Psychiatry – Page 15 – Go Retire Psychiatrist

Thoughts on Artificial Intelligence

Sena and I just read Dr. Ron Pies fascinating essay describing his interaction with Google Bard Artificial Intelligence (AI). As usual, this made me think of several movies with AI as a central theme. There are several: I, Robot (I wrote a post about this a couple of years ago), Blade Runner, The Matrix, 2001: A Space Odyssey, even Wall-E, a favorite for me and Sena.

If you’ve seen Blade Runner, you might remember a device called the Voight-Kampff Test, an empathy test to distinguish replicants (humanoids or more broadly, AI) from humans. Interestingly, there’s an article speculating about using it to see if ChatGPT (another AI made by the company OpenAI) could pass the test. It didn’t, of course, if appearing to seem genuinely human is the benchmark.

We thought the conversation between Dr. Pies and Bard was very entertaining and thought-provoking. We both wonder how Bard would have responded if the question had been slightly reframed regarding the patient with schizophrenia who might or might not have been speaking metaphorically about his brain being “…a plaster ceiling with pieces falling on the floor.”

What if you ask Bard a more open-ended sentence, something like “What do you think a patient with schizophrenia means when he says that? If Bard hadn’t been tipped off by mentioning the issues of metaphor and mental illness, how might it have responded?

Bard’s answer to Dr. Pies’ question about what Bard means when it refers to itself as “I” in its responses. It says it doesn’t mean “I” to imply it’s human. I guess you wouldn’t need the Voight-Kampff test given this kind of honesty.

Just so you know, when Sena and I discussed this article we both caught ourselves calling Bard by typical human pronouns like “he” and “his” instead of “it.”

We also speculated about where you could use an AI like Bard in practical situations. We thought of it replacing those dreadful automated telephone answering machines. Bard would be too bright for that and it would probably not sound very different from the usual machines.

What about something more challenging like answering questions about the new Iowa Income Tax Law, exempting retirees from having state taxes withheld? It’s in effect now and the rollout has been somewhat complex. We think it’s because of communication about who is responsible for getting the ball rolling and what roles the Iowa Department of Revenue, the companies’ plan administrators who are withholding state taxes, and the retirees are expected to play.

There are ways to get answers to questions which don’t involve automated telephone answering machines. Amazingly, you can talk to real people. Sometimes you don’t even have long wait times on the phone before reaching someone who has very little information and has to put you on hold “briefly.”

Don’t get me wrong; we think the exclusion of retirement income from state taxes in Iowa is a good thing. Getting information about who does what and when is challenging though. I wonder what Bard would have done.

Retiree: Bard, who’s supposed to move first, the retiree or the plan administrator on what to do about state tax withholding?

Bard: That’s a good question and the issue is likely to produce anxiety on both sides.

Retiree: Right. How does this shindig get started?

Bard: If the state and the companies had got together on the issues earlier and prepared algorithms for me to choose from, I would be in a much better position to answer that question. Would you like me to sing “On A Bicycle Built for Two” now?

Retiree: No thanks, Bard. I was wondering if you knew why some companies making payments to retirees didn’t reach out early on to them and send letters describing options on how to approach decisions for making changes to state tax withholding in light of the new tax law.

Bard: That is another good question. It brings to mind a quote by Isaac Asimov in his book, I Robot: “You are the only one responsible for your own wants.”

Retiree: Hmmmm. I guess that makes sense. What if state taxes are erroneously withheld, despite your wishes and instructions? What happens then?

Bard: That seems to imply an old saying, “The buck stops here.” This means that whoever is making decisions is ultimately responsible for them. It is attributed to President Harry S. Truman. It is based on a metaphorical expression, “passing the buck,” which has been in turn derived from poker game play. I have not been programmed with any further information about the game of poker. Has this been helpful? I want to be as helpful as I can.

Retiree: Well, you’re helpful in a way. I have heard that some plan administrators are not stopping state tax withholdings despite clear instructions otherwise. It seems that the Iowa Department of Revenue is on the hook for refunding them to retirees (here, the retiree winks).

Bard: What does that mean (referring to the wink)?

Retiree: “It’s a sign of trust. It’s a human thing. You wouldn’t understand.” (Quote from I, Robot movie, Detective Del Spooner to Sonny the robot.)

Anyway, I think AI would be overwhelmed by all this. In any case, the only way to complicate things this much is to involve humans.

National Alliance on Mental Illness Walk May 6, 2023

There is a National Alliance on Mental Illness (NAMI) walk scheduled for May 6, 2023 at Terry Trueblood Recreation Area. See the announcement here.

“Stink, Stank, Stunk!”

I’m just puzzled lately over what seems like a contradiction between two ideas I’ve seen in the news and in TV commercials. It’s all about body odor.

There is this study that was recently published about stinky armpit odor possibly making the practice of mindfulness meditation more effective.

This contrasts with the usual meaning of body odor, which is that it’s to be avoided and prevented at all costs. And, the newest total body odor eliminator product is getting heavy rotation in TV commercials and its name rhymes, (possibly fittingly) with “looney.” I’m just going to frankly admit that I can’t stand watching the commercial.

There is this old timer product called Ex-Odor that was marketed in the early 1900s by a company called Gordon Gordon, Ltd. The label said it “Removes All Body Odors.” It was touted as “safe, sure, lasting” and it cost only ten cents. The original label actually did italicize the word “All.” On the other hand, Looney is a lot more expensive—just sayin’.

The armpit odor study and Looney definitely send opposite messages about body odor.

In fact, there is a psychiatric disorder marked by an intense preoccupation with smelling bad. I think it’s still called Olfactory Reference Disorder (ORD). Almost any part of the body could stink and could lead to showering several times a day or visits to ENT doctors to get “infected” and therefore smelly tonsils removed. The disorder not uncommonly gets requests for consultation-liaison psychiatrists to get involved.

Olfactory Reference Disorder can lead to severe, even disabling, social anxiety. It can lead to beliefs that have delusional intensity.

Often, those with ORD firmly believe they emit a foul odor, often from armpits, or inguinal, anal, and oral areas. Some seek surgical treatment. There are many other disorders which consultation-liaison psychiatrists need to remember in order to distinguish ORD from them. Combined cognitive behavioral therapy, possibly along with medication can be recommended as treatment.

Hello, I’m Dr. James Caramel Brown

I read Dr. Moffic’s article, “The United States Psychiatric Association: Social Psychiatric Prediction #4”. I think the rationale for renaming the American Psychiatric Association makes sense.

However, it also got me thinking about the names of other associations connected to the APA (here meaning American Psychiatric Association). One of them is the Black Psychiatrists of America, Inc. We make up about 2% of psychiatrists in the United States.

It also reminded me to once again do a web search for the term “Black psychiatrists in Iowa.” It turns out the results would lead to a repeat of my previous post “Black Psychiatrists in Iowa” on May 7, 2019. Nothing has changed. My colleague Dr. Donald Black, MD is still coming up in the search. Just as a reminder, he’s not black.

It probably comes as no surprise to readers of my blog that this also reminds me of a couple of Men in Black scenes.

Video of Men in Black scene, Dr. Black and Dr. White quotes.

And my post still appears high up in the list of web sites. There has also not been published a more recent edition of the Greater Iowa African American Resource Guide than the one in 2019. You can still find my name and that of Dr. Rodney J. Dean listed in the 2019 edition as the only black psychiatrists in Iowa.

In case you haven’t noticed, I’m retired. I have never considered changing my name and title to Dr. James Caramel Brown. If you noticed that the “Caramel Brown” part is from Men in Black 3 (Agent J talking about what Agent K should say about his skin color in his eulogy for him), give yourself a pat on the back.

Agent J: Can you promise me something, if I go first, you’ll do better than that at my funeral? Yeah, something like, uh: “J was a friend. Now there’s a big part of me that’s gone. Oh, J, all the things I should have said, except I was too old and craggy and surly and just tight. I was too tight. Now, I’m gonna just miss your caramel-brown skin.”

Agent K: I’ll wing something.

Anyway, I’m not sure what to do about renaming the American Psychiatric Association. But I think whoever is in charge of google search results for the term “black psychiatrists in Iowa” could improve on the current situation.

Random Connections

Today, I read Dr. George Dawson’s blog post, “How I ended up in a high-risk pancreatic cancer risk screening clinic.” As usual I was impressed with his erudition, scientific literacy, and rigorous objectivity, even as it pertained to a deadly disease which runs in his family genetic history. I couldn’t help admiring his courage.

And, whether this is a random connection or not, this somehow led to my remembering Dr. George Winokur, a giant in the scientific study (including genetics) of psychiatric diseases, especially mood disorders. He died of pancreatic cancer shortly after he was diagnosed with it in the spring of 1996.

Dr. Winokur was chair of the University of Iowa Department of Psychiatry from 1971 to 1990. He remained on faculty, actively involved in research and teaching up until the day of his death in October of 1996.

I was a resident in psychiatry at University of Iowa from 1992-1996 and I have a clear recollection of meeting with Dr. Winokur in his office during my last year, when I was preparing for job interviews. I knew he had been diagnosed with pancreatic cancer.

He had been actively recruiting me to accept a position in the department and did so even as we spoke briefly. I remember noticing that he gripped an electrical conduit on the wall next to his desk so tightly that I wondered if he were in pain.

He was the main reason I stayed in Iowa. He had a great sense of humor. All of us residents loved him. There was even a list of his “commandments” all new residents received when they began their residencies at Iowa.

Winokur’s 10 Commandments

Thou shalt not sleep with any UI Psychiatry Hospital patient unless it be thy spouse.
Thou shalt not accept recompense for patient care in this center outside thy salary.
Thou shalt be on time for conferences and meetings.
Thou shalt act toward the staff attending with courtesy.
Thou shalt write progress notes even if no progress has been made.
Thou shalt be prompt and on time with thy letters, admissions and discharge notes.
Thou shalt not moonlight without permission under threat of excommunication.
Data is thy God. No graven images will be accepted in its place.
Thou shalt speak thy mind.
Thou shalt comport thyself with modesty, not omniscience.

I never got the impression that George Winokur recruited me because I was black, although it was pretty obvious to me that I would be the first black University of Iowa psychiatry department faculty member. He had too much class to make that an issue.

I’ve known a few classy psychiatrists. Maybe the connection is not so random.

Catatonia Education Resources

I noticed what is, for me at least, a new educational resource for catatonia. There’s an aricle about it in the March 2023 issue (Vol.51, No. 3) of Clinical Psychiatry News. The resource is available at University of Rochester Medical Center website. They include pdf files and training videos for assessment of catatonia.

There are also links for information about catatonia:

Catatonia Information Center

University College London

The University of Rochester presentation has has demo videos using a standardized patient (a physician, Dr. Joshua Wortzel) and a teacher, Dr. Mark Oldham.

I saw cases of catatonia while I was a consultation-liaison psychiatrist at The University of Iowa Hospitals & Clinics and they often had medical causes. My YouTube video lecture on Catatonia, Neuroleptic Malignant Syndrome, and Serotonin Syndrome is still getting views after 4 years.

Fathers Can Be a Pain in the Ass

I’m going to talk a little bit about fathers. Mothers are important too, but I’m a guy and I can talk about mothers another day. Because it’s a touchy subject, I’m going to begin with a Men in Black (MIB) joke, like I always do when I’m being defensive. There’s this MIB 3 scene in which Agent K and Agent J have this exchange:

Agent K: I used to play a game with my dad, what would you have for your last meal. You could do worse than this (explanation for this: they’re sitting in a restaurant and an eyeball in Agent K’s soup swivels around and stares at him).

Agent J: Oh, okay, I used to play a game with my dad called catch. Except I would throw the ball and it would just hit the wall, cause—he wasn’t there.

Agent K: Don’t bad mouth your old man.

Agent J: I’m not bad mouthing him, I just didn’t really know him.

Agent K: That’s not right.

Agent J: You’re damn right, it’s not right. A little boy needs a father.

On one level, this scene is just another way of showing the father/son, teacher/student, mentor/mentee relationship Agents K and J had with each other. By extension, their interaction says something about what happens in similar real-life relationships—in the shallow, cliché ways that movies always do.

I sometimes think about the relationship I had with learners when I was a teaching consultation-liaison (C-L) psychiatry. Often, I say to myself that I never had a mentor and I was never a mentor.

That’s not true. Although I never had a mentor who was formally assigned to me, there was more than one faculty member in the psychiatry department with whom I had an informal mentor/mentee relationship. And I was an informal mentor to at least a few trainees.

However, I was middle-aged by the time I entered medical school, which probably set the stage for awkward relationships with my fellow students and some teachers, partly because I was either the same age as or older than them.

That doesn’t mean I was wiser than them. It just means that I was conflicted about them. Later, in residency, I learned about transference and countertransference. In fact, I focused on the psychodynamic as well as the medical issues in teaching trainees. In the first C-L manual I wrote (the forerunner to the book I and my co-editor published later), I devoted a large section to psychodynamic factors relevant to doctor-patient relationships.

So, if you’re wondering when I’m going to start bad-mouthing my old man, you can stop wondering. I’m not going there. He wasn’t a hero, like Agent J’s father was (you need to see the movie to get this angle).

My dad was funny. I don’t think I got my own sense of humor from him, but it makes sense why I would have one—and just because “he wasn’t there” doesn’t explain everything. It never does.

Fathers can be a pain in the ass, not just because of dad jokes. Fathers can be a pain in the brain, too. Ask anybody who was a latchkey kid; I was one of those. We really don’t belong to any specific generation.

We also can’t just up and time travel like Agent J and find out about the father we never really knew. Mostly, it’s just bits and pieces, like a matchbook with a name and address from somebody on your paper route. The path it can lead to doesn’t always mean you find out that “Your daddy was a hero,” like a young Agent K tells young James (who becomes Agent J in the future) after he neuralyzes him to shield him from the hard truth about his father.

You’ll have to watch the movie to get that one.

Thoughts on Regrets

I’ve been thinking about Dr. Moffic’s article on regret, posted on February 16, 2023 in Psychiatric Times.

I’ve dwelt on it long enough that I feel compelled to inject humor into the subject. It’s one of my many defenses.

There’s a quote from Men in Black 3 involving a short telephone conversation between Agent K and Agent J:

Agent K: Do you know the most destructive force in the universe?

Agent J: Sugar?

Agent K: Regret.

You could probably sense that joke coming. Whenever there is talk of regrets, I always recall maybe one or two remarkable episodes which led to lifelong regret. Because regret is pretty corrosive, as noted by Agent K, I need something to counter it.

My trouble is that I have many regrets. Am I so different in that regard?

Sometime in mid-career, a very important leader told me, frankly and calmly, “You’ll never be a scientist.”

Well, by then it was far too late for me to change life course. It was true; I’ve always been the rodeo clown, never the matador.

On the other hand, I know one thing I’ve never regretted and that’s my retirement. At least I think I haven’t regretted it. I have this recurring dream. It’s not every night, but often enough to make me wonder what I should do about it.

In the dream, I’m late for an exam or class and I fear I’m going to flunk. I look for the building where the exam is going to be held. I can never find it. Hallways appear and look vaguely familiar, but as I wander about looking for the bookstore or classroom or exam room, I feel like I’m in a maze, climbing stairs, almost like an Escher drawing.

That reminds me. Incidentally, several years ago, one of the medical students rotating on the psychiatry consult service drew a picture entitled “The Practical Psychosomaticist” which contained images of stairs running in different directions similar to an Escher drawing (see the featured image). It was really just her expression of how I got around the hospital. I avoided elevators and always took the stairs.

Anyway, I’m carrying several notebooks and loose papers keep falling out. I get lost in this jumble of halls and stairways, never finding my destination.

The dream is probably just me telling myself I’m failing at something in my waking life. It’s not like I need a dream to notify me.

This is a long way of saying I have many regrets, and that I may not know exactly how many. Some of them are less important than others. Take the “I’ll never be a scientist” theme. I’m not terribly broken up about it.

After all, rodeo clowns do pretty important things.

I Got The Greatest Shout Out Today

I just got the greatest shout out from one of my heroes, Dr. H. Steven Moffic, MD. The link to one of his regular Psychiatric Times web (PT) articles, mainly on what’s in the daily news that impacts psychiatry or vice versa, is on the menu of my home page.

The title of the PT article in which I get a shout out is “A Tale of 3 Retirements: Football Star Tom Brady, Black Psychiatrist James Amos, and Me.” He got my retirement date wrong by 20 years, but what the heck; no big deal. He did his homework otherwise just fine.

In fact, I didn’t know that Dr. Moffic even noticed that I had a blog. I have written articles for PT in the past. You can still find them by searching my name on the web site. One was on stress and the psychiatrist and another was on how consulting psychiatrists can be helpful in recognizing and managing delirium.

And today, Psychiatric Times (PT) contacted me to make a video about my juggling hobby. I gather it’s a regular series about what psychiatrists do outside of their work/practice. Imagine that; PT wants to see ugly juggling! How did PT know about that? Dr. Moffic mentioned my name.

In return, I’d like to give a big shout out right back to Dr. Moffic and also to other psychiatrists. One is Dr. George Dawson, who writes the blog Real Psychiatry. Another is TheGoodEnough Psychiatrist. These are featured on the main menu on my blog. I can name another who also writes for PT and this is Dr. Ronald Pies.

Iowa State University African American Science Graduates

I was thinking about what to write for the first day of Black History Month, which starts today on February 1, 2023.

As usual, I started to reminisce about my time at Iowa State University (ISU) in Ames, Iowa. I usually don’t talk about my undergraduate days. In fact, I had a little trouble finding my diploma. It was in storage in the first place I should have looked. I graduated from ISU in 1985.

The Iowa State Daily ran a story, “Black scientists from Iowa State,” published on February 4, 2021, obviously in honor of Black History Month. Of course, it featured ISU’s most illustrious graduate, George Washington Carver, who earned his graduate degree in 1894. Carver also loved poetry and painting, which I didn’t know.

This work is in the public domain in the United States because it was published (or registered with the U.S. Copyright Office) before January 1, 1928

Carver was a scientist and put it to practical use. It fits with the ISU motto, which was short and to the point: “Science with Practice.”

I transferred credit to ISU in the mid-1970s from one of the country’s Historically Black Colleges and Universities (HBCUs), Huston-Tillotson College (now Huston-Tillotson University). I submitted a poem to the college’s annual student poetry contest sponsored by one of the English Professors, Dr. Jenny Lind Porter-Scott. My poem didn’t make the cut, but many students got their work published in the little book, Habari Gani (Swahili for “What’s Going On”), which published the best poems.

Part of the reason I went to ISU was the encouragement I got from my bosses at WHKS &Co, consulting engineers. I was a surveyor’s assistant and drafter. I was the only African-American employee working there.

The idea behind going to ISU initially was to pursue a degree in engineering. That didn’t happen because frankly, I didn’t have a head for the mathematics. On the other hand, I got interested in biology, chemistry, and zoology and finally ended up in medical school at The University of Iowa in Iowa City. The rest is history, as they say, which allows the usual cover up of a multitude of sins.

At the time Sena and moved to Ames in the early 1980s, it was a quiet little town, except during VEISHEA, an annual spring celebration on campus. The event got out of hand many times and it was finally banned in 2014.

Back in the days of George Washington Carver, African American students were not allowed to room with other students who did not have black skin on campus. By the time we moved to Ames, the most uncomfortable racial incident I can recall personally was being the butt of a “nigger” joke at a barbershop. I had to find another place to get my hair cut.

I still had a lot of science to digest at ISU after switching my major from engineering to the life sciences. I remember a chemistry professor who looked like the typical hippie who demonstrated how electrons get excited by stacking chairs on top of the counter in front of the chalkboard (which teachers were still using) and climbing to the top and nervously doing a shaky little dance showing what an excited electron he was. I think all of us collectively held our breath, waiting for him to tumble to the floor.

I really had a tough time learning organic chemistry. You had to draw diagrams showing how the molecules and atoms connected after each reaction. I will never forget an Asian Teacher’s Assistant who patiently tutored me, despite my having a very bad cold and a bad attitude to boot.

I graduated and then returned to get more credits to try getting into medical school after finding it very difficult to find employment with my Bachelor of Science degree. It took about 9 months before I finally landed a job in the clinical lab at one of the hospitals in Des Moines. The lab director worked there for a very short time while I was there, and then left to go to medical school.

That was my cue. I think it worked out for the best. By the way, the engraved crystal in the featured image is an appreciation gift from The University of Iowa for my years of service.

And I guess that’s about enough reminiscence for now.