I heaved a sigh, realizing I was going to relive a scenario I had lived too many times. I would take too much time, I would be behind my schedule, but I was going to do this thing. I was going to figure out why he had gone off his medication. Frankly, I did not think anyone else could or would take the time, so I would do it.
He was a schizophrenic who had been without medication, maybe a month or so. He had come in wanting some because his misery was indescribable. He could barely speak and he had a downcast gaze, fixed at his toes and the floor. He sat stiffly in a chair. I slithered down on the floor, on my back, and tried to insinuate my eyes into his line of gaze. He screamed. “You are too strong. You are going to annihilate me.” I could only answer “sorry” and get back to my seat. He started saying a lot of things about the importance of being Christian and following Christianity. It did not matter what I knew or thought I knew about Christianity. It only mattered that I could fit into whatever he thought Christianity was, right or wrong. I could make little sense of his thoughts. I have a standard way of dealing with this.
“Look,” I said, “I am not Christian and I am not going to pretend to be Christian.” I am a Jewish lady psychiatrist, I am fully qualified and licensed in the state of California. I am also a full blooded descendant of the House of David. If you think that the God you believe in is able to work through me, then I am going to help you the best I can. If you do not believe that God can work through me, and you want a Christian doctor or some other doctor, we will try to figure out what you need and get you to the right person.”
Read more on Neglect Based On Religious Belief…
Filed under Religion by on Jun 1st, 2010. Comment. 
There was a man who came to me and told me that his therapist had comforted him on how to deal with his heart problem, and he was doing better now. Huh? Without telling him that I thought his psychotherapist was a lazy fool who enjoyed charging by the clock and seemed to believe that all he had to do was to keep his patient in the room and talking for the entire hour, I simply said I had probably spent more time studying the heart than his therapist had, so I could maybe be more help. Psychotherapy is subjective at best. Psychotherapists of any qualification known to me require “supervision,” or reporting of their cases to someone (presumably) older and more experienced who can “guide” them. The better of the psychotherapist supervisors will sometimes ask to see the patient, especially early on in supervision, to get at least a feeling for how the trainee is reporting the experience and the patient. Several trainees have approached me at various times in my career about supervision. I have supervised generations of psychiatric trainees and therapist trainees in university settings. I have even done a little in an insurance setting. Nobody has ever chosen me as a psychotherapy supervisor in a private setting. There are many reasons of this that I can figure out, judging upon what the potential trainees say.
1. I charge too much (more than doing the therapy myself, as I am giving people skills to use)
2. I actually expect people to work. I have been told I am too”results oriented” in many aspects of my life. Some people have even told me that my approach to psychotherapy is like an “ex-surgeon,” because I like to get the job done and get out. I think psychotherapy needs specific goals and objectives, a specific time frame, and specific ways that could actually achieve those goals and objectives.
3. I am “by the book,” although I have some flexibility as to which book. (This is a direct corollary of the above.) Although some people believe that psychotherapy comes from vague personal directives, and that the efficacy of therapies is impossible to measure, there is research done where therapists are given a “therapy manual” which they follow and document and there is good stuff. Sure, there is placebo effect, and that is hard to measure.
But there are ways to do real science here, not slumber into the poofie-cloud of feelings, which are soft, soft science in their stongest moments. If nobody wants to fund research in this direction, it is not my problem. I have tried to do things. An article like this one is courageous.
Now there are some things about psychotherapy which I know are true. Way back in the fifties, when the world was a bit more innocent, (and there was no internet) there were some nice, scientific articles in something called the “American Psychologist” Journal. It was shown, quite nicely, that the likelihood of someone to get better in therapy was a direct function of how much they wanted to get better, and of the degree of trust in the psychotherapist. The “type” of therapy used did not seem to matter much. Read more on What Are Therapists Up To?…
Filed under News by on May 31st, 2010. Comment.
I slowly realized what was going on. He seemed to forget what I had said almost as quickly as I was able to finish saying it. He had already asked me twice if I were really a doctor and a psychiatrist. I get that a lot, probably because of the bright colors I wear and my informal conversational style.
Slowly we got the part of the examination called the “mental status exam.” He did not know the date or the day of the week or even what city we were in. Apparently a “case manager,” one of those people who is assigned to work as an assistant to help low-functioning patients get to the clinic, had brought him in. He could only tell me that he had spent most of the past ten years in jail. As a matter of fact, he said jail was easier for him than the world outside. He said he always violated parole, because calendars were hard to read and he seemed to never show up on the right day.
When he finally had no parole left, and was done with jail, he scraped up all the marijuana he could find and called 911 to come arrest him, so he could get back to jail.
Filed under Brain Damage by on May 24th, 2010. Comment.
She was exactly my age, with a birthday only two days before mine. Same year. I know that there are more people born under the sign of Aquarius than any other astrological sign, so I am no longer surprised at the number of people who have birthdays in February. (Especially since, if you count back nine months, you end up with June, which is when everyone’s thoughts turn to love and their thyroids and probably other glands are hyper-secreting.) But this was one of those people who makes me think I look awfully good my age. Probably a function of middle class privilege and doing more intellectual than physical work.
This woman had a son who cared about her. The fact that she came to the clinic with him made her fairly special among those I was serving at the time. He had been worried when she seemed too sleepy and too angry and not herself.
Like most patients, she really did not want to tell me much about the other doctors she saw or what medications they gave her. I told her that I could check for interactions, and that her failure to tell me would increase her risk of having problems. I know that a lot of people get “pain killers” and don’t think that they count for “real medicine.” Read more on The Shrink As Sherlock — Detecting Opioid Addiction…
Filed under Addictions by on May 20th, 2010. Comment.
People told me I would have troubles in France because it was a “Catholic” country. I do not think any trouble I can remember came from the few people who actually attended church regularly. But back to politics. The parties were grouped into “left,” “right,” and “center.” The left included the commies, whom I had to reassure that even though I was an American I did not hate them. I found “rightists” fearing change as obsessively as any conservative (read “ultra-republican” American ever could. Read more on Psychology of Politics (and Politicians)…
Filed under Addictions, politics by on May 19th, 2010. Comment.
Her teeth were mostly missing. I did not ask her to remove her ill-fitting wig, for I wanted her to keep whatever pride she had been able to preserve.Her face was worn, but her cheekbones proud and high.
Filed under prescription drugs by on May 17th, 2010. Comment.
He did have obsessive compulsive disorder. He had been on a variety of medications which one might expect to be helpful with that, but which had not. In my experience this was not uncommon. He was seeing a therapist who was trying to help him with this, but who was doing traditional “insight oriented” therapy. Of course, this did not work. His worries were mainly about cleanliness and order; common ones. I recommended the most recent edition of hte book I have been recommending for years, in its most recent edition. (Bantam Press) Despite my efforts to avoid making his therapist sound like an idiot, I sent him to some of the wonderful free self-help you can find on the internet. But wait, there’s more. He said that he frequently heard, in his head certain lines or phrases of songs he had performed in the sixties. Not whole songs or even parts he liked. Just opening lines, or one line or phrase, that would repeat an infinity of times. He had tried to drown it out, all sorts of things, and yet he felt victim to it. It was frustrating and he did not know how to stop it. This was not conventional obsessive compulsive disorder. Read more on Musical Hallucinosis — Too Much Of A Good Thing?…
Filed under depression by on May 14th, 2010. Comment.
“Happy families are all alike; each unhappy family is unhappy in its own way.”
So begins the novel Anna Karenina. However, if Leo Tolstoy tagged along with me when I’m summoned to come rescue a clinic with troubles, he would doubtless come up with a similar observation about happy clinical staff and unhappy clinical staff.
In my role as a consultant – spending a relatively brief amount of time in a clinic to help it get on track and solve problems – I see troubled staff and administrators. Unfortunately, I’m not called in to observe happy clinics and partake of celebrations of success.
Each clinic has its unique challenges and problems. And although they ARE problems, it’s the unique part that intrigues me. After all, the problems are severe enough that they are willing to pay me to come untangle the mess. Read more on Surviving In The Society of Women…
Filed under News by on May 13th, 2010. Comment.
“Just gimme the Prozac and let me outa here.”
In a clinic where most people were indigent and needed more than twenty clinics could give them (food, shelter, friends, job) this woman was well dressed and snappy. She looked a little like some petite actress, maybe Holly Hunter, playing a businesswoman.
In fact, she told me that she was a real estate broker and was not producing enough so that was the proof that she really needed her Prozac. She had been on it for a while, in steadily increasing doses, and now was on 60 mg. Over a couple of years, her dose had slowly been raised from the fairly standard 20mg.
It was a treatment for depression. I had no way — except notes written by previous psychiatrists long-gone — to figure out how depressed she had been when she had actually started on Prozac. And the old notes weren’t much help. Read more on “Just gimme the Prozac!”…
Filed under prescription drugs by on May 12th, 2010. 2 Comments.
He was 35 and tall and thin, with beige hair and a rare grin he claimed only I could elicit. He enjoyed seeing me. He always came with a knapsack, because he didn’t really trust the other people in the residence where he lived. He probably had reason to feel that way, for things had been stolen from him before. Things like medications. He reported these things to the pharmacy involved. Both they and I believed him. After all, these things happen. He had not abused anything known to us. Besides, medications are frequently stolen.
The diagnosis was schizophrenia, that too-often debilitating disease that hits at least about 1% of the population and that is still generally considered manageable but incurable. He was actually doing pretty well, living in a residence and “stable” after countless hospitalizations. I asked him about his plans for the future. He told me he had been attending information sessions about an interesting course at a local college. Now I knew that local colleges, this one in particular, were famous for providing “practical” education. I had even heard of a bachelor’s degree in auto body work. He told me he wanted to learn to make guns. I tried not to appear nervous here, but I was impressed that he could read my emotions well enough to tell I was worried.
“Don’t worry, Dr. G. I am not going to hurt anybody and I don’t want to kill myself. You must worry a lot about that because you ask me every time.” Good — he was smart about that. But what could happen if his medicines were stolen before I could replace them? In his distant past, he had some real troubles with “false beliefs,” worrying that criminals were out to get him. What if he believed that, and tried to shoot someone? I could not ask him that, I knew he would tell me it would never happen – but I knew it could. “I really like hunting animals. Little ones, not bears or anything. Squirrels, but that was a long time ago. There are lots of squirrels and things like that around here.” He went on. He was exhibiting more insight and understanding than I had ever heard from him.
“I like the insides of the gun and how it works and I want to learn how to make them. I did like the feeling of shooting a little animal, because it meant I was smarter than he was.”
Filed under Disease by on May 10th, 2010. Comment.