She was 22 and dirty, poorly dressed, having been dragged into my clinic office by a social aide. She knew her diagnosis.
“I got social anxiety disorder. I am social phobic. I don’t want to leave my apartment.” She was looking me straight in the eye, through her tangled blond hair with a purple streak. I think her clothes had been black, what the kids call “goth,” before they became soiled.
She didn’t do drugs; that was the good news. She did drink; her friends brought her that in exchange for; guess what. Yes, whatever charms she had, she certainly was not ashamed to exchange them for booze.
Read more on Social Phobia — Sometimes There IS A Happy Ending…
Filed under Psychotherapy by on Jan 6th, 2010. 1 Comment. 
I looked at her, better dressed than most of the folks at the clinic where she was seen, with an open mouth. I had to take a few extra minutes to figure out what I was going to say next. In case you have not guessed, that is pretty far from my usual state.
“I have a chemical imbalance,” she said. She looked a little like Sharon Osbourne, hip and trendy but expensively dressed. “He gave me some medicines that really helped, like Xanax and Ativan, and either of those would be just fine.”
I freely admit that psychiatric diagnosis and treatment have a long way to go to meet either the organic precision of the surgical specialties or the subjective enthusiasm of the non-prescribing mental health professionals, such as psychologists or psychotherapists. But there are practitioners out there who are either so indifferent or so pressured that they rattle off words without meaning and give prescriptions that hinder more than help.
Filed under Diagnosis by on Jan 12th, 2010. Comment.
All of this balderdash from opponents of so-called “Obamacare” health care reform about “Death Panels” that will come and put your grandparents to sleep like an injured Chihuahua makes me think about the patients I’ve had to counsel regarding end-of-life issues.
I have a wonderful patient who is still struggling, after many years, with her father. He is, like many men of his era who spent a fair amount of time in the military, the kind of guy who speaks little. He has outlived his wife, which is statistically unlikely, for she was very ill for a very long time. He is tired, just plain tired, of medical interventions. He had a hunk of colon taken out some years ago, and there was something somewhere between normal and cancer on it. Who knows when he tells his daughter. Her confusion is expressed to me through tears.
Filed under End Of Life by on Jan 14th, 2010. Comment.
When I heard shortly before Christmas that another Hollywood star died of suspected prescription drug interactions, I thought, “Here we go again…”
Brittany Murphy — young, beautiful and only 32 was the latest rider on the Fame-Drugs-Dysfunctional lifestyle carousel. A month later, still no official cause of death has been issued although rumors abound. The death certificate said “natural causes” and “cardiac arrest.” In the absence of congenital defects or some type of disease, cardiac arrest in a 32-year-old female is not natural. Read more on Brittany Murphy — Another Victim of Prescription Drug Abuse?…
Filed under Celebrities by on Jan 15th, 2010. 1 Comment.
Body mass index cutoff for college graduation? Give me a break.
It is idiotic to foster prejudice against the obese at an institution of higher learning when we know that people are discriminated against for jobs by their weight. To offer courses and help is good. To confound intellectual output with girth is just plain stupid.
Has anyone ever been refused a university degree because they failed to quit smoking? Has anyone ever been refused a degree for non-compliance with any kind of medical treatment? Obese people do not get the same quality of medical care as non-obese people. Yes, there are lifestyle changes that seem to be able to help. But there are also a large variety of putative interventions that may help, or theories. Obese people do not even get the right size of chairs or gowns when they get into a doctor’s office. Read more on A College Degree Based On Your Figure…
Filed under Prejudice by on Jan 19th, 2010. Comment.
Although I don’t hang around with a lot of psychiatrists, I certainly have met a lot. Some of the most famous and powerful had “subspecialties.” That means, they had pet theories which they had developed and written books about. They had simple ideas that they thought described the entirety of human behavior. They did a lecture circuit.
After their academic book had sold the requisite less-than-ten copies, mostly to their immediate families, they were sometimes able, by tying their findings to the popular and moneymaking arts, to write a “popular” equivalent of their learned meanderings.
One of the more successful was an older guy I knew back in New England, who had me visit a campus outside of that august “6-state area” regarding an opening that never materialized. He had a whiff of “Harvard” about him, so I have no doubt that if such an opening ever materialized, it was filled with a person of that same origin.
My job-seeking life was filled with similar experiences, which explains a little bit of how I became a “renegade” doctor.
This great thinker believed that everybody’s behavior everywhere was primarily motivated by shame. He took painstaking care to explain this using as an example the plot of “Les Miz“ on Broadway then. I think he may have even played some recordings in his lectures. (He actually sang me some of the airs from that same show in my interviews with him, and very badly.)
“Shame” is not a bad concept. I am certain that riding the coattails of the then popular “Les Miz” was a good move. I did not know then and will not now whether it was his own idea or that of a publicist. I think “Les Miz” is one of the great stories of all time and I have certainly heard of careers built on worse. But one of the few words I said during that depressing interview had something to do with my perceived greatness of Victor Hugo.
Filed under Psychotherapy by on Jan 22nd, 2010. Comment.
She was twitching. A sweet little girl only 23 years old with make-up and a hair-do that probably cost her more than one week’s worth of my salary.
I once saw a professional opera production of Donizetti’s “Daughter of the Regiment.” The leading lady — whose hair I remember because she was a redhead like me — had a less elaborate hairdo. But unlike the diva of the opera, this young lady twitched. My God, could this girl twitch.
The therapist at the agency who called for my assistance in this unusual case went out of her way to tell me that this girl was not a substance abuser. This adorable Dresden Doll of a woman did not abuse substances and she was twitching faster and faster as she and a social worker aide sat in my office. And she was getting more nervous. I always try to relax people and to make them feel at home, but this girl was a bundle of nerves.
The best news was that she had not seen another psychiatrist or even a general doctor. A “normal” medico would have zonked this little doll with drugs to keep her zombied-out – the standard treatment for nervousness in most health facilities. Ugggh!
Read more on Anorexia and Laxative Abuse — Potentially Deadly…
Filed under eating disorders by on Jan 22nd, 2010. Comment.
Last summer, there was a movie, called “Snakes on a Plane“ which I think my husband wanted to see. The “plot” (which obviously fell a little short of classic Shakespearean construction) has something to do with a witness transported on a plane and somebody tries to “whack” him with a bunch of snakes. I absolutely did not want to see it. (To my husband’s credit, we still have not. Yes, there are men who love their wives THAT much.) I don’t much like snakes. I tend to avoid them. I do not run screaming if I see a garter snake.
Incidentally, they say the film initially did quite well, probably because of a lot of internet hype. It went on to do less well than expected. I cannot help but wonder if that had something to do with the way a lot of people feel about snakes.
In college when I took comparative vertebrate zoology, they called it “herpetophobia,” which literally means fear of reptiles. The more correct term is “ophidiophobia,” more specifically meaning fear of snakes. Read more on Getting Rid of Phobias Without Drugs…
Filed under Psychotherapy by on Jan 25th, 2010. Comment.
After all the tragic news the past year or two about celebrities who have died after using a combination of legal prescription drugs, it’s enough to make someone wonder how you can avoid becoming a victim, yourself.
Today — with the internet — it is relatively easy to find out which drugs can be dangerous if mixed. And if you get your drugs from a pharmacist, you can accept the “counseling” offer and ask specifically about interactions.
I hate to say it, but asking your doctor may be a distant third place in finding out the right information.
I don’t claim to have invented the internet, and I doubt I could be considered a pioneer of the ‘net, but wherever I have traveled to help out clinics and institutions over the past ten years, I insisted that I needed internet access to practice medicine. At the time, I only needed access to one site. It was a database sponsored by a major drug company and it had drug-drug interactions. Now it charges a fee for access and the data isn’t as good. Read more on Take Steps To Avoid Drug Interactions…
Filed under prescription drugs by on Jan 29th, 2010. Comment.
While so-called “Universal Health Care” can have tremendous advantages in the primary care field, it is totally unable to deal with specialized care. A case in point — and an all-too-common case — is cancer treatment. Time is of the essence when dealing with cancer, as the chance of recovery and survival is best if it is caught and treated early.
This video is not an isolated case. A very dear friend of mine could tell you a very similar story about her thyroid cancer and the frustrations of the Canadian Public Health system — but without the happy ending.
Filed under Healthcare reform by on Jan 30th, 2010. Comment.