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He was just 18. He had been followed by child psychiatry with a diagnosis of depression. He had long refused to take any pills.  As far as this poor, agricultural county was concerned, I was just seeing him so I could bill MediCal and fatten up the county coffers. The previous psychiatrists had simply noted he was depressed, was not suicidal, and refused any participation in his own treatment.

He was a young man of few words, with a common Hispanic name.  He sat there and twirled one of his lush curls. It became pretty obvious he wasn’t going to give me a complete history.  He said he would never take pills, not ever. To his credit, he did say I could talk to his mother, if I wanted to, but he had to be in the room and hear what she said. Someone brought her to me, from the waiting room.  She spoke only Spanish; fine with me. I learned my Spanish mostly from my patients, who in that time and place could rarely communicate well in either Spanish or English. His mother was charming, really grateful that I wanted to talk to her. She kept complimenting my clothes and elegance. I told her it was all thrift shop.  I doubt she believed me. Read more on Diagnosis From The Guts…

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She was an administrator at the rural branch of a county mental health system. A therapist by training.

On the classical scale in the hallowed paradigms of the twentieth century, a psychiatrist like me who had sacrificed (or in other cases, put on hold or marginalized) her biological destiny — well, a psychiatrist like me would have been the head of the team.  I would have sat at the head of the table with those who had not survived anywhere near as many years of authoritative education silencing each other to hear authoritative pronouncements. But she was the chief, not me. Read more on The Language and Culture of Psychiatry…

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