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Adult ADHD from the board-certified PMHNP behind the YouTube channel Focus Path and the book The Process. Clinical perspective on medication, frameworks, and the conversations the internet hasn't been having.
My name is Jonathan Murphy,
psychiatric nurse practitioner.
Welcome back
This podcast is sponsored by
the Focus Path YouTube channel.
You can check that out
at Focus Path Systems
It's where over the past year I've
created 107 videos aimed at providing
clinically dense but entertaining
videos about mental health topics.
Over the past few episodes of Actually
ADHD, I've diverted, as many people
have, into the Lindsay Clancy case.
However, my situation is a little bit
unique because I grew up in Duxbury.
So the first time I talked about
the trial, I focused in on that
aspect, my thoughts about the
demographic considerations.
Then last time, I talked a bit about
just the media, the problems with
what happens when we consume media
and having boundaries with technology
and understanding the limitations of
what something like this tells us.
When we talk about media literacy,
- what about systems thinking?
What about judicial and legal
understanding, let alone
psychiatric understanding?
You know, going to nursing school,
getting a master's degree in nursing,
specialized in psychiatry, graduated
from Boston College, and I know what
I know because of work experience and
going to school for all the things I
went to school for, nursing, psychology.
But when I went to school, there was
something comforting about just saying,
"Just do what you're supposed to do.
You signed up for this job.
Learn what you're supposed to do and
do what you're supposed to do and
filter your thinking through that."
And psychiatry's really good for that
nursing's really good for that.
There's ethics that guide your judgment,
and it's all in a clinical consideration.
So this is where it's messy with
the insanity defense and why
it's so important, I suppose, for
people in an age of self-diagnosis.
Just like with media literacy in
an age of potentially developing
mobs or influence among other
people, it's important to understand
group psychology and media theory.
But in a similar sense, if we're gonna
be collectively speculating about
the mental ability to do something
willfully or not, we gotta understand
the DSM-5, and I have the text revision.
So yesterday, I went through and
I underlined the most important
and significant things, but
I wanted to go through it.
And yesterday was great to do because
it did confront me with the reality.
Honestly, I have my gut.
And the DSM 5, what people
need to understand is it's a
important billing and, um, piece
of bureaucratic information.
But for clinical consideration, which is
why this book is designed for the clinical
care of patients, it's a starting point,
and it's a really, really good one.
And any mental health clinician or
novice in the field can probably
think back to writing these.
Criteria one, criteria two.
But the reality is we get a read
on people, and we develop skills
that extend far beyond this.
That's the whole point of it.
Then we can, if we're so
inclined, add to the next edition.
And Reddington, during the trial, heard
there's been a lot of disparaging of
the mental health field because of this,
and I think that's not fair because
that's totally missing the point.
I think that's a completely
different discussion.-
For me, morally, I start there.
I'm not perfect, and the world
is the world that we live in.
And then, you can move forward from there.
But we're talking about
Lindsay Clancy and the trial.
You often get, "Oh, the system's broken."
It's like, well, what does that even mean?
That's just a platitude.
. What system?
And who put it there?
And what was there before?
This is media literacy, and this is
honestly not to divert too much, but
the book How to Read a Book changed
my life 'cause it really helps you
understand how to take in information.
Unfortunately, public school , didn't do
a great job, It's pertinent and important
for actually ADHD because ADHD, you
think things quickly, and you're jumping
to conclusions, and you're developing
concepts of the world that we retain fast.
But they might not be accurate,
which is often the case.
But the problem is that inaccurate
understanding for people with
ADHD with impulsivity leads into
expectations and reality not lining up.
Because you have this jury
and , the televised spectacle
I think one thing is clear We have a few
people that aren't going away, you know?
You could say a star is born.
A star is born with Redington, a star
is born in Lindsay Clancy, and true
crime has never been bigger business.
So we're gonna see the fallout of
this case for so long, and I'm hoping
maybe we can all collectively quench
our thirst on this topic, because
when you do, then the algorithm
will just stop showing it to you.
So we have to remember that in the
social media world, our impulses to
learn and know things, if it's through
social media, that fuels the algorithm
So the way it's gonna work with
the DSM as a clinician is you're
gonna wanna diagnose your patient.
And as soon as you get
your hands on this thing
it's a huge book.
And all of these things, you
know, people think about it
and they're like, "Oh, what?"
Like, "These are all made up."
It's like, yes, they are made up.
And what they are are categories or
labels to define a problem, which
essentially is associated with billing,
and then gets on medical records
and is clearly important in these
proceedings, so there's a legal aspect.
So in this case, the Lindsay Clancy
case, um, the first thing I did
was go to the index and look for
postpartum psychosis because You
hear like, "It's not in the DSM."
So it's just, the DSM is a very,
it's a very technical book.
It's not that complicated.
It's boring.
It's a reference.
It's something that unless
you're a mental health clinician,
you haven't probably used.
But it's not hard to use, it's more
detailed and sort of, um, tedious.
There's a tedium to it.
But if you're interested in the
stuff, it's fascinating in the
beginning you have neurodevelopmental
disorders, and that means diagnoses
that are about using your brain.
So things that are gonna involve
your thinking, cognition.
Of course, that's where ADHD and
autism spectrum disorder live.
Then you have schizophrenia spectrum
and other psychotic disorders.
And this is an interesting category
because Lindsay Clancy's in here, okay?
And a lot of this has to do with the time.
I did this yesterday when we could say
if there's anything that makes sense,
it's brief psychotic disorder, which
is what's gonna capture psychotic
symptoms that only pop up in less
than a month but we're gonna dive
into that section in a little bit
Okay, so now we're getting
into how to use this darn thing
This text is designed to provide
a practical guide to using
DSM-5, which is a coding system.
So this is interesting here.
DSM-5 is a classification of mental
disorders that was developed for use in
clinical education and research settings.
Notice that there was no law in there.
Diagnostic categories, criteria,
and textual descriptions are meant
to be employed by individuals
with appropriate clinical training
and experience in diagnosis.
It is important that DSM-V not be
applied mechanically by indivision,
without clinical training.
The specific criteria included in
DSM-V are guidelines to be informed
by clinical judgment, are not meant to
be used as a rigid cookbook fashion.
For example, the exercise of clinical
judgment may justify giving a certain
diagnosis to an individual even though
the clinical presentation falls short
of meeting the full criteria for the
diagnosis, as long as the symptoms that
are present are persistent and severe.
And that's why it comes down to being
a battle of the experts, this trial
Okay.
So now we have the cautionary statement
for forensic use of the DSM-5 DSM-5
is used as a reference for courts
and attorneys in assessing the legal
consequences of mental disorders to
meet the needs of clinicians, public
health professionals, and research
investigators rather than the needs
of courts and legal professionals.
Can assist legal decision-makers like
the jury, the, and the judge, and the
defense and prosecution legal counsel
for a subsequent legal determination,
for example, involuntary civil commitment
The diagnosis enhances the value and
reliability of the determination.
, By providing a compendium based
on a review of pertinent clinical
and research literature, DSM-V may
facilitate legal decision-makers'
understanding of the relevant
characteristics of mental disorders.
The literature related to
diagnosis also serves as a check on
ungrounded speculation about mental
disorders and about the functioning
of a particular individual.
However, the use of DSM-V in
forensic settings should be
informed by an awareness of the
risks and limitations of its use.
While DSM-V categories, criteria,
and textual descriptions are employed
for forensic purposes, there is a
risk that this diagnostic information
will be misused or misunderstood.
The dangers arise of the imperfect
fit between the questions of ultimate
concern in the law and the information
contained in a clinical diagnosis.
In the clinical diagnosis of a DSM-5
mental disorder such as intelligence
disorder, gambling disorder, or pedophilic
disorder does not imply that an individual
with such a condition meets legal criteria
for the presence of a mental disorder or
mental illness as defined by the law or
specific legal standard like compliance
for criminal responsibility or disability.
For the latter, additional information
is usually required beyond the
contained in the DSM-5 diagnosis, which
might include information about the
individual's functional impairments.
Let me say that again,
functional impairments and how
these impairments affect the
particular abilities in question.
It is precisely because these
impairments, abilities, and disabilities
vary wildly within each diagnostic
category A certain diagnosis does
not imply a specific level of risk,
impairment, or disability necessâ¦
Be cautioned that a diagnosis does not
carry any necessary implications regarding
the etiology of causes of the individual's
mental disorder or the individual's
degree of control over behaviors that
may be associated with a disorder.
Even when diminished control over the
individual's own behavior is a feature of
the disorder, having the diagnosis itself
does not demonstrate that a particular
individual is or was unable to control
his or her behavior at a certain time.
So there's tons of legal
information out there.
In this episode, I just wanna give you the
understanding of how I would use the DSM.
You're gonna hear my opinion, my
personal clinical opinion here.
But
Along the way, there's a lot of
interesting things about a lot of the
terms that are being thrown around
So rather than start with bipolar disorder
or depression or anxiety, , which are
terms thrown around a lot, I wanna
hone in on the auditory hallucination,
and it's a command hallucination.
So I wanna hone in on that.
The bipolar diagnosis
or provisional diagnosis
Or any of the other ones
that are speculated.
It's not that they're off the table,
it's just that this is how I'm
gonna crack open the book first.
I'm really trying to identify and get
granular with this auditory hallucination
So here we are, brief psychotic disorder
The presence of one or more of the
following symptoms, at least one of
these must be one, two, or three.
And one, two, and three are
delusions, hallucinations.
Three, disorganized speech, for
instance, frequent derailment
or incoherence And four, grossly
disorganized or catatonic behavior.
That's when someone's
basically a vegetable.
So we know that we have hallucinations
that were reported at the time of the
crime, a command hallucination voice.
Now we're going to criteria B, duration
of an episode of the disturbance is at
least one day but less than one month.
So in other words, it's
occurring in a limited timeframe
and I wanna go down to
associated features.
Although the disturbance is brief, the
level of impairment may be severe, and
supervision may be required to ensure,
ready, that nutritional and hygienic
needs are met, and that the individual
is protected from consequences of
poor judgment, cognitive impairment,
or acting on the basis of delusions.
There appears to be an increased
risk of suicidal behavior,
particularly during the acute episode.
So right there, you can hear,
like, to get really concrete, and
that's why it's not so simple.
Even though I have my clinical
judgment, um, it's not so simple.
And, and based upon what she's
claiming right now or what is the
defense claim that the auditory
command hallucination occurred over
the course of eighteen minutes.
So even though maybe the risk wasn't
apparent to the outside world, we
just saw or we can understand that
pathology playing out just there But
under differential diagnosis, we have
malingering and factitious disorders,
and this is really important to think
about because clinically it's taboo
to bring this up in clinical settings
In cases that there is evidence that
symptoms are intentionally produced, okay?
When malingering involves apparently
psychotic symptoms, there is usually
evidence that the illness is being
feigned for an understandable goal.
Okay?
So the understandable goal in
this case is not the murder.
That's not understandable.
But what's understandable is being
in a trial and wanting to defend
yourself as you're presenting yourself.
You're, you're a defendant, and
there's a winner and loser, so
that's an understandable goal,
winning or losing the trial.
Swaying the jury or not
So we're gonna have to go into
malingering and factitious disorders now
malingering, 835.
It's right in the back
Here we go
The essential feature of malingering
in, is the intentional production
of false or generally exaggerated
physical or psychological symptoms
motivated by external incentives such
as avoiding military duty, avoiding
work, obtaining financial compensation,
evading criminal prosecution.
And then we're going to go
down to the points here.
So number one, malingering should
be strongly considered if any
combination of the following is noted.
Medical legal context of presentation.
For example, the individual is
referred by an attorney, the clinician
for examination, or the individual
self-refers while litigation or
criminal charges are pending.
Two, marked discrepancy between
the individual's claimed stress
or disability and the objective
findings and observations.
So anytime you look at Lindsay Clancy
and she's on TV, that's an objective
finding about the presentation of
her behavior and her emotional state.
Three, lack of cooperation during the
diagnostic evaluation and is complying
with the prescribed treatment regimens.
So in her case, there's three
signs out of four for malingering.
There's the context, there's the
discrepancy because just 18 minutes,
and one of the main points on this
is she doesn't look psychotic.
She was on Facebook, et cetera, et cetera.
And it's like, "Oh,
well, you cannot know."
But there's a discrepancy, okay?
So that's the point,
the marked discrepancy.
It's not that it couldn't be possible.
It's that malingering should already
be considered because of the context
that we're using this right now.
So then we got three points for
malingering, just because we're trying
to think about Lindsay Clancy in using
the DSM-5, it's considering a legal case
right now, or at least the circumstances
for which the evaluating psychologists
or clinicians or DSM-trained clinicians
are, um, coming to their conclusions.
- It's all within the legal purview, so
malingering needs to be considered.
The fourth one is presence of
antisocial personality disorder.
I did not check this.
She does not meet criteria for
antisocial personality disorder.
That much is clear.
Her Facebook would not look as
pretty if that was the case.
Malingering differs from factitious
disorder in that the motivation for the
symptom production in malingering is an
effective incentive, whereas in factitious
disorder, external incentives are absent
Interesting.
Okay
So
Malingering
That's just something to consider.
There's three check marks for that.
But that doesn't give
her a diagnosis, right?
So that's not good enough for saying she
doesn't have brief psychotic disorder.
It said strongly consider
antisocial personality disorder,
so we're gonna go and look at it
so the personality disorders
are grouped into clusters.
Cluster A, B, and C.
There's a lot of overlap
within each cluster
So we got antisocial
personality disorder here.
So a pervasive pattern of disregard
and violation for the rights of others
occurring since age 15 indicated
by three or more of the following.
That doesn't line up with what any of
her friends said and what looks like on
her Facebook page than what we've seen.
There's no evidence for this at all.
But number one, failure to
conform to social norms, uh,
with respect to lawful behaviors.
You know, it's not a repeated pattern.
Deceitfulness, um, conning others
for personal profit or pleasure.
No, that doesn't seem to
be, um, the main thing.
So I'm already going, "Huh?"
So let's go to that
differential diagnosis.
Other personality disorders
may be confused with antisocial
personality disorder because they
have certain features in common.
It is therefore important to distinguish
among these disorders based on
differences in characteristic features.
However, if an individual has personality
features that meet criteria for one
or more personalities disorders in
addition to antisocial personality
disorder, all can be diagnosed.
Individuals with antisocial personality
disorder and narcissistic personality
disorder share a tendency to be
tough-minded, glib, superficial,
exploitative, and lack empathy
That's gonna bring us to
narcissistic personality disorder.
All right.
And this is where I took a lot of notes
A pervasive pattern of grandiosity
and a need for admiration and lack of
empathy beginning in early adulthood
and present in a variety of contexts
I'm gonna just go over the
things I took notes on.
Has a grandiose sense of self-importance.
For example, exaggerates
achievements and talents.
Expects to be recognized as superior
without commensurate achievements.
So I see someone that is successful
on the surface, but the exaggeration
of achievements, the grandiose
sense of self-importance, to me the
biggest red flag is giving birth to
your child and then running a race.
I've never heard of that before, I
have a lot of patients that are hyper
exercisers, and there's a lot of patients
with ADHD that hyper exercise, and
it's usually a sign of perfectionistic
tendencies But let's keep moving on.
Two, is preoccupied with fantasies
of unlimited success, power,
brilliance, beauty or ideal love.
Okay.
Success, power, brilliance,
beauty or ideal love.
Five, has a sense of entitlement,
unreasonable expectations or especially
favorable treatment or automatic
compliance with his or her expectations.
So a sense of entitlement.
Is interpersonally exploitive,
takes advantage of others
to achieve his or own ends.
So this would explain the type of person.
Oh, you know, would ⦠Is
she malingering?
We have to look at antisocial
personality disorder.
We went to the differential, and now we're
in narcissistic personality disorder,
because the two are closely linked
Lacks empathy, is unwilling
to recognize or identify the
feelings or needs of others.
So that doesn't mean she doesn't love
her children, it doesn't mean she
doesn't recognize her feelings, but the
lacking of empathy must be considered
when you're thinking about the crime.
Is often envious of others or believes
that others are envious of him or her.
Shows arrogant, haughty
behaviors or attitudes.
Let's just say hypothetically she
is malingering and she does have
narcissistic personality disorder,
There's a lot of audacity to say, "I'm
not guilty," and appear before the world
If this was the case, that would
be very haughty, wouldn't it?
All right, so we're gonna go in
further in diagnostic features.
I've underlined some things here.
They may feel that they can only
be understood by and should be
associated with people of high
status and may attribute unique,
perfect, or gifted qualities to
those with whom they associate.
And this is where Duxbury matters.
As I talked about in other
episodes, I'm from Duxbury.
She moved to Duxbury, chose to move there.
I grew up there.
That's very telling.
If you choose to live in Duxbury,
you care about that status.
It's why it's called Deluxebury.
Every time I had to introduce
myself, "Where are you from?"
"Duxbury."
"Oh, Deluxebury?"
And it's like, yeah, there's people
that have money there, you know?
Soâ¦
And it's really cold in the winter,
and dark, and frigid, and traffic,
and I, I digress, but that fits for me
Needs are special beyond
the ken of ordinary people.
They insist on having only the top
person with the best institutions,
so this is, um, insisting on working
at Mass General, the best one and
instead of just quitting her job,
like can't quit her job, Mass General.
Doesn't wanna go back to work,
doesn't need the job 'cause
the husband makes enough money.
You, you putting this together?
They may constantly fish for
compliments, often with great charm.
This is of note with
her coworker, the nurse.
She-- oh, yes, she always wanted to have
kids, and she was just going around,
like interviewing all the nursing staff
about, looking for approval from, every
single parent, and, that type of behavior
on a nursing floor, it's like treating
it like you're at a cocktail party.
Um, it's always a red flag the
young person comes in on the nursing
floor and the kind of seasoned
older people are all like, "Ugh."
They expect to be catered to
and are puzzled or furious
when this does not happen.
Okay, this is where we wanna think about
her going to all these different doctors.
She reports different things,
she was not begging for help.
I've seen people beg
for help and not get it.
This is someone that was going for
help, talking to clinicians and being
dishonest, doing one thing and saying
another, inconsistencies in the chart
Did you get the medical records?
Did you do this and that?"
That's just blaming the person
that's just trying to work a job in
a system that they didn't create.
, Every time you interview a
patient, that's the interview.
The DSM is what you need and
the clinician that's trained.
That's sufficient to
perform an evaluation.
And in regards to telepsychiatry versus
in-person, I feel that I am much more
effective on telepsychiatry because I'm
staring at someone directly in the face,
listening to them directly into my ears.
It's a much more intimate experience
without the uncomfortable, like, sort of
feedback that you're dealing with, with
an in-person interaction that can be a
little bit activating for the clinician.
So for me to be able to be calm completely
and observe someone, and I'm looking
at them directly, I have the headphones
on, I am able to read micro expressions.
You know, there's the technical
problems, but I believe I'm better
at my job So there's arguments
to be made on either side.
Cause she chose telepsychiatry.
She checked herself out of
McLean, I believe, which is
another top, you know, place.
And anyone that's really trying to
get help, and I'm sure nurses, you
know, like I always tell people,
"Go to the independent clinician.
Go to the private practice."
You don't wanna go to the big
institution because it's usually training
clinicians and people that are green
so moving on.
For example, these individuals may
expect great dedication from others
and may overwork them without regard
for their impact on their lives.
So this guy Patrick just seemed to beâ¦
He didn't look like the picture of
health, even though he's an exerciser,
he looks frail, and his testimony
was clearly traumatized to me.
So they tend to form friendships or
romantic relationships only if the
other person seems likely to advance
their purposes or otherwise enhance
their self-esteem, they often usurp
special privileges and extra resources
that they believe they deserve.
Okay, well, this trial's
costing a lot of money.
Okay, associated features.
Narcissistic personality disorder,
very sensitive to criticism or defeat.
Okay, so put that in your
back pocket for later.
Such experiences may leave them
feeling ashamed, humiliated,
degraded, hollow, and empty.
They may react with disdain,
rage, or defiant counterattack.
However, such experiences can also
lead to social withdrawal or an
appearance of humility that they may
mask and protect the grandiosity.
Interpersonal relations are typically
impaired because of problems related to
self-preoccupation, entitlement, need
for admiration, and relative disregard
for the sensibilities of others.
Individuals with narcissistic
personality disorder can be competent
and high-functioning with professional
and social success, while others can
have various levels of functional
impairment Professional capability
combined with self-control, stoicism,
and interpersonal distancing with
minimal self-disclosure can support
sustained life engagement and even
enable marriage and social afflictions.
Sometimes ambition and temporary
confidence leads to high achievements,
but performance can be disrupted because
of fluctuating self-confidence and
intolerance of criticism or defeat.
Low self-esteem with inferiority,
vulnerability and sustained feelings of
shame, envy and a humiliation accompanied
by self-criticism and insecurity can
make individuals with narcissistic
personality disorder susceptible to
social withdrawal, emptiness and depressed
mood this can evoke suicidal ideation.
Suicide attempts in individuals with
narcissistic personality disorder
tend to be less impulsive and are
characterized by higher lethality compared
with suicide attempts by individuals
with other personality disorders.
So that's something that, you
know, we want to think about.
Excessive pride in, in achievements,
relative lack of emotional display,
ignorance of disdain for others'
sensitivities help distinguish
narcissistic personality disorder from
histrionic personality disorder, which
is more dramatic theatric person.
Although individuals with borderline,
histrionic, and narcissistic
personality disorder may require much
attention, - those with narcissistic
personality disorder specifically
need that attention to be admiring
So they need that attention.
Individuals with antisocial
and narcissistic personality
disorder share a tendency to be
tough-minded, glib, superficial,
exploitative, and unempathetic.
Now I'm really zeroing in here, okay?
In both narcissistic personality disorder
and obsessive compulsive personality
disorder, the individual may profess a
commitment to perfectionism and believe
that others cannot do things as well.
However, while these obsessive compulsive
personality disorder tend to be more
immersed in perfectionism related to
order and rigidity, individuals with
narcissistic personality disorder
tend to be high perfectionistic
standards, especially for appearance
and performance, and to be critically
concerned if they are not measuring up.
Measuring up to Duxbury, measuring up to
the perfect mom, measuring up to Facebook
And so she was never
like this before, right?
We're going into brief psychotic disorder
previously because this is fairly new.
She was mostly good and then she started
to decline in a period of couple months.
So suspiciousness and
social withdrawal, okay?
But when these qualities are present in
individuals with narcissistic personality
disorder, they derive primarily from
shame and fear of failure or having
imperfections or flaws revealed.
Many highly successful individuals
display personality traits that
might be considered narcissistic.
Only when these traits are, ready,
inflexible, maladaptive, and
persisting and cause significant
functional impairment or subjective
distress do they constitute
narcissistic personality disorder.
So inflexible,- I gotta run a
marathon when I gave birth to a kid.
I need to have three kids and
still be a labor delivery nurse.
I need to work even though my
husband is taking care of me.
So now we're going into
three other things below.
The differential diagnoses.
Persistent depressive
disorder, which is what Dr.
Mack had said.
Experiences , that threaten self-esteem
can evoke a sense of inferiority and
sustained feelings of shame, envy,
self-criticism, and insecurity in
individuals with narcissistic personality
disorder that can result in persistent
negative feelings resembling those
seen in persistent depressive disorder.
If criteria are also met for
persistent depressive disorder,
both conditions can be diagnosed.
So how could someone do this?
Then obviously it's gonna be
a little bit more complex.
So I hear a lot of narcissistic
personality disorder.
This is about creating the conditions
that could kill in this manner and
carry on in this manner willfully,
knowingly We're going into obsessive
compulsive personality disorder.
And you've already heard
narcissistic personality disorder.
Now let's go into obsessive compulsive
personality disorder So we get
preoccupation with orderliness,
perfectionism, and control at the expense
of flexibility, openness, and efficiency
beginning in early adulthood, okay?
Preoccupied with details, rules, lists,
order, and organization or schedules.
So she wrote lots of notes, right?
Shows perfectionism that
interferes with task completion.
Because strict standards are not met.
Excessively devoted to work
to the exclusion of leisure
activities and friendships.
I'm not sure about that Is over
conscientious, scrupulous, and
inflexible about matters of
morality, ethics, or values.
. Not accounted for by cultural
or religious identification.
So he's like, "I gotta kill," you know?
Shows rigidity and stubbornness
Other personality disorders may be
confused with obsessive-compulsive
personality disorder because they
have certain features in common.
It is therefore important to distinguish
among these disorders based on differences
in their characteristic features.
However, if an individual has personality
features that meet criteria for one
or more personality disorders in
addition to OCPD, all can be diagnosed.
Individuals with narcissistic personality
disorder may also profess a commitment
to perfectionism and believe that
others cannot do things as well.
But these individuals are more
likely to believe that they have
achieved perfection, whereas those
with OCPD are usually self-critical.
Individuals with narcissistic or
antisocial personality disorder
lack generosity but will indulge
themselves, whereas those with
OCPD adopt a miserly spending
style toward both self and others.
So it's clearly narcissistic
personality disorder.
So that's my take on it.
But you just heard me go
through and use the DSM.
You start somewhere and you keep moving,
and it tells you how to think, but you
gotta have the clinical experience.
So you heard me do that.
Now you hopefully have a better
lens on how the other doctors were
supposed to come to their conclusion.
And look at how many people are
involved in writing this book.
Look at this book.
Buy this book.
Look at it.
Hold it in your hands.
It's hard not to be impressed by it,
and I've enjoyed using it because it
gives a solid basis for understanding
the things that you're taking in.
Because at the end of the day,
each clinician is trained to
have the individual skill.
And if you work in mental health,
even as someone that's a nurse's
aide, as I started in psychiatry in,
inpatient unit, you get a feel for it.
And that's the interesting
thing with social media, is this
duality where people are observing
And commenting on things and taking in
this trial, and everyone has their own
personal life experience and is just
projecting onto this moment in time.
But in terms of the legality of
it and the responsibility of it,
she's not going away either way.
And even if she goes to jail, she's
not gonna get the death penalty.
. The system can't cure everyone.
So in patient hospitals, there's
these patients that always get
restrained and are always violent.
There's patients that go to jail and
enjoy living in jail and are able to
get, you know, get out of jail early.
And all these things exist because
we don't live in a perfect world.
But the way that we maintain civility
and prevent bad things from happening
is by individually sharpening our
adult minds and removing emotion.
So the other duality is the jury in
the legal process, they're supposed
to remove emotion, but the media and
social media is fueled on emotion.
So we have to ask ourselves, the
first thing we wanna do is we
wanna say, " Am I stressed out?
Am I anxious?
Am I frustrated?"
And if our mind's going, we
wanna put it somewhere else.
And that's what I'm gonna do right now.
This was definitely the longest
episode of Actually ADHD
Thanks for coming along with this
little bit of a ride with me.
I'm enjoying nerding out with you guys
That's gonna do it for today.
Until next time, this is Jonathan
Murphy, psychiatric nurse practitioner.
Talk to you later.