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. 
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 known by the whole clinic as a tough patient. He missed appointments, saying he was “busy,” but never explaining with what.
He looked like an obese surfer dude; blond, blue-eyed, always tanned. He was quiet and polite and said little, very little. His long-standing diagnosis was schizophrenia.
We knew that he lived with his mom. She had once monitored his medications, but now she was ill. He did not take well to home visits, so there had been none for a very long time. Most anti psychotic medication makes folks put on weight. I had seen many obese schizophrenics in many clinics, but his elusive nature made us wonder how sick he really was, what his life was like. We even wondered if he sold the medicine on the street to make ends meet, as some folks do.
He lumbered in, if irregularly, to get his injection. He always took it quietly. Mention him at a staff meeting, at least within the last three months during which I had called in to consultant, and every case manager turned their eyes heavenward, groaning. Everyone agreed, he was frustrating, at the very least. Nothing could be done for him; he wouldn’t listen. He told contradictory stories about his life. People told me he was a substance abuser –crack, cocaine, pot. I saw no clinical signs of substance abuse when I visited with this patient. However, I had only seen him twice, for he did not come to appointments often. “I am a busy guy. I drive around; I do things.” He couldn’t tell me what. “For my mother. Sometimes, I like to be with my girlfriend.” Read more on The Starving Surfer…
Filed under Nutrition by on Mar 31st, 2010. Comment.
Whenever I go into a new situation with a medical staff, the other psychiatrists seem to enjoy having me assess and treat people who have stumped them. It doesn’t matter if it is a community mental health center, a VA facility, private HMO clinic, University hospital – whatever. The favorite game is “Stump The Renegade Doctor.”
One challenge was a woman was 28 years old who was a little on the hypomanic side (meaning only a mild mood-swing toward the manic) and a little on the depressed side and a little paranoid — and a lot uncomfortable. She was informally and a tad sloppily dressed in clothes which nobody would have called “new” or “chic,” and her hair was a little messy.
She explained to me: “I can’t sleep. I never get more than two or three hours in a night, with a lot of ups and downs and stuff. I don’t know what is going on, but they already gave me all the medicines for sleep, and on me nothing works.”
Yeah, sure. I suspected already that her problem had nothing to do with picking the “right” medicine, but people really do think that pills can fix anything psychiatric. She had obviously had drilled into her head the idea that the right medicine would fix her. “They said you were good with pills, and you could figure me out,” she said.
I was flattered. My colleagues generally won’t say such things to my face – they just dump their problem patients on me and go back to whatever they were doing.
I told her that first, we were going to talk about something called “sleep hygiene.” She had never heard the words before and acted like I was talking a foreign language. There are lots of things that can stop someone from sleeping, and lots of things that can help someone sleep. Read more on Sleep Problems Often Solved By Common Sense — Not Drugs…
Filed under Sleep by on Mar 26th, 2010. Comment.
An administrator of a clinic where I worked long ago and far away once told me how he had to go to an orthodox (Jewish) rabbi and get some sort of a special document in order to satisfy his community (and mostly his wife) when a cardiac surgeon decided to put a pig valve in his heart to keep him alive.
I was not as impressed with the gravity of the situation as he wanted me to be. Sure, I know that Jews aren’t supposed to eat anything that comes from a pig because it wallows in the mud and is thus “dirty.”
The prohibition against consuming its flesh is often credited with saving generations of (religious) Jews from getting sick with trichinosis. Medicine has, however, advanced considerably since Biblical designs.
Whatever people believe about our Creator, there is no way that he or she is going to introduce information to the world that we can’t understand because our technology is not advanced enough. Nobody told about genetic recombination on Mount Sinai. Nobody talked about transplantation in the era when the Gospels were being written.
The obvious conclusion is that it is time to stop worrying about right or wrong in religious doctrine and start living as fully and joyously as our medicine and technology will permit. Instead, I find that people whose spiritual beliefs seem associated with organized churches, seem to be given easily to generalizations and even name-calling: blatant intolerance. Read more on Animal Rights vs. Human Progress…
Filed under Research by on Mar 26th, 2010. Comment.
The place was Billings, Montana. I was living with my husband in a posh downtown hotel. Sounds nice, doesn’t it?
Oh yeah – I forgot to mention that it was the dead of winter.
You are probably wondering why the original “California Dreaming” girl would take off from a winter haven like Palm Springs to frost over in Montana – and the answer is the only one that would account for these circumstances: Somebody needed help.
Like the Lone Ranger, I could not refuse – and besides, it was a heck of a challenge.
The twist is –- I was helping out a managed care insurance company. A huge one.
So now we have the makings of a first class mystery. Renegade Doctor rushing to help out managed care corporation in the coldest part of the country when she could be warming her tootsies in the balmy desert oasis.
Let me go back and set this in perspective. Read more on Cheap And Accessible Medicine Is Worthless If It Is Shoddy…
Filed under medicine by on Mar 16th, 2010. Comment.
I started wondering when I first heard that the First Lady, Michelle Obama, was out to conquer childhood obesity. I am not obsessive about a lot of things — such as fashion and politics — that seem to ignite public passions like a match nearby a gas jet.
Journalist Jane Fryer with the 3 1/2 lb burger at Hillbilly Hotdogs in Huntington, WV
I suppose I can forgive Mrs. Obama for sublimating her true identity as a Harvard-trained lawyer who probably could have been some kind of a government official in her own rite. After all, a lot of people call themselves conservatives and suffer some kind of painful convulsions with any evidence that the world has changed since their own childhoods. They want the comfort of mother’s breast from their First Lady, although they want that breast to be glamorous enough to fit into some kind of designer dress. Read more on Childhood Obesity Initiative — Misguided But Politically Correct…
Filed under weight by on Mar 15th, 2010. Comment.
She was twenty four, and beautiful – magazine cover, MTV video beautiful — with long black hair and exotic features. She was telling me about her childhood abuse, her drug abuse, and how she left childhood for pregnancy and married a husband who was in many ways more abusive than her own parents had been with her.
Although the precise details do not matter, this woman gradually revealed herself to be a victim of physical, emotional, and sexual battering so severe that that she actually looked back fondly on her time spent in a variety of foster homes. I rarely hear this. She told about her abuse with a certain flatness of facial expression and vocal tone, a certain acceptance. This is not uncommon in those who have survived a lot of emotional abuse. It is a survival mechanism; a way to put up a wall. I could understand that.
She was actually a fairly reasonable person to interview. She did not have many holes in her memory and managed to answer most of my questions with believable facts. I had to ask about her education. She had been doing well in school when she dropped out because of pregnancy. She had not used contraception then, still didn’t. When I asked her, she told me simply that since her family was Christian, such topics were not discussed. Read more on The Harm Done By NOT Providing Sex Education…
Filed under Family by on Mar 12th, 2010. Comment.
I remember when I was very tiny, getting a TB (tuberculosis) skin test as part of some public school campaign. It was negative. My parents were pleased with me, but they never had any doubts that I would be “clean.” They said something about poor people with poor hygiene being at risk, but not nice middle class folks like us. No problem.
Fast forward to a far more vivid memory. I had to get another TB test in France when I attended medical school there. It was a hassle, as I had to get someone to take class notes for me while I went to a cavernous and overwhelming public health office.
I was in line with all the rest of the “aliens” as the laws required me to be. There were people who looked more terrified than I — young mothers from North Africa with four or five young children orbiting around them like out-of-control satellites. Unlike this frightened young lady, at least I knew what they were going to do to me — even though I was only a first year med student. They called it a “scarification.”
There was a very petite nurse who had to reach up to give me some scratched parallel lines on my left shoulder. It was the BCG, the “Bacille de Calmette et Guerin.” They told me that it was a strain of tuberculosis that had been developed in Lille, a few miles to the north of Amiens where I was, and that it was a gift to the world. It was a benign form of tuberculosis that would give me immunity. Read more on Antibiotic Abuse — We Are Creating Monster Epidemics…
Filed under Disease by on Mar 11th, 2010. Comment.
She was 33, blonde and attractively dressed. She had been stable on some medications for bipolar illness for many months before seeing me for a renewal. She told me her marital relationship was wonderful. They ran a little boutique together in the historic part of downtown. Not getting rich, but doing what she loved.
Only one problem — her husband said she became difficult when she drank too much coffee. I asked for some description of the “difficult.” She noticed she was nervous and had trouble cooling down later. She had “panic attacks,” which had not been a problem before.
They sounded exactly like the description of that disorder in DSM-IV – the one nobody likes applied to them – the “B” word. The things she said her husband had said about her sounded like the criteria for mania. No sleep, loud arguing, anger, nerves, etc. “Let’s look at cutting out the coffee,” I told her.
She normally drank as much as a half-pot in the morning at home before opening the boutique. That may not sound like much, but others have had similar symptoms from less. She had figured out herself that coffee in the afternoon messed up her sleep beyond description.
Caffeine has a LOT of effects on the body. If it had been a modern discovery, instead of the old myth about some frisky goat in the near east chewing berries off a tree and surprising a young shepherd by omitting sleep, caffeine would have caused the FDA a struggle to pass it because it does so many things.
First, coffee is absolutely NOT the only beverage that has it. There is generally more in caffeine-containing cola drinks. Read more on Caffeine As A Bipolar Trigger…
Filed under Stimulants by on Mar 8th, 2010. Comment.