. Okay. And then because of that, when I've gone to get treated, they can never give me SSRIs. I've never tried an SSRI. Because he's tried an SSRI and then that's happened after. Okay. Prozac. Okay. Okay. I've tried a couple things. I've tried like, I was on a really high dose of lithium at one point. How did that mean, lithium? Very bland. The same thing people always say like kind of dead, you know, kind of. Yeah. Yeah. And then, kind of tried a bunch of other ones, but they're not super memorable. One of them gave me like some eye pain, so I could I had to stop taking it because I was really sensitive to light. Maybe you know, which one I'm talking about. Okay. I don't know. I tried a bunch of different ones. This is like 14 years ago, most of it. So now I don't really remember. Okay,
Speaker 1
so to the untrained ear, Matt, that sounds like someone taking not a completely deaf one, but a kind of medical history from someone with some details. So what I would get as a non-clinician from that conversation is family history of depression, close family member committed suicide, issues with medication and so on and so forth. And I'm not a trained psychiatrist. So this isn't the kind of conversation I usually get in with people or that I hear in any other venue. So I guess Dr. K would be saying, well, this is, you know, what talking about mental health looks like, but it does sound much closer to someone talking to a doctor about their experiences than someone talking to an interviewer. Yeah,
Speaker 2
getting the medical history, finding out what medications they've been given, what they've been diagnosed with, you know, history of the illness in the family and so on. So yeah, so that is the time. So, I mean, I guess the point is, I mean, the most important point is how is it perceived by, in this case, Rickfall, right? How is it perceived by the person that he's talking to? Yes,
Speaker 1
yes, that's true. Though, just to give a little bit more of the flavor of that.
Speaker 3
So here's a bit more of that discussion. So tell me what your experience of depression is.
Speaker 4
Okay, it's very hard, very hard to explain. The easiest way to explain is I've had years of my life like this where I wake up every day and I don't see a purpose to doing anything. I don't see a purpose to getting out of bed. I don't care if I stream or don't or if I go eat or don't. At some point I get really hungry and I'm'm like, okay, I guess I have, like, I feel like, it forces me to, kind of, you know? Yeah. But I don't really care one way or the other. And then I start to think I don't care if I, when I go to sleep, I don't care if I wake up, I prefer not to, actually, the sleeping was the most peaceful part of my day. Okay.
Speaker 3
And how long would this, like, how long would this stretch last? Years.
Speaker 4
With, okay. So, I've had it since I was 14, and there's like 14 to 16, and then I remember when I found photography, I was like a little inspired for a little bit and then it went away and then maybe 17 to 20, like it goes for years and then I'm happy for a little bit and then years and I'm happy for a little bit.
Speaker 3
How long is your period of happiness? My
Speaker 4
shot would know better than I do, but it's pretty short. I don't know. Like two months maybe. Okay. Yeah.
Speaker 2
One of the ways you could tell a difference between a clinical conversation and a conversation you're just having with a friend is that it's generally not reciprocity. It doesn't have reciprocity. So when you're talking with a friend, you say, oh, I was feeling, you know, really down last week and go, oh, no, that's terrible. Yeah, I've had these problems too. And the conversation shifts. You talk about yourself, the other person talks about them. There's this sort of back and forth. What you tend to see with a more clinical interview, as anyone knows, has gone to a GP. Is that the GP going, oh, you stubbed your toe. Oh, that's, I stubbed my toe last week. Do you want to have a look? No, no, they ask you questions about this, right? And it's quite neutral. And it's really an information gathering exercise. That's what a clinical conversation looks like as opposed to a normal conversation.
Speaker 1
And, you know, there is an issue about building rapport, right? Because like doctors do tell you things just because they're humans, right? And also they want to build relationships with patients. But they typically, as you say, are not divulging deeply personal elements of their life, especially psychiatrists and psychologists, for obvious reasons, because that would kind of confuse the therapeutic relationship. And here, in this interview of Reckville, Dr. Kate does talk a little bit about various things in his past, but it's mostly about gaming and some experiences he had and whatnot. It is not this kind of openness about the history of mental health. And also there, just a notepad, he asked how long was the duration of these episodes? How long did they last for? So you're getting history about depression and the experience of depression, but also some details about how long do these periods last? Is this an episodic thing or is it a chronic thing? This will be relevant later. But on the back of that, just listen to this.
Speaker 4
You hear about people like that? Yeah.
Speaker 3
I think this is a really common misconception. I think you may have clinical depression, but I think what you're describing is not clinical depression. So I'm gonna explain to you guys what clinical depression is. I think your problem is that your life is empty. That's different. And in fact, that's what we were gonna talk to the other person about today, and we will. So I got a bunch of questions about this because-
Speaker 4
Wait, so you're saying you think I was diagnosed incorrectly when they said not by police? You may have
Speaker 3
depression on top of that, but what I want you to understand is that there are different flavors of depression. One of them is a biological, organic, neurochemical kind of thing. But there are certain features of that that you don't really fit that bill. So, I'm going to describe what that is. So you may be depressed on top of being unhappy or having a life without purpose. But those are two independent things. Chris,
Speaker 2
is this education or is this a diagnosis? He's saying your your problem is that your life has no meaning. That's what that's the symptoms that you're describing.
Speaker 1
Rekful specifically says so weird you're because he says, you know, look, I don't think this is clinical depression. And then when Rekful says, you're saying I was diagnosed incorrectly, I don't have bipolar, he says, Well, no, you, might have, I'm not saying no. But you know, biological depression has these kinds of characteristics. And what you're talking about, I don't think it really meets that. So like, what your real problem is, you might have depression, that's the same thing. But your other real issue is, your life is empty. And like, that there's a very short conversation to one, reasdoids about somebody's clinical diagnosis, and two, to tell them that their life is empty. And this is their fundamental problem, right? This is a conversation of a couple of minutes. And it comes on the back of, you know, the kind of conversation that you would have of a clinician. Yeah.
Speaker 2
Yeah. So Dr. K's defense referring back to his conversation with Dr. Mike there is that this couldn't possibly be a therapeutic interview because it's so half-assed. No real therapist would like make a diagnosis within, you know, a couple of minutes of just starting to talk to somebody. But for me, the key thing is how Reckful perceives it, right? So if he perceives it as he's talking to a credentialed psychiatrist, this psychiatrist has been asking him probing questions about his medical history and has been asking him, you know, questions about issues in the family, what medications he's been given, and so on, has heard about the symptoms and now has told him what his problem is. And clearly by his response there, he said, wait, you're saying this? That's the issue. That's what causes the ethical issues, right? Like you can't go off and swindle somebody, pretend to be an accountant, and then take all their receipts and throw them down the drain, and then tell them that their accounts are, you know, they need to buy gold and Bitcoin, and say, well, no, I wasn't doing accountancy, because no accountant would ever do that. Right? Like, the important thing is that the person that you've been interacting with has been you've given them the strong impression that you are a responsible accountant.
Speaker 1
Well, this is why this relationship with Breckville ends up quite fraught because there are points where Breckville refers to what they're doing as therapy and Dr. K has as therapist and then, you know does air quotes and all this kind of thing. I don't like to be in detention so much. Beautiful. Yeah, so I'm in the tension
Speaker 4
of is he going to be my therapist or are we going to be friends? Because he said if he's my therapist, we can never travel together anywhere. Like it changes how it is. I was thinking it'd be cool. It'd be cool to go to Japan with Dr. K. You know, that sounds nice. Yeah, that'd feel nice. Yeah. Just see how he experiences things and have fun. I don't know. Yeah, so I think it's good. I really want a friend, but you know, then I'm thinking longer term. I'll have friends. So what I need is a therapist, maybe. Yeah.
Speaker 3
So I think rather than resolve that issue, reckful, I think the important thing is that you said something really, really beautiful, right? Which is that you do not like the tension. But
Speaker 1
then Dr. Kay also in later streams will correct him that you know, we're not doing therapy here, right? Okay, I want to update the viewers on what happened off-stream because they missed
Speaker 4
one therapy session. That isn't therapy. It's
Speaker 3
not therapy, right? So that's actually what we talked about, right? You
Speaker 4
know this. So
Speaker 1
there's there is this blurring of boundaries. And there's even a case later where Dr. K says that that what Rekful suffering from this, you know, clinicalness can be cured if someone is willing to love him unconditionally for two years. And Dr. K is willing to do that. So Rekful, I am confident and okay,
Speaker 3
I'm confident there's going to be someone around in your life who will be there for you. Most of the time when you need them, hopefully, for at least a period of two years. Okay.
Speaker 4
How
Speaker 3
can I be confident in that? How
Speaker 4
can you be confident? Yeah. Well, you probably... you find me simulating a talk to you and I'm not demanding too much of your time or spamming you with walls of text and even if I were, you'd feel inclined to answer me because it's... you love helping people. It's your passion. So from your perspective, maybe you can feel confident, but then if you put yourself in the shoes of any other human being, I don't know that they'll really spend two years with me unless there's something.
Speaker 3
So, Reckful, I'm not counting on them to spend two years with you. What
Speaker 4
are you counting on? I'm
Speaker 3
counting on myself. Oh, they they don't spend two years with me. Yeah, that I believe that I
Speaker 4
can believe that. So
Speaker 3
I can't trust any of them.
Speaker 4
True. So I'm going to try to love you for every week like this. I'm
Speaker 3
going to try to love you for two years at a minimum. I
Speaker 4
really appreciate it.
Speaker 1
He then does another conversation shortly after that, a few days later, taking that back and saying what he said was he is the and not that he shouldn't have said that and that was, you know, irresponsible to say that but that whole thing happening is only happening because this conversation is not a normal conversation, right? Yes, I was trying. I said my piece. He
Speaker 4
was saying that he wanted to be there for me for the next two years, but the problem is that he kind of said it in a flurry of emotion. I don't know if that's a good word. While streaming, he was getting emotional himself. He wanted to be there for me. So he said it, but he hadn't actually thought it through and what that entails Because he is not a licensed therapist in Texas and just a lot of things You know, is he how you'd have to live in Texas? To be my therapist in Texas is that how it works? Yeah
Speaker 3
so we also did talk about you know, whether you want me to be your actual therapist and what that would entail and The other thing is that bit of research which is important to remember is that the research on people on BPD, it's two years of someone who's actually a romantic partner. So it's unclear whether a friend...
Speaker 4
So yeah, I need to get in a relationship with a girl for two years and have it actually work out. And that might cure my BPD. It's a barrier
Speaker 1
crossing, blurring conversation. And this is the worst one, especially because the outcome ends up that reckful after the series of conversations, but not immediately four or five months later killed himself. And I think it's very important to note that it's very likely that there's a host of other factors that could have played into it that, you know, this conversation could have like had nothing to do with the motivation at the final end. He had a history of suicide attempts, he had long-term depression, had a family history of suicide. So it's tragic, but it doesn't have to be Dr. K's fault for there to be significant, issues with what he did, and what he perhaps continues to do, but maybe not to the same extent, because like, I think that this is a particularly extreme example, Dr. K does continue in this VN with all our people. But there is not many other people that I've seen that are as vulnerable as Reckful truly is. Yeah.
Speaker 2
Yeah. One suspects that Dr. K learnt a lesson there. And yeah, I think it is fair to say that most of his broadcast pseudo therapy sessions are with other influences and streamers and personalities who are not suffering from serious and life threatening issues. So yeah.
Speaker 1
Well, so just to carry on a little bit, Dr. K goes on to talk about Maslow's hierarchy of needs, which I know you are big into, Matt.

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