Psychiatrist Dr. Eric Bender answers your questions about mental health from Twitter. Can you develop a personality disorder? Is stress contagious? What does the Rorschach test actually prove? Answers to these questions and many more await—it's Mental Health Support.Check out Dr. Eric Bender's Youtube channel for more analysis of popular TV shows and movies: https://www.youtube.com/@dr.ericbender6371Plus, COMING SOON: Dr. Bender's upcoming podcast Shrinkage which explores mental health in TV, movies, and video games.Director: Lisandro Perez-ReyDirector of Photography: Yukihiro UemuraEditor: Richard TrammellExpert: H. Eric Bender, M.D.Line Producer: Joseph BuscemiAssociate Producer: Paul GulyasProduction Manager: Peter BrunetteCasting Producer: Nicholas SawyerSound Mixer: Russell PurcellProduction Assistant: Davis ForgePost Production Supervisor: Christian OlguinPost Production Coordinator: Ian BryantSupervising Editor: Doug LarsenAdditional Editor: Jason MaliziaAssistant Editor: Billy Ward
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00:00I'm psychiatrist, Dr. Eric Bender.
00:01Let's answer your questions from the internet.
00:03This is Mental Health Support.
00:05At Pink Penguin writes,
00:11someone please educate me.
00:13What does psychotic mean?
00:14Psychotic means a break from reality.
00:16You are experiencing things that other people might not be.
00:18That can include auditory hallucinations,
00:20hearing things other people might not be hearing,
00:22visual hallucinations, although those are rare,
00:24you might have delusions, fixed false beliefs
00:27you believe are true despite other people
00:29showing you evidence that those aren't true.
00:31Psychotic does not mean someone is going to commit crimes.
00:34At Andrea H. Perez, how does depression make you exhausted
00:37but then sometimes I'm too sad to even sleep?
00:40When you're depressed, your circadian rhythms are off.
00:43In fact, one of the first things
00:44we ask patients about is sleep.
00:46People don't realize that they have this picture
00:48that when you're depressed, you might sleep more,
00:50but in fact, it's the opposite.
00:51You wake up early and people are like,
00:53why am I waking up at five o'clock in the morning,
00:55not even setting an alarm?
00:56It's because your sleep cycle has been phase shifted
00:59or phase advanced.
01:01You go to bed earlier and you wake up earlier.
01:03We think this has to do with a lack of neurotransmitters
01:06when you're depressed.
01:07So there's less serotonin, norepinephrine,
01:09and there's less acetylcholine.
01:11And for some reason, this makes us wake up early.
01:13At Aten Supreme, anyone else think stress is contagious?
01:17I'll tell you, watching high school students
01:18in the Bay Area go through the college application process,
01:20I can absolutely tell you it is contagious.
01:22There was a study that looked at an audience
01:25watching a speech being given
01:26by someone who was very anxious.
01:27Saliva samples were then gathered from the audience
01:30as well as the presenter.
01:31The saliva had increased cortisol levels,
01:33which is that stress hormone,
01:34not only in the presenter, but in the audience.
01:36So stress is absolutely contagious.
01:38At Sayyibaby is asking,
01:40can depression be hypnotized out of you?
01:42No, hypnotherapy is very effective for some things.
01:45It can help people with smoking cessation.
01:47It can help people decrease their temper.
01:49Sometimes hypnotherapy can also be used
01:51to treat sleep disorders and insomnia.
01:53It cannot change the level of neurotransmitters
01:55in your brain that are correlated with depression.
01:57Some people are more hypnotizable than others.
01:59When you look at this eye roll chart,
02:01it gives you a sense of a gradient,
02:03how hypnotizable somebody might be.
02:05You ask them to look up into their head.
02:08When they're looking straight ahead, that's a zero.
02:10Then one is slightly, you start to see
02:12a little bit of white.
02:13Then you start to see more white.
02:15The scale goes all the way down to four,
02:16being you see mostly white, almost exorcist style.
02:19There is a correlation between those
02:20that show a lot of white when they roll their eyes
02:22and being able to be hypnotized easily.
02:24DJ Leapcard asks, what's the difference
02:26between a psychologist and a psychiatrist
02:29and which one do I need to see?
02:30Well, a psychiatrist has gone to medical school,
02:32so they can prescribe medications.
02:34If you're feeling overwhelmed and need to talk to somebody,
02:37a therapist would be fine.
02:38That could be a psychologist or a psychiatrist.
02:40If there's suspicion that medication is needed,
02:42then a psychiatrist is the one you'd wanna see.
02:45At Bell Maps wants to know,
02:46question for psychiatrist's counselors,
02:48how do you not cry?
02:50Well, at Bell Maps, to be honest,
02:51sometimes I do get tearful with patients.
02:53We are human after all,
02:55even though some people don't think we are.
02:57At Mets4ninnen33, do personality disorders
03:02work on a spectrum?
03:03Like, can you have mild disorder of narcissism?
03:05Absolutely, there's a spectrum here.
03:07You can absolutely have narcissistic traits.
03:09When it's unhealthy is when you start
03:11to think only of yourself.
03:12Fantasies and obsessions over unlimited power or beauty.
03:16And then the full-blown disorder,
03:18you could go as far as to be a malignant narcissist.
03:20You have a lack of empathy
03:22and don't really care about other people.
03:23This is where we find psychopaths.
03:25At ResilienceDoc,
03:26how do you think the brain-gut connection works?
03:28Preclinical data, meaning data and research
03:30from animals, not people,
03:32shows that there's a relationship between the brain,
03:34the gut, and the microbiota,
03:35or the bacteria that populate your gut.
03:38What we found was that in some stress-induced rodents,
03:41they ended up having short-chain fatty acids.
03:44And what we find is there's actually less serotonin
03:47produced in the stress-induced rodents' guts.
03:49Now, that's not the same serotonin
03:51that's in your brain.
03:52Yes, it's the same structure,
03:53but that serotonin in your gut
03:56doesn't cross the blood-brain barrier.
03:57However, what we find is that the inflammation
04:00that is caused during the stress
04:01causes the vagus nerve, which is involved in depression,
04:05to not fire the way it's supposed to.
04:07And so as a result,
04:08this inflammation might have something to do
04:10with a depressive state.
04:12It suggests that with a healthy gut and healthy microbiome,
04:15we can actually have improved mood.
04:17Okay, next question.
04:18AtDareisNobot wants to know,
04:20when did psychiatry start?
04:21Well, formal psychiatry can be traced back
04:23to the 19th century.
04:24We used to have a group of doctors called alienists,
04:27and their job was to understand and treat
04:29and be with people who had an alienation
04:32from the rest of society
04:34that was due to mental health issues.
04:36In 1895, Freud wrote,
04:38"'Studies in Hysteria'."
04:40Some consider that the birth of psychoanalysis.
04:42Why does no one talk about how depression and anxiety
04:44can cause major memory loss?
04:46Depression really can make us have memory issues.
04:49What we think that has to do with is a lack of glutamate.
04:52Glutamate is the excitatory neurotransmitter.
04:54And when there's less of that,
04:56we find that people don't lay down memory.
04:58Processing speed of somebody with a depressed mind
05:00can be 40% below what it is when they're not depressed.
05:03There's something called pseudodementia in fact,
05:06this false appearance of dementia,
05:07but it could in fact be a depression.
05:09AtMaggieMag26,
05:11you ever had a random ass thought
05:12that just won't leave your head?
05:13I'm going through it right now.
05:15First off, every human being has a random ass thought.
05:17If we don't want them, they're called intrusive.
05:20And then they can become obsessive
05:21if you can't let go of it.
05:22And that's when it can start to go
05:24into the obsessive compulsive disorder range.
05:26So the obsessive thought pathway starts
05:29with the connection between the orbitofrontal cortex
05:31and goes back to these areas here called the basal ganglia.
05:35When that pathway is activated, there's a worry,
05:38but then the inhibitory pathway goes back
05:40to the orbitofrontal cortex and actually shuts it down.
05:44It inhibits it.
05:45In someone with an obsessive thought disorder
05:47where they keep worrying about the same thing,
05:49there's over activation of that direct pathway back
05:51and under activation of the inhibitory pathway.
05:55It's like, there's no brakes to stop this worry.
05:57So we have the cycle that goes on and on and on and on.
05:59Cognitive behavioral therapy or CBT is used
06:02to help somebody with these kinds of obsessions.
06:04You can also do something called
06:05exposure and response therapy.
06:07That's where you make a hierarchy of fears.
06:09Let's say somebody's fearful of spiders.
06:11First rung on that hierarchy of fears might be,
06:14all right, let's talk about spiders.
06:15The next thing might be going to the tarantula exhibit.
06:17Then the last thing might be petting spiders
06:19and letting them crawl all over you.
06:21Oh, not that Mimi is asking,
06:22why does TikTok keep telling me I have ADHD?
06:24TikTok's gonna tell you a lot of things.
06:26Please do not look at TikTok as your sole source
06:29of information for mental health.
06:30A study looking at 500 videos on TikTok
06:32with the hashtags mentalhealthtips and mentalhealthadvice
06:35showed that about 84% were misleading.
06:37About 31% had inaccurate information
06:40and 14% had information that was damaging.
06:42Only 9% of the people doing the videos
06:44even had relevant qualifications to do the videos.
06:47As a society right now,
06:48our brains are being trained to be stimulated
06:51for only a few seconds and to go to the next thing
06:53and to go to the next thing and to go to the next thing.
06:55I think people find they have a hard time focusing.
06:58It's not ADHD.
06:59Maybe it's being on TikTok too long.
07:01At Mendy.
07:02I wish there was more information available
07:03on how shrooms can help manage PTSD, anxiety, and depression.
07:07The information's here and more is coming.
07:09There is a lot of promise that shrooms or mushrooms
07:12can actually help with PTSD or with depression.
07:15What we're talking about when we talk about shrooms
07:17is really psilocybin,
07:18a chemical that binds to the serotonin receptor,
07:22particularly in the thalamus,
07:23so that we have these hallucinations.
07:25But what's interesting is it's not the hallucinatory
07:28experience that necessarily is the treatment.
07:31There's a case report of a man
07:32who did have a psilocybin-guided treatment.
07:35He didn't have the psychedelic experience
07:37and was actually kind of disappointed he didn't,
07:39but 40% of his depressive symptoms went away
07:42based on his reports
07:44and the structured evaluations that he was given.
07:46There's something about having a guided treatment,
07:48something about having somebody there with you
07:50can be really helpful and really powerful.
07:52It shows us that there's really a value
07:54to being interconnected with each other.
07:56At Hexbags.
07:57Am I having a panic attack, heart attack, heartburn,
08:00weird chest pain?
08:01What is it?
08:02Cry emoji, cry emoji.
08:04A panic attack is abrupt.
08:06It comes out of nowhere.
08:07You can have chest tightness,
08:08difficulty breathing.
08:09It can feel like your throat's constricting.
08:11You might have sweaty hands or sweat all over
08:14and maybe some pain.
08:15So it feels like you're gonna have a heart attack.
08:17That anxiety peaks after a certain number of minutes
08:20and then it comes down,
08:20but you're so worked up and so worried
08:22that absolutely you feel panicked.
08:24There's also something called an anxiety attack.
08:26Maybe you're giving a presentation,
08:28maybe you have to take a test
08:29and you get more and more anxious
08:30and you feel like you can't go on.
08:31That's an anxiety attack.
08:33At Tune of Your Death wants to know,
08:34help, I'm having an anxiety attack in the middle of class.
08:37Sad face.
08:38What do I do?
08:38Help.
08:39You can do a grounding technique.
08:41Remind yourself where you are and what you're doing.
08:44I'm here, I'm sitting in the room.
08:45There are people around me.
08:47Some people go by the rule of three, three, three.
08:49See three things, hear three things
08:52and move three parts of your body.
08:53A common thing people say is just breathe.
08:55That is not helpful.
08:57I never find that helpful to say just breathe.
08:59A good breathing technique
09:00is actually inhaling through your nose
09:02and exhaling for twice as long.
09:04So you can inhale for say a count of three.
09:08And exhale for a count of six.
09:12It's the exhale that's actually relaxing.
09:15At Angel Disrupted, I'll be honest,
09:17I don't know the difference between serotonin or dopamine
09:19or oxytocin or endorphins.
09:21And at this point, I'm too afraid to ask.
09:23Endorphins are hormones.
09:25Endorphin comes from the name endogenous,
09:26meaning it's made inside us.
09:28And morphine, which is a painkiller.
09:30And the endorphins imitate what morphine does.
09:33That runner's high comes from endorphins.
09:35Serotonin and dopamine are neurotransmitters.
09:38They transmit messages in the brain.
09:40Serotonin has to do with mood and anxiety.
09:43And dopamine has to do with joy, pleasure,
09:45and sometimes even motivation or attention.
09:47Serotonin is implicated in depression
09:50and anxiety when it's low.
09:51And dopamine can also be low in depression and in ADHD.
09:55Oxytocin is that loving or bonding hormone.
09:58In women, when they breastfeed,
10:00that actually helps form a loving relationship
10:03with the child.
10:04At AnxietyAloner, it says,
10:06has anyone tried fish oil
10:07or omega-3 supplements for mental health?
10:09It's meant to be good for anxiety and depression.
10:11Did you notice any difference?
10:12Omega-3 fatty acids increase blood flow in the brain.
10:15Now, this doesn't necessarily correlate
10:16to improvements in mood,
10:18but some people do report improvements in mood
10:21and that omega-3s can actually help with depression.
10:24Even with ADHD, there's a population
10:26that will respond to that
10:27and they'll be able to concentrate more.
10:29You can take one gram or up to two grams,
10:31but studies show that going up to four grams
10:34doesn't really do anything.
10:35One gram is the equivalent of having salmon meals
10:37maybe three times a week.
10:38You could get fish burps, though.
10:40Just be aware of that.
10:42At Ryder Trilla writes,
10:43I would love to know what triggers schizophrenia.
10:45Like, actually study that shit.
10:46We do know that now there are over 200 genes
10:48responsible for schizophrenia.
10:50And what happens is if you have enough errors
10:53in those 200 genes, you might develop schizophrenia.
10:55Even in schizophrenia,
10:56and something we know has strong genetic component to it,
10:59there are environmental factors.
11:01And we know this from studies of twins.
11:02If one twin develops schizophrenia,
11:04there's a one in two chance the other will,
11:06but it's not 100% suggesting
11:08there's something in the environment.
11:09What might unlock that could be substance use.
11:12It could be trauma.
11:13We're still trying to figure out
11:14the connections between these.
11:15What is the environmental factor exactly?
11:18What genes are turned on exactly?
11:19Here's another one.
11:20How does stress work?
11:21How do you destroy the freeze response?
11:23When we face stress,
11:25there's a section of the brain called the amygdala.
11:27It's a nuclei, a collection of cells.
11:29That senses a threat and sends a message
11:32to the hypothalamus.
11:33The hypothalamus then gets our body ready
11:35to make adrenaline or cortisol,
11:37which allows us to have that fight or flight response.
11:39Are we gonna get ready to stand up to this threat?
11:41Or are we gonna take off?
11:42What can also happen is another response
11:44called the freeze response,
11:45the deer in the headlights response.
11:47Your body's been flooded with cortisol
11:49to get you ready to fight or flight.
11:51But if your body's not responding,
11:52then you don't do anything.
11:54Destroying the freeze response
11:55would probably involve some cognitive behavioral therapy
11:58or other types of therapy where you talk about
12:00what is it that is keeping you frozen in place.
12:03At Lifting Humanity,
12:04can depression be beaten or only managed?
12:06Absolutely, depression can be beaten.
12:08I have seen people have depression
12:10in what's called remission.
12:11It's not coming back again.
12:12What happens in depression
12:13is that we have lower levels of serotonin.
12:16And when I talk about serotonin,
12:17I mean between neurons in the synapse,
12:20that connection between nerve cells.
12:22There are medications
12:23called selective serotonin reuptake inhibitors,
12:25big fancy name, SSRIs,
12:27that target serotonin receptors
12:30and block them.
12:31And then the serotonin sticks around in that synapse.
12:33With that, you get increased dendrites,
12:34which are the branches of the nerve cells.
12:36And with that, you get an elevation of your mood, hopefully.
12:39Medications in this category might include fluoxetine
12:41or the brand name Prozac,
12:43sertraline, which is Zoloft,
12:45escitalopram, which is Lexapro.
12:47What we think these medications do
12:48is increase the number of dendrites.
12:50That's part of the reason it might take two to six weeks
12:52for these medications to work.
12:54You're increasing synaptic connections.
12:56So medication is one way you can beat depression.
12:58And some studies show therapy and meds together
13:01help more than just medication or therapy alone.
13:04Atgoldus27 writes,
13:05I was telling my therapist about Encanto,
13:07how it was all about generational trauma.
13:09And she was like, are you sure about that?
13:11A Disney movie?
13:12Yes, I'm sure about that.
13:13Encanto was absolutely about
13:14what's called transgenerational trauma.
13:16Abuela, the grandmother, lost her husband, Pedro.
13:19He was killed right in front of her.
13:21What ends up happening is that that trauma
13:23was so disruptive.
13:24She wants to keep her children close.
13:26She wants them to not do anything
13:28that will cause her any kind of worry or pain.
13:30Everyone is trying to protect Abuela
13:32from experiencing any kind of loss or sadness again.
13:35And in the case of Bruno, who recognizes,
13:37wait, this doesn't feel right.
13:39He is the one who's outcast
13:40because he's not part of this group of people
13:42who are protecting Abuela.
13:44She wants nothing to do with him.
13:45We don't talk about Bruno.
13:46Well, you know, you should talk about Bruno
13:48because Bruno's actually realizing something's wrong.
13:50Atletre asks, are mental health issues genetic?
13:53There's a gene on my mom's side of the family.
13:55It has me questioning my reactions all the time.
13:57Some mental health conditions
13:58do have a very strong genetic component.
14:00Things like bipolar disorder, schizophrenia, autism,
14:04even ADHD.
14:05In fact, in ADHD cases, sometimes 25 to 50% of the time,
14:10a parent has ADHD.
14:11But genetics are not the only part of the picture.
14:14Your environment plays a huge role
14:16in whether your genes are expressed.
14:18So you could have a gene or several genes
14:21that contribute to you showing a mental health issue.
14:24And if they're not turned on,
14:26then you're not gonna express that.
14:28That's called epigenetics.
14:29It means there's something else
14:31that turns on this genetic code that unlocks it.
14:34At metal guru girl is asking,
14:36how many of us take a form of antidepressant medication?
14:38Well, the CDC data is actually from 2015 to 2018.
14:41They said that during that timeframe,
14:43about 13.2% of the population took an antidepressant.
14:47However, that was before the pandemic.
14:49The American Academy of Pediatrics said in their journal
14:51that from 2020 on, there was a 64% increase in prescriptions
14:56to children and teens alone in terms of antidepressants.
14:58So it's certainly more than 13.2% of the population now.
15:02At Sours Kitsles asks,
15:04does ketamine therapy work?
15:05Asking for a friend.
15:06Yes, there's a lot of data on ketamine
15:09working for depression.
15:11However, it's really important then to know
15:13that ketamine therapy is not recreational ketamine.
15:16There's an amount that you take
15:18either by an intravenous infusion.
15:20There's also a spray, S-ketamine.
15:23What ketamine does is it blocks
15:25the excitatory neurotransmitter, glutamate.
15:28By blocking that, the glutamate can increase.
15:31It allows us to actually feel better,
15:33but it only lasts for two or three days.
15:36The drug rapamycin is being looked at.
15:38It's being given with ketamine.
15:39And what that does is it's actually preventing
15:41glial cells in the brain, which chew up neurons,
15:44from chewing up neurons.
15:45And the length of ketamine is lasting longer.
15:48So there's promise here.
15:49That's being investigated at Yale
15:50and we need to still see more results and more data.
15:53At RubyBegonia3 is curious,
15:55is there a test for psychopathy?
15:56Yes, Robert Hare, a Canadian psychologist,
15:59came up with a scale called the psychopathy checklist.
16:02He wrote out a number of traits that you look at
16:04to see how someone fits on a scale of psychopathy.
16:07Those include personality traits
16:09and those include criminal behaviors.
16:11Some of the personality traits might be
16:12pathologically lying, particularly about your own history,
16:15or you might be glib.
16:16You might not share much that's real with other people.
16:18Someone goes through each of these 20 items
16:20and scores it zero, one, or two.
16:22Zero is not present, two is very much present.
16:25The maximum score is 40.
16:26If someone is 25 in some places,
16:29particularly for research,
16:30they meet criteria for psychopath based on this checklist.
16:33The closest diagnosis from DSM
16:35is antisocial personality disorder.
16:37That's where you break rules a lot.
16:39But not everyone with antisocial personality disorder
16:41is a psychopath.
16:42However, typically those with psychopathy
16:44are in fact having criteria
16:46for antisocial personality disorder.
16:48At MalikMars wants to know,
16:49can you develop a personality disorder?
16:52I think I caught one from somebody.
16:53You can catch lots of things from people,
16:55but typically a personality disorder isn't one.
16:57Now that said, there are a couple of cases
16:59where people might show personality traits
17:02when that is already in their family.
17:04For instance, histrionic personality traits,
17:06being very dramatic about things.
17:08If someone in a family acts that way,
17:11you might start to do that too.
17:12There's something called folly adieu,
17:14which is folly for two.
17:15And that's when a mental health experience
17:17is transmitted to somebody else
17:19and they have the same experience.
17:20That often happens when you're living
17:21with someone who's psychotic
17:22and maybe they have a break from reality.
17:24In fact, the next Joker movie is called folly adieu,
17:27referring to Harley Quinn
17:29and the Joker and their relationship.
17:31At RealJawbreaker wants to know,
17:32what does the DSM-5 say about me thinking
17:34everyone is constantly talking shit about me behind my back?
17:37Well, the DSM-5 might actually say,
17:40you are a paranoid person.
17:42There is something called paranoid personality disorder
17:44where the DSM lists out criteria
17:46saying that you might have delusional beliefs.
17:48The DSM-5 is the diagnostic and statistical manual
17:52of mental illness.
17:53It's essentially the guidelines with all the criteria
17:56that psychiatrists and psychologists use
17:57to diagnose people with a mental illness.
18:00Sometimes it's controversial.
18:01In early DSM volumes, being gay was a disorder.
18:05Clearly that has changed over time.
18:07A new version of the DSM can come out
18:09once every 11 or 12 years or so.
18:11So I guess I'll have a new one to look forward to
18:13in another five years or so.
18:15At xTadashi wants to know,
18:17what does the inkblot test even prove?
18:19The inkblot test, also called the Rorschach test,
18:21was developed by Herman Rorschach.
18:23He was a psychologist and a psychoanalyst.
18:25And what happens when you're given a Rorschach test,
18:28someone might hold up the card and say,
18:29tell me what you see.
18:30Batman, some kind of animal, something sexual.
18:34And then there's a scoring system.
18:35You would look at what part of the picture
18:37did someone focus on?
18:38And the idea is that it reveals something
18:40about their unconscious.
18:41Initially, Rorschach thought this could be a way
18:44to diagnose schizophrenia.
18:45We know that that's not the case.
18:47The Rorschach test is still used in some ways
18:50in psychotherapy, particularly with kids.
18:53You get a sense into how they're thinking
18:54and what their life is like.
18:56So there's a way to glean something about somebody
18:59from this test.
18:59It's just not gonna be a way to diagnose schizophrenia.
19:02At soulmoney says,
19:04what do you think about integrative psychiatry,
19:05which merges traditional medicine with alternative therapy?
19:08Can these things work together?
19:09I have actually had patients given terminal diagnoses
19:13of illnesses.
19:13They took on conventional treatment
19:16and then brought in spiritual healers
19:19or guided meditation.
19:21And what was a terminal diagnosis
19:23has turned into this person's tumor shrinking.
19:25There was a study that looked at around 30,000 outcomes
19:29and the outcomes with anxiety
19:31were that therapy and medication together did better.
19:34To me, that's an example of how you can combine treatments
19:36and do a lot of good.
19:38So those are all the questions for today.
19:40Thanks for watching Mental Health Support.