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I recently had a patient who walked in to see me wearing a vintage Dior suit. I complimented her, of course, as I think that an ideal way to dress. She presented as powerful, and in control of her life.

She looked me straight in the eye, as if she were delivering me a deep and secret truth. Read more on Useless Phase For Today: “Chemical Imbalance”…

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Beneath the University hospital that was associated with the medical school I attended in Amiens, France there was a seemingly infinite maze of interlocking concrete passages that connected all of the different “pavilions” (“units”) of the hospitals. I remember how my feet echoed as I walked along those corridors.

They had been constructed during World War II, to bring the hospital safely underground in case of German Bombing.

One day I was walking in step with all the other surgeons, echoing together, with a regular beat. Read more on They Don’t Need To Understand — They Are Peasants!…

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When one is designated as an “adult” psychiatrist,” that basically means the person who walks into your office (or is wheeled in or staggers in) has the insurance for which you are approved and an age somewhere between 18 and infinity.

Those who are closer to 18 usually have as at least one of their complaints, “I guess I need to go to school or find a job or something.” Read more on What Do You Want To Do When You Grow Up?…

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At least I finished reading this article without banging the screen.

Even though the amount of psychotherapy I have time to practice is abbreviated and minimal at best, I am glad I know what I do. Read more on …

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I had never heard of ECT (Electroconvulsive Therapy) until I was about 6 years old and my Bobie, my paternal grandmother of blessed memory, was folding laundry on the living room sofa.

“Your mother thinks you are stupid, ” she told me.  “Your mother actually still thinks that you don’t know that her mother, your other grandmother, is locked up in the crazy-house and that is why you never see her and never will.”

I don’t remember yelling or making any sound at all other than bounding up the stairs to my parents where my mother of blessed memory was folding another bunch of laundry on her own bed.

I told her my grandmother had told me this “stuff” and she hadn’t, and I was not stupid and needed to know exactly what was going on.

I barely got the words out of my mouth before my mother slumped on the bed and started crying like an endless fountain, like nothing I had ever seen and told me that it was true, and she just thought I was too young to understand, and she was going to tell later, when she thought I was ready.

I ran quickly into my room and pulled a book from the shelf on my desk and brought it back to her.  As I pointed out, I was reading “All about the Human Body” which told all about sex and the horrible things men and women had to do together to have a child.

They had signed something special that I was mature enough for this so I ought to be able to hear anything about someone who was sick, especially in my own family.

She brought a photo, 9 by 7 inches or so, of her mom in elegant 1930’s clothes.  She looked well-dressed and sophisticated enough, with curly short hair.

My Mother told me then and there that I couldn’t just hear about the sickness.  I had to hear about the woman.  Her name was Sylvia Gutensky Baver.  She has a gravestone in or near Springfield, Massachusetts.  She was a founder and lifelong fundraiser for the Jewish Home for the Aged of Springfield, Massachusetts.

She wanted more education than she had, always wanting to become a nurse or to work in a clinical laboratory or something like that, but my grandfather of blessed memory always said my grandmother was “just fine,” and since he, illustrious son of a blacksmith who owned a pawn shop, would give her everything she needed and she would be fine.

He had been very limiting with her.  She loved to write songs and stories.  He decided there was no question of her becoming published.

“She would have loved you a lot,” said my mother, “because you got to do all the things nobody ever would let her do.”

My mother told me that she sad sometimes happy, with her music and poems and would dance around the house, but became sullen and withdrawn when my grandfather became home.

It had been some kind of one of those old-fashioned Jewish “arranged marriages,” and it sounded to me as if it were some kind of a recipe for a complete disaster.

My mother could only nod.  She cried another flood.  “Yeah, I guess he pretty much drove her crazy.”

She died a couple months later.  My mother took a quick train trip to Springfield for the funeral.  She didn’t tell me why until after she returned.  She didn’t want to hang around with the rest of her family, who were pretty crazy.

I don’t believe her husband could go.  He was confined, by his profound Alzheimer’s disease, to the Jewish Home for the Aged of Springfield Massachusetts, that bore both a plaque to honor her foundership and a plaque as her memorial.

The irony was not lost on me, even then.

My mother told me briefly, only after her mother’s funeral, that my “Bobie Sylvia” had thoughts about killing herself when she got really depressed and saw it really as the only way to get away from my grandfather.

My grandmother’s treatment in Northampton State Hospital of Massachusetts had precious little actual treatment.  Her “work,” my mother said, was a large gray mat, she would knit and rip out and reknit so she “always had something to do.”  She had “some kind of medicine to knock her out,” and there was, of course, the Electric Shock Therapy or “ECT.”

I read enough to know it had evolved.

I didn’t have any kind of major trauma when a senior preceptor offered to “teach” me how to do this.  I did tell my mother, for I felt a little pride the granddaughter of the shockee was going to become a “shocker.”  I was told it paid better than pharmacology, as there was really not much anyone else could think of that could pass as a “procedure” for surgeon-magnitude building in psychiatry.

I think my mother of blessed memory was more traumatized than I when I told her.  Shouldn’t have told her.

Me, I believed (and in a way still do) that this paradox of life simply confirmed that knowledge could produce power.

Here is a little about the history of the procedure.

In my grandmother’s day, the major risk of the procedure was long bone fractures.  Anesthesia is wildly improved since then.

The person lies still and with one or another position or strength of electrode a “grand mal,” seizure, the kind that can make a body shake largely all over, is induced.  Not physically, for the body remains artificially paralyzed, but it is discretely recorded by a little EEG (electroencephalograph) meant to measure the same.

It is still used — and still works amazingly well — for something nobody seems to understand as well as they think they do.  Here is a modern discussion of the procedure from the Mayo Clinic.

Although depression, bipolar illness, and even psychosis can be treated with this, it is usually necessary to show resistance to pharmacology before getting insurance to pay for this.  Even more of a deterrent is patient mythology and fear.  I have not done this for many, many years, mainly because most patients run like crazy when you mention it.  I would not consider it “controversial,” but there are a few side effects and some folks still think it controversial.

As for the illness, my grandmother Sylvia Gutensky Baver was probably bipolar, as were both my parents and my brother, may all of their memories be blessed.

At one time, I kneeled before the Torah on the sacred Jewish altar, thanking God for having spared me from the effects this illness wrought on their lives.

I have used whatever it is I have got to fight this monster.

I think this is a really big piece of how I became the Renegade Doctor.

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In 1973, Dr. Zimbardo, well-known psychologist from Stanford, but together the Stanford Prison Experiment.

He had heard about the brutality of prison guards in American prisons.  He seems to have wondered about whether the brutality of the guards came from their personalities, or from the social structure of the system. Read more on …

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Some say it is the biggest controversy in psychiatry; even the only controversy in psychiatry.

Me, I think it is rubbish, really.  Someone ought to cut to the heart of the matter.

Every single edition of the Diagnostic and Statistical Manual of Psychiatry (Current edition is  DSM-5) has been based on the description of behavior.  Clarified with counting of behaviors.  To assign one of the diagnostic codes necessary to receive a pension takes counting how often someone has a panic attack, how many nights a week someone has trouble sleeping — things like that. Read more on Damn The DSM!…

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You never heard of Ignaz Semmelweis?

There is a sentence about him in lots of medical books.

I first heard about him scrubbing in for surgery with the Chief of General Surgery at the Jewish Hospital of Cincinnati Ohio. Read more on Ignaz Semmelweis Saved Lives With Three Words…

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Sexual harassment has been making the news lately.  Dozens of powerful men in Hollywood (especially) and business and government are being accused of misconduct by vulnerable young women (and men in some cases).

Post Traumatic Stress Disorder can result from any trauma. Car accidents, animal attacks, a bad fall — not just sexual assault or war.

A high-school student doing a report for school recently wrote to me asking about PTSD.  I thought my answers might be of interest to others, so I’m sharing them with you. Read more on Student Questions About PTSD…

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Down with oversimplification. I have no interest in seeing life resolved to “yes” or “no” questions. This is what “mass media” seems to be doing. I hate, for example, people who agonize trying to decide if I am “conservative” or “liberal.”  If a patient tries to focus on this sort of thing (and it is amazing how often they do) it is not too tough to find out what they want me to be and to convince them that I’m exactly what they want me to be.  (It usually involves either telling them I am a veteran of the U.S.Army or telling them I went to undergraduate university in Boston.) Read more on It Is Not A “Yes” Or “No” Question…

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