He was in his fifties and he wanted the same medications he had, except for one thing. He just could not manage to have sex with his live-in girlfriend. He never had. I was filling in at a clinic where I knew this was the only time I would see him.
There are a couple of strategies with prescription medications that sometimes work. A partial agonish to reverse a receptor; adding another antidepressant. I reluctantly told him about them, since a complex mental illness was being otherwise quite well managed. I mean, this man’s diagnosis was “schizo- affective disorder.” He had been really psychotic, hearing bad things and thinking they were real and running naked in the streets. As much as I think an interest in sex is healthy and part of normal living, I certainly did not want to risk having all of these horrible things happen to him again. Luckily, he told me the last thing in the world he wanted to think about was another drug. Even a little bit of another drug.
There are herbal solutions that actually work. I was thinking about some oriental herbs, which I certainly did not think were that expensive. But he assured me he had no disposable income at all. Maybe true, maybe not, but I always wonder at least a little bit when people tell me that they want something very badly, but then do not seem to find any money for it. I mean, he was a heavy smoker (over a pack a day) and I was certain insurance did not pay for that. I tried to approach this subject, and he became so angry at me I would have dived under the desk for protection if it had been physically possible. Read more on Men Just Want To Talk About Sex…
Filed under relationships by on Jun 16th, 2010. Comment. 
She was in her thirties and had miscarried, again. Proof that the universe is infinite in its wisdom, she had failed to carry past three months a child conceived while she was hooked on crack. To say I was relieved was to put it mildly.
She already had two children in her care, aged 9 and 7. I had sent Child Protective Services to check them out. Her mom and extended family seemed to be participating in their care. They seemed to be doing pretty well.
She was not only unhappy; she was angry. I had been so careful. Taken her off any medications that had a serious chance of causing malformations in an unborn child. Keeping her on just enough to keep her from hearing voices and “body-slamming” herself into a wall. Something the voices, she said, told her to do. Not a very good thing for a woman to do who was pregnant, so we kept her on a little medicine. Always checking with the California Board of Teratogenicity, a wonderful place where both patients and doctors could find out from the published medical literature just how dangerous prescriptions could be to unborn children. Those who did not believe in abortion could work with their doctor about advantages and risks and being careful and trying to do the right thing. Good God, this was a woman who had used crack. Read more on “The Abilify Doesn’t Work!”…
Filed under prescription drugs by on Jun 16th, 2010. Comment.
The above study was also reported in the Clinical Psychiatry News in March. It had no funding, just an enterprising fellow in forensic psychiatry. And her apparent mentor was Glen Gabbard, some of whose work I read when he was at Menninger. One of the guys who is old enough that he has seen things.
I give them points on reminding the world of something it seems to have forgotten. There are people who qualify as doctors, who are taking care of patients, and who are trouble. The problems in the group studied, people who have “professionalism issues,” range from sexual boundary issues to gross incompetence and cover specialties that are not necessarily psychiatry. The physicians studied are mostly Caucasian males, which comes as no surprise to me.
The physicians studied mostly have psychiatric diagnoses. Things that sound like any fairly competent psychiatrist could have diagnosed them. There was some kind of “rehabilitation” involved when they were in training, for the most part, so they went on and acted rotten anyway. Read more on There Are A Lot Of Good Doctors Out There, But ……
Filed under News by on Jun 14th, 2010. Comment.
Before you read this, I want to warn you – at any moment, I can veer off into an emotional rant. And after you read this, you should be outraged, also.
There is a prescription form of Omega-3 fish oil being marketed by a major pharmaceutical company. It costs about seven times more than the same amount of Omega-3 fish oil you can buy as a dietary supplement.
If I had no other reason to dislike “Big Pharma” this would suffice. Everything I learn about pharmaceutical companies makes me think less of them. They are stealing our effective and useful natural substances without adequate science, creating patentable molecules, and making more money than any of us can imagine off human suffering and death. Read more on Fish Oil For $100 A Pill…
Filed under big pharma by on Jun 11th, 2010. 2 Comments.
I had seen this woman as a patient only once before, but I had seen more like her than I could count. She was in her late fifties, like me. Her gray hair fell in waves down her shoulders, Alice-in-Wonderland style. All of her clothing was childlike, too. If her hair had been blonde (as she had insisted it once was and was still meant to be) she would have looked, from the back, like a little girl in her calico dress.
She had been “traumatized” by her family. She didn’t want to talk about details and was more than a little surprised that I made no effort to push her to divulge them. She wanted to tell me about all the types of psychotherapy she had studied and learned, or even more she wanted to tell me about all of the great and famous figures of psychology she had met personally, and how wonderful they were.
“I don’t care if you met God himself or—–herself.” She was not happy with my response, but by now she had enough sense not to be surprised. She was labeled as a “borderline personality disorder” as well as a “treatment resistant depression.” She had refused anything even remotely resembling an antidepressant; she was worried about all kinds of side effects. She was on diazepam (generic Valium) and would accept nothing else. Among other things, this drug would do a fine job of keeping her depressed. She would not consent to anything else and it seemed to have helped minimally with anxiety. The choice of medication had been only one in a garden of self-sabotaging choices. She had been a training patient for a couple of generations of therapists, none of whom seemed to have been able to do her the least bit of good. Read more on If You Are Stuck — Try Dancing…
Filed under Psychotherapy by on Jun 10th, 2010. Comment.
I have had a couple of emergency room admissions as a patient; usually, I was out cold or damned close to it. Sometimes I think I was just in pain or so uncomfortable or so horrendous that I blocked out the memory entirely. Other people, people who seem to know something about medicine, did tell me about things that I did not remember.
Putting their accounts together with what I did check out or do remember, I am convinced that nothing wrong or horrible was ever done to me in an American emergency room. Not in my late teens and early twenties when I worked in an emergency room in downtown Boston, although many of the technologies we now take for granted were not
available then.
I have never been cared for in a French emergency room, except for the time the left half of my face and windpipe swelled up because of an acute allergy to some rare species of white celery that grows in France. I was taken to the emergency room because I felt quite ill indeed. But by the time I got there the symptoms had gone away. They delegated an advanced medical student (perhaps more accurately, a young intern) to talk to me and I was sent home with no treatment, except being told never to eat that rare kind of celery again, which I have not. I do, however remember that interview in some detail. I can tell you, from that interview as well as from my studies, that French doctors, and probably others who study in countries with similar systems, do not think the same way that American doctors do. Read more on American Medicine: Good at Acute Care But Lousy With Chronic Illness…
Filed under medicine by on Jun 9th, 2010. Comment.
I was up and watching Dr. Oz on June 3, in the morning, because I knew he was popular and wanted to see what he was doing. I only saw the end of the show. He was dancing (in scrubs) with some Brazilians who presented a form of self-defense camouflaged as dance. He was fairly lithe, not overly muscled, and moved well, to the great enjoyment of the audience.
Obviously he was beloved as a personality. But did he really have knowledge? He has the good looks required to get a shot at TV, but there are a lot of caring and skilled doctors who aren’t photogenic or charismatic enough for the ‘tube (and probably don’t dance well, either).
It seemed that people were cheering for him as a personality.
He entertained questions from the audience. A woman had the tail end of a Bell’s Palsy. She asked him how to get rid of it. He told her to wait longer and it would probably go away.
I could tell right away that despite the lovely slide he flashed on the monitor, this woman had been the victim of her Bell’s Palsy long enough that she would probably be stuck with it for life. He got a round a round of applause, presumably for hugging her and telling her that her smile was beautiful. Read more on Dr. Oz: Being On TV Doesn’t Make One A Wizard…
Filed under Celebrities by on Jun 8th, 2010. 1 Comment.
He was pleasant, in his fifties, graying at the temples, articulate,and pretty much burned out on the symptoms of an alleged schizo-affective disorder. Like many of the people I treat he had been involved with the Hollywood entertainment establishment years previously. Now he lived in a residence suitable for his situation, and told me there was nobody he could talk to; he hated it. He even produced a lovingly-constructed list of names of people who had been important to him in the past. He did not know where they were, had no intention of finding them, so it served no ostensible purpose, except maybe to help him live in the past, because he had no interest in his dull and frustrating present. He said he simply could not relate to anyone in the residence where he was. They had no words, in many cases were illiterate, and were of no interest to him because they would not converse. He said he was depressed, but it was clear this was not the kind of depression you medicate.
I called for his case manager, who told me he had been offered another placement where it was expected there would be more conversation; not once, but twice. He had declined. The complaints I heard from him had been going on for years. I asked him what was going on. He told me, again quite articulate.
“I can’t decide. I’m like someone who stays in a marriage, even if they don’t love the other person. They just can’t change. I have tried, and I don’t think I can. Maybe people like you should leave me alone and stop trying to help me. I don’t think even a smart lady like you can do a good job of treating somebody who can’t make decisions.” Read more on Decisions, Decisions!…
Filed under Uncategorized by on Jun 8th, 2010. Comment.
On the one hand I am amazed that somebody actually noticed that employees with more control on the job are happier. On the other hand, I am amazed nobody thought of this.
I am certain none of you remember the industrial revolution, as it happened a while ago. To my amazement and delight, internet to the rescue. Really, you can learn about anything you feel like learning on this internet thing.
The great thing, I think, is that this 18th and 19th century period was full of inventions and improvements in the standards of manufacture that made the standard of living better for a lot of folks. The bad thing is the human toll. Working women and children in particular had no laws to protect them. People did not know about factories and production and what it would do to people. I remember reading a long time ago about how rebellious the first factory workers were, rebellious at the outset. People had been living primarily on largely self-sufficient farms. Nobody told them when they had to start work and end work and such. So it really is not any surprise, given the fact that a relatively low alcohol content grog was the main drink available, that people went out for grog breaks as frequently as they could manage. They concentrated poorly and required direction from a management that could probably only be seen as repressive, no matter what they said or did. Read more on Working For A Living — And Loving It…
Filed under News, politics by on Jun 4th, 2010. Comment.
When I was very young, my nails were never painted. My mother of blessed memory thought it impractical and a waste of time. My grandmother of blessed memory enjoyed a weekly ritual that seemed to remind her she was a woman of leisure, when she removed and replaced what had been chipped the week before with a fresh coat.
In French medical school, where I first had an awareness that female beauty was some kind of power or currency, I tried weekly polish for a little in the early years, but found it tough to maintain without chips, even with a pale color, and transparent did not seem worth the trouble. Men didn’t seem to notice, or care.
When I left surgery for other branches of psychiatry, there was a brief affirmation of nail painting, as if I were declaring to the world I was no longer a manual laborer, but an intellectual one. I even remember telling someone about the medieval guilds of barber-surgeons, but how nobody could lump barbers in with the esoteric works of an intellectual not-a-manual laborer type physician. Read more on Some Fingernails Just Aren’t Cut Out For Polish…
Filed under News by on Jun 4th, 2010. Comment.