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…


The first person I remember who approached me telling me clearly and articulately that uncertainty was his problem was Dr. W.

Not that he was (or ever could have been) a medical doctor.  He was an engineer who had been laid off for being somehow “supernumerary” from Boeing Aircraft in Wichita, Kansas.

Very stable, very “establishment, a former president of the synagogue (where we had met) the late Dr. Larry Weller was the kind of guy who wore a necktie around the house, just because he was more comfortable that way.  His wife was a sharp-as-a-tack social worker.  He was continually thankful for this, as his two adult children were living and working elsewhere and the two of them could keep their home and live fairly well (with the occasional flight to New York to visit relatives) on her salary. Read more on Uncertainty Is A Tough Mistress…

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In 1932, my paternal Grandmother-Of-Blessed-Memory bought the house where my father and aunt – and eventually my brother and I — grew up.  Until her passing while I was in medical school, she was the undisputed queen of the castle.

As a stereo-typical Jewish Mother, she was in constant competition with my mother in the kitchen.  My mother always tried to act pleasantly, but between her father driving in from two hours to the west and arriving at 6 am on Sundays to tell her she was too fat, and my father’s mother besting her in the kitchen, she was generally miserable and had little ability to hide her misery from me.

My father did not show my mother any affection where I could see. Read more on The Power Of Silence…

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I have heard just a little too much about suicide among the religious — from patients, from others, now this; to the son of a published pastor who gave an invocation for the Obama folks.

I really do feel for the family, for death of the younger generation before the older one by any means including suicide by his own hand, is a horrible thing that is anti-nature and has a profound wrongness, a too-deep effect on all involved.

I was way back in residency when I attempted to gather some statistics on the association between religion and psychiatry in Kansas, sending a basic questionnaire on feelings about mental illness (and referral patterns to mental health professionals) to a big list of Wichita area “religious professionals.”
First, I had already made the assumption from the French part of my education that not too many people actually went to church, but none of them seemed to much care about mental health professionals.

In Kansas, with the world’s worst statistics (no major support on this from my

Read more on Religion — And Suicide…

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I was looking at Paul Fink’s column in the April 2010 Clinical Psychiatry News, one of those newspaper format “journals” that we like to call “throwaway journals” because subscriptions are free and they summarize other journals, as they usually end up in the trash. He writes for other psychiatrists.  It is possible to identify with him if you do this for a living and are sentient enough to know what is going on around you.

I always liked this guy.  Older people have a lot to say when they have practiced long enough to see trends go up and down and know their fate.

If I remember correctly, he is the one who said a while ago something to the effect that psychiatry is like prostitution in that the amateurs think they know as much as the professionals.  Nobody has better nailed the central difficulty of this job. Read more on Purpose and Aging…

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The above study was also reported in the Clinical Psychiatry News in March.  It had no funding, just an enterprising fellow in forensic psychiatry.  And her apparent mentor was Glen Gabbard, some of whose work I read when he was at Menninger.  One of the guys who is old enough that he has seen things.

I give them points on reminding the world of something it seems to have forgotten. There are people who qualify as doctors, who are taking care of patients, and who are trouble. The problems in the group studied, people who have “professionalism issues,” range from sexual boundary issues to gross incompetence and cover specialties that are not necessarily psychiatry.  The physicians studied are mostly Caucasian males, which comes as no surprise to me.

The physicians studied mostly have psychiatric diagnoses. Things that sound like any fairly competent psychiatrist could have diagnosed them. There was some kind of “rehabilitation” involved when they were in training, for the most part, so they went on and acted rotten anyway. Read more on There Are A Lot Of Good Doctors Out There, But ……

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She was beautiful. Early forties, slender, blond hair with a few streaks of gray. She could not stop crying and could not think of any way out of her predicament. Several had been suggested. The one she kept thinking about, however, was suicide. She thought it was the only one, and I believe it never is. This woman literally could not look at an electric cord without thinking how to choke herself with it. She could not look at a plastic bag without thinking how to asphyxiate herself with it.

Patty Hearst/SLA

Patty Hearst/SLA

As far as I am concerned, this is a biological problem. It has something to do with low serotonin in the central nervous system. I remember years ago, reading about a study done in Detroit, comparing the serotonin in the cerebrospinal fluid (the fluid around the brain and spinal cord) in people who had been gunshot victims with levels of the same chemical in people who had shot themselves. Those who had shot themselves had less.

People are still working hard to track the brain chemistry of suicide. Read more on A Victim Of Stockholm Syndrome…

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