“I don’t like other women. They gossip. I hate gossip. I think they should all go pound sand.” No, it is not a patient who said this. It was my (Great-) aunt Etta, who wore her hair like “Bride of Frankenstein.” She had been militant about her disdain for “gossip,” and certainly wore a bitter expression on her face most of the time. But she would not tell the little girl I was then any more of her story.
I had a really depressed patient. She had just had one leg amputated below the knee because of advanced diabetes. Of course, I prescribed some antidepressants, and made sure the medical stuff (medical causes of diabetes) had been eliminated. I asked her why she couldn’t dance. “I can’t walk and you want me to dance?” she asked, as if holding back tears.
He was just 18. He had been followed by child psychiatry with a diagnosis of depression. He had long refused to take any pills. As far as this poor, agricultural county was concerned, I was just seeing him so I could bill MediCal and fatten up the county coffers. The previous psychiatrists had simply noted he was depressed, was not suicidal, and refused any participation in his own treatment.
He was a young man of few words, with a common Hispanic name. He sat there and twirled one of his lush curls. It became pretty obvious he wasn’t going to give me a complete history. He said he would never take pills, not ever. To his credit, he did say I could talk to his mother, if I wanted to, but he had to be in the room and hear what she said. Someone brought her to me, from the waiting room. She spoke only Spanish; fine with me. I learned my Spanish mostly from my patients, who in that time and place could rarely communicate well in either Spanish or English. His mother was charming, really grateful that I wanted to talk to her. She kept complimenting my clothes and elegance. I told her it was all thrift shop. I doubt she believed me. Read more on Diagnosis From The Guts…
My telephone was cradled between my left ear and my shoulder, as I pounded the keyboard of the sluggish rural county computer with one of the requisite patient visit fill-in-the-blanks atrocities — er, I mean “reports.” Finally, I heard the person I was waiting for pick up the other end.
“Hello,” I said. “Is this doctor A…….(name unpronounceable to native speakers of English)?”
-“Yes,” he answered, “I am the only doctor here.”
“This is Doctor Goldstein. I am one of the psychiatrists at the county mental health clinic.”
-“Really? And you call me?” Read more on The County Mental Health Clinic’s Referral…
It gets pretty evident pretty fast, to any psychiatrist who deals with the general public, that depression is daily bread. I mean, with current estimates at 19 million patients per year coming down with a depression — even with less than one half of them seeking treatment — it is a pretty sure bet that depressed people are common.
This in no way diminishes the anguish I have seen in patients having that disease. The anguish is real and dramatic.
I remember one of my earlier newspaper columns written for the Wichita Eagle-Beacon — the largest daily newspaper in Kansas — asking this simple question:
Why — when someone broke their leg — a salt-of-the-earth next-door neighbor would never fail to bake a pie. But when someone had a depression, nobody would bake anything.
The depressed person was basically treated like someone with a contagious disease. Read more on Why Some Get Depressed And Some Do Not…
The psychological ability to adjust to chronic medical illness is an area where there has been very little study. Lately, I find myself working mostly with this population of people. I’m noticing that some adjust very well and some do it very poorly. It depends on a lot of factors.
The situation is clearest when the illness we’re talking about is back or neck pain. Back pain, more than neck pain, has been clearly correlated to the presence of major depression. If a person walks into the office crying and says they’re having trouble controlling what’s going on, it’s a pretty sure bet we’re dealing with depression.
Most back pain patients aren’t prepared for the kinds of life adjustments they are required to make. Generally, many will need to switch from a job that has involved lifting or other physical work to a job that is more sedentary. Quite honestly, most back pain patients are in no way prepared to do this. Mostly, this is because anything that is sedentary is going to require a higher level of education. Most of the folks I’m seeing are not highly educated, so the back pain leads to incapacity. Read more on Adjusting to Medical Illness…
Prison populations continue to rise while rehabilitation efforts, if they even exist, continue to fail. We can do so much better. The Washington state prison system might just be onto something really, really good. Read more on Let’s Help Prisoners Contribute to the Greater Social Good…
Britney Spears doesn’t make the news much anymore. Her career is probably still going strong, but her wild ways and scrapes with the law are old news. The media has latched on to new starlets and scandals, and they will never run out.
However, I noticed recently a story about conservatorship of this once-superstar (perhaps now only a mega-star?), and wanted to take the occasion to talk about this very serious legal step of conservatorship.
Miss Spears’ father is her conservator, and he wants her boyfriend appointed as a co-conservator over her well-being, and this might be a sign that he’s getting ready to marry her. There is something very wrong with this picture.
People having conservatorship over other people should not be taken lightly. Read more on Brittany Spears, Conservatorship and the Abuse of Power…