Psychiatrists

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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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Most people who know me well know that I was (briefly) a professional comic.

Long before I became a psychiatrist, I wanted to be funny.  I copied TV comics as best I could and quickly learned that when you were funny, people seemed a bit more likely to enjoy your company. Read more on Cut The Funny Business — You’re A Doctor!…

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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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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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I’m on my way to shoot a video with my dear friend Christelle Tachon that will end up on my new podcast site.  This is actually the second time I will have filmed with Christelle, and the first episode with her is nearly completed in the editing process.

Read more on New Podcast Is Available — Mona Jones, Part 2…

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The first psychiatric office I rented had two mildly to moderately comfortable chairs in the center, facing in the same direction. We all know that psychiatry started with the patient lying on a couch, staring at the ceiling, and remains that way in “New Yorker” cartoons.  Those of us in the know, we know that Freud was actually a pretty shy guy, not liking to stare his patients in the face, but rather letting their subconsciouses roam freely while staring at the ceiling.

We also know that the subconscious is a scary entity, full of (imagined) murder and rape and pillaging and such. The ideal when I trained was to sit face-to-face across a desk from the patient.  Nobody I know actually did that.  The reality slipped into 90 to 120-degree angles, exactly like what the classical psychiatrist Harry Stack Sullivan recommended. Read more on High Tech-High Touch Psychiatry…

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By now I think folks on the business management level of health care are at least aware that we Americans spend a lot of money on health care and seem to get very little in return. The author of a provocative piece in Forbes thinks “unnecessary health care” is our worst problem. This statement hit me broadside.  This does seem pretty true for the example she chose, even though it is decidedly outside of my field.

As far as I can figure, this sort of planned emergency delivery she talks about brings nothing to obstetric science or to the quality of human life whatsoever. Around the net, I see estimates of how much of what we do is actually science.  It usually comes out as about 50 or 60%; maybe a little over half. This is happening as part of what seems to be a massive drive towards EBM, known as “Evidence Based Medicine.”

Read more on Too Much Unnecessary Care…

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Too many Americans can’t afford to and simply do not–take their medicines as prescribed. That estimate is based on information from the (American!) Centers for Disease Control). I have had patients come into my office who take their medications –in both cases, for life-threatening infectious diseases — only every other day, simply because that is all they can afford. I explained to each one individually the idea of the half-life of a drug. They only stay in your body for a certain length of time, then they leave your body in waste products.  That is why taking a drug every other day is not really effective. They both gave me almost exactly the same response — It was all they could afford, and it was probably better than nothing. Read more on Big Pharma Is Capitalism Out Of Control…

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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…