He looked more like the romantic hero from the era of Lord Byron than a psychiatric patient – he wore his hair longer than today’s style and he obviously pumped iron. Indeed, I found out that working out was an important part of his life.
He was 28, and he had just been released from a two day stay at hospital and his medication was standard fare — Zoloft (sertraline) antidepressant.
I had no clue why he had to be seen by me on an emergency basis. It turned out he had been admitted to the hospital because he was uncomfortable about his roommate’s anger. He had been concerned he might get “attacked.” I had no way of telling whether the roommate had an actual history of this sort of behavior or if this was delusional. But the roommate was not the patient before me. “Just give me klonopin,” Lord Byron said. “Everybody else does.” Read more on Fixing The Problem Is Much Better Than Taking Addictive Drugs…
Filed under Addictions, Substance Abuse by on Oct 8th, 2010. 1 Comment. 
My husband and I were staying in one of these extended-stay hotels in a medium-large California town while I spent a few weeks getting the local clinic straightened out.
A large group had pretty much taken over the hotel for a wedding ceremony in the garden on Saturday. So Friday and Saturday nights there were some pretty wild looking revelers whom my dear husband had to dodge on the way to the ice machine.
A group on the second balcony; another one by the pool — laughing loudly, behaving erratically. Every age group represented, but it seemed they were all getting along together happily. Read more on The Wild Wedding Weekend…
Filed under Substance Abuse by on Sep 29th, 2010. Comment.
I’ve heard people say this about something that is a waste of money, “You might as well just flush your money down a toilet.”
That isn’t always the best way to dispose of something – even excess money.
Recently there was a major national “event” where people take back and dispose of drugs free of charge. It was supposed to have something to do with publicity. Since I am constantly trying to be the most up-to-date of anyone who prescribes psychotropic drugs, I have to conclude that the publicity is unlikely to have been extremely effective. My patients sometimes exchanges prescriptions with friends or family — or steal them — and when I tell people they are only intended for the person whose name is written on the label, they get angry at me. Read more on Disposing Of Old Prescriptions Is Tricky…
Filed under prescription drugs by on Sep 28th, 2010. Comment.
There was only one patient in the waiting room. “Shalom, Dr. Goldstein,” was what I heard. I answered in the only possible way. “Shalom.” It means “peace” in Hebrew, and is a traditional greeting.
She was excited to have a doctor with a name like “Goldstein” who might actually be Jewish. She was a Jew from the east coast who had landed in the semi-rural place where I found myself; no synagogue, no Jewish community, “only a couple of Messianics.” These are Jews who consider themselves “completed” having “added” Christ on to their belief system. I am not, and won’t be, one of them. This woman wanted a “Jewish word” so badly that she took my hand. She also wanted at least three prescriptions, one of which would be for Xanax (alprazolam), the most addictive of the benzodiazepines. She had run out several weeks ago. No wonder she looked so nervous. I told her I used to be a cantorial soloist — someone filling the role of a cantor (which is a formal title of the temple choir leader, the singer of liturgical solos and who also leads the congregation in prayer). So, yeah, I really was Jewish. Read more on Shalom In The Waiting Room…
Filed under Religion by on Sep 27th, 2010. Comment.
Rarely do I see a poll or study that lines up so perfectly with what patients tell me as this study showing that plenty of women have no interest in sex. Whatever creator you believe in, with a seemingly infinite sense of humor, has given males a sexual response that sometimes looks or sounds like little more than a simple spinal cord reflex.
Although I will admit that I am sometimes a bit surprised at what the cues are, there seems to often be something unlikely that provokes the pleasure response pretty directly. Two of the strangest – and yet most common – things men tell me that are “turn-ons” are seeing a woman’s fingers with deep red fingernail polish resting on her blue-jeans leg warmers; and watching a woman bend over to fix the sink (yes – fully clothed). Read more on Lack Of Female Desire? Throw A Pill At It!…
Filed under big pharma, prescription drugs by on Sep 23rd, 2010. Comment.
I actually worked in Palmdale, California, once upon a time. I remember my final day on the job, my husband took a photo of me leaving the front door of the county mental health clinic, looking thoroughly jubilant.
Why is this woman smiling? Let’s just say, “Relief.” In all of Los Angeles County it is the place where one can live cheapest. It is the farthest settlement from the metropolis. In fact it’s actually closer to Bakersfield, which is in the next county. Not quite rural, but one of the several patients who had left the congestion of downtown Los Angeles for Palmdale told me that at least you could breathe the air in Palmdale. It was also a place where exchanging sexual favors for rent in a trailer park was not uncommon. It was also a place where local TV pickings were slim enough that I was actually on television. Not as a physician, mind you, but singing the songs of Edith Piaf. In those days before “American Idol” they broadcast from the local karaoke bar on a weekly basis. The night I was there, the special guest star was the fellow who played harmonica on the hit record “Moon River” forty years earlier and had been a bit-part actor in movies such as “The Wild One” with Marlon Brando. He had fallen on hard times – he dressed like a homeless person and used a length of rope as a belt for his pants.
That’s my impression of Palmdale. Read more on Cults Are Still Around, So Watch Out…
Filed under End Of Life, News, Religion by on Sep 22nd, 2010. Comment.
Ah, the Midwest, the gracious “heartland” where I spent the hunk of my career when I returned to America from Europe. I actually spent little time in Wisconsin. I know more about Milwaukee than I do about Madison, although I suspect there is at least one physician there I helped train and get into some kind of desk job because he seemed to be scared of patients. Response to criticism was not his strong suit, either. I blocked him out so completely I cannot remember his name now. I do remember how grateful he was that I had figured out something that sounded good to put on his letter of recommendation for this public health type desk job. I had asked everybody in the department for advice on how to word it. “Is at his best dealing with patients earlier in the process of developing illness” is something like what I came up with.
Although regional generalizations are by definition rather superficial, I suspect that the mentality in Wisconsin is more similar to Kansas or Ohio than it is different. The true colorful eccentrics — not grossly pathological, but eccentric — seem to be found in the Midwestern United States the way in France, they were found in the smaller, even semi-rural towns. I remember the writer Richepin wrote things about such eccentrics that I loved. He is hard to find in English, but there is at least one link. Read more on Touchy Musician: Everybody’s A Critic…
Filed under News by on Sep 21st, 2010. Comment.
September 11, 2010 has come and gone and – surprisingly — no new war started nor has the planet been annihilated. It really looked touch-and-go there for the previous week.
We have probably already forgotten about the events of this day, nine years after the most cataclysmic terrorist attack in US history. We are mainly thankful that nothing like it has happened since.
By now, I suppose those of us who still believe in print media are using the September 11th, 2010 edition of our favorite newspaper to line the bottoms of bird cages or litter boxes or whatever. It seemed that this year, we were very, very close to something very, very bad happening. We were literally on the brink of internecine warfare that could easily have destroyed the earth. Read more on Surviving 9-11 — Again!…
Filed under News, Religion by on Sep 20th, 2010. Comment.
She was 32 years old and a child of the streets. I wondered if she were a Down syndrome — what we medical types call the mosaic (partial) trisomy 21 — the chromosomal abnormality some still call Mongolism. This was purely an intellectual exercise, as the county health service would surely not pay for the expensive study, so I would probably never know.
Previous doctors had prescribed anti-psychotic medication, but she did not tolerate any of the various brands available through the county clinic. I had her try a little Abilify (arapiperazole) and it did seem to help when she remembered to take it. Or when she slept somewhere it would not be stolen.
Read more on Public Medicine — Cheap Is More Important Than Quality…
Filed under Public Health System by on Sep 17th, 2010.
I have been working with criminals longer than I care to admit. I suppose it is a condition of my accepting temporary consultation assignments, going where the need is greatest. A lot of work in prisons. Some with people later, during the parole process. Sometimes they are contrite — more often not.
I am still waiting to meet the smart criminal. The Moriarty to some law-enforcement-colleague Sherlock. The high IQ planner, the applied psychologist, the brilliant criminal.
Maybe they are so brilliant that they never get caught. Or – if crime truly does not pay – maybe they are the ones who go to those so-called “Country Club Prisons” after they have become wealthy from stock market schemes. They might get “classier” psychiatrists, males with receding hairlines and goatees who wear neckties. I know they don’t get better ones. Read more on Santa Claus, Tooth Fairy And Smart Criminals — All Myths…
Filed under Personality Disorders by on Sep 16th, 2010. 3 Comments.