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Dr. Alex, Dublin (2025)

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.

07/11/2025

The Lord of the Flies

In high school, we had to read the book about a group of British boys who, after a plane crash, end up on a deserted island. At first, they try to organise themselves, choose a leader, make rules, and keep a signal fire burning for rescue.

Gradually, revolts break out and the boys begin to kill each other. Through this story, Golding wanted to show that evil and cruelty exist within each of us, and that education and civilization can easily be destroyed.

In fact, I don’t think I actually read the book back then — I just remembered what it was about from hearing my classmates discuss it during English lessons. It seemed like such an improbable nonsense to me! Reading now about the evacuation of British children during World War II and learning that Golding was inspired by that, it all makes more sense. Plus, age (mine) gives me a different perspective on things.

As if reality didn’t already show us enough, the book illustrates what happens when social control mechanisms disappear and children and teenagers are left alone with their own impulses. The novel was a warning — “based on real facts,” on real observations.

It makes more sense to look through a sociological lens when trying to understand antisocial behaviour in adolescent groups, which can be extreme and even lead to murder. Rather than focusing only on individual psychological mechanisms, which explain things on a micro scale, we should look at group dynamics.

Conclusion: the supervision of children and adolescents by parents and the community remains the point where action should be taken — not isolated psychiatry or psychology interventions.

06/11/2025

Berkeley’s Tree
An Irish philosopher famous for the idea “esse est percipi” — to be is to be perceived. In other words, things exist only insofar as they are perceived by a conscious mind.

There’s a famous parable about a tree falling in a forest where no one is present, raising the question: if no one is there to hear the tree fall, does it make a sound? The sound being a sensory experience, it depends on an observer.

Suffering is similar. We might think that if no one observes, acknowledges, or validates it… then it hasn’t really happened. Some people try to protect themselves from pain by hiding it from others, on this same principle — if it’s not seen, it doesn’t exist. It’s a very effective strategy — until it isn’t.

Of course, that tree, as it falls, moves the air and creates sound waves. Of course, suffering exists even — or perhaps especially — when it is not observed, recognised, or validated. And that suffering only grows, becomes chronic, entrenches itself, and creates the conditions for even more suffering.

That’s why healing begins when a person allows someone else — perhaps a therapist — to witness the noise and the desolate scene left by their fall, alone, in the silent forest of that moment.

04/11/2025

When the Doctor Becomes the Patient

What a delicate and unusual situation! Why do the cobbler’s children go barefoot, and why do doctors so rarely go to the doctor themselves?
Why does the dynamic shift so easily, and why do we, as doctors, avoid seeking medical care—even when we know we can’t do without it?

Medicine, by tradition, is a culture of competition and perfectionism. Many doctors, without bad intentions, end up communicating in a cold or defensive manner, especially with colleagues. It’s their protective mechanism—but when you are the patient, and therefore vulnerable, you feel invalidated.

As doctors, we’re used to being the experts, the ones in control, giving instructions to the patient. When the roles reverse and the patient-doctor starts asking questions or challenging reasoning, the treating doctor may feel they’re losing control and will tend to minimise the symptoms: “It’s not that serious!”

Medicine offers validation through data, not emotions—but patients need emotions, because their experience is subjective, and the feeling of illness cannot be quantified scientifically. “Your tests are fine, so you’re fine” is an extremely invalidating response.

Empathy between professionals is sometimes blocked by fear. When a doctor faces another doctor’s suffering, they may perceive it as a personal failure and fear ending up in that same situation themselves. They’ll do anything to avoid confronting the emotions that come with it.

There’s also a heightened level of awareness: what would sound like a harmless comment or standard advice to others can be felt more intensely—“Do you think I don’t know I should watch what I eat? Why are you telling me that?”

Doctors make difficult patients, often even more so depending on the culture we were trained in, how we relate to illness, suffering, and vulnerability—and whether health truly stands as a core personal value.

03/11/2025

Implementation Science

I attended a webinar on Friday about this concept, which was new to me. Implementation science is a field that studies how we can put research findings into practice in an effective and sustainable way, how to ensure that what we learn from science is actually used correctly in the real world (in hospitals, health policies, etc.).

It’s not enough to know that cognitive-behavioural therapy works as a first-line treatment for moderate depression under controlled study conditions — we also want to see that it works in my own clinical setting, where I work directly with patients and the conditions are quite different!

Each country has its own particularities. Something that works in France might not work in England or Romania — or perhaps some adjustments could make the same approach effective anywhere in the world. A good idea can remain just that — a good idea on paper — if it’s not implemented in a structured way, following a study that analyses local barriers and limitations.

I was also thinking about the NICE guidelines (from the UK’s National Institute for Health and Care Excellence). They are excellent — we can read them from Germany, France, or Eastern Europe — but if local public health policies don’t implement them, they won’t actually work. Without similar infrastructure and systems, they remain beautiful examples of how others do things in their own context.

What can you do at a local or individual level? You can observe and document what works and what doesn’t in your own setting. You can try to adapt a guideline to your clinical context, being aware of its limitations. You can take part in implementation projects or quality audits. You can contribute feedback that eventually reaches the policy level.

I felt the need to write this because too often, suggestions for improving a system arise, and doctors within that system get excited about the wonderful idea but then feel discouraged, thinking, “This will never happen in our country.”
Hold on, not every idea can be implemented in its ideal form on paper and in practice.

02/11/2025

These days I’ve been reflecting on an observation from my clinical work.
We know that Maslow described how our needs follow a hierarchy — from the most basic to the highest. The basic ones are physiological (food, sleep, water), followed by the need for safety (emotional, physical, financial). Then come the needs for belonging and love (relationships, friendship, connection), followed by the needs for esteem (recognition, self-worth). At the top lies the need for self-actualisation — the desire to develop our potential and to live in alignment with the meaning of our own life. You can’t move to the next level unless the previous one has been satisfied. It’s like in video games!

In psychiatry, we meet people who are stuck at the first two levels — those who can’t sleep, can’t eat, and have lost the energy to meet even their basic needs. A person with mental illness doesn’t feel safe; the anxiety that accompanies most mental disorders is an alarm signal telling them they are in danger. Many have come to suffer from a mental illness precisely because of the experience of not feeling safe — of feeling alone, of believing that no one cares. They enter a vicious circle that makes it almost impossible to begin trusting a psychiatrist or psychologist. It takes time — and sometimes medication — to artificially create, at first, the feeling that those needs are met, so that the person can move up the pyramid and start “working” on more complex needs.

I’ve also been thinking about the stress experienced in concentration camps, where people were reduced to those exact basic needs. From my favourite book, Man’s Search for Meaning, I gather that those who had a life filled with meaning, values, and purpose seemed to possess an inner anchor — something that helped them endure the physiological regression without a complete collapse of the self. Thus, knowledge of the higher levels can be protective — not biologically (it won’t stop hunger) but psychologically, because it preserves a memory of dignity and self-worth.

It makes perfect sense to use medication to help my patients climb out — even artificially for a while — of the pit into which they were pushed or have fallen unintentionally. Only by seeing what lies above can they form a representation of what else exists in the world, beyond hunger and insecurity — and thus regain hope. You cannot strive toward something you’ve never known or experienced; you’ll call it ridiculous, a mere product of imagination.

P.S. People often self-medicate through substance use or self-destructive behaviours for the same reason — to escape the trap of suffering.

09/09/2025

When Institutional Perfectionism Creates Tragedies

Too often, the official guidelines for autistic children’s therapy are written for a world that does not exist, a world with unlimited resources, no waiting lists, and equal access for all. On paper, they look flawless. In reality, they become a cruel excuse.

Because when the “ideal” intervention cannot be provided, what happens? Families are left with nothing, or with piecemeal, uncoordinated services that, in truth, are no intervention at all. Sometimes a workshop here, a vague strategy there, with no continuity, no integration. It’s a simulation of care, not care itself. And the cost is immense: children lose the most critical developmental time, while parents are rarely told that the opportunity is slipping away.

History warns us what neglect does. The tragic cases of so-called “feral children” show that once developmental windows close, they cannot be reopened. And we all remember the Romanian orphanages, where children raised without stimulation or consistent support carried scars for life.

To repeat these mistakes today, dressed up as “respect for natural development” or even claiming that therapy is harmful, is hypocrisy at its most dangerous.

Inaction is not neutral. Piecemeal, fragmented action is not neutral. Both are forms of harm.

The harsh truth is that there comes a point where nothing more can be done, because the chance was missed. And yet parents are rarely told this openly.

What children and families need is not perfection on paper, but real, coordinated, timely intervention. Imperfect but consistent support is always better than polished guidelines that never translate into reality.

21/08/2025

Love Receptors – Use it or Lose it

Nature works on a simple principle: use it or lose it.
We see it everywhere around us:

1. Muscles shrink if we stop moving.

2. A bird’s unused wings grow weak.

3. A language not spoken is forgotten.

4. An eye that isn’t used properly will lose its ability to see.

5. Our sense of smell dulls when ignored.

We are all born with the capacity to receive love and form attachment bonds. This isn’t optional – it’s instinct, because our survival depends on it.

But sometimes, a child has nothing to receive. A parent may be too overwhelmed with their own survival, emotionally stunted and demanding love instead of giving it, or simply disinterested in the child. In such cases, the child’s “love receptors” go unused. And just like muscles that aren’t exercised, they begin to fade away.

As adults, these people often end up searching for a theoretical, fantasy version of love — pieced together from books, TV, or stories from others. Real love, when it shows up, isn’t recognized, because the inner sensor is missing.

The good news? Healing is possible. Therapy can help rebuild what was lost, awaken those receptors, and teach the heart how to recognize and receive love again.

20/08/2025

On Pieces!

Imagine going to the gym and working with one trainer just for your left arm, another one only for your right leg, and yet another for your abs. After a few months, the result would be… an anomaly.

That’s often how therapy for autism looks when it’s done in pieces. One therapist does occupational therapy, another does speech and language therapy, another does sensory integration—yet no one is truly coordinating the process to follow the natural stages of a child’s development. The outcome? Sometimes alarming behaviors that clearly show important steps have been skipped.

For example:

A child needs to learn to use the toilet before they can learn to read in a functional—not automatic—way.

A child needs to master joint attention before moving on to structured social skills.

A child needs to develop basic play before being pushed into academic tasks.

When best practice guidelines—early diagnosis and coordinated intervention—are not respected, what follows is chaos. Families and professionals start searching for explanations, and sometimes the pressure builds toward psychiatric labels that don’t truly reflect the child’s situation.

I never thought I’d live in a time when people would defend the idea that a child “has a psychiatric illness” just because it feels like there’s more light there than in the messy reality of fragmented therapy.

It’s a bit like cooking—if you don’t add the right ingredients at the right time, the recipe won’t work. And beyond a certain point, the result can’t be reversed.

Holistic, coordinated therapy isn’t just best practice—it’s what every child deserves.

Dr. Alex

12/11/2025

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