May 2010 Archives


During residency training in psychiatry, when I was learning how to do psychotherapy, I learned that the lady at the front desk ran the clinic.  She did the “statistics.”

I thought she was hyper, but she told me she subsisted on coffee and crashed on the weekends.  She actually told me so much personal information, I suggested she become a patient at the resident clinic.  She said there was a rule against it.  I told her to go to another clinic, but she told me she could not get time off, something I never quite believed.  But she told me, also, that she understood what was going on with me.  This was news to me, except that I knew I was struggling to be a good psychotherapist.

The stories of everybody’s lives that they told me were so terrible I thought I might just go home and cry every night.  I did a little at first, but I got over it.  Then, she told me my “statistics.” It seemed that more of my patients came back for more visits than anyone else’s.  They liked me. Read more on You Don’t Have To Be A Jewish Mother To Have Empathy…

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His diagnosis was schizophrenia, but this man in his mid forties looked more sad than schizophrenic.  I asked his story. He hadn’t had any of the symptoms of schizophrenia for years; as a matter of fact, he was doing fine; no voices, no symptoms, working as a peer counselor.  But he was sad.

His white hair looked so distinguished; I would have guessed he was a businessman, not a schizophrenic.  But the downcast eyes, the slow shuffle of his walk, told me that sadness had taken over his daily life.  As for the white hair, he told me his hair had turned quickly, at the time of his loss; a story I had heard before.  To me, this was more empirical evidence of the Mind-Body connection — emotions affect bodily functions in a large number of ways. Sometimes we know more about the biochemistry than others, but everything I learn amazes me.

Like many with his diagnosis, he had struggled with relationships.  He thought he had won the game, for he found a woman about whom he cared greatly. Then, she died. Read more on Fighting Grief With Positive Activities…

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He was 35 and tall and thin, with beige hair and a rare grin he claimed only I could elicit.  He enjoyed seeing me. He always came with a knapsack, because he didn’t really trust the other people in the residence where he lived.  He probably had reason to feel that way, for things had been stolen from him before.  Things like medications.  He reported these things to the pharmacy involved.  Both they and I believed him.  After all, these things happen.  He had not abused anything known to us.  Besides, medications are frequently stolen.

The diagnosis was schizophrenia, that too-often debilitating disease that hits at least about 1% of the population and that is still generally considered manageable but incurable.  He was actually doing pretty well, living in a residence and “stable” after countless hospitalizations.  I asked him about his plans for the future.  He told me he had been attending information sessions about an interesting course at a local college.  Now I knew that local colleges, this one in particular, were famous for providing “practical” education.  I had even heard of a bachelor’s degree in auto body work. He told me he wanted to learn to make guns.  I tried not to appear nervous here, but I was impressed that he could read my emotions well enough to tell I was worried.

“Don’t worry, Dr. G.  I am not going to hurt anybody and I don’t want to kill myself.  You must worry a lot about that because you ask me every time.” Good — he was smart about that.  But what could happen if his medicines were stolen before I could replace them?  In his distant past, he had some real troubles with “false beliefs,” worrying that criminals were out to get him.  What if he believed that, and tried to shoot someone?  I could not ask him that, I knew he would tell me it would never happen – but I knew it could.  “I really like hunting animals.  Little ones, not bears or anything.  Squirrels, but that was a long time ago.  There are lots of squirrels and things like that around here.”  He went on.  He was exhibiting more insight and understanding than I had ever heard from him.

“I like the insides of the gun and how it works and I want to learn how to make them.  I did like the feeling of shooting a little animal, because it meant I was smarter than he was.”

Read more on Schizophrenics and Guns…

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“Just gimme the Prozac and let me outa here.”

In a clinic where most people were indigent and needed more than twenty clinics could give them (food, shelter, friends, job) this woman was well dressed and snappy.  She looked a little like some petite actress, maybe Holly Hunter, playing a businesswoman.  

In fact, she told me that she was a real estate broker and was not producing enough so that was the proof that she really needed her Prozac.  She had been on it for a while, in steadily increasing doses, and now was on 60 mg.  Over a couple of years, her dose had slowly been raised from the fairly standard 20mg.

It was a treatment for depression.  I had no way — except notes written by previous psychiatrists long-gone — to figure out how depressed she had been when she had actually started on Prozac. And the old notes weren’t much help. Read more on “Just gimme the Prozac!”…

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“Happy families are all alike; each unhappy family is unhappy in its own way.”

So begins the novel Anna Karenina. However, if Leo Tolstoy tagged along with me when I’m summoned to come rescue a clinic with troubles, he would doubtless come up with a similar observation about happy clinical staff and unhappy clinical staff.

In my role as a consultant – spending a relatively brief amount of time in a clinic to help it get on track and solve problems – I see troubled staff and administrators.  Unfortunately, I’m not called in to observe happy clinics and partake of celebrations of success.

Each clinic has its unique challenges and problems.  And although they ARE problems, it’s the unique part that intrigues me.  After all, the problems are severe enough that they are willing to pay me to come untangle the mess. Read more on Surviving In The Society of Women…

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He was over 60 years old when he walked into my office; a colorful relic of the sixties, with his multicolor T-shirt, love beads, turquoise earrings.  Like many people found in Southern California who are a little older than their “moment of fame” in the entertainment industry, he had frozen that moment.  I did not recognize his name, but someone who followed the music scene in the sixties may have known his group.
Many of the numbers for which he was known back then were associated with “getting high,” something he told me he had done infrequently then, for it impaired his ability to perform.  He certainly had not done it much since, for there had been some odd jobs (of which he spoke little, obviously not proud he had to do them) and some performances on some kind of a 60’s revival circuit, where he was revered for still being who he was.  There were some problems.

He did have obsessive compulsive disorder.  He had been on a variety of medications which one might expect to be helpful with that, but which had not.  In my experience this was not uncommon.  He was seeing a therapist who was trying to help him with this, but who was doing traditional “insight oriented” therapy.  Of course, this did not work. His worries were mainly about cleanliness and order; common ones.  I recommended the most recent edition of hte book I have been recommending for years, in its most recent edition. (Bantam Press) Despite my efforts to avoid making his therapist sound like an idiot, I sent him to some of the wonderful free self-help you can find on the internet. But wait, there’s more.  He said that he frequently heard, in his head certain lines or phrases of songs he had performed in the sixties. Not whole songs or even parts he liked.  Just opening lines, or one line or phrase, that would repeat an infinity of times.  He had tried to drown it out, all sorts of things, and yet he felt victim to it. It was frustrating and he did not know how to stop it.  This was not conventional obsessive compulsive disorder. Read more on Musical Hallucinosis — Too Much Of A Good Thing?…

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She was 38 and attractive, by any measure, but she was manic. Sleeping was a problem, despite some pretty high doses of prescription drugs.  She was open about her past; surprisingly.  She had been recently dismissed from her eleventh hospitalization.  She was 10 days out, and would have been living on the street if the county had not sprung for accommodations in a less than glamorous motel.  She had not a penny to her name.  She was in the area where I was only because she had once had some friends there.  Now all her friends were either gone or dead.

Her teeth were mostly missing.  I did not ask her to remove her ill-fitting wig, for I wanted her to keep whatever pride she had been able to preserve.Her face was worn, but her cheekbones proud and high.

She had not expected a female physician.  She said she always got tired old men with white beards.  She said I was too attractive to be a psychiatrist.  That I probably could have done well in her profession, had I dared too.  I thanked her for what I took as an amazing compliment; what else could I do? Read more on Victimless Prostitution? Think Psychiatric Victims…

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I never professed to understand French politics as more than an observer.  It was one part of the French civilization that seemed a bit overwhelming.  I remember being told there were over fifty political parties.  It seemed as if getting anything done required an amazing amount of compromise. I was impressed by the fact they had elections on Sundays.  How delightful to have an election day when nobody had to work, let alone request an excuse from the same.  No little “I voted” stickers. I remember thinking we never could have pulled off Sunday elections in the states.  Certainly not in the Boston area, where I grew up.  Home of blue laws, those strange laws that said things like you could not dance in certain places on Sunday, the day of the Lord, so people in bars in certain localities where such laws persisted would park their bottoms on bar stools and tap their feet in all manner of ways, so that no church could define such activities as dancing.

People told me I would have troubles in France because it was a “Catholic” country.  I do not think any trouble I can remember came from the few people who actually attended church regularly. But back to politics.  The parties were grouped into “left,” “right,” and “center.”  The left included the commies, whom I had to reassure that even though I was an American I did not hate them.  I found “rightists” fearing change as obsessively as any conservative (read “ultra-republican” American ever could. Read more on Psychology of Politics (and Politicians)…

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She was exactly my age, with a birthday only two days before mine. Same year.  I know that there are more people born under the sign of Aquarius than any other astrological sign, so I am no longer surprised at the number of people who have birthdays in February. (Especially since, if you count back nine months, you end up with June, which is when everyone’s thoughts turn to love and their thyroids and probably other glands are hyper-secreting.) But  this was one of those people who makes me think I look awfully good my age.  Probably a function of middle class privilege and doing more intellectual than physical work.

This woman had a son who cared about her.  The fact that she came to the clinic with him made her fairly special among those I was serving at the time.  He had been worried when she seemed too sleepy and too angry and not herself.

Like most patients, she really did not want to tell me much about the other doctors she saw or what medications they gave her.  I told her that I could check for interactions, and that her failure to tell me would increase her risk of having problems.  I know that a lot of people get “pain killers” and don’t think that they count for “real medicine.” Read more on The Shrink As Sherlock — Detecting Opioid Addiction…

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He was 28 and he was crying, He was not particularly suicidal, for he had tried his hand at that most final of activities and he had failed a couple of times. Didn’t take enough pills to do anything but sleep a little bit extra. I wanted at least to convince him not to think of this as a failure, but as a desire to live so great that he could not and ought not to try and fight it. I was maybe a little help, but not much. “I don’t think anybody can help me, nobody else has, and you probably won’t. Don’t worry. I’ll take the medicines because it is even worse without them. And I guess I’ll stay alive.” Great. Success, perhaps, but hardly an endorsement of my art.

I slowly realized what was going on. He seemed to forget what I had said almost as quickly as I was able to finish saying it. He had already asked me twice if I were really a doctor and a psychiatrist. I get that a lot, probably because of the bright colors I wear and my informal conversational style.

Slowly we got the part of the examination called the “mental status exam.” He did not know the date or the day of the week or even what city we were in. Apparently a “case manager,” one of those people who is assigned to work as an assistant to help low-functioning patients get to the clinic, had brought him in. He could only tell me that he had spent most of the past ten years in jail. As a matter of fact, he said jail was easier for him than the world outside. He said he always violated parole, because calendars were hard to read and he seemed to never show up on the right day.

When he finally had no parole left, and was done with jail, he scraped up all the marijuana he could find and called 911 to come arrest him, so he could get back to jail.

Read more on How To Lose Neurons Quickly…

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