tag:blogger.com,1999:blog-3268926966951743162011-07-07T14:38:11.388-07:00musings of a psychiatrist in trainingschlockdocnoreply@blogger.comBlogger241100tag:blogger.com,1999:blog-326892696695174316.post-30739939377278705612010-08-09T11:35:00.000-07:002010-08-09T11:37:26.246-07:00

“Doctor, I’m afraid I might have ruined my brain.” Mr D’s wide brown eyes bore a pleading expression.  He was a young law student with a cherubic dimple set in his left cheek.  He had had no history of psychiatric issues until six months prior to our appointment.  Then, one Saturday evening during his winter recess from school, he’d celebrated the end of the semester with friends by smoking an

schlockdocnoreply@blogger.com4tag:blogger.com,1999:blog-326892696695174316.post-44358526219676751882010-07-19T16:31:00.000-07:002010-07-19T16:35:54.540-07:00

So let me say up front that this is a Rant, one inspired by the fifth young go-getter this week to walk across my threshold demanding I diagnose him with AD(H)D and prescribe him Adderall to get him through his dissertation/term paper/research proposal/whatever.In my (not so) humble opinion, AD(H)D is not so much a disease (in the sense of a physiologic malfunction) as an unfortunate interaction

schlockdocnoreply@blogger.com6tag:blogger.com,1999:blog-326892696695174316.post-6173421018697733892010-07-03T18:04:00.000-07:002010-07-03T18:05:50.809-07:00

Mrs U first came to my attention some time after the birth of her first child. She was a stately woman, dark and slender, dressed always in brightly colored robes. Her husband brought her to see us because she had stopped speaking. Ever shy, he reported that she'd become gradually more and more taciturn, and at the time of our first meeting she hadn't said a word in several weeks.At first we

schlockdocnoreply@blogger.com6tag:blogger.com,1999:blog-326892696695174316.post-14630253222229565892010-05-02T14:53:00.001-07:002010-05-02T14:53:57.128-07:00

(The characters sketched in this piece are composites of several individuals I’ve encountered in my training and my life. They contain elements of real patients and acquaintances but do not represent strictly true accounts of specific people.)The couple who walked into my office for a consultation the other week seemed, at first, similar to many of the South Asian immigrants I've met. He,

schlockdocnoreply@blogger.com11tag:blogger.com,1999:blog-326892696695174316.post-70863115317032338102010-04-15T23:33:00.000-07:002010-04-15T23:37:19.496-07:00

(A little note about my extended absence: After a promising start, I let this blog go by the wayside just about a year ago, shortly before I had my first baby. I find being a parent is absolutely fantastic and also supremely absorbing and time-intensive. My daughter is now ten months old and I'm just starting to recover my interest in the world around me. It seems like a good time to revive

schlockdocnoreply@blogger.com3tag:blogger.com,1999:blog-326892696695174316.post-5105290033226056652009-04-06T14:28:00.000-07:002009-04-06T14:31:22.432-07:00

Imagine you are getting your car serviced. You bring it to the shop, you get an estimate. When the work is done the shop presents you with a bill. It may be a little more or less than the estimate was, but either way that's what you'll be paying. Now imagine that instead of paying the bill as it's presented, you tell the shop: No, I don't think your work is worth this much. In fact I think

schlockdocnoreply@blogger.com7tag:blogger.com,1999:blog-326892696695174316.post-784157462735836532009-03-14T11:50:00.001-07:002009-03-14T11:50:54.686-07:00

What do you do with a healthy patient who wants to die?Ms K was 95. Her face was only softly lined, and her ash-white hair was smooth and silky as a girl's. She was in what one might call quite good health, having survived both a heart attack and a cancer many decades ago. Save a matched pair of titanium hips, her body parts were all factory originals.By all accounts, her life was still a full

schlockdocnoreply@blogger.com1tag:blogger.com,1999:blog-326892696695174316.post-258784383527263472009-01-24T22:56:00.001-08:002009-01-25T19:31:14.811-08:00

You came into the hospital hoping to deliver a baby. In fact you weren't pregnant, but you wouldn't believe that; so the ER called me. We had a pretty nice conversation. I didn't challenge your belief that you were pregnant despite a negative urine pregnancy test and an ultrasound showing a normal nongravid uterus; and in turn you loosened up just a little bit. You were still clearly

schlockdocnoreply@blogger.com2tag:blogger.com,1999:blog-326892696695174316.post-27315475254795971902008-11-12T19:06:00.000-08:002008-11-12T19:12:06.579-08:00

I've had a number of people wonder why, as someone with a research background, I'd be interested in psychiatry. There's a tendency to view psychiatry as 'fluffy' and not something that would be interesting to a person who has spent years getting down and dirty with cells and proteins.In my view, psychiatry is truly biomedicine’s last frontier, and no medical specialty could be more fascinating

schlockdocnoreply@blogger.com3tag:blogger.com,1999:blog-326892696695174316.post-50029351122891500612008-11-04T16:15:00.000-08:002008-11-04T16:20:26.662-08:00

The screech of my pager jolted me from sleep. A soft-voiced nurse informed me that they were having some trouble with one of the patients and his behavior was very disruptive to the others, so could I come by and see him, please?I asked for some further details. Apparently he was kneeling on the bathroom floor screaming that Satan was trying to remove his soul through a portal in the back of

schlockdocnoreply@blogger.com2tag:blogger.com,1999:blog-326892696695174316.post-38373433298970791252008-09-19T13:06:00.000-07:002008-09-19T13:52:12.115-07:00

Disclaimer: I am not a child psychiatrist and do not speak with professional authority on this subject. These are my own ideas based on various readings and personal experiences.Everyone loves to hear about someone overcoming obstacles to become a star. This NYT article about Michael Phelps, ADHD-child-turned-Olympian-superstar, caught my eye.I found most intriguing the bit where Phelps’ mother

schlockdocnoreply@blogger.com5tag:blogger.com,1999:blog-326892696695174316.post-64781913856878567942008-08-31T22:22:00.000-07:002008-09-01T08:11:16.109-07:00

A new patient walked into my psychopharmacology clinic last week. She seemed reasonably typical at first. A line in the chart noted that she was somewhat wary of psychotropic medications, but then many patients are, and I don't tend to mind that attitude myself since I also subscribe to the less-is-more theory of psychiatric meds.She was on a fraction of the normal dose of a common antidepressant

schlockdocnoreply@blogger.com0tag:blogger.com,1999:blog-326892696695174316.post-15432772126463158382008-08-26T10:12:00.001-07:002008-09-02T10:11:23.653-07:00

I wrote last week about how surprisingly simple it can be to turn around an angry patient. Two small words hold the key to taming the beast: "You're right." Those words are like a magic tonic, a soothing balm. The patient drops his offensive posture, loses his hostile glare. His hackles soften. His ears are open, receptive. Magic. But it's not enough merely to mouth the two magic words.

schlockdocnoreply@blogger.com0tag:blogger.com,1999:blog-326892696695174316.post-28874193534279989912008-08-24T17:14:00.001-07:002008-09-02T10:08:59.294-07:00

I'm in a seminar that meets once a week to educate ourselves in the technique of CBT (cognitive-behavioral therapy). This is only one of a plethora of available therapeutic modalities (dialectical behavioral therapy, psychodynamic, psychoanalytic, etc etc etc).We're learning specific, codified techniques for making our interactions with patients productive. Some of them are very simple; but the

schlockdocnoreply@blogger.com2tag:blogger.com,1999:blog-326892696695174316.post-24685996177402102742008-07-10T19:20:00.000-07:002008-07-14T20:35:15.126-07:00

I was speaking with a very intelligent and insightful patient today who mentioned that he'd felt his problems (depression, some obsessional traits, a mild eating disorder) were all 'psychological' until he found a drug that significantly improved them. From that point on he was convinced they were 'biological,' and embarked upon a quest for the Magic Pill that would solve all his neuroses at a

schlockdocnoreply@blogger.com0tag:blogger.com,1999:blog-326892696695174316.post-29269670323499654452008-07-02T20:46:00.000-07:002008-07-26T16:56:08.834-07:00

We've a number of eating-disordered patients on the unit at the moment.  Eating disorders have never been a particular interest of mine; yet as I work more closely with eating-disordered patients, I've come to realize their problems raise a number of interesting philosophical questions.We've all had the experience of being of two minds.  We want something, yet we do not want it. One experiences

schlockdocnoreply@blogger.com2tag:blogger.com,1999:blog-326892696695174316.post-84648354176412763852008-07-02T19:46:00.000-07:002008-07-12T18:27:07.842-07:00

One of my more interesting recent patients had a problem straight out of a daytime talk show. This was a young gay man in love with his heterosexual roommate. The two of them had a very close relationship, eating dinner together, going to movies as a couple, and generally engaging in very couple-like domestic activities. They also had a surprisingly open relationship. The gay man had

schlockdocnoreply@blogger.com0tag:blogger.com,1999:blog-326892696695174316.post-59324255555041534642008-06-08T12:13:00.000-07:002008-06-22T15:37:30.922-07:00

Psychiatrists - and doctors generally - see two kinds of symptoms.  There are the 'classic' symptoms that have meaning because they signify something we can treat, and the 'off-road' symptoms that don't seem related to any disease process we understand.In psychiatry, the former are typified by people who are having frank hallucinations and delusions.  I know how to recognize them  - they look ill

schlockdocnoreply@blogger.com0tag:blogger.com,1999:blog-326892696695174316.post-72656204786066337402008-05-30T19:55:00.001-07:002008-06-22T17:33:19.874-07:00

I'm on an outpatient neurology month, mostly a pretty calm scene compared to the inpatient psychiatric wards - until Ms Q arrives on the scene.  Forty-five minutes late for her appointment, she stumbles in on the arm of the fellow, mascara streaking down her cheeks.  "She's intoxicated," the fellow murmurs gently in his refined hint-of-British, hint-of-Indian accent as he steers her to a chair.  

schlockdocnoreply@blogger.com0tag:blogger.com,1999:blog-326892696695174316.post-69083406362548234092008-05-30T19:13:00.000-07:002008-05-30T19:48:00.851-07:00

Mr W, a first-break schizophrenic in his twenties, had looked just terrible on initial presentation.  Flat, near-mute, meeting all efforts to initiate discussion with "No comment," or just a hostile wall of blankness.  Gradually the medications began to work their magic and he became more able to relate to others; but he continued to refuse to discuss his symptoms.  He kept it all inside until

schlockdocnoreply@blogger.com0tag:blogger.com,1999:blog-326892696695174316.post-48359307718680428302008-05-30T18:38:00.000-07:002008-05-30T19:01:44.557-07:00

I found out for myself, again, the hard way, why 'professional boundaries' are so important.  Cardinal sin - I hugged a patient.  Should have thought twice, then twice again.  He was a thin wreck of a heroin junkie with wise sad gentle eyes behind scholarly horn-rims, sunken cheeks fuzzed with gray stubble, yellow horse-teeth in an occasional bitter laugh.Strange how some patients leave me

schlockdocnoreply@blogger.com1tag:blogger.com,1999:blog-326892696695174316.post-23593032093110847052008-05-30T18:31:00.000-07:002008-05-30T18:34:52.069-07:00

What a vast wreckage of human potential this senseless, endless war has brought.  These boys must have been so sturdy and shining, all big grins and lanky muscles; elan and eagerness; brawn and bravado; going somewhere  Now they recount their grisly everydays in beaten voices, giving no special emphasis to the horrors that became as nauseatingly familiar to them as weak tepid OJ in the glaring

schlockdocnoreply@blogger.com0tag:blogger.com,1999:blog-326892696695174316.post-66306352693788573662008-05-27T13:58:00.000-07:002008-06-08T12:26:09.640-07:00

Mr G, a gentleman in his sixties with an engaging manner and a professional degree, had never set foot in a psychiatric unit until today.  Bald and avuncular, with a rich white beard and a mischievous wink, he had a bit of a drinking problem and some deep-buried scars from his time in Vietnam.  But nothing else really, none of the 'meat' of inpatient psychiatry (schizophrenia, schizoaffective,

schlockdocnoreply@blogger.com0tag:blogger.com,1999:blog-326892696695174316.post-85084338126303575682008-05-27T13:23:00.000-07:002008-06-22T17:33:58.918-07:00

The unspoken derives its power from its very mystery.  To make explicit is to deprive of power. The psychotic patient knows this, perhaps better than we.  Psychotic patients often seem in touch with a deeper, animal reason. Mr. B. behaved like nothing so much as a cornered animal in the locked psychiatric unit.  Behind closed doors, he admitted his demons to his worried mother, who relayed them

schlockdocnoreply@blogger.com0