It seems like every few years there is a spate of news stories about the supposed risk of developing schizophrenia from having a pet cat. The bottom line is that there is no direct link, but you can’t tell a reporter that. I mentioned the issue in a blog post about a feral cat in our neighborhood last year.
The research about this often has limitations, some of which are pointed out in this web article. A Psychiatric News article published in 2017 presented a reasonable position which apparently no reporters have read.
I’m allergic to cat dander. On the other hand, some cats are important enough to be entrusted with carrying an entire galaxy around their belts, reported in the Men in Black documentary which is in large part about a cat named Orion.
This post is mainly a reminiscence about my days as a consultation-liaison psychiatrist. I often evaluated patients who had chronic hepatitis C. The liver disease itself and the treatment (interferon alfa) often led to patients struggling with depression.
The impetus for this came from noticing a couple of items. One is the recent l blog post about treatment of depression by George Dawson, MD (“Are Medication Trials for Depression Too Long in Duration?”). The other is a Psychiatric Times article about the Star-*D depression treatment study published in Psychiatric Times (“Star*D: It’s Time to Atone and Retract” by Nicolas Badre, MD and Jason Compton, MD).
Back in the day, I thought it made sense to use depression rating scales in my clinic practice. I use the term “clinic practice” reservedly because in actual practice I was too often running the hospital psychiatry consultation service to see outpatients regularly.
There has been a recent call to retract the Star*D study. I wasn’t involved in the study, of course. I was too busy running around the hospital responding to consultation requests. I noticed the criticism in the Psychiatric Times article by Badre and Compton of the specific depression rating scale, the QIDS-SR (which stands for Quick Inventory of Depressive Symptomatology (Self-Report).
I tried to integrate into my practice the QIDS-SR as well as the Clinically Useful Depression Outcome Scale (CUDOS). The latter was designed by psychiatrist Dr. Mark Zimmerman around 2008. I believed in the principle of measurement-based assessment of psychiatric symptoms and did my level best to integrate them into my practice.
It was very difficult to do. My patients were typically suffering from both medical and psychiatric illness. Often, they had physical symptoms that you could attribute to either the medical problem itself or “depression”—or both. This is a common challenge in consultation psychiatry.
Returning to my experience with patients who had chronic hepatitis C, in my early career, some of them who were on interferon alfa would not uncommonly develop depressive symptoms during treatment. Sometimes that meant stopping the treatment. Moreover, they sometimes had other side effects including thyroid function abnormalities, which can also cause mood disturbance.
There have been debates about whether to count physical symptoms in depression because of the overlapping symptoms: fatigue, appetite loss, trouble sleeping and the like. There’s also what has been called the “fallacy of good reasons.” Wouldn’t you be depressed too if you were sick and tired of being sick and tired? This could lead to undertreatment of depression. Some diagnostic models suggested counting all symptoms regardless of etiology.
Some randomized controlled trials of antidepressants in the past showed antidepressants were effective in the medically ill with depression. Others showed they were not better than placebo.
Nowadays there is a new pharmacologic approach to treating hepatitis C and those are in the category of direct-acting antivirals (DAA). According to fairly recent literature, the DAAs offer a better chance of cure of hepatitis C and less psychiatric side effects. That doesn’t mean psychiatrists are no longer needed. The common issues such as comorbid substance use and cognitive disorders, highlighting the ongoing need for collaborative care between medicine and psychiatry.
Just in case you missed it, the FDA posted an announcement about Kratom in February this year. According to the FDA:
“Kratom is a tropical tree (Mitragyna speciosa) that is native to Southeast Asia. Products prepared from kratom leaves are available in the U.S. through sales on the Internet and at brick-and-mortar stores. Kratom is often used to self-treat conditions such as pain, coughing, diarrhea, anxiety and depression, opioid use disorder, and opioid withdrawal.”
The other day as we were driving home on Highway 1 through Iowa City, I saw a sign advertising Kratom on a small store. I thought that might be illegal, but when I checked the Iowa Office of Drug Control and Policy, I found out it’s currently legal in the state.
Opinions vary about risks of using Kratom. The DEA tried to place in on the Schedule I, but the American Kratom Association and other supporters apparently prevented that simply by protesting it. The pharmacist who wrote the article (link above) raised a note of irony by questioning why marijuana is still regulated as a Schedule I drug.
The legality of Kratom also varies across the country. There is a very detailed review article about it that attempts to examine the use of Kratom from both the medical practitioner and patient points of view.
I recommend Dr. George Dawson’s recent posts on seeing the practice of medicine as a calling and his passing a big milestone with 2 million reads on his blog.
I wrote a post entitled “Remembering Our Calling: MLK Day 2015.” It was republished in a local newspaper, the Iowa City Press-Citizen on January 19, 2015. And I reposted it in 2019 on this blog.
The trainees I taught also taught each other about psychiatry and medicine when they rotated on the consultation-liaison service at the hospital. We put them into the format of short presentations. I called mine the Dirty Dozen. The trainees and I also presented the Clinical Problems in Clinical Psychiatry (CPCP).
There were many of those meetings, which were necessarily short and to the point because the service was busy. We got called from all over the hospital. We answered those calls and learned something new every time.
I posted a lot of the trainees’ presentations in my previous blog, The Practical C-L Psychiatrist, which was replaced by this present blog. I haven’t posted the presentations partly because I wanted to give the younger teachers their due by naming them as they did on their title slides. But I would want to ask their permission first. They are long gone and far flung. Many are leaders now and have been for many years. I still have their slides. I’m very proud of their work. When they were called, they always showed up.
So, you’ll just have to put up with my work and my cornball jokes.
Sometimes I write “depressing” blog posts. On the other hand, I have both good and bad news today.
I found out that, according to the Treatment Advocacy Center, Iowa’s state psychiatric hospital bed availability is dismal according to 2023 figures. That’s actually not new. Although we rate last in the nation for this, we still get a Grade B overall. I’ll have more to say later about it. You can check your own state’s grade on the web site’s map graphic.
And a recently published article about antidepressant prescribing for young people is sort of depressing, there are ways to address the likelihood that adolescent females are being prescribed antidepressants more often than adolescent males.
I tend to agree with the author of another article on adopting a more nuanced perspective on what is often called “depression” in young people. Not everybody who is distressed is depressed.
Even if we are depressed, there are healthy activities we can engage in to heal. We don’t all necessarily need antidepressants. That’s the point of a recent systematic review and meta-analysis on the role of exercise for managing depression. Exercise is effective either by itself or in addition to psychotherapy and antidepressant.
Iowa actually seems to be putting a lot of hard work in mental health outreach, such as Your Life Iowa. It’s funded by the Iowa Dept of Health and Human Services under the Division of Behavioral Health.
As I approach the end of the book “Our Hidden Conversations” by Michele Norris, I find myself doing what I often do when I feel uncomfortable emotionally. I start to deploy my sense of humor.
As a psychiatrist (now retired since 2020), I learned early in my residency training that humor can be thought of as a “mature” psychological defense.
Given the painful memories that the book evokes, I find that I self-edit my usual habit of turning pain into comedy. Maybe it’s not always mature.
On the other hand, there are times when facing what is nowadays called my “lived experience” about racism and identity in the era my wife and I grew up in, while not funny, can be peeked at most safely from the funny edge.
So, with that in mind I took a look at the web page of the National Association of Black Social Workers (NABSW) which summarizes the organization’s position on white adoption of black children. I first read about it in Ms. Norris’s book, in the chapter “Black babies cost less to adopt.”
I was surprised to see the actual document, which has been posted since 2013. Sections of the position paper titled “Transracial Adoption Statement (c) 1972” are underlined. It expresses clearly an opposition to placing black and transracial adoptees with white parents. I might have missed it, but I don’t see another position statement that modifies it.
There are 30 state chapters of the NABSW. Iowa is not listed.
There is no National Association for White Social Workers. There is a website for the National Association of Social Workers (NASW). When I typed in “National Association of Black Social Workers” in the search field on the NASW website, almost 800 results were returned. When I applied the filter for ethnicity and race, there were 5 results attesting to the NASW efforts in countering racism. I didn’t see any mention of the NABSW. Maybe I just missed it.
I lived for a brief time in an African American foster home eons ago. I can’t think of anything funny to write about it. Has there ever been an opportunity for cross talk between the NASW and the NABSW? I’m not judging anyone here. I’m just asking.
Moving right along, I have again searched the web using the term “African American psychiatrists in Iowa.” I’ve posted about this before, looking at it from the funny edge (this allows me to take a deep breath). I still find my former colleague, Dr. Donald Black, MD listed. The only thing black about him is his name. And my 2019 blog post is the 3rd link down from the top, preceded by two from Psychology Today.
Most of the mental health care providers from the Psychology Today lists are Nurse Practitioners who are black. One of them does not look black. She looks white. She’s a psychiatrist. I’ve worked with her in the past and don’t recall her ever identifying as black. But because I’m reading the race card stories in “Our Hidden Conversations,” and because I’ve been around a little while, I’ve learned that some black people can look white. You can’t always judge a book by its cover.
A good black psychiatrist is hard to find. In fact, a black psychiatrist of any quality is hard to find. However, in general, there are notable black psychiatrists in our history. One of them was Chester Middlebrook Pierce, MD. Among his many accomplishments, he was the founding president of the Black Psychiatrists of America in 1969, which was one year after the NABSW was established. Dr. Pierce was also the president of the American Board of Psychiatry and Neurology in 1978. I didn’t learn about him until today. How is that possible?
There is a website for the Black Psychiatrists of America and you can try the search field to look for a black psychiatrist there. I couldn’t find any listed in Iowa. Most of them seem to be in Texas. I had a little trouble applying the search filters.
Those are my thoughts for now about “Our Hidden Conversations” by Michele Norris. This is not a funny book.
Recall that I had been checking to see if the Distinguished Education Lecture given by Dr. Russell Ledet, MD, PhD on January 17, 2024 during the MLK Celebration of Human Rights would be available for the general public. While somebody may be working on that, I managed to find Dr. Ledet’s YouTube, entitled “Bootless II.” I think it’s a great distillation of his major theme.
We enjoyed the Dr. Martin Luther King, Jr. Distinguished Education (originally given on January 17, 2023) by Dr. Russell Ledet. He’s definitely a mover and a shaker and this is another recorded presentation that I wish was available for the general public.
His bio is knockdown impressive. And even more interesting to me is that he’s presently in residency toward boarding in adult psychiatry and child psychiatry as well as pediatrics.
That’s right—triple boarding.
His talk was a fascinating oral autobiography from his upbringing in poverty to his military career, to his undergraduate and graduate college career, and his achievement in organizing a very successful nonprofit, The 15 White Coats. This helps get underrepresented minority students into medicine by giving them inspiration and financial support.
His life story by itself is inspiring. It’s also exhausting. The person introducing him wondered aloud if he ever slept!
He began with a well-known quote by Dr. Martin Luther King, Jr:
“It’s all right to tell a man to lift himself by his own bootstraps, but it is a cruel jest to say to a bootless man that he ought to lift himself by his own bootstraps.”
Dr. Ledet’s story of his path from bootlessness to crowning success is compelling. You really have to hear it from him to get a clear idea of how difficult it was. It’s hard to imagine that a star like him once rummaged through dumpsters for food for the family while his mother was on the lookout to make sure he didn’t get caught.
I think a big part of what kept him going was his wife and kids. In fact, his wife, Mallory Alise, insisted that he take the path because of her fear he would die if he continued a dangerous assignment in the military.
A member of the audience who had a career similar to Dr. Ledet asked a question about what more should he do to make sure young people of color would get the kind of opportunities to succeed. Dr. Ledet had a very good answer, but that was not the most interesting part of the interaction. Firstly, the questioner didn’t sound (I know this is going to sound crass) black. He sounded more like someone who had grown up in the Northern United States—like me. But during the course of the conversation, it was clear that he was black. He just didn’t sound like Dr. Ledet. He also mentioned, almost in passing, that some people of color who succeed may develop imposter syndrome.
This sounded strange at first, but I quickly realized that I sometimes had felt like an imposter. This cuts two ways with me. One was the obvious context in which I came out of an impoverished background to finish college and medical school, and had a career as a consultation-liaison psychiatrist at a university medical center where I published and taught for many years. At times I felt like a phony.
The other situation in which imposter syndrome arose was when I went to Huston-Tillotson University (an HBCU formerly called Huston-Tillotson College) in Austin, Texas back in the 1970s. Most of the students were from the region. I had a Northerner’s accent and somebody once remarked on it, asking me “Why do you talk so hard?” I was easily identified simply because of how I spoke. I didn’t always feel comfortable, despite for the first time being not the only black guy in school. Ironically, I didn’t feel like I fit in, even in an HBCU. Even among those who looked like me, I sometimes felt like a phony. But that was not an enduring affliction.
And I think Dr. Ledet has a great deal of confidence and energy. More power to him.
February is Black History Month and in 2024 the theme is African Americans and the Arts.
This reminds me of a blues artist I heard on KCCK on the Big Mo Blues Show last Friday. His name is Toronzo Cannon and his career as a blues guitarist and songwriter is skyrocketing. I heard his song “The Preacher, the Politician, and the Pimp.”
The lyrics reminded me of a character (or maybe more properly a non-character) called Rinehart in Ralph Ellison’s book, Invisible Man. I’m by no means an Ellison scholar but in chapter 23 the main narrator gets mistaken for a black guy named Rinehart who has many faces in the black community. He’s a preacher, a numbers runner, a pimp, and is also related to a political movement in the novel. Rinehart is all of them and none of them, moving between the “rind and heart” of who black people are in America. The implication is that the identity of black people is multifaceted and the similarity of the theme in Toronzo Cannon’s song is striking.
Cannon is also multifaceted. He’s a Blues guitar star and song writer and is also still a bus driver for the Chicago Transit Authority. How does he find time to do all that?
I wonder if Cannon got the idea for the song from Ellison’s novel. I guess I’ll never know.
This reminds me of an encounter I had with a black writer at Huston-Tillotson University (then Huston-Tillotson College, located in Austin, Texas) in the 1970s when I was an undergraduate in college. I’ve described this episode before in another post (“Black Psychiatrists in Iowa” 2019). The excerpt below includes a reference to a book review I wrote that was published in The American Journal of Psychiatry over 20 years ago:
“This reminds me of a book review I wrote for the American Journal of Psychiatry almost 20 years ago (Amos, J. (2000). Being Black in America Today: A multi perspective review of the problem. Am J Psychiatry, 157(5), 845-846.).”
The book was written by Norman Q Brill, M.D. It reminded me of my experience at Huston-Tillotson College (now Huston-Tillotson University, a private school, historically with largely Black enrollment) in Austin, Texas back in the 1970s. I wrote:
“Dr. Brill’s appraisal of many black leaders in chapters such as “Black Leaders in the Black Movement” and “Black Anti-Semitism” may be refreshingly frank in the opinion of some. He tailors his prose so as not to denounce openly those whom many would describe as demagogues. At the same time, it is apparent that his underlying message is that a substantial number of them are not only out of touch with mainstream black America but may even mislead black people into adopting ideological positions that impede rather than foster progress. Dr. Brill’s description of the issue reminded me of my own experience with this phenomenon as a freshman in the mid-1970s at a college of predominantly black enrollment in the southern United States. A guest lecturer (who, as I recall, had also written a book about being black in America) told us that the white man would never allow a black man to be a man in America. He had only three choices: he could be a clown, an athlete, or a noble savage. These corresponded to the prominent and often stereotyped roles that blacks typically held in entertainment, sports, and black churches.”
I was taken aback by the speaker’s judgment and asked him what my choice should then be. He was equally taken aback, I suspect. He advised me to be a clown.
The lyrics of Cannon’s song “The Preacher, The Politician, and the Pimp,” Ellison’s Rinehart, and another writer’s characterization of the roles allowed in American society for black men all resonate together. What drives the similarity of this perception across different artistic platforms?
When I reflect on how I’ve negotiated my life’s path over they years, I guess I would have to admit that I’ve often played the clown. Anyone can see that in the way my sense of humor comes across. Is it the healthiest way to respond to racism in this country? In terms of the psychological defense mechanisms, I think it’s a relatively mature strategy. You could argue with that by asking, “But where’s the maturity in dad jokes?”
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