March 2026 – Go Retire Psychiatrist

I was just going through the many files on one of my old thumb drives that I still keep after I retired from consultation-liaison psychiatry over 5 years ago. I found a file that I must have typed from a source on how to help medically ill persons who are demoralized. Demoralization is not the same thing as depression or adjustment disorder. What I have copied from the original source is below, along with the reference.

Treating Demoralization

Ask first: “how are your spirits today?” Then ask “what is the most difficult thing for you now?”

Coherence Versus Confusion

1. How do you make sense of what you’re going through?

2. When you are uncertain how to make sense of it, how do you deal with feeling confused?

3. To whom do you turn for help when you feel confused?

4. (For religious patient) When you feel confused, do you have a sense that God has a way of making sense of it? Do you sense that God sees meaning in your suffering?

Communion Versus Isolation

1. Who really understands your situation?

2. When you have difficult days, with whom do you talk?

3. In whose presence do you feel a bodily sense of peace?

4. (For religious patients) Do you feel the presence of God? How? What does God know about your experience that other people may not understand?

Hope Versus Despair

1. From what sources do you draw hope?

2. On difficult days, what keeps you from giving up?

3. Who have you known in your life who would not be surprised to see you stay hopeful amid adversity? What did this person know about you that other people may not have known?

Purpose Versus Meaninglessness

1. What keeps you going on difficult days?

2. For whom, or for what, does it matter that you continue to live?

3. (For terminally ill patients) What do you hope to contribute in the time you have remaining?

4. (For religious patients) What does God hope you will do with your life in days to come?

Agency Versus Helplessness

1. What is your prioritized list of concerns? What concerns you most? What next most?

2. What most helps you to stand strong against the challenges of this illness?

3. What should I know about you as a person that lies beyond your illness?

4. How have you kept this illness from taking charge of your entire life?

Courage Versus Cowardice

1. Have there been moments when you felt tempted to give up but didn’t? How did you make a decision to persevere?

2. If you see someone else taking such a step even though feeling afraid, would you consider that an act of courage? (If so) Can you imagine viewing yourself as a courageous person? Is that a description of yourself that you would desire?

3. Can you imagine that others who witness how you cope with this illness might describe you as a courageous person?

Gratitude Versus Resentment

1. For what are you most deeply grateful?

2. Are there moments when you can still feel joy despite the sorrow you have been through?

3. If you could look back on this illness from some future time, what would you say that you took from the experience that added to your life?

Griffith, J. L. and L. Gaby (2010). “Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness.” Focus 8(1): 143-150.

There are a couple of resources I routinely used as a psychiatric consultant in the general hospital. One of them was the general outline of how to recognize and help someone who is demoralized (above). Another was a free online (non-AI) cognitive behavioral therapy resource that is still available called The MoodGym.

These are not the same thing as Artificial Intelligence (AI), which I think in some cases might be the wrong way to help someone with depression and anxiety that is more reactive to situational and medical stressors. AI can also be harmful to some people.

I have seen the brief psychotherapy guide above published and referenced in different articles on the web, one of them published as recently as 2025. Griffith and Gaby first published the guide to help those who are demoralized in 2005. It’s been around for 20 years and in my opinion is better than AI will ever be.

References:

James L. Griffith, Lynne Gaby,

Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness,

Psychosomatics,

Volume 46, Issue 2,

2005,

Pages 109-116,

ISSN 0033-3182,

(https://www.sciencedirect.com/science/article/pii/S0033318205701006)

Abstract: Bedside psychotherapy with medically ill patients can help counter their demoralization, which is the despair, helplessness, and sense of isolation that many patients experience when affected by illness and its treatments. Demoralization can be usefully regarded as the compilation of different existential postures that position a patient to withdraw from the challenges of illness. A fruitful interviewing strategy is to discern which existential themes are of most concern, then to tailor questions and interventions to address those specific themes. Illustrative cases show how such focused interviewing can help patients cope assertively by mobilizing existential postures of resilience, such as hope, agency, and communion with others.

https://psychiatryonline.org/doi/full/10.1176/foc.8.1.foc143

Alyssa C. Smith, Jonathan S. Gerkin, Diana M. Robinson, Emily G. Holmes,

Consultation-Liaison Case Conference: Management of Demoralization in the Medical Setting,

Journal of the Academy of Consultation-Liaison Psychiatry,

Volume 67, Issue 1,

2026,

Pages 71-78,

ISSN 2667-2960,

(https://www.sciencedirect.com/science/article/pii/S2667296025005087)

Abstract: Demoralization has important implications for patients’ health, but consultation-liaison psychiatrists may be less familiar with diagnosis and management due to limited inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. We present the case of a multivisceral transplant patient who experienced demoralization due to complications from her posttransplant course. We discuss the diagnosis of demoralization, including differential diagnoses to consider, followed by a discussion of management of demoralization in the inpatient setting using acceptance and commitment therapy. We then discuss the consultation-liaison psychiatrist’s role in assisting with management of teams’ counter-transference to difficult patient cases, including the possibility of teams experiencing their own demoralization.

Keywords: demoralization; transplantation; transplant psychiatry; acceptance and commitment therapy; consultation-liaison psychiatry

We watched the 1953 movie “War of the Worlds” last night. I can vaguely remember seeing the remake starting Tom Cruise years ago. I ran across a free pdf of H.G. Wells novel “The War of the worlds, published in 1898 and quickly read it today for the first time. Apparently, it was a pretty racy book not suitable for children as this quote shows:

The War of the Worlds by HG Wells quote in Book One, The Coming of the Martians, Chapter 14 In London pg. 129: “He heard footsteps running to and fro in the rooms, and up and down stairs behind. His landlady came to the door, loosely wrapped in dressing gown and shawl; her husband followed ejaculating.”

You won’t see anybody ejaculating in this movie.

Contrast this with Book Two, The Earth Under the Martians, Chapter 2: What We Saw From the Ruined House, pg 202: “In the next place, wonderful as it seems in the sexual world, the Martians were absolutely without sex…” Apparently, they reproduced by budding.

I was surprised to see one of the main characters in the movie, the scientist Dr. Clayton Forrester (Gene Barry) square dancing with the other star Sylvia Van Buren (Ann Robinson). That’s when I knew this was going to be a real horror flick, because I remember being required to learn how to square dance in grade school. What a nightmare! Anyway, in the movie they were do-si-dosing and allemanding left all over the joint. Check out the video of the scene below:

It quickly got scarier when the Martians arrived. The space ships were modeled by imitating the shapes of cobras and manta rays, but the actual Martians who drove them reminded me of little E.T. The Extraterrestrial in the movie of the same name.

By the way, Orson Welles was not related to H.G. Wells but he did perform the radio show adaptation of it in 1938, which led to many stories reporting that the listeners peed their pants in widespread panic, but that didn’t really happen. Most people didn’t listen to the radio and preferred to play video games on their cell phones. H.G. Wells met with Orson after that and taught him how to spell his name right.

The attitude in the 1950s toward women actors was atrocious and Ann Robinson was required to have two or three episodes of hysterics and at least one near-fainting spell per scene with Gene Barry. However, her hair was never mussed and her makeup never smeared, even after she beat the crap out of a Martian who tried to square dance with her.

The Martians were really out of shape and flabby so they used their technology to make copies of Chuck Norris, who round-house kicked the entire military force into next week. Of course, the Pentagon was still trying to back-engineer UFOs that crashed in places like Roswell, New Mexico so they were naturally ill-equipped when it came to battling the Martians.

However, what the Martians didn’t know about earthlings was the strength of our immune systems. In fact, they didn’t know what immune systems were (which even some earthlings don’t understand). They were unaware of the power of snot, which some people are able to focus, aim, and fire with pinpoint accuracy.

On the other hand, according to a reliable scientific opinion from a well-documented, unimpeachable source (Men in Black movie 1997): “Human thought is so primitive it’s looked upon as an infectious disease in some of the better galaxies.” On the other hand, we can do-si-do when properly motivated.

I think this movie is OK, outside of square-dancing special effects. I give it a 3/5 Shrilling Chicken Rating.