I want to give a shout out to Dr. George Dawson for his post today “The Autocratic Approach to Homelessness” in reference to President Trump’s most recent executive order, “Ending Crime and Disorder on America’s Streets.” As a retired psychiatrist, I look back and remember seeing the problem of the homeless mentally ill a lot. You can read my take on it from last summer’s posts:
I spend a lot of time joking around on my blog, but this is no joking matter. I think the President gets it wrong.
I just noticed something about one of my YouTube videos that I made sort of as a combination gag and educational piece about pseudobulbar affect. It needed a couple of updates—one of which is minor and which I should have noticed 10 years ago when I made it.
It’s a pseudo-rap performance (badly done, I have to agree although it was fun to make), but it’s one of my most watched productions; it has 18,000 views.
One minor update is about the word “Dex” in the so-called lyrics of this raggedy rap song (see the description by clicking on the Watch on YouTube banner in the lower left-hand corner). It stands for dextromethorphan, one of the ingredients along with quinidine in Nuedexta, the medication for pseudobulbar affect. Dextromethorphan has been known to cause dissociation when it’s abused (for example, in cough syrup).
The most important update is about Dr. Robert G. Robinson, who I joked about in the piece. He passed away December 25, 2024. He was the chair of The University of Iowa Dept. of Psychiatry from 1999-2011. He was a great teacher, mentor, and researcher. He published hundreds of research papers and books on neuropsychiatric diseases like post-stroke depression and pseudobulbar affect. He lectured around the world and was widely regarded as a brilliant leader in his field.
Early in my career in the department, I left twice to try my hand in private practice psychiatry. Both times Dr. Robinson welcomed me back—warmly. He was my co-editor of our book, Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry, published in 2010.
All who worked with Dr. Robinson will never forget him.
Here’s something fun, try to explain what the phrase “in the pocket” means. The song selections in the pod show led up to a short discussion of what it means—which I didn’t get at all. I don’t think it matters for the ordinary listeners, although former music teachers like Big Mo obviously know what the term means. He taught music for years, has performed, and uses the lingo to explain what “in the pocket” is all about. It’s way over my head, but then I don’t need to know anything about it to enjoy music.
I tried to look up the meaning of the terms “in the pocket” on the web. I took a quick look at a website called Sage Audio. The title is “What is In-the-Pocket for Music?” I couldn’t find the author’s name because I didn’t see a byline. It’s very long and technical and seems geared for sound engineers. One sentence by the writer caught my attention under the heading “What is In-the-Pocket for Music in Detail”:
“It isn’t uncommon to hear a music term and wonder what it means exactly. Becoming well versed in music means understanding its discourse, which can certainly be easier said than done.”
Here’s how far out in left field I am. Depending on how I read that, I’d almost recast the last part of that sentence: “…which can certainly be easier done than said.” I realize the sense of it is that becoming adept in making music means understanding the lingo. I just don’t understand the lingo, which makes me wonder if musicians have some kind of inner body sense for timing in music as it’s performed which may not readily translate to language for the layperson.
I was like a lot of other students in junior high music class. We were pretty good at whispering or half-mumbling the songs we were supposed learn to sing out loud. That really annoyed the music teacher. I don’t know if Big Mo can relate to that or not. We were supposed to learn the song “Sloop John B.” I’m not sure if we were doing the Beach Boys version or the original “The John B. Sails.”
It hardly mattered. We sounded like we ate up all the corn and held it in our mouths while mumbling. We just stuck our hands in our pockets, moaned the words, and were never in the groove. I don’t think a metronome helped. In fact, I’m not sure there was a metronome.
I have to mention that I probably was too young to know that the song by Little Ed and the Blues Imperials, “Walking the Dog,” was about a kind of dance. I never danced although most of the dancing kids on American Bandstand had the same answer to Dick Clark’s question on what they liked about the song—it was always “the beat.” I guess they knew that meant the number was “in the pocket.”
Yesterday I noticed a hummingbird hovering about the flower pots on our porch. I hurried to get my point and shoot camera and shot video, through a window as usual and it was getting a little late in the evening too, so light was low.
Can I blame the bird for always looking like a blur—or not? Anyway, the video looks similar to others I’ve managed to capture in years past, except this one was the closest I’ve ever gotten to one. I tried messing with the clip using my video editing software, but I ended up believing it best to leave it mostly unmessed around with.
On the other hand, the one I got about 6 years ago was pretty fair for an amateur backyard birder. Same camera, same software although I was closer to the birds and I’m pretty sure I was sitting outside and very patient. They were very interested in our little feeder.
I think the hummingbirds we’ve seen are ruby-throated species partly because that’s the most common in Iowa. Typically, I think it’s just the males who have ruby-colored throats; our visitor didn’t.
I guess the usual way to attract hummingbirds is with a feeder but other people say there are other reasons hummingbirds visit us. More common to the indigenous peoples, they may be thought of as the spirits of those who recently died and are visiting those they were close to.
I don’t remember the movie “The Curious Case of Benjamin Button” so well but I’ve glanced briefly at web articles which connect it with hummingbirds, which has something to do with their ability to fly backwards or in a figure 8, maybe connecting that with reverse aging or infinity. Other symbolic connections are with joy, healing, and partnership. There are so many connections they seem to blur together—sort of like the bird itself as it hovers and flits from flower to flower.
I think this hummingbird just really liked Sena’s flowers.
There’s an extreme heat watch starting tomorrow through Thursday in eastern Iowa. Heat indices of 95 to 105+ are expected.
There is a list available of cooling centers published by KCRG although that was published on June 20, 2025, so it is not current.
Heat safety tips are at this link.
The atmosphere for the Svengoolie TV show airing of the 1934 movie “The Black Cat” was nothing short of electric—as in electrical storm. I thought the mood of ambivalence in the film was firmly set for about the first half hour of the movie. That was how long the TV station weather alert was on screen, shrinking the viewing size of the movie somewhat to make room for a map of the counties at risk and the scrolling warnings about which east central Iowa counties were affected by the flood watch and guidance about what to do.
Anyway, the film is not related in any way to Edgar Allan Poe’s short story of the same title. The movie was directed by Edgar Ulmer and starred Bela Lugosi as the Hungarian psychiatrist and ex-WWI POW (that’s right, I said “psychiatrist”), Dr. Vitus Werdegast; Boris Karloff as the satanic and necrophiliac Hjalmar Poelzig, the former WWI commander of the Fortress Marmorisch and a famed architect who built an ultra-modern mansion on top of the grisly site where thousands of soldiers were killed. Vitus and Hjalmar play chess for the souls of the aspiring novelist Peter Alison (David Manners) and his wife Joan (Jacqueline Wells) who, unfortunately get stranded there along with Vitus after the bus carrying them crashes on the way from the train station to various hotels and Disney World.
The mood of ambivalence I thought was evident, contrasting the creepiness of Hjalmar and Vitus grimly gambling in a chess match for the lives of Joan and Peter and the comicality of the two policemen interviewing the Alisons and the two heavies about the bus accident. The lieutenant and the sergeant arguing with each other in a “My hometown’s better than yours” exchange reminds me of Abbott and Costello. I recommend you see it for yourselves on the Internet Archive; it’s about 35 minutes in.
Contrast this with the hysterical cat phobic Vitus (despite being a psychiatrist) throwing a knife at one of the many black cats prowling around the house after it ejects a hairball on the floor! Or Hjalmar thumb wrestling with Vitus until the latter chooses to pick up what looks like an emery board from an array of much larger knives and bazookas on a large table—and prepares to flay Hjalmar with it. This would only make Hjalmar look even more excruciatingly well groomed, along with the precisely trimmed haircut carefully smeared with a pound of Brylcreem.
I think “The Black Cat” is a hoot. It’s a litter box full of nuggets of melodramatic ailurophobia with here and there a hairball of ambivalence but hey, nobody’s purr-fect!
Shrilling chicken rating 4/5
Well, I’ve been waiting all morning for the Big Mo Pod Show and it usually shows up long before now on Saturday morning. In spite of this, Big Mo did say on the blues show last night that the first two songs on the show would be on the pod show and I know what they are. So I’m going to go ahead and start without Big Mo and Producer Noah today.
The first one is a song by someone Big Mo mentioned last week, Monster Mike Welch, “Keep Living Til I Die.” It just happens to be related to my post yesterday on death doulas—only it’s full of raw and feisty humor in how it approaches the usual ideas about death, which can be morbid.
In the lyrics, I think there’s even a classical Greek mythology reference to the river Styx, “I pay my toll at the river…” It could be referring to the river which separates the living from the dead in Hades.
There’s nothing morbid about death in this tune. The singer doesn’t seek death, but neither does he try to run away or hide from it. He’ll just keep living till he dies.
I’m less sure what to think of the next song Big Mo would be on the pod show. It’s by Lil’ Ed & the Imperials, “Walking the Dog.” I can’t make sense of the lyrics.
That’s about as far as I can go so far without the pod show. On the other hand, there was another song on the blues show by an artist I didn’t know about until last night. “Been Here Before” is a striking song because right away I wondered if was about reincarnation. It is sort of related to the idea of what happens after we die.
In fact, the artist, Christone Kingfish Ingram speculates in an interview he might be open to the idea of his have been reincarnated. This is not that different from a few of Dr. H. Steven Moffic’s thoughts about the death, reincarnation, and the afterlife in some of his recent Psychiatric Times columns. A couple of examples are “Past Lives and Psychiatry” and “Past Lives, Death, Dying, and the Afterlife.”
And that’s the “old soul” side of the story about death.
I listened to the Rounding@Iowa podcast “End-of-Life Doulas” twice because I’m at that difficult age when I think about my personal death. I don’t think about it at great length, mind you, but when I think about it, I feel afraid. Early mornings tend to be the time I wonder how much time now until…?
There was the usual podcast format, Dr. Gerry Clancy interviews Mary Kay Kusner, who is certified death doula to get the overview and details about what death doulas are all about.
I listened to the podcast in the late afternoon and discussed it only briefly with Sena. I felt out of sorts for a few hours afterward. I was in a funk until later in the evening when my thoughts almost abruptly switched to something funny. It was about a topic I’m thinking of for another blog post which has a humorous angle to it. I even chuckled a little out loud. I didn’t force that line of thought—it just happened.
But I know why it happened.
I didn’t know what a doula was until I listened to the podcast. Because I’m a writer by inclination, I looked for the original definition, which is a female servant who helps women with birthing. That didn’t enlighten me much, obviously; I can’t remember the last time I was pregnant (see what I did there?). An end of life-or-death doula helps people come to terms with impending death, death when it happens, and with whatever comes up after death has happened.
The title of this post comes from the Mary Kay Kusner’s short anecdote near the end of the podcast. Early in her career as a chaplain, she met with a 4-year-old child in the oncology unit who had a terminal illness, evidently death was coming and asked her, “How will I get to heaven?” They talked about it and the next thing the child said was, “So it’s like another dimension?” which Kusner evidently validated in some way. It’s a really cute story.
Anyway, there was a thread running through the podcast which pointed to what is apparently an ongoing psychological disconnect medical professionals have about death because we’re so focused on cure. It’s disappointing, but there you go. Death doulas are around to fill the role of talking calmly and matter-of-factly about it with patients and families.
There are some nuts and bolts about the profession, some of which I get and others which I scratch my head about. There are a couple of doula organizations in Iowa City which Kusner mentions: Community Death Doulas and Death Collective Eastern Iowa. Mary Kay Kusner is certified as a death doula via online training through INELDA.
Interestingly some people do not believe that this is a profession which can be certified, at least without some practical clinical experience. There’s a web site in which the question-and-answer section is longer than the article itself about this. The author recommends specific courses.
Death doulas are not covered by health insurance, so the practitioners arrange for payment, often through a sliding scale hourly fee. Part of the reason for the training of and demand for death doulas is that hospice nurses have heavy caseloads.
This reminds me of the hospice where my younger brother died after his battle with cancer. He was in his forties. Before he entered hospice, I had to be one of his doctors on the medical psychiatry inpatient unit after he accidentally overdosed on his pain medication.
When my brother was in hospice, I sat at his bedside. Most of the time, he was delirious. I watched and listened as one of the hospice workers as he asked him whether he was entering the dying process. He used those words. My brother was just as delirious as he was when he had to be admitted to the medical-psychiatry unit. I don’t know how much he heard.
I sat at his bedside, determined to hold some kind of death watch vigil. This was interrupted, ironically, by some friends of his who visited. They stood opposite the bed so that I had to look at them instead—and to listen as they told me stories about how close they’d been to him and how much they loved him.
By the time they were finished and I turned back to my brother, he was gone. It took me a little while to figure out I had not missed anything I really needed.
So, I think death doulas could be vital in building a bridge between those who are dying and those who need to connect with them. That’s the main thing.
Hey, I’ve got some confusion about one of the tunes in the Big Mo Pod Show today. I heard most of the Big Mo Blues Show last night although I think I might have dozed off for a few minutes about the time one song came on about 7:40 pm. I guess I don’t feel so bad about not remembering Kris Lager’s song “Shake It” because Big Mo didn’t either.
The first thing I wonder about is the spelling of Kris Lager’s name on the pod show. His first name was spelled “Chris.” That’s minor; those things happen. But the remarks by Big Mo and producer Noah on it were intriguing.
While the short clip (starts about 10 minutes or so in) of the song “Shake It” (which is a cover) by Kris Lager was played, Big Mo said the song originally was done by Howlin’ Wolf and he thought it was “Shake for me.” I also vaguely remembered the guitar licks from somewhere in my distant past, but when I played the YouTube Howlin’ Wolf “Shake for Me,” it didn’t sound at all to me like Kris Lager’s version of “Shake It.” The clip from the On Air Schedule from last night didn’t sound like the clip on the pod show either. I tried looking up Lager’s song “Shake It” from the album Blues Lover and got misdirected to other artists who did songs with the same title. I found Lager’s version on Apple Music and heard a preview, but it didn’t sound like the pod show clip either.
I realize that probably part of the problem is the clips are too short. But I can’t account for why Howlin’ Wolf’s version would sound so different. Big Mo mentions Hubert Sumlin’s guitar lick, referring to the clip but I just can’t get that from the Howlin’ Wolf band recording of “Shake for Me,” at least not the one I found.
Big Mo mentions a Mike Welch, which implies that he “Shake It” but all I can find is a blues artist called Monster Mike Welch but no connection to a song by that name. He mentions John Popper (musician connected to the group Blues Traveler) but nothing “shakin” there.
Long story short, which is too late because we’re way down the rabbit hole by now, Big Mo gives up and has to admit he doesn’t recall playing the song “Shake It.” He says he found something which he might have been doing a web search on at the time of the pod show. He found something from 2023 but the Blues Lover album with the song “Shake It” is from 2021. He says Lager was “around here this summer” but I don’t know whether “here” means Iowa or not. I think he’s coming to Okoboji this summer but I’m not sure.
Then Noah asks Big Mo which version of “Shake It” he likes better: Howlin’ Wolf’s or Kris Lager’s. Hang on a sec, I didn’t find comparable versions on the web as I mentioned earlier! Amazingly, Big Mo then replies that Lager’s version is a lot slower than the one by Howlin’ Wolf—but near as I can tell they’re not the same song. He says it has that “recognizable Hubert Sumlin lick” on the guitar—except I can’t hear Hubert Sumlin doing that.
That’s how far I went down the rabbit hole. Can anybody throw me a rope?
I read Dr. Ron Pies, MD’s essay today, “What Long COVID Can Teach Psychiatry—and Its Critics.” As usual, he made thought- provoking points about the disease concept in psychiatry. What I also found interesting was the connection he made with Long Covid, a debilitating illness. He cited someone else I know who was involved with a group assigned to create a working definition for it—Dr. E. Wes Ely, an intensive care unit physician at Vanderbilt University in Nashville, Tennessee.
I remember when I first encountered Dr. Ely, way back in 2011 when I was a consulting psychiatrist in the University of Iowa Health Care general hospital. I was blogging back then and mentioned a book he and Valerie Page and written, Delirium in Critical Care. Back then I sometimes read parts of it to trainees because I thought they were amusing:
“…there is a clearly expressed opinion about the role of psychiatrists. It’s in a section titled “Psychiatrists and delirium” in Chapter 9 and begins with the sentence, “Should we, or should we not, call the psychiatrist?” The authors ask the question “Can we replace them with a screening tool, and then use haloperidol freely?” The context for the following remarks is that Chapter 9 is about drug treatment of the symptoms and behaviors commonly associated with delirium.”
I would point out that the authors say, while acknowledging that the opinions of psychiatrists and intensivists might differ, “…we would advocate that a psychiatrist should be consulted for patients already under the care of a psychiatrist or on antipsychotic medications”. Usually, in most medical centers in the U.S.A. a general hospital consultation-liaison psychiatrist sees the delirious inpatient rather than the patient’s outpatient psychiatrist. And many delirious patients don’t have a previous formal history of psychiatric illness and so would not have been seeing an outpatient psychiatrist in the first place.” (Page, V. and E.W. Ely, Delirium in Critical Care: Core Critical Care. Core Critical Care, ed. A. Vuylsteke 2011, New York: Cambridge University Press).
I’m pretty sure I got an email from Wes shortly after I posted that, with his suggestion that I write more about the delirium research he was doing. He sent me several references. I met him in person at a meeting of the American Delirium Society later on and attended an internal medicine grand rounds he presented at UIHC in 2019, “A New Frontier in Critical Care Medicine: Saving the Injured Brain.” He’s also written a great book, “Every Deep-Drawn Breath.”
Anyway, Dr. Ely and others were tasked by the Administration for Strategic Preparedness and Response and the Office of the Assistant Secretary of Health in the Department of Health and Human Services tasked the National Academies of Sciences, Engineering, and Medicine (NASEM) with developing an improved definition for long Covid.
At first, I was puzzled by the creation of criteria that essentially defined Long Covid as a disease state which didn’t even necessitate a positive test for Covid in the history of patients who developed Long Covid. I then read the full essay by Family Medicine physician, Dr. Kirsti Malterud, MD, PhD, “Diagnosis—A Tool for Rational Action? A Critical View from Family Medicine.”
I was hung up on the dichotomy between physical illness and somatization and thought the Long Covid definition posed a dilemma because it purposely omits any need for an “objective” test to verify previous Covid infection, making the Long Covid diagnosis based completely on clinical grounds. The section on persistent oppositions (dichotomies) was helpful, especially the 2nd point on the dichotomy of the question of whether an illness is physical or psychological (p.28).
The point on how to transcend the dichotomy was well made. I guess it’s easy to forget how the body and mind are related when a consultation-liaison psychiatrist is called to evaluate somebody for “somatization.” Often that was the default question before I ever got to see the patient.
Still, the person suffering from Long Covid often doesn’t seem to have a consistently effective treatment and may stay unwell or even disabled for months or years. Social Security criteria for disability look well-established.
I can imagine that many persons with Long Covid might object to have their care transferred to psychiatric services alone. I can see why there are Long Covid clinics in several states. It’s difficult to tell how many and which ones have psychiatrists on staff. The University of Iowa calls its service the Post Covid Clinic and can refer to mental health and neuropsychology services. On the other hand, a recent study of how many Long Covid clinics are available and what they do for people showed it was difficult to ascertain what services they actually offered, concluding:
“We find that services offered at long COVID clinics at top hospitals in the US often include meeting with a team member and referrals to a wide range of specialists. The diversity in long COVID services offered parallels the diversity in long COVID symptoms, suggesting a need for better consensus in developing and delivering treatment.” (Haslam A, Prasad V. Long COVID clinics and services offered by top US hospitals: an empirical analysis of clinical options as of May 2023. BMC Health Serv Res. 2024 May 30;24(1):684. doi: 10.1186/s12913-024-11071-3. PMID: 38816726; PMCID: PMC11138016.)
I’m interested in seeing how and whether the new Long Covid definition will be widely adopted.
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