Diagnosis

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In 1987 I started my psychiatry residency. Since then, they have changed the Diagnostic and Statistic Manual three times and it still does not seem to be keeping up with how fast the world is changing around me.

I one saw lots of “lethargic” depressions. Slow and sleepy “ain’t got no energy” depressions. “I feel like a human blob” kind of depressions.

Now most of them turn out to be Type II (“adult onset”) sugar diabetes or the thyroid just stopped working for some creative reason. Read more on Then and Now…

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There is paranoia about the coronavirus. Patients come into my office for other reasons and we have often ended up talking about it.

There are a variety of classifications of paranoid thoughts in the latest (fifth) edition of the Diagnostic and Statistical Manual of psychiatry. Even though I have to hang a moniker from it on my work in order to get paid by any insurance for my services, there have been plenty of research articles published by responsible people tho show that it is pretty much useless. Read more on The State Of The Coronavirus…

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A fair amount of psychiatric illnesses have a genetic component.

Being formally “diagnosed” by a doctor does not make them official.

It is hard to tell when a woman says “my mother was probably depressed and anxious” what was going on. There may be a genetic component. Read more on Family Histories…

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My preceptor in Kansas taught me — while I was finishing my training and in my psychopharmacology fellowship — how to do “ECT”, which stands for “Electroconvulsive therapy.”

AKA: Electroshock therapy Read more on Yes They Can Still Force Electroshock Therapy…

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Sometimes a good psychosis or delusion, is less harmful than medication — especially in a person who has previously been compromised by illness.

The first I saw was a veteran many years ago. Curiously enough, he was the kind of “old salt” you see plenty in San Diego street clinics but I saw him back at the Wichita V.A.

Then as now I enjoy the older veterans, The kind of folks who, although they were members of a nameless hoard of uniformed youth, have assimilated the serviceman’s identity into their own. Read more on When A Doctor Decides Not To Treat The Hallucinations…

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Here is an article that is what researchers call a “meta-analysis.”

That means that plenty of people have done research on something. So somebody throws together the statistics from several articles, on similar things, to give them more “power.” To show that they are pointing at one strong inference of proof. Read more on Doctor’s Burn Out Like Rocket Ships…

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Psychiatry is an imperfect science at best. It is by no means a “pseudoscrience,” although it is frequently blamed for being same.

I have known LOTS of honest, decent people who have (I think, sincerely) seen psychiatric research as a difficult attempt to elucidate truth about the human animal. Read more on The “Crazies” are not very violent…

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His mother had been seeing me and they had signed mutual releases. Mother wanted me to see him as soon as possible, because he was “nervous and unable to sit still at all.”

When he came, he denied a “nervousness” which his mother thought looked like “attention deficit disorder.”

I can’t treat what people don’t think they have.

He described problems with his girlfriend and his mother, since his mother had told him he could not go to a party in the home of his girlfriend’s family on the bad side of town, “where they would just as soon shoot you in the street as say ‘hello.'”

He sounded like he had pretty routine mother-and-girlfriend problems.

She contacted me on the weekend, worrying about him frequenting strip clubs, something I had not asked about and he had not told me about. Sometimes, she said he became so angry she physically feared him.

Their two narratives were simply inconsistent. I drew the line at her feeling scared of him physically.

I told her about “tough love,” and I told her if that happened again, to call the cops.

My husband reminded me of the ultimate authority in my profession — Hugh Laurie as “Dr. House” — who repeatedly said on television in public for all the world to hear, “Patients lie.”

Which one of them? Maybe both of them. I told her what I had told them; and would indeed, tell anybody who gave me the opportunity. I can try a session with the two of them together and help to resolve things, but I could not promise that it would resolve things. I would try. I always try as hard as I can to do the best that I can.

She said she knew this to be true.

I had told him and also told his mother on the phone, that the hardest thing a young man (or a young woman) ever had to do in his (her) life was establishing themselves as an individual distinct from parents. This usually meant a period of confusion before resolution. There may be (and there was) some confusion about vocational direction, too.

One can only press forward. The ability to communicate openly is precious, and irreplaceable. 

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These intrepid Aussies blew me away with a thoroughly researched article that really tells it like it is.

Everybody is depressed and anxious. I have seen enough figures saying that mostly all — 60 to 70% — psych meds are given for anxiety and depression. Some say 1/5 to 1/4 of the American/World/choose your country population is growing in anxiety and depression.

Depression can be a pretty darn serious illness that can bring a person’s productivity to a screeching halt.

I have survived numerous theories as to what actually causes depression. Earlier in my training I heard about families in Iowa (where presumably nobody ever moves) where generations of antisocial personality-disordered males had depressed wives,

I think that was supposed to prove the genetic nature of depression, but I always figured, if I were married to an antisocial male I would be depressed too.

I have heard depression blamed on all manners of pollution and industrial waste. Pesticides? Manufacture of plastics?

Just when people start finding all sorts of aches and pains and bodily problems concurrent with depression. Just when I start sending A LOT of my depressed patients to my clever P.A. to beef up their immune systems.

My P.A., (Physicians’ Assistant) Dr. Craig Jace, is a doctor of oriental medicine, a naturopath and homeopath and acupuncturist and probably a lot of stuff I forgot.

I can’t do everything by myself — but with people like Dr. Jace helping me, we are making progress!

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After less than a week in second year medical school, I had survived the elimination contest exam, coming in 38th of the 650 examinees. Thus I earned my place in the amphitheater that held only 110 people, including the spare chairs wedged into the stairwell.

The cornerstone on the building — the original cornerstone — said clearly, “1568.” It was not a museum, but a living medical school building. I suppose some monks had practiced here in the building at the outset when medicines were mostly tinctures, maybe marijuana if they were lucky. 
In the ancient dissection room, were four slate tables for cadavers. They were not easy to obtain, for it was said very few wanted their bodies dissected after death. The slate tables had rivulets carefully carved into them. The floor around the tables had buckets to catch various bodily fluids.

During my dissection, the master who supervised pointed a finger at me and the three other students at our table. Tradition said that “Sylvius, of the “Sylvian Fissure” had dissected at that very table. Sylvius,” meaning “from the woods” in Latin is “DuBois.” a common name in French. This fissure, that separates the frontal and temporal lobes, is so named in all the language in which medical terminology is known to me. He is sometimes claimed by Germany and sometimes by Holland.

I have looked into it enough to know he had a couple of “teaching voyages” around Europe, and his dates of activity would have made his presence in my dissection room very possible, indeed. The first day I was in this amphitheater, my physiology professor, from an ancient French family which alleged lineage dating back to 18th century pre-revolutionary French nobility, sidled up to my table and rapped on it, as if to focus his attention on me — before starting his lecture. “Mademoiselle,” he said, “you should be ashamed of yourself. You have taken a seat in this class away from a deserving Frenchman, who could earn a salary and raise a family.” The amphitheater could not have been more silent since 1568. I heard my own voice tremble. “With all due respect, Monsieur, I am here according to the Napoleonic Code of 1802, which opened the Universities of France to people coming from all nations who are capable of speaking the French language, so that they return with French culture to their nations of origin. I am pleased to be so honored. Vive la France!”

Pretty much any time you say “Vive la France!” in am amphitheater of students it is fairly certain that the whole amphitheater will end up cheering and shouting “Vive la France,” which they did. My poor professor was silenced, and shook his head. Nobody else said anything derogatory about my origins to me for the remainder of my education.

Later that week was my first lecture in neuroanatomy. I had loved the brain and its mystery and majesty long before starting the study of medicine. In first year medicine we were focused primarily on learning the limbs, with the brain and the head, neck thorax, and abdomen saved for the second year. Strangely I cannot remember the professor’s name. He was ancient and had to be helped up to the master’s lectern, One of the students told me he had been teaching before World War II. He had an essential tremor — head and neck, and sometimes the whole of his body. His voice seemed feeble, even with the microphone of the lectern. He wore a vest and trousers beneath his white coat.

“Mesdames, Mesdemoiselles, Messieurs … To me, falls the responsibility of teaching you the brain. When I address you, I speak to your brain. Assiduously studied, for hundreds of years, we knew little about it before World War I. The brave “poilus,” the French soldiers who protected this great nation in WWI , gave their lives — and all too often, gave us their brains. From knowing what part of their brain was missing and what they were unable to do in their twilight of their young lives, we learned what part of the brain did what. From this, we have evolved into a people whose knowledge of the brain we share with the world.”

He stared at me, and I felt as if his eyes burned holes in my flesh. “This organ is so complex, I do not teach with the pathologists’ photographs or drawings, but with simple circles of colored chalk to show you their bunches and bundles in cross-section. Learn them well, for they were learned from people’s lives and memories.” The other students told me later, when I talked to them that they were suppressing giggles. Me, I was suppressing tears. I have heard many complaints about nearly everything about medical education. But I have never heard anybody tell me about a deeper contact with being part of the research and education tradition than I did at that moment.

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