Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Kleptomania

Episode Date: March 4, 2025

Kleptomania is defined by an undeniable compulsion to steal, so it has wavered between legitimate diagnosis and flimsy criminal defense to somewhere in between since its inception. This week on Sawbones, Dr. Sydnee unpacks the facts from fiction while Justin tries to steal the show.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/Harmony House: https://harmonyhousewv.com/

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, this one is about some books. One, two, one, of misguided medicine. For the mouth. Oh, he pinched me.

Hello, everybody, and welcome to Sawbones, a marital tour of misguided medicine. I'm your co-host, Justin McElroy. And I'm Sydney McElroy. You really kind of stole my thunder there, Sid, because I was going to do a whole bit, but you kind of stole my thunder. How did I steal your thunder by saying my name? You just kind of stole the show with how great you are, and I feel like you kind of stole my thunder. How did I steal your thunder by saying my name?

You just kind of stole the show with how great you are and I feel like you kind of. I said my name. Yeah, and you really stole the show. Oh, oh. Yeah. I stole the show. Well, Justin, I couldn't help it.

Did you come all the way over here just to kiss me? To steal a kiss. Hey. That's right, folks. It's the Kleptomania episode. We are going to talk about Kleptomania, Justin. That was also good. I didn't even pick up.

It was such a subtle intro. It was like a whole skit. I wrote a whole skit about it. Before we get into kleptomania, I do want to very briefly talk about the measles outbreak that's happening in Texas, because I've gotten a couple emails asking some questions about vaccine,

about boosters for adults. And then in my actual, in my IRL, that's what they say, right? IRL. Yes. People have asked me this question multiple in the last few days. So I felt like keeping with current things, just very briefly, before we get into kleptomania, there is, of course, it's been widely publicized, there's a measles outbreak happening in Texas.

And so far there are, I believe, about 124 people. As of when I researched for this episode at the time that you listened to this, that number almost certainly will have gone up who have contracted measles. There has been, at this moment, unfortunately, one death from measles. That is the, it is important to note, the first death from measles we've had in the United States in a decade. So that is, even though the HHS secretary has said

that this is not uncommon, this is absolutely uncommon. Yes, of course there are measles cases still in the US. Why would the HHS secretary say it's not uncommon? Because he's a vaccine denier and should not be listened to. Okay, so we wanna be super clear about that, that you should not be listening to the Department of Health and Human Services right now. We feel good about it.

To anything that, well, oh man, that's a big, there are a lot of good people who work within these agencies, right? Like we know that. We know that there are smart, hardworking, evidence-based people within these agencies, but the problem is that those people are being weeded out. And so, I mean, they're still there at the moment, but like, there's still good information,

but it's going to be overtaken. You just have to bring to it the rigor and skepticism you would bring to like a Ringling Brothers, a Barnum and Bailey, a Ripley's Believe It or Not style production. A med school buddy of mine sent me, he had downloaded all of the CDC website and sent it to me in a file so that I had access to it prior to it being, prior to information being purged from it. So think about that by the way, if that-

But hey folks, can I tell you something real quick about that, just to, it's a good reminder about that by the way if that but hey folks, but measles I tell you something real quick about that just to The dark it's a good reminder about that that kind of thinking because the like saw bones has taught us nothing else The dark ages is temporary every single time we get into another one and then we get back out of it So let's like keep the information. Yeah, it's like button batten down the hatches. Okay, let's just like keep it tight You know, you know what you know and the truthes, okay? Let's just like keep it tight. You know what you know and the truth is the truth whether it's on a website or not. And folks, the truth is going to be the truth in 10, 15, 20 years.

That's a good thing is the truth don't need no, as we're seeing in Texas, the truth does not need advocates. The truth is the truth. So here's what you need to know about me. I'm not sure why Jerry Seinfeld is bringing this up like a dire warning. We've got to talk about kleptomania. I promise this is going to be a lighter episode after we get through. But I do want to give you this information.

So measles, of course, is highly, highly contagious. It's got an R0. How many people would a person with measles be expected to infect? The R0, you mean? Yeah. Three. No. Four. Eight. I'm naught you mean? Yeah. Three. No.

Four. Eight. Seven. Two. As high as 18. 12 to 18, 15 average. Anyway, it's a very contagious disease. You get two vaccines as a kid, you should.

One between the ages of 12 to 15 months, one between the ages of four to six years. That is when it's most effective is if you get both boosters in childhood. Those people who have gotten that series of vaccines are most likely protected, very, very high rate of protection if you've gotten both shots. Adults who were born prior to 1957 have been assumed to have immunity because they probably got it, right?

Right. Because that was before vaccines. If you were born between 57 and 68, so you got a vaccine somewhere in that timeframe, 57 to 68, they are recommending that you get a booster because the vaccine that was used in that timeframe for some people was an inactivated form that was not as effective.

You may have gotten the good one, you may not have. You probably don't know for sure. A lot of people don't have those records still at this point in their life. So if you fall into that category, you may indeed need a booster. I've already advised my parents to get boosters. Adults who are vaccinated between 68 and 89, Justin.

Yeah. That's us. Welcome to the conversation. You may have only gotten one. If you have access to your vaccine records, it'd be great to check and see. I mean, in what? I know, this is- You know my dad.

In what world do I have access to my vaccine records? If you only got one MMR, that's the vaccine we're talking about, it would say MMR, you may indeed need a booster. And there have been multiple public health officials who have said it wouldn't be the worst idea in the world to get one. Now, you may have gotten both. The only way is if you have access to your records. That's the only way you know for sure.

What should I do? Let's pretend like my dad didn't keep that in a safety deposit box. We are not saying get a booster. Currently, the public health position is consider getting a booster or if you want to know for sure, you can have something drawn called titers. Titers are amounts of the antibodies to these viruses that exist in your system. You can go get blood drawn and they will tell you, are you immune to measles, mumps, rubella, each individual. If you are immune, you don't need a booster.

If your titers are below a certain level, they will tell you you're not immune, in which case you do need a booster. All this being said, we know that in the US this stuff costs money, and it may be cheaper and more cost-effective and efficient if you aren't sure to just go get a booster that would not be harmful even if you did have the original series. So anyway, check your records, talk to your own healthcare provider. It's important to remember,

one in five unvaccinated people who get measles will need hospitalized on average. Last year during measles cases, 40% of people in the US who were unvaccinated and contracted measles were hospitalized. What I mean is that it's serious, measles is serious. It's a big deal. And people in areas of outbreaks may need a booster anyway.

If your kids are due for their vaccines, we highly recommend get them vaccinated. Talk to your healthcare provider if you have questions. The MMR vaccine is safe and effective and not in any way linked to autism. Just super clear. Now. Kleptomania.

All right, you stole eight minutes from cleptomania. I stole eight minutes, I know. I, you know, Justin, we kind of skim over things like cleptomania in med school. Now listen, I didn't do a psychiatry residency and I'm certain if I had pursued psychiatry as a field of study, I would know a lot more about it. In family med, we do a ton of behavioral health.

Shout out to all my primary care physicians who have to know everything every day all the time. But we generally, a lot of what I manage is a lot of the more common stuff, like depression and anxiety. And then even in my field, where I do a lot more behavioral health, PTSD is very common, psychotic disorders,

I don't personally manage a lot of kleptomania. And obviously I don't do therapy. And so any of those sorts of modalities, I don't know how to do. But of course if you did a psych residency, you probably know a lot more. All I knew is that it has to do with stealing. I think that's what most people would know.

And if you know the Greek words for kleptomania, they're both from the Greek for to steal and a mad desire or compulsion. So kleptomania literally means you have a mad desire to steal. So this is something, it was kind of an idea that we've been talking about how these sorts of like medical issues or diseases or disorders or however you want to put it that are popularly understood to be a certain thing. And like, I feel like kleptomania or has been portrayed in the media to be a certain thing or not.

I feel like kleptomania is not as much like the media present like portrayals, but it is absolutely one of those things that it feels like in school, when you were a kid and you found out about the idea of kleptomania, it would come up a lot. It was like something that was like, well, it could be that they're not someone who steals, they're just like maybe a kleptomaniac and they're forced to steal. Like this idea of a psychosis, like a diagnosis,

like crime being a diagnosis was a very big thing for us as kids in the 90s. This idea that like you would eat a Twinkie and your blood sugar would make you do crime is something that was like discussed a lot as a kid. Which you know it's interesting Justin because we're going to get into the history of kleptomania because our obviously our understanding of it has evolved quite a bit since we first described it. But there is a lot of research that we understand now, the underpinnings of what we understand about kleptomania now, that was done in the 90s. There was a lot of evidence published that kind of

furthered our understanding in the 90s. So, I wonder if it was part of this idea you have is because it was in the popular conversation at the time. Probably, yeah. It would have been, and I imagine, you know, I don't remember this happening, but if, you know, a big study was published about kleptomania back in like 91, 92, I could see that catching the attention of popular medicine media, right? The stuff, popular medicine, meaning the stuff that we do in medicine that people find interesting

enough that they would make like a human interest news segment about it. Not everything does and honestly sometimes the really important stuff can't rise to that level of popularity because it's kind of boring but it also might be really important. Kleptomania is very interesting to people. So what the diagnosis means, so if you have the, if you meet criteria, it's in the DSM, there are criteria that we use to diagnose these disorders. It's an impulse control disorder, that makes sense. You have an impulse, can't control it.

And it is the recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value. I think that's important to distinguish because if you're stealing medicine when you're sick, that's not... You know what I mean? Right. Or if you're stealing a silver candlestick from a priest that is very kindly taking you in and while on the run from the law, he brings you a second candlestick because you're trying

to start a new life, then that's not necessarily kleptomania. No. And if you're stealing a loaf of bread because you're trying to start a new life, then that's not necessarily kleptomania. And if you're stealing a loaf of bread because you're hungry. Right. Family's like, yeah. Yes, okay. No, and it is, you have to have the criteria

of you have a sense of tension before you commit the theft. This is true with a lot of impulses, right? I have that sense, I have to do this, I have to do this. And you feel that tension building, like I must do this thing. And then you have relief or pleasure and you feel that tension building, like, I must do this thing. And then you have relief or pleasure after you do it. There is a sense of, oh, okay, I did the thing that I had to do.

It's not out of vengeance or something else. It's not in response to something. You're not stealing because you're mad at somebody, so you're stealing from them, right? It's not like that. And then, of course, with all of these, it's not better accounted for by something else because things can come in packages. You can have a stealing behavior as part of another diagnoses

and you wouldn't necessarily have kleptomania. This would be just this impulse, right? So you could be like, you're saying it could be part of a constellation of things? Yes, because you can often depression can run concurrently with kleptomania, sometimes anxiety disorders can, so there are other, there have been cases of certain eating disorders being associated with kleptomania. So like there can be co-occurring things.

I'm so tempted to start like armchair psychologizing on why it would give people a release, but I want to hear what the medical community says, because I bet they're probably a little bit more well-acquainted. Yes. Yes. I will say it's pretty rare. The estimate is about 0.6% of the population. Where it's like a clinical, like you can actually clinically diagnose it.

Yes. And it's tough. Now, I will say it's tough, because as you may imagine, most people don't admit that they steal things because it is illegal. And so usually people are diagnosed when they are caught stealing and then arrested or face some sort of legal consequence. And then the diagnosis comes out as a result of that legal interference. Like yeah, or like you're examining a pattern, right?

It's not like a one-off. It's like you have to have a history that you're looking at. Because it is something that you would be worried you'd get in trouble for, a lot of people, even to their therapist or psychiatrist, if they have an established relationship with somebody that they could tell, they're not necessarily coming to them and saying,

hey, I steal stuff all the time, right? Because you'd be scared. And so it is not something that is. And you're ashamed not necessarily coming to them and saying, hey, I steal stuff all the time. Right? Because you'd be scared. And so it is not something that is. And you're ashamed. And that's, I think, a lot of compulsions too. That shame is all part of the package. And unfortunately, a lot of people don't get treatment. They get punishment, especially.

So it's interesting, the gender breakdown, it is a three to one female to male diagnosis, more common in women. That being said, men who are diagnosed with kleptomania are more often to just, they don't receive treatment, they receive some sort of legal ramification, jail time or something like that. They very often don't get treated for it, unfortunately. But as you may have guessed, this has been a really contentious diagnosis over time because it feels, I think that it's one of those things where if somebody says, well, I only stole because I had to, and I, like I had to, I couldn't control it, I had to, how do you, it would be hard for people to believe that, right?

And I am not saying you should question it, but obviously a lot of people did question it. And so over time, our understanding of kleptomania, why do people do it? Is it something you really can't control? And then in each individual case, because it's going to be used as a defense in some sort of trial in many cases. How can you distinguish, are they just saying this so that they can get away with a crime, or are they really experiencing this impulse control disorder? So there's a lot that's been written about it,

and of course, you know, there was a time period where the psychoanalyst had to get on it so there's a lot of Odd history behind kleptomania Beyond what you would already imagine. So I want to tell you about that. We're gonna take us back to 1816 But before we do that, we do have to go to the building department. Let's go All right, let's get back in that way back machine Sydney Let's kill it Macabre for the mouth All right, let's get back in that way back machine Sydney. The first name that I found for kleptomania back in 1816 from a Swiss physician, Matthew was clopomania, which also just means stealing madness, stealing insanity.

Yeah, I mean, it's the same roots, the same Greek roots. They just, he just used the word differently. And then the French psychiatrist, Mark, wrote about it in 1840 and was like, kleptomania. And everybody's like, oh, that sounds so much better. We're going to stick with that. Same roots, same words. Kleptomania is the one that stuck.

Mark gets more credit because I guess we like, it just rolls off the tongue. We just like kleptomania better. Kleptomania. Kleptomania. It is good to say. The way that both of the doctors describe it is pretty much the same and it's pretty much the criteria we use today. People who say, I stole something and I could not stop myself.

I had to do it and I felt so much better after I did it and yes, I knew it was wrong. Obviously, this isn't someone who doesn't understand, you wouldn't fit criteria. If you didn't know that it was stealing, if you thought it was okay to walk into a store, pick something off a shelf and walk out, that's not stealing.

So it's like, it's not that you don't know it's wrong, you do know it's wrong. Yes, but you cannot stop yourself, yes. And they also noted at the time that it seemed to be something that mainly women experienced. They both studied under a very prominent French alienist. This was in the time of alienists,

which was the term for therapists, psychiatrists, psychoanalysts, the precursor to that. And Etienne Esquerel was his name, and he was the one who sort of wrote a lot and took this sort of early research on kleptomania and listed it and defined it as he believed there were a whole series of monomanias, and that means a singular fixation, mania at the time was being used for like any sort of, fixation, mania at the time was being used for like any sort of what they would have called madness or insanity. You know, these are not the way we use these terms today.

When we say mania, we mean something very different. But what a monomania meant that in most ways you behave exactly like everybody else, but in this one specific behavior, you cannot control yourself. And there's a whole list of things that he said you could have a monomania in, kleptomania being one of them. In every other way, you behave like everyone else in society, but when you're in a department store, you just can't stop yourself. You got to steal something.

And monomanias were eventually called into question, like, is this a real thing? Are there really a whole series of singular behaviors? We know now that some are, some aren't, and also it's probably more complex, right? It's probably underneath it there is an impulse control problem and it can manifest in a variety of ways. Does that make sense? As opposed to there's just this one place in your brain where you cannot stop yourself from doing this one specific thing. Yeah. Yeah, that makes sense. So he called it a lesion of the will. Basically, the idea is that,

and I think this is kind of a fascinating concept of humanity, we all want to steal all the time. Yes. But we all have willpower that stops us from doing it, except occasionally someone doesn't in that one specific way. So we all, I mean, if you apply this to human behavior, we all want to do all the things we're not supposed to do all the time.

We all want to kill all the time. We all want to steal all the time. But we have will that prevents us from doing it, except occasionally that part of our brain isn't working the way it's supposed to, and so then we do. Okay. Yes. And it's pretty much the way it works.

No, but that's- No, but that was his idea. That was his idea. Eating a squirrel. There are great descriptions from, they would interview women and ask them about, like, why did you steal something? And one woman said,

"'I have a crazed envy that drives me to take possession of all that I see, such that if I had been in a church, I would not have been able to resist stealing from the altar. J. Camden I gotta say, I do wonder if this is also an illness that has evolved now that we have so many things. Like, you know, we're clogging these departments, like the cost of these goods through industrialization and modern production techniques. I feel like there's so many more things. And I don't think that I like even if I had a compulsion, the idea that I would like that would really bum me out if I wanted to bring more things

into the house because I, I just can't. Back then they didn't have as many things is what I'm saying. Like, I don't want any of the things at church. Like, my stuff is so much better than the stuff at church is what I'm saying. Okay. This is really interesting that you're saying this because you are exactly in the mind of the French psychiatrists that followed as to their idea as to why kleptomania existed. It's really interesting that this would be your conclusion because that is exactly what a number of psychiatrists in the late 1800s and early 1900s began to believe. So initially it was thought this is largely, first of all, it was blamed

on all the stuff that anything wrong with women was blamed on at the time at first, right? Like they were like, well, it's probably hysteria. It has something to do with your period. Menstruation was blamed. Menopause was a very frequent like, well, it's because of menopause that made you steal stuff, you know, how menopause makes you steal stuff. That was a lot of the other things that like, they thought it was some sort of constellation of what they would have called at the time like cerebral defect, meaning you don't understand. You fundamentally don't understand that it's wrong to steal and so you can't stop yourself. And then all the woman stuff, it's your uterus probably.

But then there was this rising idea in the late 1800s, early 1900s, that it wasn't actually a problem with you, woman. It was a problem with the department stores. They're becoming so incredible now. At the turn of the century, department stores were becoming so luxurious. And that was literally what it was blamed on.

Department store atmospherics were becoming so luxurious. And that was literally what it was blamed on. Department store atmospherics was thought to be the underlying cause of kleptomania. Because you go in there and you just want to steal. Because it's all great. You want all this stuff. They just invented all this stuff. You can't have any of it because your husband's owns some sort of, you know, till, or he owns some sort of textile factory or something, but he makes you work there and he won't use like Fabergé eggs everywhere,

they got gas lights, it's incredible, you know, and you can't, you can just go in there and steal it. That's exactly what they thought was happening. They thought that women, and that was why not only was it largely women, it was women who did have money. So they weren't blaming women who perhaps in this description, their husbands couldn't give them enough money to buy the things they wanted. They were saying, no, these women probably do have some money, like not necessarily the

richest but women of some means who could buy something. And maybe they couldn't buy everything they wanted, but they could buy something. But they come into these department stores and they're so overwhelmed by the amount of beautiful things that they could acquire if they had endless means that they can't help themselves and they just begin stealing things. And this would be used in their defense a lot. So there were trials, very high profile trials at the time. A lot of these happened in Paris and I can only imagine that just the circus, the courtroom

must have been because there were these, I don't know if they were beautiful. In my mind, there are these beautiful high society Parisian women who are tearfully describing how overcome they were by these beautiful department stores. And then these psychiatrists like Esquirel would go defend them. They would go to trial. It is true. Take it from me, eating a squirrel. It is true. These department stores are beautiful. You want to steal, steal, steal. I went through one to take pictures for you. I steal three things. They would come to high prominence, these psychiatrists, by going to trial and

defending, you know, very chivalrous, these poor women who were at the mercy of these gorgeous Paris department stores. Patrick Larkin Psychiatrists like, for example, eating a squirrel. Nicole Soule- I don't think that's, I'm probably saying it all. Patrick Larkin How would you say his name? Nicole Soule- A squirrel? Patrick Larkin No, say his whole name together.

Etienne? Etienne? Esquirel? Etienne Esquirel. Oh, no, okay, okay. Yes, that's exactly what they say. There was one department store, as they were writing about one of these trials,

they talked about a department store in Paris where they said, they were talking about a display where there was a bunch of lace, and they said, the temptation was acute. It gave rise to an insane wave of desire that unhinged every woman. Lace is pretty. I have never once seen a display of lace that has unhinged me, I don't think. I don't think.

But anyway, so this was really believed at the time that it was the problem of the department stores. And there was one, this was another that I really enjoyed. It was a description of one of the court reporting things. So there was a woman, she had been arrested on September 3rd at 7 p.m. in Printips, that was a department store. Having concealed under her garments a silk garment, a search of her home revealed large quantity of other stolen goods,

all unused and with their price tags still on. The list, which is rather long, included five pairs of boots, 22 pieces of wool and silk, two dozen handkerchiefs, 50 pairs of black stockings, 33 pairs of collared stockings, and it goes on and on. Now, 49, she had stolen early in life, by the way, but was virtually incarcerated by her husband for 15 years for stealing.

So basically she stole some stuff. Her husband found out, locked her in the house for 15 years, wouldn't let her get out. And then this latest burst of thieving, when he loosened the bounds, she went to Printips that day and shoplifted. As soon as he let her out of the house, she shoplifted. And she said, this theft for her was the beginning of a new existence. She was transformed. Her household, her husband took second priority

and she had but one overriding thought to return to the department store to shoplift. She couldn't help herself. I have to imagine that being locked in the house for 15 years would make you wanna go steal stuff. At the very least. So anyway, there were all these high profile cases. Everybody thought it was,

these women can't help themselves. Women being the weak things we are, can't help ourselves in these beautiful department stores. But the problem in the early 1900s as this came into fashion, as soon as it did, there was criticism because a lot of people stole stuff that wasn't expensive. They were stealing cheap things.

They weren't stealing fancy things. And so then those explanations started to fall apart. So almost as soon as you saw this movement in the early 1900s that it's because of department stores, you started to see competing ideas. No, no, no, no, no, that doesn't make any sense. Look at the stuff they stole. If they were just trying to, they would steal the lace. They didn't steal the lace. They stole like a, you know, a pair of cheap cotton socks or something. And so like, why, how

does that make sense? We can't square it. So then you started to see all of these other ideas come into play. And a lot of this was led by this time period we're in is the time of psychoanalysis. So a lot of Freud's disciples, Freudian thought, and people who followed Freudian thought are kind of taking over our concept of kleptomania and a lot of other obviously psychiatric diagnoses at this point. Yeah, they were steering the conversation.

So what do they think it has to do with? What do they think everything has to do with? Their moms. Your mom and sex. That's always, when you get to the psychoanalysts, sexual repression has got to come into the conversation and then we're going to talk about your parents. So let's, Justin, I want to play a game with you. Okay, I'm ready. So the psychoanalysts thought that stealing things had to do with sexual repression.

Okay. And that the objects you stole could give them a lot of insight into what was causing you to steal. Okay. Because the objects were symbolism. Okay. So Justin, if you steal a pencil, what does that symbolize? Penis envy.

It's a penis. Very good. The pencil is a penis. If you steal an umbrella, what does that symbolize? Penis envy. Specifically, it's an erect penis, but yes, it is a penis. If you stole a glove, what does that symbolize? Penis envy. Specifically, it's an erect penis, but yes, it is a penis. If you stole a glove, what does that glove symbolize? Oh, the glove symbolizes...

What thing? What thing? Yeah, the umbrella's a penis, the pencil's a penis, what's a glove? Oh, is a hand. It's a condom. Okay, for the penis? For the penis, yeah. Now, if you steal a music box,

is the trick, is the trick. Is that a vagina? That's right, it's a vagina. That's what I always call them. Yeah, the music box. The music boxes. So there you go. And every object represents something, usually sexual,

and everything was related to some sort of trauma from birth, from exiting your mother's body some sort of trauma from birth from exiting your mother's body and then trauma from that. There's a lot of Oedipal desires wrapped up in that. It's either depending on if you have a penis or not, you're either stealing because of penis envy. So like I might steal a pencil. Since I do not have a penis, I would steal one because I wish I had one. Now why would you steal a penis? Why would you steal a pencil? Why would I steal a penis?

Because I'm Dr. Penis Thief, the penis stealer. Why not wiener over here? I'm going to steal it and take it back to my cave. That's why I steal a penis. Why would you steal a pencil? You don't steal a pencil because of penis envy. Oh, because I'm mad at my penis. You're afraid of castration. I pencil because of penis envy. Oh, because I'm mad at my penis.

You're afraid of castration. I'm afraid of my penis. No, you're afraid of losing it. Oh, okay. So everybody without a penis steals things because they want one. Everybody who does have a penis steals things because they're afraid of losing theirs.

There's also a lot that has to do with a drive to either obtain milk or feces or the contents of your mother. I mean, really, if you read into these ideas about kleptomania, it all comes back to sex and your parents. And then a lot about penises. So all of this psychoanalytic thought about why people stole, and there's lots of writings about like, well, we talked to this person who said they had kleptomania and we understood it was because they were trying to steal their father's penis.

And that was why they did the thing they did. At the same time that psychoanalysis in general was falling out of favor, I mean, because this was sort of like all of this rose and then everybody went, that sounds kind of silly. And then it fell out of favor. So what happened is Kleptomania itself started to get called into question because it got tied to all of these sexual repression penis envy theories.

And everybody was like, well, this isn't even a real thing anymore. When of course it was a real thing, it just had nothing to do with penises. So it wasn't until the DSM-3 was published in 1980 that we see kleptomania listed again among the impulse control disorders using the criteria that basically we still use today,

which I've already cited in this episode. So it really took that long for us to kind of get back to, can we talk about why sometimes people can't stop themselves from stealing? And now we recognize it as an impulse control issue. There's actually, so as I mentioned, Justin, there was a lot of research done on this in the 90s. So 1980, we see it mentioned as an impulse control disorder again. And the leading, it was funny as I was looking through the more recent research on it, the leading researcher,

they were all listed as McElroy et al. So I had to know, there's a Susan McElroy who works out of Cincinnati, out of the University of Cincinnati, who has done a ton of research on kleptomania to understand it in a modern context. As an impulse control disorder, as something related to, like if you think of obsessive compulsive disorders and that kind of, you know, I can't,

people who can't control themselves from washing their hands again, or from checking to see if the door is locked again, or from, you know, saying a word out loud, same idea. They can't control themselves when it comes to stealing. And so when we talk about treatments for it, it's the same sort of treatments that we pursue for other impulse control disorders. They're looking into obviously things like cognitive behavioral therapy, some desensitization

training even. I found some like you go into a store and want to steal something but don't, right? Like the idea of like that. And then also medication therapies, similar to things we would try for other impulse control disorders So they've tried SSRIs and SNRIs those are sort of the most common antidepressants Like if I named a list of them you've probably heard of a lot of them That you could try for any impulse control disorder. They've studied things like naltrexone, which is actually an opiate antagonist

We can use it for substance use disorder in some cases. They've tried naltrexone and seen some evidence that might help with it because again, this impulse idea, trying to stop yourself from an impulse that you feel like you can't stop yourself from doing. Topiramate is another medication. It's an old anticonvulsant seizure med that we're now studying for some impulse control and also addiction-like behavior.

So anyway, there are ways that we can address it and treat it. It is pretty rare, but it is a real impulse control disorder and nowadays we don't think it has anything to do with anyone's penis. I noticed you didn't talk about kleptomania in relation to Winona Ryder. And I'm curious if Winona Ryder just kind of shoplifted

or if she tried to say that was a kleptomania related incident. Justin, I don't know. I didn't even think, I mean, I, now that you say that, I do remember that that was a well publicized thing. I've been looking, it doesn't look like she has ever said that this kleptomania, she hasn't actually talked about a lot because I, why would you get it?

But like- Yeah, I probably wouldn't. I would talk about stranger things a lot more than that if I were her. I would be more focused on stranger things. I would say this though, if it was a manifestation of kleptomania, that is what I think a lot of people's assumption

was at the time because she had been in all these movies and made a lot of money so she wouldn't need to steal. And I don't know if she did need to or not. But I would argue, even though that was probably very embarrassing for her at the time, I do think that in context of what we're saying, it probably was like some much needed like legitimacy and visibility for this. Because if you have someone like her doing that, like, I think that that helps to reinforce that it isn't a choice, that it isn't motivated

by like personal gain, you know, that there is a, there's obviously like a place where people are just trying to, you know, come up with fake defenses, but there's a real thing behind it. COLLEEN O'BRIEN And it's really something that people who have described, who experienced it, certainly if you're listening, you've experienced any sort of impulse control disorder, you know, not necessarily kleptomania, but any of the things where you feel that compulsion to do something. And it is very much a physical thing that they describe that is happening that becomes

so overwhelmingly, I mean, I don't even know if uncomfortable. I've had patients use the word painful to describe the need to do the thing that then eventually they just, they can't stop themselves, they must do. That is what people are experiencing. I think it's helpful to hear those descriptions and understand that people with kleptomania are experiencing that same thing when they steal things. And so it makes total sense. Obviously there are people who just steal things too. I'm not saying that. And as always, if you see somebody stealing food,

no you didn't. Hey, thanks so much for listening to our podcast. Thanks to the taxpayers for use of our song, Medicines, our song, I could just claim that. Use of their song, Medicines, is the intro and outro for our program. Thanks to you for listening, that's gonna do it for us. Oh, I did wanna mention something real quick.

We, there's lots of stuff for sale at McElroyMerch.com. And if you head on over there, this month, 10% of all proceeds are gonna go to Harmony House, which is a place that's very near and dear to our hearts, for people, support people experiencing homelessness here in our area. There's lots of great new stickers. We've got a Dare to Care sticker.

There's some Sawbone stuff on there, but 10% of all proceeds go to Harmony House. So if you don't mind going over there and buying some stuff, that'd be very cool of you. Or just donate directly to Harmony House, I guess. Yeah, we really appreciate it. I know all over the country, things are tough with people losing their jobs and more and more people experiencing homelessness

and definitely our area's getting hit hard as well. So any help you can give, it means so much to us. That's gonna do it for us. Until next time, my name's Justin McRoy. I'm Sydney McRoy. And as always, don't drill a hole in your head. All right, guys! All right! All right! All right!

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