I find a lot of things I like in the New York Times. This article resonated with me as few others. First, there is the purpose of the human profiled.  Changing medicine into data science?  God save us all.

Sometimes I feel the best thing I do for a patient is to be human.  Just to have the pretension (a pretension which I do not take lightly) of being one human being in a room with another human being, trying to make them feel better.  This does more, I think, to make most of my patients “better” than all of the pills I have spent years studying about. All those years studying normative use of medications on large populations of humans.  And they work enough to please the powers that be.

Read more on Human Beings Are Not Computers…

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It does not matter what country they were from. The father got into the system when his 19 year old son went stark raving looney bonkers and started destroying the homestead. Luckily it was an apartment in an urban setting, or I don’t think anyone else would have known about it. There was one older child who had already flown the coop, one wife who had died because the strain of leaving the old country had been too much. I had a feeling she had also gotten raped or something, but that was father’s post-traumatic stress disorder if anything. I told him to come back for himself, but I never saw him again. He swore on a stack of bibles that his son did not use drugs.  He said nobody had ever explained to him what was wrong with his son. At least no way he could understand and explain back to me.

For an American the solution would have been a support group, like the Alliance for the Mentally Ill. They lived in a rural area, though, and I did not know if the local chapter had anybody who spoke his language.  There is no way the patient could have handled that – and probably not the father, either. Read more on You Can’t Pick And Choose Which Medicines You Want…

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She was 29 years old and so obese that she had to walk through the door to my office sideways.  She had put on most of the weight, she said, after she had
been date-raped.

She did not remember much about what happened.  She knew the guy who had been with her, and avoided him as best she could, although she still had thoughts of him, that intruded into either her nighttime dreams or her daytime thoughts.  And she had the characteristic “hyper-arousal.”  I have learned, the hard way, never to think of slamming the door or clapping my hands to test this one.  I only did that once or twice and always regretted it.  I just asked her if a sudden noise made her jump in the air, ever, and she nodded.  “How did you know?”  she asked. Read more on Roofies, Ruffies, or Mexican Valium: It Doesn’t Say “I Love You.”…


There was only one patient in the waiting room.  “Shalom, Dr. Goldstein,” was what I heard.  I answered in the only possible way. “Shalom.”  It means “peace” in Hebrew, and is a traditional greeting.

She was excited to have a doctor with a name like “Goldstein” who might actually be Jewish.  She was a Jew from the east coast who had landed in the semi-rural place where I found myself; no synagogue, no Jewish community, “only a couple of Messianics.”  These are Jews who consider themselves “completed” having “added” Christ on to their belief system.  I am not, and won’t be, one of them. This woman wanted a “Jewish word” so badly that she took my hand.  She also wanted at least three prescriptions, one of which would be for Xanax (alprazolam), the most addictive of the benzodiazepines.  She had run out several weeks ago.  No wonder she looked so nervous. I told her I used to be a cantorial soloist — someone filling the role of a cantor (which is a formal title of the temple choir leader, the singer of liturgical solos and who also leads the congregation in prayer).  So, yeah, I really was Jewish. Read more on Shalom In The Waiting Room…

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He was 19.  I saw that on his papers before I let him into the office. I knew it meant trouble.

Someone who was only 19 and was in the county mental health system had to be either big trouble or a big manipulator.  Working with adolescents is tough for me because I have to “set limits;” often yell and scream.  That is absolutely not my favorite way to be a psychiatrist, to read people the riot act.  But 19 year olds often need that.

The doctor is a catI sometimes have to be more of a surrogate mother than a psychiatrist.

He had been recently hospitalized for a “psychotic break.”  That is when someone who is alleged to be normal suddenly starts hearing voices and seeing things.  It’s not always mental illness — maybe some drugs on board, maybe some kind of stress.  At least I had the records from the hospitalization.

Yeah, drugs on board.  Some speed, some pot.  The “baby-momma” of his first child (God, was he proud) was no “fun” anymore.  She wanted things like child support — clearly not a “fun” request.

Now I have read some recent studies from other countries — this is not the kind of thing they do here — that when there is the risk of hereditary pathology you can feed a kid Omega-3 fish oil and maybe prevent this “psychotic break” —  or at least delay it. And yes — to me someone 18 or 19 years old is still a kid. Read more on You Can’t Help Me Unless You Are Like Me…

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People who have panic disorder go to doctors to take care of it.  I have had maybe hundreds of patients, more than I can count over my years of practice, who have come to me with this.  Most of them do well. Usually the panic disorder runs its course.

That is not to say that panic disorder is not terrifying.  Often people believe that their first panic attack is a heart attack.  Often they have come to me already addicted to benzodiazepines by emergency room physicians who (understandably) worry a lot more about the immediate comfort of the patient than about the long term situation. Here is the official government take on panic disorder. Yes, find a psychiatrist you can trust. Yes, they recommend family and support groups.  Good stuff, but free and easy to recommend. Yes, there is some exciting new research but as long as insurance companies and HMOs determine how people get treated, it is unlikely that research will be quickly translated into treatment.

Most people who go with the mainstream treatment do pretty well. Here is another description of mainstream treatment, a little more complete. Read more on A Real Doctor — Like House MD…