How a Physicist Helped Create a Psychiatrist I was anxious as an adolescent. I was 15 years old and had no idea what I was going to become in the future. In truth, I had some suspicions, but these were dreams and did not seem likely to come to fruition, ever. Moreover, my older brother, 2 1/2 years my elder, was already an accomplished scientist, as it were. He had spent many years learning chemistry on his own, and  had already taught chemistry to his high school class as a kind of adjunct teacher on weekends. His career path was already in cement. I, on the other hand ,had no future guideposts to speak of. One particularly anxious evening, I went to see my brother in his garret bedroom. He and I were quite close throughout our childhood. I looked to my older brother as a teacher and as a guide. I shared with him my angst over a future I could not begin to discern. He listened supportively, but said little until I was done with my catharsis.
Myself, My Patients, and COVID-19 Several patients of mine, as well as friends and associates, have been asking how others I treat are reacting and responding to the current COVID-19 pandemic. This is what I see. To gain perspective, this is being written five weeks into the stay-at-home orders of the state governments. Only workers deemed essential are allowed to leave home for places of work; all others are either working from home on-line or they are temporarily or permanently unemployed. Unemployment rates are soaring quickly, the economy is headed for a major recession if not a full blown depression, and many here in Pittsburgh are frightened by the mismanagement crisis in Washington.                                                                                                                              We are still early in the game. It appears we will be dealing with massive disruptions for months if not years to come, until and beyond the date of an effective
                                                              Joints and Gender My training as a psychiatrist taught and emphasized the skill of being what I would call a human ethologist. We were to be keen observers of human behaviors, emotions, and motivations, the three pillars of what defines the world of human psychology, much as Jane Goodall observed and studied chimpanzees in Africa. In retrospect, our program at the University of Colorado was exceptional in this regard. I cannot NOT be a human ethologist anymore; it's in my blood. In my daily office practice, I get to observe many people, more than half of them women. Aside from monitoring their psychological presentations, one cannot avoid their physical gestures as well. I have been struck by how very much women's joint ankles differ from those of my male patients. Indeed, I have also witnessed these differences in all non patients as well. I shall attempt to describe these differences in writing rather than
                                                                                                Dreams I had a dream one week ago. In it, I had returned to medical school at NYU as an adult. It was the first week of classes. The first course, taking up the first half of the week, was in hypertension. I was sitting in the second course, on rehabilitative medicine, next to a student I had been jealous of 45 years ago. He suddenly put on his baseball cap, and cracked a joke which made me laugh even in the dream. He said he needed to look good for the nuns who had just into the back of the classroom. I remarked to myself how very clever and smart he really was, unlike the negative attitude I'd had for him previously. After class, I walked in the hallway with a female peer who was sitting on my other side in the class. I uncharacteristically put my arm around her in a friendly manner. I felt a little more accepted in medical school than I had been years earlier. Upon awakenin
The Arc of Psychotherapy: What is Personality? What Are Personality Disorders? Most people are not familiar with the process of psychotherapy. To non-professionals, psychotherapy may look like a lot of hocus pocus with little clarity or focus. Because of this I thought it would be useful to publish a series of case studies in several therapies that I've been privileged to perform. I will outline, in clear and concise detail, the specific problem which generated the therapy, the treatment course(the "arc"of therapy), and the therapeutic outcomes.  I  will comment on some of the theory and techniques employed in psychotherapy. I hope, thereby, to demystify an otherwise arcane process, and to demonstrate how it can lead to important changes in thoughts, feelings, and behaviors. But first, some basic understanding of the underlying biology of personality. We are all born with differing temperaments. When I was a medical student at NYU, our attending, not a psychiatr
Psychotherapy Part I: Is It for Real? Does it Work? What Do I Look For? Psychotherapies work, and work well. They are gaining ever more attention and prominence, even in the world of medicine. In Part I will discuss personality, personality disorders, and the variety of "talking therapies" to treat them. Medical and medication therapies are outlined in other posts. The question of how therapies achieve their goals, their mechanisms of action, are touched upon here, but will be elaborated more extensively in Psychotherapy: How Does it Work?  Part II Let's begin with some basics. Even before we consider psychotherapy, we need to ask: What is the "psych" in psychotherapy, This is Greek  for "mind," such that psychotherapy refers to treating the mind. What functions constitute mind? Simple. All thoughts, feelings(emotions) and behaviors fall into the realm of psychology. Moreover, though less intuitively, most thoughts are themselves connected in t

Upside Down Medicine

What Happened to  Medica l CARE? : Upside Down Medicine                                                   I was recommended to visit a well-regarded foot surgeon for repair of a dislocated toe, likely incurred while running. At the initial (and only) appointment with him, I was kept waiting 3 hours. When he arrived, he was followed by his surgical residents, and for much of the 15-minute appointment, the surgeon directed his comments to them rather than to me. I did not see him at the surgery center either before or after the surgery. Indeed, I never saw him again. Immediately upon arousing from anesthesia, I was instructed to get up and was placed on crutches after just  5 minutes of training. I was so dizzy I could barely hold myself upright, and struggled extensively with the crutches. I was  nonetheless ushered out the door within minutes. When I arrived home, my foot, still numb, brushed a stair up to the mudroom. The stitches opened, and my wife whisked me to the an ER for a r