current events – Go Retire Psychiatrist

Groundhog Day Finally Explained

Well, by now everybody has heard the official news about what Punxsutawney Phil saw this morning since it’s Groundhog Day. On the other hand, the unofficial news is this: for some reason he saw extraterrestrials instead of his shadow. I know about it only because a drunken official calling me from the Pentagon spilled the beans to me and abruptly hung up just before he passed out.

Apparently, they were looking for a decent rib joint, which they’re always on the lookout for after traveling halfway across the galaxy.

You have to question the ETs preference for using so much fuel and creating missing time and hallucinations for thousands of people gathered for this time-honored and totally bogus event which the editors of The Old Farmer’s Almanac repeatedly try to debunk in a futile attempt to educate us about the seasons.

What almost nobody knows is that recently declassified government documents obtained by Brer Rabbit has led to the discovery of yet another conspiracy to hoodwink the American people about the ETs preoccupation with finding the best BBQ rib joint in the galaxy, which is genetically linked to their inability to distinguish humans from woodland creatures whose only real purpose in life is to dig holes in the ground so they can secretly write books circulated only amongst groundhogs about how silly it is for humans to call them ridiculous names like “whistle pigs.”

The truth is groundhogs know perfectly well how the seasons change and it has nothing to do with them—it’s all about the tooth fairy. But…ETs can’t handle the truth, as Col. Jessup has repeatedly pointed out in countless memes and gifs over the years.

We can only hope this deplorable state of affairs will be rectified when scientists eventually back engineer and reverse the polarities of the device (which is, trust me, stored in a cardboard box in a garage in Area 51) ETs use to hypnotize the criminals amongst their own kind into endlessly flying around in their souped up Tic-Tac UFOs in the absolutely pointless search for the perfect rib joint—all because the ET leaders can’t come up with a better solution to close the gaps in their worthless criminal justice system.

I hope I have made all this clear. Happy Groundhog Day!

Observations on Jonathan Eig’s Martin Luther King Distinguished Lecture

I discovered that the University of Iowa made a video presentation of Jonathan Eig’s speech for the Martin Luther King Distinguished Lecture on January 21, 2026. Mr. Eig wrote the MLK biography, “King: A Life” which was published in 2023. We just got a copy of it along with “The Autobiography Of MLK. We’re reading them now. We both watched the one-hour long video, which is available only in Panopto format to University of Iowa employees who could not attend the event in person.

He’s an engaging, humorous, and humble guy who spoke without using notes and ad libbed the entire talk which covered the most important events and people in King’s life including his wife and several other famous people in the civil rights era of the 1960s.

He had an interesting anecdote about the young National Park Service ranger, Gordon, “Gunny” Gundrum who adjusted King’s microphone repeatedly while he was giving his “I Have a Dream” speech in Washington in 1963. It was caught on camera and interpreted by some as an effort to interfere with the speech. In fact, it was because King was only 5’7” tall and his face was obscured by the microphone. Eig questioned him about it (yes, he was still alive) and at first Gundrum didn’t even recall doing it.

Sena wondered why Eig didn’t mention Rosa Parks in his presentation. In his book, he describes her refusal to take a back seat on a city bus as the catalyst for the Montgomery bus boycott, and her role in considerable detail.

On the other hand, Eig pointed out that King’s wife, Coretta, was the one who taught King about activism in the first place since she had been involved doing that before they ever met.

Eig mentioned that King has attempted suicide twice in his adolescence. On the other hand, even though I’m only partway through his book, I recall these were described early and involved being upset about his grandmother on a couple of occasions. One when his brother slid down a banister, hit his grandmother in the head and knocked her out cold. The other was when she actually died. He was not seriously injured in either incident. Eig also shared that King was psychiatrically hospitalized several times. Some suggested he undergo regular outpatient psychiatric treatment, but he declined because of the stigma.

One of his more moving anecdotes was about what King said just before he was gunned down at the Lorraine Motel in Memphis in 1968. King had stepped outside to get some fresh air. It was a cold and one member of his group suggested he go inside and get a jacket. King replied, “Yes, I will.” As he turned to do so, he was shot and killed. The way Eig framed King’s last words made you think of that statement as an affirmation of how he’d responded to the many challenges and demands in his life.

Another Silly Bill in the Iowa Legislature

I saw a story in the Iowa Capital Dispatch by Robin Opsahl today that there’s a bill in the Iowa legislature which seeks to make the drugs ivermectin and hydroxychloroquine over-the-counter (OTC) in Iowa. It doesn’t actually specify the reason why but it’s probably because some Iowans want the drugs available to treat Covid-19. I think the motivation sounds similar to the bills introduced in March of 2025 which were designed to make it illegal to get mRNA vaccines for Covid-19 in Iowa. They both died in funnel week last year.

The bill was discussed yesterday and, while there were 3 commenters in favor of it, there are several reasons to be suspicious of whether it would be a good thing for Iowans. Both ivermectin and hydroxychloroquine were studied for evidence of efficacy for Covid-19 and the studies failed to show that.

The FDA has made it clear that it doesn’t recommend either ivermectin or hydroxychloroquine for treatment of Covid-19.

However, the Iowa bill HF 2056 seeks to make both available OTC and require pharmacies not only make it available but protect the pharmacist from legal or criminal liability for any harms that might result from its use.

While you can find news stories saying simply that 4 states (Tennessee, Idaho, Arkansas, and Idaho) have adopted similar laws, there is at least one recent follow up news story indicating that the pharmacists still have some reservations.

A Boise, Idaho pharmacist says he’ll dispense ivermectin to callers—as long as they have a doctor’s note. Most callers don’t have a parasitic infection. The pharmacist points out that, while the Idaho law says he can dispense ivermectin without a prescription, the FDA hasn’t approved it to be used this way. “It’s not designed or packaged for retail sale,” according to the pharmacist. It’s not made for OTC use.

There’s also a hitch when it comes to health insurance coverage for OTC drugs, implying you might have to pay out of pocket. Arkansas and Tennessee pharmacists say that, despite the law change allowing OTC sale of ivermectin in their states, they won’t sell it that way.

I hope their example will be followed by the other states who seem to be going the same way as Iowa. On the other hand, I’m pretty sure there might be plenty of conscientious objectors in Iowa who might slow down the legal push to get either hydroxychloroquine or ivermectin OTC.

Just because lawmakers put in a lot of language in a bill in an effort to persuade pharmacists that they won’t get sued or go to jail if they always give the customers what they want doesn’t mean they’ll obey a law based on misinformation and which makes them disobey their principles. I don’t understand how the legislative machinery works but I’m hoping the fate for this bill will be the same as what happened to those from last year.

We Just Got MLK Jr Biographies Delivered Today

We just got both of the Martin Luther King Jr. biographies delivered today! They both have great photographs and we’ll get started reading them. We’ll keep you posted on what our impressions are.

We also saw a YouTube video of a 1963 TV program of civil rights leaders including MLK Jr posted a few years ago.

Thoughts on Martin Luther King, Jr. Day

Today being Martin Luther King Day, I’m reminiscing a little about my short time as a student at Huston-Tillotson College (one of this country’s HBCUs, Huston-Tillotson University since 2005) in Austin, Texas. It’s always a good idea to thank your teachers. I never took a degree there, choosing to transfer credit to Iowa State University toward my Bachelor’s, later earning my medical degree at The University of Iowa.

However, I was a reporter for the college newspaper, The Ramshorn Journal. That’s where the featured image comes from.

Although I didn’t come of age at HT, I can see that a few of my most enduring habits of thought and my goals spring from those two years at this small, mostly African-American enrollment college. I learned about tenacity to principle and practice from a visiting professor, Dr Melvin P. Sikes, in Sociology (from the University of Texas) who paced back and forth across the Agard-Lovinggood auditorium stage in a lemon-yellow leisure suit as he ranted about the importance of bringing about change.

He was a scholar yet decried the pursuit of the mere trappings of scholarship, exhorting us to work directly for change where it was needed most. He didn’t assign term papers, but sent me and another freshman to the Austin Police Department. The goal evidently was to make them nervous by our requests for the uniform police report, which our professor suspected might reveal a tendency to arrest blacks more frequently than whites.

He wasn’t satisfied with merely studying society’s institutions; he worked to change them for the better. Although I was probably just as nervous as the cops were, the lesson about the importance of applying principles of change directly to society eventually stuck. I remembered it every time I encountered push-back from change-resistant hospital administrations.

As a clinician-educator I have a passion for both science and humanistic approaches in the practice of psychiatry. Dr. James Means struggled to teach us mathematics, the language of science. He was a dyspeptic man, who once observed that he treated us better than we treated ourselves. Looking back on it, I can see he was right.

Dr. Lamar Kirven (or Major Kirven because he was in the military) also modeled passion. He taught black history and he was always excited about it. When he scrawled something on the blackboard, you couldn’t read it but you knew what he meant.

And there was Dr. Hector Grant, chaplain and professor of religious studies, and devoted to his native Jamaica. He once said to me, “Not everyone can be a Baptist preacher.” He tried to explain that my loss of a debate to someone who won simply by not allowing me a word in edgewise was sometimes an unavoidable result of competing with an opponent who is simply bombastic.

Dr. Porter taught English Literature and writing. She also tried to teach me about Rosicrucian philosophy for which she held a singular passion. Not everyone can be a Rosicrucian philosopher. But it prepared the way for me to accept the importance of spirituality in medicine.

I didn’t know it back in the seventies, but my teachers at HT would be my heroes. We need heroes like that in our medical schools, guiding the next generation of doctors. We need them in a variety of leadership roles in our society. Most of my former HT heroes are not living in the world now. But I can still hear their voices.

What Questions Should We Ask on MLK Day?

I ran across this quote from Dr. Martin Luther King, Jr. in my notes:

“Human progress is neither automatic nor inevitable… Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals.”

― Martin Luther King Jr.

This week we’ll be getting the two biographies of Martin Luther King, Jr. One of them is a biography published a couple of years ago by Jonathan Eig, titled “King: A Life.” The other is an autobiography, “The Autobiography of Martin Luther King, Jr.”

This morning, I was focused on puzzling over Eig’s book, in which there is a focus of how depression affected Dr. King. Gradually, I found out more about his struggles with mental health than I ever knew, and people were aware of them many years before Eig.

Dr. King never shared his emotional problems with anyone while he was alive in order to avoid the stigma in those times. Initially I asked “Why?” type questions. Why does anyone dig into a person’s private health information? That’s called PHI for short and it’s not supposed to be readily available to just anybody. Health professionals know that.

And then I remembered something I learned gradually over the course of my career as a psychiatrist. It’s hard to frame useful answers to “Why?” questions. It’s often more helpful to ask “What?” questions, mainly because they lead to actionable replies about things we might need to change.

What did I do as a teacher before I retired from consultation-liaison psychiatry in order to train those who would improve on what I did?

I shared with my students what I thought would be most helpful to them in their careers going forward:

The shortage of psychiatrists in general, and of C-L psychiatrists specifically, still leads me to believe that George Henry was right when he said:

“Relegating this work entirely to specialists is futile for it is doubtful whether there will ever be a sufficient number of psychiatrists to respond to all the requests for consultations. There is, therefore, no alternative to educating other physicians in the elements of psychiatric methods.”– George W. Henry, MD, 1929 (Henry, G.W., SOME MODERN ASPECTS OF PSYCHIATRY IN GENERAL HOSPITAL PRACTICE. Am J Psychiatry, 1929. 86(3): p.481-499.)

There was so much in Henry’s paper published in 1929 that still sounds current today. I can paraphrase the high points:

Practice humility and patience
Avoid psychiatric jargon
Stick close to facts; don’t get bogged down in theories
Prevent harm to patients from unnecessary medical and surgical treatment, e.g. somatization
“The psychiatrist deals with a larger field of medical practice and he must consider all of the facts.”

The psychiatrist should “…make regular visits to the wards…continue the instruction and organize the psychiatric work of internes…attend staff conferences so that there might be a mutual exchange of medical experience”
Focus on “…the less obvious disorders which so frequently complicate general medical and surgical practice…” rather than chronic, severe mental illness

The advantages of an integrated C-L Psychiatrist service (here I mean integrating medicine and psychiatry; mind and body) are that it increases detection of all mental disorders although that requires increasing the manpower on the service because of the consequent higher volume demand in addition to other requests, including but not limited to unnecessary consultation requests.

Further, what still astonishes me is the study which found that among consultee top priorities was an understanding of the core question (Lavakumar, M. et al Parameters of Consultee Satisfaction With Inpatient Academic Psychiatric Consultation Services: A Multicenter Study. Psychosomatics (2015). The irony is that the consultees frequently do not frame specific questions (Zigun, J.R. The psychiatric consultation checklist: A structured form to improve the clarity of psychiatric consultation requests. General Hospital Psychiatry 12(1), 36-44; (1990).

Moreover, it is sometimes necessary to give consultees bad news. A consultant should be able to tell a colleague what he or she may not what to hear. This principle is applicable across many disciplines and contexts. And it is best delivered with civility.

A former president of the ACLP said:

“A consultation service is a rescue squad. At worst, consultation work is nothing more than a brief foray into the territory of another service…the actual intervention is left to the consultee. Like a volunteer firefighter, a consultant puts out the blaze and then returns home… (However), a liaison service requires manpower, money, and motivation. Sufficient personnel are necessary to allow the psychiatric consultant time to perform services other than simply interviewing troublesome patients in the area assigned to him.”—Dr. Thomas Hackett.

I don’t think it’s too much to expect things to improve. Speaking of improvement, Stephen Covey called it “sharpening the saw,” one of the 7 habits of highly effective people. For this, The University of Iowa Hospitals and Clinics C-L Psychiatry has the Clinical Problems in Consultation Psychiatry or CPCP. This was started by Dr. Bill Yates in the 1990s, and it was originally called Problem-based Learning. “PBL…emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education…most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%) …PBL conference was ranked the highest of all the psychiatry resident educational formats.”

Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.
- Covey, S. R. (1990). The seven habits of highly effective people: restoring the character ethic. New York, Simon and Schuster.

What did I do when burnout made me a less effective teacher? In 2012 I started getting feedback from colleagues and trainees indicating they noticed I was edgy, even angry, and it was time for a change.

After reflecting on the feedback from my colleagues and students, I enrolled in our university’s 8 week group Mindfulness-Based Stress Reduction (MBSR) program. Our teacher debunked myths about mindfulness, one of which is that it involves tuning out stress by relaxing. In reality, mindfulness actually entails tuning in to what hurts as well as what soothes.

Maybe we should ask what helped Dr. Martin Luther King, Jr. persevere in spite of the inner turmoil and external pressure.

A Squall’s a’Comin’!

There’s a 30 percent chance of snow squalls this afternoon.

Ain’t a fit day out for man nor beast!

Replace Sycophantic AI with Marvin the Paranoid Android?

I found the perfect JAMA article explaining that sycophancy is programmed into Artificial Intelligence (AI) therapy chatbots.

This reminded me of Marvin the paranoid android (“Life! Don’t talk to me about life!”) in the book series “The Hitchhiker’s Guide to the Galaxy” by Douglas Adams. Marvin is an incredibly depressed robot who would never make a good psychotherapist.

There’s even a Facebook page listing someone posts of questions to ChatGPT about non-inspirational quotes from Marvin.

If programmers can make sycophantic AI therapists, there should be a way to make them less sycophantic. For more specific information, you can check out this relatively recent article published in Psychiatric Times by Dr. Allen Francis, MD and Justin Angel, a tech expert. I would probably substitute the term “confabulation” for “hallucinations” in most places where you read the latter.

Confabulation in Artificial Intelligence

I saw an excellent post on Artificial Intelligence (AI) in Dr. George Dawson’s post today, “The Problems With AI Are More Readily Apparent.” He mentions AI producing confabulations which are sometimes called hallucinations in AI. I distinguish hallucinations from confabulations because the former are sensory or perceptual problems while confabulations are making things up. In dementia, confabulations are often described as attempts to fill in gaps in knowledge or memory without any intention to deceive.

I sometimes read that AI is being sycophantic in its interactions with humans, which sounds a little strange to me. The definition of sycophancy is more about trying to please someone else by being obsequiously flattering. It’s puzzling but I have gotten that impression from AI, yet it’s a machine and I don’t know how anyone would program AI to be sycophantic because it’s a human trait.

On the other hand, I got a comically sycophantic reply from AI to my question inquiring about the definition of Calvinball Cribbage. It’s just a made-up term and, to be fair, I’ve also gotten bluntly frank denials from AI that there is any such thing as Calvinball Cribbage.

As a reminder, Calvinball is a term that arose from a comic strip called Calvin and Hobbes. In the strip, the characters invent a game called Calvinball and the only rule is making up the rules as you go along, although there is a goal of capturing your opponent’s flag. But you can’t play it the same way twice.

The most recent hilarious AI confabulation I’ve previously posted about was when Sena and I played our game of 11-card cribbage. There are cribbage players out there who make fun of such variations from standard 6-card cribbage and the name for it from one such player was “Calvinball crib.” My simple question was as usual, “What is Calvinball Cribbage?” The reply is copied below:

“Calvinball Cribbage is a humorous mashup of the chaotic, rule-free game from Calvin & Hobbes with traditional Cribbage, often involving themed boards or rule modifications, where the core idea is applying Calvinball’s fluid, make-it-up-as-you-go spirit to Cribbage’s scoring and play, adding wild, non-sensical rules like using mallets, changing hand values, or scoring points for silly actions, making each round unique and unpredictable, not a single defined game but a creative approach to Cribbage.

What it is (The Calvinball Aspect):

No Fixed Rules: Just like original Calvinball, there’s no single set of rules; the players invent them as they go.
Rule Changes: A key rule is that rules can’t be repeated, and players constantly invent new scoring, actions, or penalties.
Props & Actions: You might use mallets, balls, trees, or make up actions like “scoring three points for pointing at a cloud” or “losing a turn for looking left”.

How it Applies to Cribbage:

Themed Boards: You can find or make custom cribbage boards featuring Calvin & Hobbes, adding visual flair.
Modified Scoring: Instead of just points for pairs and runs, you might add a “Hobbes Bonus” for a specific card or penalize for “too much logic”.
Strategic Chaos: Players still play cribbage (cards, pegs, crib), but the gameplay is constantly disrupted by invented rules, turning strategic plays into potential jokes or absurd victories.

Example Calvinball Cribbage “Rules”:

“If you play a 7, you must hop on one foot until your next turn”.
“The crib gets 5 points if it contains a card with a face on it” (referencing Calvin’s drawings).
“A ‘skunk’ is achieved by making your opponent laugh out loud”.

In essence, Calvinball Cribbage is about injecting unpredictable fun and silliness into the structured world of cribbage, making it a game of spontaneous creativity rather than strict strategy. “

This could be an example of sycophantic confabulation because almost all of it was probably cooked up by AI from scanning my blog posts about the subject. What’s a little eerie about it is that I never published any specific rules or strategies about the fictional game of Calvinball crib. You can actually find and purchase a Calvin and Hobbes cribbage board from a shop in Canada.

While this is an example of the occasional comicality of AI, that shouldn’t lead us to deny that it can do scary things, some of which Dr. Dawson describes. My early experiences a couple of years ago with what used to be called Google Bard were somewhat alarming because it confabulated then. And it still does.