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Medication as tool

February 2, 2015  |  Posted by Dr. Madhavan | No Comments

My patients  know I often use metaphors to communicate ideas and one useful way of thinking about medication is as a tool.  Tools are not inherently useful.  Their utility has a lot to do with the context in which they are used and the skill of the worker.  In the hands of a skilled worker, a hammer can be use to construct a safe and effective shelter.  A careless worker can cause damage with the same hammer.  A hammer is not always the best tool for the job.  Not every nail needs to be pounded into place.  Understanding what is needed to construct an outcome means at times leaving some nails unused.  When considering an addition or change of medication, it is important to understand how medications fit into the larger picture of a person’s life.  It is also important to remember that there are often many ways to construct a dwelling and that not all dwellings require the same tools.

Expanding hours

February 2, 2015  |  Posted by Dr. Madhavan | No Comments

I am excited to announce an expansion of Soundview Psychiatric Services, PLLC.  I will be adding additional clinic hours starting this week.  Since 2007, my goal has always been to provide the most effective, evidence-based psychiatric treatment available and to provide it in a timely manner.  These additional hours will allow me to continue to meet this goal.

Psychiatric presentations are often acute.  It can be difficult to locate a psychiatric referral quickly and this can exacerbate the underlying condition.  While I am not able to accommodate all acute referrals, I am often able to see urgent new patients within 48 hours.  I strive to see all new patients within a week.

I am happy to discuss your situation with you.  You can call me directly at (425) 803-2024.

Theory of Mind

January 12, 2015  |  Posted by Brain Rules | No Comments

Theory of Mind is about as close to mind-reading as people can get. Most formal definitions go along the lines of the ability to discern the intentions, and motivations of yourself or another person. To develop a Theory of their Mind, hence the term. I think it has two components to it, especially if you're talking about one person trying to understand another's behavioral space. 

First, it's the ability to penetrate inside someone else's psychological interiors and understand the rewards and punishment systems inside that interior.Second, it's the ability to understand at all times that the rewards and punishment systems inside your head are not necessarily the same ones inside your neighbor's head. But he or she is not going to react like you do because he or she doesn't have the same rewards and punishment systems you do.

I joke in the book about calling the following saying John Medina's Second Law of marriage. Here's the saying: what is obvious to you is obvious to you.

I believe Theory of Mind skills are very important in the establishment and maintenance of social relationships. Necessary for success, though I would argue not sufficient. People often confuse it with empathy, but there are important distinctions. You can have terrific Theory of Mind skills and be a Mother Teresa. You read people insightfully and care about what you see. You can also be an SOB with it, too. You can read people insightfully and manipulate them in order to achieve some goal of yours. A dictator may be born with terrific Theory of Mind skills, but they use their talents to squash anybody that gets in their way.

Theory of Mind

January 12, 2015  |  Posted by Brain Rules | No Comments

Theory of Mind is about as close to mind-reading as people can get. Most formal definitions go along the lines of the ability to discern the intentions, and motivations of yourself or another person. To develop a Theory of their Mind, hence the term. I think it has two components to it, especially if you're talking about one person trying to understand another's behavioral space. 

First, it's the ability to penetrate inside someone else's psychological interiors and understand the rewards and punishment systems inside that interior.Second, it's the ability to understand at all times that the rewards and punishment systems inside your head are not necessarily the same ones inside your neighbor's head. But he or she is not going to react like you do because he or she doesn't have the same rewards and punishment systems you do.

I joke in the book about calling the following saying John Medina's Second Law of marriage. Here's the saying: what is obvious to you is obvious to you.

I believe Theory of Mind skills are very important in the establishment and maintenance of social relationships. Necessary for success, though I would argue not sufficient. People often confuse it with empathy, but there are important distinctions. You can have terrific Theory of Mind skills and be a Mother Teresa. You read people insightfully and care about what you see. You can also be an SOB with it, too. You can read people insightfully and manipulate them in order to achieve some goal of yours. A dictator may be born with terrific Theory of Mind skills, but they use their talents to squash anybody that gets in their way.

How does memory work?

October 24, 2014  |  Posted by Brain Rules | No Comments


Watch John Medina talk about how memory works

How does memory work? To begin with, we have to destroy the premise behind the question. We don't just have a memory system - like a computer has a hard-drive. We have various memory systems, each in charge of different types of learning. And they work in a semi-independent way from each other.

Though we've spent a long time looking, we don't actually know much about how these individual systems work. We know even less about how they are integrated.

Let me give you one striking example of how separate the systems are. James McGaugh has worked with a woman for a long period of time called A.J.

A.J. doesn't impress you with dramatic memory abilities when you first meet her. She is a C student. She doesn't have any flashbulb tendencies. Her declarative memory systems - the ability to remember things you can declare, like "Lincoln was the 16th president" appears to be pretty average. If all you looked at were her declarative systems, you wouldn't want to study her at all.

The problem is, AJ has more than just one memory system.

A.J.'s has a memory system that is anything but average.

She has very powerful what we call semantic autobiographical memory. She can remember anything she has ever done, what she has worn for dinner 15 years ago, what flowers she cut and put on the table, and so. Jim has studied her for years and can confirm that she remembers anything of a semantic autobiographical nature. In fact, she is eidetic in this category, photographic, flashbulb like.

Now here we have a conundrum. How come she can't apply that same talent to her schoolwork? The reason is simple. She has two memory systems that work in a semi-independent fashion. She has a great memory for personal experience, She has a poor memory for facts.

You see, memory isn't simple. So when you ask me "how does memory work?" my first response must be "Pray, about what memory system are you talking?"

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