Psychiatry

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I believed once that the U.S. military was a noble and distinguished place. Not that any of my direct lineage (or collateral relatives, for that matter) had ever served. My father was rated a 4F by the draft in WWII for his flat feet.

My grandmother of blessed memory told me to “take care of America” for her. In the Ukraine, she had not considered herself pious enough to make it in Isreal. She preferred the USA, having heard the streets were paved with gold and streets also somehow held an opportunity for upward mobility.

She never told me exactly what that meant, but as a resident doctor whose residency school had folded (with no neurosurgical residencies elsewhere in America) I made the military recruiting office into a system to get the US Army to pay my residency salary and get training in Canada.

A military stint as a general medical officer assigned to active duty — well, I didn’t have too much trouble convincing myself grandmother would be proud.

I ended up, through a variety of machinations, going to active duty in general psychiatry at a large Army base.

So indirectly, from my proud induction and joyous oath of allegiance to the US, I landed in a world where:

Many young men, before judges in America, were given a choice between military and prison, and continued to act as if criminal behaviors learned on the streets continued to be appropriate.

The medical command though this woman MD with a background in neurosciences should take care of ob-gyn and such because she was “a female.” (I got the necessary books out of the library and kept them in my office and did as ordered.)

The incidences of sexism were too numerous to recount.

And criminals? Although I have worked many prisons, I was ordered to evaluate my one-and-only axe murderer, he was seen while he was confined to an Army prison.

Not that he was cooperative. He answered no questions at all, laughing at the female officer who had been sent to interview him.

The techniques I derived to get any of my assignments done at all served me well later in my career.

The criminal patients, from the naive and young, to the masters, have stood with me.

The Huffington Post seems to have reported on a serious crime that happened in the military, and bore further investigation.

There are military press officers, and they release things to the public, but they don’t seem to release things like this.

America may want to know who is in the military, and why, and about horrible things that go on and are crimes against humanity and such.

Be afraid be very afraid.

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She was 28, a bit overweight but tired and nervous at the same time.

“I’d like 15mg. of Celexa. My other psychiatrist wouldn’t give it to me, so I left him. He said it was either 10mg. or 20 mg. and that’s it.”

Not the usual “chief complaint” for why someone comes to a psychiatrist — but what the heck? Read more on How To Get 15 mg. of Celexa…

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The depth of psychiatry deals with the entrails — the innards.

The world of psychiatry of the deepest personal thoughts is a world of fantasies of murder and fantasies or death and they are deep, so very deep, that sometimes people don’t even know that they think about them. Read more on It Sounds Like A Joke But —…

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While I was training in psychiatry 30 years ago, the field was changing around me.  The older psychoanalysts were forced — reluctantly — to add prescription of psychotropics to their practices or else patients would never make it to their door. Of course, they had little to no training in pharmacology and less interest so they didn’t usually know what they were doing. While I was ascending in the ranks of psychiatric trainees, the best and the brightest of us were ushered into special training in pharmacology research.  I was (and probably still am) about as idealist and apolitical an up-and-coming psychiatrist that anyone could have invented. Read more on The Politics of Drug Development…

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The first person I remember who approached me telling me clearly and articulately that uncertainty was his problem was Dr. W.

Not that he was (or ever could have been) a medical doctor.  He was an engineer who had been laid off for being somehow “supernumerary” from Boeing Aircraft in Wichita, Kansas.

Very stable, very “establishment, a former president of the synagogue (where we had met) the late Dr. Larry Weller was the kind of guy who wore a necktie around the house, just because he was more comfortable that way.  His wife was a sharp-as-a-tack social worker.  He was continually thankful for this, as his two adult children were living and working elsewhere and the two of them could keep their home and live fairly well (with the occasional flight to New York to visit relatives) on her salary. Read more on Uncertainty Is A Tough Mistress…

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In 1932, my paternal Grandmother-Of-Blessed-Memory bought the house where my father and aunt – and eventually my brother and I — grew up.  Until her passing while I was in medical school, she was the undisputed queen of the castle.

As a stereo-typical Jewish Mother, she was in constant competition with my mother in the kitchen.  My mother always tried to act pleasantly, but between her father driving in from two hours to the west and arriving at 6 am on Sundays to tell her she was too fat, and my father’s mother besting her in the kitchen, she was generally miserable and had little ability to hide her misery from me.

My father did not show my mother any affection where I could see. Read more on The Power Of Silence…

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I have heard just a little too much about suicide among the religious — from patients, from others, now this; to the son of a published pastor who gave an invocation for the Obama folks.

I really do feel for the family, for death of the younger generation before the older one by any means including suicide by his own hand, is a horrible thing that is anti-nature and has a profound wrongness, a too-deep effect on all involved.

I was way back in residency when I attempted to gather some statistics on the association between religion and psychiatry in Kansas, sending a basic questionnaire on feelings about mental illness (and referral patterns to mental health professionals) to a big list of Wichita area “religious professionals.”
First, I had already made the assumption from the French part of my education that not too many people actually went to church, but none of them seemed to much care about mental health professionals.

In Kansas, with the world’s worst statistics (no major support on this from my

Read more on Religion — And Suicide…

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I was looking at Paul Fink’s column in the April 2010 Clinical Psychiatry News, one of those newspaper format “journals” that we like to call “throwaway journals” because subscriptions are free and they summarize other journals, as they usually end up in the trash. He writes for other psychiatrists.  It is possible to identify with him if you do this for a living and are sentient enough to know what is going on around you.

I always liked this guy.  Older people have a lot to say when they have practiced long enough to see trends go up and down and know their fate.

If I remember correctly, he is the one who said a while ago something to the effect that psychiatry is like prostitution in that the amateurs think they know as much as the professionals.  Nobody has better nailed the central difficulty of this job. Read more on Purpose and Aging…

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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 ……

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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.

Patty Hearst/SLA

Patty Hearst/SLA

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…

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