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Dr. Alex, Dublin (2026)

19/12/2025

Scary, but familiar

I don’t think there is anyone left who doesn’t know that technology in childhood reshapes the brain. We overprotect children in real life, depriving them of ordinary experiences that give them a sense of competence and independence—while underprotecting them in an artificial, adult-designed world that is vast and largely unknown.

The natural consequence? A rise in mental health difficulties. Children lose opportunities to learn essential skills for problem-solving and relating to others.

Another natural consequence? Medication is more limited than ever in what it can actually achieve. It’s like cardboard armour that breaks at the first hit. It’s as if I am faced with a 17-year-old who has been smoking since the age of 12 and I’m expected to treat lung disease.

Another natural consequence? One-to-one psychotherapy becomes ineffective and often fails. It’s like working with a 17-year-old who has been given alcohol since the age of 10 and is now expected to refuse drinking on their own simply because “it’s not good”—despite the fact that it has become normalised.

Change cannot come from the individual alone. It must come from a larger group—from the community.

19/12/2025

Diagnosis or formulation?

The conclusion is both diagnosis and formulation, yet the tension between these two camps—at least as I perceive it—often becomes so strong that it leads to extreme decisions.

A diagnosis is a standardised clinical label used for rapid and efficient communication, research, treatment guidelines, and medico-legal documentation. It removes subjective personal interpretations and saves time. It is particularly useful in acute contexts or where time pressure means intervention should not be delayed.

A formulation is a personalised explanation of the patient’s difficulties within their family and social system. It supports deeper understanding of the case, is dynamic (can change over time), and is built by identifying predisposing, triggering, maintaining, and protective factors.

Autism diagnosis without formulation:
Reductionist. The same intervention is recommended for everyone, without exploring the child’s or family’s resources or the meaning of symptoms and behaviours. It becomes a rigid label—family and school may see the child only through this lens. Prognosis is often perceived as fixed.

Formulation without diagnosis:
Something is described in detail but never named. Given my background in pathology, this is like describing a cancer in great detail without calling it cancer—or describing something benign at length without stating that it is benign. In psychiatry, the risk is significant: there are no clear treatment or intervention guidelines, parents “don’t know what their child has” and continue searching, classic autism features may be misinterpreted as mental illness and treated ineffectively, or difficulties may be underestimated and assumed to be part of normal development.

Conclusion: Diagnosis + formulation, always.

26/11/2025

It’s exactly as I suspected: you cannot increase someone’s self-esteem through “talk therapy”.
Parents often expect the therapist to tell the child the same messages they’ve already heard a thousand times – that they are smart, beautiful, and capable – but which the child has never absorbed. The hope is that if someone else says it, a professional, an authority figure… then the child will believe it and accept it.

It doesn’t work! That’s simply not how things function, whether we like it or not. Self-esteem is a consequence and a product of internal self-evaluation processes, which are influenced by what the child does. In other words, if a child has multiple opportunities to do things and succeeds in doing them, they will conclude that they are capable. The opposite is equally true! If a child or an adult does not have the opportunity, or actively avoids doing things, they will not have direct experience that they can succeed and will conclude that they are incapable. No matter how false that conclusion may be theoretically, it becomes true in day-to-day life.

Returning to therapy — it is not a battle to convince someone that they are capable, nor a debate where whoever has the stronger arguments wins: “yes you can / no I can’t!”. Therapy can be useful if it creates opportunities for success. This refers to occupational or behavioural therapies — the only suitable ones for young ages, where the cognitive part is not yet developed enough to understand complex cause-and-effect links or operate with more sophisticated psychological concepts.

At older ages and for adults, psychoeducation works: you teach them what self-esteem means and what they can do (at home, at work, in social life) to improve it. That’s all! Nothing more philosophical or complicated than that. There is no need for years of therapy and digging in all directions. Of course, therapy often goes in circles because that’s where the “light” is, while the real issue is ignored. Both the client and the therapist feel they are working on the problem. False — it’s just elegant avoidance.

One more important thing for parents: you cannot help your child build self-esteem if you don’t first understand the concept yourselves and work on your own self-esteem!

21/11/2025

The Grandmother Test

It’s not an actual test — it’s a practical rule used to check the clarity and simplicity of a medical explanation. The idea is simple: “If I explained this diagnosis, treatment, or medical concept to my grandmother, would she understand it?”

In medicine, we’ve always been encouraged to “speak in a way the patient can understand,” and I’ve noticed that those who can do this connect fastest with patients and build safe, trusting therapeutic relationships.

On social media, the same thing happens: complex topics are explained in a very quick and simple way so that “even your grandmother would get it.”
The problem is that this simplification creates the illusion of full understanding. People watching such content may feel they’ve grasped everything about a diagnosis, treatment, or psychological mechanism — even though the real details are far more complex. Social media favours short, catchy messages that simply can’t capture the nuances and important exceptions.

In the therapy room, frustration appears when you try to explain more but the person relies on that simple explanation they’ve already accepted as “enough.” They become prisoners of oversimplification.

18/11/2025

S*x is s*x, gender is gender.
It’s genuinely hard to understand even for doctors who don’t work in psychiatry. S*x is a concrete concept (we can see it), while gender is an abstract one—like friendship or justice. We don’t ‘see’ these things; we build and interpret them. They are constructs.

A simple way to picture it: skin colour is a concrete concept (we see it!). Ethnic or cultural identity, on the other hand, is not visible. It develops from the information and experiences someone internalises while growing up. Just like I wrote about TCKs: a child of Romanian parents, raised in a different country, might not feel fully Romanian. They may feel closer to the culture they were raised in, or a unique blend of both.

Why does the confusion bother me? Because modern medicine is moving on. It can’t afford to wait for people to mix up concepts. The big focus now is s*x-differentiated medicine. The internet is full of examples of how women have been ignored or left out of medical research for decades because the “standard” research subject was the healthy adult white male aged 20–40.
Where does gender fit into these biological studies? It doesn’t. So in medical conversations, we should keep them separate. Researchers already handle gender when it’s relevant and ensure it doesn’t interfere with studies focused on s*x.

Research shows that oestrogen is neuroprotective—though cyclic—women are more prone to certain conditions due to hormonal constellations, women respond differently to various medications, and dosage should often be optimised based on s*x, not gender.

Take zolpidem, for example. We already know women typically need lower doses than men.

Conclusion: S*x-differentiated medicine is the near future. Let’s not get stuck in mixing up s*x and gender—leave the gender work to the specialists who study it.

16/11/2025

There isn’t a more brilliant book than this, honestly!
A scenario that came to mind while reading about intuition (fast, emotional, automatic thinking) versus slow thinking (logical, evidence-based, and yes—lazy): sometimes a parent tells me that their child or teenager “can sense people” and will immediately know whether I or the therapist are “good”. It’s funny on some level, but it also complicates things a lot.

Intuition can be useful in certain situations, but it’s based on first impressions and very superficial cues. Fast thinking often gets things wrong—it relies on appearances, on things that feel familiar or similar, and on the child’s own fears. A child or teenager may reject someone simply because they have a deep voice, a foreign accent, are a man or a woman, or unconsciously remind them of someone who once made them feel uncomfortable. Our mind creates stories instantly, but not necessarily accurate ones.

Intuition isn’t a special talent; it’s a natural mechanism that can generate both helpful reactions and errors. Yes, we’re all inclined to listen to our intuition when making decisions, but if we don’t examine this process and become aware of the patterns of mistakes we make, we’ll keep repeating them.

This book is so valuable—the insights make you reflect on all the moments you’ve made decisions or repeated poor ones: in relationships, friendships, business and investments, your career, and even how you voted!

Hashtags:

12/11/2025

Fake it till you make it — it seems this idea has a scientific basis.
Our emotions are influenced by the feedback we get from our facial expressions and body posture.

That’s why guided imagery techniques work — when you gradually relax your body, you end up feeling calm and relaxed. The same goes for actors: by changing their facial expressions, movements, and posture, they can induce real emotions. They don’t just pretend to be sad; they actually feel sadness — and that’s why they seem genuine and professional.

It now makes more sense why theatre workshops can work as therapeutic interventions.
That’s also why we have the classic warning: “viewer discretion advised – strong emotional content.” Nobody becomes depressed right after watching the news, but unconsciously the body reacts, posture changes, and emotions follow.

What’s interesting is that this works the other way around compared to cognitive-behavioural theory — instead of changing thoughts first to influence emotions and behaviour, you start by changing your facial expressions, body posture, and tone of voice, and the emotions will follow. It’s a more direct behavioural intervention.

For children under 13–14, who aren’t yet developed enough for cognitive “talk therapies,” this behavioural approach through play, movement, and even theatre seems the most effective.

Finally, be mindful of emotional contagion: we subconsciously mirror each other’s facial expressions and body language. Children instinctively learn this nonverbal communication — and the emotions attached to it.
When surrounded by cheerful, kind adults, a child is more likely to mirror that behaviour and feel safe and relaxed.

10/11/2025

At the beginning of my residency, there was a situation where I assessed a patient during an on-call shift, but I wasn’t sure about the diagnosis or whether I had done the right thing. A senior colleague asked me how I had felt during the evaluation, and I realised I had been very afraid. It was a mix of fears — mine and the patient’s.

That same colleague told me that, in psychiatry, we must pay close attention to how we feel during a session, because it can reveal a lot about how the patient feels. He was right. Still, it takes continuous training and constant supervision to learn how to distinguish between the patient’s emotions and your own inner state — so that you don’t get “contaminated” and take those emotions home or into the next session. Even more importantly, so you don’t get lost in the patient’s experience and can truly help them.

There’s a lot of talk nowadays about emotions and how to “manage” them — perhaps too much, I’d say — without really understanding what an emotion is and how it arises. You can’t manage something you don’t understand.

Emotion is a response — a reaction — at the level of thought, body (heartbeat, breathing, intestinal movements), and behaviour, triggered by a stimulus. This stimulus is analysed by our nervous system, and a decision is made — based on past experiences and one’s ability to interpret — whether it’s something that can be handled “by the secretary” or “by the manager.” In other words, much of the information is processed unconsciously (by the secretary), and only some is escalated to a higher decision-making level.

But what happens when it rains information — when the “secretary” can’t keep up, the threshold is constantly exceeded, and the “manager,” the higher decision-maker, becomes overwhelmed without knowing why? We become emotionally contaminated without realising it.

We are biologically programmed to absorb others’ emotional states. The good news is that once this mechanism becomes conscious — once the manager realises the secretary is overwhelmed or ineffective — we can actually do something about it.

09/11/2025

“Change is not made without inconvenience, even from worse to better.”

This phrase was spoken by Richard Ho**er, an English theologian from the 16th century. He lived during a time when religious changes — from Catholicism to Anglicanism — led to intense conflict, persecution, and material loss. His observation was that people resist change even when it is for the better — “better” for social or spiritual order.

On another scale, the same thing happens in individual or family therapy. The change we seek often requires giving up the habits and ways of thinking that brought us to our current point and facing uncertainty. Even when the final outcome is positive — overcoming fear or changing a self-destructive behaviour — the process is stressful and uncomfortable. I’d even go so far as to say that if the process isn’t stressful and uncomfortable, it probably isn’t the real thing. If therapy is only a place where we go to feel good and vent, then it’s not what it should be.

On the contrary, sometimes when things get hard in therapy, we’re tempted to leave before actually working through that difficulty. We may project those feelings onto the therapist — this is called negative transference. In other words, if we feel unable to face our own negative emotions, we may feel that the therapist isn’t helping enough or doesn’t understand us the way we need.

This happens so often that experienced therapists expect it and are careful to “catch the moment” — to discuss it in sessions so that the client can move past it and continue toward healing. Unfortunately, the therapist’s experience alone isn’t always enough, and sometimes the process ends prematurely, with the person concluding: “I tried therapy, but it didn’t help.”

08/11/2025

The Psychiatrist and the White Coat

About nine or ten years ago, when I was a resident, I prepared a poster for an international conference. It was about how we had used an art-based intervention to try to help an adolescent. I remember — although I no longer have the poster — that I used some Pokémon images, and the psychiatrist Pokémon wore a white coat. In our hospital, we wore coats, while the adolescent… expressed that he hated doctors.

At the conference, several of us colleagues attended, and while we were in the hall, our spouses were walking around the poster area. They happened to catch a moment when two women from Italy (I think) were looking at the Pokémon poster. Apparently, they laughed at the idea of a “psychiatrist” wearing a coat. I felt quite hurt in my professional pride.

For the next seven years, I wore the white coat while working in public hospitals in Romania. When I left, I couldn’t wait to get rid of it — I had developed resentment and even disgust toward it. I’m a doctor, but I don’t feel any better in a white coat than I do in my regular clothes — perhaps even the opposite. I often feel it sends the wrong message.

I think of a situation where a teenage girl was diagnosed with dyslexia. When her classmates found out, they started saying she should be hospitalised and that it must be something serious — maybe even cancer. The diagnosis caused a lot of fear and confusion, but luckily it had come from a psychologist, and the perception was quickly corrected. What if the diagnosis had come from a doctor in a white coat?

Here, psychiatrists don’t wear white coats — neither in the community nor in hospitals. I think that’s for the better, though others may disagree. And let’s be honest: in psychiatry, the most physical contact we usually have is a handshake or a light, reassuring pat on the shoulder. There are also situations when a small child might climb onto your lap or even spit at you — and in those moments, the white coat doesn’t help much either.

Dr. Alex

19/12/2025

19/12/2025

26/11/2025

21/11/2025

18/11/2025

16/11/2025

12/11/2025

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