Sawbones: Kleptomania

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.

All right, tomorrow meeting is about to books.

one, two, one, two, three, four.

We came across a pharmacy with its windows blasted out.

We pushed on through the broken glass and had ourselves like a rum.

The medicines, the medicines, the escalat macabre

Hello, everybody, and welcome to Sawbones, a marital tour of misguided medicine.

I'm your co-host, Justin McElroy.

And I'm Sidney 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...

I said my name.

Yeah, and you really stole it.

You really stole the show.

Oh, oh.

Yeah.

I stole a 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 all so good.

I didn't even pick up.

It was such a subtle intro.

I didn't even.

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 U.S.

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 want to be super clear about that, that the

that the that you should not be listening to the Department of Health and Human Services right now.

We still got to be.

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.

Yeah.

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 that 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.

But measles.

Can I tell you something real quick about that?

Just to

the dark, it's a good reminder about that.

That kind of thinking, because

Salvin's 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, let's like batten down the hatches.

Okay, let's just like keep it tight.

You know what, you know what you know, and the truth is the truth, whether it's on a website or not.

And, folks, the truth's going to be the truth in 10, 15, 20 years.

That's a good thing.

Is the truth don't even know,

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 measles.

I'm not sure why Jerry Seinfeld is holding this 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 R-naught.

How many people would a person with measles be expected to infect?

The R-naught, you mean?

Yeah.

Three.

No.

Four.

I'm just going to tell you.

Seven.

It's as high as 18.

12 to 18, 15 average.

Anyway, it's a very contagious.

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 because that was before vaccines if you were born between 57 and 68 so you got a vaccine somewhere in that time frame 57 to 68 they are recommending that you get a booster because the vaccine that was used in that time frame 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 you 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,

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 know this is a very important thing.

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 check your records, talk to your own health care 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 U.S.

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 the moment.

I stole eight minutes.

I know.

I, you know, Justin, we kind of skim over things like kleptomania 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 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 any of the, I don't do therapy.

And so any of the, those sorts of modalities, I, you know, I don't know how to do.

But, of course, if you did a psych residence, 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 had been talking about how

these sort of of of like medical issues or diseases or disorders or however you want to put it that that are popularly understood to be a certain thing and like i i feel like kleptomania or has been portrayed in the media to be a certain thing or not i i feel like kleptomania is not as much like the media present it 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 I did, 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, that 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 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.

Right.

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, you 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

like a silver candlestick from a priest that has very kindly taken 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.

Right.

Then that's not necessarily clipping to me.

No.

And if you're stealing a loaf of bread because you're hungry,

your family says, 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.

I 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, it 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%.

It's not 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 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.

It's it because it is something that you would be worried you'd get in trouble for.

A lot of people, even to their therapists or psychiatrists, 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.

Sure.

Right.

Because you'd be scared.

And so it is not something that is.

And you're, 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, 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 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 psychoanalysts 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 going to take us back to 1816, but before we do that, we do have to go to the billing department.

Let's go.

The medicines, the medicines that

You know, we've been doing my brother, my brother, me for 15 years.

And

maybe you stopped listening for a while, maybe you never listened.

And you're probably assuming three white guys talking for 15 years.

I know where this has ended up.

But no, no, you would be wrong.

We're as shocked as you are that we have not fallen into some sort of horrific scandal or just turned into a big crypto thing.

Yeah, you don't even really know how crypto works.

The only NFTs I'm into are naughty, funny things, which is what we talk about on my brother, my brother, and me.

We serve it up every Monday for you if you're listening.

And if not, we just leave it out back and goes rotten.

So check it out on Maximum Fun or wherever you get your podcasts.

All right, we're over 70 episodes into our show.

Let's learn everything.

So let's do a quick progress check.

Have we learned about quantum physics?

Yes, episode 59.

We haven't learned about the history of gossip yet, have we?

Yes, we have.

Same episode, actually.

Have we talked to Tom Scott about his love of roller coasters?

Episode 64.

So how close are we to learning everything?

Bad news.

We still haven't learned everything yet.

Oh, we're ruined.

No, no, no.

It's good news as well.

There is still a lot to learn.

Woo!

I'm Dr.

Ella Hubber.

I'm regular Tom Lum.

I'm Caroline Roper, and on Let's Learn Everything, we learn about science and a bit of everything else too.

And although we haven't learned everything yet, I've got a pretty good feeling about this next episode.

Join us every other Thursday on Maximum Fun.

All right, let's get back in that Wayback Machine, Sydney.

The first name that I found for kleptomania back in 1816 from a Swiss physician, Maffy, was Klopomania,

which also just means stealing madness.

Stealing insanity.

Stealing madness.

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.

Uh-huh.

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, it's like, it's not that you don't know it's wrong.

You do know it's wrong.

Like you know you're not supposed to do it.

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 Esquerol 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

what they would have called madness or insanity.

You know, these are, 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 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've 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?

Yeah.

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.

Yeah.

That makes sense.

Um, 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 this i mean if you apply this to the 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 no but that's but that was his idea that was his idea

uh 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.

I got to 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 towards 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

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, this is really interesting that you're saying this because you are exactly in the mind of the French psychiatrists that followed.

Okay.

As to their

idea as to why kleptomania existed.

This is, 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 early, 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

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 uh owns um some sort of you know till or he owns some sort of textile factory or something but he won't he makes you work there and he won't either like faberge eggs everywhere they got gaslights it's incredible you know and you can't you can just go in there you want to 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.

Right.

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 the just the circus, the courtroom must have been because they were these,

I don't know if they were beautiful.

In my mind, they're these beautiful, high-society Parisian women who are tearfully describing how overcome they were by these beautiful department stores.

And then these psychiatrists, like Esquiral, 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.

Psychiatrists, like, for example, eating a squirrel.

I don't think that's, I'm probably saying.

What would you say his name?

Esquirrel.

No, say his whole name together.

Etienne.

Etienne.

Esquirrel.

Etienne the squirrel.

Okay.

That's exactly what this is.

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 kind of like court reporting things so there was a woman she had been arrested on september 3rd at 7 p.m 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 woolen silk two dozen handkerchiefs 50 pairs of black stockings 33 pairs of collared stockings and it goes on and on now uh 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, 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 want to go steal stuff.

Yeah, you want to steal stuff at the very least.

At the very least.

So anyway, there were all these high-profile cases.

Everybody thought it was, oh,

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 yes

and so then those 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 if they were just trying 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, Freud, 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?

Your 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 glove symbolize?

Oh, the glove symbolizes.

What thing?

What thing?

Yeah.

The umbrella is a penis.

The pencil's a penis.

What's a glove?

What's a hand?

It's a condom.

Okay.

For the penis?

For the penis.

Okay.

Yeah.

Now, if you steal a music box.

This is a trick.

This is a trick.

Is that a vagina?

That's right.

It's a vagina.

That's what I always call them.

Yeah.

The music boxes.

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, 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 penis.

I need a pencil because I didn't bring one.

You don't steal a pencil because of penis envy.

Oh, because I'm mad at my penis.

You're afraid of castration.

I'm not 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 ideas about kleptomania, it all comes back to sex and your parents.

And then, and a lot, 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, 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 env 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 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's 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, 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, 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.

Topiramade is another medication.

It's an old anticonvulsant seizure med that we're now studying for some impulse control and also addiction-like behaviors.

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, now that you say that, I do remember that that was a well-publicized.

I've been looking.

It doesn't look like she has ever said it is kleptomania.

She hasn't actually talked about it a lot because

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 manifesting 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 yes 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, a, a place where people are just trying to, you know, come up with fake defenses, but there's a real thing behind it.

And it's really something that people who have described, who experience it, certainly if you're listening, you've experienced any sort of impulse control disorder, you know, if you any, not necessarily kleptomania, but any of the things where you feel that compulsion to do something.

And it is, 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, they can't stop themselves.

They must do.

Um, that is what people are experiencing.

And 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 just claimed it.

Use of their song Medicines is the intro and outreach program.

Thanks to you for listening.

That's going to do it for us.

Oh, I did want to mention something real quick.

There's lots of stuff for sale at mackerelmerge.com.

And if you head on over there this month, 10% of all proceeds are going to go to Harmony House, which is a place that's very near and dear to our hearts for people, supports 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 the 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 is getting hit hard as well.

So, any help you can give, it means so much to us.

That's going to do it for us.

Until next time, my name is Justin McLroy, and I'm Sidney McRoy.

And as always, don't drill a hole in your head.

Maximum Fun, a workaround network of artist-owned shows, supported directly by you.