suicide

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He had tried to hang himself, and had managed to break some veins, maybe fracture a little cartilage, by the time his wife discovered him. It had been touch and go, I suppose, and a long time in the intensive care unit, but he had truly cheated death.

This 55-year old highly-credentialed university professor didn’t look the part of a depraved rapist — little or no hair, red-faced, bashful, perhaps — but that very accusation caused him such despair that he tried to take his own life.

A student had accused him of this horrible “impropriety.“

Obviously, these charges of sexual misconduct shamed him severely.  He maintained that the charge had been trumped up.  The woman who had accused him had indeed some kind of a psychiatric history.

It is not uncommon for women to make this sort of accusation.

A False Accusation May Be The Result Of A Broken HeartHe told me he did not want to hate women.  He also told me that he had a female judge.

I cannot help but think of the E.M. Forster novel “A Passage to India” which draws as accurate a psychological picture as anyone could of the sort of young woman who could make such an accusation.

Strangely enough, I could find essentially nothing about this as part of the psychological literature.  I did find a lawyer who had started a blog online, and said that this was a very large and essentially ignored problem. Read more on False Rape Accusations — Who’s The Victim?…

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She was a young female staffer in her first professional position.  What she may have lacked in experience, she made up for with a lot of heart and she extended her maximum effort for every single patient.

Dr. Goldstein posing with brain model when she was a neurosurgeon

Dr. Goldstein as a young neurosurgeon.

I had been like that in the beginning, too.  At first, you have no body of knowledge to draw upon, but you quickly learn every time a new patient comes in.  With experience, you see it becomes clear patients are more alike than different, and the work is at least a little less onerous.

But our newbie had a very few months experience with this intense clinical situation.  So every single patient was new and scary, and she gave her all. One week before she had dealt with one of the most difficult situations.

Read more on The Operation Was A Success, But The Patient Died…

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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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He was 23 years old with a rich ethnic heritage and identity that he said gave him strength.  He looked like any one of hundreds, maybe thousands, of “youths” you could find on the streets.  A couple of tattoos. The kind I would see when I was driving with my husband and think sometimes “wow, it was so much easier in the days of Marlon Brando movies.” I would have preferred a handsome renegade in a leather jacket to this obese, angry, unkempt person who clearly did not want to talk to anybody, including me. He was not my patient.  A frustrated therapist asked me to see him because no medications had worked on him.  She had expected me to come up with a miracle drug we could get samples.

He told me the same thing, over and over again, that he was doomed, that nobody could help him, that I was a nice lady, nicer than most, but I was wasting my time just like the rest of them.

He heard voices, always angry and deprecating voices, telling him he was going to die, that he was no good and deserved to be killed.  Many times, in his life, he had attempted to prove the voices correct. Read more on The Devil’s Role In Mental Illness…

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As far as I know, every antidepressant has the same “black box” warning on its package insert, as reported by a reputable academic psychiatrist in a reputable journal a while ago.

Incidentally, he has, in this editorial type piece, effectively logged most of the “attacks” recently made upon psychotropics.  He advises the readers, presumably other psychiatrists or at least physicians of some sort, to do “nothing.”  This is the common way of academics, to wait and gather data.  It is not a common way of doctors, at least ethical or idealistic ones, who still scramble at any chance to save people.

black-box warning

For now let’s look at the warnings about antidepressants that have merited the special FDA attention. Except that it is in a “black box”  (has a black border like a funeral announcement) and there may be a couple of things added on relative to an individual brand, this is the disclaimer: WARNING: SUICIDALITY AND ANTIDEPRESSANT DRUGS Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of Major Depressive Disorder (MDD) and other psychiatric disorders.

Anyone considering the use of (Brand Name) or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Read more on Black Box Warnings — Read Carefully!…

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