Archive for August, 2010
The Texting Shrink
I like texting. It’s a fast and efficient way to exchange information, and I’m a bit prone to yakking, so this allows for a no-nonsense exchange without all the gabbing about how the kids are doing or the latest on someone’s ingrown toenails, or the usual assortment of small talk items. Running late, order my salad. Yes, Bobby can get a ride home with us. Or, if you’re Roy: “do you have triple sec for the mango margaritas?” Roy makes surprisingly good mango margaritas without using any triple sec. Just so you know– and I don’t mean to brag– I’m fast with the thumbs.
I text with patients as well. Do other psychiatrists do this? It works well for “Need to cancel my session this week, see you next week.” Or “Running 10 minutes late, traffic.” Once in a while I’ll even text a reminder to someone who misses appointments frequently. I was happy to hear that there is a dentist in town who also sends text message reminders.
Here’s the problem with texting patients:
People have taken to texting me with problems. “I feel horrible and like I might want to end it all right now.” (This did not really happen). I’ve done a few back and forths and realized that I’m not good at psychotherapy via text. Usually problem texts get met with “Come in at…..” and if …. is not Very Soon, or if the patient says that’s not good, I call, or text “call me.” I’ve been texted insurance information, drug reactions, appointment changes, negative biopsy results, “will you call refills in to my pharmacy?” and most notably, “Your office door is locked” after I haven’t responded to the knocking, only to find my patient sitting on the hallway floor.
What’s good about it? Somehow it feels less intrusive than a phone call, and the time taken up is more predictable. I’m prone to ramble and so are many of my patients– texts messages take seconds and phone calls can take minutes and involve many phone-tag back-and-forth exchanges. When someone texts their pharmacy number, I can click on it and get through–if it’s on voicemail, I often have to re-listen when I have a pen available, and often the number is at the end of a long message. It seems to me that texting is no less documentable than a phone conversation, so I can’t come up with any legal reasons it’s not kosher.
What’s bad? I have taken to telling patients that while I’m happy to try to negotiate appointment times via text, or “running late” messages, that it’s not a good way to negotiate problems– for drug reactions and symptom changes, we should start with the phone. My biggest concern is that if I’m on vacation, there’s no way to set a coverage text message, and my voicemail has the names and numbers of covering doctors. I’ve been pretty clear with people that I’m not blowing them off, and that if they don’t get quick reply to a text message, they need to CALL the office.
What do you think? It’s a different take on the shrink when there’s nearly instant access a good deal of the time.
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Posted in First Medical Marijuana, now Healthy Hallucinogens?
Last week’s article in Science looked at the effects of the anesthetic/dissociative drug ketamine (“vitamin K” or “Special K” on the street) in brain cell function in rats, concluding “that ketamine might be useful in treating depression because it increases brain activity instantly – so there is no need to wait weeks or months for the drug to take effect.“
Another article from Nature Reviews Neuroscience reviewed the state of the art in psychedelic science and found that “countless studies show that hallucinogens promote healthy neural activity in the brain. The researchers also created a chart to show what test subjects’ states of mind are, according to studies, when under the influence of various substances.“
Go to Lanny-Yap (great site!) for links to the articles.
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What’s Next?
Cut and Paste. I don’t know what to say. Oh my.
In tomorrow’s New York Times, Lisa Miller will write “Remembrances of Lives Past“
IN one of his past lives, Dr. Paul DeBell believes, he was a caveman. The gray-haired Cornell-trained psychiatrist has a gentle, serious manner, and his appearance, together with the generic shrink décor of his office — leather couch, granite-topped coffee table — makes this pronouncement seem particularly jarring.
In that earlier incarnation, “I was going along, going along, going along, and I got eaten,” said Dr. DeBell, who has a private practice on the Upper East Side where he specializes in hypnotizing those hoping to retrieve memories of past lives. Dr. DeBell likes to reflect on how previous lives can alter one’s sense of self. He, for example, is more than a psychiatrist in 21st-century Manhattan; he believes he is an eternal soul who also inhabited the body of a Tibetan monk and a conscientious German who refused to betray his Jewish neighbors in the Holocaust.
Belief in reincarnation, he said, “allows you to experience history as yours. It gives you a different sense of what it means to be human.”
———————-
I’d comment, but I don’t know what to say.
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The Bickering Friend
Everybody probably knows someone who likes to debate. If you say one thing, they’ll say something different just for the sake of having a discussion and engaging someone. It’s a relationship thing, like talking about the weather. Nobody really cares if it’s sunny or too hot or if there’s a storm approaching, it’s just a way of maintaining a connection. For some people, bickering serves the same function.
I appreciate a good debate occasionally because this keeps me sharp mentally. When someone tells me I’m wrong I question my assumptions, do some homework and learn something. My bickering friend learns something too (I hope). If the debate goes on too long or gets uncomfortable, I disengage or admit that I’m too tired to continue. It’s not a big deal. People who maintain relationships with bickerers can’t be too sensitive. There’s nothing personal about it, it’s just a way of life.
And by the way, Dinah was right: the period goes inside the quotation marks. Dinah effectively affected a change in my writing affectation. Can you guess what her writing quirk is??
Affectionately yours,
Clink
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I Speak Your Language
In spite of crime-solving TV shows like the CSI series, as a forensic psychiatrist I know that real life is much more mundane. Although I get to interview lots of interesting folks, most of the work involves writing extensive reports (or editing the reports of others). And just when I think I’ve got my writing skills down pat, a copy editor comes along to prove otherwise.
Dinah, Roy and I spent several hours together this week going over the proof of our book. We reviewed our editor’s corrections and quibbled about our own. I discovered that Dinah had learned rules of grammar that I had never heard of, and that some of the truisms I learned no longer applied. Language is like that.
Fortunately, as children we pick up grammar and syntax without any conscious awareness. Certain sentences or phrases just naturely “sound right” because they get built into our brains somehow. We speak the language and vocabulary we hear, and we write the way we speak.
This is a problem when you live in Baltimore. Every day I get exposed to Baltimore urban vernacular. In this city people don’t get beaten up, they get “banked.” They aren’t relaxed and happy, they’re “chillin’.'” They aren’t merely annoyed, they’re angry “for real.” And they don’t lose their tempers, they “zap out.”
In my clinical practice it helps to speak my patients’ language. If my patient tells me he “caught a hopper”, I know he doesn’t like his young and restless cellmate. If he asks me for help with an “8-505″, I can explain the legal process for doing this. I am unexpectedly multilingual through the coincidence of where I live and work.
I just have to remember not to write like that or my editor will “zap out for real.”
***************
Dinah adds:
OMG! I can’t believe we wrote an entire book together and you’re still putting the periods outside the quotation marks! Shoot me now. From Grammarbook.com:
| Rule 1. | Periods and commas always go inside quotation marks, even inside single quotes. | |
| Examples: | The sign changed from “Walk,” to “Don’t Walk,” to “Walk” again within 30 seconds. | |
| She said, “Hurry up.” | ||
| She said, “He said, ‘Hurry up.’” | ||
********************************
Clink responds:
Life is never that easy. See discussion here and here. Nevertheless, I changed them.
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Very Little Very Sad People
I thought I’d give you a heads up that The New York Times Magazine will be featuring an article on Preschooler Depression this weekend. I am working on my ability to see into the future, and it’s going well.
Pamela Paul will write:
Diagnosis of any mental disorder at this young age is subject to debate. No one wants to pathologize a typical preschooler’s tantrums, mood swings and torrent of developmental stages. Grandparents are highly suspicious; parents often don’t want to know. “How many times have you heard, ‘They’ll grow out of it’ or ‘That’s just how he is’?” says Melissa Nishawala, a child psychiatrist at the New York University Child Study Center.
And some in the field have reservations, too. Classifying preschool depression as a medical disorder carries a risk of disease-mongering. “Given the influence of Big Pharma, we have to be sure that every time a child’s ice cream falls off the cone and he cries, we don’t label him depressed,” cautions Rahil Briggs, an infant-toddler psychologist at Children’s Hospital at Montefiore in New York. Though research does not support the use of antidepressants in children this young, medication of preschoolers, often off label, is on the rise. One child psychologist told me about a conference he attended where he met frustrated drug-industry representatives. “They want to give these kids medicines, but we can’t figure out the diagnoses.” As Daniel Klein warns, “Right now the problem may be underdiagnosis, but these things can flip completely.”
It’s long. Just say, “I saw it at Shrink Rap first.”
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Emotion versus Mental Illness
My favorite commenter, “Anonymous,” wrote in to my Duckiness post to say that it was good I could post something totally silly without being told I need more meds. Oh, if life were that simple. And it is true that once someone has a diagnosis of bipolar disorder, not only does the world question their emotions in a black & white “are you sick again?” kind of way, but patients don’t trust themselves to feel for it’s own sake.
If you’re not sick, then being asked if you took your meds is insulting and degrading. And so I thought I’d put together some guidelines for Emotion versus Mental Illness. I’m inventing this as I go, with no evidence-based anything, so take my suggestions at your own risk.
- If you are ultra-successful, rich, brilliant, gorgeous, famous, and comfortable with your diagnosis, you may want to consider telling people you have a mental illness because it decreases stigma and people like being with the ultra-successful rich, famous, brilliant and gorgeous and won’t care that you have a mental disorder. It helps even more if you’re charming.
- If you’re not ultra-successful, you may want to pick and choose who you tell that you’ve been ill and are on medications. This isn’t always possible, especially if your illness is evident to others or if the presentation of your symptoms resulted in a hospitalization. It’s good to tell close family members.
- If multiple people are looking at you strangely, or commenting on your behavior, or saying you need medications, you might want to at least entertain the option that you could be sick. Unfortunately, poor insight and judgment are symptoms of mania.
- Tell the people close to you not to make medication jokes. It confuses the issue if you seriously do need medication changes, and it’s rude, degrading, dismissive, and disrespectful. There, I said it.
- If you want to be silly, go for it. Be silly when you’re well so that being silly is part of your baseline personality and no one equates this with being out-of-character. You’ll note the duck invaders did not come after me, rather they said, “There’s Dinah posting yet another stupid duck post.” If I’d posted about why chocolate should be outlawed and made into a controlled substance, those same duck invaders would be asking “What’s wrong with Dinah?”
- Mental illnesses come as constellations of symptoms. There is no “Sending out silly duck stuff” as a symptom. People think about mania when the ducks are combined with more energy, racing thoughts, a decreased need for sleep, increased mood OR irritability, and other symptoms of mania. Know the list and if someone bothers you, say, “I posted about ducks, I do not have any other associated symptoms.” Recite them if necessary. If you do have the other symptoms, refrain from posting about ducks. I don’t want Posts Duck Blog Posts to show up anywhere in DSM-V and these days you just never know.
- No one controls how any other person thinks of them or judges them and it’s not reasonable to live life ruled by a desire to be perceived in a certain way . It’s another form of poultry, but Don’t Let the Turkeys Get You Down. There are a lot of turkeys out there.
Moods happen on a spectrum. Some people have large variations in their mood—large enough or severe enough such that it causes suffering, and we call it an illness. Some people don’t have much variety to their moods and live in a calm, even-keel place, and it’s great that we have such people. But, I absolutely promise you that if we lived in a world where everyone had a very narrow range of mood, this would be one terribly boring planet. We should celebrate our diversity, not condemn those who like ducky stuff.
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My Favorite Lawsuit
Clink note: There are certain cases that are just fun to read. This is one of them.
JOGEZAI KAKAR KHAN, Plaintiff, v. WILLIAM SESSIONS, Defendant.
No. C93-04394 CW
UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF CALIFORNIA
1994 U.S. Dist. LEXIS 1385
February 7, 1994, Decided
February 8, 1994, Filed
CORE TERMS: forma pauperis, intelligence, prostitution, kidnapping, software
JUDGES: [*1] WILKEN
OPINION BY: CLAUDIA WILKEN
OPINION
ORDER DENYING PLAINTIFF’S APPLICATION FOR IN FORMA PAUPERIS AND DISMISSING COMPLAINT
BACKGROUND
Plaintiff’s complaint alleges a vast conspiracy involving, among others, named Defendant William Sessions (former director of the FBI), former President George Bush, the Queen of England, the Consulate of France, French President Mitterand, the San Francisco Chronicle, several university professors, gangs in Hong Kong, the drug cartel, CIA agents, U.S. Army Intelligence agents, British government agents, former British Prime Minister Margaret Thatcher, H. Ross Perot, Israeli corporate intelligence “consultants,” Paul Newman, Kirk Douglas, Frank Sinatra, John Carradine, Dennis Hopper, Robert Mitchum, Orson Wells, Phil Donahue, the founders of Israel, the “Jewish Mafia” in Russia, U.S. Postal employees, a “humanoid alien extra-terrestrial leader speaking Greek,” Oliver North, and several local people known and unknown to Plaintiff, including hypnotherapists who advertise in local papers.
Plaintiff brings the action for concealment, false information, fraud, threats to commit a violent act, racketeering and treason. Specifically, he alleges that the people [*2] named above acted separately and together to accomplish the following: false processing of computer chips, or software, containing dangerous elements to endanger the life of users; the shooting death of Pablo Escobar in Columbia; placement of a former political prisoner high up in the Pakistani government to conceal secret sales of computer software parts; the poisoning death of Plaintiff’s father (whose death was attributed to heart attack), allegedly a witness to illicit shipments of oil and petroleum products; covert prostitution at local utility companies; the theft of Plaintiff’s father’s luggage in New York city in 1953; operation of various prostitution rings, and related blackmail, murder, kidnapping and torture of American and foreign women and girls, including forced transsexual operations; withholding of Plaintiff’s letters to George Bush, and issuing false receipts for mail; trafficking in various drugs, human blood and body parts for witchcraft and human sacrifices; electronically bugging Plaintiff’s residence; bribing university personnel; the sale of a major American airline to a British company; participation in a “Traitor Spartan Greek club co-opting Persian habits [*3] and Golds since 478 B.C.”; planning and participation in the Polly Klaas kidnapping through using remote channellers in alleged kidnapper Davis’s home; use of UFO-like aerial objects to wire remote-control or radio-in false signals to the human ear and brain using planted electronic devices; and entrapment and framing of California State Assemblymen and U.S. senators (for unspecified crimes).
Plaintiff seeks leave to proceed in forma pauperis.
DISCUSSION
Title 28 U.S.C. Section 1915(d) authorizes federal courts to dismiss a claim filed in forma pauperis prior to service “if the allegation is untrue, or if satisfied that the action is frivolous or malicious.” Under this standard, a district court may review the complaint and dismiss sua sponte those claims premised on meritless legal theories or that clearly lack any factual basis. Denton v. Hernandez, 118 L. Ed. 2d 340, 112 S. Ct. 1728, 1733 (1992); Neitzke v. Williams, 490 U.S. 319, 324, 104 L. Ed. 2d 338, 109 S. Ct. 1827 (1989). A finding of factual frivolousness is appropriate when “the facts alleged are ‘clearly baseless’ . . . a category encompassing allegations that [*4] are ‘fanciful,’ ‘fantastic,’ and ‘delusional,’” Denton, 112 S. Ct. at 1733 (citations omitted), or “rise to the level of the irrational or the wholly incredible. . .” Id.
Plaintiff’s allegations clearly come within this doctrine.
CONCLUSION
Accordingly, Plaintiff’s request to proceed in forma pauperis is DENIED and the complaint is hereby DISMISSED without prejudice.
The clerk shall close the file.
IT IS SO ORDERED.
Dated: February 7, 1994
CLAUDIA WILKEN
UNITED STATES DISTRICT JUDGE
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Too Much Duckiness to Ignore.
Let the facts of the case present themselves:
In the early pre-dawn morning (approximately 4:00 a. m.) of June 18, 1972, the windshield of the automobile which appellant was driving along North Columbia Boulevard in Town X, suddenly shattered causing a splinter of glass to enter Smith’s right eye, which resulted in permanent impairment of sight in that eye. Investigation proved that the cause of this unfortunate mishap was that Smith’s car had struck an airborne mallard duck or conversely that the mallard had struck Smith’s car. The rationale for this conclusion was the finding of the body of a deceased mallard at the scene of the accident and duck feathers and other parts inside car. The question of negligence, or the degree thereof, attributable to the only participants involved in the accident, namely, the mallard and Smith, is not before us.
The scene of the accident was that portion of North Columbia somewhat adjacent to the plant of defendant-appellee, Malarkey Company (Malarkey). Since Smith is a citizen of Washington, Malarkey is an Oregon corporation and the amount in controversy exceeds $10,000, the federal courts have been chosen as the forum in which Smith seeks recoupment for his injury.
His complaint, a model of brevity, contains two counts: (1) negligent maintenance of a duck pond on the Malarkey property, near North Columbia, a public thoroughfare; and (2) creating thereby an unreasonably dangerous condition to the public using that thoroughfare.
After several unsuccessful attempts by Malarkey to dispose of the matter by motions to dismiss for failure to state a claim, for partial summary judgment and for summary judgment, the case came on for trial before the Court without a jury. Subsequent to the trial, the Court delivered its opinion1 finding for the defendant.
The Court refused to conclude that the maintenance of the pond by Malarkey was an “ultra-hazardous activity” and referred to parks and places, public and private, in the vicinity where waterfowl might congregate. As to negligence, the Court held that there was “no showing that the defendant knew, or reasonably ought to have known”, that such a pond “was likely to lead to harm of the general character involved in this case” or that the fact that dead ducks had been found on the highway was notice to Malarkey that ducks were a hazard to motorists. In short, the Court could not find “the vital element of foreseeability” in relating the Malarkey pond to the accident. Accordingly, judgment was issued dismissing the complaint.
Plaintiff called as witnesses persons who, while driving along North Columbia, near the Malarkey property, had seen dead ducks at the side of the road, ducks walking across the road, ducks sitting in the middle of the road and ducks flying at low levels across the road. In one instance, the front of a motorist’s car had struck a duck, with unfortunate consequences for the duck. If ducks chose to walk across a well-traveled public highway used by motorists instead of using less dangerous aerial routes better suited to flying ducks, they might well have subjected themselves to such an eventuality. The roadside dead ducks certainly indicated that motorists were a hazard to road crossing ducks, but by no means that such ducks would be likely to be the cause of the type of injury incurred here. Furthermore, even if it had been, one would have expected the record to have been replete with incidents of ducks crashing into motorists with notice thereof to Malarkey.
Appellant also adverts to the Malarkey habit of putting food and grit around the pond about 4 o’clock in the afternoon and argues that even if the pond itself was not the well-spring of the dead duck’s conduct, Malarkey was still culpable because of these other lures with which it seduced the birds to come to the pond. However, once again, even assuming appellant’s premise that mallards find food and grit irresistible, there is no way of knowing whether the Malarkey provender was the aim of this duck’s low trajectory. And there is no evidence which would indicate that the duck was in the area for a midnight snack twelve hours ahead of schedule or that the pond was the duck’s intended destination. Further speculation along these lines would be pointless. But even if this feeding practice caused an undue assemblage to partake of Malarkey largesse, it would not account for the unexpected flight of a single duck in pre-dawn darkness. Furthermore, the pond was 100 yards from the highway, surrounded by a seven foot fence with railroad tracks between highway and pond.
The area is a game reserve and should be naturally attractive and conducive to migratory birds. In addition to the parks and open areas previously mentioned, there is somewhat nearby the Columbia River, the Columbia River Slough and green fields where ducks have been observed to congregate and feed.
The waters of the Malarkey pond might well be said to be alluring to ducks but by no stretch of the imagination is the maintenance of an artificial pond an ultrahazardous activity or a foreseeable cause of an injury of the unusual nature suffered here. The activity is neither abnormal, unusual, or especially dangerous see, Reter v. Talent Irrigation District, 258 Or. 140, 482 P.2d 170 (1971) at least not in an area which is already rife with waterfowl and water.
Appellant says “Nothing short of removal of the pond could eliminate the risk” (Appellant’s Brief, p. 6). But query, would elimination of Malarkey’s rather minute pond remove the risk? Complete protection of motorists might well require the elimination of the game refuge, the surrounding green fields, the Columbia River Slough and possibly the diversion of the Columbia and Willamette Rivers as well, if flying ducks were to be recognized as a constant peril to motorists.
The parties here both have proceeded in a well-accepted format of argumentation, namely, an almost biological analysis of cases and the Torts Restatement. They have dissected and then put under the microscope each and every element stated therein. Tort cases, however, so much dependent on their own particular facts, are not suited to such treatment. The Trial Court here heard and reviewed the evidence presented and then, in finding for the defendant, held that the maintenance of the Malarkey duck pond was not an “ultra-hazardous” activity and that the type of accident here suffered was not foreseeable. The law and the facts support this conclusion.2
Judgment affirmed.
Honorable Leonard P. Moore, Senior United States Circuit Judge, Second Circuit Court of Appeals, sitting by designation
The oral opinion dated March 14, 1974 has been transcribed as an opinion, filed as findings of fact, and conclusions of law and order pursuant to Rule 52, and is to be found at pages 149-155 of the record on appeal
There is an indication in the record that the Judge and counsel planned to visit the Malarkey property on the afternoon the trial ended, thus giving the Court and counsel the advantage of visual inspection
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The Psychology of Survival
This story resonated with me because lately I’ve been hearing a lot about a new book, No Way Down, which was featured on NPR along with some other mountain disaster books. No Way Down covered the story of several teams of mountain climbers who were stranded on K2 when an icefall cut their ropes. Most of the climbers died although a few managed to pick their way back to base camp.
Survival stories have always been popular. Entire television series now feature teams of people pitted against one another to overcome some test or challenge. Disaster movies were popular back in the ’70s, when the Towering Inferno, Airport and the Poseidon Adventure let us watch people get picked off one by one.
Why do we love this stuff?
I think it’s because these stories reflect humanity’s greatest strength, the power of adaptation. Whether we’re talking about natural disasters, accidents, the exploration of Colonial American wilderness or longterm science expeditions to Antarctica, the psychology of survival is fascinating because we like the idea that one’s mental attitude can make the difference between life or death.
A search of Amazon reveals a surprising number of books about survivor psychology. Most focus on outdoor adventurers, but others were based on interviews with survivors of accidents like plane crashes or fires.
The survivors in these books lived because they were trained and experienced in outdoor living. They weren’t “survivalists” per se, people who stockpiled food and weapons for the future fall of civilization. These survivors were people who were able to stay calm and reason in the face of fear, people who retained their optimism and determination in spite of great odds. Survivors focussed on others rather than themselves, either thinking about their families or their fellow survivors.
Sitting in a prison cell for several years seems like nothing compared to surviving a high altitude mountain disaster, but I think there are some principles that apply in both cases. The prisoners who do well are the ones who are future-oriented and determined to “work the time” for self-improvement. They have external family they care about and plan to return to. And yes, previous prison experience helps too.
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