New York City Memories

The recent New York Post story about the man who shoved a 76-year-old retired schoolteacher down a flight of subway stairs caught my attention.

The assailant had been sent to Bellevue for a court-ordered psychiatric assessment for similar agitated behavior not long before this assault. My understanding from news stories is that he was held for a day or so and released. Shortly after his release, he killed someone.

There were statements made by psychiatrists who decried the decision to release the assailant so quickly, given his history of repeated attacks.

This reminded me of an incident a little over 25 years ago when I was an assistant professor of psychiatry at the University of Iowa attending a short course in administering electroconvulsive therapy (ECT) for a study of continuation pharmacotherapy for preventing relapse following ECT at New York State Psychiatric Institute (NYSPI) at Columbia University. It was published in 2001 in JAMA although I was not a coauthor, of course, given my limited role:

Sackeim HA, Haskett RF, Mulsant BH, Thase ME, Mann JJ, Pettinati HM, Greenberg RM, Crowe RR, Cooper TB, Prudic J. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001 Mar 14;285(10):1299-307. doi: 10.1001/jama.285.10.1299. PMID: 11255384.

It was my first visit to New York and while there were a lot of sights to see (I took one fascinating Gray Line bus tour), my main goal was to complete the ECT training at NYSPI, which was scheduled for 2 or 3 days. I passed with flying colors and my training staff members threw me a little party with wine and cheese in an office with a giant window giving us a splendid view overlooking the Hudson River.

However, the memory is clouded by a scary incident on the New York subway, which I used to get from my hotel to NYSPI. One morning, when I was packed in the car with many other riders, a very agitated man got on who started to yell incoherently in everyone’s face—including mine. It was impossible to tell exactly what he was upset about, but he was apparently psychotic. He moved from person to person, got right in our faces and spewed gibberish and curses about something nobody could make sense of. He seemed right on the edge of attacking somebody.

I watched him move from one passenger to another. His behavior was the same with each one. He would get within an inch of their noses and shout at them. Not one of them reacted. They seemed eerily calm. They never made eye contact. I was afraid that, sooner or later, he would blow his top because they were ignoring him.

He got to me and yelled in my face and I just copied what everyone else was doing. I assumed a blank expression and didn’t look him in the eye. He practically screamed “Look at me!” For a split second, I thought he would try to hurt me. But he didn’t. He just moved on to someone else. I was so relieved when I reached my stop and got off.

I can’t clearly recall whether I spoke to my staff at NYSPI or not. I must have. I have a dim memory of one of them telling me that all of the people on the subway were doing the right thing by ignoring the man. I could not understand how anyone could ride the subway every day and tolerate that kind of confrontation without reacting. It’s kind of like an animal freezing, almost like an opossum’s response to a threat. Play dead.

But the opossum’s reaction is an involuntary reaction to extreme fear. It’s a catatonic state, which is kind of ironic because psychiatrists use ECT to treat catatonia in humans.  I don’t want to give you the impression that New York is all bad. Sena and I had a great time on vacation there around 9 years ago. But humans ignoring danger in their faces is not involuntary in situations like what happened on the subway 25 years ago. It’s a calculated risk, a decision to ignore threats. Twenty-five years later, it looks like New York hasn’t changed.

Getting Enough Sleep for the Most Important Person in the World: You

So, what’s on the menu for Mental Health Awareness today? It’s what some experts call sleep hygiene and there are all kinds of lists on the internet telling you how to get enough sleep.

I think you’re OK with focusing on helpful tips that seem right for your age, your temperament, and your life and work setup. I’m going to focus on my age group. I’m a retired psychiatrist in my 70s and maybe AARP is a good place to start for me.

This reminds me. I’ve looked at several lists of sleep aids on the web. Everybody has a list. You know what I notice? Nobody has a list including what to do about a snoring bed partner. We’re on our own here and I don’t have a one size fits all solution. I’ve even blogged about how this is a challenge in our life. Eventually we opted for separate bedrooms. I don’t think it helps to keep this topic taboo and not being able to find solutions for snoring on a list of options for dealing with insomnia is too bad. Psychiatrists have a word for this—denial.

OK, so AARP’s list is otherwise reasonable. Oh, the other thing I need to mention which many people younger than I am might not think of is some kids couldn’t take a nap during rest time in kindergarten. I guess kindergarten still exists as a grade level prior to first grade. It was the only one in which nap time was compulsory. I flunked it. My teachers could not understand that. So, I started out being an insomniac early in life.

Anyway, AARP has 8 tips on the list for sleeping better:

  1. Fret strategically: OK, I admit I’ve been a worrier ever since kindergarten when I could not take a nap when the teachers demanded it. I seemed to get into situations that increased the risk for worrying and insomnia, like going to medical school, residency, and beyond. Actually, because I was born an insomniac, I did OK on call in the hospital—except on slow nights. I was always vigilant for the pager to go off. The first night I was on call on the medical-psychiatry inpatient unit, I didn’t sleep a wink all night. My problem was I fretted non-strategically. I was always worrying about what I was going to do when (not if) a patient with serious acute medical problem and delirium hit the unit. But now that I’ve been retired and I’m never on call—I still have trouble sleeping.
  2. Wind down together: Sena and I do something a little like that although we like to watch different kinds of TV programs in the evening. That’s why we have two TVs. She tends to flip channels a lot, while I tend to stick to one or two channels. We’re not necessarily on the same page when it comes to what to watch either. I watch Svengoolie movies which comes on MeTV (short for Memorable Entertainment Television), which is a network for older folks. Don’t you hate that word “folks”? No? You must be younger than me. It hardly makes a difference what you watch on TV. In a typical hour-long show, after every 10 minutes of program, you get interrupted by about 5 minutes of 8-15 inane commercials. Sometimes the volume of the commercials gets a lot louder. Bottom line here is that I think the suggestion of complimenting each other in the evening is a great idea. It’s better than watching anything on TV.
  3. RISE and shine: The acronym RISE stands for: R to refrain from hitting the snooze button; I means to increase your physical activity level; S to splash your face with cold water, and E to expose yourself (Hmmm, no, wait that’s wrong; that could get you arrested). It’s actually E to expose yourself to sunlight. At first glance, this seems counterintuitive for helping you sleep, but the idea is to get energized right away in the morning and to stay that way until you drop from sheer exhaustion.
  4. Here comes the sun: Trying to get enough natural sunlight can be challenging but it’s important to get you set in the cicadian rhythm. Oops, that would be the rhythm of the cicada, which is a bug that spends most of its life underground and comes up every 13 years or so to drive people nuts with an incessant buzzing noise that keeps you awake. What I mean is the circadian rhythm, the 24-hour cycle which keeps you awake during the day and asleep at night.
  5. Appreciate yourself: Try to focus on who appreciated you and expressed gratitude to you. Forget this if you live in New York City. You need to stay alert because any second someone could try to shove you into the path of an oncoming subway car. Actually, gratitude is a real thing and letting yourself welcome this gift could help you sleep better at night. It could also make you happier during the day.
  6. Can’t sleep? Get out of bed: It’s really common to just lie in bed and maybe try counting sheep or Meerkat turds, but that won’t help you sleep. You need to leap out of bed and do some powerlifting! No, don’t do that. Try sitting up and reading for a while, something that will be dead certain to put you to sleep in seconds, like Robbins Pathologic Basis of Disease textbook, preferably the 7-pound 3rd edition with 1,467 pages, which I had to slog through in medical school. No one should go unpunished.
  7. Consider your mattress: if your mattress is too soft or too hard it can interfere with sleep. On the other hand, there’s one more hazard. If you get a mattress in a box, and you don’t follow directions about unpacking it, that thing might just snap open and give you a concussion. The one we got for the snoring problem came with a warning note (and I am not making this up): “This mattress knows Kung fu and may unroll itself at lightning speed. Keep small pets and children free from its kick radius. Please be extra careful when cutting it free from its bindings.”
  8. Take baby steps: Don’t expect too much of yourself in changing your old habits too fast just to get a good night’s sleep, especially if you’re an old person. Remember what Benjamin Franklin said: “Sleep is overrated.”

Thank you for your time.

Svengoolie Show Movie: “First Men in the Moon”

Svengoolie Intro: “Calling all stations! Clear the air lanes! Clear all air lanes for the big broadcast!”

I thought the 1964 film, “First Men in the Mood” was a hoot, mostly because of the antics of Joseph Cavor (Lionel Jeffries), who could yell incessantly “Briggs!” more than a dozen times, at the guy who was supposed to be watching the boiler where the Cavorite anti-gravity substance was cooking but instead was drinking beer and playing cribbage with the other two laboratory workers.

It’s still not clear to me why Kate Callendar (Martha Hyer) insisted on pronouncing “Cavor” with a long A (Kayvoar) while Cavor and Edward Judd (Arnold Bedford) pronounced it with a short A (Kavoar). Whatever.

Anyway, the movie was based on H.G. Wells novel, “The First Men in the Moon) published around 1899, which I tried to read last week on both the Internet Archive and the Gutenberg Project but because the Internet Archive version kept restarting at page 40 every time I took a break and the Gutenberg Project version page setup was annoyingly wide and the warning about the requirement that you have to donate millions of dollars just to read the first 3 pages was so scary, I didn’t get far so I just read the Wikipedia summary.

The movie opens in the 1960s with modern astronauts landing on the moon without incident unless you count the problem with a non-functioning toilet and discovering a Union Jack flag along with note dated 1899 warning “Please hurry up the invention of Raid insecticide!” which wouldn’t happen until the mid-1950s. The rest of the film is Arnold Bedford’s flashback of the 1899 adventure which was actually the first moon expedition.

After Cavor, Judd, and Callendar enter the polyhedron-shaped spaceship and close the Cavorite-swabbed window shades, they blast off to the moon and eventually blunder into the underground hive of a large colony of insectoid beings Cavor calls the Selenites (derived from the word “Selene,” the name of the Greek goddess of the moon), and a synonym for “lunatic” which describes the ensuing adventure as well as the film itself.

Most of the Selenites resemble cockroaches and grasshoppers which Judd beats up at every opportunity over the objections of Cavor, who sneezes on them, giving the game away about the eventual outcome of the conflict. One creature is a giant caterpillar who menaces every other bug in sight until Judd moons it, making it shrink in embarrassment before turning into a monarch butterfly and then heads for South America. Long trip. Callendar fries the chickens she brought along for the trip from Earth and tries to feed it to the Selenites, which they refuse to eat without barbecue sauce.

Cavor is brought before Hopper, the head locust who figures out the best way to prevent any more humans from traveling to the moon is to hold him prisoner and make him paint all the minerals, including gold, a dull shade of gray and transmit telepathic messages back to earth making plumbers rewrite all the instructions for making toilets on spaceships so they work in reverse.

I think this movie is funny, so it deserves a Shrilling Chicken Rating of 3/5.

Shrilling Chicken Rating 3/5

Big Mo Blues Show Penultimate KCCK Party

John Heim, aka Big Mo of Iowa KCCK radio blues show delivered his penultimate program last night. I heard the “penultimate” title from Ron Adkins who announced it on his Afternoon Jazz show which comes just before the Big Mo blues show. It’s one of those adult words that Big Mo would probably never use—only he did last night. Penultimate means “next to last” and Big Mo’s last show will be next Friday. It’s hard to believe.

Big Mo dropped some gentle goodbye notes into his program. Among them was a shout out to local and national Blues artist Kevin Burt. He won the Acoustic Blues Artist award a couple of days ago at The Blues Foundation’s 47th Annual Blues Music Awards event in Memphis, TN. Congratulations to Kevin Burt!

We also really liked the music of Jimmy Thackery and the Drivers that Big Mo played. He praised the brilliant performance on the Stratocaster guitar evident in the number “Daze in May.” I almost didn’t find this tune because I thought the title was “Days in May” which at first made sense. Anyhow, Big Mo spelled it right. I’ve never looked up the Stratocaster on the web, but I did for the first time today. We like the tremolo.

There are a couple of ways to interpret the title “Daze in May.” One of them is an obvious connection to Big Mo’s upcoming retirement next Friday, May 15th, which will be his last show. And, I think there are a lot of Big Mo’s fans, including me, who are dazed that his long KCCK career in blues music broadcasting is coming to an end.

The other big feature of his show last night was a more colorful and detailed Shout Outs list—and I’ve always wondered if I was on it. Now I’m pretty sure I’ve been on it for a while. It turns out Jim the Shrink is probably me. He told a short anecdote about how he first heard from a guy who emailed him about where he could find MayRee’s hand-battered catfish. It really tickled Big Mo that he’d got “a clinical psychologist” to bite on this faux sponsor gag. That happened about 4 years ago.  He mentioned an idea he had about designing a tee shirt about MayRee. That led to me writing a blog post (my blog is Go Retire Psychiatrist) suggesting a design and making a fake picture of me wearing it. It never caught on, for some reason. But I made the Shout Outs list.

Ticks Among Us

I was struck by how much ticks and tick-borne illness is in the news lately, although it shouldn’t be surprising as it’s that time of year for people to be outside in the garden or the woods.

There’s a great podcast on Rounding@IOWA on tick borne illness that I thought was pretty interesting. I was also reminded of the time just last month I picked a tick out of my wife’s hair. That was the day she neglected to apply DEET.

The first 40 minutes of the podcast is pretty much for doctors and science nerds (not that there’s anything wrong with that!). But in the last 10 minutes or so there was excellent guidance for preventing tick-borne illness.

This tends to be really simple things like wearing DEET but also includes “nerdy” things like wearing really bright colored clothing (makes the ticks really stand out) and sticking your pant cuffs inside your socks, which makes it harder for ticks to find your skin.

Another interesting and helpful thing I learned from this podcast was that sometimes, if you find a tick on your skin and pick it off with tweezers within 24 hours, that may sometimes prevent illness from occurring in the first place.

Shout Out to Dr. Fawad Taj for Psychiatric Times Article on Cannabis and Psychosis Risk

I rarely see an article that impresses me as much as the Psychiatric Times piece on psychosis risk and cannabis by Dr. Fawad Taj, MD.

It makes sense that he is also a consultation-liaison psychiatrist. He’s on staff in the Dept. of psychiatry at University Hospitals of Cleveland. There is a highly esteemed scholar special to me in the department. She’s a former trainee of mine, Dr. Jeanne Lackamp, MD. In fact, she is currently Chair of the Dept. of Psychiatry at University Hospitals. I couldn’t be prouder. Way back in 2006, she was the resident sponsor nominating me for the Leonard Tow Humanism in Medicine award at University of Iowa Health Care.

Anyway, Dr. Taj’s point that today’s marijuana is not your grandfather’s pot is well taken. It’s far more potent than decades ago. He’s quotable:

“Psychiatry should also be able to hold 2 ideas at once. One can oppose overly punitive criminalization and still acknowledge that normalized, commercialized, high-potency cannabis exposure may carry real psychiatric consequences. Those positions are not contradictory. Responsible public health policy requires both. Cannabis may now be legal across much of the United States. It may be profitable, packaged, and culturally normalized, but it is not harmless.”-Dr. Fawad Taj.

Mental Health Affirmations for May 6, 2026

Today is May 6, 2026 and the Mental Health Awareness affirmation for today (from the Mental Health Awareness calendar) is about Affirmations:

“Affirmations can improve people’s overall well-being, help them feel better about themselves, and reduce anxiety. Pick a supportive phrase and repeat it today.”

I picked one from the list of suggested affirmations:

“I have the power to practice daily routines that nourish my physical and mental health. As I do so, I won’t forget that rest, connection, and stillness are pivotal pieces of those routines.”

Every now and then, I get off my exercise routine. However, for the last month, I’ve been doing better. One incentive was finding out I’ve gained a fair amount of weight since I retired in 2019. I realized that climbing six to 8 flights of stairs a day probably was pretty good exercise—but I don’t get to do that anymore. Sena is an avid gardener. I have a set exercise routine, which I’m recently more regular about doing.

Being still and connected means mindfulness meditation for me, which I first learned around 12 years ago. My essay for the Gold Foundation is dated in some respects, but it’s still relevant.

Happy Mental Health Awareness Month!

Thoughts on Nature

Yesterday afternoon when Sena came inside from working in the backyard garden, I noticed she had some swelling around her lips and eyes. Despite applying OFF! Deep Woods she got trapped in a swarm of gnats.

This reminded me of a similar swarm last spring around this time while we were out at Terry Trueblood Recreation Area. I wrote a post partly about that because of how thick they were.

Today I found a recently posted article about gnats, which have a variety of different names: no—see-ums, black flies, midges, punkies, moose flies and so on. One other author recommended seeing a doctor if you got swelling around your eyes and lips. Another author doesn’t mention that. Sena’s swelling was reduced this morning, but still noticeable.

She thinks the dozens of mulch bags she got caused most of the problem. That’s probably true since mulch is wet and can attract fungus gnats. While fungus gnats are said to be the non-biting kind of gnat, that doesn’t make them less of a nuisance.

The other day, Sena also saw the groundhog we filmed last year close to our back property line. It stood right up in about the same spot we saw it last year, when it had baby groundhogs. Sena talked about going out there to continue poking holes at the mound it made digging its burrow.

I told her that groundhogs carry a number of diseases, including rabies, and maybe the best bet would be to leave it alone. Today, I found a YouTube video from 11 years ago of a news report that demonstrated how dangerous groundhogs can be—no matter how cute they looked in our video last year.

I’m OK with nature, as long as it stays outside.

The Excitable Electrons

I’ve talked about some of my college professors when I was attending, Huston-Tillotson College in the 1970s. It’s an HBCU in Austin, Texas. But I haven’t talked about my teachers elsewhere. That just occurred to me in the last few days. I had some exciting teachers at Iowa State University in Ames in the early 1980s. Three of them come to mind. I’ll refer to them as Dr. X; Dr. Y; and Dr. Z. I don’t have any long stories about them; just a few short anecdotes that struck me as interesting or slightly odd.

Dr. X was my microbiology professor. He was very intelligent. I remember our class was in the lab one day and I asked him if the colonies growing on my agar plate were encapsulated microorganisms or not. He pointed at the glistening puddle in my plate and just said, a bit impatiently, “That’s capsule!” I remember being a little embarrassed, but all he was doing was demonstrating that capsule through a microscope looks different when you view it with the naked eye. One day, during a class lecture, he shared with all of us that he’d been having some personal challenges. He said that his divorce had just been finalized and announced dramatically, “I am now available for dates.” I couldn’t tell whether he was just kidding or making a pass at the female members of the class. It was a little awkward, but we got past it.

Dr. Y was one of my chemistry professors. He lectured while writing on a blackboard with a piece of chalk. I realize this is now an ancient rite in the modern age of PowerPoint, which didn’t really get up to speed until after 1987. He highlighted major points and separated them by drawing a line between them. His fingers were always caked with chalk dust. There was no smoking in any of the lecture halls. However, one day after the end of lecture, a student approached him and told him he was joining the military. Dr. Y evidently knew the student and immediately struck up a conversation which looked and sounded like a father talking to a son. He hopped up on the table in front of the chalkboard, took out a cigarette and smoked it. He asked him, “When you leaving?” evidently referring to when the young man would be shipping out. I got the impression Dr. Y was an old military man himself.

I think the most interesting of the three professors was Dr. Z. He was also a chemistry professor, and early in his career. He wore his hair long, talked hip, and appealed to the young audience. He didn’t really use the chalkboard much. He had a flair for the dramatic. One day, he was talking about the periodic table in relation to electrons and their excitability the further they get away from the nucleus because they’re less tightly bound to it. Dr. Z used the table in the front of the chalkboard like a stage. First, he hopped up on the table and started jumping up and down a little, showing how electrons get excited. He grabbed a few chairs and put one of them on the table. He set a chair on the table and climbed on the chair. He then did a little jitterbugging on the chair, and waved his arms about, exclaiming “I’m an electron and I’m getting excited!” He managed to set another chair on top of the first chair and gingerly clambered upon it. He was a little slower about standing up, and the tower jiggled a bit—which made him pause. For a split second, I thought he was going to take a tumble and smack the nucleus. But he hung in there, slowly rose to a stand and waving his arms, proclaimed “I’m a really excited electron now,” or something like that. The class collectively held its breath. Dr. Z was a very excited electron—and managed to safely return to a lower energy state without breaking a leg.

Students remember teachers like these.

Shout Out to Dr. George Dawson for Medical Reasoning Post!

I just wanted to make a shout-out to Dr. George Dawson for his post from yesterday, “Medical Reasoning vs. A Diagnostic Manual.”

It reminded me of the diagnostic challenge of catatonia, which I saw several times during my career as a consultation-liaison psychiatrist. There’s an excellent recent review of the evaluation and management of catatonia.

Iyer V, Spurling BC, Rizvi A. Catatonia. [Updated 2025 Dec 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430842/

I also published a case report about lorazepam withdrawal-induced catatonia, illustrating one of the many causes of catatonia. In the discussion section of the report I point out that there are a number of metabolic, neurologic, and substance-induced secondary causes of catatonia, including substance-induced withdrawal (alcohol, benzodiazepines).

Amos, J. J. (2012). Lorazepam Withdrawal-Induced Catatonia. Annals of Clinical Psychiatry., 24(2), 170–171. https://doi.org/10.1177/104012371202400210

Kudos to Dr. Dawson!