Psychiatrists

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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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I don’t like to give prescription sleeping pills.  They are a great source of disappointment to me.  It is hard to think any of the prescription stuff that is not habituating, requiring higher and higher doses to get the job done.

I have been worrying about patients taking them, literally, for years and years. I remember one of those studies that they release to the media.  It happened shortly after we moved to the San Diego area about 2004 when I heard on the radio that people who used prescription sleeping pills just did not live as long as people who did not. Read more on Sleeping Pills Are Not The Best Things For Sleep…

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We were sitting in a circle, like an AA meeting or something, but we were inside a recording studio talking about how to market music.  We were going around the circle, telling our names and what we had done in music. Me, I said I sang weird stuff (I do) but I was really a psychiatrist.  My main talent had been choosing to marry my husband, who discussed his serious musical accomplishments.

Read more on The World Needs More Of What You’ve Got…

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Back in the days before Noah’s flood, a psychiatrist would take care of both the medical and the psychotherapeutic needs of a patient. Of course, we all knew that it took “a different kind of doctor.”  In the old days they said it had to be a Jewish doctor who was afraid of the sight of blood. Of which I am not — I mean, I used to be a surgeon so I put that one to sleep.

Read more on You Are The Boss of Your Therapy Sessions…

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eThe kindest doctor you will ever meet.

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Back in the days before Noah’s flood, a psychiatrist would take care of both the medical and the psychotherapeutic needs of a patient. Of course, we all knew that it took “a different kind of doctor.”  In the old days they said it had to be a Jewish doctor who was afraid of the sight of blood. I am not.  I mean, I used to be a surgeon so I put that one to sleep.

Read more on You’re the Boss…

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It happened several years ago, when one of the immigrants of Mexican origin I frequently saw as a patient in the poorer counties of California came to see me and pulled a pen and a steno pad out of her purse.  My Spanish was a bit more rudimentary than it is now. She was matronly, with mostly grayed hair in the classic bun.  She asked me if I could spend a few extra minutes with her.  I told her I would take all the time I could, and try to serve her needs. It wasn’t her, she said.  It was her youngest daughter, aged 13.  Read more on Delayed Gratification And Life…

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People often want to know something about their psychiatrist.

There is this thing called “transference” where their past relationship history can certainly color what they think and feel. I have no big secrets to hide from my patients, so I can usually be direct and take only an insignificant amount of time on these issues. Usually it just takes one of my stabs at humor.

For those to whom religion is an important facet of life, I am often asked about my beliefs. I often end up saying things like, “I am very sorry I am Jewish and not the Christian you would have preferred, but do you think Christ could work through a crazy old Jewish lady like me who would work really hard to help you feel better?” A “yes” and a laugh and we get straight into the meat of things with that one. Read more on Liberal or Conservative — Different Brains or Different Opinions?…

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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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She was an administrator at the rural branch of a county mental health system. A therapist by training.

On the classical scale in the hallowed paradigms of the twentieth century, a psychiatrist like me who had sacrificed (or in other cases, put on hold or marginalized) her biological destiny — well, a psychiatrist like me would have been the head of the team.  I would have sat at the head of the table with those who had not survived anywhere near as many years of authoritative education silencing each other to hear authoritative pronouncements. But she was the chief, not me. Read more on The Language and Culture of Psychiatry…

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