Diagnosis

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It is hard for me to digest the events of July 14 in Nice, France, as I feel especially close to them.

I was present at seven such annual patriotic ceremonies during my tenure as a student of medicine in a French government facility.  I loved the street-fair atmosphere, where I sang at the top of my lungs and danced with a whole heart.

As a medical student in government service, a terrorist attack would have mobilized me into service of France, a nation I can only love, which gave me a medical education essentially free of charge, asking only for me to prove on an exam that I had what it takes.

I wear a tiny Eiffel Tower around my neck — I stroke it as I write. Read more on Terrorism In Nice…

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Every honest and complete psychiatric evaluation includes screening for delusions. A delusion is a strongly held belief that is totally without basis in the factual reality that we all use to live our daily lives. I have taken care of several people, institutionalized and not, who have had such beliefs.  Medications known as “antipsychotics” can be very effective on the hallucinations — the hearing voices and seeing things and such — that are the hallmark of a lack of mental “normalcy” as is generally expected and accepted in the community. The same medications may be less effective on these delusions, these beliefs.  Sometimes, in a particular kind of delusion, a kind that hits folks somewhere between 18 and 90 (average age 40) where there are no hallucinations, just beliefs.  They are less frequent.  They are also hard to treat, with antipsychotic medicines working maybe about half the time — in those who can actually be convinced to take them. Read more on Screening For Delusions…

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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…

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I grew up with the Reader’s Digest, although I do not think that was what my parents had in mind.

I was a very early reader. I had the activity pretty much nailed by the time I was three. I could even do phonetic “sounding out” of words, as well as the obsessional “dictionary searching” that I now do on line. I also had an obsessional interest in books intended for “bigs.”

The Reader’s Digest, to which my parents had some kind of a lifetime subscription or something, was consistently to be found on top of my mother’s bedside table — which had actually been her old “hope chest.”  I would “borrow” the current copy of the Reader’s Digest in the morning when they were still asleep, and generally return it before they would wake.

I will admit I had promised them to ask about anything I did not understand, but I have no memory of ever having to do so. Read more on Facial Diagnosis…

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This story found me in the headlines: Colts’ Jim Irsay discusses addiction.” I had never heard of and would not have been able to cite the name of the owner of the Baltimore Colts. I certainly am no fan of professional football.  I have reviewed recent problems in other posts. It seems to me that football — seemingly more than other sports — breaks brains, heads, bones and lives and may foster drug addiction to boot. Read more on Baltimore Colts Owner Jim Irsay – Too Rich To Need Help?…

Filed under Diagnosis, Sports, Substance Abuse by on . Comment#

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There are rich stories of human suffering all around us couched in terms of financial crisis – stories we encounter in our news media, in the streets and even in our own families.

Nevertheless things are getting worse all the time and I have been in the middle of the battle on the same losing side as the mental health patients.

I have been in the middle of mass human suffering which nobody seems to have the power to alleviate.  For many years, as the situation worsens, I have done what I could.  I have been on every front of the battle known to me and accessible to me – in community mental health centers, the VA, state prisons and private, for-profit, insurance-driven treatment centers. Read more on The Cost Of Not Caring…

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I don’t think we plan what our real specialties are going to be.

I frequently tell patients I am an expert on getting through menopause now that I have been able to come through my own relatively unscathed.

I became somewhat of an expert on Asperger’s because I diagnosed many elements of it in my father and just about all criteria in my brother.

They both carried additional diagnoses of bipolar (a.k.a. ‘manic-depressive’) illness.  Neither one was in any way typical.

Both surely had their problems in life.  My father was assisted considerably by his domineering mother who gave him lots — I mean lots — of direction.  She even helped him choose a wife — my mother — who took care of the things in life that were difficult or even impossible for him. Read more on From Sandy Hook to Santa Barbara — Asperger’s Syndrome And Violence…

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I am an expert on this — Anti-overweight discrimination.

First, from my practice.  I remember a woman in her forties I saw in Oklahoma for a routine antidepressant renewal who told me that she had a cardiac condition and had been to her primary physician (this is back in the prehistoric days when I took insurance) and he had told me it was her own fault she was overweight and she was risking her life by doing nothing about it.

She was not suicidal.  She told me she would never see that doctor again.  And she was not going to take any heart medicine. Read more on Anti-Obesity Discrimination and Obesity Treatment…

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Lady Gaga had to cancel some shows because she has Synovitis. Can you get that from wearing raw meat?  Just checkin’.  Actually, I know a little something about this. Synovitis, I mean.  Not the wearing meat part; I much prefer to eat mine.

Go back to me at 18.  Yes, I know it was a long time ago.  But there are some things you do not forget, like my first days in the emergency room at the ancient and venerated Massachusetts General Hospital.  It had been open since 1811.  I read the log; the first patient was a French sailor — ships could dock at the front door, then — with what was politely referred to as a “social disease.”  It was a work-study job assigned to me as an undergraduate, allegedly pre-med, at the sprawling Boston University. They laughed when I said I was going to be a doctor. I took people’s wallets from their pockets, looking for identification and insurance cards and I was good at that nefarious profession.  I loved the moments when it was quiet up front and I could sneak back to an operating or treatment room, stealing a generally useless tidbit of medical knowledge.  Such tidbits seemed so precious then. I remember sneaking back to the cast room when a handsome, muscled, orthopedic surgeon was casting a leg.  He was laughing at me, like everyone else.  He told me to ask him questions. The lady with fake blond hair, whom he was casting, was laughing, too.  “Go ahead, honey.  Ask him questions.” I asked him, I guess she hurt her knee.  “How do you know how high up and how low down to build the cast?”  Above and below the injury.  Knees were kind of a mess, but you always worried about the articulations above and below.  The orthopedist was not particularly articulate.  I started thinking that any idiot could be one, and medical school should not be that hard to get into. I thanked him and turned to leave when he hit me with something I have never forgotten.  “Casts are easy.  Broken bones are easy.  The tough stuff is soft tissue.  Nobody knows a damned thing about soft tissue injuries.  They act like they do, but they don’t.”  I repeated my thanks, and felt bad that I had to slip back to the front desk and the business of who people were and who paid for all this.  Read more on Lady Gaga’s Synovitis…

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The medicating of Americans for mental illness has continued to grow over the last decade.  And while that’s not exactly a news flash, I have seen no approach as fresh as the one taken by the folks at CrazyMeds”.

They are not doctors.  They are presumably patients or potential patients, then, just as some doctors are or should be.  Their approach is so fresh that I am amazed to notice the grain of truth in it.  This is the same way I felt when I visited the Psychiatry Kills” Museum in Los Angeles, operated by the Scientology folks.  They had a distorted view, but I saw where they were coming from. Read more on Psychotropic Drugs, According to their Users…