drmargaret

One of the most frequently asked questions I get asked is “What is the difference between a psychologist and a psychiatrist?” Now when you ask a psychiatrist that question you are going to be told that a psychiatrist is a medical doctor and they can prescribe medications and a psychologist can’t. But that’s not what I say.

What I say depends on how much time I have. If I have a lot of time I say a lot. Most psychiatrists wanted to be medical doctors first. The decision to get into mental health was an after thought. In college they signed up to take pre-med as a major. They took biology, anatomy, chemistry, and all the science classes. In contrast the psychologists decided they wanted to be psychologists. They took four years of psychology. It wasn’t an after thought that they wanted to get into mental health. It was their first decision. They took the psychology 100 series of courses, then the 200 series, then the 300 series, then the 400 series. Then they went to graduate school in psychology. They spent an average of 4 to 6 years learning more about psychology. They get a doctorate in psychology. There are two kinds of doctorates from the school I went to and since I know about those those are the ones I will talk about: a Psy.D . and a Ph.D. The Psy.D. involves writing a paper which is published on the applied use of psychology. The one I have is a Ph.D. The degree requires publication of a book called a dissertation. It’s a research paper on a theoretical aspect of psychology which contributes to the science of psychology. Mine was on sexual dysfunction in women and focused on lesbians. Back in 1978 it was big news that lesbians had the same types of sexual dysfunctions that heterosexual women had. It made a lot of small talk at cocktail parties. It got me a lot of notariety at the time. My brother used it as a way to introduce me to his friends. Here’s my sister, the sex therapist. I got dragged off into corners at parties after he said that with the opening line of “I’ve got this friend who…” It was an interesting time.

Psychiatrists go to medical school after they finish their premedical major in undergraduate college. They do an internship. They decide at that point they want to be a psychiatrist and do a residency and a fellowship in psychiatry. They get a couple of years of mental health training after medical school. All the rest was medicine. They are doctors first.

Psychologists don’t even get to call themselves doctors and get to treat people until after they complete their liscense. In California, they work under supervision for 3000 hours for their internship and residency. Then they sit for their liscensure exam. The exam is designed so that 50% of the people taking it do not pass. It’s given 2 times a year.

I also tell people that there is a doctorate in medicine. Most MDs don’t have that degree. Most psychiatrists don’t have that degree. Psychiatrists are not educated in the same manner as psychologists. Psychologists have, on average, 6 years more training in mental health. Medical doctors are expertly trained technicians of the body. They are the equivalent of a master’s level professional in my field. Master’s level professionals are allowed to use equipment and to do testing. They can operate machinery. They collect data and report data. They are technicians. Especially in fields like neuropsychology, their work is invaluable. When I use a technician, I value their input into my decision making. I value medical doctors as well.

Psychiatrists provide a wonderful assistance to people. Very few psychiatrists provide psychotherapy services. Some do. They are few and far between. Most seem just to provide medication. Psychotherapy is then delegated back to psychologists, social workers, counselors, or others trained in mental health. The psychiatrists I used to work with used to do some psychotherapy with patients. We had good communication and kept in touch to be sure we knew what was going on with the patient. As more and more patients got covered by managed care, who I was able to refer to, became limited to who was covered by the patient’s managed care policy. When I started out in practice there wasn’t much health insurance covering mental health so it wasn’t much of an issue. Now more than 90% of people are covered by some form of health care insurance.

Lots of people don’t like the idea of taking medications. Some conditions require medications. No one questions the need for medications for conditions like severe diabetes, asthma, or heart disease. Some forms of mental illness also need medications. Psychotherapy can be used with medications. In many cases psychotherapy can be used so that medications don’t need to be used. I have a lot of medical problems. If I take good care of my health then the amount of medications I need to use is kept at a minimum. The same is often true for mental disorders as well. If someone can manage their lives well, then the need for medication and treatment can be kept to a minimum. If things get out of control then emergency room treatment or hospitalization might be necessary. It takes much longer to get better when things get out of control.

Now getting back to psychology, I decided I wanted to be a psychologist because of a very famous psychologist named Dr. Clark. He was a researcher. He changed the world with a very simple study. His study involved four dolls. He had a 2 black dolls and 2 white dolls. One of the black dolls was a boy doll. One was a girl doll. One of the withe dolls was a boy doll and one was a girl doll. He went into the deep South where there was segregation in the schools. He talked to children. He showed the children in the South the dolls. He asked the children which dolls were black and which were white and the kids pointed. He asked which were boys and which were girls and the kids pointed. Then he asked which were pretty. Which dolls were ugly. Which dolls were smart? Which dolls were not smart? Which dolls looked like them? And these kids, who were segregated in these “separate but equal” schools, said the white dolls were smarter, prettier, and had all the good qualities while the black dolls had all the bad qualities and looked like them. He said that was due to the effects of segregation. And that was in part what the Supreme Court based their landmark decision on in Brown vs. Board of Education of Topeka. It’s an elegant study. It lead to the Civil Rights Act of 1964. It changed the world. He was one of the most important psychologists I ever heard of. He made me enter the field. He got me to want to become a researcher. That’s the difference between psychology and psychiatry. We want to change the world.

I tell dog stories. I have two dalmations. Both were rescued dogs. One is Cinnamon. One is Baxter. They are slightly different varieties of dalmation. Cinnamon is liver spotted. Baxter is black spotted. We got both when they were about 2 years or so old. They are now almost 6. They had very different lives.

I tell my dog stories to people with children. Cinnamon is hyperactive. She had a very bad upbringing. We know a little bit about her early life. Cinnamon was found on the streets of Pacoima where she was estimated to have been running loose for several weeks as a puppy. She had caught distemper and survived the infection. She had contracted several different types of parasites. She is believed to have been living with people who may have fed her beer and pizza. She runs to the sound of a can opening and she runs to the sound of opening cardboard boxes. We think Spanish may have been the first language she heard apart from dog, but that’s based more on the area where she was found and her lack of responding to English commands. She did not track or follow and would lose track of a piece of food for a distance of 6 inches. She ran and ran and ran, all over the stairs and all over the yard. She was picked up first by the pound then by four different homes before we got her. She was always scared and always hungry. She acted tough to show she wasn’t scared.

Baxter was found outside the door of the Glendale pound. It was estimated he’d been on the street for all of 10 minutes. He was thought to have lived with an older lady who could no longer care for him. She likely had cats. He has cat gestures. Some dogs take offense to these gestures. Baxter is mellow. He expects food will be there eventually and doesn’t worry about it. Sometimes he snubs his food. He has a habit of having eating things that aren’t food and has had his intestine operated on, which may be why he was outside the pound.

Baxter was easy to train. Cinnamon was difficult to train. I am a stupid dog owner. Stupid dog owners are like stupid parents. They don’t have clear rules for the dogs. I certainly didn’t. They don’t have appropriate expectations for the dogs. I was a previous cat owner and knew nothing about dogs. They don’t prepare the house for dogs. I was an idiot. But I was an idiot who could read books and I knew about behavior work. Cinnamon was fixable. It took time. It took work on my part. I called in a dog specialist to help me. Cinnamon was fine, I was stupid. I needed help. I tell that to parents who tell me that some therapist is working with their child alone doing some type of therapy to help with some type of behavior problem. No one took Cinnamon out of the house, fixed Cinnamon and brought Cinnamon back. They worked with me. I was the one in charge of giving Cinnamon the commands she wasn’t following. I was the one who had to get Cinnamon to listen. I had to get Cinnamon to not drag me through the front door and break my hand or throw a tantrum. Did you know dogs throw tantrums? She used to jump on me and snarl and really scare me. The trainer just stood there and put the leash up on the shelf and told her she wasn’t ready to go for a walk since she wasn’t sitting. Cinnamon threw the biggest doggy tantrum I ever saw yet. She barked. She whined. She crawled like she was going under barbed wire commando dog style. She begged. She jumped up at the shelf. After about 5 minutes she sat nicely. The trainer said “good dog” and put the leash on her. After that I never got pulled out the door again.

We had a couple of prior dogs. Zoey was my husband’s dalmation dog and she was already trained. Archie was the untrainable dog from hell and I ended up giving him back to the rescue organization after I was told by two trainers he wasn’t fixable. So these were the next two dogs. Baxter about 6 months prior to Cinnamon. Zoey died from cancer and then we got Cinnamon.

Now I’ve never particularly been fond of dogs to start with. I was never particularly fond of kids but I ended up raising 6 step children over time. And over time you get attached. Baxter is clearly my dog. Cinnamon is my husband’s dog. They chose us. If Baxter was allowed, he’d sleep in the bed with me. They used to be allowed. Now that they are 74 pounds each and it’s been completely stupid to have a dog push me out of the bed onto the floor, the rules have been made clear: no dogs on the bed.

There were other rules. My husband and I had to eventually agree on them. Things left on the floor were fair game for the dogs. Pick stuff up or it gets chewed. Follow a schedule. Feed the same food. Dogs are sensitive about what they eat. Don’t leave anything you care about unsupervised with the dogs at dog level. If they bang on the door they want out or in. Don’t feed them candy or people food. Keep them off the furniture. Don’t let them off leash around people. Don’t leave them unsupervised around children or animals.

Now people make excuses for not requiring their dogs to behave or their children to behave. It’s bad training. Most people don’t train their dogs. Most people don’t train their kids. My dogs aren’t perfectly trained. I’m not looking for perfection. Baxter likes people. If you pet him he’s going to try to pet you back. It’s a bad habit. He ends up pawing people. I don’t deal with many people at my home so it’s not much of a problem. I just warn people and hand them a pillow. He doesn’t paw you when you have a pillow on your lap.

Cinnamon I watch like a hawk when someone is over. She gets a doggy massage and I make sure she’s happy with the person. If she seems the least bit aggressive she either gets crated or she goes outside. Cinnamon either likes someone or she doesn’t. There have been a couple of Cinnamon “incidents” and I’m just cautious.

People don’t do that enough. There were two incidents. Everyone tells me they are no big deal. I think they are a huge deal. The first incident happened right after we brought her home to see Baxter. We took her and Baxter off to a wilderness area near where we live. She was only a few months old. She runs off and comes back dragging a rabbit she had just killed almost the same size she was. So Baxter see this. He must have figured he was supposed to do something similar so he runs off and brings back some dead squirrel. Now both dogs are really excited over what they brought us. Oh boy a long dead ant covered squirrel and a freshly killed rabbit. So we put the leashes on them and get them to leave their prized possessions behind and walk them home, Cinnamon growling and pulling to go back all the way. The second incident happened a couple of years ago. I came home to find the dogs noses all covered with scratches. So I went outside to see if they had been digging under the gate or in the brambles. I saw nothing. I walked the entire perimeter of the property. About 150 feet at the rear by the tree I started seeing the cat fur. It continued in tufts for the full length of the property until I came to the body of the cat. It had been dismembered. It was clear both dogs had been involved based on the scratches on their faces. The cat had put up quite a fight.

I went to all the neighbors asking if they lost a cat. No one on my block had. The next day the neighbors from the house a bock over came to the door asking if we had found their cat. They had a photo. The fur was the same color. It had been a pretty cat. It was an indoor cat and someone had accidently let it outside. They had dogs so the cat wouldn’t have thought dogs were a problem until after the stalking had started. I told them what happened to their cat. It was awful.

I did put up signs that said beware of dogs. My husband pointed out that cats can’t read. I still think it protects people. I worry about unsuspecting people. Dalmations are cute dogs. People come up to them to pet them. Cinnamon can get moody. I watch her. I watch Baxter when they are together. I’ve seen the two of them hunt. They tag team. It’s only been two incidents. I don’t want a third.

There have been some books which have been extraordinarily helpful to me in managing them. I recommend them to parents in managing children. The first is Karen Pryor’s book “Don’t Shoot The Dog.” It’s not about dogs. It’s about doing behavior work. It’s about teaching and training. The second one is about dogs: “The Hidden Life of Dogs” by Elizabeth Marshall Thomas. It’s useful in how she watches and takes the point of view of her subject. It’s very important in behavior work that this change in point of view take place.

The last thing that I want to write about here is on the socialization of dogs. In order to be able to integrate a dog into a family or a pack you have to socialize a dog within the first two years of the dog’s life. You have to expose it to other dogs or to people and get it to understand expected ways to behave. If dogs are not appropriately socialized they become hyperactive and aggressive. Children have to be socialized between ages 0 and 4. The basic things are similar. A dog in a family has to learn to track and follow. To listen to commands. To sit. To stay. To come when called. To use the bathroom appropriately. To eat appropriately. To stay with their owner when in a variety of places. To leave things alone on command. To go to a place and stay there on command. And to fetch (pick things up and put them somewhere). Those are the basic commands that every dog must master by age 2 and every child must learn by age 4. Those commands are taught.

I was one of those stupid dog owners who thought the dogs came preprogrammed. All you have to do is issue the proclaimmation and the dog does it. There are parents who have the same idea. So I completely understand where the idea comes from. Dogs don’t come with an owner’s manual. Kids don’t come with an owner’s manual. I told the dogs what to do. The dogs did whatever they felt like. I was a horrible dog trainer. My timing was bad, especially with Cinnamon who did everything quickly and I was either too fast or too slow in reinforcing. Fortunately she was bright and she could watch what Baxter did. I would say “sit.” Baxter would sit and eventually she would sit. Later still I would remember to say “good dog,” by then, they would both be standing back up. I was a very stupid dog owner. Fortunately I had smart dogs.

Cinnamon has become less hyperactive over the years. She now understands English. She does follow commands. Baxter is still faster in following commands. I still am slow in saying “good dog.” The dogs make do with me. They realize I’m a bit forgetful for a person. They watch me in case I get lost or forget who they are or give them the wrong dog bowl. They wake me in the mornings and remind me to feed them. I’m an old and slow dog owner.

Some people ask about medication for hyperactivity for dogs or children when I tell them about Cinnamon. In the beginning, when she was impossible, we certainly talked about it with the veterinarian. She is still very active. Much more so than Baxter. But her behavior is manageable with the training and she’s not a problem. On the other hand she’s not being put in a classroom and being asked to learn to read, write, do spelling and do math with 30 others. If that was the case, she might very well need medication or a different plan to help her focus and succeed. But medication is not where I would start. I’d start with training first.

I work as a psychologist in Southern California. My work involves psychological testing to determine how people function in various aspects of their lives. Most of the people I see are applying for Social Security Disability benefits. They come from all ages and all walks of life. I see them only once for the most part and write a report on them.

Most people never expect to be disabled. More than 1/2 of all adults will experience some period of disability in their lives. When it happens few will be prepared.

Lots of people with disabilities are children. They are born with birth defects. They have learning disorders which impact their ability to function in school. They have problems with their behavior and their mood.

Some people develop a mental illness which causes them to become disabled. Some people develop physical illnesses which lead to depression and anxiety. Some people have illnesses or side effects of illnesses or medications which cause depression or anxiety. Some people even hallucinate or become delusional. These people are all very ill. Some of them will get better with treatment. Some of them will not.

There are some people who decide that getting paid for not working through the SSDI system is a great idea and they attempt to mimic what they think disabled people go through. They try to act sick, or depressed, or anxious or crazy.

There are other people who try to act not sick. They are stoic and try to act like their illness isn’t any big deal and if they just make believe that nothing is wrong they will be well again.

There are other people who are sick but try to exaggerate their symptoms to prove how sick they are. They want to convince people they are really deserving of benefits and sympathy.

My job is as simple as it is complex. My job is to find out how people are actually doing. I get to ask them and report back on what they say. Sometimes their answers are funny. Sometimes their answers are very poignant.

I want to use this blog to tell stories about my work. I’m not going to say anything that will let anyone identify anyone except me. I will tell stories about my dogs. I tell dog stories in my work all the time. I’m going to tell them here.

Feel free to write comments.