Marijuana & Driving

Dear Dr. Guterson: I know that drinking and driving is not a great idea. How about marijuana and driving? A: Obviously, with the increasing legalization and use of marijuana, this is a key question. Based on a research study that was published in 2022, the upshot was that using cannabis does indeed impair driving up to 3.5 to 4.5 hours after using. This may seem obvious to most, but what was significant is that it made no difference whether someone used alot vs. a little marijuana. In addition, the study found that one’s own perception of their readiness to drive safely was also off kilter. In other words, many in the study felt they were safe to drive 30 minutes to 1.5 hours after using - but they really weren’t. So - this is a case where self perception is not reality! Therefore, the general rule would be to throw your own feelings and thoughts out the window and wait 3.5 to 4.5 hours after using before driving.

Faking it?

Dear Dr. Guterson: I have a cousin who has a seizure almost every week. I don’t want to sound unkind, but I think he’s faking it. How do I know for sure?

A: Your question is one that we psychiatrists are challenged with all the time - and not only with regard to seizures. Are our patients telling us the truth?

We do have a name for seizures that are not real: psychogenic nonepileptic seizures (PNES). In short, patients with PNES often exhibit certain symptoms - like screaming or crying, side-to-side movements of the head, and closed eyes - that do not generally occur in those with real seizures. Also, those with PNES will usually ‘wake up’ quickly after the event whereas those with real seizures can be quite confused for many minutes to hours.

To help these patients, it is important to be nonjudgmental and to show understanding. In psychiatry, we see patients all the time who may make things up or who intensify their problems. Recognize that this person is in pain, probably a type of pain that is vastly different from what they are saying or exhibiting, oftentimes a deep, psychological, traumatic pain.

By listening with kindness, you will see that amazing gates of sharing will soon open up.

A Mother's Wisdom

Dear Dr. Guterson: I’m interested in becoming a psychiatrist. Could you please tell me how?

A: Your question reminds me of what my mother said to me when I was about 15 years old: “John, you should become a psychologist; or, better yet, go to medical school and become a psychiatrist.”

I had no idea what she was talking about.

To become a psychiatrist is a long and winding road, but in my mind, it’s sure worth it.

First, you do need to go to medical school. And to get into medical school one needs (1) a college degree which includes at least one year each of biology, general chemistry, organic chemistry, physics, and math. In my mind and experience, these courses are not easy but they are also the study of G-d’s physical creation, and therefore fascinating; and (2) to take the medical school admissions test.

I will be honest: (1) and (2) above are rigorous and many people lose their momentum and ultimately get ‘weeded out’ in the process. And getting into medical school is competitive. But if you are dedicated and willing to put in the time, and keep your eye on the goal, it can certainly be done.

Medical School itself is not a piece of cake. But the coursework is certainly intriguing as one is learning and experiencing the wonders of the human body. Medical School is a four year process - I will leave the details of these four years to another time, but suffice it to say, upon graduating medical school, one then can choose the specialty one desires: internal medicine, pediatrics, obstetrics/gynecology, radiology, ophthalmology, etc.,or PSYCHIATRY!!

Psychiatry is, yes, different than most fields of medicine. It is the ultimate integration of science and art. It is the exquisite journey of the human mind and soul. And there are a huge range of possibilities that are open to a psychiatrist: hospital psychiatry; private office practice; research; forensic psychiatry; child/adolescent psychiatry; geriatric psychiatry; writing; psychoanalysis; and many more.

As medical professionals, psychiatrists have the option to prescribe medications as well as doing psychotherapy. In contrast, psychologists do psychotherapy alone.

Perhaps that is why my mother said “better yet,… become a psychiatrist.” She saw more opportunities for a psychiatrist. Who knows?

I certainly didn’t know when I was 15 years old, an age when we all know way more than our mothers.

(Postscript to my readers: please don’t misconstrue my words. I think

the world of good psychologists, who are generally much more gifted at

psychotherapy than we psychiatrists.)

- Dr. John Yaakov Guterson