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While I was training in psychiatry 30 years ago, the field was changing around me.  The older psychoanalysts were forced — reluctantly — to add prescription of psychotropics to their practices or else patients would never make it to their door. Of course, they had little to no training in pharmacology and less interest so they didn’t usually know what they were doing. While I was ascending in the ranks of psychiatric trainees, the best and the brightest of us were ushered into special training in pharmacology research.  I was (and probably still am) about as idealist and apolitical an up-and-coming psychiatrist that anyone could have invented. Read more on The Politics of Drug Development…

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They call it pareidolia. It is all right if you never heard of it — you have probably experienced it. We don’t just love stories.  Our brain seems to need them.  We take what is inanimate and give it an identity, a spirit, a character, a story. In 1944 a couple of psychological researchers at Smith college showed an unimaginatively dull and insipid movie of black triangles and lines and such moving about to 34 “subjects,” probably unpaid Smith students (who may also have been emotionally or even sexually frustrated) when all but one of them described this 2 1/2 minute movie with amazing “humanity.”  They saw scenarios like two male triangles keeping a female circle prisoner. Read more on Seeing Virgin Mary or Christ In Stains…

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If you don’t at least occasionally check out my Facebook page, you might enjoy my latest update.  Just a hint!

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If you think I bare my soul in this blog, then you would be surprised at how much further I can take – “to the next level” as they like to say – in my private, opt-in newsletter.

I don’t just reprint blog posts in the newsletter – or vice versa.  I jump right in to the deep end.

I haven’t produced a newsletter recently – although in some promotional things on my various web page I have called it “weekly” (that’s stretching it).  But I have a new one coming out tomorrow. Read more on What Changed When I Wasn’t Looking…

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I first learned that I was a “receptacle personality” in Baltimore, Maryland.  I was serving our fine country in the US Army Medical Corps as psychiatrist to the 82nd Airborne Division in Ft. Bragg. NC

There was some sort of a training group there that all of the other active duty psychiatrists seemed to have attended.  The Army – in its wisdom – had decided to take me – a trained neurosurgeon – and make me a psychiatrist.

Our country needed me (in this position, at least) and I obeyed, like a good soldier. Read more on Meet Dr. Receptacle…

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There’s a joke about a woman whose blood pressure was 180/90.  She didn’t think she had reason to be concerned.  After all, she argued, 180/90 is the mathematical equivalent of 2/1 and that doesn’t seem so high, does it?

I once treated a young man of color, obese and sad looking, whose numbers were close to this – 170/100.  And I was not laughing.

This young man was schizophrenic for sure, but pretty harmless.  Life had beaten him down enough that his jail experiences — assault, as directed by disembodied “voices” — had him so frightened that he would never do anything the voices said. Not now, not ever, and I believed him.

As a psychiatric physician, I always managed to get “vital signs” on all patients.  That should not have been a battle, but it was. I did not understand nor relate to the medical assistants who took them.  Why?  18 months training after high school and they had not been nice to me — not at all — criticizing my lunch and the fact they did not think I worked hard enough.Exploding Heart Bursting From Chest

I was concerned when I saw a blood pressure of 170/100.  Patient said he had been on some kind of medicine.  The best I could get with one of my “naming medicines and seeing what it sounded like” was hydrochlorothiazide — maybe. And of course the relevant parts of the chart were missing, as was the case more than actually finding anything.

He said he had stopped his medications a couple of days before because they gave

Read more on High Blood Pressure Medication…

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Have you been told that you have high cholesterol?  Or at least that you have to watch what you eat so you don’t get high cholesterol?

Of course you have!  This is like a mantra – every health care professional and the writers who cover healthcare join in the party line.  Everywhere you turn, it seems like everybody is on the “low-cholesterol” bandwagon.

Everybody?  Hmm … (looking around)  Well, there are exceptions.

Pardon me while I clear my throat and say in a loud, confident voice (and – might I add – a well-informed, scientifically and medically educated voice) – Bunk. Read more on ‘Tis The Season For Bad Dietary Advice…

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I get blazing mad whenever one of those knee-jerk “patriots” cry, “You don’t support our troops!” if anyone should criticize the military, our government’s foreign policy or any specific wars, invasions or other actions we’ve taken in this brave new millennium.

I was in the peacetime United States Army. Since my honorable discharge, I’ve served several Veteran’s Administration medical facilities in several states, and in private practice, I’ve made a special study of the treatment of Post Traumatic Stress Disorder – which the military routinely denies even exists and doesn’t even try to treat in many VA facilities.

Yes, I was in the Army, and No – I wasn’t in combat. Nevertheless, with the idea of war always hanging over my shoulder, my life was different. I never really understood the “grunts” — the infantry without appreciable rank — who wanted nothing more than to see “action.” Read more on Can’t We All Just Get Along?…

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He had tried to hang himself, and had managed to break some veins, maybe fracture a little cartilage, by the time his wife discovered him. It had been touch and go, I suppose, and a long time in the intensive care unit, but he had truly cheated death.

This 55-year old highly-credentialed university professor didn’t look the part of a depraved rapist — little or no hair, red-faced, bashful, perhaps — but that very accusation caused him such despair that he tried to take his own life.

A student had accused him of this horrible “impropriety.“

Obviously, these charges of sexual misconduct shamed him severely.  He maintained that the charge had been trumped up.  The woman who had accused him had indeed some kind of a psychiatric history.

It is not uncommon for women to make this sort of accusation.

A False Accusation May Be The Result Of A Broken HeartHe told me he did not want to hate women.  He also told me that he had a female judge.

I cannot help but think of the E.M. Forster novel “A Passage to India” which draws as accurate a psychological picture as anyone could of the sort of young woman who could make such an accusation.

Strangely enough, I could find essentially nothing about this as part of the psychological literature.  I did find a lawyer who had started a blog online, and said that this was a very large and essentially ignored problem. Read more on False Rape Accusations — Who’s The Victim?…

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He was pleasant, in his fifties, graying at the temples, articulate,and pretty much burned out on the symptoms of an alleged schizo-affective disorder. Like many of the people I treat he had been involved with the Hollywood entertainment establishment years previously. Now he lived in a residence suitable for his situation, and told me there was nobody he could talk to; he hated it. He even produced a lovingly-constructed list of names of people who had been important to him in the past. He did not know where they were, had no intention of finding them, so it served no ostensible purpose, except maybe to help him live in the past, because he had no interest in his dull and frustrating present. He said he simply could not relate to anyone in the residence where he was. They had no words, in many cases were illiterate, and were of no interest to him because they would not converse. He said he was depressed, but it was clear this was not the kind of depression you medicate.

I called for his case manager, who told me he had been offered another placement where it was expected there would be more conversation;  not once, but twice. He had declined. The complaints I heard from him had been going on for years. I asked him what was going on. He told me, again quite articulate.

“I can’t decide. I’m like someone who stays in a marriage, even if they don’t love the other person. They just can’t change. I have tried, and I don’t think I can. Maybe people like you should leave me alone and stop trying to help me. I don’t think even a smart lady like you can do a good job of treating somebody who can’t make decisions.” Read more on Decisions, Decisions!…

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