I always start a session with a patient by asking what is going on with them. I expect something about how he or she feels that moment, sitting in my office. I almost never get that. In a typical work day, a simple “Hello, how are you doing?” has been met with such things as:
“I don’t think I am ever going to get better.”
“I still can’t get over what my mother has been doing.”
“I am going to end up on the streets.”
These statements are filled with emotional intensity concerning the past and/or future. Worries about the future. Obsessions about the past. The fastest, easiest, and most effective ways to deal with this kind of emotion are to focus on the moment that you are living in. Then, it suddenly becomes possible to process logically in your head what is going on. So people who claim they are happy or relieved to see me are actually very distressed when they do not have to be.
The notion of living in the “here and now” is a very powerful notion that can help even “normal” people to get through life with considerably less distress. A complete “living in the here and now” is impossible by definition. After all, we are who we are because of our pasts. If we do not take control of the planning for our future, we are doomed to be controlled by forces outside ourselves. Good, if we are lucky enough to focus on the positive stuff. Bad, if the negative thoughts and agendas around us take charge of things. Read more on How To Get To The Here-And-Now…
Filed under Stress Relief by on Apr 5th, 2010. Comment. 
He was an urban youth. I could not even determine his racial origin and I had to ask him (county regulations – tracking who it paid for – not my choice). It was mixed, and essentially indeterminate, a regular American melting-pot.
His head was shaved, so I could not make any guesses on the basis of hair type. There were facial tattoos, of the tribal sort, lots of triangles, but nothing as fiercely antisocial as some of the obscene drawings or sayings I had seen tattooed on prison inmates faces. Or in the case before me – ex-cons. And there was one of those little cylinders in his earlobe –the kind that men wear to stretch the open hole in their earlobes large enough to allow passage by a small sparrow. I believe the tradition is for tribal identity to prove something about achievement in the face of pain. It differs according to whom you ask, and this young man was not ripe for asking about that topic.
“I’m depressed. Real depressed.”
I wanted to know why. “I got kids. Seven of them, three different states. The seventh one was born three days ago. I was with the Mommy, and we were really happy because he looks just like me.”
Quite an achievement for someone only 22 years old. However, my congratulations did not bring him solace. “I guess you aren’t feeling too great about it, though, or else you wouldn’t be here, feeling depressed.”
At least he wasn’t suicidal. I could treat him as an outpatient. Read more on Male Postpartum Depression (Yes — MALE!)…
Filed under Family by on Apr 6th, 2010. 1 Comment.
She was 32 and she looked tired. She told me she had been abused in childhood. A general physician whom I trust and who does a good job had sent her to see me, thinking she could be a little more relaxed and doing better with pharmacology. We had not even talked about what kind. This young woman was not sleeping well. She made the interview easy as she already knew her diagnosis – post-traumatic stress disorder (PTSD).
She said the abuse had been both physical and sexual. She still had an occasional dream or daytime thought about it. She did her best to avoid the people who had done these horrible things to her. Also she was “high strung.” She confirmed that she tended to hyper-react to loud noises. “I jump ten feet in the air,” she said. So she had the three hallmarks of the diagnosis. I am a woman with little faith in colleagues, so I always confirm the diagnosis.
I noticed, to my horror that the only medication she was receiving was Klonopin, also known as clonazepam, a half mg. twice daily. Now she had been on nothing but this for many months. I have a lot of troubles with drugs of this class: they are addictive, abusable, and at higher doses, which many people take sometimes, they can cause shakes or even seizures with withdrawal. If she ever skipped a dose she would feel it. Besides, they are central nervous system depressants, so they can actually cause someone go get more depressed. Read more on Informed Consent Is Your Legal Right…
Filed under informed consent by on Apr 7th, 2010. 2 Comments.
The last time I saw my maternal grandfather, my Zadie, alive, he was mostly bedridden, in an institution for the aged in Springfield, Massachusetts.
He was 88 years old. He had long since retired from his profession of pawnbroking and about eight years before had been hauled in by the police since he was unable to locate the rented room where he desired to live alone, limiting his contact with his three daughters so that he could reassure himself he was not a burden. My mother worked frantically to convince him that she was indeed his daughter who lived in Boston. After a while, she finally elicited a smile from him.
“Boston. I have a daughter who lives there.” His inability to recognize my mother left her crying uncontrollably, despite my then meager (I think I had only recently become a doctor) attempts to explain to her what was then known about his brain disease, known as Alzheimer’s. Read more on Alzheimer’s Prevention Not As Important As Looking HOT!…
Filed under Alzheimer's Disease by on Apr 20th, 2010. Comment.
I am now far less involved with these folks. Not that I do not venerate them and respect their struggle. Rather, the condition of being a person requiring transgendering is so mainstream, that plenty of types of medical insurance pay for this.
Read more on Sex Changes Are Confusing Enough When You Have Accurate Information…
Filed under big pharma by on Apr 20th, 2010. Comment.
Sometimes people are shocked to find that I lead a relatively normal life. After all, I’m supposed to be some high-falutin’ muckety-muck know-it-all doctor – not your average American woman.
But believe it or not, I live the same mundane life as many others. I am married and have laundry and meal preparations and shopping just like most people. Although, I must admit, I have a husband who is more helpful than the ordinary married man when it comes to the mundane things in life.
Often when we are out shopping and doing errands, I let my husband run in to a store and take care of business while I sit in the car. Most of my time is spent in offices and I live in a natural wonderland of beauty – Southern California – that I get to enjoy all too seldom. It seems as if in the life I have chosen, moments of quiet and calm are too rare, and I like to daydream, and look at fresh ideas, and to observe my world.
Recently, while my husband made an appointment to take the car in for a minor repair, I waited in the vehicle and observed a small flock of crows. They were gathered on the sidewalk, under a tree.
I watched a crow who could walk only to the left. He did not appear to have a wing or leg injury. Apparently there was some kind of potential crow food on the ground. He was having no luck at all retrieving it. As the obviously impaired bird moved to the left, the food was unreachable on its right. Read more on Why Can’t People Be More Like Crows?…
Filed under Brain Damage by on Apr 23rd, 2010. Comment.
It was not the first time I had spoken with this attractive, fifty-ish woman. The first time this co-worker had come into my office at the clinic where we both worked “to say hello.” She occasionally stopped by to report to me one of her great successes with a patient. Often she would also tell me how wonderful I was. But this time, her pleasant visit ended with a real break-down, reducing this lady to teary exclamations about how horrible her job was. The tears and complaints spilled out so fast that she soon was complaining about how rotten her entire life was.
I knew this person was a cracker-jack therapist — one of the best I had known, ever. Until then, I didn’t know she was also miserable, with the worst and loneliest professional life I had heard of in a while — divorce and abandonment from men who sounded as if they had not been as resourceful and energetic and smart as she was.
It was a clear – and severe – case of professional burnout. Of course, that’s not a real psychiatric diagnosis. She may have needed something for depression or anxiety or both, but there was no way — none at all — I would ever consider thinking in those terms about a coworker, no matter how much I liked her. Read more on Burning Out On The Job…
Filed under Stress Relief by on Apr 28th, 2010. Comment.
I was in line at Wal-Mart, sandwiched between two women. One was behind me in line. The other was the cashier ringing up my purchases.
“She is the best checker here. You are lucky to get her before she leaves,” said the woman behind me in line.
“This is my last week!” shouted the radiant young girl checking me out. “I’m getting married and I’m moving out of here and I will never have to work at Wal-Mart again!”
A lot of people have told me about a lot of reasons to get married. I have got to admit that not having the imagination to figure out how to spend your life other than working at Wal-Mart — well, let’s just say it did not impress me as a particularly good reason. Read more on Marriage Is Not A Wise Escape Plan…
Filed under relationships by on Apr 28th, 2010. Comment.
I’m often asked for my opinion of and reaction to our new healthcare reform.
My immediate reaction is to correct the concept that this legislation has anything to do with healthcare. It is more properly insurance reform.
I stopped accepting insurance payments in 1996. In the intervening years, I’ve successfully operated a cash-only practice and in the past few years have been drawn into coaching other doctors in how to operate such a practice and consulting with people who are tired of insurance tyranny.
The term bandied about in the recent debates about healthcare reform is “access.”
The talking heads — both media and governmental — claimed a large number of people were uninsured. I recall numbers in the range of 40 million, and I’ve heard such numbers debunked.
Read more on Access Is A Null And Void Concept…
Filed under Healthcare reform by on Apr 29th, 2010. Comment.
She was beautiful. Early forties, slender, blond hair with a few streaks of gray. She could not stop crying and could not think of any way out of her predicament. Several had been suggested. The one she kept thinking about, however, was suicide. She thought it was the only one, and I believe it never is. This woman literally could not look at an electric cord without thinking how to choke herself with it. She could not look at a plastic bag without thinking how to asphyxiate herself with it.
As far as I am concerned, this is a biological problem. It has something to do with low serotonin in the central nervous system. I remember years ago, reading about a study done in Detroit, comparing the serotonin in the cerebrospinal fluid (the fluid around the brain and spinal cord) in people who had been gunshot victims with levels of the same chemical in people who had shot themselves. Those who had shot themselves had less.
People are still working hard to track the brain chemistry of suicide. Read more on A Victim Of Stockholm Syndrome…
Filed under abuse by on Apr 29th, 2010. Comment.