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No, mental health care is not what it used to be.  Especially inpatient units.

Even though this is a 2014 article, and British, it may articulate the losses more clearly than anything else I have read recently. Read more on …

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“I got low self-esteem.”

It is a surprisingly common initial complaint for new patients, especially younger ones.

If they make it to my office, folks often think a medication is going to fix this.  What the folks who complain about this are more likely to get, from me at least, is a response more like “Sorry, honey, if I had a pill for low self-esteem, I would have sold it out years ago.” Read more on …

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Primary care doctors as well as psychiatrists give out antidepressants more than other kinds of medicine.

At the time I started training in psychiatry, we memorized the antidepressant side effects for early chemical classes derived from antituberculosis drugs and became overjoyed when the SSRIs came out.  Actually something safe and effective and pretty “clean” of risks and side effects and interactions!  First Prozac, which was FDA approved a day I was getting off call and grabbing a few hours of shuteye to be awakened by the morning news proclaiming that the new “safe” antidepressant would be a “wonderful advancement for psychiatry.” Read more on …

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At least I finished reading this article without banging the screen.

Even though the amount of psychotherapy I have time to practice is abbreviated and minimal at best, I am glad I know what I do. Read more on …

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I had never heard of ECT (Electroconvulsive Therapy) until I was about 6 years old and my Bobie, my paternal grandmother of blessed memory, was folding laundry on the living room sofa.

“Your mother thinks you are stupid, ” she told me.  “Your mother actually still thinks that you don’t know that her mother, your other grandmother, is locked up in the crazy-house and that is why you never see her and never will.”

I don’t remember yelling or making any sound at all other than bounding up the stairs to my parents where my mother of blessed memory was folding another bunch of laundry on her own bed.

I told her my grandmother had told me this “stuff” and she hadn’t, and I was not stupid and needed to know exactly what was going on.

I barely got the words out of my mouth before my mother slumped on the bed and started crying like an endless fountain, like nothing I had ever seen and told me that it was true, and she just thought I was too young to understand, and she was going to tell later, when she thought I was ready.

I ran quickly into my room and pulled a book from the shelf on my desk and brought it back to her.  As I pointed out, I was reading “All about the Human Body” which told all about sex and the horrible things men and women had to do together to have a child.

They had signed something special that I was mature enough for this so I ought to be able to hear anything about someone who was sick, especially in my own family.

She brought a photo, 9 by 7 inches or so, of her mom in elegant 1930’s clothes.  She looked well-dressed and sophisticated enough, with curly short hair.

My Mother told me then and there that I couldn’t just hear about the sickness.  I had to hear about the woman.  Her name was Sylvia Gutensky Baver.  She has a gravestone in or near Springfield, Massachusetts.  She was a founder and lifelong fundraiser for the Jewish Home for the Aged of Springfield, Massachusetts.

She wanted more education than she had, always wanting to become a nurse or to work in a clinical laboratory or something like that, but my grandfather of blessed memory always said my grandmother was “just fine,” and since he, illustrious son of a blacksmith who owned a pawn shop, would give her everything she needed and she would be fine.

He had been very limiting with her.  She loved to write songs and stories.  He decided there was no question of her becoming published.

“She would have loved you a lot,” said my mother, “because you got to do all the things nobody ever would let her do.”

My mother told me that she sad sometimes happy, with her music and poems and would dance around the house, but became sullen and withdrawn when my grandfather became home.

It had been some kind of one of those old-fashioned Jewish “arranged marriages,” and it sounded to me as if it were some kind of a recipe for a complete disaster.

My mother could only nod.  She cried another flood.  “Yeah, I guess he pretty much drove her crazy.”

She died a couple months later.  My mother took a quick train trip to Springfield for the funeral.  She didn’t tell me why until after she returned.  She didn’t want to hang around with the rest of her family, who were pretty crazy.

I don’t believe her husband could go.  He was confined, by his profound Alzheimer’s disease, to the Jewish Home for the Aged of Springfield Massachusetts, that bore both a plaque to honor her foundership and a plaque as her memorial.

The irony was not lost on me, even then.

My mother told me briefly, only after her mother’s funeral, that my “Bobie Sylvia” had thoughts about killing herself when she got really depressed and saw it really as the only way to get away from my grandfather.

My grandmother’s treatment in Northampton State Hospital of Massachusetts had precious little actual treatment.  Her “work,” my mother said, was a large gray mat, she would knit and rip out and reknit so she “always had something to do.”  She had “some kind of medicine to knock her out,” and there was, of course, the Electric Shock Therapy or “ECT.”

I read enough to know it had evolved.

I didn’t have any kind of major trauma when a senior preceptor offered to “teach” me how to do this.  I did tell my mother, for I felt a little pride the granddaughter of the shockee was going to become a “shocker.”  I was told it paid better than pharmacology, as there was really not much anyone else could think of that could pass as a “procedure” for surgeon-magnitude building in psychiatry.

I think my mother of blessed memory was more traumatized than I when I told her.  Shouldn’t have told her.

Me, I believed (and in a way still do) that this paradox of life simply confirmed that knowledge could produce power.

Here is a little about the history of the procedure.

In my grandmother’s day, the major risk of the procedure was long bone fractures.  Anesthesia is wildly improved since then.

The person lies still and with one or another position or strength of electrode a “grand mal,” seizure, the kind that can make a body shake largely all over, is induced.  Not physically, for the body remains artificially paralyzed, but it is discretely recorded by a little EEG (electroencephalograph) meant to measure the same.

It is still used — and still works amazingly well — for something nobody seems to understand as well as they think they do.  Here is a modern discussion of the procedure from the Mayo Clinic.

Although depression, bipolar illness, and even psychosis can be treated with this, it is usually necessary to show resistance to pharmacology before getting insurance to pay for this.  Even more of a deterrent is patient mythology and fear.  I have not done this for many, many years, mainly because most patients run like crazy when you mention it.  I would not consider it “controversial,” but there are a few side effects and some folks still think it controversial.

As for the illness, my grandmother Sylvia Gutensky Baver was probably bipolar, as were both my parents and my brother, may all of their memories be blessed.

At one time, I kneeled before the Torah on the sacred Jewish altar, thanking God for having spared me from the effects this illness wrought on their lives.

I have used whatever it is I have got to fight this monster.

I think this is a really big piece of how I became the Renegade Doctor.

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There is more happening and more being done about psychiatry and the brain now than ever in the history of the world.  I like the idea of “consumer-run” organizations and I love the idea of this one:

Like most things I find on the internet, it is hard to describe how I got here.  Probably it has something to do with “keywords” and “searches.” Read more on …

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In 1973, Dr. Zimbardo, well-known psychologist from Stanford, but together the Stanford Prison Experiment.

He had heard about the brutality of prison guards in American prisons.  He seems to have wondered about whether the brutality of the guards came from their personalities, or from the social structure of the system. Read more on …

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“Ten” (10) is an easy number to remember.

I have no doubt, although many years have passed, that 10 grams per decileter was the laboratory value at which I had to prescribe a blood transfusion for everybody. Read more on Where Do They Get Those Numbers For Blood Tests?…

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Most people who know me well know that I was (briefly) a professional comic.

Long before I became a psychiatrist, I wanted to be funny.  I copied TV comics as best I could and quickly learned that when you were funny, people seemed a bit more likely to enjoy your company. Read more on Cut The Funny Business — You’re A Doctor!…

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She was a well-known and respected matron in Orange County who called at 10 PM with a “health concern” so I called her right back so I could sleep easier.

The problem was an easy one.  She had her first “abnormal” blood test and had been diagnosed with what those defeatist doctors call “prediabetes”  and started on metformin which is about the safest thing that exists to lower blood sugar.  I mean some blood sugar medicines and lower blood sugar so much that they make people nervous and shaky and worse.  But this one wouldn’t hurt her. Read more on Diabetes Is Not A Death Sentence…