I was in my psychiatric training. My supervisor and clinic director had booked me to see a patient. I was often booked for some very difficult patients, because I am good at this sort of thing. But he warned me about this particular patient.
“She is not a patient we want to follow in this clinic. Just see if she needs medicines, and give her a little bit. The psychologist will do the work.”
I thought he had to be kidding, as I prided myself on being an all-around psychiatrist, and I wanted to take care of everything psychiatric. Especially while in training, under the malpractice coverage of the University, with their supervision.
“They say she has multiple personality disorder. We don’t believe in that diagnosis. We leave it, as much as we can, to the psychologists that do. This patient is a mess. Lots of commitments, lots of suicide attempts, lots of restraining orders. Let the psychologist do it. Stabilize her quickly on medication, and get her out of here, with monthly checkups, then bimonthly.
Read more on Multiple-Personalities — Rare, but they happen…
Filed under Dissociative Disorder by on Dec 1st, 2009. Comment. 
Someone who “has it all;” a beauty queen from Argentina, seems to have died in an effort to improve her buttocks. A life risked, and lost, for a “firmer behind.”
Our friends at Wikipedia (I never had a patient who went for one of these) call it a “Brazilian butt lift,” so I expect it is some kind of a South American “point of interest.” The procedure, however, seems to have little to do with what happened to the ex-beauty queen.
Read more on A Tragic Loss: Beauty Queen’s Plastic Surgery Is Fatal…
Filed under medical errors by on Dec 2nd, 2009. Comment.
Most of the times I am involved in “should-we-pull-the-plug” type decisions, it is at the end of life and not the beginning.
A “DNR” or “DO NOT RESUSCITATE” order simply means that if someone has a heart or lungs that cannot work on their own, the decision is made NOT to use artificial heart or lung type machines to prolong life. I have seen people sign their own documents to this effect.
As a matter of fact, I saw a DNR order signed by my father when he was in a nursing home, basically bed-bound, and it was a correct decision.
Filed under End Of Life by on Dec 3rd, 2009. 1 Comment.
She was a depressed woman in her 50’s, on conventional antidepressants, who I saw in a clinic. She had none of the “neurovegetative” signs of depression. That means, she slept well and ate well and her mood was acceptable. All of the things that we generally measure in antidepressant response were there, so there was really not a lot more for me to do, except to renew the prescription. I did ask a few questions.
Did she have a purpose in life? Yes, she had a job in a bookstore, which she enjoyed, and grown children, who had babies of their own, and she loved to play with them, but they lived a bit of a distance away, so she could not play with them as often as she liked.
So I asked her what was the most fun in her life. She started laughing wildly, and stamping her foot. I knew this had to be a good answer, and I was ready. I thought she was going to talk about drugs or sex. I was really surprised with what she came up with.
Read more on Happy Dances and the Contact High…
Filed under depression by on Dec 3rd, 2009. Comment.
I first heard the term “helicopter parent” on some news broadcast. I started my search, as I do with all new concepts, with Wikipedia. Despite or perhaps because of its imperfections, I have come to rely on Wikipedia as my first line on what people think and do.
These are the folks who originated the name tag, and sell the products that are supposed to help fix the problem.
Read more on “Helicopter Parenting”: The Ultimate Over-Protection…
Filed under Family by on Dec 14th, 2009. Comment.
Here is a letter signed by prominent Irish psychiatrists saying that there is no evidence whatsoever that antidepressants cause homicide.
The “PLOS” or “Public Library of Science” is supposed to be an easier and gentler place to get science published, although the esteemed (foreign) colleagues who have done research with me on natural substances have informed me it is not so easy a door to enter.
Nevertheless, here is a very scholarly angle. There is evidence that the prescription of antidepressants may engender aggression, violence, or homicide.
There is also an article cited by Dr. Peter Breggin in the Journal of Safety and Risk in medicine, to which I cannot seem to link anyone directly but a download is available through the wonderful people at this Irish foundation. These folks are trying to bring forth the truth and the light.
I am now of the opinion that the academic ideal I once pursued does not exist, and is, if it exists, a pack of lies at best.
There are FDA black box warnings about antidepressants promoting aggression, but I am unaware of such warnings having ever stopped a colleague from prescribing any antidepressant.
Read more on Seeking Truth In Drug Research — And Getting Frustrated!…
Filed under prescription drugs by on Dec 15th, 2009. Comment.
I have learned my lesson. I have now done this long enough to know that not everything comes out initially. It takes time.
I had thought that more intelligent celebrities would have learned that public relations is best left to the professional public relations agents, to the “spin doctors.”
I guess Tiger Woods did not learn this valuable lesson. We heard a lot of reports, generally conflicting, but often sounding as if an attempt were being made to make something serious sound a great deal less serious.
“Stonewalling never works…” reads the Baltimore Sun post-mortem on the number of mistresses who have come out of the woodwork.
A chronology and an attempt at a sort of “fact” list by the Toronto Globe and Mail is not without use.
Filed under Celebrities by on Dec 19th, 2009. Comment.
There are actually people in southern California who complain about the winter. You have to get your jacket out of storage. It gets dark too early, but luckily some people start their night lives earlier.
There are flus and there are coughs.
There is cough syrup.
When I was in grade school, the only cough syrup our kindly family practitioner could give was something with codeine. I was a sick little girl who seemed to be allergic to everything she touched, so I got a little of some kind of precious substance when the winter snows hit New England, and my respiratory system remained intact with that little bit of codeine.
Filed under Substance Abuse by on Dec 21st, 2009. Comment.
“I’m heterosexual and proud of it. Do you need a reference from my husband?”
Such was my response to a drop-dead-gorgeous male transvestite who sidled up to me once, at one of the unusual affairs my husband and I were accustomed to attending at the time, and wanted to know if I had been born male.
Oh, there were a couple like me, she said, and even if I were a lesbian, it would be so wonderful to have someone like me, a “professional” woman, for a friend.
Oh, there were a few like me, she said, who did not care as much as they ought about appearance, and she wanted desperately to have an opportunity to make me up a bit, and maybe even lend me some clothes.
I declined, as politely as I could. I actually gave her a card, told her we could have lunch, if she wanted. She (I had learned to call people by their publically identified sex) told me she had run out of cards. I told her to just call, and I would be available for lunch, and I was certainly open for friendship.
Filed under Gender Identity Disorder by on Dec 22nd, 2009. Comment.
Query: Why won’t Santa’s elves work now that Santa has lowered wages and they have hastened the assembly line and there are no cookie breaks?
Answer: They all have low elf-esteem.
No I don’t know the origin of the above joke. I don’t even know about low elf-esteem, as Santa must be referring his (psychologically) non-functional elves to someone that takes his insurance.
I do know that the knowledge of “low self-esteem” as a problem has entered the language and the culture with an enthusiasm and vengeance reserved only for high-frequency psychobabble which has been divorced so completely from its academically-derived meaning that it was possible for me not long ago, when walking dangerously close to a Starbucks, to overhear two people saying it was the cause of their woes.
Our friends at Wikipedia define it as a term used by psychologists, an enduring aspect of personality encompassing beliefs, emotions and behavior.
Read more on Low Self-Esteem — Not Worth Much As A Diagnosis…
Filed under Personality Disorders by on Dec 23rd, 2009. Comment.