It’s hard for many who know me to believe – and it is even hard for me to believe – but from a very early age, I loved the brain.
Looking at my professional path, one can see that everything I’ve done has been related to the brain (with a few side trips, of course). I tell most people now that my change from neurosurgery that ultimately landed me in psychopharmacology was a result of personal maturation. After all, I once believed that most medical problems had mechanical, or near mechanical solutions.
I once believed that a hematoma drained, using squishy squeegie apparatus, just like my mother of blessed memory would have used to baste the Thanksgiving turkey.
The truth of the matter is that I had become convinced slowly that a brain, once touched or handled, changed in immeasurable ways. My own dexterity seemed piteously inferior to the task of brain manipulation. It was not fear — at least I do not think it was. It was more a sort of reverence for the complexity of that which I struggled to lay my hands upon – literally to manipulate. Read more on Messing Around With The Brain Is Serious Business…
Sometimes, when I was taking care of patients at a community clinic – whether in Oklahoma or Kansas or Massachusetts or even California – I would get students or assistants of some sort. Nurses, nursing students, a physician assistant, physician assistant students, students from nearby colleges who are training to be medical assistants, or sometimes some kind of doctor extender I’d never heard of or didn’t understand would be assigned to me or rotate from a pool of available helpers.
Of course, I would always like them to actually get some knowledge from me. Sometimes that was the toughest thing for me to do. They needed to both pay attention and have a few functioning neurons. Although I usually figured out a way to quiz them a bit, they usually seemed, if I ended up running into them days or weeks later, to remember me as the one who was fun and told stories and paid attention to them.
Sometimes, they do remember certain things I would consider “rituals.” One of my best known rituals is “The standing O” – Literally rising from my desk, applauding and shouting “BRAVO!” if someone did something I considered exceptional. You know, like a standing ovation for an actor or musician. Read more on “Standing O” For Birth Control…
While traveling extensively over the past year or so, I always check out “drop-in” dance classes when I get to a new city.
Seriously. I can’t claim to be the next Eleanor Powell, but I have the basic steps down for real tap dancing. And yes – I have real tap shoes – a couple of different kinds.
But I had a real problem trying to get enough “sound” out of my taps. After all, one of the goals of this art is to make some noise! Otherwise it’s just “the old soft shoe.” I believe, without too much in the way of pretention, that I was able to get my feet in the right place at the right time. Other students, obviously younger, just seemed to have more slap in their tap.
Back when I left academics to start my private practice (this would have been around 1992), I filled in some vacant days at county mental health clinics until I could fill my private office schedule.
From the very first, I was exposed to mentally ill patients who lived in boarding homes. Some of them were reasonable – I wouldn’t say any were good – but some were tragic situations and the residents were basically trapped. They needed somebody to take care of them, and in many cases they were taken advantage of.
I just kind of tripped over this recent report of abuses in the board-and-care homes. The hard thing for me is that it is so easy to believe. I am glad the video was not released to the public because I am certain that it would be the most popular “viral video” on the internet.
The number of people in any world — mine in particular — who get off on physical cruelty is beyond mind-boggling. Since we are dealing with “care homes” I will avoid diving into what family members do to each other. In California, private homes can be licensed for “non-medical custodial care.” I have avoided setting foot in these facilities for a number of reasons, but let us say simply that the laws here permit the licensure of facilities as small as single family homes, with six guests or less living like a surrogate family, to bigger facilities that look for all the world like nursing homes. The tinier facilities account for 90% of the lot, or about 8100 facilities. Read more on Nursing Homes and Care Homes Should Not Be For Abuse…
He was in his mid-fifties and seemed pretty clueless. What’s more, he had more abnormal movements than any 20 people and looked like he was dancing with an invisible partner.
He sat at home all day trying to get himself involved in things like doing laundry and watching television so that he could get himself tired enough to sleep, focused enough to avoid the voices. He was safe — no forced hospitalization was necessary or even possible here. He promised that he would not harm himself no matter what the voices said, but it became clear that he lived in a world where devils and demons gave him a continuous commentary on everything from why Obamacare would never help him to — the size of his wife’s behind. There may have been some exhortations to harm self or others in the distant past, but they were indeed distant.
He said he had no medicine for the past ten years. I asked how he lived and he said his family was no help, but his woman was. He was married to someone else but this woman was the only person who knew his day-to-day life and she had brought him to the clinic, so I got a release signed and got her in there. I told her he said he had no medicines in say, the past ten years or so. She started laughing.
THE PLACE: Medical school, France
THE TIME: 1975
I have survived the “concours,” a competitive examination that I would compare to an intellectual equivalent of “American Gladiators” and through human dissection, the anatomical study of a human who previously walked the Earth.
Now our class is now going to start doing medicine with real, live people.
The excitement is great on our first day of an immense multispecialty class that will take the year, called “Semiologie.” The best English equivalent I can think of is “diagnostic signs.” We each receive notebooks and documents throughout the year that are signed off on by professorial-level clinical teachers who are doctors and have practices.
I have not been a chronic television watcher since early childhood, mainly because the projections on a two dimensional screen seem to be to be — at best — a weak distillation of the human drama that happens in my office.
But for my patients, I know well that the line between what they see on television and what they see in their living room is blurred at best.
I have, however, been compared to various TV shrinks — which I have been told is a compliment. The first person who told me I was like one, I asked why. When she said “because you always say the right thing.”
When you work with poor people, there will be at least one who earns his or her daily bread in the world’s oldest profession. Some of them may even admit it.
I have done lots of work in various county mental health clinics in various states and I developed a couple of hard and fast rules for when I work with economically disadvantage people.
I always try to “connect” with them. I have always loved the quote “I am human, so nothing that is human is foreign to me” by Publius Terentius Afer, better known as Terence. He was the Neil Simon of the ancient Roman empire, an author of comedies.
I have always imagined the modern embodiment of this quote to be the state of being stuck with a perfect stranger in an elevator. I want to believe that if I am not only a good psychiatrist but a good human being, I can generate a conversation with anybody. And the people who enter my office in some of these placements are poor folks whose experience of life on the planet is very, very far from my own.
Gail Sheehy, author of the groundbreaking book “Passages,” (and 15 subsequent spin-off books) is still using that way of looking at life to make a living. I certainly give her points for having figured out how to do that.
The reason is because one of the immutable laws they give you in marketing class is that it is essentially impossible to sell “prevention.” If you do not do “fill in the blank” something horrible will happen.
Something like illness.
When I thought I had diabetes (I don’t) and followed the directions I was given, I told my beloved husband — as well as my parents of blessed memory, who thought that since I was always thought of as a healthy and reliable one and couldn’t possibly be REALLY sick — that I would take good care of myself so that my old age would see me being strong. And comfortable. And of course, reliable to others.
That was when I really believed things that doctors told me., Especially the things that academic doctors told me. They were the people who had taught me, after all, be that in one country or another.